Introduction
Due to advanced caries or accidents such as injuries during sports, root canal treatment is often necessary. Especially the incisors often fall victim to falls due to their unprotected position.
Cause
The main reason why a root canal treatment is necessary is due to untreated caries. Through daily food intake a plaque forms on our teeth, the so-called plaque. If the plaque is not sufficiently removed by daily oral hygiene, bacteria such as streptococci can develop.
These bacteria metabolize the sugar from food and form lactic acid, which attacks the tooth and destroys the tooth structure. If the caries is not treated, it continues to work its way through the tooth until it reaches the inside and the root of the tooth. The root of the tooth consists of at least one canal, which is filled with tooth pulp, as well as the tooth nerve and small blood vessels for supply.
The tip of the root is open so that the supplying vessels can enter the tooth and a connection to the rest of the body is established. The tooth must be supplied with nutrients, otherwise it would die. However, if bacteria have penetrated to this point, an inflammation develops.
This causes the vessels to expand, which presses on the tooth nerve. A strong, unpleasant pain develops. If the pain is ignored, the bacteria can migrate even further and attack the bone until an abscess develops.
In addition, a traumatic damage to the tooth, due to a fall or an accident, may make root canal treatment necessary. Especially the incisors are in danger due to their prominent position in case of a fall. If an incisor needs root canal treatment, this can be done in several sessions at the dentist.
At the beginning, the affected area is drained with small cotton rolls to prevent saliva and bacteria from entering the tooth during the treatment. In addition, saliva is removed during the treatment with the teat. In the past, this absolute drying out was achieved with a coffer dam, but this has proven to be very unpleasant for the patients.
However, it can still be used and has the advantage that the probability of saliva entering the tooth is much lower. The tooth is then locally anesthetized, otherwise the treatment would not be bearable due to the severe pain. The drugs used are lidocaine, mepivacaine or bupivacaine.
Any allergies, medications taken or intolerances must be reported to the doctor before the treatment in order to exclude side effects. In addition, a substance similar to adrenaline is usually added, which causes narrowing of the veins and prevents bleeding. The dentist can now open the tooth with a drill.
This enables him to remove the pulp with the nerve fibres from the root. Thus the inflamed tissue is removed from the tooth. This requires special root files of different lengths and thicknesses, so that the right one can be found for each tooth.
Especially the root of the canine tooth is very long. The front teeth usually have one root each. After hollowing out, the canal is rinsed with different solutions.
These are chlorhexidine (has anti-inflammatory and antibacterial effects), hydrogen peroxide (disinfection, hemostasis) and sodium hypochloride (for disinfection). The first part of the root canal treatment is now complete. Now it depends on how much the incisor was affected.
If it was only a minor inflammation, the filling can be started directly. If the procedure is more severe, an antibacterial and anti-inflammatory drug must first be placed in the tooth and left to rest for a few days. The paste usually contains calcium or cortisone with an antibiotic.
When the time comes for the filling, a material is filled into the canal, which resembles a rubber-like mass. It is called gutta-percha and it should seal the canal tightly. As a sealant, a paste is used, with a material that resembles the cement of the tooth.
It is called dense cement. With these two agents, the filling of the root is complete. However, the treatment is not yet finished, because after the filling, an x-ray of the incisor must be taken to check if the root is completely and tightly filled to the tip of the root.The degree of healing is checked in subsequent follow-up appointments.
These appointments should be kept to avoid possible complications. A root canal treatment is often the last chance to save the natural tooth. It could also be pulled out and a prosthetic restoration could be sought, but in any case, the preservation of a natural tooth is a gain for the patient, even though the treatment can be long, painful and difficult.
However, if the tooth is saved, it retains its firm place in the jaw, so that chewing comfort remains unrestricted. Nowadays, prosthetic restorations are very good and in some cases can hardly be distinguished from natural teeth, but their production is connected with costs and time. In addition, it may be necessary to sacrifice hard tooth substance of adjacent teeth for a prosthetic restoration.
A natural tooth can never be 100% reproduced in terms of aesthetics and function. A root-treated tooth can also be used later for a prosthetic restoration. Preserving the natural teeth is one of the highest priorities and has also aesthetic advantages, since the tooth situation is preserved.
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