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Root canal treatment

Synonyms

Root Canal Treatment, Endodontic Treatment, Endo, WKB

introduction

Root canal treatment belongs to the field of Endodontics.

This means everything that relates to the tooth nerve and the tooth chamber, i.e. the inner workings of the tooth.

This treatment serves to preserve the tooth in the oral cavity and ensures that the infection cannot spread and the neighboring structures do not become infected.

procedure

A root canal treatment describes the cleaning and disinfection of inflamed root canals and the subsequent filling of these using a sterile and rubber-like material (=Gutta-percha). This is followed by a prosthetic or restorative treatment of the tooth.

In general, a root canal treatment takes several appointments (usually two), which can sometimes take longer. However, the duration is highly variable, as it depends on various factors such as Level of difficulty, Number of root canals etc. depends. Further appointments are necessary for the final restoration of the tooth with a crown or a filling.

After taking an initial X-ray, the dentist first removes the caries and creates a clearly visible access to all the root canals of the tooth. As a result, the root canals are processed, i.e. emptied and cleaned, using manual or electric files. Depending on the tooth and the curvature of the root canals, this can be difficult. The dentist works his way down the canal step by step and removes the inflamed or necrotic (= dead) tissue from the canals. He always uses files that are getting bigger and bigger in order to be able to finally clean the canal well on every wall.

Between its tissue removal steps, the canal is repeatedly rinsed with special antibacterial and disinfecting rinsing solutions. The purpose of this is also to remove the small pieces of tissue that could block the root canal without flushing.

Depending on which tooth is being treated and how many canals it has, several sessions may be necessary. The canals that have already been treated are then temporarily filled until the next appointment. A temporary filling is also made if the inflammation is very severe and may have already spread to surrounding tissue. The tooth is then treated with an anti-inflammatory drug and temporarily filled for about 14 days.

When the root canals have been completely emptied, another X-ray is usually taken to make sure that all tissue has been removed. Then the root canals are filled with a rubber-like material (= gutta-percha). This material is particularly compatible and durable. When the filling of the canals is complete, some dentists take another x-ray to check the quality of the filling.

Finally, a root-treated tooth is usually provided with a prosthetic crown. Depending on the degree of destruction, if only a little of the tooth has been lost, a filling can also be created.

More information can be found here: Root canal treatment process

Root canal pain

A root canal treatment is used to clear out the inflamed root canals and to prevent inflammatory processes in the area of the dental pulp. In this way, pathogenic germs should be prevented from spreading to the jawbone and other parts of the teeth holding apparatus. For this reason, root canal treatment generally follows a fixed procedure.
In order to prevent severe pain during the root canal treatment, local anesthesia is carried out before the hard tooth substance is opened. As a rule, a root canal treatment can therefore usually be carried out painlessly. During the therapy, the patient only notices a slight pressure in the area of the tooth.
In the presence of strong inflammatory processes within the root canals, it may happen that the smallest nerve fibers cannot be completely switched off and pain occurs during the root canal treatment. In order to enable the patient as symptom-free treatment as possible in these cases, it is possible to apply the local anesthetic directly into the pulp after opening the root cavity. In most cases, this causes pain, which, however, subsides after a few seconds and makes the rest of the root canal treatment painless.

The pain to a root canal treatment depend on the individual pain sensation. In general, pain after a root canal treatment is quite common. However, these usually subside after a short time.
They are normal Healing painwhich can be expressed as a throbbing or knocking as well as being very sensitive to touch. In order to reduce the pain to a minimum after the treatment, it is a prerequisite that the entire root canal has really been freed from infected tissue. As soon as there is still residue in the canals, painful inflammations can occur again and the root canal treatment was not successful.

As a rule, pain after a root canal treatment can be treated by taking mild pain relievers (analgesics). Ibuprofen shows a particularly good effect in everyday clinical practice in terms of relieving pain after a successful root canal treatment.

It can also happen that the dentist accidentally presses the rinsing solution beyond the root tips into the surrounding tissue. In this case, too, severe inflammation and associated pain can occur.

Read more on the topic: Pain during a root canal treatment

Duration of a root canal treatment

Root canal treatment is used for an acute inflamed pulp.

