Introduction
A so-called “dead” tooth is a tooth whose vital functions are no longer intact. The nerve vessels and blood vessels within the tooth pulp have died off and can therefore no longer supply the tooth from the inside. The tooth is now insensitive to thermal changes: it feels neither heat nor cold. Over time, the hard tooth substance that is no longer supplied becomes unstable and brittle and the tooth can become discolored. If the tooth is not crowned after a certain time after root canal treatment, there is a risk of fracture.
What symptoms can a dead tooth cause?
Symptoms accompanying the necrosis of the tooth can vary greatly. These include:
- Severe pain, pressure sensitivity and biting (while the tooth is dying off)
- Severe pain completely disappears after a few days
- Formation of an abscess (with pus-filled, encapsulated cavity)
- Strong, foul bad breath
- Taste disorders
- Tooth discoloration (black)
Since a tooth with a dead tooth nerve can lead to massive inflammation and usually causes very severe pain in the surrounding tissue, the tooth must be treated with root canal therapy. The following is carried out
- Trepanation (opening of the tooth and removal of tissue)
- Irrigation and disinfection of the tooth chamber
- Wait one week (is the tooth still causing problems?
)
- Root canal filling
- Crowning (for stabilization)
If the tooth is painful despite another root canal treatment (the second root canal treatment is called revision), surgical intervention is recommended. In the so-called root tip resection, the roots of the tooth are now treated from below. The gums are cut open and the root is shortened and closed.
Everything is disinfected in advance. After complete healing, this tooth can now be crowned, provided that it is inconspicuous and the person concerned has no more complaints. If even a single or multiple apicoectomy is unsuccessful and the tooth continues to cause discomfort, it may be the better option to have the tooth removed.
After the extraction wound has healed, one has to think about subsequent replacement of the extracted tooth in order to select the best possible form of tooth replacement for the individual. A root canal treatmentA root canal treatment for a dead tooth is a routine procedure, but usually more complex than for a tooth that is still vital, since the bacteria and the already metabolized biomasses must be completely removed from the inside of the tooth and disinfected. In most cases only cell remains are left.
For the root canal treatment of the dead tooth, the tooth must first be drilled out to access the patient’s root canal system. This does not necessarily require anesthesia, since the tooth no longer perceives any stimuli due to the dead nerve tissue. The individual root canals are then made common with hand or machine files and the entire vessel material is removed.
When the canals are reached, a decaying odor usually comes into play, which signals that bacteria have already begun to metabolize the tissue, producing unpleasant smelling gases as decomposition products. The next step includes a medicinal insert and disinfectant rinsing liquids to remove all bacteria within the root canal system. The tooth is then left with the medication for one to two weeks until it is free of symptoms.
In order to protect the tooth from intruding food and bacteria, it is temporarily filled with a temporary filling. Only when the tooth is free of complaints will it be treated with a root filling after the canals have been completely widened and prepared. The root canal filling can be placed either thermo-stable or thermo-plastic, which means that it is available in liquid or rubber-pen form.
Once the root canal filling is complete, the tooth is usually healed. After a period of two to three months, after the tooth has remained free of complaints and inconspicuous, the tooth is crowned and thus completely reintegrated into the dental arch. A dead tooth should only be extracted when all attempted therapy approaches have failed and the tooth causes persistent complaints.
Contrary to the approaches of many alternative practitioners, who are of the opinion that all dead teeth should be extracted immediately, teeth can be completely reintegrated into the dental arch after treatment and are considered to be a full member. The thesis that dead teeth must be extracted immediately is absolutely unfounded, since successful root canal treatments are scientifically confirmed to heal the affected teeth. Root canal treatment has an approximately ninety percent chance of success.
If the treatment has not achieved freedom from symptoms, the treatment is either a revision, the removal of the old root canal treatment and the reinsertion of a new one, or a root tip resection. In apicoectomy, the tip of the root is surgically capped and, if necessary, the root filling is sealed from below. If the root apex resection has not been able to alleviate the symptoms either, it should be discussed whether a new root apex resection should be initiated.
If the symptoms have not been alleviated after the second apicoectomy, the only remaining option is tooth removal to alleviate the symptoms.Nevertheless, dentists and oral surgeons try everything possible to preserve a tooth, because a dead tooth does not mean that you have to use forceps at the same time. Nowadays, with the latest techniques and materials, a tooth can be prepared in such a way that it can be preserved in the long term. As the vessels die, the tooth is no longer optimally supplied with nutrients.
It is only supplied by the root skin, the Desmodont, which ensures that the tooth develops a certain brittleness. If the tooth also has a large defect (a “hole”), it can break more easily. To prevent the tooth from breaking off, a crown is made, which fully integrates the tooth back into the tooth structure.
The crowning is especially desirable in the posterior region, since the teeth have to withstand the most chewing force and chewing stress. In the anterior region, a crown or veneer is usually necessary for esthetic reasons, since non-vital teeth can become grayish over time. The black discoloration of devitalized teeth is primarily an aesthetic problem for those affected.
The discolored tooth no longer fits into the harmonious nuances of the dental arch and is even noticeable from a distance. There are possibilities to whiten these discolored teeth again. One possibility to whiten teeth is bleaching.
In bleaching, hydrogen peroxide, which is also used to bleach clothes and hair, is used in low concentrations to lighten the enamel. However, large cracks are not possible. An effective bleaching to 2 shades is realistic.
If you want to bleach the dark, almost black colored devitalized teeth, you can never be sure whether the resulting shade will harmoniously match the existing teeth. Moreover, bleaching removes moisture from the tooth. This makes the already weakened tooth even more unstable.
Therefore, bleaching is not recommended for dead teeth. A safe way to integrate discolored teeth back into the dental arch is to crown them. On the one hand, the crown restores the flawless aesthetics, on the other hand, the weakened tooth is protected by the crown and is no longer in danger of breaking.
Due to today’s wide range of materials, shapes and colors for crowns, the perfect look is restored and it is impossible for a layman to tell that it is a crown at all. Dead teeth darken when iron is deposited from the blood vessels, which is why they appear grey. This can also be caused by a non-dense root filling or remaining tissue.
These teeth can be lightened by bleaching. Only one tooth can be whitened by a splint, or the bleaching material can be placed inside the root canal. This makes it possible to whiten a maximum of two to three tooth shades. However, the bleaching effect does not last permanently, so that it usually needs to be refreshed once a year. Private costs of 40 – 80 Euros for the treatment of the tooth must be expected.
