Root canal treatment is indicated for those damaged teeth in which the caries process has involved the vital living portion residing within the root canal system. The vital portion of the tooth containing the blood and nerve supply is known as dental pulp. Once the pulp becomes inflamed and diseased, it is not possible to save the teeth through simple filling procedures. Root canal treatment involves making a pathway to reach the diseased dental pulp tissue followed by its complete extirpation, thorough cleaning and shaping of the canal spaces and compact filling to make a hermetic seal to prevent leakage and ingress of infectious agents in future.
This is an extremely specialized procedure as the whole treatment is carried out in a small closed chamber of the tooth. An unimpeded and straight line path within the root canals is the key to perform state of the art root canal procedure. Modern science of endodontics has evolved various techniques and instruments to achieve the required outcomes. Specially designed files and armamentarium are used by highly skilled and trained clinicians for patient’s benefit. Cleaning and irrigation solutions help through the procedure by actively removing the dead and necrotic tissues. Intra canal medicaments are placed during visits to disinfect the space. The following article helps the patients to understand the science of endodontics and provides the clinicians various tips to perform a comprehensive root canal therapy procedure.
Following on from the preparation of an access cavity that allows good straight line access to all of the canals, the next stage is to clean and shape the canals.
It is important to scout the canal initially with a pre-curved #10K file to check canal patency and to ‘get a feel for the canal’. This physical feedback then allows the clinician to assess how to proceed with canal preparation. I always curve the tip of the file to ease the passage down the canal. Canals are almost always curved to some degree, and curved files will find their way more easily down curved canals. The endodontic glide path is a smooth tunnel from canal orifice to canal terminus, which allows the preparation instruments to follow the natural path of the canal. If the #10 file glides easily straight to length, very little work needs to be done to secure a glide path.
It must be remembered that canal shaping is not an end in itself. The shaping of the canal is carried out to allow delivery of the chemical cleaning agent to remove necrotic debris and kill bacteria. It is essential to constantly irrigate the canal from the start and throughout preparation using sodium hypochlorite in a side vented, 27 or 30 gauge endodontic syringe. This is especially important to remember when using file systems that shorten preparation time. Unless you constantly and copiously irrigate, you can prepare a beautifully tapered canal but without removing the bacteria and necrotic debris the treatment has a much lower chance of success.
Root canal treatment can be a great success now !