Everything about root canal treatment

What is root canal treatment?

Root canal treatment belongs to endodontic treatments. Endodontic treatments are  treatments of the inside of the tooth.

Root canal treatment preserves a tooth whose pulp is either irreversibly inflamed or dead. For this purpose, the pulp is removed from the root canal, the root canal is widened, possibly damaged dentin is removed, and last but not least, the root canal is filled.

Root canal treatment can preserve dead teeth. Currently, there is no real alternative to root canal treatment other than extraction of the tooth with appropriate dentures.

When is root canal treatment necessary?

Root canal treatment is necessary in case of inflammation of the dental pulp (pulpitis) The causes of pulpitis can be very different:

• Most often, due to damage to the tooth caused by caries, bacteria can enter the tooth and cause the inflammation
• In addition, a tooth fracture – i.e. damage to the tooth caused by an accident – may be responsible for the bacteria penetrating to the tooth nerve
• Another reason may be treatment trauma, for example when a tooth overheats during grinding (e.g. for a dental crown)
• More rarely, so-called retrograde pulpitis may occur – in this case, the cause of pulpitis is an inflamed gingival pocket and the inflammation rises above the root apex into the dental pulp

Symptoms of inflammation of the pulp are, at the beginning, increased sensitivity of the tooth to cold, and later to heat, and increasingly pain radiating at night and occurring when biting. Typically, pain-free phases alternate with painful phases. Severe pain may occur at times.

In some cases, a healthy, vital tooth must undergo root canal treatment, for example, if it is to be used as an abutment tooth for a telescopic denture and has an unfavorable position.

What is the procedure for root canal treatment?

Root canal treatment can usually be performed within one treatment session at the dentist. This takes 60 minutes on average, but can be longer or shorter depending on the complexity. During the actual treatment, the dentist proceeds in three steps:

Step 1: Access to the pulp

Root canal treatment is usually performed under local anesthesia and is therefore virtually painless for the patient.

First, a so-called rubber dam is applied around the tooth, if necessary. This serves to protect surrounding teeth.

The tooth is then drilled out to allow access to the tooth’s canal system. The access should be large enough to give the dentist a good view of the inside of the tooth, but not too large so that healthy tooth structure is not unnecessarily destroyed.

Step 2: Shaping and cleaning the tooth canals

In this step, the first step is to measure the length of the root canal or canals – this is done either on the basis of an X-ray image together with special measuring needles or electrically by so-called endometry (measurement based on the electrical resistance between the root skin and the mucosa).

To fill the sewer system, the sewer inlets are then widened and the sewer system is treated. Then the root canal or canals are widened with hand files of the special rotating elements and the inflamed tissue is removed. By flushing the channels with special solutions, impurities are removed and microorganisms are combated. In some cases, a laser is also used for disinfection. The aim is for the tooth to be germ-free.

During this step, the dentist must be very careful not to damage the tip of the tooth root.

Step 3: Filling

Finally, the root canals are filled. So-called gutta-percha (a rubber-like material) and sealing cement (sealer) are usually used for the filling.

Sometimes an immediate filling is not possible, in which case the dentist first makes a medicinal insertion and the teeth are closed with a temporary filling. The final filling is then made in another treatment session.

What should patients be prepared for during root canal treatment?

Pain only in rare cases

Patients often think of root canal treatment as being associated with severe pain. However, due to modern treatment methods and local anesthesia, this is no longer the case today.

In rare cases, severely infected tissue prevents the effect of local anesthesia, but in such cases the dentist can prepare the patient for root canal treatment with antibiotics.

High chances of success

Root canals are often finely branched, which is why root canal treatment is not always successful. Under optimal treatment conditions, in 90% of cases the tooth can be preserved by root canal treatment.

Complications and re-treatment

However, it may be more common for root canal-treated teeth to have complications. Common reasons for this are, for example, particularly stubborn microorganisms that have survived cleaning, root canal sections that are very difficult to access, a perforation of the root or fractures of the root.

In such cases, a new root canal treatment becomes necessary, which is basically the same as the first root canal treatment, but is more time-consuming, as the filling material has to be removed from the tooth and medications are often used in the tooth. Accordingly, the success rate for a repeat root canal treatment is also lower.

Apicoectomy with retrograde root filling

In some cases, an apicoectomy with retrograde root filling is necessary in addition to root canal treatment to save the tooth. This is a surgical procedure that is necessary when the root is so damaged that root canal treatment alone is not sufficient, or there is a root fracture or root resorption (breakdown of the tooth bone in the area of the tooth root).

For this purpose, the dentist gains lateral access to the root tip through the jawbone in order to shorten the root tip and possibly remove further inflamed tissue. Then the dentist cleans the inside of the root from the tip fills it. After the procedure, the jawbone heals around the root end.

What costs should I expect for a root canal treatment?

In root canal treatment, costs are often differentiated according to the number of root canals, as this determines the cost of the root canal treatment.

In Switzerland

in Switzerland, the following costs for root canal treatment can be expected:

• For one canal (anterior teeth): CHF 650 – 800
• For two canals (premolar teeth): CHF 850 – 1’300
• For three canals (molar teeth): CHF 1’100 – 1’800

In European foreign countries

It may be worthwhile to travel to other European countries for root canal treatment of (several) teeth.

Money can already be saved in Germany and Austria, where costs of between EUR 200 and EUR 1,000 can be expected for the treatment of a tooth root.

Patients can be treated particularly favorably in the Czech Republic and Hungary, where costs of EUR 50 – 300 for a root canal treatment can be expected at particularly favorable clinics. In Greece, the cost level is EUR 150 – 400 per treated tooth.

The following table provides an overview of root canal treatment costs by number of roots for the countries mentioned here:

Country	Root canal treatment 1 canal (anterior teeth)	Root canal treatment 2 canals (premolars)	Root canal treatment 3 canals (molars)
Switzerland	CHF 650 – 800	CHF 850 – 1’300	CHF 1’100 – 1’800
Germany	EUR 200 – 500	EUR 400 – 700	EUR 600 – 1’000
Austria	EUR 200 – 500	EUR 400 – 700	EUR 600 – 1’000
Greece	EUR 150 – 400	EUR 300 – 400	EUR 300 – 400
Czech Republic	EUR 50 – 300	EUR 80 – 300	EUR 100 – 300
Hungary	EUR 100 – 300	EUR 110 – 300	EUR 120 – 300

Sources: Various dental offices

Who covers the cost of root canal treatment?

In Switzerland, the basic insurance usually does not cover dental treatment costs, normally 100% of dental costs have to be paid by the patient. An exception exists if certain serious diseases of the masticatory system are present or if the consequences of serious diseases make dental treatment necessary.

Private supplementary dental insurance in Switzerland usually covers the costs of root canal treatments. Most insurance companies offer different rates with reimbursements ranging from 50% to 80%, but often there is a maximum reimbursement in a year.

In the event of root canal treatment as a result of an accident, the accident insurance will cover the costs after clarification.

Last update: December 15, 2022