Root canal treatment

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 that is intended to result in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion. It is generally done when the cavity is too big for a normal filling. 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.

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. In the past, in the discredited Sargenti method, an antiseptic filling material containing paraformaldehyde like N2 was used. 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.

The procedure is often complicated and may involve multiple visits over a period of weeks.

Before endodontic therapy is carried out, a correct diagnosis of the dental pulp and the surrounding periapical tissues is required. This allows the endodontist to choose the most appropriate treatment option, allowing preservation and longevity of the tooth and surrounding tissues. Treatment options for an irreversibly inflamed pulp (irreversible pulpitis) include either extraction of the tooth or removal of the pulp. Partial pulp amputation (pulpotomy) is the treatment of choice to preserve the pulp in teeth with open apical foramen.

Removing the infected/inflamed pulpal tissue enables the endodontist to preserve the longevity and function of the tooth. The treatment option chosen involves taking into account the expected prognosis of the tooth, as well as the patient's wishes. A full history is required, along with a clinical examination (both inside and outside the mouth), and the use of diagnostic tests.

There are several tests that can aid in the diagnosis of the dental pulp and the surrounding tissues:

If a tooth is so compromised (because of decay, cracking, etc.) that future infection is considered very likely or inevitable, a pulpectomy (removal of the pulp tissue) is advisable to prevent such infection. Usually, some inflammation and/or infection is already present within and/or below the tooth. To cure the infection and save the tooth, the dentist drills into the pulp chamber and removes the infected pulp. To eliminate bacteria from the pulp chamber and root canals, the use of efficient antiseptics and disinfectants is necessary. The soft tissues are either drilled out of the root canal(s) with engine driven rotary files, or with long needle-shaped hand files.

The endodontist makes an opening through the enamel and dentin tissues of the tooth, usually using a dental drill fitted with a dental burr.