What is Root canal treatment or RCT?
“Root canal” is the term used to describe the natural anatomic cavity within the root of the tooth and towards the coronal aspect of the tooth this space is referred to as pulp chamber.This space is filled with a highly vascularized, loose connective tissues called dental pulp.Its function is to provide nourishment and hydration to the teeth, making it more resilient and resistant to fracture from masticatory stress. Additionally, the dental pulp provides sensory function to hot and cold. In earlier times if a decay or trauma involving the pulp, the only treatment option was to extract(removal) the tooth. But gradually with advancement in dentistry, root canal treatment was introduced and it had brought about a smile in the face of patients as their tooth was saved.
Endodontic therapy or root canal therapy is the treatment for infected pulp of a tooth which results in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion thereby saves a tooth from extraction. Root canal treatment involves removal of infected pulp tissue, the subsequent shaping, cleaning and decontamination of the hollows with small files and irrigating solutions, and the obturation (filling) of the decontaminated canals with an inert filling such as gutta-percha.After post endodontic permanent restoration and crown cementation, the tooth continues to function like any other healthy tooth.Root canal treatment saves the tooth from extraction, also saves the patient from unforseen complications of retained infected tooth.Endodontic treatment helps you to maintain your natural smile and limit the need for on-going dental work.
Situations where RCT is performed
Severe toothache pain upon chewing or application of pressure
Prolonged sensitivity/pain to heat or cold temperatures
Discoloration of the tooth
Swelling and tenderness in the nearby gums
A persistent or recurring pimple on the gums
Pulpal involvement due to caries, trauma etc
Procedure of Root canal treatment
The general sequence of a root canal procedure is as follows:
Step 1
Local anesthesia is administered via injections to numb the tooth to be treated and the surrounding tissues. If the pulp in a tooth is acutely inflamed, it may take a while to into thenumb state, but your dentist will not start the treatment until it is anesthetised.Once anesthetised patient wont experience any pain throughout the procedure.
A dental dam will be placed over the affected teeth to isolate it from the rest of the mouth. This allows the root canal treatment to be carried out in a sterile environment free from contamination by bacteria found in saliva or the rest of the mouth.
Step 2
A small access hole is drilled through the biting surface of an affected back tooth or from behind a front tooth, allowing access to the pulp chamber and root canals for treatment.The diseased and dead pulp tissue is removed from the tooth with specially designed instruments. Once the pulp along with the nerves is removed, the canals are disinfected with antiseptic and antibacterial solutions.The canals are then shaped with tiny flexible instruments(RCT files) to allow them to receive root canal fillings and sealers. The canals are washed and cleaned again to remove root canal debris prior to sealing them. The canals are then dried using sterile paper points.
Step 3
Root canal fillings are selected that will exactly fit into the freshly prepared canals. Usually a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material, which is packed into the root canals to seal the prepared canal space along with the sealer material. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria.A temporary or permanent filling material will then be placed to seal the access opening that was made to treat the canals, and the dental dam is removed. If the tooth lacks sufficient structure to hold a restoration in place, the dentist or endodontist may place a post in one of the canals inside the tooth to help retain it.
After the procedure, an antibiotic may be prescribed to treat or prevent infection. After-effects of treatment are minimal, generally lasting from a couple of days to about a week. It is normal to have some minor discomfort after treatment including slight soreness that can usually be managed with pain medications.
After root canal treatment the tooth becomes brittle in nature as it has lost its vasculature. So a root canal treated tooth should be restored with a crown over it to strengthen it. Most often patients who undergo root canal treatment neglect the placement of crown over the tooth. Over a period of time due to the normal chewing forces the crown of the tooth breaks off and the tooth has to be extracted. Remember that a root canal treated tooth should be protected by placing a crown over it.
What is Re Root canal treatment?
As occasionally happens with any dental or medical procedure, a tooth may not heal as anticipated after initial treatment for a variety of reasons:
- Narrow or curved root canals sometimes pose complications during the initial procedure.
- Complicated root canal anatomy, presence of lateral/ accessory canals in the main root canal
- The placement of the crown or other restoration was delayed following the treatment, resulting in reinfection of the root canals.
- An inadequate seal of a restoration allowed recontamination of the inside of the tooth.
When there is a reinfection in the root canal treated tooth your dentist/endodontist will advise for a re treatment wherein the root canal filling of the tooth shall be removed and a refilling shall be done after cleaning the root canals.
Recent advances in root canal treatment
Currently root canal treatment is done using rotary files when compared to the conventional hand files. This has led to increased efficiency and saves time. The introduction of endodontic microscope has led to enhancement of quality of the procedure as the endodontist can visualize the entire root canal of the tooth through the microscope. Root canal treatment with the help of endodontic microscope is expensive when compared to conventional root canal treatment.
Cone beam CT has provided a 3 dimensional view of the root canals of the tooth when compared to the one dimensional x rays. Additional canals in a tooth can be easily identified by the help of cone beam CT.
What is the successrate of RCT?
A properly restored tooth following root canal therapy yields long-term success rates near 97%. Root canal treated teeth may fail to heal, for example if the dentist does not find, clean and fill all of the root canals within a tooth. Any tooth may have more canals than expected, and these canals may be missed when the root canal treatment is performed. Sometimes canals may be unusually shaped, making them impossible to clean and fill completely; some infected material may remain in the canal. Sometimes the canal filling does not fully extend to the apex of the tooth, or it does not seal canal as it should. Sometimes a tooth root may be perforated while the root canal is being treated, making it difficult to fill the tooth. An endodontist can often re-treat failing root canals, and these teeth will then heal, often years after the initial root canal procedure.Endodontically treated teeth are prone to extraction mainly due to non-restorable carious destruction and to a lesser extent to endodontic-related reasons such as endodontic failure, vertical root fracture, or perforation.
How can I prevent RCT?
Root canal treatment can be prevented by some simple measures like;
Dental decay if detected should be restored in the initial stage itself.
Dental decay should be prevented by simple home care measures like use of fluoridated toothpaste, fluoride mouth rinse, flossing, regular visits to a dentist etc.
Children involved in contact sports should wear mouth guard to prevent injury to their teeth.
Motor bike riders should wear helmets and motor vehicle drivers should wear seat belts to prevent injury to their teeth.
Dr Benley George
Vice Principal, Pushpagiri College of Dental Sciences, Tiruvalla,
