Apical periodontitis

Root tip inflammation

Apical periodontitis ( inflammation of the root tip ) can occur when bacteria multiply in a tooth that is no longer vital and penetrate to the tip of the root canal. You can find all the information you need on this topic on this page:

What is root tip inflammation?
What are the causes?
What symptoms does it have?
How is it treated?
What preventive measures can I take?

What is the root tip?

The root of the tooth (lat. radix dentis) is the part of the tooth that is anchored in the jaw and is not visible. This root is conical, i.e. it tapers from the crown of the tooth to a rounded, open tip. This is where the blood vessels and nerves from the jawbone enter the tooth.

Inflammation of this entry point, i.e. the root tip, is usually preceded by inflammation of the tooth root. In most cases, this in turn has its origin in a deep caries disease that has damaged the pulp (dental nerve).

Causes: How does root tip inflammation develop?

Root tip inflammation is caused by bacteria at the root tip. These multiply in a tooth that is no longer vital, which can go unnoticed by the patient for a long time due to the lack of pain. The causes can vary.

If a tooth decay is treated too late and damages a tooth down to the pulp, in severe cases this can lead to inflammation of the tooth root. This usually leads to the death of the tooth. If this death occurs on an already damaged pulp, it is possible that the patient will not feel any major pain. If the dentist fails to treat the tooth, the bacteria can continue to damage the tooth unhindered and penetrate to the tip of the root, leading to abscesses on the gums or pus deposits. In this case, only root canal treatment can save the tooth.

However, even a root canal that has been recognized and root canal treatment can also lead to inflammation of the root tip. If the root filling is not placed up to the apex or if not all bacteria are successfully removed, the infection can migrate to the root tip despite treatment. A revision of the root canal treatment becomes necessary.
This is why high precision and the use of technical possibilities are playing an increasingly important role in endodontics. The use of dental microscopes, ultrasound measuring devices, mechanical files, etc. significantly increases the probability of success of the first root canal treatment.

Chronic apical periodontitis

Root tip inflammation can be chronic or acute. In the chronic variant, the bacteria multiply in the tooth up to the root tip, where they emerge and react with the surrounding bone tissue. The patient feels nothing of this; the clinical picture only becomes apparent to the dentist on the x-ray. It is often only a matter of time before chronic apical periodontitis turns into an acute form, which then manifests itself in severe pain in the jaw and around the affected tooth.

Therapy: Revision of root canal treatment or apicoectomy

Apicoectomy is the last resort for apical periodontitis. In our dental practice in Friedrichshain we will first try to contain the inflammation by means of root canal treatment or (if this has already been carried out but was unsuccessful) by revising it. Only if it becomes apparent that the inflammation is still present in the tissue around the root tip even after the root canal has been filled again will a apicoectomy must be considered.

This is a surgical procedure in which the doctor opens the bone of the jaw laterally and removes the inflamed part of the tooth root and the inflamed tissue surrounding the tooth. The root canals are then filled from the tip (“retrograde”). As our practice specializes in microscopic endodontics in Berlin we also perform root tip resection using a dental microscope. In this way, we can proceed with particular precision and have the best conditions for successful treatment.

Prevention: To prevent root tip inflammation from occurring in the first place

Even though there may be other causes of tooth root inflammation in rare cases, the most common cause is tooth decay. The best way to prevent inflammation at the root of the tooth is therefore to prevent tooth decay. This includes first and foremost

Thorough brushing: twice a day with the aid of dental floss and interdental brushes
Prevention: 1-2 annual check-ups to detect tooth decay at an early stage
If advised: Once a year professional teeth cleaning

If root canal treatment does become necessary, it is advisable to proceed as thoroughly as possible in order to contain the inflammation as well as possible the first time. The success rate of preserving the tooth decreases slightly with each new treatment. From this perspective, a successful first root canal treatment is the best way to prevent an unpleasant apicoectomy in the case of an inflamed tooth.