Root canal treatment

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.

Primary treatment

1. Dental dam

First the tooth is isolated from the mouth cavity using a rubber cloth (dental dam). For one thing this prevents the bacteria from the saliva getting into the tooth and for another thing it prevents the rinsing liquids from going down your throat.

2. Access

The dental surgeon gains access to the canal system in order to look at the extremely fine canal structures. In doing so he must be very careful not to unnecessarily weaken the tooth. Magnification systems (such as magnifying spectacles or a microscope) are often absolutely essential in order to be able to clearly see the smallest details and perform treatment while protecting healthy material.

3. Root canal preparation

The dental surgeon then cleans the canals with fine instruments and disinfectant rinses. The most important thing is to clean the canals along their entire length. This requires an X-ray to be taken. The length of the canal can also be very accurately determined electrometrically. Sometimes several appointments are needed for medicaments to be inserted to remove bacteria from the tooth.

 

4. Root canal filling

After the canals have been thoroughly cleaned, the dental surgeon fills the canal system with gutta-percha, a biocompatible natural material. This prevents bacteria from colonizing and infecting the canal system again. The access through the crown of the tooth is sealed with a filling material.

Retreatment

Why does my tooth need another root canal treatment?

The aim of a root canal treatment is to clean the bacteria out of the tooth’s root canals and prevent re-colonization using a tightly sealed root canal filling. But if bacteria remain in the canal system, these can multiply again, if

  • Canals were overlooked
  • Canals were not treated along enough of their length or width.
  • The effect of the cleaning was not sufficient due to complex canal anatomy

Another reason for reinfection caused by bacterial colonization of the filled canal system can be a root canal filling that is exposed to saliva and the bacteria it contains. This is often the consequence of tooth decay or treatment with a filling or crown that is done too late.

If my tooth is “dead” why does it still hurt?

During root canal treatment the vascular nerve bundle is removed from within the root. But the tooth is embedded in a tooth socket which can become inflamed. If bacteria from within the tooth cause acute inflammation of the tooth socket, this can result in pain, swelling and pus formation.

Can all teeth be preserved using retreatment?

Any medicinal therapy has its limits. In complex cases it can be impossible to completely clean the canal system. Sometimes a surgical procedure also has to be carried out in order to preserve the tooth.

If I am not in pain does that mean my tooth is healthy?

With chronic forms of infection there is often no discomfort at all. It is not uncommon for the consequences of the infection to only be discovered on an X-ray. The dental surgeon sees that bone has disintegrated from around the root of the tooth. This degradation is progressive and can turn into acute inflammation with pain, swelling and pus formation.

Performing a Retreatment

1. Dental dam

First the tooth is isolated from the mouth cavity using a rubber cloth (dental dam). For one thing this prevents the bacteria from the saliva getting into the tooth and for another thing it prevents foreign objects from going down your throat.

 

2. Removal of the old canal filling

First the dentist has to remove the existing filling from the canals. If the tooth has a dental post this must also be taken out.

Depending on the type of material used in the root canal filling and the type of dental post, removal can be very difficult and very time-consuming. Magnification systems (such as magnifying spectacles or a microscope) are very helpful for this and sometimes even essential in order to clearly see the smallest details and perform treatment while protecting healthy material.

3. Root canal disinfection

It is also important to thoroughly clean the whole canal system. If the old root canal filling did not completely fill the canal system, the untreated parts must also be accessed. If this is successful, the root canals can be cleaned using fine instruments and disinfectant rinses.

 

4. Root canal filling

After the canal has been thoroughly cleaned, the dental surgeon fills the root canal system. The access through the crown of the tooth is initially temporarily sealed with a filling material.

 

Microsurgery

Why does my tooth need surgical root canal treatment ?

Root canal treatment is carried out to preserve the tooth. The key to the success of this treatment is careful cleaning of the extremely fine root canal system. Even using optical magnification and delicate instruments, in some cases old root filling materials or dental posts, for example, cannot be removed from the canal. Despite the utmost care and the latest treatment technology, bacteria can also remain, which cause problems.

A supportive surgical procedure can also be necessary after non-surgical root canal treatment, if it is failing to heal. In these cases, inflamed tissue usually forms at the root tip or there is discomfort.

If the option of repeating the root canal treatment does not seem promising, in most cases surgical root canal treatment in the form of root tip resection (apicoectomy) is the only way to preserve the tooth.

Performing a root tip resection (apicoectomy)

Generally it is often necessary to replace the root canal filling that has already been carried out, in conjunction with root tip resection. This means that the root canal is cleaned, disinfected and filled again (retreatment). The surgical procedure takes place in the following stages:

1. Exposure of the root tip

In the first stage, after administering an anesthetic, the oral mucosa above the root tip is loosened and lifted to expose the bone above the root tip. Then in a second stage the inflamed tissue is removed and the area around the root tip is cleaned.

2. Cleaning the root canal

The root canal is prepared and cleaned from the root tip upwards using delicate ultrasonic tips. For a gentle and safe procedure, especially in terms of cleaning and filling of the root canal starting from the root tip, delicate specialist instruments such as fine ultrasonic tips, the finest filling spatulas and condensers are necessary.

3. Root canal filling and wound closure

After cleaning, the root canal is refilled through the root tip and the wound area is stitched up. The result is checked using an X-ray.

4. Healing and follow-up checks

Following successful treatment, the bone defect heals within a period of several months. The healing process is checked using X-rays at regular intervals.