Root canal treatment

REASONS FOR ROOT CANAL TREATMENT

There are a number of reasons which would necessitate a root canal treatment. The most common case is when the pulp tissue of the tooth becomes infected with bacteria. The bacteria causing cavities (tooth decay) sometimes spread deep enough into the hard tissues of the tooth (the enamel, the dentin and the cementum) that they reach the pulp chamber, where the blood vessels and nerves supplying the tooth are located. The pulp chamber can also become infected if the tooth breaks in an accident, where the injury allows bacteria to enter the inner regions. Infection can also spread out from the supporting structure of the tooth (called the periodontium), as a consequence of periodontal disease. Pulpitis sometimes develops suddenly, accompanied by intensive pain, at other times gradually over a period of years, without symptoms or pain. The developing inflammation eventually causes the tooth to die. This means that the blood supply to the tooth is cut off, and its nerves die off. When inflammation becomes advanced, it first spreads from the pulp chamber towards the roots, then to the bone and the supporting structure of the tooth. It eventually leads to a severe inflammatory condition which can cause tooth loss. Our main aim with root canal treatment is therefore to eliminate the inflammation present in the pulp chamber and potentially in the roots, as well as in the bone and periodontium surrounding them – and prevent possible reoccurrence.

MECHANICAL CLEANING OF THE ROOT CANALS

Mechanical preparation of the root cavity system and the canal walls is highly important for the success of the treatment. For this mechanical cleaning we use so-called root canal needles. These tools remove the infected layers of the root canal walls and the infected debris inside them. During this process we sometimes have to supplement manual tools with special engine-driven root canal needles. These motorized instruments are made of a special, highly flexible nickel-titanium (NiTi) alloy. They are mainly needed for the filing of curved canals, but can also be used in straight canals in certain cases. The chemical cleaning of the canals is done with the use of various disinfectants. We inject these using special cannulas along the whole length of the root canal. In some cases a laser device can be used to increase the disinfection effect inside the canals.

FILLING THE ROOT CANALS

After canals have been cleaned and shaped, the roots have to be filled. Depending on how severe the inflammation was, a temporary filling may be necessary first using an antiseptic material.
There are a variety of techniques for permanent root filling. The most common one used is called “cold lateral condensation”. This technique consists of filling a rubber-like root sealing material (gutta-percha) into the canals in a cold state, and pressing it against the walls. There are some difficult cases where this technique is not possible: other filling techniques are therefore used, which deliver the material into the root canal in a warm, still liquid state.

PERMANENT RESTORATION OF ROOT CANAL TREATED TEETH

Root canal treatment involves removing a significant part of the hard tissues, which weakens the tooth. It is therefore often necessary to make a crown, to prevent the weakened tooth from breaking.

POSSIBLE DIFFICULTIES DURING THE TREATMENT AND SUCCESS OF ROOT CANAL TREATMENT

Root canal is one of the most difficult treatments in dentistry, requiring great precision. We often have to navigate difficult canal systems without actually seeing the area we are working on.  This may require the use of various magnifying devices which allow us to take a deeper look inside the canals. The exact, precise execution of these steps is crucial to the success of the therapy.  The complexity of this work can vary greatly depending on the number and shape of the canals, the position of the tooth and the severity of the inflammation. Some treatments can therefore be finished within a short time, while other cases can take up to one and a half, or close to two hours.

If an old root canal filling seems inadequate (e.g.: not the correct length, not compacted enough), it may be necessary to replace it. In such cases, the time needed for the treatment will be longer, considering the old filling material has to be removed completely from the root system. If a previously root canal treated tooth requires a retreatment, we often need to correct the canal shaping errors. This can often be a difficult, lengthy procedure and may slightly reduce the success rate. In general, root canal treatments are 90-95% successful.

MICROSCOPIC ROOT CANAL TREATMENT: A STATE-OF-THE-ART TECHNIQUE

Starting from the end of 2021, our dental clinic also offers microscopic root canal treatment. This novel technology can significantly increase the success rate of the intervention.

With microscopic root canal therapy, the treating dentist uses a special microscope to examine the roots. This allows them to explore canals which were previously invisible to the naked eye, and also increases the chances of saving teeth with unusual, more difficult anatomy. 

Microscopic root canal treatment has several advantages which justify the recommendation of this technique over the traditional root procedure.

• It allows setting up a much more reliable diagnosis and treatment plan.
• There’s a better chance to save teeth with more complex, unusually shaped anatomy. 
• In most cases, it prevents the necessity of bridges, thereby saving intact teeth from being grinded down unnecessarily.
• It is the safest way to save teeth with advanced decay, thereby avoiding tooth extraction. The success rate of the intervention is much higher than with traditional root canal treatment. 
• It also allows us to retreat teeth which have already been root canal treated before, but have presented problems again, thereby enabling us to save and heal them.