Root canal treatment

 

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My own teeth – for all my life

Your teeth should last your whole life time. Due to diseases or accidents, yourteeth or their roots may become damaged and an endodontic treatment,also called root canal treatment, might be necessary.What exactly is an endodontic treatment? What will happen to me? These and more frequently asked questions on endodontics will be answered in the following pages, illustrating how worth your while it is, to conserve your teeth.

Why would I need an endodontic treatment?

The soft tissue in a tooth is called dental pulp. It consists of nerve fibers, blood and lymphatic vessels and connective tissue. The pulp may become inflamed and infected by bacteria due to a deep-seated cavity, a crack in the tooth, a broken off tooth or a gap between tooth and filling. The tooth may react to cold or heat causing sudden or lasting pain. Nevertheless, the infection could also stay unnoticed until discovered on an x-ray or during a sensitivity test while at your dentist.

If the inflammation is not treated, bacteria might destroy the entire dental pulp and spread into the jaw-bone causing bone-loss, purulent inflamma-tion, weaken the general immune system or trigger diseases in other parts of the body.

The only possibility to permanently keep the in-flamed tooth without risk of disease is through endodontic treatment (from the Greek endo ‘inside’ and odons ‘tooth’), i.e. a root canal treatment. To-day, a root canal treatment will save a tooth which formerly could not have been saved.

What is an endodontic treatment?



Opened crown from above

Root canal treatment is a procedure that can save a diseased and infected tooth for many years to come. First, the dentist removes the infected or dead nerve tissue. Then the hollow space in the root is cleaned and disinfected thoroughly to the tip, eliminating bacteria and other germs. The canals are then filled and sealed, minimizing the risk of new infection. 

Root canal treatment may take one or several visits. The sequence is usually as follows:

What actually happens in detail?

1. Opening the tooth
First, the tooth to be treated is numbed. With a rubber dam, it is isolated to prevent saliva from reaching the tooth and rinsing solution from entering the oral cavity. When the dentist has opened the tooth, the canal entrances must be found and accessed and the pulpa has to be removed thoroughly. For the treatment to be successful, it is important to find all canals so the bacteria can be removed. Optical magnification with a dental loop or microscope can be very helpful in the search.

2. Determining the canal length
For optimal cleaning, the length of the root canal must be determined correctly. In addition to the traditional x-ray imaging, modern computer assisted electrical devices are available to ascertain the root canal length with precision that x-rays alone are not able to achieve.


3. Cleaning the root canals
Once the length of the root canals is determined, they are either cleaned with very fine hand instruments or very flexible rotary instruments made of a nickel/titanium alloy. The highly flexible nickel / titanium instruments make it possible to treat even complex and strongly bent canals. This modern preparation method provides treatment results of a quality unthinkable just a few years ago. Thanks to these instruments, endodontic treatment, one of the most difficult procedures in dentistry, becomes easier, safer and more predictable.


4. Disinfecting the root canals
During and after root canal preparation, the root canals will be thoroughly cleaned with disinfecting solutions. The efficiency of these solutions may be increased with ultrasonic activation.

5. Filling the root canals
There are several methods and materials for filling the root canals. In most cases gutta-percha, a natural and elastic material, is used in combination with an adhesive. Warm gutta-percha is introduced into the canal to fit the canal anatomy and to fill the hollow spaces and lateral canals. Gutta-percha may also be introduced in the canal coldly. It is important to completely and hermetically fill the canals to prevent bacteria from re-entering and causing a new infection.

6. Sealing the tooth
Once the root canals are filled, the opening in the crown of the tooth will be sealed with a stable and dense filling.

Electronic length determination

Apex locator with touch and zoom for high-precisely length-determination

Will I feel pain during or after the treatment?
Today’s modern techniques and anesthetics allow almost always for pain free treatment. In rare cases, the tooth may be tender for a short time after the treatment. If necessary, a painkiller will help relieve the pain. If the pain gets stronger or persists, please contact your dentist.

