Root Canal Treatment

Introduction
Why Would You Need Root Canal Treatment?
Signs and Symptoms
Length of Treatment
Measuring and Cleaning the Root Canals
After Root Canal Treatment
Possible Complications
Pain, or the Lack of It
Introduction
Endodontics is the branch of dentistry that deals with diseases of the tooth's pulp. The pulp is found in the center of
the tooth and in canals (called root canals) inside the root of each tooth. Pulp includes connective tissue, nerves
and blood vessels. Pulp nourishes the tooth when it first emerges through the gum. Once the tooth matures, the
pulp can be removed without destroying the tooth. That's because each tooth also is nourished by a blood supply in
the gums.
Removing the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal
therapy. Many people refer to pulp removal as "having a root canal." Root canal treatments are quite common. In
the United States, they save about 24 million teeth each year.
Why Would You Need Root Canal Treatment?
Root canal treatment is needed for two main reasons. The first is infection. An untreated cavity is a common cause
of pulp infection. The decay erodes the enameland dentin of the tooth until it reaches a root canal. This allows
bacteria to infect the pulp. Antibiotics can't get to infections inside teeth. The inflammation caused by the infection
reduces the blood supply to the tooth. The reduced blood supply also keeps the pulp from healing.
The second reason for a root canal is damage to the pulp that can't be fixed. Trauma or a fractured tooth can
damage the pulp. So can a lot of restoration, such as severalfillings placed in the same tooth over a period of time.
Sometimes, common dental procedures, such as preparing a tooth for a crown, can hurt the pulp. Then the tooth
might need a root canal.
When the pulp is inflamed but not infected, it may heal on its own. Your dentist may want see if this will happen
before doing root canal treatment. If the pulp remains inflamed, it can be painful and may lead to infection.
An infection in the pulp can affect the bone around the tooth. This can cause anabscess to form. The goal of root
canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the
empty root canals with a material called gutta percha.
If root canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth
if you can. If a tooth is missing, neighboring teeth can drift out of line. They also can be overstressed from chewing.
Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges. Also, if you ignore
an infected or injured tooth the infection can spread to other parts of your body.
Having root canal treatment on a tooth does not mean that the tooth will need to be pulled out in a few years. Once
a tooth is treated, it almost always will last the rest of your life.
Signs and Symptoms
If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause
pain and swelling. In some cases, an abscess will form.
Your tooth might need a root canal if:

It hurts when you bite down on it, touch it or push on it

It is sensitive to heat
It is sensitive to cold for more than a couple of seconds
There is swelling near the tooth
It is discolored (whether it hurts or not)

It is broken
To determine whether your tooth needs root canal treatment, your dentist will often place hot or cold substances
against the tooth. The purpose is to see if it is more or less sensitive than a normal tooth. He or she will examine
the tissues around the tooth and gently tap on the tooth to test for symptoms.
You also will be given X-rays of the bone around the tooth. The X-rays may show a widening of the ligament that
holds the tooth in place or a dark spot at the tip of the root. If either of these is present, your dentist probably will
recommend a root canal procedure.
Your dentist may need more information about the tooth. He or she may use an electric pulp tester. This hand-held
device sends a small electric current through the tooth. It helps your dentist decide whether the pulp is alive. This
test does not cause pain or a shock. You may feel a tingling sensation. It will stop when the tester is removed from
the tooth.
An electric pulp tester should not be used if you have a cardiac pacemaker or any other electronic life-support
device.
Length of Treatment
Root canal treatment can be done in one or more visits. It depends on the situation. An uncomplicated root canal
treatment often can be completed in one visit. Some teeth may be more difficult to treat because of where they are
in the mouth. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer. Some
teeth have curved root canals that are difficult to find. If you have an infection, you will visit the dentist several times
so that he or she can make sure that the infection is gone.
Once the root canal treatment is finished, you will need to see your general dentist to have a crown or filling placed
on the tooth. You are likely to receive a crown if the tooth is discolored or if it is used for chewing. The purpose of
the crown is to prevent the tooth from breaking in the future.
Measuring and Cleaning the Root Canals
Measuring
First, your dentist or endodontist will numb the area around the tooth. You also may receive sedation, such
as nitrous oxide. Your dentist also has other ways to reduce your anxiety. Before your first appointment, ask what is
available.
The dentist will make a hole in the top or back of your tooth to get to the pulp chamber. He or she will remove some
of the diseased pulp.
Then the root canals have to be measured. Your dentist needs to know how long the canals are to make sure the
entire canal is cleaned. He or she also needs to know how much filling material to put in the cleaned canals.
To measure the root canals, dentists use X-rays or an electric device called an apex locator. For an X-ray, your
dentist will place a file into the canal and then take an X-ray. An apex locator measures a root canal based on its
resistance to a small electric current. Many dentists use both methods.
Cleaning
After the canals have been measured, your dentist or endodontist will use special tools to clean out all of the
diseased pulp. Then the canal is cleaned with antiseptic. This helps treat and prevent infection. All the canals within
a tooth must be cleaned. Teeth have different numbers of canals:

The top front teeth have one canal.

