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Root canal treatment has come a long way from what it used to be just a few decades back. Dentists are now able to perform the procedure more quickly, with less pain, and with more predictability. Let us have a look at how this change came about.

What is root canal treatment?

Every tooth in our mouth has two parts: the part that you can see inside the mouth — called the crown — and the part that is embedded inside the jaws, called the root. Through the center of the tooth, from the crown to the tip of the root, runs a canal which carries the nerve endings of the tooth [1]. Damage to these nerve endings due to any reason requires the dentist to clean out the entire canal and then fill it so that the problem can be resolved [2].

This process of cleaning, shaping, and then filling the canal is called a root canal treatment.

How have root canal treatment techniques changed in recent times?

There has been a massive upgrade to the techniques that were initially used for root canal treatment. Each step of the procedure is now quicker, can be done more reliably, and is visualized in a clearer way than was ever possible before.

Lets us look at some of the most important advances in root canal techniques.

Rotary Endodontics

For a long time, dentists were required to gain access to the canals in the roots and then manually shape them with files designed for this purpose. That process was time-consuming and had a higher chance of error because of the human element involved [3].

Now, the most common method of performing an RCT is through the use of rotary endodontics. The files designed for cleaning and shaping the canal are attached to a machine which turns them at a pre-fixed torque. The procedure is exponentially quicker than the manual method and results in a very predictable final shape of the final canal [4].

The advantage to the patients is that they have to sit in the chair for a much shorter time, the success rate of the procedure goes up, and the chances that the entire RCT will be completed in one appointment are also increased greatly [5].

Apex Locators

One of the key things in a root canal procedure for the dentist is to determine the length of the root so that it can be cleaned out completely till the tip. If the cleaning is left short of the root tip (called the apex) or the instrument exceeds the length of the root then the patient may have postoperative pain.

The earlier method of determining this apex was rudimentary. It involved placing a file till an approximate length, taking an X-ray to determine the error, correcting it, and taking another X-ray to determine whether the length was now correct. In the back teeth where there can be three roots and four canals, this process was quite cumbersome [6].

Nowadays, Apex locators make the process seamless and do not require a single X-ray in the process. All the doctor will do is attach one end of the apex locator the file and place it in the canal. The length is increased until the apex locator beeps and that’s it — the length of the canal has been determined [7].

Once again, the patient benefits from having to spend less time on the chair and an increased accuracy. It must be mentioned here that the accuracy of apex locators can be a little questionable in certain conditions and so the dentist may choose to use the traditional method of confirming the root length in some cases [8].

Microscope/Loupes

One of the most transformational changes in root canal treatment has been the use of magnification to visualize the inside of the tooth better. Root canal treatment was considered to be a "blind" procedure because there is no direct line of sight into the tooth.

The use of magnification loupes and endodontic microscopes has changed that perception. Dentists can now see the canal of the teeth at a detail that could not have been imagined a few years back. At such detail, many small errors become obvious and end up helping increase the success of the procedure [9].

Procedures such as the retrieval of broken instruments from the canal can be performed much better under a microscope [10]. Dentists are also better able to catch any anatomical aberrations like the presence of an extra canal or small accessory canals which need to be cleaned out as well.

Patients who are treated with the use of magnification know that they are being treated with the best possible technique available. In the short term, this can mean an increase in the cost and even the total treatment time but there is no question that the end result of the treatment is far superior to traditional root canal techniques.

Conclusion

These are just three of the big changes that have made root canal treatment faster, more predictable, and easier for the patient to go through. There are smaller advancements in every single aspect of the treatment procedure, all of which add up to a fantastic leap in root canal treatment procedure techniques in recent years.

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