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Root Canal Treatment

A root canal is a treatment to remove the infected or inflamed pulp from the inside of a tooth. The pulp contains blood vessels, nerves, and connective tissue. Reasons for needing a root canal include deep tooth decay, cracks, injuries, or electively to better retain a crown. Left untreated, infection from the pulp can spread and cause bone loss around the tooth. During a root canal, an endodontist carefully cleans, shapes, and seals the inside of the tooth to prevent further infection.

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What is a Root Canal?  Root canal treatment is the process of removing the inflamed or infected pulp tissue from within the tooth  To better understand the concept of root canal treatment, it is necessary to understand the tissue called “the dental pulp”
What is the pulp?  The pulp, commonly referred to as “the nerve of the tooth", is comprised of:  Blood vessels  Nerves  Connective tissue Tooth in cross section Detail showing cellular components of the pulp
What is the pulp?  Root canal treamtent consists of removing inflamed or infected pulp tissue.  Enamel  Dentin  Pulp  Root  Bone Sagittal section of mandible and teeth
Why is a root canal necessary? Deep tooth decay (cavity) A cracked tooth Traumatic dental injury Elective (for added retention of a crown)
Why is a root canal necessary? Tooth Decay (Cavity) Tooth decay is caused by bacteria. The pulp’s defense against bacteria is inflammation, called pulpitis. Irreversible pulpitis is the term used to describe the level of inflammation where the pulp tissue will not recover and heal. Eventually this will lead to an infected pulp (“dead nerve”), followed by a dental abscess (infection).
Pulpal Inflammatory Changes  As Bacteria enter into the pulp, they cause tissue destruction spreading through the pulp and into the canal system.  If left untreated the bacteria can spread out of the tooth and cause pathology and infection in the bone surrounding the tooth Pathways of the pulp 10th edition Textbook of Endodontology 2010
Why is a root canal necessary? Cracked tooth A crown is necessary to restore a cracked tooth to normal chewing function and prevent its loss to further fracture Root canal treatment is often necessary to remove the inflamed pulp prior to crown placement
Why is a root canal necessary?  Traumatic injury  May expose the pulp  May disrupt the blood supply to the pulp
Why is a root canal necessary? Elective – an elective root canal may be recommended: If a substantial portion of your tooth is missing and requires more retention for the new crown If a tooth with extensive fillings or cracks requires a crown
Progression of Disease  The following example illustrates the progression of disease from tooth decay.  Early stages of pulpal inflammation can be seen before decay reaches the pulp  Once into the pulpal tissue, necrosis and infection are inevitable Bone Root Periodontal ligament Pulp Inflamed Pulp Tooth decay Pathways of the pulp 10th edition
Progression of Disease  As bacteria further penetrates, pulp necrosis (tissue death) occurs Inflamed Pulp Necrotic Pulp Tooth decay Pathways of the pulp 10th edition
Progression of Disease  Bacteria penetrate further causing infection and destruction of the pulp Pathways of the pulp 10th edition
Progression of disease  With complete necrosis and infection of the pulp, pathologic changes are seen in the surrounding bone  These changes are due to the immune system’s reaction to infection  This leads to bone loss and possibly an abscess (localized collection of pus) Periapical lesion Pathways of the pulp 10th edition
Progression of disease  Acute Abscess  As an abscess expands there can be swelling in the gum tissues and face  This may require surgical drainage and/or antibiotics  In severe cases this may require hospitalization Pathways of the Pulp, 9th ed 2006
Progression of disease  Chronic Abscess  Sometimes when an abscess expands it burrows through the bone and exits through the gums  This is called a sinus tract, but commonly referred to as a “gum boil” or a “pimple”  Usually the point of exit is on the cheek or lip side of the gums at the root tip level or at the gum-line. Textbook of Endodontology 2010
How Do I Know If My Tooth Needs A Root Canal?
What are the Signs I Might Need a Root Canal?  Signs and symptoms that you may need a root canal  Pain  Pressure - sensitivity when biting or pressing on the tooth  Temperature – sensitivity to hot or cold, especially if it is prolonged or lingers  Spontaneous or constant dental pain  Swelling  Ranging from a small bump or “pimple” on the gum to a swollen jaw or face  Note that some teeth requiring root canal treatment have no symptoms  The best way to determine if you need a root canal is to see your dentist who may then refer you to an endodonitst.
Diagnostic Tests  To confirm that root canal treatment is necessary, an endodontist will perform certain tests on your tooth  These tests, along with x-rays, help in accurately assessing the status of the pulp and whether root canal treatment will benefit you Pulp tests – measure responsiveness of the pulp
Technology Utilized During Root Canal Treatment
Surgical Operating Microscope  Magnification of the tooth up to 17x the normal size has many advantages:  Greater accuracy and precision to yield the highest quality of treatment  Identifying treatment complications  cracks/fractures of the tooth for example can affect treatment outcomes  Identifying complexities of the root canal system  Multiple canals within a single root if left untreated can adversely affect the success of the root canal treatment
Electronic Apex Locators  Apex locators allow us to accurately determine the length of the root canals, thereby limiting the amount of x-ray images we need to take
Digital X-Rays (radiographs)  Decrease radiation up to 90% compared to dental film radiographs  Appear on high-resolution widescreen monitor instantaneously  Aids in pointing out to you key elements of your dental condition
High-tech Instruments  Rotary nickel-titanium (Ni-Ti) files  Efficient way to clean the canal system, significantly reducing operating time  Able to navigate curved canals due to their flexure  Ultrasonics  Ultrasonic vibration of instruments produce energies capable of removing debris, tooth structure, and bacterial biofilms  Many applications in endodontic treatments
Root Canal Treatment
Accessing the Root Canals  To gain access to the root canals of the tooth, a small opening is made either on the chewing surface of the tooth (for back teeth), or on the tongue side of the tooth (for front teeth). Upper anterior tooth showing access opening into canal
Accessing the Root Canals  In a multi-rooted tooth, gaining access into the root canals is more challenging  With the aid of a microscope we are able to locate any hidden or calcified canals Upper molar showing access opening into canals, and location of a hidden fourth canal
Rubber Dam Isolation  Isolation of the tooth is accomplished with a rubber dam  Keeps bacteria in the saliva from entering into the tooth  Prevents debris, instruments, etc. from going down the patient’s throat
Cleaning the Root Canal System  We use many instruments of different sizes and shapes to properly clean and shape your specific root canal anatomy
Disinfection of the root canal system  Sodium hypochlorite is one of the disinfectants used to reduce the bacteria load within the tooth  Specialized blunt-ended needles are used to deliver these disinfectants to the end of the root in a safe and effective way
Final preparation  After thoroughly cleaning and shaping the canals, the canals are dried prior to filling the roots
Obturating (Filling) the Root Canals  Finally, the canals are sealed with two components:  Sealer – a cement that sets over time  Gutta percha – a filler made of a natural form of latex  This serves as the permanent root canal filling Resected bone and root from a mandibular molar showing placement of gutta percha Gutta percha cones cones
Root Canal Treatment Completed  Upon completion of the root canal treatment, a temporary filling is placed over the sealed canals that has two parts:  Cotton pellet soaked in an antibacterial solution  A solid temporary filling on top  A final restoration (usually a crown) is placed by your dentist  This will restore functionality to your tooth and protect it from fracturing  Follow Ups  We will see you back to evaluate healing  The healing bone takes one year (on average) to completely heal