Root Canal Treatment

Root Canal Treatment, also known as Endodontics Treatment, is a dental procedure in which the diseased or damaged pulp (core) of a tooth is removed, and the inside areas (the pulp chamber and root canals) are filled and sealed.

Endodontics / Root canal treatment is a specialty of dentistry that deals with diseases of the dental pulp and its supporting structures. In order to understand Endodontics treatment, Teeth have several layers. The outside layer of the tooth is composed of a hard layer called enamel. Enamel is supported by an inner layer called dentin, which has at its center a soft tissue known as the pulp.

The pulp receives its nourishment supply from vessels which enter the end of the root. Although the pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

Root canal treatment at Jehangir OraCare Dental Centre, Pune

Steps In Completing A Root Canal Treatment

Gaining access to the canal

Placing a rubber dam around the infected tooth

After numbing your tooth but before beginning the actual process of performing the root canal treatment, your dentist will stretch a sheet of rubber around your tooth. Dentists call this sheet of rubber a "rubber dam." It is held in place by a small clamp that grasps your tooth.

The purpose of a rubber dam is to allow the dentist to keep your tooth saliva free to prevent it from getting re-contaminated with bacteria while your root canal treatment is being performed as saliva does have bacteria in it.

Gaining access to the nerve area of the tooth

The dentist needs to access that area inside your tooth where the nerve tissue resides to start your root canal treatment. This is accomplished by using a dental drill and making an "access cavity" that extends down to the pulp chamber of the tooth. On posterior teeth this hole is made on the chewing surface of the tooth. On front teeth the access hole is made on the tooth's backside.

Cleaning the tooth

The next step of the root canal treatment process is to clean out the interior of your tooth (the pulp chamber and all root canals). This cleaning process removes any bacteria, toxins, nerve tissue, and related debris that are harboured inside your tooth.

Most of the part of cleaning process is accomplished by using "root canal files" and copious irrigation. Root canal files look like straight pins with rough surface. These instruments literally are files and are used as such.77

Your dentist will work a series of root canal files, each of increasing diameter, up and down in your tooth while simultaneously using a twisting motion. This action will scrape and scrub the sides of the tooth's root canal(s) and thus cleans it out.

As an additional part of the cleaning process, your dentist will wash your tooth periodically ("irrigate" the tooth) so to help flush away any debris that may present. Traditionally, a number of different solutions have been used for this purpose. Nowadays, sodium hypochlorite (bleach, Clorox) is commonly used. An added benefit of Teeth Whitening is that it is a disinfectant.

Detrmining the length of Root Canal

Radio graphs are important for root canal treatment. Throughout a root canal treatment the dentist will need several x-ray pictures of the tooth to determine the position of the instruments and filling material inside the canals. The dentist also advises to have a good pre-operative picture to determine the approximate length of the roots and their particular shapes and curvatures.

Sealing is done in root canal

Once the tooth root canals are suitably cleaned and shaped and infection free they can be sealed off. A root filling material (usually a rubbery material called gutta percha) is placed into each canal with a special sealer.

Final restoration becomes important in root canal process

Placing a suitable final restoration is almost as important as the root treatment itself. If the restoration leaks bacteria can migrate down the side of the root sealer and re-infect the tooth.

First, your dentist will have to build up a foundation to strengthen the tooth and support the crown. This build-up is called a core. To help hold the core in place, your dentist may have to use a post. A post is a metal rod.

There are two ways to put a post and core in a tooth.

  • The post can be pre-made and used with a core material that is built up around it. Or, the post and core can be custom-made in one piece to fit your tooth.
  • This second type often is used in front teeth. It takes two dental visits. During the first visit, your dentist prepares the tooth and takes an impression so the post and core can be made. During the second visit, your dentist cements the post and core to the tooth.

Finally, a crown is made and cemented onto the tooth. If a post and core have been placed in the tooth, the crown is then cemented over the post and core.

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Instrumentation used for root canal treatment

The root canals are identified and then cleaned out with special root canal instruments. Some are used by hand, others rotate in a hand piece. They all have the function of removing debris from the canal and smoothing and shaping the walls of the canals to create a smooth, clean surface along the entire length of the tooth root canal. The canals are constantly rinsed to aid in debris removal and canal sterilization. In some, but not all root canal cases, the canals may be dressed with various medications and sealed with a temporary filling material to allow time for the infection to clear.

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Myths Vs Facts

Teeth that have had Endodontics therapy are eventually lost anyway

Depending on several factors the tooth that is affected with root canal can last lifelong which are listed below:

  • Expertise with which the treatment is done by a general dentist or an endodontist
  • Survey shows that 94% of Endodonticss cases are successful when done by endodontist.
  • Proper restoration of tooth is crucial to the entire treatment which serves below mentioned purposes:
    • The restoration must be able to provide a lasting seal that prevents contaminates from the oral environment from seeping back into the tooth's root canal space
    • The restoration must also be one that can help to protect the root canalled tooth from future damage (such as fracture or breakage)

Pulling a tooth is a better option than having root canal

Tooth extraction may be an easier and cheaper choice rather than root canal treatment. This seemingly simple and inexpensive choice, however, may prove to be a very poor choice in the long run for the following reasons:

  • If a tooth is removed, its neighboring teeth will tend to shift towards the vacant space, sometimes significantly.
  • A change such as this can lead to problems with chewing, aesthetic concerns or jaw joint function.
  • Alignment changes can also create food traps or make it so your teeth are more difficult to clean. If so, you will be placed at greater risk for developing problems with tooth decay and gum disease.

Having Endodontics therapy hurts

For most of the patients the procedure involved in root canal is no different than other dental procedures. Moreover the dentist will numb the affected area with local anesthetic. So it may be a boring session for a patient while the dentist carry out the end-to-end procedure however, the chances for any excruciating pain is almost negative.

A woman who is pregnant can't undergo Endodontics therapy

Thankfully it is only a myth and not a fact. However a pregnant woman should consult before going for root canal as the protocol will vary considering her pregnancy.

Certain issues can be considered in case of root canal carrying out on a pregnant woman:

  • Treatment timing : A consideration must be made that weighs the timing of the pregnant patient's root canal treatment in regards to their overall comfort and the well being of them and their fetus.
  • Appointment length and number of visits : Instead of one relatively longer appointment, in order to keep a pregnant patient physically comfortable, their root canal treatment may need to be divided up into two or more shorter visits.
  • The use of radio-graphs (x-rays) : However, it is likely that the dentist will want to employ techniques that help them to keep the needed number of x-rays to a minimum in order to avoid the fetus to get exposed to X-rays.

After having Endodontics therapy, the tooth has been completely restored

Once the Endodontics therapy has been completed, the prompt placement of an appropriate dental restoration is needed too. This final restoration will help to protect the integrity of those accomplishments produced by the root canal treatment as well as the tooth itself.