What is RCT?

Like every other part of the human body, the teeth also have vessels which carry blood to the tooth and nerves that sense pain.

X-ray of a tooth showing the presence of the nerves in the centre

When there is a trauma or a tooth cavity which is deep enough to irreversibly infect or inflame the nerve tissue and associated vasculature (together known as the pulp) inside the tooth, it would warrant a root canal treatment (RCT). The procedure involves removing the pulp and replacing it with a biocompatible material so that the tooth does not have to be extracted.

Will having a root canal treatment done hurt me?

That is a common misconception. It doesn’t hurt, in fact it relieves pain. There are a few situations where profound anesthesia is unattainable but a well-trained dentist can manage the situation efficiently.

My tooth does not hurt but why have I been recommended a root canal?

I get a lot of this question. The honest answer is, sometimes it is necessary. There are cases where the disease process has progressed slowly and caused enough damage that the degenerated pulp tissue cannot transmit any pain impulse anymore. The disease process continues silently in these cases and can result in loss of the tooth if it isn’t treated immediately. An ethical dentist would never unnecessarily recommend a RCT.

Who is an endodontist?

An endodontist is someone who specializes in RCT and has a post-graduate degree for the same. According to me, an endodontist is not just someone who has learnt the principles and practices of endodontics, but it is someone who has the passion and drive to perform the procedure with the highest standards consistently.

Why do I need a crown following a RCT?

A tooth that requires a RCT almost always has lost some percentage of tooth structure due to the decay process. Additionally we remove more tooth structure to gain access to the root canal space and also shape it with a series of instruments which hollow it further from within. This makes a tooth highly susceptible to a fracture and then warranting an extraction. A crown encircles the tooth and reinforces it. So the fact is 90% of the root canal treated teeth will require a crown.

What about the remaining 10% who don’t not need a crown?

The answer is simple. We all know of laparoscopic surgery where a procedure is completed effectively through a small opening no bigger than a keyhole. Similarly when a tooth is minimal invasively operated on, a crown can be avoided preserving the natural dentition. Let me take this to the next level to further explain this.

Transforming from Endodontics to a Micro-endodontics. 

When a RCT is done with the assistance of an Operating Microscope the operator gets to look at the tooth at a much higher level of magnification than the human eye can.

Minimal invasive Microscopic RCT Vs Conventional RCT which destroys a lot of tooth valuable tooth structure

 You can always treat something you see bigger much better, as the procedure that is done with extreme precision and results in very minimal removal of tooth structure and preserving what is natural. Let me to introduce a new terminology. “Minimal invasive Endodontics (MIE)”. In simple terms it refers to RCT performed with the co-axial illumination and magnification offered by a Microscope. This gives a micro-endodontist a definite upper hand and a much higher percentage of accuracy enabling him to restore even the teeth most endodontist would opt to extract.

In simpler terms just like the human finger print, no two teeth are alike. Cases with unexpected variations are in plenty when it comes to the tooth morphology. Under a microscope a clinician finds it easier to deal with the minutest variation and also the drastic ones. In fact, I take over cases from my colleagues frequently to rectify unmanageable situations and procedural errors they have got into during a RCT they initiated.

Can all badly broken down/decayed teeth be root canal treated?

Honestly its complicated. Simply rendering a tooth pain-free is different from making it fit enough to endure the daily functional use and abuse that we put the teeth to. Whether to restore or to extract the tooth is purely dependant on how far-sighted your dentist is.

Hidden crack visible under a microscope

With magnification the hidden entities which lead to failure can be identified and the prognosis of questionable teeth can be assessed better and the appropriate treatment can be rendered.

How long will a root canal treated teeth last?

To be very honest with you if every dentist asks himself this question “How long will the root canal I did last?”, and implement the procedures and principles he has learnt, I can assure you it will last a long, long time. Long enough for you to have gained a fortune more than what you have paid for it.However the protocols followed when RCTs are carried out under the microscope, are far more stringent and precise giving you a higher rate of success.

Are root canals expensive and why do different doctors charge differently for the same procedure?

A fee is purely based on the armamentarium and the skill level of the doctor you visit.

For a RCT, it is wiser to pay a good endodontist more than to repeat the procedure when it fails. To let you in on a trade secret the finest clinicians make their money redoing failed RCTs than 1st time straight forward ones.

Article Credits: Dr. Reuben Joseph , MDS (Endodontics) practices at 32 INTACT Dental Clinic, Chennai. He has 9 years of experience as a micro-endodontist. He is one of the few dentists in the country who strictly practices micro-dentistry only.