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All about Endodontology

It is not always easy to preserve your teeth for your whole life – especially if they are inflamed. On this page we would like to explain a few of the most important aspects of root treatment by a specialist.

Inside of the tooth: Endodontists are going to the roots

If your den­tist recom­mends tre­at­ment by an endodon­to­lo­gist, she or he pro­bab­ly suspects there is some­thing wrong with the insi­de of a tooth. The tre­at­ment of spe­cial cases requi­res spe­cial trai­ning and exten­si­ve expe­ri­ence in this spe­cia­li­zed field of den­ti­stry – and also the spe­cial tech­no­lo­gy to visua­li­se and work on the tiny root cana­ls insi­de the tooth.

In the past, teeth with root canal dise­a­se were often pul­led. Today, advan­ced tech­no­lo­gies and medi­cal deve­lo­p­ment make it pos­si­ble to save almost any tooth.

At ENDOPUR our main goal is to pre­ser­ve your natu­ral teeth. And our high suc­cess rate is very reas­su­ring: The vast majo­ri­ty of teeth trea­ted at our cli­nic can be saved by expert­ly car­ri­ed out endodon­tic tre­at­ment, with good prognosis!

Why is my tooth bad?

In most cases a tooth decays due to caries-causing bac­te­ria but acci­dents and den­tal or orthodon­tic tre­at­ments can also be a cause. Inflamma­ti­on or infec­tion wit­hin the tooth can result from these sti­mu­li. Insi­de a tooth there is a bran­ching sys­tem of cana­ls con­tai­ning living tis­sue (pulp) with ner­ves and blood ves­sels. Unfor­tu­n­a­te­ly the defen­si­ve abi­li­ties of this tis­sue are very limi­ted so the body some­ti­mes can­not suf­fi­ci­ent­ly deal with the irri­ta­ti­on and heal the infection.

There used to be no way of saving these teeth. Becau­se the canal sys­tem in a tooth is often very fra­gi­le and has lots of bends, there was no pos­si­bi­li­ty of tre­at­ment so the tooth had to be removed.

What can the dentist do so that I can keep my tooth?

In order to be able to pre­ser­ve an infla­med or dead tooth its root must be trea­ted. The bac­te­ria in the tooth must be remo­ved and the tooth sea­led so that no new germs can get in.

Becau­se the root sys­tem of a tooth has lots of small bran­ches, like a tree (some as small as 0.06mm!), they can only be seen under a micro­scope. This tech­no­lo­gy and the asso­cia­ted fle­xi­ble, minu­te instru­ments enab­le the opti­mum pre­pa­ra­ti­on for remo­val of the bac­te­ria and the dise­a­sed tis­sue – and the­re­fo­re also incre­a­sed tre­at­ment suc­cess. Then the resi­due is remo­ved with a rinsing solu­ti­on. As a final pre­pa­ra­ti­on for fil­ling the root canal sys­tem, the root canal is pre­pa­red with high­ly fle­xi­ble micro-files. For the fil­ling, the mate­ri­al gutta-per­cha, which is rela­ted to natu­ral rub­ber, is hea­ted and put into the now per­fect­ly pre­pa­red sys­tem in com­bi­na­ti­on with an adhe­si­ve cement.


The cost of the tre­at­ment depends on the time requi­red. The esti­ma­ted cost is cal­cu­la­ted befo­re the tre­at­ment, based on indi­vi­du­al cir­cum­s­tan­ces such as the degree of inflamma­ti­on and the ana­to­my of the tooth.

Howe­ver, in Ger­ma­ny such spe­cia­li­zed and sophisti­ca­ted tre­at­ment, which is tailo­red to each patient’s needs, is not cove­r­ed by the sta­tu­to­ry health insuran­ce com­pa­nies. This means the costs are to be borne by the pati­ent, who will, depen­ding on their level of bene­fits, be reim­bur­sed by their pri­va­te health insurance.

