What are the steps of the root canal process? (videos) -
An outline of the procedure your dentist follows when performing endodontic therapy. / Details and selected videos.
The root canal procedure -
This page contains a collection of videos that both explain and show what having root canal therapy is all about. Some are animations that outline the individual steps of the procedure. Others are clinical videos we've selected that show scenes of the treatment process in action.
Watch Video What are the steps of root canal treatment? - Part 1
Run time: 2 minutes 41 seconds. / Type: Animation
Three of the videos on this page are members of a series we created that details the individual steps of the root canal process. This first one explains the initial actions that a dentist must perform before any detailed work is begun inside the tooth.
What this video covers:
a) The beginning of the patient's root canal procedure.
As initial steps of the process, the dentist must:
- Numb up the tooth and surrounding tissues.
- Isolate the tooth (create a barrier that separates it from direct contact with the rest of the patient's mouth) by way of placing a rubber dam.
Doing so prevents contaminates from the oral environment from entering the tooth while it is being treated.
- Once numbed and isolated, the dentist can then begin the process of "opening" the tooth.
To do so, they'll create an "access cavity," which is simply a hole that's drilled through the tooth to its pulp chamber (a cavernous "nerve" space inside the center of the tooth).
B) Determining how much treatment will be accomplished during the first visit.
Once access into the tooth has been made, the dentist must decide how much additional work will be performed during this initial appointment. As the video explains, what they decide will depend on:
- The conditions they observe inside the tooth after opening it. (Does the tooth have live pulp tissue or is it necrotic? Is pus present?)
- What has the patient experienced leading up to their appointment? (Has the tooth displayed any symptoms or has it been "quiet"?)
i) Treating problematic teeth -
In those cases where a patient's tooth has been troublesome (has produced pain or swelling), this video describes some of the different approaches the dentist may use to relieve the patient's symptoms and stabilize conditions within their tooth.
They can then be rescheduled for a subsequent appointment (after the tooth has had a chance to settle down) during which treatment can be continued or even completed.
ii) Treating quiet teeth -
Some teeth slated for treatment may display no apparent symptoms. (The tooth's need for therapy may have been unexpectedly discovered via x-ray examination. Or possibly the tooth had previously shown symptoms but has since settled down.)
If so, the steps performed so far may simply constitute the initial segment of the total amount of treatment the tooth will receive during this appointment. (In some cases, a tooth's entire root canal procedure may be completed in one sitting).
Watch Video What are the steps of root canal treatment? - Part 2
Run time: 2 minutes 55 seconds. / Type: Animation
This second video of our series explains the steps of the root canal process that tackle the task of cleaning and disinfecting the tooth.
What this video covers:
a) Cleaning the tooth's interior.
Once the tooth's access cavity has been created, the dentist can begin that aspect of the treatment process that involves removing pulp tissue and contaminates (debris and bacteria) from within the tooth's root canals.
i) Measuring the length of the canals.
As a first step, the dentist must establish the length of each of the individual root canals. That's because they want to clean the full extent of each one but not beyond. (Doing so would irritate the tissues that lie beyond the root's tip.)
As this video explains, historically this was done by way of taking an x-ray showing the position of the dentist's tools within each canal. Today, electronic devices can be used to make this measurement. A dentist might use either method or both.
ii) Cleaning and shaping the canals.
Once armed with the measurements of the root canals, the dentist can begin the task of "cleaning and shaping" each one.
- Root canal files are used for this process. They are tiny pin-shaped instruments that are worked up and down inside a canal. (The files can either be manipulated by the dentist's fingers, or placed in a dental handpiece that makes the needed motion for them.)
The file's action helps to both break up and remove tissue and debris. It also draws the file against the canal's walls, thus rasping off its surface layer (which is typically impregnated with contaminates).
- As illustrated in the video, the dentist will use a series of files, each one minutely larger than the one before. And as each is put to use, the diameter of the canal becomes enlarged.
As the video explains, this is an important aspect of cleaning the canal. It also aids with the sealing process to follow.
iii) Irrigating the tooth.
Beyond just the use of files, tooth "irrigation" also plays an important role in cleaning the interior of the tooth.
This refers to flushing the tooth out periodically during the cleaning process (such as after each file has been used) so to remove loose debris. In some cases the irrigation solution that's chosen will have properties that can help to disinfect the tooth too.
b) Deciding how much more work will be accomplished during this visit.
Just like with the steps discussed in our first video, once the dentist has completed cleansing and disinfecting the tooth's interior, a convenient stopping point has been reached. The dentist must then decide if any more work can, or should, be completed before dismissing the patient.
- If the tooth has displayed symptoms immediately prior to this appointment, or if time constraints exist, the dentist may stop here.
If so, they will "temporized" the tooth (place a temporary filling in the tooth's access cavity, possibly along with some type of medication. They'll then schedule the patient for the completion of their work, most likely within the next week or so.
- With other cases, the dentist may simply proceed on with the next phase of the tooth's treatment.
Watch Video What are the steps of root canal treatment? - Part 3
Run time: 2 minutes 23 seconds. / Type: Animation
This third video segment explains the steps associated with filling in and sealing off the tooth's now cleansed pulp chamber and root canals.
This is the final portion of the root canal process proper. However, the tooth will still need to be rebuilt before its full treatment has been completed.
What this video covers:
a) Filling and sealing the tooth.
i) Selecting the filling materials.
- In most cases, gutta percha (a inert rubbery compound) and some type of paste-like sealer are used to fill in the cleansed space inside a tooth.
- Gutta percha comes in pre-shaped cones that have an identical size and taper as the root canal files that were used to clean the tooth. Cones are selected for placement in the tooth's individual root canals depending on which size of file was last used to clean and shape it.
ii) Placing the filling materials.
- The dentist will first dry the tooth's individual root canals.
- They will then place one or more cones of gutta percha in each one, usually after first dipping it in a paste-like sealer.
- When more than one cone is used, they are frequently compressed against each other, so to minimize any space that exists between them. Collectively, they may also be heated up (so they become soft and rubbery) and condensed together inside the tooth.
Overall, the goal of these steps is to simply create a solid mass that completely fills in and seals off the hollow space that exists within the tooth. Once that's been accomplished, formally speaking the tooth's root canal process has been completed.
b) Explaining to the patient what additional work their tooth requires.
Every tooth that has received root canal therapy will still require additional dental work. At minimum, some type of restoration will be needed to fill in their tooth's access cavity. (A temporary filling will be placed at the completion of its endodontic treatment.)
i) Coronal leakage.
Actually, when discussing root canal work there are two seals that are important.
- The internal one that your dentist creates during therapy (as described above).
- The seal of the access cavity created by the dental restoration that your dentist places after your root canal treatment has been completed.
The latter seal is just as important as the former when it comes to the long-term success of your tooth's treatment. (This page and video explain why.)
That means you'll need to heed your dentist's advice regarding both the type of restoration that should be placed (dental crowns are often chosen for this purpose), as well as when.