What happens with my tooth after the treatment?
A root canal treated tooth needs to be checked regularly by your dentist. Under too much stress, many root canal treated teeth have a higher risk of breakage. Therefore, it may be necessary in some cases to provide the tooth with a full or partial crown. Especially when a tooth has only little tooth substance left over, a core build-up with a root post might be recommendable.

What is the lifespan of a root canal treated tooth?
According to the German Society for Conservative Dentistry, the expected success rate for long-term conservation of a root canal treated tooth is 95% when the initial treatment was uncomplicated. In more complex cases or when a treatment must be repeated (retreatment), the expected success rate is still indicated at 80%. Modern treatment methods and techniques will help your dentist to establish the best possible prognosis for your teeth. Nevertheless, no medical treatment is able to guarantee a 100% success rate. Your dentist will inform you about your individually expected success rate.

What are the alternatives to endodontic treatment?
The alternative to root canal treatment would be the removal of the tooth. A missing tooth might cause difficulties such as tooth migration, change of bite or cosmetic problems. The tooth must be replaced either by an implant, a bridge or prosthesis to restore chewing function and to prevent mal-positioning of the neighbouring teeth. These methods have inherent disadvantages. Therefore, replacing will never compare to the benefit of saving your own tooth, no matter how modern the method. Furthermore, in many cases, endodontic treatment is significantly more cost effective.

How much will the treatment cost?
Costs for a root canal treatment depend on the anatomy of the tooth, the number of canals and what materials and devices will be used. Your dentist will be pleased to advise you and inform you in detail about the costs to be incurred.

Electronic length determination

Important facts regarding root canal treatment
Before instrumentation or placement of a filling, the exact root canal length needs to be determined. This is particularly important since only a root canal filling which reaches up close to the root canal tip will be able to preserve your tooth long-term. If the filling is too short, bacteria would remain within the tooth. If, however, the filling is too long, the bone might suffer and an inflammation might occur.

Problems with the traditional measuring method
A few years ago, radiographs were the only option to determine the exact root canal length. Since, however, a radiograph is merely a two-dimensional picture of a three-dimensional root canal, the exact determination of the root canal length was often difficult. This results in inadequate root canal treatment. 

Electronic length determination - an advanced measuring technique
Due to the introduction of so-called electronic length determination devices, a measuring technique is now available permitting a more precise determination of the root canal length compared to traditional radiographs. The RAYPEX®6 electronic length determination device enables the dentist to determine the exact position of the apex via impedance measurement. This, in turn is the basis for a successful root canal treatment.

Thanks to this modern measuring device, the number of radiographs necessary during the treatment may be reduced.

Results of scientific studies
Moscoso S., Pineda K., Basilio J., Alvarado C., Roig M., Duran-Sindreu F.
"Evaluation of Dentaport ZX and Raypex 6 Electronic Apex Locators: An In Vivo Study."

Simple cases (no need for bone grafting) can be done in as few as four appointments

1. First visit involves a comprehensive consultation including medical history, clinical inspection, x rays, DVD scans and implant simulation. A detailed treatment plan including a breakdown of costs and schedule will be made.

2. At your 2nd visit implant placement and temporary restoration will be done.You will never leave our practice without temporary teeth whilst the implant osseointegrates (fuses to your bone). In a conventional implant procedure a healing abutment (unsubmerged healing) or cover screw (submerged healing, below the gums) is put on the implant. In immediate loaded implants a temporary crown is loaded onto the implant right after the implant placement (see immediate implantation).

3.The osseointegration phase (the healing in phase of your implants) takes around 3 months (complex cases involving bone or soft tissue replacement take longer).
At your 3rd visit we will take impressions which allow our technician to make your final implant supported tooth.

4. At your final visit your implant supported tooth (fixed implant crown) will be integrated (fine tuned) to your bite and mastication.

Replacing a single tooth

If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.


Replacing a single tooth with a single implant and a crown

Main benefits

  • A fixed, stable & secure solution
  • A long-lasting solution, often for life
  • Healthy, neighbouring teeth are not part of the reconstruction like in a bridge

Installing a single tooth implant most times falls in the category of simple implant cases.