We will thus pro­vi­de each pati­ent with a detail­ed, bin­ding cost esti­ma­te prior to their treatment.

Regu­lar check-ups are essen­ti­al fol­lowing suc­cess­ful tre­at­ment of peri­odon­tal dise­a­se (gum dise­a­se) to pre­vent recur­rence or a new infec­tion. Only regu­lar visits with your den­tist and a tho­rough oral hygie­ne rou­ti­ne at home can pre­vent peri­odon­tal disease!

“Cri­ti­cal areas” requi­re regu­lar check­ups. Make an appoint­ment for the clea­ning of those hard-to-reach nooks and cran­nies to help pre­vent the for­ma­ti­on of “peri­odon­tal pockets”.

Ask about our recall pro­gram: we are happy to call you when your next check-up is due. Or just arran­ge a new appoint­ment after your visit to the den­tal hygie­nist. Your healt­hy gums will thank you for it.



The only alter­na­ti­ve is usual­ly to remo­ve the tooth and fill the resul­ting gap with an implant. The costs of res­to­ring your natu­ral smile are not to be unde­re­sti­ma­ted eit­her. They are often much hig­her than those of a root treatment.

Myths about root canal treatment


Rea­li­ty: Root tre­at­ments do not cause pain, they era­di­ca­te pain.

Most pati­ents visit their den­tist or endodon­to­lo­gist when they have a per­sis­tent toot­ha­che. This pain often comes from dise­a­sed pulp (nerve) tis­sue wit­hin the tooth. In root canal tre­at­ment the dise­a­sed tis­sue, and thus the cause of the pain, is removed.

Sto­ries about pain­ful root canal tre­at­ments have no place in modern endodon­to­lo­gy. These days, anesthe­tics (anesthe­tic injec­tions) and the tar­ge­ted tech­ni­ques of endodon­to­lo­gy make root canal tre­at­ment no more uncom­for­ta­ble than put­ting in a fil­ling. A sur­vey show­ed that pati­ents who have expe­ri­en­ced root canal tre­at­ment were six times more likely to descri­be it as “pain­less” than pati­ents who had not had root canal treatment.


Rea­li­ty: Root canal tre­at­ments are a safe and suc­cess­ful treatment

In the past, a small group of medi­cal prac­ti­tio­ners alle­ged that there was a con­nec­tion bet­ween teeth that had under­go­ne root canal tre­at­ment and the emer­gence of cer­tain ill­nes­ses. This opi­ni­on was based on the long out­da­ted study by Dr. West­on Price from 1910–1930!

Many sci­en­ti­fic stu­dies that have been publis­hed in this area over the last 70 years show that there is no con­nec­tion bet­ween root canal tre­at­ment and any kind of ill­ness. The latest rese­arch into this issue shows that a tooth that has had good root canal tre­at­ment does not pose any risk to health whatsoever.


Rea­li­ty: Pre­ser­ving your natu­ral tooth is surely the best option.

Not­hing can com­ple­te­ly replace your natu­ral tooth. Arti­fi­cial teeth some­ti­mes force you to chan­ge your eating habits. Retai­ning your own teeth means that you can still enjoy eating and the plea­su­re of dif­fe­rent foods. Root canal tre­at­ment is the most orga­nic way of trea­ting dise­a­sed tis­sue wit­hin your tooth (pulp).

Good root canal tre­at­ments have a very high suc­cess rate. Many teeth that have had root canal tre­at­ment last a life­time. Repla­cing lost teeth using brid­ges, den­tures or implants usual­ly requi­res more time and incre­a­sed finan­cial out­lay. The tre­at­ment of the adja­cent teeth and under­ly­ing tis­sue is also usual­ly necessary.

The operation microscope: precision and full control

The ope­ra­ti­on micro­scope enab­les the pre­cise visu­al moni­to­ring of the tre­at­ment process.

