Root Canal Treatment

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)

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

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

 Traumatic injury
 May expose the pulp
 May disrupt the blood supply to the
pulp

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


 As bacteria further penetrates, pulp necrosis
(tissue death) occurs

Inflamed Pulp
Necrotic Pulp
Tooth decay


 Bacteria penetrate further causing
infection and destruction of the pulp


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


 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

 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

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

Root Canal Treatment

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Root Canal Treatment