The duration of a root canal treatment is largely dependent on the initial condition, i.e. the extent of the inflammatory processes in the area of the root cavity of the affected tooth. In addition, the individual anatomical conditions (width, depth, curvature of the root canals) and the number of tooth roots also play a decisive role in the duration of a root treatment. In uncomplicated cases with a low degree of inflammation and short, straight root canals, the therapy can usually be completed within a one to two hour session. As a rule, however, a root canal treatment is rarely absolutely uncomplicated. Most patients do not see the dentist until they experience pain in the area of the diseased tooth. This pain suggests that significant inflammatory processes are taking place inside the tooth. In these cases, a complete root canal treatment with a good chance of success cannot be conscientiously completed within one session.
In most cases, anti-inflammatory drugs have to be introduced into the opened tooth and this has to be temporarily closed.
The duration of the root canal treatment thus comprises several sessions and can stretch for a few weeks.

Read more on the topic: Duration of a root canal treatment

Root canal treatment costs

In many cases, a root canal treatment is the only promising way to preserve a severely inflamed tooth. Even with uncomplicated anatomical conditions, it is a complex treatment that requires a considerable amount of time. Despite the good results of root canal treatments, statutory and private health insurances do not cover the costs in all cases.
A root canal treatment is therefore not necessarily a health insurance benefit. The root canal treatment can only be billed as a health insurance benefit if the tooth to be treated is classified as worthy of preservation.
With anterior teeth, the assumption of costs is guaranteed in almost every case. In the area of the molars (lat. Molars), however, it is not necessarily possible to classify a diseased tooth as worthy of preservation and to bill the therapy as a health insurance benefit.
The costs of a root canal treatment on molars are only covered by health insurance companies under certain circumstances.
Molars are considered worthy of preservation:

stand in a complete row of teeth without any gaps
are at the end of a complete row of teeth that would be shortened on one side by removing the tooth in question
serve to support an already existing denture

In individual cases, however, the treating dentist can justify the need to preserve a diseased tooth on the basis of other guidelines and bill the root canal treatment as a health insurance benefit.
In general, however, the prospect of success of the root canal treatment must be assessed positively by the dentist. Health insurance companies generally do not pay for therapy attempts with unclear prospects of success. In addition, it must be noted that both statutory and many private health insurances do not or only partially bear the costs of special, novel therapeutic measures.
If individual measures or even the entire root canal treatment cannot be invoiced by the responsible health insurance company, the patient must pay the costs himself.
Various supplementary dental insurances have meanwhile declared themselves ready to cover a larger scope of treatment and thus to keep the patient significantly more therapy options open.

Learn more here: Cost of a root canal treatment

Root canal treatment in pregnancy

During pregnancy, many women suffer from carious defects and / or inflammation of the periodontium (technical term: Periodontal disease). Deep carious defects, which make a root canal treatment necessary, in most cases cause severe pain.
The Postponing the necessary therapeutic measures to a point in time after the delivery is therefore often not possible without problems. Basically, if you want to have children in front a dentist should be consulted during pregnancy.
This should collect a dental status and examine the condition of each tooth, the gums and the other structures of the tooth support apparatus.
In women with healthy teeth and optimized oral hygiene, tooth decay and gingivitis occur much less frequently during pregnancy.

Root canal treatment during pregnancy is usually possible. It is important that the root canal treatment is only carried out if it is unavoidable and cannot be postponed.

Every root canal treatment during pregnancy involves certain risks, which can, however, be reduced to a low level by taking special measures. Unfortunately, in most cases, an X-ray is essential. These recordings are used to determine the exact length of the root, to estimate the extent of inflammation and to check the root filling. However, X-rays should be avoided during pregnancy. On the one hand, this means that it is much more difficult to place a root filling, since the length of the root canals remains unknown.
Furthermore, no follow-up recordings can be made after the root canal treatment during pregnancy. For this reason, only a so-called root canal preparation is generally carried out in pregnant women. This means that although the inflamed tooth pulp and the nerve fibers embedded in it are removed, the root canals are not finally filled. However, special protective measures are also taken by the dentist and the practice team. Furthermore, if an X-ray image cannot be dispensed with, special endometry devices can be used to measure the length of the root canal. In general, however, an X-ray is a prerequisite for successful root canal treatment. To numb the affected areas and to disinfect the root canals, compatible anesthetics or agents are used especially for pregnant women to protect the unborn child.