The bottom front teeth have one or two canals.
The premolars have one or two canals.
The molars have three or four canals.
The location and shape of the canals can vary quite a bit. Some endodontists look inside the tooth with a
microscope to make sure all the canals have been cleaned out.
Once the canals have been thoroughly cleaned, the roots are filled. A temporary filling is then placed over the tooth.
The top of the tooth should then be covered with a permanent filling or crown. The temporary filling you receive is
not meant to last.

In most cases, the tooth will need a crown. A crown will help to restore the tooth's strength and protect it from
cracking. If a crown is indicated it should be placed soon after having root canal treatment.
The pulp that was removed during root canal treatment is the part that responds to temperature. Your tooth will no
longer be sensitive to hot or cold after the root canal is treated. There still are tissues and nerves around the tooth,
however, so it will respond to pressure and touch.
After Root Canal Treatment
As with most invasive medical or dental procedures, complications can occur. Here are some possibilities.
Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start
growing. This causes swelling and pain.
Blood vessels enter the tooth through a small hole at the bottom of the root. Sometimes during a root canal
procedure, bacteria are pushed through this hole into surrounding tissue. If this happens, the surrounding tissue will
become inflamed and possibly infected. This can be treated with painkillers and sometimes antibiotics. However, it
may be painful until it clears up.
A root canal treatment can puncture the side of the tooth. This can happen if a canal is curved or hard to find. The
tools that the dentist uses are flexible. They bend as a canal curves. Sometimes they bend at the wrong time and
make a small hole in the side of the tooth. If saliva can get into the hole, it will have to be filled. Sometimes, the
tooth has to be removed. If the hole is far enough under the gum that saliva can't reach it, the hole may close on its
own.
Finding root canals can be difficult. If all of the canals aren't found and cleaned out, the tooth can stay infected. This
also can happen if a canal isn't measured correctly and pieces of infected or inflamed pulp are left near the bottom.
In this case, the root canal procedure would have to be done again. Occasionally, root canals have branches that
the dentist's tools can't reach.
The tip of a file may break off inside the tooth. If the canal is clean, your dentist can leave the piece of file in the
tooth. But if canal is not completely cleaned out, the file piece may have to be removed. Sometimes this can be
done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure
called an apicoectomy. A small cut is made in the gum so the dentist can get at the root of the tooth. The dentist
shaves off the bottom of the root and gets into the canal from the bottom to remove the file piece.
Possible Complications
In most cases, you will not have any pain during a root canal procedure. Your dentist will numb your tooth and the
surrounding area. Let your dentist know if you are feeling any pain during the root canal. Some people fear the
numbing shots more than the root canal treatment itself. Today, numbing gels and modern injection systems have
made injections virtually painless. If it does hurt when you are getting an injection, let your dentist know
immediately. He or she can change the way the injection is given to avoid causing pain.
Pain, or the Lack of It
The prognosis is very good for extrinsic stains. Intrinsic stains may be more difficult or take longer to remove.

What is a Root Canal?

Root canal treatment is the removal of the tooth's pulp, a small, thread-like tissue in the center of the tooth.
Once the damaged, diseased or dead pulp is removed, the remaining space is cleaned, shaped and filled.
This procedure seals off the root canal. Years ago, teeth with diseased or injured pulps were removed.
Today, root canal treatment saves many teeth that would otherwise be lost.
The most common causes of pulp damage or death are:

A cracked tooth
A deep cavity
An injury to a tooth, such as a severe knock to the tooth, either recent or in the past.

Once the pulp is infected or dead, if left untreated, pus can build up at the root tip in the jawbone, forming
an abscess. An abscess can destroy the bone surrounding the tooth and cause pain
How is a Root Canal Done?
Root canal treatment consists of several steps that take place over several office visits, depending on the
situation. These steps are:

First, an opening is made through the back of a front tooth or the crown of a molar or pre-molar.
After the diseased pulp is removed (a pulpectomy), the pulp chamber and root canals are cleaned,
enlarged and shaped in preparation for being filled.
If more than one visit is needed, a temporary filling is placed in the crown opening to protect the
tooth between dental visits.
The temporary filling is removed and the pulp chamber and root canal permanently filled. A tapered,
rubbery material called gutta-percha is inserted into each of the canals and is often sealed into
place with cement. Sometimes a metal or plastic rod is placed in the canal for structural support.
In the final step, a crown is usually placed over the tooth to restore its natural shape and
appearance. If the tooth is very broken down, a post may be required to build it up prior to placing
a crown.

