Tooth Preservation in Dortmund: When the Microscope Decides
Your Tooth Is Not Lost. It Needs the Right Tool
Every year, around 7 million root canal treatments are performed in Germany (Source: KZBV Statistical Yearbook, 2023). Behind that number are 7 million teeth that someone wanted to keep. Teeth that hurt, that are inflamed, or where a previous dentist has already attempted treatment. In moments like these, patients sometimes hear the sentence: "That one has to come out."
Often, that is not true. It is especially not true when the treatment takes place under an operating microscope.
At Pul's Zahnmedizin in the WiloHealthCube at Wilopark 15 in Dortmund, tooth preservation is not an empty phrase but the core principle of our work. Our practitioner, who specializes in endodontology, works exclusively with one of the most precise dental microscopes available today. In this article, we explain step by step what that means for you as a patient.
Why Your Own Tooth Is Always the First Choice
"The preservation of the natural tooth always takes precedence over extraction followed by implant placement. Modern endodontic procedures under the operating microscope achieve success rates that justify this principle in the vast majority of cases." -- German Society of Endodontology and Dental Traumatology (DGET), Position Paper 2024
Modern implants are an impressive achievement of dentistry. But no implant is your own tooth. That is not sentimentality; it is biology.
Your natural tooth has a periodontal ligament (desmodont), a specialized ligament that anchors it in the jawbone with a slight, spring-like give. It cushions chewing forces, registers differences in pressure with a sensitivity of a few micrometers, and communicates with your nervous system. No implant can fully replace that.
What is more, an extraction is final. It sets off a chain reaction: without load, the jawbone at the gap recedes, neighboring teeth tilt, and the height of the bite changes. A preserved tooth protects this biological balance.
The good news: the 6th German Oral Health Study (DMS VI), published by the KZBV and the IDZ in March 2025, shows that tooth loss has become significantly less common in Germany. The share of edentulous younger seniors (aged 65 to 74) has fallen from 12.4 percent in DMS V to just 5 percent, a decline of around 60 percent. Older adults today have an average of 19.3 natural teeth, compared with 16.7 in the previous study (Source: KZBV, DMS VI, March 2025). Prevention and tooth preservation work.
Our aim is to carry this development further for every individual patient in our practice by saving every tooth that can be saved.
What Is a Root Canal Treatment, and Why Does the Microscope Make the Difference?
Before we talk about microscopes, a brief explanation: inside your tooth are fine channels, the so-called root canals, which contain nerves and blood vessels. With deep decay, a crack, or trauma, bacteria can enter these canals and cause inflammation. Left untreated, a pus-filled lesion forms at the root tip, which in the worst case damages the jawbone.
A root canal treatment (endodontics) cleans these canals completely, disinfects them, and seals them permanently. The tooth is preserved: without its nerve, but fully functional.
The Problem: What the Eye Cannot See
The most common reason a root canal treatment fails is missed root canals. A back molar can have three, four, sometimes five canals. Some are so narrow that they are simply invisible without magnification. Studies show that when an operating microscope is used, more than twice as many additional canals are found as with the naked eye or simple magnifying loupes (Source: meindentist.de, specialist research on microscope endodontics).
The result is measurable: while the average success rate of a root canal treatment without a microscope in German practices is around 52 percent, it rises to over 90 percent for initial treatments with microscopic technique (Source: meindentist.de / zahnarztpraxis-felgner.de, overview of clinical studies). For retreatments, that is, re-treating a tooth that already has a root canal filling, the microscopic method achieves success rates of 75 to 85 percent, which would hardly be conceivable without a microscope.
Our Operating Microscope: More Than a Magnifying Glass
The operating microscope we work with belongs to the premium class and was developed specifically for dentistry. It is not simply a "big microscope". It is a precision-engineered instrument for diagnosis and treatment.
Specifically, our microscope offers the following advantages for your treatment:
- Highest optical resolution: With a maximum resolution of 64 line pairs per millimeter, it significantly outperforms other dental microscopes, as demonstrated in a comparative study (Source: PMC / National Institutes of Health, Comparison of optical performance among dental operating microscopes, 2021). This means that cracks, canal openings, and bacterial contamination that would otherwise remain invisible become visible.
- Fluorescence mode: Under special illumination, caries bacteria glow orange-red, without contrast agents and without detours. This allows diseased tissue to be removed more precisely while sparing as much healthy tooth structure as possible.
- TrueLight and NoGlare modes: For restorations under the microscope, TrueLight prevents composite materials from curing prematurely, and NoGlare eliminates distracting reflections. Both increase the precision of the restoration.
- Ergonomics: The practitioner works in an upright position that is easy on the back. That may sound like a minor detail, but it is not: working without fatigue means greater concentration throughout the entire treatment.
If you would like to learn more about our digital equipment, you will find an overview in our article on the fully digital workflow.
Endodontics and Your General Health: An Underestimated Connection
"Oral health is inseparably linked to general health. Chronic inflammation in the mouth and jaw area is an independent risk factor for cardiovascular disease." — National Association of Statutory Health Insurance Dentists (KZBV), press release on DMS VI, March 2025
An inflammation at the tooth root that requires treatment (apical periodontitis) is not a purely local problem. It releases inflammatory mediators that enter the bloodstream and trigger systemic reactions.
