Root Canal Treatment: Is Saving the Tooth Worth It?

Anna sat across from me with an X-ray showing a dark shadow at the tip of tooth six, an apical granuloma. The tooth had not hurt for a month. «Doctor, could it heal on its own?» she asked. No. An apical granuloma is a chronic infection in the bone that slowly destroys it. A silent disaster eating away the years. The question was simple: save the tooth through root canal treatment, or extract and place an implant?

I always try to save the natural tooth. It has a periodontal ligament with proprioception, it feels biting forces and temperature correctly. Implants are a great technology, but not a full replacement. They are fused directly with the bone, with no shock absorption. If I have a chance to save the natural tooth, I choose root canal treatment. For Anna I did the treatment. Eight months later the follow-up X-ray showed the granuloma had disappeared. The tooth has been working normally for the third year now.

Why root canal treatment is needed

Inside every tooth is the pulp: nerves, blood vessels, connective tissue. When bacteria penetrate through deep decay, a crack, or trauma, pulpitis or apical periodontitis develops. Goal of treatment: remove infected pulp, mechanically and chemically clean canals, seal hermetically.

Treatment steps

1. X-ray diagnostics. number of canals, shape, apical infection
2. Anaesthesia. pain-free even with active inflammation
3. Rubber dam. isolation required by modern standards
4. Instrumental shaping. NiTi rotary files for curved canals (private add-on)
5. Irrigation. sodium hypochlorite eliminates bacteria
6. Obturation. canals sealed with gutta-percha
7. Restoration. crown mandatory for multi-rooted teeth

What GKV covers

GKV covers root canal treatment under BEMA standards:

• Basic endodontic treatment (manual or standard rotary instruments)
• X-rays within the treatment
• Temporary and permanent canal filling

Private add-ons (not GKV-covered):

• Dental microscope. significantly better visibility and precision. Additional cost: €150–400 per tooth
• CBCT (3D X-ray). for complex anatomy, retreatments: €80–180
• Retreatment of a previously filled canal. GKV only partial coverage

When extraction is the better choice

• Vertical root fracture (Längsfraktur), an absolute indication for extraction. Root canal cannot save a fractured tooth.
• Bone loss over 2/3 of root length due to periodontitis. The tooth will not last long even after successful endo.
• Retreatment has failed twice. A third attempt has low odds.
• Implant costs less when the natural tooth's prognosis is doubtful.

After treatment, the tooth will need a crown, a non-vital tooth becomes brittle.

Treatment step by step

Standard protocol in my practice:

1. Diagnostics (15-30 minutes). Examination, tests (thermal, percussion, vitality). X-ray. With complex anatomy, CBCT (3D). Heil- und Kostenplan, agreement with the patient on cost and techniques.
2. First session (60-90 minutes). Local anaesthesia, rubber dam isolation. Caries removal, access to the pulp. Pulp removal with NiTi files. Irrigation with sodium hypochlorite 5.25 percent plus EDTA. Calcium hydroxide dressing inside (antimicrobial for 7-14 days). Temporary filling on top.
3. Second session (60-90 minutes) after 1-2 weeks. Symptom check. If pain-free, final obturation: canal filled with gutta-percha and sealer. Follow-up X-ray. Temporary filling on top.
4. Third visit after 2-4 weeks. Remove the temporary, place a permanent filling or prepare for the crown.
5. 4-6 weeks later: the crown. Fabrication and bonding of the permanent crown. This is the key step. Without a crown, the root canal will fail within 2-3 years.
6. 6-12 month follow-up. An X-ray verifies the granuloma has resolved and the bone is healthy near the apex.