Introduction
Endodontic treatment (root canal treatment) removes the pulp and the microorganisms from the root canal system, shapes and disinfects the canals and seals them. The access cavity is its first operative step: every later step depends on it, and most procedural errors – missed canals, ledges, perforations – begin with a poor access.
Aims and biological principles
The aim of endodontic treatment is to prevent or heal apical periodontitis by eliminating microorganisms from the root canal system and preventing its reinfection. Apical periodontitis is caused by bacteria in the canal, so the approach depends on the state of the pulp:
- Vital pulp (irreversible pulpitis): the canal is still largely free of bacteria – the task is prevention, removing the pulp under strict asepsis without infecting the canal.
- Necrotic, infected pulp or existing apical periodontitis: the task is disinfection – reducing the bacteria to a level at which the periapical tissues can heal.
The endodontic triad
Textbooks group it slightly differently; the usual form is:
- Cleaning and shaping – removing tissue and debris and enlarging the canal to a tapered form that irrigants and the filling can reach;
- Disinfection – irrigation, mainly with sodium hypochlorite, and between visits an intracanal dressing, usually calcium hydroxide;
- Three-dimensional obturation (obturatio, closing) – filling the whole canal system, including its irregularities, with gutta-percha and sealer, followed by a tight coronal seal.
Coronal leakage reinfects even a well-filled canal: between visits the access is closed with a temporary filling at least 3–4 mm thick, and the tooth is restored definitively as soon as possible.
Principles of work
- Asepsis: rubber dam is mandatory for every root canal treatment – it keeps saliva out of the canal and protects the patient from swallowed or inhaled instruments and irrigant. Caries and leaking restorations are removed and the tooth and dam disinfected before the pulp is entered; instruments are sterile (isolation: topic 33).
- Work within the canal: instruments and filling stay inside the canal and end at the apical constriction, usually 0.5–1 mm short of the radiographic apex (topic 41); debris, irrigant and filling material must not be pushed beyond the foramen.
- Conservation: remove only the tooth structure the next step needs – the remaining dentin decides the tooth's long-term survival.