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.
Enamel
Dentin
Pulp
Root
Bone
Sagittal section of mandible and teeth

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 pulps 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
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

Pathways of the pulp 10th edition

Progression of Disease
As bacteria further penetrates, pulp necrosis
(tissue death) occurs

Inflamed Pulp
Necrotic Pulp
Tooth decay

Pathways of the pulp 10th edition

Progression of Disease
Bacteria penetrate further causing
infection and destruction of the pulp

Pathways of the pulp 10th edition

Progression of disease
With complete necrosis and infection of
the pulp, pathologic changes are seen in
the surrounding bone
These changes are due to the immune
systems reaction to infection
This leads to bone loss and possibly an
abscess (localized collection of pus)
Periapical lesion

Pathways of the pulp 10th edition

Progression of disease
Acute Abscess
As an abscess expands there can be swelling in the gum tissues
and face
This may require surgical
drainage and/or antibiotics

In severe cases this may

require hospitalization

Pathways of the Pulp, 9th ed 2006

Progression of disease
Chronic Abscess
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.

Textbook of Endodontology 2010

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

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

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

Accessing the Root Canals

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

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 patients 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

Gutta percha cones

Resected bone and root from a mandibular

molar showing placement of 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