Root canal treatment: Information & specialists

If the pulp in the area of the tooth root is inflamed, root canal treatment is often the only way to save the tooth after root inflammation. This involves filling the inside of the tooth under local anesthetic, sealing it and, if necessary, crowning it. The cause of severe root inflammation is usually caries.

Here you will find further information as well as selected root canal treatment specialists and centers.

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Article overview

Root canal treatment - Further information

What are the causes of root inflammation?

Caries is by far the most common cause of root inflammation(pulpitis). If caries is not treated in time, it eats deep into the tooth. Bacteria can then penetrate the pulp. This results in inflammatory changes inside the tooth, which usually manifest themselves in pulsating, severe pain.

At this stage, the dentist can still treat puplitis without root canal treatment.

If the pain suddenly disappears, this is a sign of permanent damage to the nerve tracts in the pulp. It is dying off. It must now be removed from the inside of the tooth in order to avoid serious consequential damage. Consequential damage includes, for example, the inflammation spreading to the jawbone or complete tooth loss.

Accidents or surgical procedures on the teeth are much less common causes of root inflammation than tooth decay. For example, a blow to the jawbone can break the enamel and expose the dental nerve, allowing bacteria easy access. In rare cases, the dental nerve can be damaged during caries treatment.

What is the aim of root canal treatment?

In the past, severely damaged teeth were simply extracted to prevent the inflammatory process from spreading to the rest of the body. Today, the aim of root canal treatment is to avoid this and preserve the tooth.

A preserved tooth is more advantageous for the masticatory system than a replacement with implants or partial dentures.

The aim of the filling is to seal the prepared root canal with a special filling material so that it is bacteria-proof. The tooth should thus be permanently secured and preserved.

General root canal treatment

The dentist must first determine whether the tooth is still alive, i.e. whether the pulp is only inflamed or already dead.

Dead teeth no longer react to cold and heat. The dentist will therefore subject the tooth to a cold test (the so-called vitality test):

  • healthy teeth only feel the cold,
  • severely inflamed nerves react with a short, sharp pain, and dead teeth
  • dead teeth neither feel the cold nor react painfully.

An X-ray then provides definitive information about the presence and extent of the root inflammation.

The principle of root canal treatment is to remove inflamed or dead tissue from the inside of the tooth. The resulting cavity is then sealed with filling material.

The procedure is usually performed under local anesthesia, as it is very painful. Root canal treatment can be divided into 4 stages:

  1. Removal of the pulp
  2. Determination of the root canal length
  3. Preparation of the individual root canals
  4. filling and sealing the root canals
Darstellung einer Wurzelbehandlung
Using tiny instruments, the dentist removes the pulp and prepares the root canals © Maksym Yemelyanov | AdobeStock

Removing the pulp

First, the dentist opens the crown of the tooth to remove the pulp. A drill is used to completely remove any existing caries before a hole is drilled to the inside of the tooth. An extirpation needle is then used to completely remove the exposed pulp.

To completely seal the hollow interior of the tooth, the dentist must determine the length of the individual root canals. This allows him to determine the working length of the instruments for the root canal treatment.

To do this, the preparation instruments are first pushed through the opening into the inside of the tooth and then an X-ray image is taken. The image shows how far the instruments are from the root tip and what length they may have in the canal.

In some cases, the canal length can also be determined electrically. A small probe is inserted into the open root canal, which indicates the end of the canal using a measuring device.

Preparation of the root canal

The root canal is then prepared for the root filling. The dentist smoothes and widens the canals using flexible drills and files, which can be operated either mechanically or manually.

In addition to instrument-oriented preparation, canal preparation with ultrasound is now also a more gentle preparation method.

Laser light has a thermally induced bactericidal effect. The root canal is sterilized by the laser light. This eliminates the need for repeated rinsing with antibacterial solution and medicated inserts.

For the patient, this means a considerable reduction in treatment time and an acceleration of the healing process.

The use of laser light is particularly useful in cases of pus infestation in the root canal. This usually eliminates the need to split the root canal treatment into two sessions. It is not necessary to wait for antibacterial and anti-inflammatory medication to take effect.

Before the actual filling of the root, the dentist thoroughly rinses out the inside of the tooth.

Filling the root canal

The filling material is always a foreign substance that is

  • impermeable to bacteria,
  • non-absorbable and
  • radiopaque

should be radiopaque. In practice, there are several methods for filling root canals:

  • pure paste filling
  • filling with post and paste
  • filling with several posts and a small amount of paste

Pure paste fillings consist of either

  • epoxy resin, which has very good sealing properties and good volume stability, or
  • gutta-percha, a thickened latex obtained from the tropical gutta-percha tree.

Pastes that are used in conjunction with posts are either

  • also based on gutta-percha or
  • on a mixture of zinc oxide and eugenol.

The combination of inserted posts and paste gives the tooth additional stability. This is particularly important when a lot of tooth tissue has had to be removed.

Posts can be either semi-solid or solid.

Semi-solid posts must always be used in conjunction with a paste. These posts consist of a mixture of

  • Gutta-percha,
  • zinc oxide,
  • waxes and
  • plastics with good biocompatibility.

There are also solid posts made of silver, titanium or plastic. They can either be inserted into the root canal in combination with a paste or used on their own.

The disadvantage of pure post fillings is that they do not form a tight seal with the walls of the tooth. This creates cavities in which bacteria can colonize again. For this reason, such filling methods are not used in most cases nowadays.

Once the root canal has been filled, another X-ray is taken. This allows the dentist to ensure that the canals have been filled completely and without bubbles.

Depending on the size of the opening hole, a filling is then placed or a crown is applied to rebuild the tooth. This turns the tooth back into a fully load-bearing part of the masticatory system.

Complications during root canal treatment

Only in the rarest of cases do complications occur during root canal treatment. They can be caused by

  • Root canals that are barely accessible or not accessible at all
  • Resistant bacterial infestation
  • Continuation of chronic inflammation despite removal of the pulp
  • Breakage of the dental instrument
  • Breaking through the outer tooth wall

If the root canals are not accessible to the dentist, the only option is usually to remove the tooth completely.

Resistant bacterial infestation and continued inflammation require medical treatment. Either oral administration of antibiotics or local application of medication directly into the opened tooth root are used. In some cases, a combination treatment of oral and local administration of antibiotics is appropriate.

At this point, the dental treatment is interrupted and a temporary filling is placed over the tooth. The root can only be filled after the bacterial infestation has been removed.

There is a particular risk of the dental instrument breaking off when the root canal is prepared mechanically. In order to remove the small metal parts, the dentist often has to remove more healthy tooth substance.

If the broken instrument cannot be easily removed, it will remain in the root canal permanently even after the canal has been filled. Depending on how deep the instrument is inserted, there is a risk of inflammation of the surrounding tissue. The root tip is particularly at risk.

In rare cases, the root canal may be perforated laterally during preparation. This is particularly possible if the course of the root canal is very bent and curved. The dentist calls this via falsa, the wrong way.

The resulting hole is simply closed during the sealing of the root canal. It should not cause any further problems once the root canal treatment has healed.

In some cases, the root of the tooth is already so damaged and attacked that root canal treatment will no longer be successful. An apicoectomy may then be necessary.

The damaged part of the root tip is removed from the outside by means of a minor surgical procedure. In this way, at least the rest of the tooth can be saved.

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