Root Canal Treatment

Root Canal/ Endodontic Treatment

Tooth decay, accidents, trauma and wear-and-tear can cause the hard tissues of a tooth to be broken, chipped or fractured. The openings in the tooth enamel are entry points to allow bacteria to infect the centre of the tooth (the pulp). The pulp is made up of nerves, blood vessels, and connective tissue.

It is found inside the tooth and runs along the jaw bone. Infection may spread out from the root of the tooth and to the bones supporting the tooth. Pus (dead tissue, live and dead bacteria, white blood cells) is formed and swelling of the tissues within or around the infected tooth.

Patient will experience sharp, shooting, throbbing toothache when the pulp is infected or when the abscess develops at the root tips. Other symptoms include bad breath, sensitivity, fever and swelling of gums which may spread to jaws and neck.

The enamel, dentin and cementum are the hard tissues of a tooth, while the soft tissue at the centre consist of blood vessels, lymph vessels, connective tissue and nerves called the pulp.

Can all teeth be saved using Root Canal Treatment?

Unfortunately, teeth that are too badly damaged cannot be saved and such teeth will need to be extracted.

Since not all broken or split teeth can be saved, Dr Leong will do a comprehensive examination using a Cone Beam CT scan and microscope before proceeding with the treatment.

If the tooth is badly broken/split (i.e. a fracture that extends beyond the gum margin) and cannot be saved, he will advise you accordingly. Split teeth (vertically fractured that extend beneath the gum margin) may require surgery to remove successfully.

So What Exactly Is Root Canal Therapy/Treatment?

(R-L) the infected tooth, access is opened to the pulp chamber (which leads to the root canals), the root canals are cleaned, the roots are filled and the tooth is restored.

Root canal/endodontic treatment is the dental procedure to remove the tooth's pulp tissue (which is the soft tissue at the centre of the tooth that is composed of connective tissue, nerves and blood and lymph vessels) under local anaesthetic (Mepivacaine or the equivalent).

Before proceeding on to root canal treatment, a rubber dam will be placed around the tooth to isolate the tooth from saliva, tongue and bacteria. This allows better vision of the tooth and also prevents contamination of the tooth. An opening is made by using a tiny drill to remove the crown (enamel and dentin) of your tooth and expose the pulp to remove the pulpal tissue from the pulp chambers and root canals.

Each of the canals are cleaned and shaped using small narrow nickel-titanium files and/or rotary instruments. Disinfecting solutions are used to clean the root canals of the tooth to clear the infection. An apex locator is used for precise length determination of each canal. This step is usually the most time consuming part of the procedure and involves using a series of fine, flexible instruments to remove the pulp tissue and any infected material from inside the root canal(s) of the tooth.

Medicament - after the initial cleaning there is almost always still some bacteria in the tooth and medicament (calcium hydroxide paste) is placed in the tooth. The paste has antiseptic properties and helps eliminate any residual bacteria. The patient will also be given antibiotics to treat and prevent infection.

After that, the canals will be sealed with a combination of a specially formulated root canal cement (Mineral Trioxide Aggregate, or MTA) and/or injected with warm Gutta Percha. Read more:

Why is Root Canal Treatment necessary?
After Root Canal Treatment
Aftercare Root Canal Treatment
Causes of Root Canal Treatment Failure

Warm vertical condensation

Core build-up - Once the root canals have been sealed, the upper half of the tooth needs to be sealed with a filling material, usually a resin or glass Ionomer cement type material.

The reason we do not seal the upper half of the tooth with the same Gutta Percha and cement as the root canals is that these materials are actually relatively soft, and also some of the cements are known to discolour the tooth structure.

Root canal treatment, unlike root end surgery (apicoectomy) is not Medisave claimable.

Root canal backfill

Schematic of dental crown

Often when a tooth needs a root canal treatment, there is pre-existing damage to the tooth structure caused by extensive decay or trauma.
A dental crown is often necessary after a root canal therapy to restore the tooth to full function and to improve the protection and maintaining of the visible part of the tooth. A dental crown also lessen complications such as fracturing, and prevent bacteria from infiltrating the tooth. We refer to this as a 'coronal seal' and it plays a vital part in the success of root canal therapy.

The entire root canal treatment process from the start till the completion of the crown usually take a minimum of 2 visits, consisting of approximately 1 hour per session. This is especially so for the molars as they have more canals and are harder to reach, hence more time is needed.