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Endodontic therapy is a sequence of treatment for the pulp of a tooth whose end result is the elimination of infection and protection of the decontaminated tooth from future microbial invasion. In the situation that a tooth is considered so threatened (because of decay, cracking, etc.) that future infection is considered likely or inevitable, a pulpectomy, removal of the pulp tissue, is advisable to prevent it. The standard filling material is gutta-percha, a natural thermoplastic polymer of isoprene, which is melted and injected to fill the root canal passages. For patients, root canal therapy is one of the most feared procedures in all of dentistry; however, dental professionals assert that modern root canal treatment is relatively painless because the pain can be controlled. Lower right first molar (center) after root canal therapy; the pulp chamber and root canals have been cleaned of debris, decontaminated and filled with gutta percha. At this first visit, the dentist must ensure that the patient is not biting into the tooth, which could also trigger pain. After removing as much of the internal pulp as possible, the root canals can be temporarily filled with calcium hydroxide paste. After receiving a root canal, the tooth should be protected with a crown that covers the cusps of the tooth. The procedure is often complicated, depending on circumstances, and may involve multiple visits over a period of weeks. In the last ten to twenty years, there have been great innovations in the art and science of root canal therapy.
There is no scientific evidence that root canal therapy has any adverse affects on the over all health of the individual. Barium is added to the isoprene so the material will be opaque to X-rays, allowing verification afterwards that the passages have been properly completely filled in, without voids. Sometimes the dentist performs preliminary treatment of the tooth by removing all of the infected pulp of the tooth and applying a dressing and temporary filling to the tooth. Otherwise, over the years the tooth will almost certainly fracture, since root canals remove tooth structure from the tooth and undermine the tooth's structural integrity.
Dentists now must be educated on the current concepts in order to optimally perform a root canal. People with special vulnerabilities, such as prosthetic joint replacement or mitral valve prolapse, may need to take antibiotics to protect from infection spreading during dental procedures.
Effective root canal therapy performed by adequately trained clinicians results in very high success rates with no systemic relationship to the patient's overall health.
To cure the infection and save the tooth, the dentist drills into the pulp chamber and removes the infected pulp by scraping it out of the root canals.


In the United States, it would typically cost US$400-1,000—though exceeded by the even more expensive related crown procedure, typically around US$500-1,500 with usually only 50% being covered by the dental insurer (DMO or DPO).
Root canal therapy has become more automated and can be performed faster, thanks to advances in automated mechanical instrumentation of teeth and more advanced root canal filling methods. They may fail if the dentist does not find, clean and fill all of the root canals within a tooth. Once this is done, the dentist fills the cavity with an inert material and seals up the opening.
However, in some cases it may be very difficult to achieve pain control before performing a root canal. The dentist may also remove just the coronal portion of the dental pulp, which contains 90% of the nerve tissue, and leave intact the pulp in the canals. This is commonly due to the fact that the blood supply to the tooth, which nourishes and hydrates the tooth structure, is removed during the root canal procedure, leaving the tooth without a source of moisture replenishment. In India, the root canal procedure would typically cost INR 1,500-4,500 (US$35-110), when performed by an endodontist — and the crown procedure, for a ceramic crown, would cost around INR 2,000-5,000 (US$50-125). Dentists also possess newer technologies that allow more efficient, scientific measurements to be taken of the dimensions of the root canal that must be filled. For example, on a top molar tooth, there is a more than 50% chance that the tooth has four canals instead of just three.
For example, if a patient has an abscessed tooth, with a swollen area or "fluid-filled gum blister" next to the tooth, the pus in the abscess may contain acids that inactivate any anesthetic injected around the tooth. Placement of a crown or cusp-protecting cast gold covering is recommended also because these have the best ability to seal the root canaled tooth.
Many dentists use microscopes to perform root canals, and the consensus is that root canals performed using microscopes or other forms of magnification are more likely to succeed than those performed without them.
But the fourth canal, often called a "mesio-buccal 2", tends to be very difficult to see and often requires special instruments and magnification in order to see it. If enough of the tooth has been damaged, or removed as a result of the treatment, a crown may be required. In this case, it is best for the dentist to drain the abscess by cutting it to let the pus drain out. If the tooth is not perfectly sealed, the root canal may leak, causing eventual failure of the root canal. Although general dentists are becoming versed in these advanced technologies, they are still more likely to be used by specialist root canal doctors (known as endodontists).


So it may be missed, and this infected canal may cause a continued infection or "flare up" of the tooth. Releasing the pus releases pressure built up around the tooth; this pressure causes much pain. The pulpectomy and pulpotomy procedures eliminate almost all pain until the follow-up visit for finishing the root canal. Any tooth may have more than one canal, which may be missed while performing the root canal. The dentist then prescribes a week of antibiotics such as penicillin, which will reduce the infection and pus, making it easier to anesthetize the tooth when the patient returns one week later.
Arnaldo Castellucci, an Italian dentist, has recently authored a three-volume treatise on endodontics which thoroughly covers these modern concepts. Sometimes the canal may be unusually shaped, making it impossible to fill it completely, so that some infected material is still left in the canal. The dentist could also open up the tooth and let the pus drain through the tooth, and could leave the tooth open for a few days to help relieve pressure. A tooth with a root canal still has the ability to decay, and without proper home care and an adequate fluoride source the tooth structure can become severely decayed – without the patient's knowledge since the nerve has been removed, leaving the tooth without any pain perception.
Sometimes the canal filling does not extend deeply enough into the canal, or it does not fill the canal as much as it should.
Therefore it is very important to have regular X-rays taken of the root canal to ensure that the tooth is not having any problems that the patient would not be aware of. Sometimes a tooth root may be perforated while the root canal is being performed, making it difficult to fill the tooth. The hole may be filled with a material derived from natural cement called "MTA", although usually a specialist would perform this procedure. Fortunately, a specialist can often re-treat and definitively heal up these teeth, often years after the initial root canal procedure.



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