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Root Canal Treatment(RCT)

Single Sitting Root Canal Treatment

A root canal is the space within the root of a tooth. It is part of a naturally occurring space within a tooth that consists of the pulp chamber (within the coronal part of the tooth), the main canal(s), and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root. The smaller branches are most frequently found near the root end (apex) but may be encountered anywhere along the root length. There may be one or two main canals within each root. Some teeth have more variable internal anatomy than others. This space is filled with a highly vascularized, loose connective tissue, the dental pulp. The dental pulp is the tissue which forms the dentin portion of the tooth. The formation of secondary teeth (adult teeth) is completed by 1-2 years after eruption into the mouth. Once the tooth has reached its final size and shape, the dental pulp's original function ceases for all practical purposes. It takes on a secondary role as a sensory organ.

Facts About Root Canal Treatment

What Are the Goals of Root Canal Treatment?

As an alternative to an extraction, the goals of root canal treatment are to save the tooth and allow it to be retained in the mouth for many years in a state of health, function, and comfort. Root canal treatment is directed towards removing diseased tissue from the inside of the tooth and subsequently filling and sealing the root canal space in order to minimize the possibility of future re-infection.

Why Is Root Canal Treatment Called Endodontic Treatment?

Endodontic is a word composed of two Greek words, "endo" meaning "inside," and "odont" meaning "tooth." Endodontics is that branch of dentistry that deals with the diagnosis, prevention, and treatment of diseases that arise from the soft tissues inside the tooth. These tissues are referred to as the dental pulp and they occupy the root canal space. Thus, endodontic treatment is also called root canal treatment.

If a Tooth Has Had Root Canal Treatment, Is It a Dead Tooth?

Root canal treatment does not kill a tooth. Even though root canal treatment removes the pulp tissue from inside the tooth, the tooth is by no means "dead." Following successful endodontic treatment, the tooth continues to receive its blood supply and nourishment from the surrounding tissues and the supporting bone. The body's immune system continues to recognize an endodontically treated tooth as viable and healthy, just as it recognizes any other normal non-treated tooth. An endodontically treated tooth generally requires a protective crown and, once this restoration has been completed, the tooth continues to function as an integral component of the dental arch. A tooth that has had root canal treatment and has been properly restored is no more susceptible to fracture, decay, or gum disease than any other tooth.

Fundamentals For A Root Canal Therapy

RCT is one name that gives many patients shivers when told about it. However, in reality, it is not that bad. Infact, it is an instant pain reliever and the best treatment to retain the original teeth. A Root canal treated tooth serves its purpose and function just as a healthy tooth. 

A root canal is a capillary, which runs from the base of the root of the tooth to the middle of the crown (the visible part of the tooth). The root canal carries the pulp (a network of blood and nerve cells), which brings the tooth to life.

The nerve of the tooth gets damaged due to many reasons. One of the main causes is cavity in the tooth that grows deeper and touches the nerve. Since the cavity is filled with bacteria, the root canal gets inflamed and causes pain. Other reasons that may damage the teeth are accidental cracks or infection from gums reaching to the base of roots. In such cases, root canal treatments can easily stabilise the position.

There are two ways to get relief from the pain: perform the root canal therapy, or pull the tooth, clean the gum below, and replace the tooth with a denture or bridge. We advise removing teeth as a last resort natural teeth are the ones best suited for the mouth.

It's important to have root canal therapy done quickly. The bacteria will travel down the canal to the root and into the jawbone. If this happens, the pain of your toothache will spread to your jaw. Even more important, the infection can cause your jawbone to deteriorate and weaken the structure that holds your teeth.

The best way to avoid root canals is to take good daily care of your teeth to prevent the growth and spread of bacteria. Brushing and flossing are important. Just as important are regular trips to the dentist, to check for the first sign of decay or cracks that could eventually lead to an infected tooth. In this case, an ounce of prevention really is worth a pound of cure!

Root Canal Treatment From Start to Finish

 

1. A Deep Infection

Root canal treatment is needed when the tooth's root becomes infected or inflamed through injury or advanced decay.

 

2. A Route to the Root

The tooth is anesthetized. An opening is made through the crown of the tooth to the pulp chamber.

 

3. Removing the Infected/Inflamed Tissue

Special files are used to clean the infection and unhealthy pulp out of the canals. Irrigation is used to help clean the main canal (called lateral canals).

 

4. Filling the Canals

The canals are filled with a permanent material, often gutta-percha. This helps to keep the canals free of infection or contamination.

 

5. Rebuilding the Tooth

A temporary filling material is placed on top of the gutta-percha to seal the opening until the tooth is ready to be prepared for a crown. A crown, sometimes called a cap, is made to look like a natural tooth, and is placed on top.

 

6. Extra Support

In some cases, a post is placed to give the crown extra support.

 

7. The Crowning Touch

The crown is cemented into place.

 

Symptoms Of Endodontic Disease

Common Symptoms requiring an Root Canal Treatment:

  • Severe tooth pain, typically relieved by cold water and increases with the intake of hot liquids.
  • Pain worsens when you lie down and reduces when you sit up.
  • Pain stays for a long time after consuming cold things.
  • Swelling around the tooth.
  • Constant tooth pain
  • Pain when chewing.
  • Tooth pain referred to head and ears as well.
  • Tooth sensitivity on consuming sweets.

If you have any of the above stated symptoms, it would be advisable that you visit your dentist, since he is the best person to judge whether you have a root canal disease or not, as some of these symptoms may be due to other problems as well.

Why May Endodontic Disease Cause Swelling?

