Endodontic / Root Canal Treatment

Most often, patients come to our clinic with pain in one or more of their teeth. Pain is usually associated with diseased tooth which needs to be treated endodontically (endo=inside, dentes=tooth). Endodontic treatment makes up nearly 60% of our daily works and doing a correct endodontic treatment requires training and practice in this field. This article is to explain a little bit about endodontic / root canal treatment. In Indonesian term, it is called 'perawatan saluran akar /PSA'.

What is dental pulp?

The pulp of the tooth (endodontium), consists of connective tissue, blood vessels and nerves. It is located in the root canal of the tooth (pulp cavity or chamber). The tissue surrounded by the hard tooth structures cannot expand during an inflammation, generally caused by caries (tooth decay). Without endodontic treatment, the dental pulp will die, and the inflammation can then spread to the surrounding jawbone.

1 -5: the progress of dental caries to affect the pulp chamber and periapical tissues

How is the procedure performed?
The dentist first removes the decayed areas of the tooth and accesses the pulp of the tooth by drilling (trephination). The dental pulp, or whatever is left of it, is then removed. The root canal has to be cleaned thoroughly before filling it completely. The dentist first needs to determine the length of the canal with the help of special instruments and probably an X-ray. He/She then proceeds to clean the root canal using drilling and filing equipment in conjunction with disinfectant rinsing solutions (root canal preparation). Depending on the degree of the inflammation, the final filling of the canal can take place either during this visit or at a later stage. Between dental visits, the tooth is protected by means of a temporary medicinal filling.

Various methods and materials are available for filling a root canal densely and completely. Once treatment is completed, the correct length of the root canal filling is checked by means of an x-ray and the tooth is sealed with a filling. The tooth inevitably becomes more fragile after root canal treatment. It is therefore advisable in the long term, to stabilise teeth that have been subjected to root canal treatment, e.g. by means of a crown.

The lenghty treatment time makes root canal treatment not a favourite treatment to be done. It is possible to shorten the number of visits in selected cases. Most of the cases need to be done in 2 or 3 visits, depends on the lesions and difficulties of the treatment.



Endodontic treatment sequences

Completed root canal treatment

Alternative to Root Canal Treatment

 The only alternative is extraction of the tooth, followed by closure of the resulting gap with artificial dentition (implant, bridge etc).



What are the complications?

Despite the greatest care, the following incidents may be associated with the root canal treatment – in addition to the risks involved in local anaesthetisation:

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  Injury of the mucous membrane, tongue, and bone tissue and less commonly of the bone tissue by the dental instruments, is usually of a harmless nature and heals naturally.
• In rare cases, drilling through the tooth (perforation), injury of the jawbone or breakage of dental instruments inside the root canal may occur; this would necessitate further treatment.
• In rare cases, the solution used for rinsing may escape via the tip of the root, resulting in irritation of the surrounding tissue; a subsequent swelling is treated with an antibiotic preventively.
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  Leakage of the filling material via the tip of the root, resulting in possible damage of the surrounding tissue (including nerves), is extremely rare. The filling material should be removed surgically if it gives rise to complaints.