Dental teeth root

ROOT CANAL THERAPY

Root Canal Therapy (also known as endodontics) is a dental treatment which aims to save the "dead" or infected tooth in order to make it pain free and functional. This is usually done  over a number of visits. Root canal therapy is not always a painful experience as some may believe, Once local anaesthetic is given, the procedure is mostly pain free. Occasionally there may be some minor pain or tenderness after the treatment, this may be relieved by taking some analgesics.

root canal therapy

Deep caries

causing pulpal infection, tooth to die

and an infection in

the dental bone

Root canal infection

Deep restoration  

causing tooth to die

and an infection in

the dental bone

RCT root canal therapy

Completed root canal: cleaned and sealed canals with gutta percha and dental cement.

Root canal treatment completed

Infection resolved and healed dental bone, after successful root canal treatment

What does Root Canal Therapy involve?

  • The infected pulp is removed through an opening in the  tooth

  • Following this, the root canals are cleaned, disinfected and shaped so that the canals can later be filled.

  • In between visits, some medications are used to help to kill the bacteria inside the canals and a temporary filling is placed  to cover the opening .

  • Several X-rays may also be taken to determine the lengths and apices of the tooth canals

  • The tooth canals will then be filled with some rubber material, usually Gutta percha and dental cement. This seal will help to prevent bacteria from re-infect the canals.

  • The final step involves restoring the tooth. Most of the time, a crown (cap) will be required to protect the tooth for long term, especially for back teeth (premolars and molars)

What causes the tooth to die or be infected?

  • deep or aggressive tooth decay which reach down to the pulp (dental nerve area)

  • deep fillings

  • facial injury or trauma (e.g. blow to a tooth or jaw)

  • Cracks within the tooth

  • idiopathic (unknow cause)

Can all teeth  be saved with root canal therapy?

  • Not all teeth  but the majority can be saved.  Teeth with vertical root fracture for example have a poor to  hopeless prognosis  to treatment.

  • A few may not respond well even after treatment and may require further treatments or referral to specialists (endodontists).

What is the success rate of root canal therapy?

  • From some studies, the success rate of root canal therapy can vary from 65% to 95% over different periods of observation (1 to 8 years)  . Such variation in the success rate may be due to different criteria to define what is a successful root canal treatment or root canal treated tooth.

  • Generally speaking, root canal therapy does have a good success rate but it will depend on many factors such as

    • the initial finding and diagnosis: Why does the tooth need to have root canal treatment in the first place. Is it because dental caries have reached the pulp or the tooth has a crack. Is there any pathologies present already in the dental bone prior to commencement of the root canal treatment.

    • the anatomy of the root systems: front teeth have usually a much better prognosis or success rate than back teeth or molars, as front teeth usually have a single and relatively straight canal while molars have  complex and multiple canals. On the other hand, a few front teeth may also have complex and multiple canals.

    • the remaining tooth structure

    • timing of the final restoration: bacteria in the mouth can enter the treated canal area. Any leakage into the canal system will reduce the long term success of the root canal treatment. A crown may be the imperative long term option for back teeth and some other front teeth (see note below)

    • Condition of the other teeth or dentition: parafunction such as grinding, malocclusion

 

How long does the tooth last after root canal treatment?

  • The material used to seal the root canals may last for a lifetime.  A crown is usually recommended and imperative especially for posterior teeth after root canal therapy as the tooth tends to become more brittle and more likely to fracture.

  • The most common cause for root canal therapy is extensive and deep decay. As a result the actual remaining tooth structure may be limited, weak and not strong enough to hold the filling. A standard filling may not able to provide a proper seal, nor be strong and durable enough.  This is also another reason why a crown may be recommended as the final restoration.

  • However regular dental check-ups and home care are also very important, as with any dental treatment including crown after root canal therapy.

root canal crown
A crown is recommended as the final restoration for the root canal treated molar.
root canal treated tooth
An endodontic file is used to clean and shape the root canals 

What is an Endodontist?

  • Not many website of general dentists would mention this on their webpage, but for the full understanding on this topic of root canal therapy, this has been included.

  • An endodontist is a "dentist" specialised in root canal treatment. Endodontists are specialists in this field of dentistry.

  • While general dentists can and do perform root canal treatment, there are some circumstances where they may need to refer the patient to see an endodontist such as:

    • complex root canal system or anatomy which general dentists may not have the skills and ​specialised equipment and technology to perform such difficult and specialised procedure.

    • endodontic re-treatment: if you had a previous root canal treatment that was not successful and needs to be redone

    • endodontic surgeries: for example apicectomy which are surgeries to remove the infected tissue and tip of the tooth's root, usually performed on previously failed conventional root canal treated tooth.

  • However, your general dentist should be the first person you should see for your oral and dental care. Your general dentist will diagnose your dental problem first,  determine and discuss what treatment options are available... Only then your general dentist may decide to refer you to  see other dental specialists, if needed. Endodontics are just one of the many dental specialties in dentistry. 

  • Lastly, the cost for root canal therapy is likely to be much lower if the tooth can be treated by a general dentist, rather than by an endodontist. There may also be a long waiting time before you can  see an endodontist, your dentist may able to carry out some temporary treatment for you to relieve from pain or discomfort.