Root canal treatment, also known as endodontic treatment, is used when the pulp inside a tooth becomes irreversibly inflamed or infected. The aim is to remove the affected tissue, disinfect and seal the root-canal system and preserve the natural tooth where it can be predictably restored.
The pulp contains nerves and blood vessels. Deep decay, cracks, trauma, repeated dental treatment or bacterial leakage can damage the pulp and allow infection to develop within the tooth.
Once the pulp is irreversibly inflamed or infected, it cannot heal in the same way as superficial tooth tissue. Without treatment, symptoms may persist or infection can spread into the tissues around the root.
Diagnosis is based on the history, clinical tests, examination and appropriate radiographs. The dentist considers whether the pulp is inflamed or infected, whether the surrounding bone is affected and whether the tooth has enough remaining structure to be restored afterwards.
• Persistent or severe toothache.
• Pain when biting or applying pressure.
• Sensitivity to hot or cold that continues after the stimulus has been removed.
• Swelling or tenderness around the tooth.
• A recurring pimple or draining sinus on the gum.
• Darkening or discolouration of the tooth.
• Some infected teeth produce few or no symptoms and are identified during examination or imaging.
Extraction removes the source of infection but also removes the tooth. Where a tooth can be predictably treated and restored, retaining the natural tooth can avoid the need for a bridge, denture or implant.
Extraction may be the more appropriate option where the tooth is severely fractured, has inadequate supporting bone, cannot be restored or has another factor that gives it a poor long-term prognosis. The decision should consider the whole mouth and the replacement options, not simply the immediate symptoms.
Published outcomes for first-time root canal treatment are commonly reported in the region of approximately 85-95%, with lower success rates for retreatment. These figures are not guarantees: outcome depends on anatomy, infection, previous treatment, restoration quality, cracks, periodontal support and patient factors.
Some teeth have complex anatomy or previous treatment that makes management more difficult. Referral to a clinician with additional endodontic experience may be appropriate in selected cases.
Root canal treatment removes infection but does not by itself restore lost tooth structure. Many posterior root-treated teeth require a protective onlay or crown because the tooth may already have been weakened by decay, fracture or previous restorations.
Where very little tooth structure remains, a core build-up and sometimes a post may be considered. A post does not strengthen the root; its purpose is to retain the core where there is insufficient coronal tooth structure.
Fibre and metal posts are both used in restorative dentistry. Fibre posts have mechanical properties closer to dentine and can offer aesthetic advantages beneath tooth-coloured restorations. Metal posts may provide rigidity but can be less favourable aesthetically and may concentrate forces differently.
Post selection is case-specific and depends on the remaining tooth, root anatomy, restorative design and occlusal forces.
1. Anaesthesia and isolation – the tooth is numbed and isolated to create a clean working field.
2. Access – a controlled opening is made to reach the pulp chamber and root canals.
3. Canal identification – the internal anatomy is located and working lengths are established.
4. Cleaning and shaping – infected or inflamed tissue is removed and the canals are shaped with specialist instruments.
5. Disinfection – antibacterial solutions are used to clean areas that instruments cannot fully reach.
6. Root filling – once the canals are prepared, they are sealed with a root-filling material.
7. Coronal restoration – the access cavity is restored and the tooth is protected with the appropriate definitive restoration.
8. Review – healing is monitored clinically and, where indicated, radiographically.
Some tenderness around the tooth can occur after treatment. Patients should follow the dentist’s instructions, avoid excessive loading while a temporary restoration is present and complete the definitive restoration within the advised timeframe.
Increasing pain, swelling or other concerning symptoms should be reviewed promptly.
The tooth is anaesthetised during treatment. Some tenderness can occur afterwards, particularly in the tissues around the root, but persistent or worsening symptoms should be assessed.
Not necessarily. Where a tooth can be predictably treated and restored, retaining it can be preferable.
Extraction is appropriate when the tooth cannot be predictably saved or another factor gives it a poor prognosis.
Many posterior root-treated teeth benefit from a protective crown or onlay, but the correct restoration depends on the amount and quality of tooth structure remaining.
Yes. Persistent infection, complex anatomy, cracks, leakage or other factors can affect outcome.
Retreatment, endodontic surgery or extraction may be considered depending on the cause.
A post is placed within part of a root-treated tooth to help retain a core when insufficient tooth structure remains above the gum. It is not placed simply to strengthen every root-treated tooth.
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