Replacing multiple teeth

If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

Main benefits of implant bridges

  • A fixed, stable & secure solution
  • A long-lasting solution, often for life
  • Healthy, neighbouring teeth are not part of the reconstruction like in a bridge
  • Dental implant bridges are the only fixed alternative in situations where no teeth are present in the molar region (free end gap) or where no natural neighbouring teeth are suitable as abutments (anchoring teeth) for a fixed bridge


First visit
involves a comprehensive consultation including medical history, clinical inspection, x-rays, DVD scans and implant simulation. A detailed treatment plan including a breakdown of costs and schedule will be made.


Typical free end gap situation


At your 2nd visit implant placement and temporary restoration will be done.You will never leave our practice without temporary teeth whilst the implant osseointegrates (fuses to your bone). Implant bridges are normally done in a conventional implant procedure where a healing abutment (unsubmerged healing) or cover screw (submerged healing, below the gums) is put on the implant. Immediate loaded implant bridges, where a temporary bridge is loaded onto the implant right after the implant placement, can only be done if multiple implants have been placed.


The osseointegration phase (the healing in phase of your implants) takes around 3 months (complex cases involving bone or soft tissue replacement take longer).
At your 3rd visit we will take impressions which allow our technician to make your final implant supported teeth.

At your final visit your implant supported teeth (fixed implant bridge) will be integrated (fine tuned) to your bite and mastication.


Screw retained implant bridge


Cemented implant bridge

Replacing all your teeth

If you are missing all of your teeth, an implant-supported full arch bridge or implant retained full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

Before the availability of dental implants - replacing all your teeth - meant removable full dentures. Dental implants are the solution that your next set of teeth are permanently fixed and look and feel like natural teeth. The placement of multiple strategical positioned implants around the jaw form the foundations for a full set of beautiful fixed teeth.

Each case must be carefully planned and considered on an individual basis. The amount and quality of bone must be measured with the help of DVD scans. In case of atrophied jaws (bone loss), the direction of any bone and soft tissue loss must be carefully evaluated. Availability of bone will finally decide the number of implants and implantation techniques, as well as the material and reconstructive kind of your new teeth.

Main types of full arch implant supported teeth replacement:

A) Full arch fixed implant supported bridge
B) Implant retained overdentures
C) All on 4 concept

 

 

full arch fixed implant supported bridge

For dental implants with dental bridges - the dental implants act as new tooth roots with a fixed dental bridge over these dental implants. With this dental implant teeth option - it is similar for the patient to having a new set of teeth, only this time on implant posts.

Main benefits of full arch implant bridges

  • A fixed, stable & secure solution
  • A long lasting solution, often for life
  • no more loose dentures, especially in the mandible (lower jaw) – improved quality of life
  • Full arch dental implant bridges are the only fixed alternative in situations where no teeth are present for anchoring.

A full arch fixed implant bridge is the closest to natural teeth and over time will just feel like natural teeth. They will provide you the comfort and natural look like a full set of natural teeth.

 

 

Implant retained overdentures

An implant-supported overdenture is a full denture that is supported by a variable number of dental implants.
Especially in lower jaws or highly bone atrophied upper jaws full dentures that only rest on the gums, where no supporting teeth are left, tend to fit less firmly and come loose easily.
Implant supported overdentures are provided with special attachments that retain them on implants providing more stability and therefore a more carefree life with dentures.

Benefits of Implant retained Dentures

  • Implant retained overdentures provide you with more stability in comparison to conventional dentures
  • allows you to eat nearly all kind of food and avoids uncomfortable situations while speaking
  • upper jaw overdentures no longer have to cover the palate of your mouth
  • dental implant overdentures are the financially economic alternative in comparison to full fixed bridges


Types of Implant Supported Overdentures

Basically there are two types of implant retained overdentures - dental implants with a bar or ball overdenture. The overdenture is removable and can be cleaned.

Bar-retained: The normally placed implants are connected by a thin metal bar that follows the curve of your jaw. A minimum of two (up to five implants) have to be inserted in your jawbone – the more implants the better the resulting stability of your denture. Various other attachments can be fitted into the bar to heighten denture stability.


