Root canal treatment process

introduction

If a root canal treatment is to be performed on a tooth, the patient often needs to be well informed about the upcoming treatment.

In order to be able to adjust to the treatment, you would like to find out how exactly the dentist works and what else is worth knowing about root canal treatment.

Reasons for a root canal treatment

A root canal treatment can be necessary for various reasons.
The most common reason for a root canal treatment is untreated deep caries, which leads to inflammation within the pulp and death of the nerve fibers.

Also with "still living"In teeth, root canal treatment can often be the only solution to preserve a tooth that has been severely damaged by inflammation and to prevent the inflammation from spreading to the surrounding structures.

Events that are traumatic to the tissue, such as a fall directly on the tooth, can also trigger the symptoms.

Root canal treatment process

The process of a root canal treatment is quite simple.
In the past, a so-called cofferdam was placed during a root canal treatment before the actual treatment. This means that a metal clamp with a rubber band is attached to the tooth to be treated. The cofferdam serves to shield the tooth so that no saliva and bacteria contained in it can get into the tooth. Since the creation of a cofferdam is very uncomfortable for the patient, a relative drainage is usually used today. The tooth is only protected from saliva by cotton rolls and the teat. It goes without saying that with this relative drying, the risk of saliva and bacteria penetrating the tooth is much greater.

Now the affected tooth is anesthetized and then opened with the "drill". The next task in the dentist's root canal treatment is to remove the pulp, including the nerve fibers contained within, from the tooth root. He succeeds in doing this with the help of root files of different lengths and thicknesses (Reamer, Hedstrom or K-files).

Since it is often difficult to anesthetize severely inflamed teeth, it may be necessary for the dentist to apply another anesthetic directly to the pulp.From this point on, the root canal treatment is absolutely painless in most cases.
The root is now prepared, i.e. hollowed out. The already mentioned root files are used in orderly order (the diameter increases). This is followed by an alternating rinse with different solutions. The solutions used are hydrogen peroxide (H2O2), anti-inflammatory, antibacterial chlorhexidine (CHX) and sodium hypochlorite.

From this point on, the procedure of the root treatment depends on the condition of the tooth. If the initial situation is less inflamed, the root can be filled quickly. If the pulp was severely inflamed, in most cases the dentist will first apply an antibacterial, anti-inflammatory drug to the tooth root and let the tooth rest for a few days.

As soon as the tooth root is germ-free and dry, it is filled with so-called guttapercha points and a density cement. The gutta-percha points are made of rubber-like material, which should fill the hollow tooth root and seal it tightly. As a rule, after the end of the root canal treatment, an X-ray control image is used to check whether the root reaches the tip (apex) is filled and the tooth is then closed.

Also read the article on the topic: Root canal treatment process

Pain in the course of the root canal treatment

In general, the root canal treatment has a fixed schedule. With a local anesthetic before opening the tooth substance and the root cavity, this can usually be carried out painlessly. If there are inflammatory processes in the root canals, pain can occur in the area of ​​the tooth to be treated, which cannot be completely eliminated.
Under these circumstances, the local anesthetic can be introduced directly into the diseased tooth pulp after opening the root cavity.
The pain that can occur will subside after a few seconds. After the anesthetic has been administered, allow for an exposure time of approximately five to ten minutes. In this way, the occurrence of pain during the remainder of the root canal treatment can be largely excluded. If patients complain of pain in the first few days after the root canal treatment, this can often be an indication that the damaged pulp or nerve fibers could not be completely removed.
The root of the tooth should then be reopened so that the root canal can be touched up.
However, the pain that occurs after a root canal treatment can also be harmless and subside after a few days.
In most cases, pain after root canal treatment can be managed well with the help of mild pain relievers. Since the active ingredient ibuprofen also has an inhibitory effect on various inflammation mediators, it is often used to relieve pain after a successful root canal treatment.

also read: Pain after root filling

How many sessions do you need?

The process of a root canal treatment is generally divided into several sessions. The first session is usually used to remove the dental pulp and the nerve fibers embedded in it, which have been attacked by inflammatory processes. Before the affected tooth can be treated, the initial situation must be determined by taking an X-ray (dental film).
Local anesthesia of the tooth to be treated is then carried out in the same session.
After an exposure time of about ten minutes, the dentist can open the tooth and expose the medullary cavity. The nerve fibers are then removed and the root canals disinfected.
In order to ensure the success of the root canal treatment, an anti-inflammatory drug is usually introduced afterwards and the tooth is temporarily closed. The actual process of the root canal treatment is continued in a second session, approximately 3-5 days later. Only if there are no more signs of inflammation during this session can the root canals and tooth be completely closed.
In order to record and control the success of the root canal treatment, an additional X-ray image (the so-called X-ray control image) is usually made.

