Root Canal Treatment

Root canal treatment is normally offered when a tooth has been damaged by an accident or by decay; and the tooth’s pulp chamber has been exposed; the tooth often displays symptoms of pain and discomfort, which may be accompanied by an infection or abscess.

Are there alternatives?

You can choose the following alternatives to root canal treatment:

1. Extract the tooth, and choose no replacement.
2. Extract the tooth, and replace with a denture, bridge or implant.
3. Extract the tooth and orthodontically close the space (rare option and not always possible).

What is root canal treatment?

In the most simple sense, root canal treatment will clean out the insides of a tooth, and seal it off; a filling or restoration is then placed on the tooth to protect and/or strenghten it.

During the cleaning stage, the nerves and blood vessels are removed and the tooth is medicated; the root canal (or nerve tunnel) is bored out and widened. This phase often provides nearly immediate relief from pain and infection. Small stainless steel or nickel titanium files are used in a “reaming” fashion to clean out the soft tissues within the pulp and root tunnels.

At the sealing stage, the tooth’s root tunnel (the root canal)  is filled with a soft material, usually a natural substance called “guttapercha”, which is inert and biocompatible. Some dentist will use a synthetic sealant which has the same properties.  This stage also normally sees the tooth restored with a filling.

Is root canal treatment always successful?

No, but the success rate is very high. In large scale Delta Dental Study of over 1.6 million patients who had root canal treatment, 97% had retained their teeth 8 years following the procedure, with most complications, such as re-treatment, need for root-tip surgery or extraction, occurring during the first 3 years after the initial root canal treatment. Rotstein I., Salehrabi R. (December 2004), “Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study”, Journal of Endodontics 12 (30): 846–50

The key factors affecting the success of root canal treatment are:

1. The use of a rubber dam.
2. Thorough cleaning of the tooth and anti-bacterial treatment.
3. Timely crowning of a tooth after root canal treatment to prevent fracture.

It is important to understand that failure of root canal treatment and loss of a tooth may NOT indicate a deficiency in treatment or treatment error but may be a factor that is OUTSIDE the control of your dentist.

ROOT CANAL RETREATMENT success rates are, unfortunately lower.

What are the known risks and complications?

Accessory or “extra” canals. During the treatment of the tooth, we expect to find 1, 2, 3 or 4 canals, depending on the size of tooth, however, nature sometimes imparts more than the “expected” number of root canals AND/OR these extra canals are very narrow or branch off the main canal deeper within the tooth. This can mean that the extra canals are NOT thoroughly cleaned and filled or missed altogether. This may cause a reinfection of the tooth.

Fractured files. Root canal treatment is carried out using fine stainless steel and/or nickel titanium files. Every care is taken to ensure that these files do not catch or bend; however, in extremely fine or constricted canals files can break leaving a small metal piece in your tooth. All our files are sterile and biocompatible or inert, and will not cause a reaction, but a fractured file means that the root canal cannot be thoroughly cleaned and sealed.

Fractured roots. Root canal treatment results in a tooth structure that may be brittle and prone to fracture under loading. This may lead to a hairline root fracture and reinfection of the tooth. Some root canal treated teeth will need posts placed into the root tunnel to help strengthen the eventual filling placed, and these may also cause root fractures.

Fractured tooth. Once root canal treatment is completed, the tooth normally needs a very large filling or restoration, if the tooth is not crowned in a timely manner, parts of the tooth may fracture after loading leading to loss of the tooth. Not all root canal teeth need crowns and your dentist will advise you on the need for a crown.

Cracked teeth. The prognosis is favourable if the fracture does not enter the root however the presence of a crack in the tooth may influence the long term success of root canal treatment and the future behaviour of the crack is not predictable.

The risks of endodontic treatment include but are not limited to - discomfort after treatment; fracture of roots;  damage to or loosening of crowns and their foundations; separation of instruments; perforation of roots; blockages of the roots (natural or  procedural) that may prevent treatment and treatment failure. If a complication were to occur during your treatment, your dentist may discuss the need to refer you to an Endodontist (specialist dentist).