However, care should be taken to ensure that the treatment is in second third pregnancyl (= 2nd trimemnon) takes place. During this time, the risk of harm to the unborn baby is lowest.

Read more on the topic: Root canal treatment in pregnancy

What complications can arise?

As with any surgical procedure, root canal treatment carries certain risks and complications that can arise during or after the treatment. A typical side effect of a root canal treatment is often swelling and pain. It can also lead to infections, injuries to muscles, nerves or bones or bleeding.

A root canal treatment is one Try to preserve a tooth that is already badly damaged by inflammation or even dead tissue. It can therefore happen that the treatment is unsuccessful because the inflammation has already spread to the surrounding tissue and cannot be combated.

In rare cases, the canal system may be so curved that inflamed tissue or bacteria remain in the canals. Then there is a risk that the tooth will become inflamed again after a short time. In this case a new root canal treatment would be necessary. In the worst case scenario, the tooth can be lost.
This is also known (somewhat out of date) as "corpse poison in the tooth".

In general, you should seek adequate advice on the possible risks.In order to avoid complications after the treatment, it is very important to first stop smoking, not be exposed to excessive heat and maintain good oral hygiene.

prophylaxis

A targeted prophylaxis directly on one Root canal treatment there is not any. Because this treatment only ever occurs after damage to the hard tooth tissue, either due to tooth decay or an accident in which the Broken tooth and so the pulp is exposed. That is why oral hygiene, see also dental care, with fluoridated toothpaste and professional tooth cleaning the best prevention, because they are the best way to prevent caries infection.

When do i need antibiotics?

An antibiotic is appropriate as soon as a patient has artificial heart valves or has ever had heart valve inflammation (=Endocarditis) has survived. Here the administration of antibiotics makes sense to prevent the pathogens from reaching the heart valves by passing into the blood and igniting the valves there. Such an inflammation of the heart valves is very dangerous, which is why the patient is shielded beforehand.

After root canal treatment, antibiotics are usually not required. The tooth is only definitely filled when e.g. there is no longer an abscess. In severe cases, an antibiotic can be prescribed to help reduce it.

However, there are only exceptional cases in which antibiotics are really necessary and helpful.

Read more about this: Antibiotics after a root canal treatment

Is the tooth dead after a root canal treatment?

After a root canal treatment, the treated tooth is dead. It is no longer supplied with blood or a nerve. Furthermore, it changes its color and becomes gray-brownish. For cosmetic reasons, the dead tooth is often restored with a crown. Thus the tooth is dead, but can still serve its purpose.

When do I need a temporary filling?

In many cases, the dentist closes the tooth with a temporary filling if the inflammation of the tooth has already been very severe and may have spread to the surrounding tissue. A sign of this is that the tooth is very painful. In this case, the dentist fills the tooth with an anti-inflammatory drug - initially closes the tooth temporarily.

Thus, the inflammation can subside over a few days and the germs can be removed from the tooth. If the Tooth no longer hurts, is sterile and dry, the root canal can be finally filled. The tooth is then finally closed. After three to six months, a check is carried out using a new X-ray.

What difference does it make whether the molar or the vaginal tooth is treated?

Every root canal treatment is dependent on different factors. These include the position of the tooth in the jaw, i.e. whether an anterior or a posterior tooth needs to be treated, as well as the degree of difficulty that is also dependent on it.

While anterior teeth in most cases only have one or two, mostly straight, root canals, three to four root canals can usually be found in the molars. In addition, the root canals of the molars are often strongly curved or twisted. This complicates the treatment and the complete cleaning and disinfection of the root canals.

In addition to the degree of difficulty and often the associated chances of success, the difference lies in the duration of the treatment and in the costs. Furthermore, molars are usually finally supplied with a crown. An aesthetic filling is made in the incisor area depending on the degree of destruction of the tooth and the possibility.

Learn more at: Root canal treatment on the incisor or root canal treatment on the molar

When can I do sport again after a root canal treatment?

Root canal treatment always means a little excitement for every patient. The body is exposed to stress and as a result one is a bit tired and exhausted after a root canal treatment. In order to protect your body a little, you shouldn't do any sport on the day of the treatment.

