Root canal treatment - ProcessThe purpose of root canal treatment is to fully remove the inflammed or necrotic (dead) pulpa from the root canal and close it off tightly.
The first step involves the complete isolation of the affected tooth with a kofferdam (dental dam). This guarantees that no bacteria-carrying saliva enters into the root canal and also further protects the patient from accidently swallowing the disinfectant liquid used for rinsing.9
Depending on the type and scope of the disease as well as the patient's individual situation, local anaesthetic is normally administered so that treatment progresses relatively free of discomfort.10
In the next step, the dentist drills a direct access inlet to the pulpa and attempts to the make the root canal visible. Through the use of finely constructed extirpation needles and files, the inflammed or necrotic nerve tissue is removed.
An essential component of the root canal treatment is an exact measurement of the root canal length prior to preparation and subsequent filling; precision is required so that the root fillings reach close to the tips of the roots and fully heal the inflammation.A filling that does not extend far enough has the consequence of leaving bacteria behind in the tooth, whereas a filling that reaches too deeply can irritate the bone and lead to subsequent inflammation. Typically, a second x-ray is made and employed in the measurement of the canal length. There does exist, however, another method of measuring which employs electric resistance (endometry).
With a precise measurement of the canal length at hand, the working length of the instruments used to perform the procedure is also established. These finely-tuned instruments are made of flexible material and are used to clean and widen the full length of the canal until the last remnants of the pulpa have been removed. The canal is periodically rinsed with a disinfecting solution. Depending on the condition of the root canal, this stage of the procedure may require multiple sessions. The ultimate goal of root canal preparation is a uniformly smooth inner canal surface.
After every session, the dentist administers an antibacterial medication which remains underneath the temporary filling in the canal until the next session. This medication serves to comprehensively remove bactreria and disinfect the target area.
The last session involves the final filling of the root canal. The canal is dried and filled with a special paste and/or rubber-like substance (guttapercha). The canal filling's tissue-compatible material serves as a long-term sealant which prevents the spread of bacteria to the jawbone. A further x-ray is subsequently made, which provides the operating dentist with a means of monitoring the length and composition of the root canal filling.
In the final step, a decision must be made regarding how to close the access inlet and care for the tooth long-term, including the full restoration of the tooth's functionality. Options include dental fillings, pin mountings, or (partial) crowns.11, 12
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