Root canal treatment
Root canal treatment is one of the most important forms of treatment for the treatment of pain in dentistry. As a rule, a root canal treatment is always indicated, if it is not to be expected that inflammation and thus freedom from pain can be achieved by other means.
During root canal treatment, the hard substance of the tooth is opened to the inside, where all soft tissue (blood vessels, nerve fibers and connective tissue) is removed. After establishing an inflammation-free situation, this resulting cavity is sealed as completely as possible by suitable materials in order to prevent further spreading of bacteria.
Below we have prepared extensive information for you.
How does an inflammation of the nerve arise??
The tooth interior is in constant exchange with external influences. This can be explained by the structure of the hard substance, similar to a coral reef. The tooth consists of a multitude of tunneling systems that can lead all small components as well as bacteria and cell toxins into the depths.
If the number of these bacteria and thus the cytotoxins increases disproportionately, so that the health balance is disturbed, this inflammatory process of the nerve tissue can occur. The tooth is no longer able to ward off the attack of bacteria and toxins. At the end of a usually long and painful path is inevitably the cell death of the Zahnmarks (Pulpa, nerve). One speaks now of a dead, devital tooth.
Why does an inflamed tooth hurt so much??
Inside the tooth are direct nerve endings, which are highly sensitive to all stimuli. This is an important device of nature to control the masticatory pressure and to use the teeth as tactile organs. The perception of fine temperature differences is only possible, but also attacks on the system, are passed on the conduction paths. Acid attacks by fruit or acid-producing bacteria are noticeable and a caries can be perceived by noticeable hypersensitivity.
If this system is attacked, the nerve continues to transmit pain signals while it is still intact. By a massive attack on the nerve this can die off at the end and thus abruptly the pain stimulus over.
In the interior of the tooth, the slow decomposition of the nerve tissue takes place, producing putrefactive gases. These gases can cause a massive pain by increasing the internal pressure. The tooth usually feels elevated, as if the body wanted to repel it.
In the next phase, the inflammatory reaction occurs outside the tooth, usually around the root tip. This can be proven by an X-ray. Pain develops in this phase through a bony spread of the inflammatory process. This could be abscess formation and development of a fistula channel possible. Shortly before the eruption of the abscess on the surface is here again to expect a massive pain, because the highly sensitive periosteum is stretched. Once the abscess has found its way to the surface via a fistula canal, the chronic course of inflammation follows. Pain occurs only subliminally, since there can be a constant secretion and pus drainage through the fistula canal.
How is the tooth treated in acute pain?
In the acute pain phase, we usually only treat the symptoms in order to achieve rapid pain relief. This could be done by a Abszesseröffnung, opening the tooth or even by a purely antibiotic systemic treatment. The state of pain is paramount at this moment and we will do everything we can to quickly take appropriate action.
When the acute pain condition is resolved, the treatment of the cause must be initiated in order to ensure the long-term success of the treatment. Now the conventional root canal treatment has to be carried out and the tooth supplied with local medication. These local medications applied by the tooth have limited effectiveness over time, so strict adherence to further scheduling is very important.
Are there any alternatives to root canal treatment??
As a rule, root canal treatment is irreplaceable in an irreversible inflammatory process. The pain stimulus alone is unfortunately not decisive for a treatment need. Thus, inconspicuous inflammatory processes and thus chronic inflammatory conditions are often the order of the day.
It is imperative that a devital tooth be treated with a root canal treatment to avoid further expansion of the inflammatory process in the depth of the bone. In routine radiographs, these inflammatory processes can often be detected as incidental findings and appropriate treatment can be initiated.
Here, the treatment of inflammation of the tooth differs, even in painless, chronic course, not from inflammatory processes in other areas. In inflammation, bacteria usually play a major role and the risk of germ transmission is always present.
A root canal treated tooth must always be over-crowned?
The devitalized, root-treated teeth become brittle over time, thus increasing fracture risk. If the tooth is fractured longitudinally by a missing crown, the complete removal of the tooth is often required. The tooth is usually also subject to optical changes over time.
By storing blood cell residues in the hard substance of the tooth, as well as by Wurzelfüllmaterialien the tooth is usually darker. This can be neglected in the non-visible area for aesthetic reasons, but shows the change in the hard substance.
I have a dark incisor, what to do?
Probably this is a root-treated, ie devital, tooth. This should be checked with an X-ray. If it is confirmed by x-ray, a crowning is to be planned here in the long term, as the hard substance becomes brittle and there is an increased risk of breakage. However, if the crowning is planned at a later date, an adaptation of the tooth color could be achieved by means of bleaching methods.
