A root canal treatment has to be performed if the dental nerve, technically called the dental pulp, (Latin: pulpa) has died or is infected. The patient may or may not experience pain after pulp death. Here you can see a Video about optimal Root Canal Treatment.
The dead tooth can lead to acute, even life-threatening complications at any time because the necrotic pulp tissue can cause acute infections called abscesses. The tooth is connected to the bone through numerous small canals at the end of the root. The objective of a root canal treatment is to completely remove the destroyed tissue (which may also be infected with bacteria in some cases) from the interior of a tooth. This way, the infection is prevented from spreading to the bone.
Since complete cleaning of the interior of a tooth is never 100% successful, the dentist attempts to close the pulp cavity and the root canals tightly with a special compound so that any remaining bacteria do not have space to multiply. This means that absolute cleanliness and a sterile working environment are prerequisites for any root canal treatment. In order to create this environment in the oral cavity, it is imperative that the dentist works with a rubber dam, because this is the only way to prevent saliva from reaching the interior of the tooth. Saliva contains many different bacteria that can endanger the success of a root canal treatment.
Furthermore, it is important to work with sterile instruments. With the aid of sterile instruments, the dentist begins to clear and clean the interior of the tooth. Special solutions are used intermittently for irrigation in order to flush out tooth chips, cell debris, and bacteria. It is important that all canals are reconditioned. Most teeth have several canals; therefore, a root canal Specialist, so called Endodontic Specialist, always works with magnification, such as medical magnifying glasses or a microscope. The dental canal must be reconditioned all the way to the root apex. The length of the root is ascertained by means of X-rays and measuring aids. Only a well-reconditioned tooth filled all the way to the root apex can be preserved permanently.
If the tooth exudes a foul smell, is painful, or bleeds severely from within, the canal should not be filled with the permanent material. In such cases, medication is applied within the canal, which is then tightly sealed for a few days. However, the temporary sealing material must be absolutely saliva-proof because only then will it keep the tooth sealed for about one week. Another cleaning session must take place no longer than a week after the initial session. If this is not done, bacteria from the saliva could enter the tooth and its canals, necessitating a repeat of the entire previous procedure.
Once the canals are clean and the tooth no longer causes any discomfort, the canals are tightly filled with a special compound, creating a tight apical seal. The tooth crown should also be tightly sealed from the top, i.e., from the access opening, because only then is it guaranteed that bacteria can no longer enter.
On this X-ray of a tooth you can see a good root canal treatment. The canals have been filled homogeneously and tightly down to the root apex. These filled canals are represented on the X-ray as a light strip within the interior of the tooth. Such a tooth is able to provide valuable service for an entire lifetime. Now there is an example of a tooth with a poorly-performed root canal. The anterior root is not filled at all, while the posterior root is only half filled. Such teeth can cause trouble even after many years and can lead to conditions like acute bone infection or abscesses. In this case, a revision of the root canal treatment and/or tooth extraction becomes necessary.
The only alternative to a root canal treatment is tooth extraction. Prevention is the best alternative!
The risks involved in a root canal treatment include the following:
- Instrument breakage in the canal
- Root canals overlooked by the dentist, who leaves them unfilled
- Perforation of the canal and the dental crown
- Overinstrumentation with respective possible consequences, such as maxillary sinusitis or bone inflammation