Try this 3 part approach to root canal treatment.
Root canal treatment can be divided into three parts. (1) the root canal seal; (2) the access seal (bonded core); and (3) the coronal seal (the final restoration or crown).
- The first short appointment should be long enough to confirm the diagnosis and do an open and drain or pulpectomy procedure allowing you to relieve pain symptoms. This appointment confirms that there are no unforseen complications that would make it difficult to continue with the treatment. Based on your findings, the patient can then be scheduled for a completetion appointment or referred to an endodontist.
- The second longer appointment allows you to complete the root canal treatment (the root canal seal) followed by the immediate placement of a bonded core (the access seal). If suitable, a final restoration can be placed at this time.
- A third appointment for a crown restoration (the coronal seal) should then be scheduled as soon as possible once symptoms have resolved.
Endodontic Procedure Tips:
Root Canal Seal:
All initial exploration for canals should be done with stainless steel files #06 to #15, as these are flexible and yet stiff enough to follow the canal pathway. The coronal orifice area of the canal should be minimally enlarged to allow for easier instrument insertion but not so large that it weakens the tooth. Canals should be enlarged to at least #15 or larger before introducing rotary instruments.
Rotary instruments should only be used for canal shaping and finishing. Rotary or NiTi instruments should not be used as the primary instrument to enter the root canal as these instruments are more likely do bind and result in instrument separation. Rotary instruments work best in straight canals or those with gentle curves. Severe curves are more likely to bind rotary instruments.
Do not attempt to remove an instrument that has separated in the root canal. Trying to remove a separated instrument without the appropriate skills and instruments may make later retrieval or bypassing more difficult.
Canals are rarely round in shape and often have complex anatomies. Most canals are wider in the buccal-lingual direction. Radiographs should be used to confirm that the root canal seal has completely filled the canal space.
Access Seal:
A bonded core (and post if indicated) should be placed immediately following the root canal seal. Temporary fillings tend to leak and don’t last very long.
Most teeth have sufficient tooth structure left to retain a core without the need for a post. All previous faulty restorations and decay should be removed from the coronal area of the tooth prior to core placement. All root canal sealing material should be removed from the access area of the tooth (but not the root canal space).
If there is insufficient tooth structure to retain the core then a post can be placed, usually in the largest canal. The post should be no larger than the space occupied by the root canal filling and should not be placed in the curved area of the root. At least 5mm or more of root canal filling material should be left apical to the post. A post that is too large or too long, may predispose the tooth to root fracture.
Coronal Seal:
In general, all molar and bicuspid teeth should be restored with cusp protected crown restorations. Teeth with cracks should have complete coverage extending into the gingival sulcus. Chamfered margins are preferred. All composite core material should be covered by the crown restoration. Some, mostly intact anterior teeth, can do well with only a composite restoration.
Dental Trauma Guide
Injuries to teeth are no longer mostly sports related as protective sports mouthguards are now almost universally used by athletes at all levels. Most dental injuries are now due to accidental contact during casual play or due to serious MVA type accidents. Trauma to teeth usually does not occur during office hours, and thus many times, these patients are seen after hours on an emergency basis.
We don’t see these injuries as often as in the past, so it is important to keep our knowledge base as current as possible. To help with diagnosis and treatment planning, the following web site link is provided specifically for this subject. This link systematically describes all classifications of dental injuries and provides a step by step treatment plan for each case.
Access the Dental Trauma Guide website
