Root canal therapy (aka endodontic therapy) is a sequence of Tx for the infected pulp of a tooth, which results in the elimination of infection and the protection of the decnominated tooth from future microbial invasion.
Method
Root canals and their associated pulp chamber are the physical hollows within a tooth, that are naturally inhabited by nerve tissue, blood vessels, and other cellular entities, which together constitute the dental pulp
Root canal therapy involves removal of these structures, the subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions, and the obturation/filling of the decontaminated canals with an inert filling e.g. gutta-percha and typically an eugenol-based cement
Epoxy resin is employed to bind gutta-percha in some root canal procedures
Canal placement includes:
Mx dentition:
1, which is ordinarily 23mm long, w/ 1 root, and 1 canal. Triangular access cavity, starting at the cingulum and widening towards incisal edge
2, which is ordinarily 22mm long, w/ 1 root, and 1 canal
3, which is ordinarily 26mm long, w/ 1 root, and 1 canal
4, which is ordinarily 21mm long, w/ 2 roots, and in 90% of cases 2 canals (B, P), 5% of cases 1 canal, and 5% of cases 3 canals (MB, DB, P)
5, which is ordinarily 21mm long, w/ 1 root, and in 75% of cases 1 canal, and in 75% of cases 2 canals (B, P)
6, which is ordinarily 22mm long, w/ 3 roots, and in 60% of cases 4 canals (MB1, MB2, DB, P) and 40% of cases 3 canals (MB, DB, P)
7, which is ordinarily 20mm long, w/ 3 roots, and in 60% of cases 3 canals (P that is longer, and MB, DB), and in 40% of cases 4 canals (MB1, MB2, DB, P)
Md dentition:
1, which is ordinarily 21mm long, w/ 1 root, and in 60% of cases 1 canal, and 40% of cases 2 canals (B, L)
2, which is ordinarily 21mm long, w/ 1 root, and in 90% of cases 1 canal, and 10% of cases 2 canals (B, L)
3, which is ordinarily 24mm long, w/ 1 root, and in 90% of cases 1 canal, and 10% of cases 2 canals (B, L)
4, which is ordinarily 22mm long, w/ 1 root, and in 75% of cases 1 canal, and 25% of cases 2 canals (B, L)
5, which is ordinarily 22mm long, w/ 1 root, and in 90% of cases 1 canal, and 10% of cases 2 canals (B, L)
6, which is ordinarily 21mm long, w/ 2 roots, and in 65% of cases 3 canals (ML, MB, D) and 35% of cases 4 canals (ML, MB, DL, DB)
7, which is ordinarily 20mm long, w/ 2 roots, and in 90% of cases 3 canals (MB, ML, D) and 10% of cases 2 canals (M, D)
Equipment
Barb broach, which removes pulp during a RCT, where the round wires are nothced w/ barbs
Gates Glidden (GG), usd for shaping the coronal 1/3rd of the root canal
X-Gates, replaces GG 1-4 and is ideal for radicular access
X-Smart Plus, an endodontic motor used for reciprocating, single file technique, or traditional continuous rotation file systems
Types of files:
ProTaper Next, which has an off-centered, rectangular cross section for increased file strength
Apex locator
Spreader, metal instruments used for packing root canal fill material to the sides of canal to make room for additional material
Materials
Chemomechanical preparation (CMP):
Na hypochlorite, which is used as an endo irrigant as it is an effective antimicrobial and has tissue dissolving capabilities, including Hypochlor 1%
EDTA (Ethylenediaminetetraacetic acid), which is a chelating agent that can aid in mechanical enlargement of difficult root canals by softening teh root canal dentin walls e.g. HALAS Canal Prep (15% EDTA), or RC PREP Cream (i.e. glycol, urea peroxide, and EDTA), and EDTA-C (which contains 15% EDTA w/ Cetrimide)
Dressing:
Odontopaste is a ZnO based root canal paste w/ 5% clindamycin (antibiotic) and 1% triamcinolone acetonide (corticosteroid)
CaOH (calcium hydroxide) neutralizes low pH of acids, has antibacterial properties, and promotes pulp tissue defence mechanisms and repair. It can however cause resorption in primary teeth
Calcimol is 26% CaOH
Odontocide is 20% CaOH and 7% ibuprofen (NSAID)
Calmix
Dycal, is a self-set rigid dental cement based onRadiopaque CaOH
Cavit G (gray) or Cavit W (white), is a temporary filling material, containing zinc oxide and zinc sulfate in different []
Sealer, including AH Plus, which provides permanent sealing based on epoxide-amine resins
Removing GP:
Chloroform, is used for plasticising GP points, to facilitate removal of GP root canal fillings in need of retreatment
Eucalyptus oil, can dissolve GP after 2 mins of immersion
Perforation repair:
MTA (mineral trioxide aggregate), used for dental root repair, formulated from commercial Portland cement, combined w/ bismuth oxide powder for radiopacity
Tricalcium silicate is the main phase of Portland cement, and Biodentine is a tricalcium silicate based material designed to be a permanent dentin substitute
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