The main reason most patients visit the dentist is toothache, which can be caused by various factors. One important cause is deep tooth decay reaching the dental pulp, causing inflammation of the pulp. If it progresses further, the tissue inside the tooth dies and infection occurs in the root canal, resulting in pain. These symptoms can be treated with root canal therapy.
Causes that may lead to pulp inflammation or infection include:
- Tooth decay or deep fillings reaching the dental pulp
- Recurrent decay or new decay under a dental crown
- Cracked or fractured teeth
- Tooth injury from trauma or accidents
Root canal treatment is a process to remove inflamed pulp or eliminate infection in the dental pulp chamber, allowing the tooth to be preserved for further use. The general steps of root canal treatment are as follows:
- Remove decayed tooth material and open access to the pulp chamber
- Remove inflamed pulp or infection using small instruments to clean, combined with irrigation using antimicrobial solutions
- If the root canal treatment cannot be completed in one visit, the dentist will place an antimicrobial medication in the root canal and seal it temporarily
- Fill the cleaned root canal with filling material
- Teeth that have undergone root canal treatment usually require a crown to prevent fracture of the tooth
The duration of root canal treatment depends on the complexity and infection of the tooth being treated. Some cases can be completed in one visit, but in cases where the root canal is complex or severely infected, 2-4 visits may be necessary. After root canal treatment, patients may experience pain or sensitivity in the treated tooth for about 2-5 days. Pain relievers can be taken to alleviate this discomfort, and the pain will gradually subside on its own.
Current studies show that the success rate of root canal treatment is as high as 90%. However, some cases fail due to incomplete elimination of infection in the first treatment, new decay, or fracture of the tooth later, causing reinfection of the root canal. Patients may experience pain, swelling, or pus formation on the gums. If failure occurs, treatment options include:
- Retreatment of the root canal: If the filling material in the tooth can be removed, the dentist will remove the old root canal filling, clean the root canal again, place antimicrobial medication, then refill the root canal and restore the tooth.
- Apical surgery: This is used when retreatment is not possible, such as when there is a large crown and post that cannot be removed, or when the first root canal treatment has limitations that cannot be corrected by retreatment. Apical surgery is another option to preserve the tooth. The procedure involves surgically accessing the root tip where the infection is located, removing part of the root tip, removing the root canal filling material with special instruments, and then filling the cleaned root tip area with a biocompatible material that promotes healing of the surrounding tissue.
Root Canal Treatment Using a Microscope
Root canal treatment requires great precision because the pulp chamber and root canals are very small. In some cases, they are too small to be seen with the naked eye. The complexity is especially true in molars with 3-4 root canals. Additionally, if errors occur during root canal treatment, correcting these errors to achieve success can be difficult or impossible without magnification.
Currently, microscopes are used to enhance the visibility of small root canals. Clear visualization improves the efficiency of the procedure and increases the success rate of root canal treatment. It also allows treatment of difficult and complex cases, providing patients with an alternative to tooth extraction. The benefits of using a microscope in root canal treatment include:
- Diagnosis, such as detecting cracks or fractures in the tooth and root canals
- Enhancing magnification to locate root canals in cases of blockage or complexity, such as root canals that split into 2-3 canals at the root tip or teeth with abnormal anatomy
- Repairing perforations in the root canal, removing broken instruments or posts from the root canal
- Treating teeth with incomplete root development, which have open root tips
- Apical surgery, which requires the use of a microscope in several stages of the procedure
