Root canal treatment (endodontics)

Why we save your tooth instead of taking it out

When decay reaches deep inside the tooth, or a tooth is damaged in an accident, the pulp can become inflamed. This is the tooth nerve with its fine blood vessels. Inflammation of this kind often causes severe pain. In the past, the affected tooth was frequently lost as a result. Today that is no longer the case. Modern endodontics preserves teeth that would otherwise have to be taken out. It is worth the effort, because no tooth replacement is as good as your own tooth with its natural anchoring in the jaw. The chances of success are well documented. About nine out of ten root-treated teeth are still in place after ten years.

We take this step by step. Not every inflamed nerve is beyond saving. If the inflammation is still reversible, the living nerve can be preserved in suitable cases. Only when it is irreversibly damaged or has already died do we remove it with a root canal treatment. And even after that there are ways to save a tooth, from redoing an old root canal to an apicoectomy (surgery at the root tip). There are no guarantees in medicine, but before every treatment we tell you what the outlook is for your tooth.

Good to know

Few procedures cause patients as much apprehension as a root canal treatment. Its reputation is worse than the reality. The severe pain comes from the inflamed nerve, not from the treatment. Under effective local anaesthetic it is no more unpleasant for most patients than a larger filling. After the appointment the tooth can be sensitive for a few days, and this usually settles on its own.

Honesty also means saying that every root canal treatment has its limits. Root canals are often sharply curved, branched or calcified over the years, and in rare cases the fine instruments can break inside the canal. With complicated canal shapes, a three-dimensional CBCT scan helps us understand the tooth precisely before treatment. Even with the greatest care, not every inflammation heals completely.

That is exactly when there is a second and even a third chance. In a retreatment we remove the old root filling, clean the canals again and seal them tightly. The chances of success are good, but lower than those of the first treatment. We discuss with you beforehand what is realistic in your case. If even that is not enough, an apicoectomy removes the inflammation directly at the tip of the root. This is a small surgical procedure and often the last step before a tooth would have to be taken out.

Rarely, a chronically inflamed nerve dissolves the dentine from the inside. This is called internal resorption. It usually causes no symptoms and shows up as an incidental finding on an X-ray. If it is caught early, a root canal treatment stops the process. This is another reason why regular check-ups are valuable.