Endodontics, Root Canal Treatment, and Root Canal Therapy for Gentle Tooth Preservation

Endodontics, or endodontology, refers to the medical treatment of the inside of the tooth—specifically, the treatment of the dental pulp and the tooth root. It is also known as root canal treatment.

Even if the infection in the tooth root is advanced or the pulp has already died, the tooth does not necessarily have to be extracted right away. With the help of endodontics, the tooth can usually be saved.

For many people, a dental appointment is a source of great anxiety. Out of fear of pain during treatment, they prefer to take painkillers. This delaying tactic can ultimately lead to the tooth having to be extracted after all.

Yet root canal treatment today—unlike in the past—is hardly painful at all. Performed by dentists with specialized training in endodontics, this treatment is successful in up to 95 percent of cases.

Illustration of endodontics (root canal treatment) © Alexandr Mitiuc | AdobeStock

Viewed from the outside, a tooth consists of the crown and the root. The crown is part of the masticatory system. It is covered with enamel—the hardest material in the human body—and protrudes from the gums.

The underlying tooth root, which extends into the jawbone, consists of dentin, which encloses and protects the pulp.

The pulp is the soft tissue inside the root canal. It consists of

• blood and lymph vessels,
• nerve fibers, and
• connective tissue.

The blood vessels supply nutrients to the teeth.

Once a tooth has fully developed, it no longer needs the dental pulp to remain anchored in the jaw. Its role in nourishing the tooth during the growth phase is complete.

Nevertheless, it is important to protect teeth from disease. Inadequate oral hygiene creates a breeding ground for bacterial caries. If caries develops, prompt treatment is essential. Otherwise, it will literally “eat” its way through the tooth crown and dentin all the way down to the tooth root.

A bacterial invasion is characterized by:

• severe pain
• a distinct throbbing in the tooth
• Sensitivity to pressure when biting
• Sensitivity to hot or cold foods and beverages

Pulp damaged by tooth decay © sinhyu | AdobeStock

If dental diseases such as

• pulpitis (inflammation of the dental pulp),
• pulp necrosis (if the pain stops, the pulp is usually dead),
• bacterial dental abscess (accumulation of pus),
• and inflammation of the root tip (apical periodontitis),

it is high time to schedule an appointment with an endodontist. Once the causes of the disease have been eliminated, the inflammation subsides and the symptoms disappear.

If you come to the office with severe toothache, you’re considered an emergency.

Before treatment, the treating dentist will perform a thorough examination. He or she will ask about the location of the pain and test for sensitivity to cold, heat, and pressure. This helps determine whether the condition is, for example, acute reversible pulpitis or acute irreversible pulpitis.

In addition, the dentist will order an X-ray to determine the exact location and extent of the inflammation. 3D X-rays provide more detailed images, but they are not necessary in most cases.

Here is a brief overview of the endodontic treatment process:

1. The dentist numbs the inflamed tooth and the tissue surrounding it.
2. Then, they place a rubber dam around the tooth. This protects the area from contamination by saliva and, consequently, from bacteria.
3. After preparation, the dentist carefully opens the tooth.
4. Next, the length and shape of each individual root canal are determined using modern, computer-assisted length-measuring devices.
5. Once the results are available, the dentist cleans the root canals with special, very fine, flexible instruments and removes the inflamed or already dead pulp.
6. While preparing the root canals with root canal files, the endodontist irrigates the canals with an antibacterial solution to ensure that all bacteria are removed.
7. Finally, he dries the root canals using thin paper points.
8. Once the root canal cavities have been disinfected, cleaned, and dried, the root canal system is filled and sealed. The specialist uses a suitable root-filling material that provides optimal sealing.
9. If a follow-up appointment is necessary, the dentist protects the root canal by placing an antibacterial medication into the root canal system.

To support the stability of teeth that have undergone root canal treatment, dentists usually recommend crowns or partial crowns. In addition to providing stability, the crown protects against renewed bacterial colonization.

During root canal treatment, patients feel virtually no pain. However, some tooth sensitivity may occur for a few days after the procedure.

Endodontic treatment is largely pain-free © Antonioguillem | AdobeStock

In most cases, patients are pain-free after endodontic treatment. If the treated tooth is slightly sore, pain relievers can help. The pain usually subsides within the first week.

To confirm that the treatment was successful, a final X-ray is taken after about six months.

You should avoid eating and drinking while the local anesthetic is still effective. Otherwise, there is a risk of injury to the mouth due to misalignment of the bite or food and drinks that are too hot or too cold.

As with any medical procedure, endodontic treatment carries a certain degree of risk.

Common complications that may occur during or after treatment include:

• Pain
• Swelling of the gums
• Bleeding
• Inflammation
• Injuries in the immediate treatment area
• Instrument fracture: Since the hair-thin cleaning and filling instruments are not very sturdy, there is a risk that they may break.
• Root canal perforation: When root canals that are very narrow or excessively curved make it difficult to completely remove the inflamed tissue.

If the treatment is unsuccessful, a repeat root canal treatment (root canal revision) may be necessary. If this measure also fails, surgical removal of the inflamed root tip is the only option.

If all attempts to save the tooth have failed, the tooth must be extracted. The resulting gap is replaced by an artificial tooth root (implant) or a bridge.

The field of endodontics is an important part of dental school. After completing their dental degree, endodontic specialists undergo additional training in this field. The duration of this training varies by provider and can range from several days to several years.

Using fine instruments and precise technical equipment, the interior of the tooth can be treated as part of endodontic therapy. Often, a damaged tooth can still be saved this way. Unfortunately, public health insurance plans only cover the costs of straightforward root canal treatments. Additional procedures, such as electronic root canal length measurement, are private services that the patient must pay for out of pocket.

Nevertheless, endodontics is a blessing for anyone suffering from tooth pain. It offers the chance to keep one’s natural teeth well into old age. The treatment itself is pain-free thanks to local anesthesia.

Modern endodontics is now a highly specialized branch of dentistry and is often performed by an endodontic specialist or experienced endodontists who focus intensively on endodontics. If the inside of the tooth is infected, the priority is to save the tooth, even if the root canal system is complex and the dental pulp has already been damaged.

The prospects for success and the likelihood of a successful root canal treatment depend on whether inflamed periapical areas, surrounding bone tissue, and surrounding tissues are completely cleared of tissue and bacteria. Endodontic treatment is performed by a dentist under anesthesia, often using a rubber dam, special irrigation solutions, fine hand instruments, and dental techniques to protect the dental pulp, the pulp-dentin complex, and blood and lymph vessels. Inflammation or infections, such as bacterial pulpitis, inflammation of the dental nerve, or chronic inflammation, can otherwise lead to the death of the dental nerve and the spread of infection into the connective tissue, the jawbone, and other tissues.

When endodontic therapy is performed correctly, root-canal-treated teeth can often be preserved long-term, thereby avoiding the need for dentures or an implant. Coverage by statutory health insurance plans is limited; nevertheless, endodontics remains a crucial component in preserving tooth enamel, the interior of the tooth, and oral structures.