Root Canal Therapy ( R C T )

At the center of a tooth is a hollow area that houses soft tissue, known as pulp or nerve. This hollow area contains a relatively wide space in the coronal portion of the tooth called the pulp chamber. This chamber is connected to the tip of the root via narrow canal(s); hence, the term "root canal". Human teeth normally have one to four canals, with teeth toward the back of the mouth having more. These canals run through the center of the roots like pencil lead through the length of a pencil. The pulp receives nutrition through the blood vessels and nerves carry signals back to the brain to warn of adverse events and circumstances.

Dental decay, when it progresses from the surface of the tooth to reach the pulp chamber, root canal infection results. Therefore, for a person who feels tooth pain or discomfort, a root canal treatment may be indicated, and a qualified dentist or more preferably an endodontist (root canal therapy specialist) should be consulted in a timely manner.

Root canal is also a colloquial term for a dental operation, endodontic therapy, wherein the pulp is cleaned out, the space disinfected and then filled.

Root Canal Treatment Procedures

Single Sitting Root Canal Treatment Procedure     
When there is an acute infection with no pus accumalation in & around the tooth, RCT can be completed in a single sitting. The biggest diagnostic aid in this case is an X-ray. The Xray usually indicates presence of pus accumalation in the form of a change (radiolucency) around the root tip of the involved tooth.     
Steps in the Single Sitting RCT procedure:          
    * First step is to open the pulp chamber to allow access to the canals.            
    * Once open, with help of special instruments known as files the infected nerves is removed. The canals are flushed with antiseptic solution.            
    * The root canals are further cleaned & reshaped to free them of all debris.            
    * Once the canals are empty dry & clean, they are filled and sealed with biocompatible material known as Gutta Purcha Points / G.P. Points
    * Radio-Visuo-Graphy (RVG), an advanced Xray facility, is used to monitor and complete the treatment procedure to the desired level          
    * The cavity is then filled with temporarily filling material which is then replaced with a permanent filling material like composite filling.            
    * A root canal treated tooth should be ideally capped after 2 weeks.            
Multiple-Sitting RCT Procedure      
When there is a chronic / long standing infection showing pus accumalation in & around the tooth without or with swelling abscess, RCT require multiple sittings to drain the pus.      
Steps in the Multi-sitting RCT procedure:     

Stage I
* First step is to open the pulp chamber to allow access to the canals.            
* Once open, the infected nerves are removed with the help of special instruments known as files. The canals are flushed with antiseptic solution. Sometimes frank discharge of pus can be seen oozing from canals along with foul odour. This should be flushed out.            
* The root canals are further cleaned & reshaped to free them of all debris.            
* The canals are dried & a temporary dressing is given. Root canal filling is not done.            
Stage II           
* After a couple of days the pulp chamber of the tooth is re-opened. The canals are checked for discharge. If the canals are dry, RC filling is done.
* If canals are still oozing, the canals are further cleaned & dried & a temporary dressing is given, without doing RC filling.            
* RC filling is done only in a subsequent sitting in which the canal is found dry and free of discharge. The number of sittings in such an RCT procedure can varyfrom case to case, depending on the nature of the infection.
Stage III
* Once the RC filling is done, a temporary filling is done which is then replaced with permanent filling like composite filling.            

In a chronic case, it may be advisable to wait for 2-3 months before the cap/crown procedure. This period ensures complete healing of the tooth. Periodic Xrays give a good idea of the healing procedure. Once healed, tooth should be capped.      

Root canals in teeth    
Crown procedures after RCT

After root canal treatment is performed on teeth, it is mandatory to perform crown procedures on them - especially in the case of molar teeth. This is because, after the treatment, with the pulp and a major chunk of the tooth substance gone, the tooth resembles a hollow shell. These teeth lose their natural hydrating mechanism and tend to turn brittle & prone to fracture.

While chewing, high forces are exerted in the molar area, any where equivalent to 60 – 300 lbs. occlusal load. Thus, if a root canal treated molar is not
crowned, it turns more prone to fracture… as the “shell” crumbles under the large amount of force being exerted on it. Crown procedures help reinforce the weakened crown and protects the crown portion of the tooth by covering it completely.


Post & Core procedures
When the crown portion of the tooth has been extensively damaged, it is important to reinforce the tooth with posts & cores after the root canal treatment, prior to the crown procedures. In such situations, if post and core procedures are not carried out prior to crown procedures, the entire tooth structure along with the crown can break away making further restoration of the tooth extremely difficult.

Complications after RCT
* In spite of meticulous and planned procedures, 5% of root canal treated cases are found to fail…due to various reasons such as inaccessible and
bifurcated canals, accessory canals, multiple and curved roots, calcified canals, long standing infections etc. However, advanced radiography techniques including RVG (Radio-Visuo-Graphy) and advanced root canal therapy procedures have helped in bringing down failures considerably. Failed root canals can also be re-treated to achieve success.

* Mild persisting ache / tenderness which is also seen as an after-effect of the procedure. However, this generally gets controlled with medication in the initial stage.

Apicectomy Surgery

In the apicectomy procedure, the root tip of the tooth is exposed surgically and sectioned. This direct approach to the root tip facilitates removal of infected tissues, granulomas, cysts etc. which generally tend to develop at the root tips of infected teeth.