In order to treat the finely bran­ching cana­ls safe­ly, a good view is not only hel­pful but essen­ti­al in modern endodon­to­lo­gy. The fine canal ope­nings are often impos­si­ble to see with the naked eye. If you leave it to touch, many cana­ls and nooks and crevices remain hid­den. The tis­sue resi­du­es and bac­te­ria that remain there could lead to recur­rence of the inflamma­ti­on even years after the tre­at­ment. Only 39% of root canal tre­at­ments car­ri­ed out in Ger­ma­ny using the con­ven­tio­nal methods are suc­cess­ful and only 12% of tre­at­ments give a result that ful­fills requi­re­ments of the ESE (Euro­pean Socie­ty of Endodontology).

Modern ope­ra­ti­on micro­scopes, equip­ped with a sophisti­ca­ted optics (up to 35 times magni­fi­ca­ti­on), mean we are no lon­ger working “in the dark”. The ope­ra­tor can now see deep into the insi­de of the tooth. This means he can also see irre­gu­la­ri­ties that devia­te from the norm. In many cases it is even pos­si­ble to see right to the end of a strai­ght canal. Intri­ca­te­ly bran­ching cana­ls can also be trea­ted in a tar­ge­ted, safe man­ner. Pro­blem cases like holes in the root canal wall or instru­ments that have bro­ken off in the root canal can also usual­ly be sol­ved with the help of the OP microscope.

ENDOPUR has ultra-modern OP micro­scopes for endodon­tic treatment.

Cone beam CT(CBCT)

X‑ray images are rou­ti­nely taken at all den­tal offices. While they are rela­tively easy to pro­du­ce, there are situa­tions where they are not the right dia­gnostic tool, such as in case of dis­tor­ti­ons, with super­im­po­sed struc­tures or where images are blur­red or unclear due to issu­es with expo­sure. In the worst case, this can lead to mis­in­ter­pre­ta­ti­on of the x‑ray image.

With Cone Beam CT (CBCT) a new era began in endodon­to­lo­gy. The high-reso­lu­ti­on 3D images pre­sent the tooth in thin lay­ers, there is no dis­tor­ti­on or super­im­po­si­ti­on and all images are to scale. CBCT dia­gnostics allows endodon­to­lo­gists to detect a wide range of dise­a­ses of the tooth and sur­roun­ding struc­tures such as bones or the maxil­la­ry sinus that would other­wi­se only be visi­ble with much more ela­bo­ra­te tech­no­lo­gies (i.e. com­pu­ter tomo­gra­phy, magne­tic reso­nance ima­ging). Ano­t­her advan­ta­ge of the CBCT tech­no­lo­gy is the much lower expo­sure to radia­ti­on com­pa­red to con­ven­tio­nal CT.

CBCT images are used …

… with suspec­ted infec­tion of the jaw­bo­ne cau­sed by the root of the tooth
… in the plan­ning of endodon­tic revi­si­on tre­at­ments
… in the plan­ning of endodon­tic micro­sur­ge­ry at the root of the tooth in close pro­xi­mi­ty to the ner­ves of the chin
… in the dia­gno­sis after den­tal acci­dents (cla­ri­fi­ca­ti­on of root and/or jaw frac­tures)
… with inter­nal and exter­nal root resorption

Cliff Ruddle – The “Grandseigneur” of Endodontology

We pro­bab­ly could call him our men­tor: Cliff Rudd­le has always inspi­red, sup­por­ted and encou­ra­ged us. As a stu­dent of Her­bert Schil­der, the famous father of “Schilder’s phi­lo­so­phy”, he fur­ther expan­ded Herb Schilder’s tech­ni­que. He also desi­gned and deve­lo­ped inno­va­ti­ve instru­ments for den­tal root canal tre­at­ment that are much finer and more effec­ti­ve than what was pre­vious­ly avail­ab­le. As we kept mee­ting him at his lec­tures and work­shops, as well as at mee­tings of pro­fes­sio­nal asso­cia­ti­ons and trai­ning cour­ses we dis­co­ve­r­ed our mutu­al fasci­na­ti­on with endodontology.