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Root Canals

Has your dentist or endodontist told you that you need root canal treatment? If so, you're not alone. Millions of teeth are treated and saved each year with root canal, or endodontic, treatment. Learn more about root canal treatment and how it can relieve your tooth pain and save your smile.
Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissue, and helps to grow the root of your tooth during development. In a fully developed tooth, the tooth can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it.
Contrary to jokes about the matter, modern endodontic treatment is very similar to having a routine filling and usually can be completed in one or two appointments, depending on the condition of your tooth and your personal circumstances. You can expect a comfortable experience during and after your appointment.
  • Saving the natural tooth with root canal treatment has many advantages:
  • Efficient chewing
  • Normal biting force and sensation
  • Natural appearance
  • Protects other teeth from excessive wear or strain 

Step 1

As a starting point for performing your tooth's treatment, your dentist will need to gain access to its nerve space. This step is called creating an "access cavity."
  • Your dentist will use their dental drill to make a hole that extends through the surface of your tooth to its pulp chamber.
  • This is the opening through which they will perform their work.
  • With back teeth, the access cavity is made right through the tooth's chewing surface (as shown in our picture).
  • With front ones, it's made on their backside.

Step 2

Once entrance into the interior of the tooth has been made, it's increasingly becoming the accepted standard of care that the floor of the tooth's pulp chamber is examined using a surgical operating microscope. These instruments aid the dentist in searching for the openings of minute root canals that might otherwise be overlooked by the naked eye.

How does a dentist make this calculation?

A dentist has two methods they can use to take measurements.

a) By taking an x-ray.

Traditionally, dentists have established/confirmed/documented length measurements by way of taking an x-ray after a root canal file has been positioned in a tooth's canal. (Since root canal files are metal, they show up distinctly on an x-ray.)
The actual calculation is made by reading markings etched on the file. The x-ray is simply used to confirm that the file is positioned properly (extends the full length of the tooth).

b) Electronic measurements.

In recent decades, electronic length-measuring devices have come into common usage.
  • The dentist will clip one of the unit's wire leads to a root canal file that has been inserted into the tooth. They'll then tuck its second lead inside the patient's lip, so to make a complete electrical circuit.
  • As the dentist slides the file further and further into the root canal (an area insulated by the tooth's root), the unit measures changes in electrical resistance as it's tip passes ever closer to the conductive tissues that lie beyond. A digital readout or a beeping sound indicates when the file has finally reached the canal's end (tip of the root).
  • Once again, the measurement itself is read from the markings on the file. The electronic unit simply indicates when its tip has reached the proper position.

c) Several individual measurements may be needed for a tooth.

A separate length measurement will need to be made for each of the tooth's individual root canals. (Teeth can have several canals and/or roots.

Step 4 - Cleaning and shaping the tooth's root canals.

The next step of the root canal process involves "cleaning and shaping" the interior of the tooth (the tooth's pulp chamber and each of it's root canals.
In regard to this step:
  • Its cleaning aspect removes nerve tissue (live and/or dead), as well as bacteria, toxins and other debris harbored inside the tooth.
  • Shaping refers to a process where the configuration of a tooth's canals are enlarged and flared, so they have a shape that's ideal for the procedure's filling and sealing step.
The whole process is a balancing act. One where the dentist seeks to accomplish the goals above without removing so much internal tooth structure that the integrity of the tooth is compromised.

a) What tools does a dentist use?

For the most part, a tooth is cleansed and shaped using root canal files.
Files look like tapered straight pins but on close inspection you can see or feel that their surface is rough, not smooth. These instruments literally are miniaturized rasps.

b) How are files used?

  • A dentist will work a file up and down, with a twisting motion.
  • This action scrubs, scrapes and shaves the sides of the canal, thus cleaning and shaping it.

c) Your dentist will use several files.

This same motion will be used with an entire series of files (probably at least six or more), each of which has a slightly larger diameter.
  • The idea is that each of the files, when used in order, slightly increases the dimensions of the root canal.
  • Since some canal contaminates are embedded within a canal's walls, this enlargement process not only produces a shaping effect but a cleaning one too.

d) Your dentist may have a handpiece that can manipulate the files for them.

At least some of the root canal files that your dentist uses in your tooth will be worked by hand. But they may also have a specialized dental drill (handpiece) that files can be placed in which generates the motion for them.
Nickel-titanium files.
Nowadays these endodontic handpieces are usually used with special files made of nickel-titanium alloy and that's a big deal.
The very flexible nature of these files combined with the mechanized motion created by the handpiece typically means that a tooth's root canal system can be cleansed and shaped much more rapidly than in the past.

Tooth irrigation is an important part of the cleaning and shaping process.

While performing their work, your dentist will also periodically irrigate (flush out) your tooth. This carries off and washes away debris and contaminants.
While a number of different solutions can be used for this purpose, sodium hypochlorite (bleach, Clorox) is the most common one. An added benefit of using bleach is that it's a disinfectant.

Step 5 - Sealing the tooth.

Once the interior of the tooth has been thoroughly cleansed and properly shaped, it's ready to be sealed (have its hollow interior filled in).
  • In some cases, the dentist will want to place the filling material immediately after they've finished cleaning the tooth.
  • With other cases, they may feel that it is best to wait about a week before performing this step.
If the latter case is chosen, your dentist will need to place a temporary filling in your tooth, so to keep contaminates out during the time period between your appointments.

a) What type of root canal filling material is used?

The most frequently used root canal filling material is a rubber compound called gutta percha. It comes in preformed cones whose sizes exactly match the dimensions (diameter, taper) of root canal files.

b) Placing the gutta percha.

When performing this step:
  • The dentist will slip an initial cone of gutta percha into the tooth's canal.
  • It's important that this first cone extends the full length of the canal and fits snugly in the region of the tooth's tip.
  • Additional cones are then added, as needed, to completely fill in the canal's interior.
In order to create a solid, uniform mass inside the canal:
  • Sealer (a thin paste) is applied to each gutta percha cone before it's placed into the canal, or else applied inside the root canal itself before the cones are inserted. It fills in any voids between pieces of gutta percha, or between them and the canal's walls.
  • The dentist may soften the gutta percha once it's been inserted into the canal by way of touching a hot instrument to it. This way it can be squished and packed down so it closely adapts to the shape of the tooth's interior.
  • As an alternative, a dentist may place gutta percha via the use of a "gun." This apparatus is somewhat similar to a hot-glue gun. It warms a tube of gutta percha. The softened material can then be squeezed out into the tooth.

Step 6 - Placing a temporary filling.

Once your dentist has finished sealing your tooth, they will place some type of temporary filling. It will seal off the access cavity created at the beginning of your procedure, therefore protecting the work that's just been completed.

Step 7 - The root canal process has now been completed but your tooth still requires additional work.

At this point, the individual steps of performing the root canal procedure have been finished but your tooth's treatment is not yet complete. A permanent restoration must still be placed.
Choosing an appropriate type of dental restoration and having it placed promptly, will help to insure the long-term success of your tooth's endodontic therapy.

              Zoc Doc

Contact Information

Smiles R Us

Babcock Office:
5460 Babcock Rd., Suite 105
San Antonio, TX 78240
Phone: 210-694-4999

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1114 SW Military Dr., Suite 112
San Antonio, TX 78221
Phone: 210-923-5422

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In Business Since 1999