What is a Root Canal?

Root canal treatment is the process of removing the inflamed or

infected pulp tissue from within the tooth

To better understand the concept of root canal treatment, it is

necessary to understand the tissue called “the dental pulp”

What is the pulp? The pulp, commonly referred to as

“the nerve of the tooth", is comprised of: Blood vessels

Nerves

Connective tissue

Tooth in cross section

Detail showing cellular components of the pulp

What is the pulp? Root canal treamtent consists of removing inflamed or infected pulp

tissue.

Sagittal section of mandible and teeth

Enamel

Dentin

Pulp

Root

Bone

Why is a root canal necessary?

Deep tooth decay (cavity)

A cracked tooth

Traumatic dental injury

Elective (for added retention of a

crown)

Why is a root canal necessary?

Tooth Decay (Cavity)

Tooth decay is caused by bacteria.

The pulp’s defense against bacteria

is inflammation, called pulpitis.

Irreversible pulpitis is the term used

to describe the level of inflammation

where the pulp tissue will not recover

and heal.

Eventually this will lead to an infected pulp (“dead nerve”),

followed by a dental abscess (infection).

Pulpal Inflammatory Changes

As Bacteria enter into the pulp,

they cause tissue destruction

spreading through the pulp and

into the canal system.

If left untreated the bacteria can

spread out of the tooth and

cause pathology and infection

in the bone surrounding the

tooth

Pathways of the pulp 10th edition

Textbook of Endodontology 2010

Why is a root canal necessary?

Cracked tooth

A crown is necessary to restore a cracked tooth to normal chewing

function and prevent its loss to further fracture

Root canal treatment is often necessary to remove the inflamed pulp

prior to crown placement

Why is a root canal necessary?

Traumatic injury

May expose the pulp

May disrupt the blood supply to the

pulp

Why is a root canal necessary?

Elective – an elective root canal may be recommended:

If a substantial portion of your tooth is missing and requires more

retention for the new crown

If a tooth with extensive fillings or cracks requires a crown

Progression of Disease

Pathways of the pulp 10th edition

The following example illustrates the

progression of disease from tooth decay.

Early stages of pulpal inflammation can be

seen before decay reaches the pulp

Once into the pulpal tissue, necrosis and

infection are inevitable

Bone

Root

Periodontal ligament

Pulp

Inflamed Pulp

Tooth decay

Progression of Disease

Pathways of the pulp 10th edition

As bacteria further penetrates, pulp necrosis

(tissue death) occurs

Inflamed Pulp

Necrotic Pulp

Tooth decay

Progression of Disease

Pathways of the pulp 10th edition

Bacteria penetrate further causing

infection and destruction of the pulp

Progression of disease

Pathways of the pulp 10th edition

With complete necrosis and infection of

the pulp, pathologic changes are seen in

the surrounding bone

These changes are due to the immune

system’s reaction to infection

This leads to bone loss and possibly an

abscess (localized collection of pus)

Periapical lesion

Pathways of the Pulp, 9th ed 2006

As an abscess expands there can be swelling in the gum tissues

and face

Progression of disease

This may require surgical

drainage and/or antibiotics

In severe cases this may

require hospitalization

Acute Abscess

Textbook of Endodontology 2010

Sometimes when an abscess

expands it burrows through the

bone and exits through the gums

This is called a sinus tract, but

commonly referred to as a “gum

boil” or a “pimple”

Usually the point of exit is on the

cheek or lip side of the gums at the

root tip level or at the gum-line.

Progression of disease

Chronic Abscess

How Do I Know If My Tooth Needs A

Root Canal?

What are the Signs I Might Need a

Root Canal?

Signs and symptoms that you may need a

root canal

Pain

Pressure - sensitivity when biting or pressing on the

tooth

Temperature – sensitivity to hot or cold, especially if

it is prolonged or lingers

Spontaneous or constant dental pain

Swelling

Ranging from a small bump or “pimple” on the gum

to a swollen jaw or face

Note that some teeth requiring root canal treatment have no symptoms

The best way to determine if you need a root canal is to see your

dentist who may then refer you to an endodonitst.

Diagnostic Tests

To confirm that root canal treatment is necessary, an endodontist

will perform certain tests on your tooth

These tests, along with x-rays, help in accurately assessing the

status of the pulp and whether root canal treatment will benefit you

Pulp tests – measure responsiveness of the pulp

Technology Utilized During Root

Canal Treatment

Surgical Operating Microscope

Greater accuracy and precision to yield

the highest quality of treatment

Identifying treatment complications

cracks/fractures of the tooth for example

can affect treatment outcomes

Identifying complexities of the root canal

system

Multiple canals within a single root if left

untreated can adversely affect the

success of the root canal treatment

Magnification of the tooth up to 17x the normal size has many advantages:

Electronic Apex Locators

Apex locators allow us to accurately determine the length of the

root canals, thereby limiting the amount of x-ray images we

need to take

Digital X-Rays (radiographs)

Decrease radiation up to 90% compared to dental film radiographs

Appear on high-resolution widescreen monitor instantaneously

Aids in pointing out to you key elements of your dental condition

High-tech Instruments

Rotary nickel-titanium (Ni-Ti) files

Efficient way to clean the canal system, significantly reducing operating time

Able to navigate curved canals due to their flexure

Ultrasonics

Ultrasonic vibration of instruments produce energies capable of removing debris, tooth structure, and bacterial biofilms

Many applications in endodontic treatments

Root Canal Treatment

Accessing the Root Canals

To gain access to the root canals of the tooth, a small opening is

made either on the chewing surface of the tooth (for back teeth),

or on the tongue side of the tooth (for front teeth).

Upper anterior tooth showing access opening into canal

In a multi-rooted tooth, gaining access into the root canals is

more challenging

With the aid of a microscope we are able to locate any hidden or

calcified canals

Accessing the Root Canals

Upper molar showing access opening into canals, and location of a hidden fourth canal

Rubber Dam Isolation

Isolation of the tooth is accomplished with a rubber dam

Keeps bacteria in the saliva from entering into the tooth

Prevents debris, instruments, etc. from going down the patient’s throat

Cleaning the Root Canal System

We use many instruments of different

sizes and shapes to properly clean and

shape your specific root canal anatomy

Disinfection of the root canal system

Sodium hypochlorite is one of the disinfectants used to reduce the

bacteria load within the tooth

Specialized blunt-ended needles are used to deliver these

disinfectants to the end of the root in a safe and effective way

Final preparation

After thoroughly cleaning and shaping the canals, the canals are

dried prior to filling the roots

Obturating (Filling) the Root Canals

Finally, the canals are sealed with two

components:

Sealer – a cement that sets over time

Gutta percha – a filler made of a natural form

of latex

This serves as the permanent root canal

filling

Resected bone and root from a mandibular molar showing placement of gutta percha cones Gutta percha cones

Root Canal Treatment Completed

Upon completion of the root canal treatment, a temporary filling is

placed over the sealed canals that has two parts:

Cotton pellet soaked in an antibacterial solution

A solid temporary filling on top

A final restoration (usually a crown) is placed by your dentist

This will restore functionality to your tooth and protect it from fracturing

Follow Ups

We will see you back to

evaluate healing

The healing bone takes

one year (on average) to

completely heal