When the pulp tissue becomes severely diseased and necrotic, the resultant infection can spread from inside the tooth into the adjacent bone and soft tissues. As a result, swelling can occur in the tissues immediately surrounding the tooth. If this situation is not treated and the disease process is not kept under control by the body's defences, the infection can begin to spread into other tissue spaces, such as those around the eye or in the neck. In some situations, this can become a serious medical emergency

Root Canal Retreatment

Can an Endodontically Failing Tooth Be Retreated?

Even when pain and/or swelling is present, the majority of failing endodontically-treated teeth can be successfully retreated in today's world of clinical possibility. By using scientific information gathered from research and clinical studies, clinicians have developed better endodontic concepts, materials, and techniques. Additionally, there are now better-trained general dentists and specialists alike. All of these factors translate into improved care for patients. The significant technological breakthroughs that benefit both doctors and patients in endodontic retreatment include:

  1. Magnification glasses, fibre optic lighting sources, headlamps, have significantly improved vision and hence elevated treatment success.
  2. Ultrasonic devices allow doctors to more efficiently and completely remove old root canal filling materials and other intra-canal obstructions so that teeth may be successfully retreated.
  3. Computer digital radiography technology allows the doctor to better diagnose, visualize, and treat root canal disease. Additionally, this technology significantly reduces radiation exposure to the patient.
  4. Improved instruments, better materials for filling and repairing canals, and innovative new technologies have all contributed to significantly improved retreatment success.

Today, well-trained general dentists and specialists alike can oftentimes perform non-surgical endodontic retreatment in a very predictable, cost-effective, and time saving manner when compared to other treatment alternatives. At times, however, retreatment cannot be managed with non-surgical efforts alone. In these situations, and as an alternative to extraction, a surgical approach may be necessary.

What Is Non-Surgical Root Canal Treatment (NSRCT)?

Non-surgical root canal treatment is a procedure directed towards saving an endodontically failing tooth. At times, the patient's existing artificial crown must be removed. In other instances, access through the crown may be possible. The access opening is created in order to give the dentist non-surgical access into the root canal space through the biting surface of the tooth. Once this has been accomplished, a non-surgical retreatment procedure oftentimes requires:

  • Locating and treating previously missed canals.
  • Removing old filling materials from the root canal space.
  • Removing posts and broken instruments.
  • Enhancing existing root canal treatment.
  • Negotiating blocked canals and bypassing canal ledges.
  • Repairing mechanical and pathological perforations in the root.

Once these objectives have been accomplished, the root canal system is re-cleaned, re-shaped, disinfected, and three-dimensionally sealed. A protective restoration can then be placed and the tooth restored to a state of health and function.

What Is Surgical Root Canal Treatment (SRCT)?

Surgical root canal treatment is a procedural effort in which it is necessary to elevate a small flap of tissue adjacent to the involved tooth in order to gain access to and treat root canal disease. Surgical root canal treatments are usually minor, in-office procedures performed under local anaesthesia. Once the pathological area is exposed, the doctor performs a "curettage" to remove the diseased tissue from around the root. This is usually followed by an "apicoectomy," a procedure in which the diseased portion of the root is removed. A small filling is then usually placed to seal the remaining portion of the root. Surgical root canal treatment will oftentimes result in a good long-term prognosis for the tooth if the cause of pathology can be effectively eliminated. 

Unfortunately, on occasion, retreatment efforts may not be possible or cost-effective and extraction may be the only alternative. However, saving a tooth that has been previously treated endodontically and is failing is usually possible, can be very predictable, and is typically the most conservative option for the patient.

Alternatives To Root Canal Treatment

The only alternative to root canal treatment is the extraction of the problematic tooth. It is wise to consider all of the implications of losing a tooth before having it removed. The decision should not be made hastily or because the tooth is painful. If pain is present and the dentist thinks that the tooth can be saved, the discomfort can first be relieved and then the alternatives explored.

The discussion about tooth replacement alternatives after extraction can be complex because each individual situation is unique and, at times, various specialists may need to be consulted. When considering the alternatives for replacing a missing tooth, a few of the major factors to consider are the long-term predictabilities of the various alternatives, the overall chair time involved in treatment, the esthetic results, the effects on the adjacent and opposing teeth, and the costs. The usual alternatives that a patient has after tooth extraction are:

  • A restored dental implant. This restoration involves a surgical procedure to insert the dental implant into the bone, a healing phase of several months, and a final restorative phase, which is similar to having a single tooth crown. Significant time and laboratory costs are involved.
  • A fixed bridge. Fabricating a fixed bridge requires cutting down ("preparing") the teeth next to the missing tooth so that they can receive the artificial crowns that support the replacement tooth. These teeth must be strong and healthy if they are to be effective bridge supports. Preparing the teeth for crowns could have a detrimental effect on their pulp health, depending on a variety of factors. This possibility needs to be discussed and factored into your decision. Fixed bridges may take multiple appointments to complete and have significant associated costs.
  • A removable partial denture. These appliances restore function and esthetics and can be inserted into the mouth and removed at will. Although many teeth are successfully replaced with removable prosthetic appliances, patients may initially find them cumbersome. Removable partial dentures may also temporarily alter phonetics as well as place unfavourable forces on the supporting teeth and soft tissues. There may be significant costs associated with this restoration.
  • Not replacing the extracted tooth. This is a poor choice in most situations. Leaving a space after extraction can lead to long-term problems with teeth shifting and tipping, destabilization of the biting system, and esthetic changes in the profile of the face. Financially and psychologically, this could turn out to be the most costly choice over the lifetime of the patient.

After considering and weighing all of the consequences of extraction and all of the alternatives for tooth replacement, in most situations it becomes obvious that well-performed root canal treatment with a protective restoration is the treatment of choice. Root canal treatment is usually the least time-consuming

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