Root Canal Treatment

Root Canal Treatment

All root canal treatments in our clinic are performed in accordance with the guidelines of the German Society of Endodontics (DGEndo).

They are carried out under magnification with the highest level of precision, using rubber dams to protect the teeth from mouth bacteria. Infected tooth nerve is completely removed and the remaining canal is disinfected in order to preserve the healthy tooth root. We follow scientific rinsing protocols and time schedules which are of utmost importance to the success of treatment. We also constantly update our knowledge and conduct root canal treatments according to the guidelines of the German Society for Endodontology and Traumatology (DGET).

What is root canal treatment?

Dental nerve tissue is removed from the root canal which is then mechanically and chemically cleaned. The aim is to keep the tooth but remove the dental nerve (pulp) which has become irreversibly inflamed or has died altogether. Infected tooth material around the root canal (root dentin) is also removed. The gaps resulting from the cleaning process are then filled with a biologically compatible material (gutta-percha).

Not only does root canal treatment allow us in most cases to keep the tooth, but this treatment also prevents the inflammation from spreading further throughout the body. If left untreated the latter can lead to potentially serious ill-health. The tooth treated will probably be sensitive for a few days following treatment.

When do you need an endodontist?

Endodontists are Specialists in root canal treatment. They carefully and safely remove the inflamed tooth nerve in patients suffering from toothache. This means that even after having suffered damage due to an accident the tooth can usually be kept. This way endodontists make your toothache go away safely and fast.

In 90% of cases, they can save a tooth, even in severe situations where there is extreme destruction of the tooth or extensive inflammation. State-of-the-art diagnosis and therapy using 3D x-ray (CBCT) and treatment using surgical microscopes are a vital part of this. Dr Mehl’s key to success consists in having excellent technical equipment, extensive experience and diligence, aided by having the time to do this work to the very highest standard.

When would a root canal treatment be necessary?

More often than not toothache points to damaged dental nerves.

There are two different types:
• Ringing, piercing and radiating pain
• Dull, pulsating pain

What do these different types of pain mean?

1. Ringing piercing pain

A vital dental nerve may become inflamed when the waste products of bacterial metabolism reach it (eg as a result of deep-reaching tooth decay). The body reacts to this by activating its defence mechanism. The dental nerve is then increasingly supplied with blood, and it starts swelling. Due to the fact that the tooth is surrounded by dentin and the tooth can only be nourished through a small opening at its bottom tip, the swelling cuts off the oxygen supply. At this point, the cells in the dental nerve can no longer be nourished (self-strangulation).

The patient will, in this case, experience piercing pain radiating into the back of their head. The patient will also be very sensitive to cold or hot food and drink in their mouth. If toothache occurs without any outside influence, and if it lasts for 10 minutes or longer, chances are that the dental nerve has been inflamed. At this stage, the patient might not be able to tell with certainty which tooth is aching. This is because neighbouring teeth tend to hurt as well. Another indication of an inflamed dental nerve is the feeling that the tooth affected appears to be “higher” than the teeth next to it.

2. Dull, pulsating pain

This occurs when a dead tooth is hurting. If an inflamed dental nerve is left untreated it will fall apart eventually, and its interior will no longer have the strength to defend itself. Bacteria can now enter the defenceless root of the tooth, and they will slowly spread to the root tips. The bacteria are now up against the body’s own immune defence. An inflammatory reaction will follow, and the bone material around the root tips will decompose. The endodontist will be able to identify the bone inflammation from the x-ray. The inflammation will show up as a dark, round shadow surrounding the root tips.

Sensitivity testing, which involves cold being applied to the tooth, can be used to determine this. This is because dead dental tissue will no longer be able to sense temperature. Following the stage of acute root tip inflammation with strongly piercing pain, the next stage is marked by duller pressing pain in the area of the bone. This may lead to a dental abscess and fistula formation. In this scenario, there is a risk of bacteria spreading to the entire body. In either scenario, an endodontist must perform root canal treatment in order to save the tooth.

Retreatment

Even when a tooth has received root canal treatment, it might still become reinfected. The patient will usually notice a returning dull pain, and the general feeling will be that “something is not right”. More often than not the tooth in question is not the cause of pain. Moreover, the inflammation may not be visible until the area is looked at in an x-ray. The area affected, around the root tips, will show up on the x-ray as a dark spot.

When retreatment is necessary?

If following root canal treatment, bacteria have remained in the canal system of the tooth root, or if they have returned after the treatment, renewed inflammation may result. This is when renewed treatment, retreatment or revision of the old root canal treatment is necessary.

Common causes may include:

• Canals have been overlooked or they have not been treated in their entirety, ie in their entire length or width
• Cleaning out the canal system could not be done sufficiently due to the complex anatomy of the patient’s root canal
• Tooth decay, leaking fillings or late treatment with a crown may have resulted in bacteria entering the root canal system for a second time

For more information regarding this treatment