Video transcript -
Title: What are the steps of root canal treatment?
Segment #1: Initiating the procedure.
This three-part dental-picture-show.com video series outlines the individual steps of root canal therapy, and hopefully can give you an idea of what to expect when you have your tooth's treatment performed.
In the broadest of terms, root canal treatment can be considered to have two phases. The first addresses the task of cleansing and disinfecting the tooth's interior (this includes both the tooth's pulp chamber and each of its individual root canals). And then, the second stage completes the process with filling in and sealing this cleansed space.
Before either step is begun, the dentist will first numb up the tooth being treated along with the tissues that surround it. They'll do this with a local anesthetic, which means giving you a shot. After numbing the tooth, they'll then place a rubber dam.
A rubber dam is a sheet of latex with a small hole punched near its center. The idea is that the dentist will stretch the dam over the tooth, leaving the tooth protruding through the hole.
Just as its name implies, a rubber dam acts as a barrier. It prevents contaminates (especially saliva) from getting into the tooth during the root canal procedure. It also prevents any of the solutions and materials that the dentist uses from finding their way into the patient's mouth.
Once the rubber dam has been placed, the next step involves making the "access cavity" for the procedure.
An access cavity is a hole that's made in the chewing surface of a tooth, or, in the case of a front tooth, its backside. It extends to the tooth's pulp chamber and is the opening through which the dentist will perform their work.
Once the dentist has created the access cavity, they'll get their first look inside the tooth. In some cases, they may find it contains at least some live pulp tissue, or it may simply an empty, although possibly foul smelling, hollow space. In situations where there's an active infection, the pulp chamber may be filled with pus.
Once the access cavity has been made, and the dentist has tended to whatever initial conditions were found, a decision must be made. Should they continue on with the next step of the patient's root canal therapy, or do conditions warrant that this is a point where the procedure should be paused?
In the case where the tooth has been painful, the dentist may decide that it is best to just place medication and a temporary filling at this point, and then reschedule the patient for a later date, after the tooth has had a chance to settle down.
If the patient has substantial swelling, the dentist may decide that they should temporize the tooth in a fashion where pus can continue to drain for a few days before any further treatment is resumed.
Or, and especially in the case where the patient's root canal treatment is a planned event and the tooth is not causing them any problems, the dentist may simply proceed on with the next stage of the procedure, which is the scenario we describe in the next segment of this dental-picture-show.com video series.
Title: What are the steps of root canal treatment?
Segment #2: Cleaning and disinfecting the interior of the tooth.
Once access to the interior of the tooth has been created, the next step of the root canal procedure involves removing debris and contaminates harbored within the tooth's pulp chamber and root canals. This can include bacteria, the waste products and toxins they have created, as well as remnants of or breakdown products derived from the original pulp tissue.
As an initial step toward completing this task, the dentist must first determine the length of each of the tooth's individual root canals. This measurement is required because during treatment the dentist's goal will be to cleanse the full length of each canal, without allowing any instruments to extend beyond its end. If they extend too far, the result will be the irritation and inflammation of the tissues that surround the tooth's root. Of course, if they aren't used to clean far enough, debris and contaminates will be left behind.
To make this measurement, the dentist will position a metal file in the tooth's root canal to that location that they anticipate approximates the canal's endpoint. They will then either take an x-ray of the tooth and then evaluate the position of the file in that image, or, if they have one available, use an electronic device that when touched to the file can make an indication for them.
Cleansing the interior of the tooth is a twofold process. One aspect involves the use of what's termed an "irrigating" solution. The idea here is simply the use of a liquid to flush out the tooth so to remove debris that was either already present, or has been created during the cleaning process. As an additional benefit, some types of irrigating solutions (like bleach) can also help to disinfect the tooth.
The other aspect of the cleaning process involves the use of root canal files. These files look like large straight pins, with the exception that their surface is grooved. They're used in an up-and-down, and sometimes twisting, motion that allows their cutting edges to rasp the walls of a canal. A dentist will either work a file with their fingers or place it in a dental hand piece that can create an appropriate rasping action for them.
When cleaning any one root canal, a dentist will make use of several files, probably at least a half-dozen or more, each of which has a slightly larger diameter than the one preceding it. As each file is used, the size of the canal will gradually be enlarged. This is needed because it's a way of removing those contaminates that have become embedded within the canal's walls. Additionally, a larger canal allows for more wide-spread penetration of the irrigating solution in the tooth. Tooth irrigation is an important part of the cleaning process and is generally repeated after the use of each file.
Once the tooth's root canal system has been cleansed, the dentist has once again reached a potential stopping point. Some root canal cases are best treated with a two-step approach. And when this applies, the dentist will place a temporary filling at this point and reschedule the patient for another visit at a later date. In other cases, the dentist will simply continue on with the next stage of treatment. This is the scenario described in the next segment of this dental-picture-show.com video series.
Title: What are the steps of root canal treatment?
Segment #3: Creating the internal seal for the tooth.
Once the dentist has finished cleaning and disinfecting the tooth, the next step of the root canal procedure involves filling in and sealing this cleansed space.
In most cases, a dentist will use gutta percha as the filling material. This rubber-like compound is chosen because it is bio-compatible, doesn't support bacterial growth and, when it's softened with heat, can easily be adapted to the internal shape of a tooth.
Gutta percha comes in performed cones, in the same sizes as root canal files. The idea is that the dentist will make a record of the largest file size they used to clean the full length of a particular root canal. They will then select a same-sized gutta percha cone for filling it.
Actually, mentioning this hints at one aspect of the tooth-cleaning process that wasn't discussed in our previous video. That's that the rasping action of a root canal file doesn't just remove contaminates from a canal's walls. It also serves as a way of sculpting a canal's shape into one that's more ideal for the sealing process, such as, if possible, making it match the round shape of the gutta percha cone that will be used fill it.
To begin the process of filling and sealing the tooth, the dentist will first dry the root canals with cones of cotton or paper. They'll then test fit the gutta percha cone they have selected for the canal and make any changes with it that they feel are necessary. Once the cone's fit has been perfected, they'll coated it with root canal sealer, and then slip it into place.
The sealer that's applied is simply a paste that fills in whatever minute space might exists between a gutta percha cone and the walls of the root canal or another cone.
Some portions of some root canals may be quite flared. And in these regions the dentist will need to place more than one piece of gutta percha. After a cone has been inserted, the dentist will use a spreader to compresses all of the individual cones against each other. Or they might soften the gutta percha with a heated instrument so it can be packed and condensed.
After the gutta percha has been placed, the dentist will also need to create a seal for the access cavity. During this visit, the dentist will probably just place some type of temporary filling material. Then, at a later date, the patient will return so a more substantial dental restoration can be made.
The type of permanent restoration that is placed is an important consideration and one that can play a substantial role in helping to insure the long-term success of the tooth's root canal treatment. We address this topic in detail in another video here on dental-picture-show.com.
