Everything You Need to Know About Root Canal Treatment

Root canal treatment, also known as endodontic treatment, is a dental procedure that involves removing infected or damaged pulp from inside the tooth and sealing off the area. The pulp contains nerves, blood vessels, and connective tissue and occupies the inner space of the tooth known as the root canal system. 

When the pulp becomes infected or inflamed due to deep decay, repeated dental procedures, cracks or chips in the tooth, or trauma, it can cause pain and swelling. If left untreated, the infection can spread through the root canal system and eventually lead to an abscess or loss of the tooth. Root canal treatment aims to save the tooth instead of extracting it.

What happens during root canal treatment?

The root canal procedure is performed by an endodontist (Dr. Shivani Mangal), a dentist who specializes in treating issues related to the tooth pulp. Here are the general steps involved in a root canal:

  • Examination and X-rays: The dentist will examine the tooth and take X-rays to determine if a root canal is necessary. Looking at X-rays helps them see the extent of the infection and figure out the length and shape of the root canals. They may also conduct additional tests to check the vitality of the tooth.
  • Anesthesia: The area around the affected tooth will be numbed using local anesthesia so you don’t feel pain during the procedure. Typically a rubber dam is also placed to isolate the area.
  • Accessing the pulp: The endodontist will drill an opening through the top of the tooth and into the pulp chamber. This gives them access to the pulp and root canal system. They may use magnification tools to optimize visibility.
  • Pulp removal: The infected or dead pulp is then removed using specialized dental instruments. The pulp tissue is extracted gently to avoid leaving any remnants behind.
  • Cleaning and shaping: The empty root canal system is then cleaned and shaped in preparation for filling. Small flexible files are used to remove debris and enlarge the canals. Irrigation solutions help flush out bacteria.
  • Root canal filling: Once thoroughly cleaned, shaped, and disinfected, the entire root canal system is sealed with an inert filling material, usually gutta-percha along with sealer cement. This prevents reinfection.
  • Buildup and crown: If a lot of tooth structure is lost, the tooth will be built up with restorative materials. A tooth-colored crown is often placed for reinforcement and aesthetics after the root canal is completed.
  • Temporary filling: A temporary filling may be placed to seal the access hole between appointments before the permanent restoration is completed.
  • Follow-up visits: Additional appointments are scheduled to check healing and complete the tooth restoration. Long-term success depends on proper repair.

With modern techniques and materials, root canal therapy is often completed in just one or two comfortably numb appointments. Careful instrumentation and filling of the root canal system at Cusp Dental give the tooth a new lease on life.

Why do root canals fail sometimes?

Though root canal success rates are generally very high, some root canal treatments unfortunately fail. Here are some of the reasons:

  • Complex tooth anatomy: Teeth with abnormal anatomies or extra canals can be difficult to fully clean and obturate. The endodontist needs additional expertise and tools to manage such cases.
  • Severe infections: Teeth with pulpal infections that have spread to other areas like the bone may not resolve even after root canal treatment. Additional interventions like antibiotics or surgery may be required.
  • Poor restoration: Lack of a proper final restoration with a crown or filling can allow bacteria to seep back in and reinfect the root canal system.
  • Undetected cracks: Cracks that extend into the root can allow bacteria access to the inner tooth structure and cause root canal failure. Such cracks need to be addressed.
  • Patient factors: Health conditions like diabetes impact healing outcomes. Very aged teeth also have reduced success rates. Follow-up compliance affects results as well.

However, with advances in materials and techniques, most general dentists and endodontists are able to perform root canals with a very high rate of success. But if a case fails, they can evaluate the reasons and discuss options like repeat root canal, apicoectomy, or tooth extraction.

The benefits of root canal treatment

Root canal treatment offers many benefits over tooth extraction:

  • Natural tooth preservation: A root canal can save your natural tooth and prevent the need for implants or bridges later. Keeping natural teeth helps maintain proper chewing function and prevents bone loss in the area.
  • Pain relief: The intense pain and discomfort caused by an infected tooth is resolved after the infected pulp is removed during a root canal. This provides long-lasting pain relief.
  • Improved appearance: Root canals allow you to keep your natural smile. There is no visible difference between a root canal-treated tooth and other teeth.
  • Enhanced oral health: Retaining natural teeth through root canals helps prevent dental problems down the line. It also allows you to properly maintain areas that would be difficult with bridges or implants.
  • Cost-effectiveness: Root canals are often cheaper than tooth extractions and replacement options. They also have high success rates, so you likely won’t need a repeat procedure.
  • Time efficiency: Root canals only require 1-2 dental visits. Getting an implant or bridge made after tooth extraction is a much lengthier, multi-step process.
  • Preserving tooth structure: Unlike extraction, root canals preserve natural healthy tooth structure. This allows the rest of the tooth to remain strong and functional.

For many with dental infections, root canals are the best option for quickly relieving pain while saving the natural tooth. If the inner tooth structure is in good condition, root canal therapy can restore full function.

The risks of root canal treatment

While generally safe and effective, root canals do come with some risks and considerations:

  • Root canal failure: In some cases, the root canal procedure fails to fully remove the infection. This can cause persistent pain and require a repeat root canal or tooth extraction.
  • Reinfection: If the crown or filling on the root canal tooth isn’t fully sealed, bacteria can re-enter and reinfect the tooth. 
  • Complications: Factors like curved roots, calcified canals, or cracked teeth can complicate the procedure and reduce success rates. An experienced endodontist is needed to manage such complex cases.
  • Restorative failure: Dental crowns or restorations placed after the root canal can become damaged and require repair or replacement.
  • Tooth weakness: The tooth may become brittle without the inner pulp. A crown helps protect and strengthen the tooth after root canal treatment.
  • Need for follow-up: Some root canal cases require additional appointments and procedures for the best outcome. Failure to properly complete the treatment can cause problems.

However, the risks are minimized with good patient care and follow-up. Seeing an endodontic specialist for difficult root canals also improves outcomes. With proper treatment and good oral hygiene, root canal-treated teeth can last for many years.

Are broken teeth always extracted?

Cracked or broken teeth were once considered hopeless and inevitably extracted. But with modern endodontic treatments, even severely damaged teeth can often be saved. Here are some repair options:

  • Root canal treatment: If the crack has extended into the pulp but the tooth root is intact, a root canal can remove the infected pulp and save the tooth.
  • Bonding and crowns: Minor chips and cracks can be repaired with dental bonding. More extensive damage requires a crown for protection.
  • Tooth extraction: If the tooth root or supporting structures are severely compromised, extraction may still be needed. But implants, bridges, and partial dentures can replace extracted teeth.

So while broken teeth present challenges, they no longer mean inevitable tooth loss. In many cases, restorative techniques combined with root canal therapy can still salvage damaged teeth.


Root canal treatment offers the most effective way to resolve the problem and save the natural tooth. Root canal therapy provides rapid relief from tooth pain and infections. 

With proper care, root canal-treated teeth can function normally for years after the procedure. While no surgery is totally risk-free, modern techniques yield successful outcomes in the vast majority of root canal cases. 

If your dentist diagnoses a condition requiring root canal therapy, you can feel confident that this treatment will fix the problem quickly and effectively, allowing you to keep your natural teeth.