Root Canal Treatment Steps

Root canal treatment

Root canal treatment is the treatment of tooth root canals to eliminate deep infections involving the pulp tissue. The treatment is performed by either a general dentist or an endodontist.

Endodontists are specialized to treat problem related to inner pulp. Therefore, the treatment is also known as endodontic treatment.

When do you need a root canal treatment?

If the innermost layer of tooth i.e, pulp becomes infected, the only choice is root canal treatment. The infection of pulp implies that a tooth is irreversibly damaged and the pulp vitality cannot be restored.

The patients with pulp infection come with a deep cavity or cavity between teeth. The dentist takes an x-ray and see the spread of the infection and decides the couse of treatment.

In some scenarios, the infection escapes out of the root into the surrounding bone (dental abcess) and causes pain and swelling. Such a patient comes with severe pain and the pain is relieved by medications or by opening the tooth to allow the pus drain.

In long-standing infections, a sinus (an outside opening or a gumboil) is formed in the gums or skin letting the pus drain.

All these cases are treated with root canal therapy. Once tooth infection is removed the surrounding bone heals itself.

What is a root canal procedure?

Root canal treatment involves making access to the root canals, cleaning and filling them. The treatment is completed in one more appointments based on the tooth involved, the spread of infection and the type of canal cleaning kit used.

Local anesthetic injection

To make the procedure pain-free a local anesthetic injection is given to numb the tooth and its surrounding structures.

A local anesthetic injection is given near the treated tooth in front teeth, however, it is given remote to the site of the treated tooth in lower molars or back teeth to numb them.

Lower molar teeth and their gums are supplied by more than one nerve and require an injection to anesthetize the larger nerve before it gives off branches.

To make Access to the pulp

The dead and decayed tooth structure is removed, and an access opening is made to the pulp cavity with a drill.

Every tooth root contains a canal where nerves and blood vessels are present. However, molars have multiple roots, and each root contains one or two canals.

Root canal therapy aims to remove the infected tissue from the root canals, clean and shape them so a filling can be placed.

Canal Length Determination

Each root canal has a different length and every root has an opening at its tip (apex) from where blood vessels and nerves enter the tooth.

The next step is to determine the length of root canal with an apex locator or by placing the sharp needles in the canal called files and taking an x-ray.

It is important to find the correct length so that the root canals can be cleaned till its apex.

If the length of root canals aren’t determined correctly, the underfilled canals leave the infected pulp behind and the overfilled canals can irritate the structures outside the root of the tooth.

Cleaning and Shaping of canals

Several files of varying colour clean and shape the canals. Each colour represents different size of the file.

The files are either attached to a motor (rotary files) or are filed by hand. Rotary filing works quickly and efficiently, on the contrary, manual filing takes time.

The canals are simultaneously washed with an antibacterial solution to disinfect them.

Drying and filling of the canal

The cleaned canals are now dried with paper points. Paper points are sticks made out of paper of varying sizes selected based on the size of the last file used.

At last coagulated latex is used to fill the canals. At this stage, root canals are sealed, and the tooth is dead.

Crown cutting and placement

A glass ionomer cement, composite or silver filling replaces the lost dentin. The tooth is finally cut with a drill for a crown and is placed at the next appointment.

If the treatment is to be completed in multiple appointments a temporary filling is placed in the tooth opening, and the patient is sent home.

is a crown always necessary with a root canal?

Yes, root canal without a crown can be done where minimum tooth structure is lost due to dental caries and the remaining tooth structure is strong enough to resist the biting forces after being filled with a silver or composite filling.

how long does a root canal last without a crown?

If there is enough tooth structure to resist the biting forces after a root canal treatment, the tooth may last up to 10-15 years. However, the quality and timing of the final restoration/coverage has its effect on the survival and success rate of root canal treated tooth.

Several research papers suggest that a root canal with a crown shows a higher long-term survival rate than the ones restored with a filling alone.

A root treated tooth is not as strong as a natural tooth because root canal treatment involves the removal of pulp, making the tooth dead. Pulp removal takes away all the moisture from dentin making it brittle and weak and more prone to breakage or fracture.

Is it normal to have Pain after a root canal treatment?

It is normal to feel mild to moderate pain for a couple of days after the treatment because of the inflammation of tissues around the treated tooth.

Take some painkillers as prescribed by the dentist or root canal dentist (endodontist). If you still feel pain 5-7 days after root canal treatment, call your dentist.

A root canal Treatment on a crowned tooth

Yes, it is possible to treat a tooth with a crown or bridge. In such situations, the prosthesis is removed, the tooth is treated as desired, and a new crown is placed.


Root canal treatment is a multistep treatment to clean and disinfect the tooth root canals to eliminate the infection. It involves making an access opening to the root canals, cleaning and filling them.

After the root canal treatment, the tooth is covered with a ceramic crown to seal it and protect it from any further damage.

The treatment is completed in one more appointment based on the location of infected tooth, the spread of infection and the type of canal cleaning kit used.

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