If it is not a root-treated tooth, a vitality test should be performed. It could be that the tooth nerve has died here, then first a root canal treatment is to be initiated.
Why does a tooth smell so unbearable at opening??
A bad odor at the opening of the tooth is only an expression of the cellular decomposition that takes place inside. The soft tissue of the tooth interior (blood vessels, nerve fibers and connective tissue) is slowly decomposed by microorganisms. These arise as metabolic products u.a. Fouling gases that escape at the opening. This is called a gangrene of the tooth, since it already decomposes from the inside.
Why does root canal treatment last several sessions??
The first treatment phase always serves the therapy of the pain symptoms. Only then do we usually initiate the treatment of the actual cause of the inflammation. In practice, we have agreed on a very gentle treatment concept, which often involves the inclusion of an antibiotic.
By regular local drug changes in the tooth a pain-free state is achieved and the body gets the necessary time to stabilize the inflammation process in depth. Only when the tooth is absolutely free from irritation and asymptomatic (no pain, no bleeding, no swelling, no pus or secretion), the final root filling is laid. This ensures that during the entire treatment phase the greatest comfort and lowest pain stimulus is given.
In the end, this concept should help you to be afraid of the biggest challenge in pain therapy. And we take that seriously.
Is not it better to remove a severely inflamed tooth??
The removal of a highly inflamed tooth is always one of the treatment alternatives. However, we always recommend doing everything to keep your own teeth as long as possible. Since the treatment options and industrially developed devices and procedures have developed so far, the prognosis of a dental preservation is quite favorable.
In practice, we have the opportunity to work with minimally invasive instruments. We prepare the tooth with the use of magnifying glasses and a microscope, can optimally reprocess the canals with ultrasound and special endomotors and since 2009 we have been able to sterilize the canals with the newly purchased precision laser as far as possible. But you should take this seriously and follow our advice. If a tooth can not be maintained, we will discuss it with you beforehand and then weigh up the initiation of all therapeutic options.
Does the health insurance cover the costs?
The statutory health insurance covers the costs only conditionally. Conventional root canal treatment with standardized instruments is only supported by the fund in limited exceptional situations. In general, one can say that the treatment attempts should not be billed to the detriment of the health insurance. For this purpose, a special committee has developed guidelines that have determined the classification of a dental tooth.
Root canal treatments to obtain a closed row of teeth, to avoid a free end situation and also to obtain an intact denture may be billed with favorable prognosis of treatment through the health insurance. For this we have developed a PDF document, because the guidelines are difficult to understand for the non-specialist.
In addition to the root canal treatment, which complies with the guidelines of the health insurance (= reimbursement), but can still costs for the use of special equipment and aids, such as. Devices for endometrial length determination, devices for reprocessing, use of loupes or the dental microscope, use of a dental laser or photodynamic therapy.
In any case, you will be sufficiently informed and put together a treatment plan that takes into account your wishes. An estimate can be made if necessary, which should give transparency over the entire treatment.
Can a treated tooth be re-inflammatory?
If a root canal-treated tooth should re-ignite, it is called a recurrence. Basically, there is always a risk from the incompletely controllable anatomical situation of the root canals in the depth. Here are often side channels that can not be reached by the conventional root canal treatment. Of these, an increased risk of recurrence can definitely arise.
If such a situation presents itself to you, it must first be checked whether a treatment of the tooth makes sense at all. The root filling should be controlled, sometimes a revision of this filling in the tooth is a good way to get back into the inflammatory region. If the revision of the filling is not promising, it must be decided whether surgical surgical intervention (root tip resection) is possible. In this treatment, the root tip is surgically removed and a closure placed on the tooth from the other side.
Since all treatment measures are complicated and time-consuming and also associated with residual risks, should always be well balanced and decided together. The costs are only partially covered by the statutory health insurance.
Is a root-treated tooth just as resilient as a healthy one??
Basically, a root-treated tooth should be stabilized early by means of crowning due to the increased risk of fracture. Thus, the tooth is quite stable and can also serve as a pillar tooth for a bridge.
Nevertheless, there is always the risk of an inflammatory recurrence here and should therefore be checked regularly. However, when chewing, care should be taken here more cautiously, as even after crowning and stabilization by means of titanium or fiberglass pin, by brittleness or overload situations a longitudinal fractures can not be completely ruled out.
Links and documents on this topic
Link to the society of the DGZMK
Link to the Society of Endodontists
Link to PDF Download: FB Patient Root Treatment
Link to PDF Download: FB Patient Root Treatment Billing Recommendations
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