Root Canal Therapy

Root canal treatment also known as endodontic treatment involves removing the nerve tissue (pulp) located in the center of the tooth or its roots(called as root canal).This treatment enables you to retain the involved natural tooth for a longer period of time, thus maintaining your natural bite and healthy functioning of your jaws.
Root canal therapy involves treatment of badly carious, fractured or non-vital teeth due to trauma. When dental caries involves the enamel, dentine and pulp (network of nerves and blood vessels), the innermost layer after dentine, there is acute pain due to pulpitis(inflammation) which can be reversible or irreversible, depending upon the nature of the of the offending lesion. When it becomes irreversible pulpits, there is apical periodontitis (passage of infectious products from the tooth to the area beyond the apex or tip of the root), leading to loss of outer layer of the bone, widening of the periodontal ligament space (ligament connecting the tooth to the bone) at the root apex, granuloma or abscess formation. There is buildup of pressure inside the root canal system, as numerous pathogenic bacteria are involved, release noxious agents, and gases.

Common signs and symptoms

Patient generally complains of a sharp, shooting, throbbing kind of pain, which generally increases on lying down. Sometimes may be associated with an abscess formation showing an intraoral swelling or bulge inside the gums. This if becomes long standing will form a tract or fistula .The vitality of a tooth is determined by its blood supply and not the nerve supply. Thus when the blood supply is lost (eg in long standing carious lesions which have invaded the pulp, and not treated, or due to trauma), the tooth becomes non-vital. Treatment of non-vital tooth generally does not require anesthesia. When blood supply is maintained, it is a vital tooth.In this case anesthesia will be required.Before starting the treatment the vitality of the tooth is always checked with a pulp vitality test. There are various methods of checking the same. The most common is the electric pulp tester or the vitalometer, which gives a digital reading. Other tests are the heat and cold tests. Sensitivity to heat or a positive heat test indicates a non-vital pulp. A cold test is also performed.

About the treatment

Thus root canal therapy is performed where the operator removes the caries ,by drilling into the tooth structure and entering the root of the tooth, removing the infected pulp, cleaning the root canal, with specialised instruments(rotary files), irrigating and disinfecting, followed by filling or obturation of the root canals with biocompatible materials(guttapercha) , thus sealing the system. This is followed by build up of lost tooth structure with tooth colored material to restore the anatomy and then finally restored with crown.

Twisted , curved ,accessory , blocked or unfilled canals may prevent the removal of all inflamed pulp, which may lead to recurrence of the symptoms or failure of the case. Thus in some cases, an additional procedure called as apicoectomy may be required. This is a surgical procedure done under local anesthesia, wherein a small hole is cut through the gums and the bone near the apex of the tooth and the infectious tissue is removed and the root canal is sealed. This helps to initiate the healing process, and formation of new bone.

Various types of treatments available:

  • Single visit/multiple visit root canal therapy.
  • Vital /non-vital teeth
  • Microscope-enhanced root canal therapy
  • Use of greater taper and rotary instruments
  • Advanced techniques in assessing the root apex, negotiating difficult root canal curvatures.
  • Thermoplasticized guttapercha root canal filling materials and advanced obturation techniques
  • Apexification (formation of root apex), managing perforations using MTA and other regenerative materials
  • Treatment of fractured teeth and traumatic injuries
  • Retrieval of broken instruments using ultrasonics and surgical operating microscope
  • Re- treatments for correction of old/ failing root canal treatments.
  • Apiocectomy or Root End Surgery
  • Core buildup restoring near normal anatomy and shape of tooth
  • Post- core treatment (insertion of a stainless steel /ceramic screw or pin with or without threads inside the root canal and cementing it to enhance the support for a badly mutilated tooth, following which it is restored with core( filling material for restoring the anatomy of the tooth structure lost due to caries or fracture).
  • Restoration with crown
  • Alternatives to Root Canal therapy: Direct pulp capping (application of calcium hydroxide to a pin point exposure of the pulp and waiting for 3-6 months for formation of reparative or new dentin thus delaying or avoiding root canal therapy. When the pulp is already exposed, and root canal therapy cannot be performed or is not performed the only other option is extraction or removal of the involved tooth.