Ball-retained:
The inserted implants are fitted with ball shaped or similar attachments that fit into the counterpart in the overdenture.

 

 

all on 4 concept

The All on 4 dental implant treatment is a revolutionary cost-effective technique that enables us to replace all your teeth with just 4 implants.
It has been developed for patients who lack sufficient bone volume and are not willing to undergo a cost and time consuming bone grafting procedure prior to implant placement.
The All on 4 makes maximum use of your bone in the anterior jaw and by tilting the two posterior implants at a 45° angle an immediate function prosthesis can be provided on the same day – also known as 'teeth in one day'.

Who benefits most from All on 4

  • Patients who have loose fitting full or partial dentures, due to severe lack of bone, will get back a quality of life like with a full set of natural teeth - for most patients an overwhelming, positive experience.
  • Patients with severe periodontitis affected teeth
  • Patients with only a few badly infected/decayed teeth left

What means 'Teeth in a day':


The All on 4 immediate function technique can be done in one day:

  • remaining teeth can be extracted before implant placement (all in one surgery)
  • fixed (non removable) acrylic provisional denture is provided on the day of the surgery

The all on 4 bridge/denture replaces not only your teeth (like in a fixed implant bridge in patients with an abundant bone situation) but also your missing jaw bone and gums (the pink part of the bridge).

If indicated a guided surgery can be done

The provisonal acrylic bridge of the surgery day should be replaced after a healing in time (osseointegration of your implants) of about 3 - 6 months by a definitve long term all-on-4 bridge solution. The better the material of the reconstructive solution - the better can be created a look and feel like sensation like with natural teeth – starting from a metal reinforced high impact acrylic bridge, to solutions involving titanium and zirconium hybrid bridges.

All on 6 dental implants: the same as all on 4 but with one additonal implant in the pterygoid region of the upper jaw.

Immediate replacement

After the loss of a tooth or multiple teeth the supporting tissues like bone and gums begin to diminish rapidly. In the first 3 months the biggest soft and hard tissue reorganization takes place – therefore the longer implant placement is postponed the more tissue gets lost. That's why it is normally best to replace teeth that need to be extracted immediately or after 4 to 6 weeks with dental implants when no socket preservation (see bone grafting) is done.
Since the first introduction of implants into dentistry, technology (implant thread design and surface texture) and our understanding behind implant osseointegration has changed dramatically. Given good bone conditions - modern implants, in many cases, can be loaded immediately (to place a crown on the implant) following implant placement.

This means teeth straight away after implant placement or also known as teeth in a day.

In most immediate dental implant cases an immediate tooth replacement by a temporary crown can be achieved.

Of course, careful evaluation of bone quality and quantity must be done in every single case, but immediate placement and restoration with a crown is done nowadays much more often than in the past.

Advantages of immediate replacement:

  • realisation of your desire to fill gaps as soon as possible
  • usually better gum management around dental implants
  • only one surgical appointment
  • often a less invasive surgery, which allows for quicker healing

Dental implant bone grafting & Dental implant soft tissue grafting

When teeth are lost, the bone and gums around them begin to diminish rapidly. Successful and long lasting implants require sufficient bone and healthy soft tissues/gums at the dental implant placement site. Bone volume can be affected by various factors but especially periodontitis, acute infections and the length of time after the loss of teeth are most critical.

The longer you wait before implant placement the more bone volume shrinks – especially in the aesthetic anterior region the inherent loss of gums can be irreversible.

As the needs of each person are different so each dental case/situation can be different. A critical and careful evaluation of the hard and soft tissues at missing teeth sites is essential for successful implant prosthetics.
Bone and soft tissue grafting techniques basically encourage the growth of bone and soft tissue where they have been lost. Bone grafting provides an optimum foundation for your dental implants and is essential in cases where aesthetics are most important.

REGENERATE WHAT HAS BEEN LOST

There are many grafting methods and materials to achieve a natural and long lasting result.
The idea behind any bone graft or transferred soft tissue graft is that it is eventually replaced by your own tissue to help support the foundations for your new teeth.

