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 standardized 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.
This article needs to be updated. (December 2017) |
Root canal treatment (also known as endodontic therapy, endodontic treatment, or root canal therapy) is a treatment sequence for the infected pulp of a tooth which is intended to result in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion. Root canals, and their associated pulp chamber, are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities. Together, these items constitute the dental pulp.
| Root canal treatment | |
|---|---|
 Tooth #13, the upper left second premolar, after excavation of DO decay. There was a carious exposure into the pulp chamber (red oval), and the photo was taken after endodontic access was initiated and the roof of the chamber was removed. | |
| Specialty | endodontics |
Endodontic therapy involves the removal of these structures, disinfection and the subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions, and the obturation (filling) of the decontaminated canals. Filling of the cleaned and decontaminated canals is done with an inert filling such as gutta-percha and typically a zinc oxide eugenol-based cement. Epoxy resin is employed to bind gutta-percha in some root canal procedures. Another option is to use an antiseptic filling material containing paraformaldehyde like N2. Endodontics includes both primary and secondary endodontic treatments as well as periradicular surgery which is generally used for teeth that still have potential for salvage.
