In what cases is root canal treatment necessary?

The most common reason for root canal treatment is periodontitis in decayed teeth.

In the case of large-scale tooth decay, bacteria penetrate the hard tissue layer of the tooth and enter the dental cavity. As a result, periodontitis develops, which is accompanied by sharp pain lasting for a long time (even for hours). These periods of toothache are usually caused by cold food/drink or when the person is lying down. However, they can also arise spontaneously.

In case of periodontitis, the periodontium can no longer be cured, the only conservative therapeutic option is removal of the periodontium and root canal treatment.

In the case of very severe periodontitis, it may happen that we cannot completely anesthetize the tooth with the injection. The reason for this is that the anaesthetic solution cannot reach the deeper tissues due to the different pH value of the inflamed tissue. In this case, we don’t start the root treatment. We place a devitalizing filling in the tooth and return the patient to a later date, when the tooth can be properly anesthetized.

In the case of untreated periodontitis, the periodontal tissue is destroyed over time and a bacteria-rich debris is created in the periodontal chamber. These bacteria can also cause inflammation in the jawbones by passing through the root tip. This usually involves a biting pain. A swelling or a fistula opening may develop next to the dead tooth, through which the inflammatory secretions are discharged towards the oral cavity. In addition, dead teeth are a dental focus, they can cause sinusitis, hair loss, skin and joint diseases. In such cases, the only conservative therapeutic method is root canal treatment.

It is important to note that the death of the dental pulp and the development of inflammation around the root apex are not always preceded by painful periodontitis. This can also develop as a result of other trauma to the dentition. In addition, it also happens that dead teeth remain symptom-free for a long time and do not cause pain to the patient. In such a case, the dead tooth is usually noticed on the X-ray, during the examination of another complaining tooth, or during a dental screening examination.

The process of root canal treatment

• Before beginning the root canal treatment, the diagnosis is made using an oral cavity examination and X-ray.
• The tooth to be treated is anesthetized with an injection
• The decayed parts are removed, and then an opening is made in the crown of the tooth, from which we can properly see the cavity of the tooth
• We determine the length of the root canals
• With the help of root canal treatment tools, we remove the dental gut (or bacteria-rich debris) from the root canals
• With the help of the root canal processing tools, we widen the root canal to a shape in which our subsequent root filling can be properly applied.
• In addition to dilation cycles, we use a proper flushing protocol to kill bacteria more effectively
• We dry the root canal
• Usually, before the final root filling, the tooth is closed with a medicated temporary filling one or more times depending on the complaints
• We fill the enlarged root canals with a gutta-percha-based root filling material

Difficulties of root canal treatment, obstacles to be overcom

In most cases, the reasons for the difficulties lie in the anatomy of the tooth to be treated. These anatomical factors can typically be:

• a large degree of curvature in the root canal
• non-circularly symmetrical root canal
• non-cleanable, impassable side channels

1. Curved and non-circularly symmetric root canals

The machining tools used during root canal treatment are without exception straight, circularly symmetrical tools.

• For this reason, it is easy to understand that in cases where the tooth root is strongly curved, processing the root canal is a more complicated process than average. In such an event, processing takes more time and special processing tools (e.g. flexible Nickel-Titanium alloy instruments, mechanical root canal dilators)
• If the shape of the root canal is very different from the circularly symmetrical one (e.g. the tooth root is sponge-shaped), the treatment time may also increase. In these cases, there is usually a part of the root canal that cannot be reached by our circularly symmetrical devices.

In such complicated cases, we always draw the patient’s attention to the fact that there is an increased risk of the root canal treatment device breaking or developing other complications.

There may be areas of the root canal that the root treatment instrument does not reach at all and thus they will not be properly cleaned. In such cases, we have to rely more on the antibacterial effect of the sewer flushing materials. In these cases, the preparation of the root filling is also difficult. In general, it is very difficult to make a root filling that provides adequate closure in the area of ​​the entire canal.

Because of the above, it can generally be said that in the case of abnormal root canal anatomy, we must always pay close attention to the healing of the treated tooth and draw up the treatment plan accordingly.

2. Presence of side channels

In addition to the main root canal, the tooth often has side canals. These canals are narrower than the main root canal and have an abnormal position. During root canal treatment, it is practically impossible to access and clean the side canals with processing tools. As a result, the side canals are filled with bacteria-rich debris even after root canal treatment.

In such a case, whether the inflammation can be eliminated by root canal treatment depends not only on the dentist’s work, but also on the patient’s immune system. In many cases, it can be seen that teeth with side canals also heal after proper root canal treatment, but this cannot be guaranteed even with the greatest care.

The presence of an infected lateral canal arises if the patient’s complaints do not go away during root canal treatment. Also, if an inflammatory lesion develops later on at the root apex next to a root filling that seems adequate.

In such a case, if possible, it is recommended to resort to root tip amputation performed by an oral surgeon. During root tip amputation, the oral surgeon’s colleague removes the tip part of the root and the inflammatory tissues around the root tip during an exploratory operation. Usually, this removed (approx. 3mm long) part of the root tip contains the side canal causing the problem.

Mechanical root treatment using machine instrument

In our dental clinic, it is possible to perform more modern mechanical root canal treatment than traditional, manual root canal treatments.

The advantages of mechanical root canal treatment are as follows:

• mechanical root expansion is significantly faster than conventional ones, most work processes are shortened
• more precisely, it creates an enlarged and cleaned root canal
• a root filling made in a more precisely widened canal seals the canal better
• the machine detects the needle getting stuck in the channel, so the chance of instrument breakage is reduced

Overall, it can be said that mechanical root fillings lead to more predictable healing than traditional methods.

Dr Diriczi Tamás