Root Canal Treatment

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Root Canal Treatment

Anatomy & Physiology
Root canal treatment involves treatment of the pulp space within a tooth. The dental pulp is a soft tissue, which is within a tooth under the enamel and dentine. The pulp contains blood vessels, nerves and connective tissue and creates the hard tissues of the tooth during development. The dental pulp occupies both the crown and root of the tooth and enters through an opening in the end of the root.

Indications
Root canal treatment becomes necessary when the inside of the tooth becomes infected or inflamed. This usually happens as a result of deep decay, trauma to the tooth and repeated operative procedures. Any of these may result in signs of pulp damage such as prolonged sensitivity to temperature, swelling or a change in tooth colour. Frequently pulp death can occur with no symptoms.

Anaesthetic
Treatment is usually performed under local anaesthesia.

Technique

Initially a thorough assessment is performed, which includes an examination of your mouth, the tooth in question and radiographs.
A sheet of rubber is placed over the tooth after the administration of the local anaesthetic. This helps keep bacteria from saliva away from the tooth and contains irrigating solutions that are used to disinfect the root canal.
An access opening is made through the crown of the tooth into the pulp cavity. This facilitates the placement of root canal instruments into the pulp space. Further radiographs are required to help determine the length of the tooth root (Fig. 1).

The root canals are shaped by instruments and cleaned with disinfectant irrigating solutions. Once this is completed the root canals are filled usually with gutta-percha and a sealing cement. Radiographs are then taken to establish the filling is satisfactory (Fig. 2). A filling is then placed to seal the access opening; this may be temporary or definitive.

Figure 1. Root canal instrument placement.

It is essential the tooth is restored definitively after the root canal treatment, as this serves to support the tooth and help reduce the chance of re-entry of bacteria. Follow-up radiographs are recommended to ensure the infection has responded to treatment.

Length of Operation
The length of the procedure varies. Straightforward cases may be completed in ½ to 1 hour. More demanding teeth may take considerably longer - sometimes over two hours. Such cases (and very infected teeth) will frequently necessitate more than one visit before the procedure is completed.

Time in Hospital
All dentists receive training in root canal treatment at Dental School and most management is performed in General Dental Practice.

Time Off Work
This will depend on the complexity of the case. It is normal to have some slight discomfort for 2 or 3 days after treatment. This, however, can usually be controlled with over-the-counter analgesics.

Outcome/Prognosis
Root canal therapy is not 100% successful. Straightforward cases may be expected to work 95% of the time; more complex teeth, however, have a lower prognosis of 65-85%. This success cannot be guaranteed. The lower success rates are usually associated with very infected teeth or teeth which have failed to respond to initial treatment or have become re-infected.

Alternative Treatments
The only alternative treatment that will remove the infection is extraction of the tooth.