Soft tissue grafting is basically practised to optimize your gums around dental implant crowns. We want to see gum tissue (keratinized soft tissue that is naturally found on your palate and around your natural teeth) around your implants. Soft tissue grafts, either free gingival grafts or connective tissue grafts, are harvested from your tuberosity or palate. There are also various materials available that help to regenerate stable perimplant soft tissues.

Dental implant bone grafting is mainly used:

  • to create new bone volume in defecient bone sites before or simultaneous with implant placement
  • as a socket preservation immediately after extraction in order to prevent further bone loss
  • to graft around implants in order to fill gaps or smaller defeciencies

There exist various types of bone grafting materials:

  • Autogenous bone: bone harvested from other intraoral areas like the tuberosity, minimally invasive near the implantation site, the chin or in severe cases out of practice from the hip bone
  • Xenografts: bone substitute processed from other species (bovine, …) most evidence based and most often used in our practice. For further information see also the most popular brand Bio Oss http://www.geistlich-na.com/en-us/
  • Barrier membranes (often xenografts) are used to guide the generation of new bone and allow maturation of new bone by blocking out other faster growing cells from the regeneration site (epithelial and connective tissue cells)
  • Alloplastic or synthetic bone graft materials: various materials with different resorbing times are successfully used here – normally some type of calcium phosphate
  • Autotooth bone: grafting material processed out of your extracted teeth– very promising but we wait for more long term evidence – soon to come in our practice
  • Allografts: bone substitute material processed out of the human species – various types eg demineralized freeze dried bone

Most often used types of bone grafting techniques in our practice:

  • GBR (Guided Bone Regeneration) / Barrier Membrane Technique
  • (see above: xenograft barrier membranes ), various kinds of membranes exist – most are resorbable like for example collagen membranes like BioOss or have to be removed at a later date
  • Block bone grafts: (see also above: autogenous bone) are only done in cases of severe atrophy of the jaw bone – not only bone blocks are transferred here, various mixed techniques exist
  • Sinus lift: The most often done bone augmentation in our practice for patients who wish for fixed teeth solutions and have not sufficient natural bone left in the posterior region of the upper jaw. The maxillary sinus (a paranasal sinus) is situated right above your upper molar teeth and if there is not sufficient bone left below the sinus an implantation is not possible without sinus augmentation. There are basically two different approaches (depending on the height of your natural bone left subantral (below) the sinus): the lateral (from the side of the sinus) and the percrestal or internal sinus lift where access is done over the implant site.


For full arch missing teeth, graftless dental implant solutions are available:

  • Allon 4 dental implants (see all on 4)
  • All on 6 dental implants: the same as all on 4 but with one additonal implant in the pterygoid region of the upper jaw

Full arch fixed implant supported bridge

For dental implants with dental bridges - the dental implants act as new tooth roots with a fixed dental bridge over these dental implants. With this dental implant teeth option - it is similar for the patient to having a new set of teeth, only this time on implant posts.

Main benefits of full arch implant bridges

  • A fixed, stable & secure solution
  • A long lasting solution, often for life
  • no more loose dentures, especially in the mandible (lower jaw) – improved quality of life
  • Full arch dental implant bridges are the only fixed alternative in situations where no teeth are present for anchoring.

A full arch fixed implant bridge is the closest to natural teeth and over time will just feel like natural teeth. They will provide you the comfort and natural look like a full set of natural teeth.

Implant retained overdentures

An implant-supported overdenture is a full denture that is supported by a variable number of dental implants.
Especially in lower jaws or highly bone atrophied upper jaws full dentures that only rest on the gums, where no supporting teeth are left, tend to fit less firmly and come loose easily.
Implant supported overdentures are provided with special attachments that retain them on implants providing more stability and therefore a more carefree life with dentures.

Benefits of Implant retained Dentures

  • Implant retained overdentures provide you with more stability in comparison to conventional dentures
  • allows you to eat nearly all kind of food and avoids uncomfortable situations while speaking
  • upper jaw overdentures no longer have to cover the palate of your mouth
  • dental implant overdentures are the financially economic alternative in comparison to full fixed bridges


Types of Implant Supported Overdentures

Basically there are two types of implant retained overdentures - dental implants with a bar or ball overdenture. The overdenture is removable and can be cleaned.

