Endodontics: Course of treatment

Although root canal treatments often have a bad reputation among patients, they are not painful if done conscientiously and correctly. Rely on the expertise, empathy and experience of our specialist Dr. Basel!

If Dr. Basel can identify the tooth affected without a doubt, she will anaesthetise it as well as its surrounding area. It goes without saying that phobic patients can undergo this treatment under sedation or intubation anaesthetia. She will then cover the relevant tooth by means of a coffer dam, and she will seal it. This is to ensure that neither bacteria nor saliva can contaminate the area. The other reason is that none of the liquids necessary for disinfection will be able to reach the oral cavity of the patient.

Then Dr Basel proceeds – with the help of the magnifying capability of a dental microscope – to gaining access to the nerve system of the toot. This is done by drilling a little hole into the chewing surface of the tooth. Following this Dr Basel cleans out the root canal system by using rotating files and a tailor-made combination of disinfectants until she reaches the root apices.

This is a very lengthy process because it is crucial to the success of the root treatment. To make sure you do not become bored, we provide video glasses. These allow you to watch films or television series of your choice.

The length of your root canal is determined by using an electronic length gage (endometrics). The electronic resistance reading used in this process allows us to determine the exact length of your root canal. This helps us avoid doing additional X-rays. Following preparatory treatment Dr Basel will proceed to cleaning the nerve canals a second time by using a specially developed file (SAF system). This step is aimed at killing bacteria and at removing tissue remnants.

Depending on the severity of the inflammation and the complexity of the patient's root canal system, most treatments of this nature require only one visit to the dentist (”one visit” principle). After Dr Basel has conscientiously and carefully prepared and disinfected the root canal, she seals it with a thick root filling. This is to prevent renewed entry of bacteria. The material we use for this is called gutta-percha, and it has proven to be very reliable.

In the area of the posterior teeth crowns or partial crowns should be used after this treatment. This is to prevent tooth fractures or reinfection. The prosthetic treatment stabilises the tooth in such a way that the tooth will be twice as well protected against fractures than would be the case with a natural tooth free from tooth decay.

The main reasons for tooth aches may be one or more of the following: tooth decay, trauma (punch or hit), cracks in the tooth, untight fillings or crowns, differences in pressure (e.g. when flying or diving), and chemical or thermal stimuli (hot and cold / sweet and sour). In rare cases tooth aches lasting for a week or two may be the result of a cold. Tooth aches caused by colds or changes in pressure initially only need to be observed.  If needed we can cover sensitive tooth necks with small fillings. Root canal treatment should only be undergone when the tooth that is the source of the pain has been identified without a doubt.

When the inflammation of the dental nerve (pulpitis) leads to uncontrolled dying off of the nerve, this inflammation may spread to the surrounding periodontium and the bone (apical ostitis). Endodontologists will be able to see this in an X-ray. It usually shows as a dark spot at the tip of the root. This is because minerals, such as calcium and magnesium, are released from the bone as a result of the inflammation. This also means that X-rays can more easily get through the bone. They expose (blacken) the X-ray film more than they normally would. In the more advanced stages of this condition the inflammation might break through the bone, and a pus-filled cavity might be formed (abscess). When it gets to this stage patients tend to suffer very severe pain.

When this abscess empties by way of the periosteum, the bone skin, and the gums into the oral cavity, this results in what is referred to as a dental fistula (purulent fistula). This is when the pain stops. Once the inflammation reaches chronic stages, dental cysts can form. In most cases this may not lead to any pain. However, the tooth affected should be treated in any case. This is to prevent the inflammation from spreading.

Dental trauma is most common among children and young people. Falling off a bicycle, slipping and tripping by the swimming pool or a sudden strike or hit of a hard object are among the most common causes. If a piece of the tooth breaks of or the tooth is knocked out altogether (complete luxation) in an accident, it is best to immediately make your way to an endodontologist. The tooth should be kept in a specially designed tooth rescue box, in saliva or in UHT milk. If the tooth can be treated, endodontologist differentiate between three different scenarios:

  • If only part of the tooth is broken off without the dental nerve being affected, the fragment can be glued back on. Alternatively, the missing part of the tooth can be completed by using a filling or a veneer. Vitality of the tooth should be checked over the coming years.
  • If a huge chunk of the tooth has broken off and the dental nerve has been exposed, the endodontologist will first of all perform root canal treatment. Depending on where the tooth is in terms of its growth stage, procedures may differ. In the early stages it may be possible to preserve the vitality of the tooth and to promote natural conclusion of the growth of the dental apice. The missing fragment can be glued back on or it can be completed by means of a filling, a veneer or a crown.
  • If the tooth has been knocked out but it was stored correctly, it can be put back in place. In this case, too, an endodontologist must first of all perform root canal treatment. This is because the dental nerve was most likely torn off as a result of the trauma, and the dental nerve may have died off. The tooth replaced will then, for a duration of three months, be aligned with the teeth on either side. It is vital to observe the tooth since root problem frequently occur.

How does root canal treatment at the dentist’s work?

More Questions?

There are still open questions about root canal treatment that you would like to have answered? We have put together a questionnaire around the topic!

FAQs: Root Canal treatment

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