Root Canal Therapy usually involves removal of the dental pulp (the tooth's soft core). Once the diseased tissue is removed, the pulp chamber and canal are shaped, disinfected, filled and sealed to prevent further contamination.
The pulp is the soft tissue that contains the nerves, blood vessels and connective tissue of the tooth. It lies within the dentin (the bone-like tissue on the inside of the tooth) which supports the outer layer called tooth enamel. Within the dentin, the pulp extends from the pulp chamber in the crown (the portion of the tooth visible above the gums) down to the tip of the root by way of the root canal. All teeth have only one pulp chamber but may have more than one root and several root canals.
When the pulp is diseased or injured and unable to repair itself, it loses its vitality. The most common causes of pulp death are a cracked tooth, a deep cavity, or a traumatic injury to the tooth. Bacteria found in the saliva can leak into the pulp eventually causing infection inside the tooth resulting in the loss of tooth vitality. If left untreated, an abscess can form at the tip of the root, resulting in pain, swelling, and destruction of bone that surrounds the tooth.
Root canal therapy is about 95 percent successful. Many factors influence the treatment outcome, including the following: the patient's general health, bone support around the tooth, strength of the tooth including possible fracture lines, shape and condition of the root and nerve canal(s). The tooth may require further treatment from a specialist to achieve lone term success.
Fractures are one the main reasons root canals fail. Unfortunately, some cracks that extend from the crown down the root are invisible and difficult to detect. They can occur on teeth from traumatic injury biting on hard objects, habitual clenching or grinding, or even normal wear and tear. Some fractures are undetectable even during root canal therapy. If a fracture occurs, it may require extraction of the tooth.
Since teeth with root canals are more brittle than other teeth, we may recommend a crown to prevent further damage. A crown is especially important with molar and bicuspid teeth. If the tooth is not permanently restored following root canal therapy, it may fracture and become un-restorable requiring additional treatment, such as an extraction.
The alternatives to root canal therapy include: extraction, with nothing to fill the space, or extraction followed by a bridge, partial denture, or implant to fill the space.