Caries or mechanical irritations may require a root canal treatment
Only the crown of the tooth is visible, but not the root, that is anchored in the jawbone. The tooth ends in one or more root tips (apices) through which blood vessels and nerves enter the tooth from the surrounding tissue. Vessels supply blood and nourish the tooth, nerves provide the sensation of heat and cold.
An intact nerve is the alarm system of the tooth. It runs through long and narrow canals up to the tooth crown. Once, deep tooth decay or caries bacteria have reached the nerve, it can cause unbearable pain. If the infection or inflammation has reached an advanced stage, and it cannot heal, a root canal treatment is inevitable to preserve the tooth. Also irritations from repeated dental procedure on the tooth can harm the nerve.
By constant attacks of bacteria the nerves dies, and these bacteria can penetrate, via the root-ends, into the bone and cause an inflammation or infection there. The tooth is sensitive when chewing and in the worst case an abscess with significant bone loss can develop.
First step of procedure – root canal preparation
When preparing the root canal, the objective is to increase the diameter of the canal and clean it with instruments and antibacterial solutions. The nerve will be completely removed.
The interior of a tooth root is like a complex canal system. There are primary and tributary canals, which are usually narrow and curved. Especially near the root-end, canals show branchings, similar to a river delta (so called root delta). An upper molar has e.g. normally four root canals. Without using an operation microscope or dental loupes, only three canals are often found. Thus bacteria remain in the canal system and can lead to a reinfection and failure of the therapy and probably tooth loss.
In case of an extensive infection or inflammation with bacteria, or spreading to the adjacent bone or root-end, supporting treatment, such as placing drugs into the tooth, will be done. Sometimes an antibiotic may be prescribed.
Second step of procedure – root canal filling
Filling the root canal can be done in a second or later treatment session. A filling is absolutely essential after having prepared the root canal.
To confirm the diagnosis, to measure the root canal length and to control the root canal filling, digital X-rays and/or electro-metric root measurements are indispensable in the course of treatment.
During this procedure sterile working is of utmost importance. Therefore, the tooth has to be isolated with a rubber dam right at the beginning of the treatment. If this is neglected, bacteria can, for example when swallowing, penetrate into the open system. Moreover, the very fine tools could be swallowed by mistake.
Dental loupes, or rather an operating microscope is necessary. An enormous magnification is achieved and improves the success of the treatment significantly.
To preserve the own tooth is always worthwhile. Not only because of the subsequent costs, e.g. for implants or bridges, but preserving the natural structures is always of higher benefit.