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Root treatment (Endodontology)

A root treatment is needed when the dental nerve (pulp) is dead. It is referred to as pulp gangrene. The most frequent causes of pulp gangrene and thus root treatments are caries and composites (these are white plastic fillings).

Pulp gangrene means that the dental nerve no longer functions and a cold test therefore produces no reaction. In addition to a negative cold test we often observe a pressing pain in the tooth and an extension of the periodontal space in x-rays. In order to avoid pulp gangrene and concomitant root treatment we should try to avoid frequent work on the tooth, as every time
  • a tooth is drilled
  • fillings are inserted

there is a threat of damage to the dental nerve. The treatment is then a root treatmen. It is therfore important to take the trouble to prevent it.

Due to insufficient cleaning in the side areas the side teeth are usually the first to get caries and need fillings. Optimising cleaning techniques, using water pik and getting regular dental check ups help to avoid root treatments. The aim of the root treatment is to completely remove the destroyed and sometimes infected tissue from the inside of the tooth and the to seal off the canal completely and thus to avoid abscesses (for example). The tooth canal must therefore be cleaned out right up to the tip of the root and to do this the length of the root will be checked with x-rays and measuring instruments. Only a well cleaned and filled tooth right up to the root tip will last long.

It is also important that all canals are treated, as most teeth have several canals. A precise dentist will therefore always work using magnification – magnifying spectacles or a microscope. Absolute cleanliness and sterile work are further preconditions for a good root treatment and in order to obtain these inside the mouth a coffer dam is absolutely necessary whilst working as this is the only way to keep clear of saliva and inner tooth tissues. In the saliva there are many different bacteria which may endanger the outcome of the root treatment. Often, however, unsterile instruments and no coffer dam are used. The instruments are left exposed in simple foam rubber holders. This is definitely one of the reasons that so many root treatments end in root tip resections or tooth extractions after some years.

If, despite clean work and several rinses with disinfectant solutions the tooth still smells bad, or there is pain or strong bleeding from inside, no permanent filling of the root canal may take place as the inflammation hasn’t healed. In such cases a medication is inserted and the tooth sealed for a number of days. The medicament has a disinfectant effect and usually brings about the healing of the inflammation within a few days. If the inside of the tooth is clean (sometimes more than one appointment is needed) and the tooth is prepared and there are no problems the inside of the tooth is sealed tight with a special filler from the top down. The tooth should be sealed tightly against entry (by means of a crown or an inlay, for example) as this is the only way to ensure that no more bacteria can gain access and/or multiply.

The additional services mentioned above (tooth reconstruction, coffer dam, microscope …) mean higher initial costs, it is true but in the long run you will not only save money but also avoid problems.

There is no alternative to a root treatment except for extraction, avoiding it is the best alternative!

The risks with root treatment include breakage from root canal instruments, the dentist missing canals, perforation of the canal or the tooth crown, excessive use of instruments with the related possible consequences such as for example inflammation of the maxilliary sinuses. A badly done root treatment leads to a root tip resection after weeks/months/years. A badly done root tip resection leads to an extraction after weeks/months/years. In between there are fistulas, abscesses and pain – the state of the tooth gets worse from year to year. It doesn’t have to be like this – ask about us in the dental forum and get your teeth away from the usual career.

Which filling in the tooth?

Why does it make sense to put a crown or an inlay on a tooth with a well-done root treatment? In order to understand this you have to understand what micro-gaps are. Micro-gap is the term for a very very tiny gap between two apparently solidly joined bodies. In dentistry the term micro-gap has a particular significance in endodontology, fillings and implantology (cone joint). Wherever there are small gaps, cracks and holes there is a danger that bacteria from the mouth will settle there and cause inflammations such as periodontitis or caries. Every good filling should therefore close up tightly to the tooth and thus obstruct bacteria from gathering and causing caries. Fillings however can only reach a certain degree of tight fit. Due to the heavy loads on materials in the mouth (pressure, temperature differences, humidity) micro cracks and gaps start to appear on fillings soon after they have been inserted. You don’t feel any pain. Pain is only felt when the caries reaches the dental nerve and infects it with bacteria – by then it is too late and you’ll have to get a root treatment done. Good dental fillings won’t get such micro cracks for decades, others might get them within a few months.

As soon as there are micro-gaps there is a danger that bacteria from saliva creep into the tooth unnoticed. The good root treatment gets loose again after years and all the endodontologist’s work was in vain. If the foundation (the inside of the tooth) is well treated, then the investment in a technically sound treatment which seals the tooth hermetically, protecting against bacteria for decades is definitely worth it. Such a well-treated tooth can last a lifetime. This is also why some teeth with bad root treatments don’t give us problems for a long time or even for life. If, after a root treatment which, although not thoroughly has been cleanly carried out, the tooth is quickly provided with a crown, for example, no bacteria from the mouth can reach inside the tooth