Bar-retained: The normally placed implants are connected by a thin metal bar that follows the curve of your jaw. A minimum of two (up to five implants) have to be inserted in your jawbone – the more implants the better the resulting stability of your denture. Various other attachments can be fitted into the bar to heighten denture stability.


Ball-retained:
The inserted implants are fitted with ball shaped or similar attachments that fit into the counterpart in the overdenture.

All on 4 Implants Concept

The All on 4 dental implant treatment is a revolutionary cost-effective technique that enables us to replace all your teeth with just 4 implants.
It has been developed for patients who lack sufficient bone volume and are not willing to undergo a cost and time consuming bone grafting procedure prior to implant placement.
The All on 4 makes maximum use of your bone in the anterior jaw and by tilting the two posterior implants at a 45° angle an immediate function prosthesis can be provided on the same day – also known as 'teeth in one day'.

Who benefits most from All on 4

  • Patients who have loose fitting full or partial dentures, due to severe lack of bone, will get back a quality of life like with a full set of natural teeth - for most patients an overwhelming, positive experience.
  • Patients with severe periodontitis affected teeth
  • Patients with only a few badly infected/decayed teeth left

What means 'Teeth in a day':


The All on 4 immediate function technique can be done in one day:

  • remaining teeth can be extracted before implant placement (all in one surgery)
  • fixed (non removable) acrylic provisional denture is provided on the day of the surgery

The all on 4 bridge/denture replaces not only your teeth (like in a fixed implant bridge in patients with an abundant bone situation) but also your missing jaw bone and gums (the pink part of the bridge).

If indicated a guided surgery can be done

The provisonal acrylic bridge of the surgery day should be replaced after a healing in time (osseointegration of your implants) of about 3 - 6 months by a definitve long term all-on-4 bridge solution. The better the material of the reconstructive solution - the better can be created a look and feel like sensation like with natural teeth – starting from a metal reinforced high impact acrylic bridge, to solutions involving titanium and zirconium hybrid bridges.

All on 6 dental implants: the same as all on 4 but with one additonal implant in the pterygoid region of the upper jaw.

Dental Implants

Today missing teeth in the anterior or posterior region of the jaw can be replaced safely and long lasting with implants.


Without dental implants, missing teeth have to be replaced with removable dentures and bridges on neighbouring teeth. But with dental implants healthy neighbouring teeth remain intact.

Do you want only fixed teeth?

Implants are the solution that allow me to provide you with a reliable long-term fixed solution for missing teeth.
With state of the art dental implant procedures it is now often possible to remove a hopeless tooth and insert an implant in just one surgical procedure (see immediate implantation) and replace the missing crown immediately (immediate loading).

Advantages of Dental Implants

  • Your healthy, neighbouring teeth do not have to be treated
  • Implants or implant crowns and bridges are fixed and do not need to be removed
  • Removable dentures are often the cause of embarrassement – not implant retained dentures
  • Feel save while speaking and eating – sometimes a real challenge with removable dentures
  • The cost of a single implant restoration is comparative to having a 3 unit bridge
  • Dental implants are a long term solution – most often a life long solution with the right after care (see implant prophylaxis / professional implant cleaning)
  • A predictable restoration technique

our SERVICES

Loupes / Microscope

Oral hygiene and prophylaxis

DIAGNOSTICS

Dental implamants and bone augmentation

Oral surgery and tissue regeneration

Plastic - Aesthetic gum surgery

Ceramic crown - bridge technique

Filling and tooth reconstruction techniques

Prosthodontics

Focal therapy

Aesthetic dentistry

Periodontitis Treatment

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CONTACT

Altgasse 25a, 1130 Vienna
+43 (0) 1 8775542

Office hours:
Mo - Tue + Thur - Fr from 9am to 6pm

Make an appointment:
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and from 2pm to 5pm
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Garage: Auhofstraße 8, or Zufahrt Hietzinger Kai 11-13, 1 minute walk