When a root canal becomes necessary
A root canal becomes necessary when the dental pulp is inflamed or has died. The most common cause is advanced caries that has reached the pulp. Other causes are trauma (for example after a fall), repeated deep restorations or a bacterial infection through the root tip.
Symptoms range from persistent throbbing pain through pressure sensitivity when biting to swelling at the gum. In some cases the pulp has already died and the tooth no longer hurts. These silent courses are not harmless: bacteria migrate through the root tip into the bone and can cause granulomas or abscesses there.
What we actually do
After local anesthesia we apply the rubber dam. This rubber protection isolates the tooth from saliva and prevents bacteria from entering the root canal during treatment. Without rubber dam a successful root canal treatment is not medically reliable.
Then we prepare the root canal mechanically with rotary nickel-titanium instruments. These instruments are more flexible than manual files and reliably reach even curved canal anatomies. We rinse with sodium hypochlorite and EDTA in parallel to completely remove bacteria and organic tissue.
After preparation we seal the canal bacteria-tight with thermoplastic gutta-percha. The tooth is then definitively restored, depending on residual tooth substance with a composite build-up filling, a post and core or a crown. This definitive restoration is medically imperative: A root-treated tooth without stable restoration fractures within months to years.
When the first root canal treatment fails
In about five to ten percent of cases, a renewed inflammation develops years after a root canal treatment. Most common cause: an anatomically complex canal that was not completely captured in the first treatment, or subsequent bacterial intrusion through a leaking restoration.
In these cases a revision treatment is possible: removal of the existing root filling material, renewed preparation with microscope, new closure. For complex revisions we work with an endodontist from the Resident network.
If a revision is not promising, apicoectomy remains as surgical alternative or extraction with subsequent implant restoration. We make the decision not alone, but together with you.
