Frequently asked questions

When is a root canal treatment necessary?

When the dental nerve is infected. This may be caused by: a chemical or physical trauma (eg when teeth are ground down), a crack in the tooth (eg by biting something hard or because of a fall), decay or a leaky crown that enables bacteria or their toxins into the dental nerve. In addition, deep fillings or crowns that are very close to the dental nerve may make a root canal treatment necessary. If there is no treatment, the inflammation (pulpitis) causes the nerve to die and the inflammation can spread to the tissues that surround and support the tooth (periodontium). This will be visible on the X-ray image as a dark spot at the root tip.

The signs of inflammation of a sick dental nerve vary from sensitivity to heat and cold, spontaneous pain (in particular at night), pain when biting, throbbing pain and swelling of the surrounding soft tissue. Sometimes a headache or jaw pain may be an indication that a root canal treatment is necessary. It is not uncommon to experience no pain at all, and in these cases an X-ray image will reveal an inflammation in the bone which comes from the tooth.

 

In chronic cases, the infection does not involve any pain. It is not uncommon for the effects of the infection to be discovered on a radiograph in the form of a dark spot at the root tip. In these cases the bone around the dental root has dissolved. This degradation is progressive and may lead to an acute inflammation with pain, swelling and pus.

Sometimes it is no longer possible to save the tooth by means of root canal treatment due to extensive damage or a root fracture. Even if you do not feel any pain the tooth should be pulled because otherwise the infection may worsen, resulting in a painful abscess in the bone or spreading into other regions of the body via the blood. After extraction the gap can be closed with an implant or bridge.

If during root canal treatment bacteria have remained in the canal system or if they have formed again after the treatment, this may result in a new inflammation. Possible causes are: 

  • canals have been overlooked or have not been treated at an adequate length or width
  • the cleaning effect has been too low because of a complex canal anatomy
  • bacteria entered the root canal system again via caries, leaky fillings or because the crown was placed too late

In case of such a diagnosis, the old root canal filling is completely removed and the complete canal system, including any canals that may have been overlooked, is thoroughly cleaned. Afterwards, filling and closure are done in the same way as the first treatment.

Usually, teeth have more root canals than are visible to the naked eye. A lower front tooth, for example, principally has one canal; in 40% of patients, however, a second canal can be detected under the microscope. If a canal is missed and inflammatory tissue remains, the prognosis is not good. Furthermore, each root is different and uniquely formed — thay can be variously C-shaped, oval, L-shaped and have bulges or sub-divide. In order to be able to clean them absolutely thoroughly, conventional methods are not sufficient. In addition to a high performance microscope, a time dependent individual irrigation protocol (disinfecting the canals) is absolutely essential. The individuality of root canals must also be taken into account with respect to the root canal filling. That is why Specialists worldwide prefer the filling with warm gutta-percha. By heating the gutta-percha within the root canal, the filling material becomes soft and can be closely adjusted to the individual form of the root canal by means of microscopic control.

The treatment usually takes one and a half to two hours and is in most cases completed within one session. Sometimes, additional appointments are necessary, especially in complex cases or if the inflammation is more serious.

 

Unfortunately not. It is not possible in the event of a root fracture or if the degree of damage is too high for a successful repair of the tooth. It is not always possible before the treatment to say for sure whether a tooth can be saved. Sometimes it is only possible to make a decision in this regard after a thorough inspection of the inner tooth.

 

Radiographs are usually taken before the treatment and at the completion of the treatment. In some cases, for example if the course of the canal is irregular, further radiographs from different angles are necessary.

Dental dam (also rubber dam) is a small sheet made of rubber that is fixed to the respective tooth with a clip to keep the bacteria in the saliva away from the treatment area during the whole treatment.

No, local anaesthetic ensures that you will not feel anything. In rare cases it can happen that a tooth is particularly sensitive, and should this happen more local anaesthetic will be provided.

