Root canal
treatment (Endodontics)

Root canal treatment is the removal of infected nerve and vascular soft connective tissue (pulp) from the tooth’s root canals and their disinfection with specialised agents to eliminate as many of the microorganisms that have entered the tooth as possible. The now empty and clean root canals are then filled with a special dental sealer to prevent further microbial growth and damage to the surrounding tooth tissue. This type of treatment used to be called “nerve extraction.”

The most common reasons microorganisms enter the tooth and endodontic treatment becomes necessary:

1. Carious lesions that were not treated in time.
2. Old leaking fillings.
3. Dental trauma.
4. Periodontal disease (periodontitis).
5. Other tooth damage (cracks, chips, erosion, wedge-shaped cervical defects).

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The tooth is protected by its outer hard tissue — the enamel. When the enamel is damaged, microorganisms reach the deeper layer of the tooth (dentin), which is made up of tiny tubules. If the surface lesion is not treated in time, microorganisms travel along these microtubules until they reach the inner tooth tissue: the pulp. Inflammation of the pulp and of the nerves and blood vessels within it then begins, which is why endodontic root canal treatment is required.

Symptoms indicating that endodontic treatment is needed:

• • prolonged acute throbbing pain, sometimes radiating to the ear (occurring in the evening or at night);

• • increased sensitivity to cold drinks or food;

• • swelling of the cheek/jaw area (in cases of long-standing infection);

• • pain when biting (in cases of long-standing infection);

• • a pimple (fistula) appearing next to the tooth (in cases of long-standing infection);

• • a darker/greyer tooth crown compared with neighbouring teeth (in cases of long-standing infection);

• • an abscess near the tooth root found incidentally during X-ray examination, even though no other symptoms are observed (in cases of long-standing infection).

At our clinic, root canal treatment is performed using the most modern motorised instruments and the highest-quality materials recognised in dentistry.

Our goal: to clean and fill the root canals painlessly and meticulously, so that the infection does not recur and the lifespan of the tooth is as long as possible.

Procedure steps:

1. Anaesthesia (local).
2. Placement of a rubber dam (protection from saliva and the bacteria it contains).
3. Removal of carious tissue and opening of the pulp chamber.
4. Mechanical and chemical cleaning of the tooth’s root canals using special instruments and disinfectant solutions. Control X-rays are taken.
5. Filling of the empty canals with a special root canal sealer. If the infection is not advanced, canal filling is performed at the same visit as the cleaning. Otherwise, special medication is additionally placed and left inside the canals, and the canal filling is done after 10–14 days. A control X-ray is taken.
6. Restoration of the crown with a temporary or permanent filling.
7. Prosthetic restoration of the tooth as needed.

Root canal treatment can be carried out in 1–2 visits, sometimes more, the number of which depends on the degree of infection, the number of canals and their complexity. After endodontic treatment, it is very important to replace the temporary filling in the tooth crown with a hermetic permanent composite filling within 2–3 weeks, to maximally protect the tooth from re-infection.

It should be noted that after endodontic treatment the tooth becomes non-vital: dry, brittle and no longer sensitive to cold or heat, since the soft tissue (pulp) along with its fluids, blood vessels and nerve fibres responsible for the tooth’s vitality and sensitivity is lost. Due to the increased brittleness of the tooth, prosthetic restoration is most often needed after root canal treatment in order to protect the tooth from early fracture. The dentist will advise on the need for prosthetic restoration after assessing the size of the crown defect.

Recommendations before the procedure:

• come to the appointment after eating and with brushed teeth;
• have professional oral hygiene done (no longer than 1 year ago, to ensure as clean a working field as possible);
• bring a control X-ray with you so the degree of infection can be assessed.