What does the endodontist do

Endodontics: Root canal treatment to preserve teeth

 

When does a tooth need endodontic treatment?

Inflammation inside the tooth can affect the pulp, dentin and the tip of the root. The triggers are mostly Caries bacteriathat penetrate into the inner tooth tissue and spread here. Such inflammations are very often the cause of severe toothache and require rapid root canal treatment by a specialist dentist.
Tooth injuries from an accident can also lead to inflammation or infection inside the tooth.

How can you tell whether the pain is coming from inside the tooth?

The pain symptoms are very important for the diagnosis. But it is often not easy for patients to pinpoint the exact location of the pain. Because pain often radiates into the surrounding tissue, so that the actual focus is not clearly identified and may not be related to the teeth at all.
Accurate documentation of the pain progression and the patient's medical history are therefore extremely important for the diagnosis:

  • When and where did the pain first appear?
  • Are there fluctuations in the daytime?
  • Is the pain permanent or intermittent, sharp or pulsating?
  • Is there any swelling on the face?
  • What dental treatments have you done in the past?
  • Are there any known symptoms of CMD?
  • Are teeth colored dark?
  • Has there been an accident with a tooth injury in the past?


Root canal treatments: what is endodontics? How is a tooth treated endodontically?
Image source: © MunichDent
 

How is a tooth treated endodontically?

A prerequisite for a reliable diagnosis is the preparation of an X-ray of teeth and jawbones, ideally with 3D X-ray technology.
Treatment of the root canal is the focus of endodontic therapy.
The dentist uses special fine instruments and files with which he prepares and enlarges the root canal. This takes place in several steps with precise up and down movements of the rotating instruments, is very time-consuming and requires a good instinct from the dentist. Because the root canals are not always straight, but can also be curved. This makes the preparation of the root canal more difficult and takes longer. X-rays provide information about the length and shape of the individual root canals and the extent of the inflammation.
The prepared canal must then be thoroughly rinsed with disinfecting solutions and made pervious to remove inflamed tissue and bacteria. Finally, the dentist dries the canal with fine paper points and seals it with special filling materials such as gutta-percha rubber sticks, pastes or cement to prevent bacteria from re-entering.

 

When is a tip resection necessary?

If the inflammation in the interior of the tooth spreads to the tip of the root, the infection can also spread to adjacent bone tissue and trigger purulent abscesses or, in severe cases, even an infection of the bone and bone marrow. Chronic maxillary sinus infections can occur in the upper jaw.
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 the surrounding tissue. One then speaks of a root tip resection.

 

Why is endodontic treatment so important?

The goal of every root canal treatment is to preserve your own tooth. Because the natural tooth is irreplaceable, retains its place in the jaw and can serve as a pillar for a bridge restoration. Dentists therefore always try to perform root canal treatment whenever possible to preserve the tooth. Thanks to modern treatment techniques and instruments, this is possible in over 90% of cases when the inside 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 last resort is to extract the tooth, which must be pulled.
The resulting tooth gap can then be closed with a bridge, an implant or a removable denture.

You can find a practice for endodontics near you here.

 

How do health insurances reimburse the root canal treatment?

A root canal treatment can only be provided as a health insurance benefit if

  1. it is not just an attempt at treatment or
  2. the treatment is to be assessed as therapy with an uncertain outcome.
  3. the reprocessing and the possibility of filling the root canal up to or close to the root tip are given.

In all other cases it is always a treatment attempt that cannot be billed to the health insurance company. Root canal treatments can only be billed within the framework of statutory health insurance if the canal situation is uncomplicated, straight, slightly curved, the root formation has already been completed and the foramen is closed (i.e. the tooth root is intact).

The chances of success of a root canal treatment, if carried out according to health insurance guidelines and the corresponding reimbursement, are around 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 success of a root canal treatment to over 90%. This is achieved through the use of increased expenditure of time, modern treatment methods, highly effective drugs and high-quality materials. Just as the effort involved in an almost predictably successful endodontics increases, so do their costs. The additional costs for a complex root canal treatment can easily amount to 500 € and more - costs that a private additional dental insurance usually covers.

Source: Supplementary dental insurance: Waizmann table - Endodontics