Root canal filling

Toothache can have many causes, two of which are pulp infection and root caries – that is, caries affecting the root of the tooth. Root canal treatment is the simplest way to resolve such conditions and save the natural tooth from extraction.

Root canal treatment is a stage of endodontic treatment carried out to save a tooth affected by deep decay or a serious root infection.

Thanks to advances in dentistry, root canal treatment is now a painless procedure, so there is no need to worry when your dentist or endodontist recommends it. According to an article published in the European Journal of Dentistry, root canal treatment is a predictable and effective procedure, with a success rate of 86% to 98%.

To better understand what a root canal treatment actually involves, we need to have a clearer understanding of the anatomy of a tooth. Inside the tooth, beneath the enamel (the hardest tissue in the body) and the dentine, lies a soft tissue known as the dental pulp, commonly referred to as the nerve. This consists, in addition to the nerve, of blood vessels and connective tissue. The pulp is extremely important during the growth of a tooth. However, once a tooth has fully matured, it can survive without the pulp, as it continues to be nourished by the surrounding tissues.

When the dental pulp becomes infected by bacteria that penetrate the pulp chamber, endodontic treatment is required to preserve the tooth in the dental arch and ensure good oral health.

In practice, the procedure involves cleaning the canals inside the root of a tooth and devitalising it by removing the connective tissue and the infected pulp.

It is best to have a root canal treatment carried out by a specialist endodontist, as their experience ensures the success of the treatment. Generally, endodontic treatment involves 1–2 appointments at the dental surgery, provided there are no other complications.

There are several techniques used for root canal filling, but in most cases, the endodontist will use a combination of these. At DENT ESTET clinics, root canal treatments are performed using an endodontic microscope, as this ensures a success rate of over 90%. The endodontic microscope allows for the removal of all affected tissue and the cleaning of the canals with the utmost precision.

It is important to note that, at the end of endodontic treatment, a dental X-ray must be taken to check that the root canal filling has been carried out correctly, and that the root canal and pulp chamber have been cleared of infection and hermetically sealed using the materials used in root canal fillings.  

Root canal filling materials can be divided into three categories:

• Gutta-percha cones;
• Root canal sealants;
• Combinations of the two. 

Gutta-percha is a pliable, insulating material used to fill a tooth following root canal treatment.  

During the root canal filling procedure, the damaged part of the tooth, specifically the pulp, is removed, and the tooth’s canals are cleaned and disinfected before being filled and sealed. Gutta-percha is a thermoplastic filling material that is heated and compressed into the tooth’s canal, then sealed with adhesive cement.

Other types of root canal filling materials include apical sealers, cements or other active materials designed to fill the gaps left after the insertion of gutta-percha. To ensure the root canal is completely sealed, the endodontist will use root canal files made of stainless steel. 

A root canal treatment is necessary when bacteria from inside the mouth invade the dental pulp. This usually happens when a cavity is left untreated for a long period of time. The tooth’s nerve can also be affected if the tooth becomes damaged or cracks appear as a result of dental trauma. 

Symptoms of a dental infection

Among the most common signs that the infection has spread inside the tooth are:

• Severe toothache when chewing or biting;
• Sensitivity to hot or cold foods, which persists even afterwards;
• A sensation of the tooth ‘throbbing’;
• A change in the colour of the tooth;
• Swollen and tender gums;
• Pus around the infected tooth;
• Swelling of the face or neck;
• Loose tooth (pus from the infected pulp can soften the bone supporting the tooth).

Here, then, are the main steps involved in performing a root canal treatment:

1. Anaesthesia – local anaesthesia will be administered to ensure the patient’s comfort during the procedure, as well as to minimise pain following the root canal treatment;
2. Isolation of the treatment area – before starting the root canal treatment, the tooth is isolated using a special device, a rubber dam, which keeps it dry during the procedure;
3. Access opening – the endodontist will create an access point to the pulp chamber and root canals using a dental drill;
4. Removal of the pulp – the dentist will then perform a pulpectomy, which involves removing the dental nerve, whilst leaving the rest of the tooth intact;
5. Disinfection of the canals – The pulp chamber and root canals are cleaned, disinfected, dried and reshaped to allow them to be filled with filling material;
6. Filling the root canals – the dentist will fill the disinfected canals with gutta-percha or other materials used in endodontic treatment;
7. Sealing the tooth – after the canals have been filled, a temporary filling will be placed to seal the tooth and prevent reinfection;
8. Final restoration of the tooth – in some cases, following root canal treatment, the tooth will require a dental crown to protect it and restore its functionality. 

Aftercare following root canal treatment should be divided into three stages: immediately after the procedure, in the days that follow, and in the long term.

Immediately after a root canal filling, the patient may feel numbness in their mouth for a few hours. Therefore, it is important not to eat foods that require chewing or drink beverages that are too hot or too cold.

Over the next few days, you should continue to eat softer foods, chew on the side of the mouth where the treatment was not carried out, and brush the tooth carefully. Any pain following root canal treatment, although minimal, should disappear after a few days.

It is important not to neglect regular visits to the dentist. With proper care, the health of teeth treated with a root canal filling can be long-lasting. 

The main aim of a root canal treatment is to save the tooth. Sometimes, however, the tooth may be too badly damaged or the enamel too fragile to withstand the treatment. These factors can ultimately lead to the loss of the tooth.

If the procedure has not been carried out properly, there is a risk of the infection returning at the root of the tooth. Furthermore, when the situation requires it, it is important to carry out a final restoration of the tooth using a dental crown to prevent bacteria from entering the interior and causing reinfection.

Following root canal treatment, there is also a risk of discolouration of the treated tooth. This occurs because the dental pulp has been removed to stop the spread of infection. However, this happens in a very small percentage of cases.

Maintaining proper oral hygiene is extremely important after a patient has undergone root canal treatment. Teeth should be brushed twice a day, in the morning and in the evening, for two minutes, and auxiliary cleaning aids such as dental floss and an antiseptic mouthwash should be used.

If you’re wondering how much a root canal treatment costs, you should be aware that the price varies depending on the complexity of each patient’s case, the type of treatment, and the materials chosen.

The patient’s recovery time following root canal treatment takes less than a week, whilst any minor discomfort can be managed with anti-inflammatory medication.

Bibliography:

• Colgate. (n.d.). The truth about root canal dangers.
• American Association of Endodontists. (n.d.). What is a root canal?
• Healthdirect Australia. (n.d.). Root canal treatment.
• Cleveland Clinic. (n.d.). Root canal.
• Mayo Clinic. (n.d.). Root canal (multimedia).