From a medical point of view, however, sport on the same day does not pose a risk. It should only be used in the sauna or the like. be dispensed with, as the heat does not promote healing in the presence of inflammation. In order not to take any risks, one should initially refrain from physical exertion for at least 24 hours after the treatment.

When can I smoke again after a root canal treatment?

Smoking not only has a damaging effect on the various tissues in the body, but also narrows the blood vessels due to the ingredients in the smoke. As a result, the tissues in the oral cavity are poorly supplied with blood and wound healing slows down. Fewer cells are transported to the wound site for healing.

To avoid bleeding it is very important to stop smoking for at least 24 hours after the root canal treatment. In the following days, the inflammation must subside and the tissue must heal. It can take up to several days for any swelling and the feeling of pressure to subside. You should also not smoke during these days, as this can worsen or even provoke inflammation and delay the healing process. However, it is not strictly prohibited. You may smoke again after approx. 1 week at the latest. However, it should not be forgotten that this naturally increases the risk of infection or inflammation.

Sick leave after a root canal treatment?

In most cases, the patient is able to work again immediately after a root canal treatment. A root canal treatment takes an average of around two hours and is performed under local anesthesia. This usually subsided a short time after the treatment, usually after three hours at the latest. In most cases there is no need to take sick leave.

However, the ability to work also depends heavily on the activity. Heavy physical labor should be avoided on the day of treatment. In these circumstances, you may be on sick leave for at least one day. In general, one feels very exhausted after a root canal treatment, as it is often stressful and exhausting for the patient. For this reason, it is advisable not to have to go to work on the same day. If possible, you should schedule the appointment for an afternoon or a Friday so that you can rest appropriately after the treatment.

Root canal treatment with a laser - is it an alternative?

Many dental practices offer treatment with a dental laser as an alternative to root canal treatment using manual or electrical devices. This has a thin glass fiber that is inserted into the root canal. Thus, the laser can work precisely at the point of treatment. Laser treatment is often recommended for severely curved root canals, as the laser should also remove bacteria and tissue from areas that are difficult to reach. The bacteria are killed by targeted heat generation, as they cannot withstand the heat. Furthermore, a root canal treatment using a laser is described as being faster in terms of time. The laser empties the root canal quickly and thoroughly and the surrounding tissue is also spared. Treatment with a laser is not covered by the health insurance. In the long term, treatment with a laser can improve the prognosis of the tooth

Find out more here: Root canal treatment with laser

Apical resection

Even with the most careful root canal treatment, bacteria can still remain in the ramifications of the root canal at its tip. This can lead to a pus focus at the tip of the root, which is enclosed by the body by a protective wall of connective tissue. However, since it is a latent source of danger, it should be eliminated with a surgical procedure, the root tip resection. For this purpose, the mucous membrane is cut under local anesthesia and the bone over the pus focus is removed.

The pus focus is eliminated and with it the tip of the root. Then the root canal is closed with amalgam or cement from the tip so that no more germs can escape. The mucous membrane is sutured again and the resection is complete. An apicectomy is relatively problem-free for teeth with one root, but very difficult for teeth with multiple roots.

Read more on the topic: Apical resection

Pulpitis

Pulpitis (tooth pulp inflammation) is an acute inflammation of the tooth pulp. It is the result of untreated tooth decay that has spread more and more in the dentin. Bacteria can reach the pulp with its blood vessels, nerves and connective tissue through the dentinal tubules. The pulp reacts with inflammation that causes great pain. The tooth pulp is irreversibly damaged and must be removed.

This is done with a vital amputation. The pulp chamber is opened and the pulp is removed under local anesthesia and absolutely dry, ideally with a rubber dam in order to avoid further bacterial infections. At the bottom of the pulp chamber, the entrances to the root canals are sought out, which can be difficult, especially in the case of teeth with multiple roots, as the entrances to the individual root canals are difficult to find, especially in older people due to the formation of secondary dentine. After widening the entrances, the remaining pulp tissue is carefully removed from the root canals. The canals are cleaned, widened with hand or machine instruments and with disinfecting solutions such as Hydrogen superoxide or Chlorhexidine digluconate rinsed to remove the remains of tissue and rasped dentin.

