Modern endodontics — saving teeth, not extracting them
Endodontics treats the dental pulp (tooth nerve) and periapical tissues (around the root tip). When pulp becomes inflamed or infected, root canal treatment is the only alternative to extraction.
Your natural tooth is always the best option. Root canal treatment, done correctly, preserves the tooth for decades — much better than extraction + implant.
When root canal treatment is necessary
Signs the pulp is affected:
- 🌡️ Intense, persistent pain to heat or cold (over 30 seconds)
- ⚡ Spontaneous pain at night, without trigger
- 🍫 Prolonged sensitivity after sweet or acidic
- 🦷 Tooth colour change (grey, black, brown)
- 🟣 Gum swelling or fistula (pus bump) near the tooth
- 🪥 Pain on touching or chewing
- 🕳️ Deep cavity that has reached near the nerve
We diagnose with vitality tests, percussion, X-ray, and sometimes CBCT 3D for complex cases.
Myth: root canal treatment is painful
FALSE. With modern anaesthesia, root canal treatment is as comfortable as a filling. The pain you associate with “root canal” is the pain before treatment — acute pulpitis. The treatment itself stops it. If you feel pain during the procedure, the anaesthesia needs to be supplemented — we say so from the start.
Why we do the treatment under microscope
Dental canals have diameters of fractions of a millimetre, are curved, branched, sometimes invisible on X-ray. The microscope (with 4-25x magnification) allows:
- Locating all canals — molars can have 3-4 canals, some hidden without microscope (MB2 canal in upper molars — in 60-90% of cases)
- Conservative treatment — we remove only affected tissue, preserve as much of the tooth as possible
- Detection of cracks and fractures that would otherwise remain undiagnosed
- Success rate above 95% for primary treatments (vs ~80% without microscope)
The procedure — step by step
1. Diagnosis and plan
X-ray + vitality tests. For complex cases: CBCT 3D. We discuss the prognosis realistically before starting.
2. Local anaesthesia
100% painless procedure for any vital tooth. For already necrotic teeth (dead pulp) anaesthesia is more for comfort than for pain.
3. Rubber dam isolation
The gold standard of modern endodontics. The dam (rubber sheet) isolates the tooth from saliva and oral bacteria. Without dam = inferior standards. This guarantees sterility and safety (you don’t swallow the instruments).
4. Access to the pulp chamber
Under microscope, we open a minimally invasive access cavity in the tooth crown. We locate all canals.
5. Mechanical-chemical cleaning and disinfection
Rotary instruments (NiTi) clean and shape the canals to optimal dimension. Between steps, irrigation with sodium hypochlorite and EDTA — dissolves remaining tissue and kills bacteria. Ultrasonic activation for deep cleaning.
6. Working length determination
Apex locator (electronic) + control X-ray — we measure exactly how far each canal goes, up to the root apex but not beyond.
7. Tight canal filling
Canals are sealed with thermoplastic gutta-percha (3D obturation) + biocompatible endodontic cement. Complete sealing = no space for bacteria.
8. Provisional restoration + crown recommendation
After treatment we place a provisional restoration. For molars and premolars we recommend a crown in 2-4 weeks — the devitalised tooth is more fragile, the crown protects it for 20+ years.
Retreatment — when the first attempt failed
If an old root canal treatment failed (re-infection, persistent symptoms):
- Removal of old filling — we remove old gutta-percha with solvent + instruments
- Re-cleaning of all canals, possibly locating canals missed the first time
- Tight re-sealing
Retreatment success rate: 70-85%. For difficult cases we recommend endodontic surgery (apicoectomy) as an alternative.
Apicoectomy — microscopic surgery
When orthograde retreatment isn’t possible or has failed, we intervene surgically:
- Access via the root apex (through the gum)
- Microscope + ultrasonic instruments
- We remove the infected root tip (3 mm)
- Retrograde sealing with MTA (biocompatible material)
60-90 minute procedure, 5-7 day recovery, 85-90% success.
After root canal treatment
First 24-48 hours
- Mild sensitivity to biting — normal, lasts a few days
- Anti-inflammatory if needed (Nurofen, Algocalmin)
- Don’t eat on the treated tooth until the anaesthesia wears off
First weeks
- Schedule completion with crown if it’s a posterior tooth — essential
- Avoid excessive force on the provisional tooth
Long term
- The devitalised tooth remains functional for decades with crown
- Regular check-ups every 6 months with X-ray monitoring of the apex
- No special care needed — normal brushing, floss
Success rate
- Primary treatment (first time): 95-97% under microscope
- Retreatment: 70-85%
- Apicoectomy: 85-90%
Data from world literature for offices using microscope and rubber dam — the standards we work by.
Booking an endodontic consultation
If you have acute pain, we accept emergencies as quickly as possible — untreated pulpitis means sleepless nights. For non-acute cases, normal booking with complete diagnosis, plan, and cost estimate before any intervention.