Duration of a root canal treatment

The duration of a root canal treatment depends on whether it is an initial treatment or a revision (= removal of an existing root canal filling), which technique and instruments are used and how severely the root canals are destroyed or inflamed.

In general, a root canal treatment takes at least 2 appointments. First, the dentist removes the caries and drills down to the pulp level, which is the entrance to the root canals. As a result, the root canals are prepared using manual or electric files, i.e. taught and cleaned.
Here, the duration of the treatment also depends on the number of root canals. Finally, the root canals are filled with a rubber-like material and then provided with a filling or crown.

Read more on this topic at: Duration of a root canal treatment

Root canal treatment costs

The cost of a root canal treatment can vary. They depend on the patient's current situation and on the respective dentist.

Basic care is provided by the health insurance companies, but certain conditions must be met.

Patients who have private health insurance usually find it a little easier to get a good and sufficient supply of a tooth and possibly also to receive treatments that go beyond standard care.

Whether the costs for a root canal treatment are covered by the health insurance must be discussed individually with the patient and the respective situation.
In general, the health insurance company only covers the costs if the treatment ensures that it can save the tooth.

The condition is that a tight filling can be carried out to the tip.
This is not always easy, because the root canals are particularly curved at the end of molars, making it difficult to fill them completely.
There are other restrictions on molars, at least one of which must be met.

The first restriction is that the affected tooth is in a row of molars that is healthy down to the tooth.
The second limitation is that if the affected tooth already has a denture, it will be preserved through the treatment.
The third and final exception is that treating the affected tooth avoids a free-end situation, so that this tooth represents the last tooth in the row of teeth.

If a molar cannot adequately meet these conditions, only the costs for an extraction will be covered by the health insurance. If you still want to undergo root canal treatment, you have to wear it yourself.
An average of 1000 euros is then due for one treatment per tooth.

Read more on this topic at: Root canal treatment costs

If the costs are covered by the health insurance, it covers the following treatment steps: drilling, disinfecting and filling the root canals.

The chance of success is around 60% - 70%. If you want to increase the chances of success, further, more specific methods are necessary that allow an even more precise analysis and processing of the root canals, but which must be borne by the patient himself.
For example, root canal treatment under a microscope would have to be paid for privately.

Medication

Root canal treatment is carried out in different phases, each with a different drug being used.

At the beginning there is an anesthetic so that the patient does not feel any pain during the treatment. With a fine syringe, agents such as lidocaine, mepivacaine, or bupivacaine are injected into the affected area. As an additive, there is usually a substance that is very similar to the body's own adrenaline. This causes the veins to narrow and less blood to reach the affected area.

In order to rule out possible side effects of anesthesia, it is important that the dentist is given all important information about his state of health. Whether there are allergies, intolerances, general illnesses such as cardiovascular problems, asthma or which drugs / substances are currently or permanently taken.

Due to the anesthesia, the pain signal does not reach our brain, so no pain is triggered. In the next step, the affected tissue is removed with the root fine.
The opened cave is then rinsed with various rinses. On the one hand, the solutions contain hydrogen peroxide (H2O2; for disinfection and hemostasis), Chlorhexidine (inhibits inflammation and eliminates all bacteria), as well as sodium hypochlorite (also has a disinfectant effect). Sodium hypochlorite is a well-known disinfectant because it is also used in swimming pools.

Either the filling of the root is started immediately, or a drug is first introduced into the root so that the tooth can rest for a few days. The medication is given into the cleaned canal in the form of a paste that either contains calcium or contains cortisone and an antibiotic.
When the time for filling comes, a material is filled into the channel, which resembles a rubber-like mass. It is called gutta-percha and it is supposed to seal the canal tightly.
A paste is used as a sealer, with a material that is similar to the cement of the tooth. It is known as density cement. With these two remedies, the root filling is completed. A subsequent X-ray will check whether the root has been filled to the lowest point. After the treatment, pain often occurs, but it is part of the normal healing process and should subside after a few days.

In order to make the healing process more pleasant, the attending physician can prescribe various pain relievers. Ibuprofen is usually the drug of choice because it not only relieves pain, but also has anti-inflammatory effects and thus has an advantage over paracetamol.

When do you need a crown after root canal treatment?

A crown after a root canal treatment is required if the tooth has been damaged too much by the previously removed caries for a filling to sufficiently stabilize the tooth. The decision as to whether a crown is useful is up to the attending dentist. It is generally recommended to stabilize a tooth in which more than two surfaces have been destroyed by caries from the inside with a fiberglass pen and then to restore it with a crown.

Read more on this topic at: Crown after a root canal treatment