Root Canal Treatment – Indications, Procedure and Cost

Root Canal Treatment: It is a procedure aimed at treating an Infected tooth where the infected pulp tissue is removed from the root canal, and the cleaned root canal system is filled up with a bio-compatible material known as Gutta purcha, then the prepared cavity is filled or restored with a suitable restorative material –
Amalgam, Composite, GIC etc.

Indications of RCT or When is Root canal treatment done:

• Root canal treatment is preferred when the infection has reached the vital tissue i.e the pulp and has infected the pulp tissue, it is also recommended when the tooth has lost its vitality (died)
• It is done when the patient wants to preserve the natural tooth structure without it being extracted.
• When there is a fracture to the tooth where the pulp tissue is damaged due to the trauma caused to it.
• If the pulp infection reaches the bone, and root canal treatment is not done there will be an abscess formation which may lead to extraction of the tooth and treating the affected bone.

There are certain Contraindications in Root Canal Treatment depending on many factors which have to be considered and depending on that the alternatives to Root canal treatment are indicated for which are mentioned below.

What is the alternative for Root canal treatment

• Extraction is the only alternative to root canal treatment.

There are some treatment plans which can be done other than extraction which is the alternative used in 99% of cases. You can check this to know more about the Alternatives to Root canal Treatment

What happens when the root canal is infected

• Sensitivity in the tooth.
• A swelling with pus in the area around the tooth.
• A swelling that may spread to other area of the face.
• Bone loss around the tip of the root.
• Abscess formation around the root tip.
• If  neglected for long a Sinus or a drain hole is formed starting from the root draining its contents to the outside.

What are the Signs and symptoms of an infected tooth

• The signs start with pain on chewing, which is relieved within a few minutes and as it progresses it leads to continuous pain after chewing or drinking hot or cold drinks etc
• If the tooth is left untreated it may lead to an abscess formation with mobility in which case the prognosis of the case becomes bad
• A tooth that hurts significantly when pressure is put on it, by biting on something or sometimes even on touch.
• Sensitivity to different modalities like heat, cold, pressure etc..
• Discoloration of the tooth with or without pain.
• Discoloration of the tooth after trauma to the tooth, which indicates that the tooth is becoming non vital.

Steps of Root Canal Treatment:

1. Diagnosis – IOPA and RVG
2. Access Opening
3. Working Length Determination
4. BMP or Bio mechanical preparation
5. Obturation

Diagnosis using IOPA or RVG: The procedure of root canal treatment begins with the diagnosis of the infected tooth, The diagnosis is done with the help of the above mentioned symptoms and the main and the final diagnosis is done after taking a radiograph of the suspected tooth. IOPA or Intra oral periapical radiograph is one method and the latest method is the RVG. Using these Radiographic methods it helps in determining the tooth affected, extent of lesion present, number of Roots, number of pulp chambers and the anatomical variations in the root.

The infected region can be detected by slight discoloration in the region from the normal and the presence of infection in the apex of the root as shown in the image.

Access Opening:

After taking a Diagnostic X-ray, the next step is to gain access to the pulp chamber which is done with the help of an Access Opening. The Access cavity preparation is the first step to a successful root canal treatment. Access canal should be prepared in such a manner that it provides unrestricted access to the pulp chamber below and allows extirpation of the pulp tissue completely.

Objectives of an Ideal Access Cavity Preparation:

1 Straight line access: A straight line access means the instruments used in BMP like – Files (manual or rotary) should be entering the pulp chamber in a straight line without any restriction.

• Improves  instrument control
• Improved obturation
• Decreased procedural errors
• Removal o unsupported tooth structure

2 Conservation of Tooth Structure: With an infected tooth already weak due to caries, it is important to make sure that as little as sound tooth structure is removed. This helps in providing strength to the remaining tooth structure in bearing occlusal forces.

• Minimal weakening of the tooth
• Prevents accidental fractures of the tooth

3 Unroof pulp chamber and expose pulp horns: Pulp horns are present in every tooth where the pulp chamber extends into the crown in the form of horns. The main criteria is to clean and clear all the pulpal tissue from the pulp chamber as remnants can lead to re-infection.

• Maximize visibility
• Aids in locating canals
• Removal of complete pulp tissue including pulp horns
• Helps to attain straight line access

Access opening is a very important aspect of Root canal treatment and in case of Failure to attain proper Access Opening or cavity will lead to –

• Missed canals
• In complete removal of infected pulp tissue
• Breakage of files due to lack of straight line access
• In case of excess removal of crown structure can lead to weakening of crown leading to crown build up or crown lengthening procedures
• Proper coronal seal cannot be attained in case of improper access opening

BMP or Bio mechanical Preparation:

BMP is divided into multiple aspects – Working length determination, Irrigation and Cleaning and Shaping of the canal to prepare the tooth for Final obturation.

After this Endodontic files are used to remove the pulp tissue from the root canals, the endodontic files are available in different sizes as shown in the image,

These files are used based in the width of the root canal as it is different in different teeth and in different individuals.

There are many types of Root Canal Shapes which should be considered during BMP after identifying the type of Root Canal morphology the access cavity shape should also be altered accordingly.

Weine’s Root Canal Morphology Classification

Vertucci’s Root Canal Morphology Classification

These files are then inserted into the root canals from the occlusal surface to clean the infected root canals by removing the pulp tissue.

These files are flexible to ease the procedure as the root canals are not always straight they are seen with many curvatures at the tip.

The procedure of removing the pulp tissue from the root canals is illustrated in the following images:

infected tooth which is to be operated on

Above given is the infected tooth which has to be operated on by the root canal treatment, seen in it is the caries infiltration in the Enamel and Dentin which is extending into the pulp, and seen in the root apex is the formation of an abscess.

removal of pulp tissue and draining of the abscess

After removal of the pulp tissue from the root canals, the empty root canals are then cleaned with disinfectant irrigating solutions, to make sure that no infected tissue remains in the canal which is capable of causing the infection again.

Then after successfully rinsing the root canals, gutta-percha points are placed into the empty root canals to replace the pulp tissue which was removed.

These gutta-percha points are available in different sizes so as to completely fill in the root canal which was emptied, the gutta percha points are adapted with the use of pressure into the canals with the help of a plugger or a dental instrument with a tip to put pressure on the gutta-percha points.

The gutta-percha points are placed into the root canal by applying cement onto them so that they are well adapted to the walls of the root canal.

After the root canal is filled with the gutta-percha points an X-ray is taken to see weather the points are in place and weather there is any gaps.

The gutta-percha point must fit well enough so that you know with the utmost predictability what the final result will look like, even before you complete the procedure.  If the preceding instrumentation has been done well the point will be very easy to fit and the result will be predictably excellent.

After confirming that the gutta-percha points are well placed then comes the turn of the restoration to be done to replace the tooth structure removed during the cavity preparation.

Mainly a tooth colored restoration is preferred by the patients for the aesthetics to be maintained, The success of the Root canal treatment is confirmed by taking a radiograph after the complete restoration is done.

Restoration or Dental Crown or Onlay:

This is one of the most important part of the treatment where the access cavity prepared needs to be filled with an ideal material which can bear the vertical stresses of occlusion, bond to the tooth structure to prevent micro leakage. Here is a list of Ideal Restorative materials used after Root Canal treatment – Ideal Restorative material after Root Canal.

After restoring the tooth, an Onlay ( in case of sound tooth structure) or Complete Crown (in case of loss of any wall of the treated too) is required to increase the longevity of the tooth treated. There are many types of crowns – Metal, Metal Ceramic, Zirconia etc.

How much Does Root Canal Cost?