The Root Canal Process

Step 1:

An opening is made in the crown of the tooth.  This allows access to the root canal system.  It is very important to have a large enough opening to find all the canals inside a tooth.  Anatomy inside the tooth is variable.  Some teeth have just one canal like most upper front teeth.  Premolars usually have 1 or 2.  Molars or the back teeth typically have 3 or 4.   Especially in back teeth, a surgical operating microscope with great illumination allows visualization much better to help find these canals.

Step 2:

The pulp is removed from the pulp chamber and root canals.  Tiny instruments are used to clean the root canals and to shape them to a form that will be easy to fill.  Irrigants are used to dissolve and flush out debris.  If this step is not completed in one visit, medication will be placed in the canals and a temporary filling will be placed in the opening to protect the tooth between visits.  Radiographs (X-rays) are taken periodically during the cleaning process to check if the instruments are cleaning near the end of the root.

Step 3:

When thoroughly cleaned, the root canals are filled with a rubber-like compound called "gutta percha." A cement is also used to help seal the canals to prevent bacteria from re-entering.  In many cases, the opening in the crown of the tooth is sealed with a temporary filling.  Either upon the request from your dentist or when we feel it is appropriate, the access opening in the crown is filled with a build-up restoration as pictured.  Occasionally, enough tooth structure is missing to warrant use of a post to help retain the final restoration.  After endodontic treatment, x-rays are taken to verify that cleaning and filling of the canals is close to the end of the root.

Step 4:

If a temporary filling was placed, it will be replaced by your regular dentist with a permanent filling and restoration as needed.  A gold crown is shown for illustrative purposes, but tooth-colored crowns are often used.  Crowns are required on teeth towards the back of your mouth since the opening made weakens the top part of the tooth which undergoes tremendous stress during eating.  Front teeth may require restoration with a crown when not enough natural tooth structure is present but otherwise can often just be restored with a filling.  Your Endodontist will discuss the requirements of your specific case after your endodontic examination and treatment planning.

What kind of materials are placed in the process?

The resulting space inside the center portion of your tooth is filled with a rubber-like material (gutta percha) and cement (zinc oxide + eugenol) to seal the root canals in vast majority of cases.  In a few special cases, the root canal space may be filled with mineral trioxide aggregate (MTA) or a plastic resin.  If a filling is placed to restore an area, it will NOT contain amalgam but usually one or more of the following: composite/glass/resin ionomer (glass and organic acid +/or plastic resin), MTA (portland cement), +/or zinc oxide/eugenol.

What if I have a temporary or buildup placed after treatment?

If a temporary was placed after completion of treatment, it is imperative to return to your restorative dentist for treatment.  Because a temporary filling is designed to last only a short time (about four weeks), failing to return to your dentist as directed to have the tooth sealed permanently with a crown can lead to the deterioration of the seal, resulting in fracture, decay, infection, gum disease and/or the possible premature loss of the tooth and require additional treatment like another retreatment or extraction. 

If a build-up was placed after completion of treatment, it's important to return to your restorative dentist for completing the restoration of the tooth.  Failing to return to your dentist as directed can result in fracture of the tooth, which in some instances is not repairable and tooth will have to be extracted.  Other things can happen, such as the deterioration of the seal, decay, infection, gum disease and even the potentially premature loss of the tooth. 

If your temporary or build-up comes out, it needs to be replaced right away.  You have invested in maintaining the tooth, so return to your restorative dentist as soon as possible (within a month)!