Microscopic root canal treatment
Microscopic root canal treatment, more precise, more successful treatments
Learn more about microscopic root canal treatment!
Is a microscopic root canal better than a plain one?
It is more correct to say safer, more precise, more thorough and therefore more successful. In the case of molars or teeth with more complex anatomy, much better results can be obtained with a microscope, as the preparation of complex anatomy can be done more precisely at high magnification. For example, in the upper sixth teeth, only 3 root canals are visible to the naked eye, whereas with a microscope, a fourth, sometimes 5th root canal is found in 96% of cases. If these remain unexplored, the infection will persist in them, so it is useless to have 3 of the 4 canals perfectly covered if the fourth one is left with infected debris and causes a nodular lesion. The treatment of the more curved root canals is also more successful with a microscope, since it is possible to work in a controlled way with tiny instruments that cannot be used with the naked eye.
Why do I need cofferdam isolation for microscopic root canal treatment?
Not only for microscopic root canal treatment, but also for free-eye root canal treatment, and for any filling where you really want to do a quality job. True, it may not be possible to put a cofferdam on teeth with a very destroyed crown, in which case we are happy to find a solution that somehow manages to avoid tooth extraction for a while.
So, the question is: what is a cofferdam good for? The kofferdam provides perfect isolation from saliva and bacteria in the mouth during treatment. It also prevents the dentist from accidentally putting something down the patient’s throat during the treatment, which could lead to life-threatening complications. If the root canal treatment is carried out in cofferdam isolation, it is possible to use disinfectants that are excellent at disinfecting the inside of the tooth but would cause build-up on the mucous membrane. Therefore, in cofferdam isolation, the tooth can be disinfected much more effectively than without it. In addition, the bacteria in the saliva do not contaminate the tooth during treatment.
Even if microscopic root canal treatment is not the treatment of choice for everyone, it is strongly recommended that it is carried out in a cofferdam, so that the doctor can use modern and much more effective disinfectants than the old ones and prevent re-infection of saliva during treatment.
The cost of cofferdam isolation is not high, but it is extra on top of the treatment. However, the small extra cost invested here will result in a much more successful treatment and thus a longer period of time for the tooth to remain in the mouth, and in the long run, a substantial reduction in treatment fees!
Why is it not enough to fill a root canal treated tooth?
The root canal must be protected, otherwise the tooth will break at a much higher rate than live teeth that have not been root canaled. Root-treated teeth can also be filled smoothly if the root canal treatment does not remove too much tooth tissue, so that the mechanical properties of the tooth remain strong enough. However, this is quite rare, as a tooth is root canal treated precisely because it has been affected by deep caries, where much of the crown tissue has been destroyed.
Where possible, it is necessary to replace the lost tooth tissue with an inlay (onlay), which covers the remaining tooth tissue, including the cusps, thus providing full mechanical protection for the tooth. In other cases, the protection can only be achieved by using a pin and a full crown if the crown part of the tooth is so destroyed.
It is a horn defect if, in the case of a successfully root canal treated tooth, the patient no longer spends on the filling and only asks the dentist for a filling. In most cases, a simple filling is not enough to protect the tooth from fracture, which later leads to tooth extraction. It is therefore worth listening to the dentist, spending a little more money on a tooth rather than losing it later, and spending a lot more time and money on a tooth replacement.
Is it more successful to treat dental nodules with a microscope?
Yes, microscopic root canal treatment can reveal the canal system more precisely. In many cases, it can also reveal root canals that the colleague missed during a previous root canal treatment with the naked eye. Such unexplored root canals often cause nodular lesions, even if the other canals have been perfectly treated.
Even if microscopic treatment is not possible, it is still worth looking for a dentist who uses a modern root canal treatment concept. This means that root canal treatment should always be carried out in cofferdam isolation and, if possible, using modern rinsing and disinfecting instruments and solutions, activating these solutions if possible. Using these methods, root canal treatment or re-treatment will be more successful without a microscope.
No, that’s not true. An experienced, precise and thorough doctor, perhaps using Loupe glasses for magnification, can achieve great success using modern root canal therapy tools.
What definitely brings success closer without a microscope is proper cofferdam isolation and the use of the latest irrigation protocols and materials.
So a ‘plain’ root canal treatment performed under no magnification can be as successful as one with a microscope if the anatomy of the tooth is not overly complicated, the dentist has adequate experience and uses the isolation, disinfection and technical tools necessary for modern root canal treatment.
In the case of a tooth with a complicated root canal, such as an upper sixth tooth with 96% supernumerary canal, or a tooth with a curved root canal, or a tooth that has been root canal filled for a long time, root canal treatment with a microscope is more successful in most cases.
The success of root canal treatment depends on a number of factors, so there is no clear answer. A good diagnosis and treatment plan is important. In many cases this may require 3 D CBCT X-ray imaging. True, this is an extra cost, but in the long run it can save a lot of money, pain, frustration and energy for a tooth removed in time, rather than having the same tooth treated for years in vain because the 2 D X-ray could not properly diagnose the irrecoverable problem.
