General information on the specialist field of endodontics (root canal treatment)
It is well-known that the pain from an inflamed dental nerve is among the worst pains which one can suffer. Relieving this pain is one of the central tasks of the dental profession. Thus we always arrange to find time for these emergency treatments, regardless of how busy we are. Once the pain is relieved and you decide that you want to preserve your teeth, then the main part of the root canal treatment starts and it is almost painless. We have a specially equipped room for the special treatment which is involved in root canal treatments . This room contains a dental microscope as well as specific equipment which contributes to the technical implementation of an optimal treatment result. The result: If root canal treatment is necessary, we do our utmost to ensure that you can preserve, use and laugh with your own teeth.
Rapid developments in the field of root canal treatment enable us today to save even severely decayed teeth with devitalised roots. By using such modern technology as the dental microscope, highly flexible nickle titanium files and special filling equipment, we can save teeth which only a few years ago would have faced the prospect of extraction by forceps. Large-scale studies have indicated that the chance of success for an initial treatment can be 90 percent!
The infected dental nerve
The human tooth consists of a crown which is visible in the mouth and one or more tooth roots which are anchored in the bone. The interior of the tooth contains a branched root canal system in which the dental nerve is located.
If bacteria in the sense of caries have settled on a tooth, the dental nerve may be infected. As a result, the dental nerve responds with an inflammation which can lead to the dying back of the nerve. The bacteria can then proliferate within the dead nerve tissue in the root canal system and cause inflammation in the jaw bone. This inflammation can lead to a frequently observed tapping sensitivity of the decayed tooth and a swelling of the affected region. In rare cases, however, accidents or dental treatments may be the cause of the decay of the dental nerve.
Microscopic root canal treatment – step-by-step
“Always ensure good visibility!”
We base any work we perform inside your teeth on this maxim. With our extensive experience and use of the surgical microscope, you are assured that we will rid your teeth of bacteria and dead tissue.
The removal of bacteria from the root canal is the primary objective of this endodontic treatment. Your tooth is first numbed and then isolated from the rest of the oral cavity by a rubber dam in order to guarantee clean and germ-free working conditions. Any tooth decay and old fillings are removed from the crown. At the same time, the canal entrance is cleared. The canal entrance is widened sufficiently so that the deep canal branches can be reached with instruments and rinsing solutions (see Fig. 3).
Treatment, cleaning and disinfection
Using state-of-the-art, mechanical nickel titanium files, as well as tradi-tional hand files, the root canal is shaped according to its natural anato-my. We place great importance on ensuring adequate rinsing with special solutions. The effectiveness of the solutions is enhanced by ultrasound. The rinsing procedure we follow guarantees disinfection to the highest scientific standards.
We want to ensure that the original canal system is as germ-free and clean as possible. This may sound very simple; however, re-infection may occur in certain small side canals (see yellow arrows in Fig. 6 and Fig. 7). These canals must also be cleaned and filled as thoroughly as possible. That’s why we take our time to perform the required chemo-mechanical disinfection of your tooth.
Upper premolar with two root canals and perfectly filled side canal.
Upper molar with five perfectly filled side canals.
Sometimes teeth have complex anatomical features which require special care. For instance, an above-average number of root canals (see Fig. 8) or noticeable bending of the canal (see figure below right).
Upper molar with six instead of the usual four root canals. The possibility of a seventh root canal was investigated in the front outer root, but did not appear to be present.
Upper molar successfully cleaned, despite considerable root bending, and filled canal system.
Treatment, cleaning and disinfection
After thorough shaping and disinfection of the root canal system, the spaces created are sealed with an anti-bacterial filling. Excellent results are obtained with what is called a three-dimensional thermoplastic obtu-ration. A type of rubber is heated to flow consistency and introduced into the root canals, where it is successively compressed into the hollow spac-es. The tooth is then sealed with a stable structure (see figure left). This structure can also be used as preparation for a subsequent crown if re-quired (see figure right) The inflammation around the root ends will heal during the next few months and bone will regenerate itself (see example in figure below).
Left: Inflammation of root ends.
Right: After application of special repairing cement, followed by disinfec-tion and filling of the root canal system, the inflammation is soothed and bone regenerates.