Revision of a Root Canal Treatment in Berlin Mitte

Revision

A tooth that has already been treated does not have to be extracted straight away. If a root-treated tooth starts hurting again, that is no reason to give up on it. In a revision, we reopen the tooth, remove the old root filling and clean the canal system thoroughly once more.

Cases like these are our everyday work. We work under the surgical microscope throughout, because in a revision the decisive spots are often the ones that were missed the first time.

Many patients come to us for this on referral from their own dentist. After the revision, their care continues there. For dentists, we have described how we work together on a separate page.

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Pain in a root-treated tooth

Symptoms in a root-treated tooth sometimes appear after weeks, sometimes only after years.

Typical signs are

sensitivity to pressure or pain when biting
a dull throbbing that comes and goes
swelling or a feeling of pressure in the gum
a tooth that feels different than it used to

Just as often, though, a renewed inflammation goes unnoticed. It sits at the root tip, does not hurt and only shows up on an X-ray as a dark area in the bone. That is why we check root-treated teeth at every check-up.

Causes of a renewed inflammation

A root canal system is rarely as straight as it looks on the X-ray. It branches, curves and sometimes ends in canals that are hard to find. That is usually where a first treatment fails.

The most common causes

a canal was missed and therefore never treated
the root filling ends too far short of the root tip
the disinfection did not reach bacteria in lateral canals
a leaking crown or new decay let bacteria back into the tooth

In all four cases, bacteria remain in the tooth or find their way back in. They multiply. Around the root tip, an inflammation develops again.

How a revision treatment works

Much of it works like the first root canal treatment, from anaesthesia to the tight seal.

01 Assessment

We examine the tooth on the X-ray. If the roots are curved, we additionally take a 3D image.

02 Removing the old filling

We remove the old filling material from all canals. If there is a post in the tooth, it has to come out as well.

03 Cleaning and disinfecting

Now we look for missed canals, enlarge them down to the root tip and rinse the entire system.

04 Resealing

Finally, we refill the canals and seal the tooth so that no bacteria can get in.

Step 3, however, makes a revision take longer than a first treatment. We remove the old material in small portions and check constantly under the microscope so that we do not lose any healthy tooth structure.

Chances of success of a revision

The German Society for Conservative Dentistry (DGZ) puts the success rate of a revision at over 80 percent. That is less than for a first treatment, but still considerably more than many expect.

It is worth comparing this with the alternative. An extracted tooth needs replacing later, usually with an implant. That is more involved and more expensive. Your own tooth sits flexibly in the jaw via the periodontal ligament and preserves the bone around it. As long as we can save it, we advise doing so.

And if the inflammation does not heal?

Sometimes the inflammation at the root tip does not heal despite a thorough revision. Then a small surgical procedure can help, an apicoectomy. We do not carry out this treatment ourselves; we refer you to a specialised practice for it and coordinate with our colleagues there.

If the tooth cannot be kept even then, we take our time to discuss with you how the gap will be restored.

Duration and cost of a root canal revision

Expect one to two sessions of one and a half to two hours each. With heavily calcified canals or a firmly seated post, a third appointment may be needed. Between sessions, the tooth receives a medicated dressing.

The cost depends on how much effort it takes to remove the old filling. We assess that after the examination, and you receive a cost estimate in advance.

German statutory health insurance covers a revision if the tooth is considered worth preserving under its guidelines. Anything beyond that, such as working under the surgical microscope, is billed privately. If you are privately insured or have supplementary insurance, reimbursement depends on your plan.

Frequently asked questions about revision

What patients often ask us

What happens if I do nothing?

The inflammation keeps spreading in the bone around the root tip. At some point pain and swelling follow, and by then the tooth usually can no longer be saved.

Why is a revision more expensive than the first treatment?

Because there is an additional step. The old filling material and any root posts have to come out before we can even start cleaning. This part often takes longer than the actual treatment.

How do I know whether my tooth needs a revision?

Only an X-ray can tell for certain. Discomfort when biting or swelling are clear signs, but an inflammation at the root tip can also be completely painless.

Kann jeder wurzelbehandelte Zahn revidiert werden?

Meistens ja. Es kommt darauf an, wie viel gesunde Zahnsubstanz übrig ist, wie der Knochen um die Wurzel aussieht und ob sich die alte Füllung entfernen lässt. Nach der Untersuchung sagen wir Ihnen, ob sich der Versuch lohnt.

Ist eine Revision schmerzhaft?

Nein. Wir betäuben den Zahn, Sie spüren während der Behandlung nichts. Weil bei einer Revision oft eine Entzündung im Spiel ist, kann der Zahn danach ein paar Tage druckempfindlich bleiben.

Was bedeutet Revision bei einer Wurzelbehandlung?

Revision heißt, dass wir eine bereits durchgeführte Wurzelbehandlung wiederholen. Wir entfernen die alte Wurzelfüllung und reinigen das Kanalsystem erneut. Danach verschließen wir den Zahn wieder dicht.