Root canal treatment with a laser – is this an alternative?

Many dental practices offer treatment with a dental laser as an alternative to root canal treatment using manual or electrical devices. This has a thin glass fiber that is inserted into the root canal. This allows the laser to act precisely at the point of treatment.

The laser treatment is often recommended for strongly curved root canals, because even difficult to reach places should be cleaned from bacteria and tissue by the laser. The bacteria are killed by a targeted heat development, because they cannot withstand the heat. Furthermore, a root canal treatment with a laser is described as faster in terms of time.

The laser empties the root canal quickly and thoroughly and the surrounding tissue is spared. However, treatment with a laser is not covered by health insurance. In the long term, the prognosis of the tooth can be improved by treatment with a laser.

+Even with the most careful root canal treatment, bacteria can still remain in the ramifications of the root canal at its tip. This can then lead to a suppurative focus at the tip of the root, which is enclosed by the body through a protective wall of connective tissue. However, since this is a latent source of danger, it should be eliminated by means of a surgical procedure called apicoectomy.

For this purpose, the mucous membrane is cut through under local anesthesia and the bone above the suppurative focus is removed. The suppurative focus is removed and with it the root tip. Afterwards, the root canal is closed with amalgam or cement from the tip, so that no germs can escape.

The mucosa is sutured again and the resection is completed. The execution of a root tip resection is relatively easy for teeth with one root, but it is very difficult for teeth with several roots. Pulpitis (tooth pulp inflammation) is an acute inflammation of the tooth pulp.

It is a consequence of untreated caries, which has spread further and further into the dentin. Bacteria can reach the pulp with its blood vessels, nerves and connective tissue through the dentine tubules. The pulp reacts with an inflammation, which causes great pain.

The pulp is thus irreversibly damaged and must be removed. This is done with a vital amputation. The pulp chamber is opened and the pulp removed under local anesthesia and absolutely dry, preferably with a rubber dam to prevent further bacterial infections.

At the bottom of the pulp chamber, the entrances of the root canals are searched for, which may be difficult, especially in teeth with several roots, since the entrances to the individual root canals are difficult to find, especially in older people, due to the formation of secondary dentine. After widening the entrances, the remaining pulp tissue is carefully removed from the root canals. The canals are cleaned, widened with hand or machine instruments and rinsed with disinfectant solutions such as hydrogen peroxide or chlorhexidine digluconate to remove the remaining tissue and chipped dentin.

Preparation of the root canal is relatively easy for teeth with a straight root, but care must be taken to prepare the canal as far as possible to the tip of the root. This is checked with an X-ray. Preparation is much more difficult for teeth with several roots.

Especially if these roots are still bent. Today there are files for this purpose which are flexible and therefore allow cleaning and widening even in curved roots.In case of acute pulpitis, when there are no more bacterial remains, the final filling of the root canals can be done immediately in one session. The root canal or canals are filled with an antibacterial paste or gutta-percha after drying with paper tips and a covering filling is placed over it.

However, if there is already a more extensive infection, an antibacterial inlay is first made and the tooth is provisionally closed. Only when the tooth has been resting for several weeks can the final restoration be made. The success of the treatment will be checked by means of an X-ray image.

The same procedure is used in case of trauma, i.e. an accident in which the pulp was opened. If the pulp is not only inflamed, but has already disintegrated due to the influence of bacteria, gangrene has developed. The treatment of gangrene is much more complex and lengthy than that of pulpitis.

When the pulp chamber is opened, foul-smelling gases escape, but the patient feels immediate relief because the gases no longer press on the opening at the tip of the root. After the decayed pulp is removed, the opening is widened and the tooth is left open or closed with a cotton ball so that the gases can escape but food remains cannot penetrate. In the next root canal treatment session, the root canal is widened and cleaned of debris.

An X-ray shows how far the canal has been prepared. After an antiseptic insert, the tooth is provisionally closed. If the tooth remains without symptoms for a longer period of time, the canal can be filled with gutta-percha or another root filling material and finally closed.

The treatment of milk teeth with pulpitis or gangrene is more difficult. Since milk teeth are smaller and enamel and dentin are thinner, the pulp is reached faster than in adult teeth. Of course, one must try to preserve the tooth, as it serves as a placeholder for the permanent teeth.

On the other hand, it must be remembered that immediately behind the milk tooth there is the permanent tooth and the roots of the milk tooth resorb. Therefore, a normal root filling / root canal treatment cannot be performed. In any case, the carious tissue is removed, then we have to decide what the further procedure is.

One possibility is to grind the tooth so that there is no congestion and no toothache. It remains open or is provided with an antibacterial insert. If the tooth is open, one should make sure that no food remains on it.

However, if the pulp chamber is wide open, this should not cause any problems. The alternative is to remove the tooth. This means that the important placeholder function is lost. This can be remedied by a placeholder that keeps the gap open so that the permanent tooth can literally break through.