Research shows that success rates range from 80-96%, but success depends on many factors.
The crown of the tooth to be root canaled is important. Is it easy to build up or is it already problematic? Is there already an inflammatory lesion at the tip of the root, i.e. has the infection already spread beyond the root or not? As long as the bone does not have a circumscribed osteoporosis that can be detected by X-ray, the prospects for a successful root canal treatment are much better than otherwise. If there is already established inflammation at the tip of the root, it is also important how large the lesion is and how long the inflammation has been present.
Bacteria involved in the infection are not cultured in basic routine root canal treatment, but here too, science has reported different success rates. Different bacterial species can be killed with different success rates. Enterococcus foecalis, for example, is almost non-existent, so if you have a root canal infected with this bacterium, success is not guaranteed (this bacterium is most common in teeth that need re-rooting, but rare in first root canal treatment).
It also matters how many rooted teeth are involved. Single-rooted teeth with a single root canal are much more successful than back-rooted teeth with many root canals.
Among many other factors, the experience, training and technique of the practitioner is not the only factor. Not everything depends on the role of magnification, for example, minimum loupe magnification is required, but even better is microscopic or isolation, where also more successful treatment is cofferdam isolation, see previous point.
Also, there is an explicit role for machining techniques, root canal scoring methods and flushing protocols.
None of these techniques promises 100%, as this is not a concept that can be understood in the human body. In addition to dentistry, there are many complicating factors in the human body that do not allow for 100% success. 100% if the root canal treatment is prevented!
But if you are looking for the best, most successful treatment, it is worth looking for a specialist in endodontics (root canal treatment), who will use microscopic root canal treatment and the latest scientific methods to get the most successful treatment out of the case presented by the patient.
ndeed, a root canal tooth may be greyer than a live tooth. The technique of root canal filling, how the crown of the tooth is exposed, cleaned and filled, is important in the first place. It is important that the crown area is completely clean, both of tissue debris and of any residual root filling. Here again I would like to draw the patient’s attention to the role of magnification: with the naked eye, the small pulp chamber cannot be cleaned as thoroughly as it can be with microscopic or at least loupe magnification, i.e., with the conventional dentist working with the naked eye, there is a greater chance of discolouring material remaining in the pulp chamber.
In addition, even with maximum cleaning of the pulp chamber, the root canal tooth may be discoloured. In this case, subsequent internal tooth whitening may help the problem. It is very important here that only teeth with a well sealed filling towards the root canal can be bleached, and that no bleaching material is allowed to enter the root canal. The bleaching devices available on the internet are for external bleaching, they are NOT suitable for internal bleaching.
In many cases, after internal whitening of a root canal treated tooth, it may be necessary to reconstruct the tooth with a whiter tooth filling material. Bleaching of grey teeth can be done with very good results, here is a case study, read on! Bleaching a grey tooth.
The first question is diagnosis. Why has this tooth become diseased, why does it need root canal treatment? What is the condition of the tooth structurally – i.e. is the crown of the tooth recoverable, what about the root, is it holding the tooth stable, or does it need periodontal treatment? What is the anatomy of the root system of the tooth. How curved or straight are the canals in the root canal? What is the anatomical structure of the tooth to be treated? Are there numerous root canals, narrow hard-to-reach canals or branches.
These many questions are answered during the diagnosis and the treatment plan is decided on the basis of these answers. For diagnosis, the specialist often requests a 3-D CBCT scan for microscopic root canal treatment.
Microscopic root canal treatment allows for a more thorough and precise treatment than traditional free-angle root canal treatment, and therefore the duration of the sessions is longer. With a microscope, the specialist works more precisely and thoroughly, which is more time-consuming. At the beginning of the treatment, a cofferdam isolation must always be done, which also takes a few minutes. The highly effective rinsing agents used in modern rinsing protocols need time to work their disinfectant effect on the tooth. This is at least 40 minutes, and even longer if there are multiple root canals.
Generally speaking, the duration of microscopic root canal treatment is at least 1.5 hours per session, rather than 2 hours. Microscopic treatment usually requires 1-2 sessions for a simple root canal and 2-4 sessions for a more complex molar, especially for re-rooting.
Steps in microscopic root canal treatment
3D CBCT X-ray
Microscopic root canal treatment
With a magnification of 12.5 times, the dentist works more precisely. Ask for a microscopic root canal treatment!
More teeth saved
Bacteria in the tooth
Tooth decay without infection
The upper sixth teeth
More successful root canal treatments
A key difference
Safer and more precise
This is not a quick process!
Modern root canal concept
“The operating microscope has completely transformed the root canal process. It’s quite different to look inside a tooth with a microscope, much more detail can be seen, and the treatment of the tooth is more precise. We can remove infected tissue much more safely and there is a better chance of saving the tooth. “