The preparation of the root canal is relatively easy for a tooth with a straight root, but it must be ensured that the canal is prepared as far as possible to the tip of the root. The control is carried out with an X-ray. The preparation is much more difficult for teeth with several roots. Especially when these roots are still bent. Today there are files for this which are flexible and therefore allow cleaning and expansion even in curved roots.

In the case of acute pulpitis, in which there are no more bacterial residues, the final filling of the root canals can be done in one session. After drying, the root canal or canals are filled with an antibacterial paste or gutta-percha using paper points and a covering filling is placed over it. If, however, a more extensive infection is already present, an antibacterial insert will first be made and the tooth will be temporarily closed. The final restoration can only be carried out when the tooth has been quiet for several weeks. The success of the treatment is checked using an X-ray. The same procedure is followed in the event of trauma, i.e. an accident in which the pulp was opened.

gangrene

If the pulp is not only inflamed, but also disintegrated due to the action of bacteria, gangrene has developed. The treatment of gangrene is much more complex and lengthy than that of pulpitis. When the pulp chamber is opened, foul-smelling gases escape, but the patient feels immediate relief because the gases no longer press on the opening at the tip of the root. After removing the disintegrated tooth pulp, the opening is widened and the tooth is initially left open or closed with a cotton ball so that the gases can escape but food residues cannot penetrate. In the next session of the root canal treatment, the root canal will be enlarged and cleaned of residues. An X-ray shows how far the canal has been worked up. After an antiseptic insert, the tooth is temporarily closed. If the tooth remains without symptoms for a long time, the canal can be filled with gutta-percha or another root filling material and finally closed.

Milk teeth

Treating milk teeth with pulpitis or gangrene is more difficult. Since the milk teeth are smaller and the enamel and dentin are thinner, the pulp is reached faster than with adult teeth. Of course you have to try to preserve the tooth as it serves as a placeholder for the permanent teeth. On the other hand, it must be taken into account that the permanent tooth is located directly behind the milk tooth and that the roots of the milk tooth are resorbed. Therefore a normal root canal filling / treatment cannot be performed. In any case, the carious tissue is removed, then you have to decide how to proceed. One possibility is to grind the tooth so that there is no jam and no toothache. It remains open or is provided with an antibacterial insert. If the tooth is open, you should make sure that no food particles close it again. With the pulp chamber wide open, this should not cause any problems. The alternative is to remove the tooth. The important placeholder function has thus been lost. This can be remedied by a placeholder that keeps the gap open so that the permanent tooth can literally break through.

homeopathy

In the context of a root canal treatment, homeopathic remedies are only suitable for accompanying follow-up care. With the help of them can there is better healing or pain relief in the affected areas. In this context, however, homeopathic medicines are only suitable as accompanying therapy. Mechanical and antibacterial root canal cleaning is essential in this case. In many cases, i.a. Use the following globules in the post-treatment of a root canal treatment: Pyrogenium D12 and Arsenicum album D12.

Pus after a root canal treatment

A possible complication after a root canal treatment is the formation of pus, which is accompanied by a very painful feeling of pressure. Pus can develop for a wide variety of reasons. On the one hand, it may be that the tooth has become inflamed again after the treatment due to the slight remaining bacteria. The root canal system can be imagined as a kind of tree in which the many branches and twigs represent the branches of the root canal. Depending on the tooth and anatomical conditions, bacteria may remain in the root canal system. In this case, pus formation can lead to severe pressure pain. On the other hand, pus can form as a result of inflammation caused by poor oral hygiene after treatment or due to premature smoking. In general, you should see a dentist as soon as possible if pus develops.

history

In the mid-1950s, many diseases were attributed to focal lesions. One suspected among other things also the nervous teeth as potential foci, for example also for rheumatism as the cause. Therefore, every tooth became its Pulp had died, extracted. One has deviated from this because by careful Root canal treatment these teeth can still provide valuable services.

Summary

The Root canal treatment is used for acutely inflamed pulp. It can be carried out in one session if it is uncomplicated. Treatment for gangrene is more lengthy and complex. The root canal treatment for milk teeth depends on the respective starting position, but differs significantly from that for adults. The root tip resection removes the pus focus at the root tip and the tip itself.