Root canal treatment

If a tooth pulp is irreparably inflamed, root canal treatment or endodontic treatment is required.

The theory

Teeth consist of a crown and a root. The crown is covered with enamel and is visible in the mouth. The root provides a firm anchorage in the jawbone. A nerve and a blood vessel enter the tooth at the root tip. These run in the root canals (in the root) up to the pulp cavity (under the crown).

If the bacteria from a deep caries (cavity) reach the nerve and blood vessel, they will become inflamed. This is usually accompanied by a lot of toothache. Sometimes this happens without pain. The inflammation will eventually kill the nerve. The bacteria then have free rein to establish themselves in the pulp cavity and root canals. To prevent the bacteria from entering the body, the body will build a line of defense at each exit of the root canals. This barrier is also inflammation. Usually such an inflammation is not much of a problem, but with a lot of stress or fatigue, the inflammation can become an abscess. This is accompanied by a lot of pain and a fat face.

The purpose of root canal treatment is to prevent the bacteria from settling in the root canal. If the bacteria are already in the canal, the goal is to remove the bacteria and nerve debris. If the canal is and remains clean, the inflammation at the root canal exit will disappear on its own.

Practice

The tooth is anaesthetized, so that the treatment is usually painless. Then the tooth is isolated from the rest of the mouth with a rubber dam. Then all caries (affected tooth tissue) is removed and the entrances of the canals are searched. The magnification of microscope/loupes offers a huge advantage here in not overlooking any channels. Now the actual cleaning of the root canals can begin. The root canals are widened with flexible files. Both during and after widening, the channels are rinsed abundantly with various disinfectants, of which NaOCl (Javel) is the most important.

When the canals are sufficiently cleaned up to the root point, they are dried and filled. Filling is usually done with gutta-percha (a type of rubber).

During treatment, X-rays are occasionally taken to monitor the course and result of the treatment.
Finally, the tooth or molar is filled. In some cases, the tooth is already affected to such an extent that a crown has to be placed. The filling that is placed in this first session is a temporary filling. During the second session, it is checked whether there are any complications. In most cases this is not an issue and a permanent filling is placed.

What is a treatment?

In this case there are still bacteria in the already filled root canals. A retreatment is technically much more difficult because the old root canal filling has to be removed. By using the microscope and other modern instruments it is still possible to successfully clean and fill the canals again.

Does the treatment always lead to a cure?

If no inflammation is visible on the X-ray, the success rate of a properly performed root canal treatment is 95%. If inflammation is visible on the X-ray, the success rate drops to 85%.

If other complications are present, the success rate drops further to 50%.

For teeth whose root canal treatment does not lead to healing, a surgical approach may be a solution.

Risks

Root canal treatment is not without risks. There may be a complication during treatment. A file can break off and remain in the root tip, or a file does not follow the shape of the canal and perforates the root. It may be necessary to place a crown if the tooth is severely weakened.

After the treatment you may suffer from after pain. This should subside after a few days. If the symptoms do not go away or if the pain is severe, contact your dentist.

Are there alternatives?

If a tooth needs a root canal treatment, the extraction of the tooth is the only alternative. The tooth can then be replaced by an implant with a crown, a bridge or a removable device. Your dentist can give you more advice on this.

Does the treatment cause pain?

The root canal treatment generally gives little after pain. Of course, the after pain will be worse if you already had pain before the treatment. Usually the pain can be suppressed well with a painkiller and only lasts a few days. In some cases, swelling occurs after treatment. If so, you should contact your dentist.

Can the tooth last for a long time afterwards?

Root canal treatment does not make the tooth more brittle, but the extensive caries weakens the tooth. A crown or a filling can restore the strength of your tooth. Discuss this with your own dentist.

Does the treatment take a long time?

The entire treatment is a meticulous job. The treatment therefore takes quite a long time. Depending on the number of roots, very crooked roots, etc. are needed between 45 min and 2-3 hours.

Source: KNMT