A Brief Note on Root Canal Treatment

Introduction

Root canal therapy (also known as endodontic therapy, endodontic treatment, or root canal therapy) is a treatment sequence for a tooth's infected pulp that aims to eliminate infection while simultaneously protecting the tooth from potential microbial invasion. The physical hollows within a tooth that are naturally populated by nerve tissue, blood vessels, and other biological entities are known as root canals and their accompanying pulp chamber. The tooth pulp is made up of all of these things.

Description

The removal of these structures, disinfection, and subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions, as well as the obturation (filling) of the decontaminated canals, are all part of endodontic therapy. Inert fillings such as gutta-percha and zinc oxide eugenol-based cement are used to fill the cleaned and decontaminated canals. Epoxy resin is used to bind gutta-percha in several root canal procedures. Analysis of four gutta-percha techniques an antimicrobial filling material containing paraformaldehyde, such as N2, is another possibility. Endodontics encompasses both primary and secondary endodontic therapies, as well as periradicular surgery, which is typically performed on teeth that are still salvageable [1].

Diagnostic and preparation

A accurate diagnosis of the dental pulp and associated peri-apical tissues is essential before endodontic therapy can be performed. This allows the endodontist to select the most appropriate treatment strategy for the tooth and surrounding tissues, ensuring its preservation and longevity. Irreversibly inflamed pulp (irreversible pulpitis) can be treated by either extracting the tooth or removing the pulp. The endodontist can assist preserve the tooth's lifetime and function by removing the infected/inflamed pulpal tissue. The treatment options chosen takes into account the tooth's projected prognosis as well as the patient's preferences [2].

When a tooth is threatened (due to decay, cracking, etc.) and future infection is expected or unavoidable, a pulpectomy (removal of the pulp tissue) is recommended to prevent infection. In most cases, there is already some inflammation and/or infection within or beneath the tooth. The dentist drills into the pulp chamber and removes the infected pulp to heal the infection and save the tooth. The use of effective antiseptics and disinfectants is required to achieve bacterial independence [3].N2 root canal material, which contains a tiny amount of paraformaldehyde, is one of the most effective. Engine-driven files or long needle-shaped hand devices known as files (H files and K files) are used to dig the nerve out of the root canal (s).

Removal of pulp tissue

The mechanical preparation of the root canal for endodontic therapy has gone through a number of revisions throughout the years. The first, known as the standardized technique, was created by Ingle in 1961 and had drawbacks like the risk of losing working length and unintended ledging, zipping, or perforation. There have been various refinements since then, which are referred to as methods. Some of the techniques include step-back, circumferential filing, incremental, anti-curvature filing, step-down, double flare, crown-down-pressure less, balanced force, canal master, apical box, progressive enlargement, modified double flare, passive stepback, alternated rotary motions, and apical patency[4].

The step back technique, also known as telescopic or serial root canal preparation, is divided into two phases: the first establishes the working length and then delicately shapes the apical portion of the canal until a size 25 K-file reaches the working length; the second prepares the remaining canal with manual or rotating instrumentation. However, there are several drawbacks to this approach, such as the possibility of unintentional apical transfer. Incorrect instrumentation length can occur, which the modified step back can fix. The passive step back technique can be used to remove obstructing debris. The crown down process involves the dentist starting at the coronal region of the canal and exploring the canal's patency with the master apical file [5].

Conclusion

No treatment or tooth extractions are two alternatives to root canal therapy. Foregoing treatment carries dangers such as pain, infection, and the likelihood of a worsening dental infection that renders the tooth irreparable (root canal treatment will not be successful, often due to excessive loss of tooth structure). If there is a significant loss of tooth structure, extraction may be the only choice.

References

1. Patel S. The Principles of Endodontics. OUP Oxford. 2013.
2. Marciano MA, et al. Analysis of four gutta-percha techniques used to fill mesial root canals of mandibular molars. Int Endod J. 2011;44:321-329.
3. Setzer FC, et al. Comparison of long-term survival of implants and endodontically treated teeth. J Dent Res. 2014;93:19-26.
4. Kishen A, et al. Advances in endodontics: Potential applications in clinical practice. J Conserv Dent. 2016;19:199-206.
5. Carrotte P. Endodontics: Part 2 Diagnosis and treatment planning. Br Dent J. 2004;197:231-238.