Root Canal Treatment Procedure
- Root canal treatment is a sequence of procedures aimed at eliminating infection and protecting the tooth.
- It involves creating an access cavity, cleaning and shaping the root canals, and filling them with gutta-percha.
- The procedure may require multiple visits over several weeks.
- The endodontist may use epoxy resin or antiseptic filling materials.
- Endodontics includes primary and secondary treatments, as well as periradicular surgery.
- Before treatment, a correct diagnosis of the dental pulp and surrounding tissues is necessary.
- Diagnostic tests include palpation, mobility assessment, percussion, transillumination, and tooth slooth.
- Radiographs and dental pulp tests are also used for diagnosis.
- The chosen treatment option considers the prognosis of the tooth and the patient's wishes.
- Infected or inflamed pulpal tissue is removed to preserve the tooth's longevity and function.
- The dentist creates an opening through the enamel and dentin tissues using a dental drill.
- Isolating the tooth with a rubber dam is essential for aseptic conditions and protection.
- The rubber dam prevents contamination of the root canal and facilitates the use of medicaments.
- It also protects the patient from ingesting or inhaling endodontic instruments.
- Tooth isolation with a rubber dam improves the prognosis of the treatment.
- Mechanical preparation techniques have evolved over time.
- The standardised technique developed by Ingle in 1961 had some disadvantages.
- Subsequent techniques include step-back, circumferential filing, incremental, and anticurvature filing.
- Other techniques are step-down, double flare, crown-down-pressureless, canal master, apical box, and progressive enlargement.
- Hybrid procedures combining step back and crown down techniques have also been used.
- The step back technique involves establishing the working length and delicately shaping the apical part of the canal.
- Potential disadvantages of the step back technique can be addressed with modifications.
- The crown down procedure starts from the coronal part of the canal after checking patency.
- A hybrid procedure combines step back and crown down techniques.
- Early coronal enlargement followed by progressive enlargement is another technique used.

Phases of Root Canal Treatment
- Initial phase involves using a 25 K-file
- Last phase divided into two refining passages
- First refining passage uses a 1-mm staggered instrument
- Second refining passage uses 0.5-mm staggering
- Engine-driven instrumentation introduced in the early nineties

Techniques in Root Canal Treatment
- Step back technique
- Passive step back technique
- Crown down technique
- Balanced forces technique
- Reverse balanced force technique

Use of Anesthetics and Irrigation in Root Canal Treatment
- Novocaine commonly used in dental procedures
- More novocaine required for root canal treatment than for simple filling
- Root canal flushed with various irrigants
- Common irrigants include sodium hypochlorite, chlorhexidine gluconate, and EDTA
- Aim of chemical irrigation is to kill microbes and dissolve pulpal tissue
- Lack of evidence to support the use of one irrigant over another
- Manual and machine-assisted agitation techniques used in irrigation

Filling the Root Canal, Temporary Filling and Final Restoration, and Endodontic Retreatment
- Standard filling material is gutta-percha
- Gutta-percha cone inserted into cleaned-out root canal
- Sealing cement used along with gutta-percha
- Thermal techniques can be unreliable due to gutta-percha shrinkage
- Pain control can be difficult due to anesthetic inactivation
- Temporary filling materials create hermetic coronal seals
- Temporary filling materials remain hermetic for less than 30 days on average
- Some temporary filling materials may remain hermetic for 40-70 days
- Molars and premolars should be protected with a crown after root canal therapy
- Anterior teeth may not require full coverage restorations after root canal procedure
- Inadequate chemomechanical debridement of the root canal is a common reason for endodontic treatment failure.
- Exposure of the obturation material to the oral environment may contaminate the gutta-percha with oral bacteria.
- Enterococcus faecalis and other bacteria may be found in failed canals.
- Endodontic retreatment is a technically demanding and time-consuming procedure.
- Surgical retreatment may cause more pain and swelling compared to non-surgical retreatment.