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Root Canal Treatment (RCT)

Whether the people know what is a root canal or not, what they know is that it is synonymous with pain. The idea that a root canal is the most painful of dental surgeries is a myth. The procedure can save a dying tooth and prevent the need for an artificial tooth.

A root canal is a hollow cavity within the tooth that houses the vital part of the tooth-the pulp. The pulp provides nutrition to the tooth via the blood and is also responsible for tooth sensitivity because of the presence of the nerves.

If a canal ever gets infected, which generally occurs when tooth cavities destroys the enamel and dentin, the pulp gets exposed to the outer environment. At this stage the patient feels an intense pain that might even radiate to head and ear, sensitivity to hot and cold and discomfort. If left untreated, an infection occurs causing the death of the pulp and also infection of the surrounding bone. The stage is usually associated with the inability of the tooth to withstand chewing forces. Unless still treated, this pain will likely remain and could result in the tooth eventually falling out.

In order to prevent tooth loss, a root canal surgery must be performed. The surgery is designed to clear out diseased material from inside the canal. To perform a root canal surgery, a hole is drilled into the tooth to allow access to the inner pulp. The diseased pulp is completely removed with special instruments, and the cavity is usually filled and capped with specific inert material.

decayed molar
Decayed Molar
RCT filling
After RCT Filling

The success rate of root canal surgery is high. Only 5% of the cases typically require remedial treatment. Complications usually involve re-infection of the pulp from diseased tissue that was inadvertently left behind. A re-infection of the tooth could mean either another root canal surgery or the loss of the tooth.

After the surgery, the tooth will remain sensitive to pressure for 2-3 days so chewing hard foods on it is not recommended for that period. However, a successful root canal surgery can restore a patient's ability to chew without continuous pain or the possibility of losing that tooth.

If you have excessive tooth pain, be sure to consult your dentist today about a root canal surgery.

Apicoectomy (root end surgery)

It is a surgical procedure involving the section and removal of the tip of a tooth root along with the surrounding infected tissue.

Conditions that require an apicoectomy include:

  • Infection persists even after completion of a root canal
  • An uncleaned root canal blocked by a fractured file that can not be removed.
  • A fracture or crack on the tooth roots.
  • A badly curved root canal obstructing endodontic files from reaching the root tip.
  • Several small branches at the sides of the root canal that can not be cleaned and sealed.

Diagnosis

The resulting infection of a failed root canal may be present in the absence of pain, therefore, X-ray evidence is usually required to diagnose the problem. An infection shows up on an X-ray as an unresolved black circle around the tooth. Sometimes a fistula or pimple might be present in the gum.

diagnosis

  1. The area is numbed with a strong dose of a local anesthetic.
  2. The surgeon will cut and lift the gum away from the tooth so the root is easily accessible. Some of the jaw bone around the root may also have to be removed to expose the root tip.
  3. The edge of the root tip up to the problem area is removed, along with any infected surrounding tissues (connective tissue or/and jaw bone).The infected tissue is removed, along with the last few millimeters of the root tip.
  4. To complete the apicoectomy, the final 3-4 mm of the root canal are cleaned and filled with a biocompatible material.
  5. An X-ray of the area is taken before suturing the tissue back in place.
  6. The bone naturally heals around the root over a period of months restoring full function. Careful follow up with dental x-rays and clinical examination is necessary to confirm that the proper healing that is expected has actually taken place.

After care:

Apicoectomy recovery is usually quick and without complications.Some soreness, swelling and pain are absolutely normal after the apicoectomy surgery.Stitches are removed 7 days after the procedure,

Some useful post-operative instructions to be taken care of are:

  • To minimize any swelling, place ice packs to the side of the face where surgery was performed, for 12 hours.
  • Follow your dentist's instructions regarding any medications prescribed (anti-inflammatory, antibiotics or pain killers)
  • To allow faster healing avoid brushing the area, vigorous mouth rinsing or eating crunchy or hard foods.
  • Reduce physical activity and rest after the procedure. No smoking for at least 2 days.
  • Avoid touching the wound area following surgery.
  • Good oral hygiene is essential to proper healing of any oral surgery site.

Prognosis:

In the hands of a skiled surgeon, apicoectomy carries a very high success rate but as in all surgery procedures there is always a risk of complications and failure. In most cases, the apicoectomy recovery time will not exceed two weeks. Any sign of remaining infection after this period indicates a failed apicoectomy In case of a failed apicoectomy, the tooth will have to be extracted.

Restoration of an RCT treated tooth- Post and Core

After RCT it is mandatory to put a crown over the treated tooth. However, RCT treated teeth present specific restorative problems because they frequently have insufficient healthy tooth structure remaining to retain the final restoration. Due to loss of tooth structure and RCT treatment, the tooth becomes brittle and prone to fracture. Various techniques are now available to address these specific problems. These techniques use special pins called as the dowels to provide necessary retention for the cores and to prevent separation of the crown from the root.

The post and cores are available as prefabricated posts or may be individually cast both for anterior and posterior teeth. The procedure involved is simple though technique sensitive. A properly selected case and dowel technique plays an important role in the reinforcement of the tooth.



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