How Long Will the Restored Tooth Last?

Your treated and restored tooth/teeth can last a lifetime with proper care. Because tooth decay can still
occur in treated teeth, good oral hygiene and regular dental exams are necessary to prevent further
problems.
As there is no longer a pulp keeping the tooth alive, root-treated teeth can become brittle and are more
prone to fracture. This is an important consideration when deciding whether to crown or fill a tooth after root
canal treatment.
To determine the success or failure of root canal treatment, the most relied-upon method is to compare new
X-rays with those taken prior to treatment. This comparison will show whether bone continues to be lost or
is being regenerated.

Tooth pulp damaged by a

deep cavity.

The pulp is removed and

the root canals cleaned
before filling.

The chamber is filled and

sealed.

Seven Steps Of Endo

Diagnosis

Vital pulp testing

Cold test, heat test, signs of swelling, radiograph

The first step is to diagnose a need for treatment. The patient will usually come to the dentist complaining
of pain. Indications such as swelling and sensitivity allow the dentist to isolate the infected area.
Sometimes the pain will feel like it is coming from a tooth that is not infected. The dentist will then use
several methods to determine the exact tooth causing the problems. X-rays can show lesions that might be
otherwise invisible. Percussion testing is the tapping on teeth with a mirror handle. Thermal testing with
ice and heated objects can help further pinpoint the problem tooth.
Access

Gain entry to the pulpal chamber

Access to the pulp is gained through the crown of the tooth. A series of burs,
including the Transmetal and Endo-Z bur are used to open up the tooth.
This is the first area where Maillefer can help your clients.. And their patients.
Proper access will help each of the remaining steps go much easier.
Extirpation

Removal of pulp tissue

The next step is removing the diseased pulp tissue. This is called
extirpation. Many dentists use what is known as a barbed broach.
Debridement

Clean and shape the canal

Locate the apex or bottom portion of the canal
Cleaning and shaping the canal is next. In the debridement step, the dentist
will use a variety of instruments, irrigants like Sodium Hypochlorite... (aka
bleach) and lubricants like Glyde File Prep to remove the rest of the infected
tooth structure. They will also shape the canal to facilitate filling (obturation).
Another key part of the debridement process is the determination of the
location of the end of the root. This process is known as determining "
working length" or "working distance". Finding the " working length" is
important because the dentist does not want to go too short, thereby leaving
bacteria in the tooth, or go too long. Going out the apex can push bacteria into
the surrounding jaw structure and cause more irritation for the patient. To find
working length, the dentist will put a hand file in the canal, set the stopper at
the cusp of the tooth, and take a radiograph. The comparison of the radiograph

with the known length of the file will allow the dentist to determine the
working length. At the apex, or bottom of the tooth, the canal narrows. This
narrowing is the CementoDentinal Junction or CDJ. This narrow spot, as
shown here, is generally one-half millimeter in length and provides a natural
stop for debris, irrigation and filling materials from being forced into the
periapical tissue. Most dentists will work to clean the canal down to this point
in their root canal procedures. There are two primary methods for shaping the
root canal structure. They are "Crown Down" and "Step Back". These utilize
files such as the SureFlex and FlexoFiles and traditional K-Files. With
both techniques, the goal is the same... A funnel shape for the canal to make
filling the canal easier.
Drying

Remove all moisture from the canal

During and after cleaning and shaping the canal in the debridement step,
the funnel shaped canal space is flooded with an irrigant to ease removal of
the contents. As we mentioned, this is usually sodium hypochlorite. The
sodium hypochlorite must then be removed from the canal space before
filling. This is done with paper points. The dentist places one or more paper
point in the canal and uses them to absorb all the moisture. This continues
until the last paper point comes back dry. Once the canal is dry, the dentist
can temporarily seal the tooth and finish the procedure on another
appointment, or as most practioners are doing today, they can opt to fill (or
obturate) the canal.
Obturation

Fill the canal to avoid bacterial growth

The obturation or filling the canal is primarily done with gutta-percha.
Gutta-percha is a very bio-compatible material. It is pink, firm, waxy
and somewhat rubbery. We offer several instruments including finger
pluggers/spreaders, Schilder instruments, and our M-Series
pluggers/spreaders to assist the doctor in packing the gutta percha in the
canal. There are several methods of obturation available including our
quick and effective Densfil thermal endodontic obturation system.
Restoration

Restore the tooth back to its original form

With the canal properly filled, we are ready for the 7th step, known as
Restoration. Here we will restore the tooth back to its original form.
When a core buildup is necessary, dentists will often times install a
post.Post systems are used to secure the material to the remaining tooth
structure. Remember though, no post will add strength to a tooth.