Root Treatments: What is Endodontics?
Root canal treatment – root canal treatment for tooth preservation
A tooth is made up of several different tissue layers. The tooth crown is from the enamel, the hardest substance in the human body, coated. Below that is less hard than the main component of the tooth dentin. This substance, also called dentin, encloses this Tooth interior, the so-called pulp.
The pulp is located in root canal, contains the finest blood vessels and nerves, runs through the entire tooth to the root tip and is here in connection with the blood circulation. For from the inside of the tooth, the supply of the tooth and in growth, the formation of hard tooth substances takes place. In the area of the tooth root, the dental cement covers the dentin.
Endodontics (= “in the tooth”) is a branch of dentistry dealing with the tooth interior, the diseases of dental pulp and dentin.
The area of responsibility of an endodontist includes the treatment of “dead” or traumatized teeth, root canal treatments and root tip resections.
Root canal treatments always have the goal of ensuring tooth preservation.
The illustration shows the tissue layers of a tooth
Enamel, dentin and pulp in the root canal.
About fine instruments, the root inflammation over the
Treated root canal.
When does a tooth have to be treated endodontically??
Intra-tooth inflammation can affect the pulp, dentin, and root-tip area. Triggers are mostly caries bacteria, which penetrate into the inner tooth tissue and spread out here. Such inflammations are very often the cause of severe toothache and require rapid root canal treatment by a specialized dentist.
Even tooth injuries caused by an accident can lead to inflammation or infections inside the tooth.
How do you know if the pain is coming from inside the tooth??
The pain symptoms are very important for the diagnosis. But often it is not easy for patients to name the exact location of the pain. Because pain often radiates into the surrounding tissue, so that the actual hearth is not clearly recognized and may not be related to the teeth.
An exact documentation of the patient’s pain history and medical history is therefore extremely important for the diagnosis:
- When and where did the pain occur for the first time??
- Are there daily fluctuations?
- Is the pain permanent or interrupted, sharp or pulsating?
- There are swellings on the face?
- What dental treatments have been done in the past?
- Are known CMD symptoms?
- Are teeth dark colored??
- There has been an accident with tooth injury in the past?
How is a tooth treated endodontically??
Prerequisite for a reliable diagnosis is the preparation of an X-ray of teeth and jawbone, ideally with 3D X-ray technology.
The focus of endodontic therapy is the treatment of the root canal.
The dentist uses special fine instruments and files with which he prepares and dilates the root canal. This is done in several steps with precise upward and downward movements of the rotating instruments, is very time consuming and requires a good instinct of the dentist. Because the root canals are not always straight, but can also be bent. This complicates the preparation of the root canal and takes longer. X-ray images provide information on the length and shape of the individual root canals and the extent of the inflammation.
Subsequently, the prepared canal must be thoroughly rinsed with disinfectant solutions and made continuous to remove inflamed tissue and bacteria. Finally, the dentist dries the channel with fine paper tips and seals it with special filling materials, such as Gutta-percha rubber sticks, pastes or cement to prevent re-entry of bacteria.
When is a root tip resection necessary??
If the inflammation inside the tooth reaches the apex of the root, the infection can also affect adjacent bone tissue and cause purulent abscesses or, in severe cases, even infection of the bone and bone marrow. In the upper jaw, chronic antritis may occur.
If careful and repeated root canal treatments fail to completely remove the infected tissue or cause the inflammation to heal, the dentist must surgically remove the root tip and surrounding tissue. One speaks then of a Wurzelspitzenresektion.
Why is endodontic treatment so important?
The goal of any root canal treatment is the preservation of your own tooth. Because the natural tooth is irreplaceable, retains its place in the jaw and can serve as a pillar for a bridge supply. Dentists therefore, whenever possible, always try to perform a root canal treatment to maintain the tooth. Today, thanks to modern treatment techniques and instruments, this is possible in more than 90% of cases when the interior of the tooth is inflamed.
However, if the tooth can no longer be saved because it is too brittle, too loose or permanently infected, the extraction of the tooth remains as a last resort, it must be pulled.
The resulting tooth gap can then be closed with a bridge, an implant or with removable dentures.
You can find a practice for endodontology in your area here.
How to reimburse health insurance the root canal treatment?
Root canal treatment can only be provided as a cash benefit if
- it is not just a treatment attempt or
- the treatment should be considered a therapy with uncertain outcome.
- the fertility and possibility of filling the root canal are given up to or close to the root tip.
In all other cases, it is always a treatment attempt that can not be charged to the detriment of the health insurance. In the context of statutory health insurance, root-canal treatments can only be billed if there is an uncomplicated, straight, slightly curved canal situation, rooting has already been completed and the foramen is closed (that is, the tooth root is intact).
The chances of success of a root canal treatment, if carried out according to the cash directives and the corresponding reimbursement, are about 50%. This means that every second tooth has to be removed later, despite endodontic treatment.
However, modern dentistry is able to increase the probability of successful root canal treatment to more than 90%. This is achieved by the use of increased time, modern treatment methods, highly effective drugs and high-quality materials. Just as the cost of an almost predictably successful endodontics increases, so do their costs. The additional costs for a complex root canal treatment can easily amount to € 500 or more – costs that a private dental insurance generally covers.
Source: Dental Supplement Insurance: Waizmann Table – Endodontics
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