Root canal treatment (also known as endodontic therapy, endodontic treatment, or root canal therapy) is a treatment sequence for the infected pulp of a tooth which results in the removal of infection and the protection of the decontaminated tooth from future microbial invasion. Root canals and their associated pulp chamber, are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities. Together, these items constitute the dental pulp.
Root canal therapy involves treatment of badly carious, fractured or non-vital teeth due to trauma. When dental caries involves the enamel, dentine and pulp (network of nerves and blood vessels), the innermost layer after dentine, there is acute pain due to pulpitis(inflammation) which can be reversible or irreversible, depending upon the nature of the of the offending lesion. When it becomes irreversible pulpits, there is apical periodontitis (passage of infectious products from the tooth to the area beyond the apex or tip of the root), leading to loss of outer layer of the bone, widening of the periodontal ligament space (ligament connecting the tooth to the bone) at the root apex, granuloma or abscess formation.
There is buildup of pressure inside the root canal system, as numerous pathogenic bacteria are involved, release noxious agents, and gases.
Endodontic therapy involves the removal of these structures, the subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions, and the obturation (filling) of the decontaminated canals. Filling of the cleaned and decontaminated canals is done with an inert filling such as gutta-percha and typically a eugenol-based cement. Epoxy resin is employed to bind gutta-percha in some root canal procedures.Endodontics includes both primary and secondary endodontic treatments as well as periradicular surgery which is generally used for teeth that still have potential for salvage.
SINGNS AND SYMPTOMS:-
Patient generally complains of a sharp, shooting, throbbing kind of pain, which generally increases on lying down. Sometimes may be associated with an abscess formation showing an intraoral swelling or bulge inside the gums. This if becomes long standing will form a tract or fistula .The vitality of a tooth is determined by its blood supply and not the nerve supply. Thus when the blood supply is lost (eg in long standing carious lesions which have invaded the pulp, and not treated, or due to trauma), the tooth becomes non-vital.
There are several diagnostic tests that can aid in the diagnosis of the dental pulp and the surrounding tissues. These include:
1. Palpation (this is where the tip of the root is felt from the overlying tissues to see if there is any swelling or tenderness present)
2.Mobility (this is assessing if there is more than normal movement of the tooth in the socket)
3.Percussion (TTP, tender to percussion; the tooth is tapped to see if there is any tenderness)
4.Transillumination (shining a light through the tooth to see if there are any noticeable fractures)
5.Tooth slooth (this is where the patient is asked to bite down upon a plastic instrument; useful if the patient complains of pain on biting as this can be used to localise the tooth)
7.Dental pulp tests
1.X-ray – It is mandatory to first take X-rays or examine existing X-rays to show where the decay is located.
2. Anesthesia – Local anesthesia is administered to the affected tooth. Contrary to popular belief, a root canal is no more painful than a filling.
3.Pulpectomy –With the use of drilling instruments, an opening is made and access is taken to the diseased tooth pulp. With the use of basic and advanced techniques infected pulp is removed and thoroughly irrigated with disinfectants. Now the tooth is ready to be filled.
4. Filling – The roots that have been disinfected are filled with gutta-percha material and sealed off with cement.
5.Crown:-After a few weeks, it is necessary to place a permanent crown or a similar type of restoration on the top of the tooth.