In 2025, the German Society for Dental, Oral and Craniomandibular Sciences (DGZMK) and the German Society of Endodontology and Dental Traumatology (DGET) jointly published a compact recommendation that names this connection clearly: patients with untreated apical periodontitis have a 1.4- to 5-fold increased risk of cardiovascular disease compared with patients without an endodontic finding. Conversely, successful root canal treatment can lower the risk of coronary heart disease by up to 84 percent and reduce mortality from heart disease by up to 49 percent (Source: DGZMK/DGET, compact recommendation "Can Endodontics Contribute to Heart Health?", 2025).
These figures show that a root canal treatment is not merely pain therapy. It is a contribution to your general health.
You can read more about AI-assisted early diagnostics, which helps us detect such findings early, in our article on AI diagnostics for dental practices.
What to Expect at Our Practice: A Microscopic Root Canal Treatment Step by Step
Many patients feel apprehensive about a root canal treatment, often because of past experiences or second-hand stories. We want to make the process transparent.
1. Diagnosis and Patient Information
Every treatment begins with a thorough diagnosis: a digital X-ray, a three-dimensional cone beam CT (CBCT) scan if needed, and a clinical examination under the microscope. We explain exactly what we see, which options there are, and what a treatment can realistically achieve.
2. Pain-Free Treatment
Modern local anesthesia is highly effective. Under the microscope, the injection can be placed more precisely. Most patients describe the treatment afterwards as considerably less stressful than expected.
3. Rubber Dam: Safety for You
Every root canal treatment at our practice is performed with a rubber dam, a thin rubber membrane that isolates the tooth being treated. This prevents bacteria from the mouth from recontaminating the cleaned canal and protects you from swallowing small instruments. According to DGET guidelines, the rubber dam is mandatory for quality-assured endodontics (Source: DGET, guidelines for specialist training in endodontology).
4. Cleaning and Disinfection Under Direct Vision
Under the operating microscope, all canal openings are identified, prepared, and disinfected with special irrigation solutions. What would be uncertain feeling-around under loupes becomes a controlled, visible process under the microscope.
5. Final Seal and Restoration
After the treatment, the tooth receives a tight filling or, depending on the initial situation, a crown that protects it in the long term. A root-canal-treated tooth can last for decades.
You can find all our endodontic services on our endodontics page, and an overview of our full range of treatments on the services page.
Frequently Asked Questions
Is a root canal treatment painful?
No, not the treatment itself. The pain that drives many patients to the dentist comes from the inflammation beforehand. The treatment is performed under local anesthesia and is well tolerated by most patients. For one or two days afterwards, the tooth may be slightly sensitive to pressure; this is a normal healing response and no cause for concern.
When is a root canal treatment still worthwhile, and when is it not?
There is no general answer, which is why diagnosis is so important. The deciding factors are the remaining tooth structure, the bone structure around the root, the number and shape of the canals and, for retreatments, the condition of the previous treatment. We assess every case individually and honestly. If a tooth has no realistic long-term prognosis, we tell you so clearly.
What does a microscopic root canal treatment cost, and does statutory health insurance cover any of it?
Statutory health insurers cover root canal treatments on single-rooted teeth and on certain multi-rooted teeth within the scope of guideline-based care. The microscopic treatment as such is a private additional service, billed as an individual health service (IGeL). We inform you transparently about any costs before the treatment, so there are no surprises.
Can a tooth that already has a root canal filling be treated again?
Yes, this is called retreatment (revision). If an earlier root canal treatment is not tightly sealed, canals were missed, or a new infection has developed, the canal can be reopened under the microscope, cleaned, and filled again. Success rates of 75 to 85 percent are realistic with modern microscope technique (Source: clinical study overview, endodontologie-hagen.de).
How long does a root-canal-treated tooth last?
That depends largely on the quality of the treatment and of the subsequent prosthetic restoration. A well-treated, well-restored tooth can last a lifetime. Studies show survival rates of over 90 percent after 10 years with quality-assured endodontics and adequate restoration (Source: DGZMK Good Clinical Practice, root canal treatment).
When is a root canal treatment a better choice than an extraction?
In the vast majority of cases, preserving your own tooth is the better option. A root canal treatment under the operating microscope achieves success rates of over 90 percent for initial treatments and 75 to 85 percent for retreatments. Extraction is recommended only if the tooth is so severely damaged structurally that a restoration is no longer possible.
How does microscopic endodontics differ from a standard root canal treatment?
The operating microscope offers up to 25x magnification and optimal illumination of the root canal system. This makes it possible to identify even the finest canal branches, microfractures, and hidden canal entrances that remain invisible to the naked eye or with loupes.
How long does a microscopic root canal treatment take?
The duration depends on the complexity. An initial treatment usually takes 60 to 90 minutes. Retreatments can take somewhat longer. At our practice, we schedule enough time so that the treatment can be completed in as few sessions as possible.
Our Location in Dortmund
Pul's Zahnmedizin is located in the WiloHealthCube at Wilopark 15 in Dortmund, a modern health center that offers short distances to other medical specialists. That is no coincidence: we believe in interdisciplinary care. Dental health is general health, and a location in the midst of a medical ecosystem makes that visible every day.
For patients from Dortmund, the Ruhr area, and the surrounding region, we offer specialized endodontic care at the level of a specialist practice, without detours via referrals.