After each invasive procedure a regeneration phase is to be expected. During the natural healing process of your body you may experience minor or moderate pain. The tissue and bones surrounding the tooth and a ligament that covers the dental root are, in most cases, inflamed before the treatment. This inflammation and the manipulation of the tissue during the treatment are the reasons for postoperative pain. As you keep your mouth open for a longer period of time during the treatment, your jaw, neck and back musculature may be slightly tense during the first days after the treatment. It can also be the case that the gums are slightly irritated for a short period of time because of the fixing of the sheet made of rubber (dental dam). The symptoms are of short duration and can usually be completely alleviated by means of painkillers such as ibuprofen or paracetamol. We recommend taking one pill for pain relief within the first hour after the treatment so that the effect occurs before the local anaesthetic has worn off. A postoperative inflammation with severe pain, swelling and fever is extremely rare. In this case antibiotics can be prescribed. Please contact our clinic if you experience such pain. After the root filling your tooth will in general feel different than the surrounding teeth for a while.

A root canal treatment involves the following risks:

  • mild to severe pain shortly after the procedure for several hours to days
  • incomplete root canal cleaning 
  • incomplete effect of anaesthesia
  • perforation of the root or pulp floor
  • swellings or abscesses shortly after the root canal treatment or later
  • breaking off of root canal instruments in the root canal
  • injury of the tissue at the root tip
  • overfilling of root canals (leakage of filling material from the root tip)
  • stain or darkening of a tooth with root filling
  • chipping, breaking off or fragmenting of teeth with root fillings
  • continuity or recurrence of discomfort, pain or inflammation

Any complications may mean that you have to take antibiotics or that further treatments, such as an apicoectomy, are necessary or even that the tooth will be lost.

The treatment by a Specialist endodontist in our clinic is carried out with the highest precision under the surgical microscope, according to the latest scientific knowledge and by means of the latest technology. We achieve success rates of up to 96%.

The chances of success, however, depend on the condition of the tooth before the treatment and on the type of aftercare. If a tooth is merely inflamed and the surrounding tissue and bones are healthy, success rates amount to 96%. If the inflammation has already spread and led to a dissolution of the bone or if the tooth is not sufficiently restored after a successful treatment  with a partial crown or crown, chances of success decrease significantly.

As with all medical interventions regarding the human body, we cannot guarantee an absolute success. If there is no improvement, further treatment steps, such as an apicoectomy or the removal of the tooth, may be necessary.

In order to avoid an injury of the soft tissue, such as cheek, tongue or lip, please refrain from hot beverages and any food intake until your local anaesthesic has completely worn off.

Without a restoration of the cusps, root-treated teeth may easily fracture. Therefore, please avoid any weight bearing of your tooth until such a provision has been included.

Do not change your daily oral hygiene measures. 

In case the cavity of your tooth has been closed with a temporary filling, it is not unusual that a thin layer wears off between the treatment dates. If you feel that the complete filling has been lost, please contact our clinic.

The completed root canal filling is only the first step to restore the functioning of your tooth. To ensure long term success the tooth must be given a suitable fixed restoration. In most cases this is includes the cusps (with an overlay, partial crown or crown) that restores the full chewing force of the weakened tooth and protects it from fractures. With good oral hygiene, the use of dental floss, regular visits to the dentist and professional dental cleaning, a restored tooth with a root filling has the same lifespan as a natural tooth. In most cases, radiographs of the tooth concerned are taken at intervals of three, six and 12 months and afterwards every year up to four years after the treatment in order to monitor the healing process. In rare cases an inflammation of the tooth does not heal or the tooth continues to cause problems. In such cases the tooth can often be saved with root canal retreatment.

In most cases, radiographs of the tooth concerned are taken at intervals of three, six and 12 months and afterwards every year up to four years after the treatment in order to monitor the healing process.

The treatments are complex and extend over several hours. In order to achieve an optimum treatment success we have to take the necessary time. Depending on the level of difficulty, patients will have to pay between £800 for a root canal treament of a tooth with a single root and up to £2,000 for difficult cases and teeth with four or more canals.

During the initial examination, all measures and the individual course of treatment are discussed. For many patients this allays their fears and concerns. If you still prefer to receive treatment under sedation or general anaesthetic, we will provide it.

In rare cases there can be a repeated inflammatory reaction at the root tip that requires a small surgical procedure. During such a treatment, the inflamed root tip is removed under anaesthesia. Afterwards the root canal is cleaned and filled so bacteria cannot enter, and the missing bone regenerates. The success rate is between 50% and 70%.

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