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.