Dentalnews (en)

Our topic in the next weeks is root canal treatment and its risks! (9/10)

In the last few reports you read about root treatment, root tip resection and the attendant risks.

Introduction to root canal treatment
Why is treatment performed on a root canal?
What happens during a root canal?
Pain after a root canal – is that normal?
What are the costs of a root canal?
Can you renew or redo a root canal?
Risks of a root canal – cyst?
Risks of a root canal – root tip resection?
Today we would like to show you a few x-rays, which are all numbered, and in the next report you will find out how to tell good root treatments from bad

We are positive that after this series of reports, you will even be able to tell whether your root canal was treated properly or not, based on x-rays.

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And you have a right to do so!

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Our topic in the next weeks is root canal treatment and its risks! (8/10)

If bone is already too badly inflamed after faulty root treatment, then it is no longer enough to clean out the inside of the tooth. The inflammation is too extensive. One option is to perform a root tip resection.

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But root tip resection just means removing inflamed tissue, the cause of the inflammation, the contaminated canal, is left untreated. Either a revision is performed to redo root treatment as part of the operation – which is then referred to as root tip resection with orthograde filling, or the root canal is sealed up from behind – referred to as root tip resection with retrograde filling.
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Why from behind? Well, sometimes it is no longer possible to perform a revision starting from the crown e.g. in the case of pivot teeth, or if the structure of the root canal is too complicated, or part of an instrument has broken off during treatment, etc. Depending on the circumstances, this sealing method can also be used to kill off the bacteria still left in the root canal, because you cut the bacteria off from their source of food, and the tooth is saved!

Our topic in the next weeks is root canal treatment and its risks! (7/10)

Not doing clean work during root treatment (no coffer dam, unsterile instruments,….) means bacteria can still get into the inside of the tooth via the dentist! This pictures shows several teeth whose roots have been treated, the green arrows marking areas where bone is inflamed – and the patient hardly even noticed anything, aside from having a “stuffy” nose. The bacteria kept multiplying until they reached a critical mass. Now they have started to invade the bone via the side canals of the tooth and are causing an inflammation – known as osteomyelitis. This process can take days, months, years or even decades, depending on the amount and type of bacteria, the structure of the root canal, instruments and materials used, etc.
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Only when a tooth is sealed off tightly can these problems be avoided! Well-sealed means that the filling compound is spread evenly right up to the tip of the root. Moreover, once root treatment has been completed, it is also a good idea to seal off the top of the tooth, e.g. using a ceramic inlay and/or a crown. A tooth which is properly treated can last a lifetime, and you can save yourself a lot of pain and lost time, and avoid getting implants or bridges!
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Poor root treatment can lead to

• a reticular cyst

• alveolitis

• chronic apical periodontitis

A reticular cyst is one common complication arising from badly performed root treatment. Inflammation of the bone stimulates the growth of residual tissue – and this eventually turns into a cyst.

Our topic in the next weeks is root canal treatment and its risks! (6/10)

Redoing poorly performed root treatment is known as „Revision“, and is definitely necessary!

Revision, as a rule, involves more work than standard root treatment. But most medical insurers do not even pay, because you could have gotten the work done properly the first time around. This is why not many dentists like to perform revisions and go right on to root tip resections and/or tooth extractions.
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Whether a revision will be successful or not depends on how heavily contaminated the tooth is by bacteria on the inside of the tooth! And also on how well the original root treatment was performed. Sometimes the bone is so badly inflamed that revision no longer helps, and you have to opt to perform a root tip resection.
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A root tip resection involves getting the inflamed tissue, resulting from faulty root treatment, out of the bone. But simply removing the tissue is not enough – you also have to clean out the inside of the tooth. If this is not done, then you may be all right for a while (a year or two), but then the problems start up again!
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Unfortunately, dentists usually don’t bother performing more than a root tip resection, and what the patient is not aware of is that this means simply removing the inflamed tissue, not treating the cause, which is the contaminated canal. And if the canal is not treated, then the problems return!

Our topic in the next weeks is root canal treatment and its risks! (5/10)

In the last report (4/10) you read that the majority of complications resulting from root treatment can be prevented by working carefully and allowing for adequate hygiene and planning in enough time.

Time is money – so good-quality root treatment of course costs more than any run-of-the-mill procedure.

However, taking the follow-up costs and problems into account (pain, sick leave, lying in bed sick) as a result of poorly performed root treatment, then calculating in another extra €1000 is still worth it! Depending on where you get the work done, dentists can charge from €100/root canal up to €1000/root canal. So the costs of treating a three-canal molar can range from €500-3000, about the cost of a dental implant!

So investing in good root treatment is definitely worth it, it ends up costing you less in the wrong run – and hurts less too!