The following represents a typical endodontic case. Each phase of the treatment provides a general narrative
|Phase 1. Evaluation. This stage of endodontic treatment typically begins with a referral from your general |
dentist requesting the endodontist evaluate a particular tooth or area. Indicators can often be tooth sensitivity or soreness, information detailed on the endodontic FAQ page. The endodontist will utilize an array of tests to
determine the problem area or areas and then inform the patient of their findings.
|Phase 2. Initiation of Treatment. Following the evaluation, the patient generally decides on the best course of |
treatment for the tooth in question. At this stage, if treatment is required and requested, the endodontist will 'open'
up the problem tooth, remove the infected pulp, and place a medicated packing into the pulp chamber. This
medication usually remains in place for 10 to 14 days, helping to ensure that the infecting bacteria is eliminated.
The tooth opening will then be closed using a temporary material and a follow-up appointment will be set.
|Phase 3. Completion of Treatment. At the follow-up appointment, the endodontist will inspect the treated tooth to |
appraise the progress of the medication in eliminating the infection. If successful, the tooth will be re-opened, the
medicated removed, and the root canal treatment initiated. The endodontist will begin to obturate the root canals
themselves, cleaning and smoothing them with special files. Once confident that all debris has been removed and
the canals are sufficiently prepared, the endodontist will fill the open canals with permanent filling materials. Finally, the endodontist will close off the root canals from infection with another placement of temporary sealant. In some cases, depending on the endodontist's evaluation of the tooth, a permanent restoration might be placed instead of a temporary one.
|Phase 4. Follow-Up. Critical to the success of the endodontic treatment, a patient will be directed to return to their |
general dentist for the placement of a permanent crown. It cannot be stressed enough how important this phase of
the treatment is. The temporary seal used by the endodontist to 'close' of the areas of the root canal has a general
lifespan of 4 weeks, or less. Following that time frame, it is certain that the temporary bond will be compromised and
bacteria will begin to re-infect the treated area. Therefore, a patient who receives endodontics MUST complete the
process by having a crown placed over the treated tooth by their respective general dentist. Failure to complete the
process with a crown will ensure the reinfection of the endodontically treated tooth, often leading to a complete root
canal retreatment or dental extraction.
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.
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.
Treatment is usually performed under local anaesthesia.
- 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.
- 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.
|Figure 1. Root canal instrument placement.|
|Figure 2. Radiograph showing filled root canals.|
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.
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.
The only alternative treatment that will remove the infection is extraction of the tooth.