Root Canal Treatment
In the center of the tooth there is a space
called the root canal. This canal contains the
dental pulp, which includes the nerves and blood
supply for the tooth.
Root canal treatment is needed when irreversible
damage occurs to this pulpal tissue. The damage
to the nerve is often made apparent by either
pain and/or darkening round the top of the root
of the tooth on X-ray.
Damage to the dental pulp may occur for many
reasons, including: -
- Infection
- Decay
- Deep
fillings
- Trauma
- Fracture
Procedure for Root canal Treatment
There are a number of tests, including x-rays,
which can be undertaken to check the vitality of
a dental pulp.
A hole is then drilled through the top
(premolars and molars), or back (incisors and
canines) of the tooth to gain access to the root
canal.
The most important factor determining the
success of a root canal is that it is free of
bacteria when it is filled. For this reason we
isolate the tooth with a rubber dam to prevent
bacterial contamination from the rest of the
mouth. The canals are then located and cleaned
and shaped to a fine taper. We have a
specialized hand piece which locates exactly
where the root filling should extend to and
automatically reverses when this point is
reached.
Once the canals are shaped, they are sealed
close to the tip using the latest technology, a
synthetic material called Gutta Percha, it is
placed into the bottom part of canal then heat
moulded to shape before soft Gutta Percha is
then moulded to the top portion of the canal.
To complete a
root canal treatment may take several
appointments, and between visits, a dressing is
placed within the canals. This dressing is
bactericidal (that is, kills bacteria), and will
sterilize a canal a seven days period- thus a
minimum of a week is required between
appointments. In addition irrigations, and on
some occasions an ozone machine, are also used
to help to sterilise the canals.
The root canal itself only involves the filling
into the canals in the roots of the tooth. Once
the root canal is completed we need to restore
the coronal part of the tooth-that is the part
which appears above the gum line. A filling is
placed to restore the tooth into the bite.
In the long term most root filled teeth ideally
require a crown for strength, aesthetics and
function. This is because teeth that require
root canal treatment often have little remaining
of their original tooth tissue, this combined
with the additional material removed to complete
the root canal means that they are substantially
weakened. A crown caps over the tooth and holds
it together providing protection from fracture.
The tooth can generally be prepared for the
crown at the same time as the filling, is placed
to save time in the long term. The filling is
still required with the provision of a crown as
the crown simply caps over the top of the tooth
– the filling fills in the space in the centre
of the tooth.
The cost of the crown or restoration is
additional to the cost of the root canal. We are
happy to provide you with a written estimate.
Root canal treatment has a very high success
rate if the canals are able to be properly
cleaned and sealed, and the tooth restored
appropriately. Success rates vary from 92-96%
for a tooth with visible infection round the tip
of the root to 82% for a tooth with a visible
area of infection on x-ray. The success rate for
re-treatment of a root canal which has
previously failed is 62%. Results from research
into why root canal treatment fail has enabled
us to employ new techniques and irrigations
which we expect will increase these success
rates.
Complications:
- Root canals
are very fine and often curved, so
instruments may occasionally fracture within
a canal. Sometimes these can be removed;
however, they may also be sealed in as part
of the root canal filling without
compromising the success of the treatment.
- Pain or
discomfort may occur between appointments.
This is common immediately after an
appointment, as the medicaments placed
within the canal take time to work.
Sometimes an infection may need to be
treated with antibiotics.
- Difficulty
in locating canals can sometimes lead to a
perforation (that is, an instrument going
outside the tooth) if this occurs it can
generally be repaired – although referral to
a specialist ( endodontist ) may be
necessary.
- If a root
canal is required through an existing crown,
this may compromise the existing crown
either necessitating its replacement or
shortening its life span.
- Occasionally
if can be difficult to negotiate and clean
canals completely.
- Infection or
pain rarely continues after root canal
treatment. If this occurs further treatment
will be required.
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