ENA tooth aches at night or reacts to heat, an abscess has formed, or a dentist at home suggests extracting a tooth that still sits firmly. Root canal treatment in Germany aims to keep your own tooth where that is realistic.
The inflamed or dead nerve is removed from inside the tooth, and the canals in its roots are cleaned and tightly sealed. Below: when the treatment is needed, how it is done, retreatment and root tip surgery, cost, where to go and how AlenMed arranges the trip.
When a root canal treatment is needed
A root canal treatment is needed when the pulp, the nerve inside the tooth, is inflamed or dead. Deep decay that reaches the nerve causes pulpitis, an inflammation of this soft tissue of blood vessels and nerve fibres. The nerve can also die after an injury or under an old large filling, and inflammation can develop at the root tip. Typical complaints are lingering pain from hot or cold, pain at night or on biting, and swollen gums. A dead nerve may stop hurting, yet bacteria remain in the canal and keep damaging the bone at the root tip, sometimes unnoticed.
Diagnosis rests on an examination, a sensitivity test and an X-ray; in complex cases, such as unusual canal anatomy, a cone beam CT of the jaw is added. A tooth with a crack running down the root or with too little of it left cannot be saved, and the dentist then discusses extraction and replacement honestly; see dental treatment in Germany.
How the treatment is done
Treatment starts with local anaesthesia, and the tooth is isolated with a rubber dam (Kofferdam), a thin elastic sheet held by a clamp so that only the tooth shows. Saliva is full of bacteria, and the dam keeps it out of the open canal, so infection is not carried back in.
The dentist works under an operating microscope, which reveals even fine extra canals, and measures the length of each canal electronically so that it is cleaned right to the tip. The canals are shaped with fine instruments, disinfected with rinsing solutions and tightly sealed. Depending on the tooth, this takes one or several sessions, with a temporary filling in between.
A root-filled tooth breaks more easily, especially when little of it remains, so a crown or partial crown is often advised afterwards; see prices for dentures and crowns.
Retreatment and root tip surgery
If an earlier root filling fails, the old filling is removed and the canals are cleaned again; this is called revision. It is more demanding than a first treatment: narrow or curved canals may not have been fully cleaned, an extra canal may have been missed, and a crown may have to come off first. Revision therefore usually takes more time, as the patient information of the German Society of Endodontology and Dental Traumatology (DGET) explains.
When retreatment through the tooth is not possible, for example because a canal has calcified, root tip surgery (Wurzelspitzenresektion) is the option: working through the gum, the surgeon removes the tip of the root with the inflamed tissue and seals the canal from the tip. It is done by oral surgeons, and the dentist assesses the chances after imaging.
What the treatment costs and what the price depends on
The cost of root canal treatment in Germany for self-paying patients is calculated under the official dentists’ fee schedule, the GOZ. Each step is a separate item: preparing, measuring and filling each canal, medication between sessions, a temporary filling. The dentist multiplies the rate of each item by a factor from 1 to 3.5; 2.3 reflects average difficulty, and a higher factor is allowed only where difficulty, time or circumstances justify it (§ 5 GOZ).
The total depends on the number of canals, as a front tooth has fewer than a molar and the GOZ charges per canal; on the microscope, which carries a GOZ surcharge; on retreatment instead of a first treatment, which takes more time; and on imaging, the number of sessions and the crown afterwards.
Before treatment the practice issues a written treatment plan with a cost estimate, the Heil- und Kostenplan. Compare estimates by their items, not by the total. There is no price list here: without an examination any figure would be unverified; see root canal treatment prices.
Frequently asked questions
Is root canal treatment painful?
Usually hardly, because the tooth is numbed with local anaesthesia. According to the German Society of Endodontology, most patients treated with modern techniques and anaesthesia report having felt hardly anything. For the first few days the tooth may be sensitive or feel different from its neighbours, which generally passes. If pain grows or swelling appears, contact the dentist.
How many sessions does it take, and can it fit into one trip?
Usually one or two sessions; retreatment and complex canals take longer. In between, the tooth has a temporary filling. The dentist estimates the number of sessions from your X-rays before the trip and confirms it after the examination. If a crown is needed afterwards, it is also planned into the trip.
Can a tooth be saved if a dentist at home advises extraction?
Often it can: if the root is intact and enough of the tooth remains, root canal treatment can keep it. The German Society of Endodontology warns that many teeth are extracted although endodontic treatment could have saved them. A root cracked lengthwise, however, means extraction. X-rays and reports sent in advance let a dentist in Germany judge the chances.
Where to go and how AlenMed arranges treatment
Root canal treatment is part of restorative dentistry, and complex cases and retreatment are handled by dentists with a specialist qualification in endodontics, the field dealing with the inside of the tooth, and at university dental centres. Charité Berlin has a department of restorative, preventive and paediatric dentistry, and there are dental centres at the University Hospital Hamburg-Eppendorf and the University Hospital Dresden.
Before travelling, AlenMed translates X-rays and reports and, where needed, arranges a video consultation; the dentist estimates the number of sessions so that the trip can be planned. We book appointments, obtain the cost estimate, prepare the visa invitation and arrange accommodation and an interpreter. AlenMed’s office is in Munich; see arranging treatment in Germany.
After treatment the patient receives records in their own language and care advice, and AlenMed helps to reach the dentist if pain returns.
This material is for reference only and is not an offer; the treatment plan is set by the dentist at an in-person appointment.