Does a root canal treatment hurt?

The treatment itself is carried out under local anaesthetic and is not painful at the time. In the days afterwards the tooth can be sensitive to pressure when biting, because the preparation slightly irritates the surrounding bone. This sensitivity usually fades within a week. The old reputation of the painful root canal dates from a time before today's methods.

How many appointments does a root canal treatment need?

This depends on the anatomy and the degree of inflammation. Simple cases can be completed in one session; with complex anatomy or acute inflammation a second session follows two to four weeks later after a medicated insert. The definitive restoration with a build-up filling or crown is then added at a further appointment.

Do I really need a crown after a root canal treatment?

With little loss of substance a build-up filling is enough; with greater loss and especially on molars a crown is medically indicated. A root-treated molar without a crown usually fractures within one to two years along its long axis. Without this restoration the root canal treatment is medically incomplete.

How good are the chances of success of a root canal treatment?

When carried out properly with microscope, machine preparation and rubber dam, primary treatments reach 90 to 95 percent success over five years. Re-treatments after an unsuccessful first root canal reach 75 to 85 percent. Pre-existing inflammation and a complex root anatomy lower the prospects, while a good definitive restoration raises them.

Is an implant not the better solution than a root canal treatment?

As long as a tooth can be preserved with reasonable effort, preservation takes priority. Your own tooth keeps its periodontal ligament, the surrounding bone and the natural bite position; an implant is a good but not an equivalent replacement. Only when the tooth cannot be preserved, for example with a longitudinal fracture, does extraction with an implant make sense.

Root canal treatment. What patients should know beforehand.

Root canal treatment today

Root canal treatment has a bad reputation, mostly from experiences in the 1980s. With microscope, machine preparation and thermoplastic root canal filling, success rates today are above 90 percent.

A root canal treatment preserves your own tooth instead of extracting it. With the tooth the surrounding bone, the natural periodontal ligament and the accustomed bite position are also preserved. An implant is a good alternative but not an equivalent replacement for your own tooth.

When a root canal treatment becomes necessary

The tooth pulp, technically the pulp, is the soft tissue inside the tooth. It contains nerves and blood vessels and extends from the crown into the root tip. If the pulp becomes inflamed or dies, bacteria spread via the root tip into the surrounding bone and cause granulomas, abscesses or chronic inflammation there.

Common causes

Deep caries. If the caries reaches the pulp, bacteria penetrate the pulp and cause inflammation.
Repeated deep restorations. Multiply restored teeth lose their pulp vitality over time, often without obvious trigger.
Trauma. After a blow or fall the pulp can die, sometimes years after the event.
Periodontitis with retrograde infection. Bacteria from deep gum pockets can reach the pulp via small lateral canals.

Symptoms

The symptomatology is not clear-cut. With acute courses patients complain of throbbing persistent pain that intensifies when lying down, or pressure sensitivity when biting. With chronic courses the tooth is often pain-free. A swelling on the gum over the root tip, a fistula or increased mobility can be indications.

In some cases the need for a root canal treatment is recognized during the annual check-up without the patient having symptoms. That is an argument for regular check-ups: early diagnosis avoids the acute pain phase.

How a root canal treatment proceeds today

Session 1. Findings and preparation

After history and clinical examination we take an X-ray. With complex anatomy we supplement with a CBCT image showing the three-dimensional course of the root canals and the anatomical particularities.

Then follow local anesthesia and the application of rubber dam, a rubber barrier isolating the tooth from saliva. The rubber dam is medically mandatory. Without it, saliva bacteria enter the opened root canal and reduce the success rate massively.

Via a small opening in the tooth crown the treatment team reaches the pulp cavity and the root canal entrances. With rotating nickel-titanium instruments the root canal is mechanically prepared, that is, cleaned and brought to a standardized shape. Concurrently we irrigate with sodium hypochlorite and EDTA to remove bacteria and organic material completely.

Session 2. Closure and build-up

With simple cases the root canal filling can be performed in the same session. With complex anatomy or acute inflammation we apply a medicated insert after the preparation and close provisionally. The second session follows two to four weeks later.

In the second session the bacteria-tight closure of the root canal is performed with thermoplastically warmed gutta-percha and a biocompatible sealer. The closure extends from the root tip to the transition into the crown and includes all lateral canals.

Session 3. Definitive restoration

A root-treated tooth no longer has its own sensitivity. It does not react to cold or warm stimuli and not to electrical tests. Mechanically, however, it continues in function and must be adequately restored. With little substance loss a composite build-up filling is sufficient. With greater loss and especially with molars a crown is medically indicated. A non-crowned root-treated molar usually fractures within one to two years along the long axis.

Success rates and what influences them

The study evidence for modern endodontics is robust. With proper execution using microscope, machine preparation and rubber dam, primary treatments reach success rates between 90 and 95 percent over five years. With revisions, that is, second treatments after unsuccessful first root canal, the success rate is at 75 to 85 percent.

The most important influencing factors on success:

Anatomical complexity. Multi-rooted teeth with curved or accessory canals are more elaborate than single-rooted incisors.
Pre-existing inflammation. Root canals at teeth with periapical granuloma have a lower success rate than at vital-inflamed teeth.
Definitive restoration. A timely and bacteria-tight crown or build-up filling is just as decisive as the root canal treatment itself.
Use of rubber dam and microscope. Both are dental standard today. Where they are not applied, success rates measurably decrease.

What the root canal treatment costs

Swiss dentists bill according to SSO tariff. Costs depend on the number of roots, the anatomy, the necessity of a CBCT image and the effort. A single-rooted incisor is cheaper than a multi-rooted molar with curved anatomy.

The definitive restoration (build-up filling or crown) is billed separately but is a medically mandatory part of the treatment.

Basic insurance does not usually cover these costs. Supplementary insurance for dental treatment can cover part. You receive a written cost estimate from us before treatment begins, which you can submit to your insurance.

Root canal or implant. A recurring question

The question arises with every tooth of questionable preservability. The dental answer is clear: as long as a tooth can be preserved with reasonable effort, preservation takes priority over extraction. The reasons are biological and economic at the same time.

A preserved tooth retains its own periodontal ligament structure, which is the shock absorber system between tooth and bone. An implant is rigidly anchored in the bone and transfers chewing forces directly. The preserved tooth retains the surrounding bone because the periodontal ligament continuously stimulates the bone. After an extraction the bone shrinks measurably. Finally, the preserved tooth retains the individual bite position and the natural sensorics. An implant is a good replacement but not an equivalent.

From a purely economic perspective: a root canal treatment including crown is significantly cheaper than an implant including crown. Both restorations last with adequate care two to three decades. The preservation of your own tooth is medically and economically the better choice in most cases.

Extraction with subsequent implant makes sense when the tooth cannot be preserved: with longitudinal fractures, extensive root resorptions or unsuccessful revision with persisting symptoms.

What to observe after the root canal treatment

Directly after treatment the tooth can be pressure-sensitive for a few days because the preparation slightly irritates the surrounding bone. This sensitivity fades within a week. With stronger or persistent complaints get in touch, we check the findings radiologically.

In the medium term the definitive restoration with crown or build-up filling is the most important. Without this restoration the root canal treatment is medically incomplete. We coordinate the prosthetic appointment directly after the second endodontic session.

In the long term we recommend radiological check-ups after six months, one year and then annually as part of the dental check. A root canal success shows in the bone regeneration around the root tip, which becomes visible on X-ray.