Endodontic therapy

Endodontic therapy or root canal therapy is a sequence of treatment for the infected pulp of a tooth which results in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion. Root canals and their associated pulp chamber are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities which together constitute the dental pulp. Endodontic therapy involves the removal of these structures, the subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions, and the obturation (filling) of the decontaminated canals with an inert filling such as gutta-percha and typically a eugenol-based cement. Epoxy resin is employed to bind gutta-percha in some root canal procedures. Endodontics includes both primary and secondary endodontic treatments as well as periradicular surgery, as applied to teeth that still have potential for salvage.

Root canal treated teeth may fail to heal, for example if the dentist does not find, clean and fill all of the root canals within a tooth. On a maxillary molar, there is a more than 50% chance that the tooth has four canals instead of just three. But the fourth canal, often called a "mesio-buccal 2", tends to be very difficult to see and often requires special instruments and magnification in order to see it (most commonly found in first maxillary molars; studies have shown an average of 76% up to 96% of such teeth with the presence of an MB2 canal). This infected canal may cause a continued infection or "flare up" of the tooth. Any tooth may have more canals than expected, and these canals may be missed when the root canal is performed. Sometimes canals may be unusually shaped, making them impossible to clean and fill completely; some infected material may remain in the canal. Sometimes the canal filling does not fully extend to the apex of the tooth, or it does not fill the canal as densely as it should. Sometimes a tooth root may be perforated while the root canal is being treated, making it difficult to fill the tooth. The perforation may be filled with a root repair material, such as one derived from natural cement called mineral trioxide aggregate (MTA). A specialist can often re-treat failing root canals, and these teeth will then heal, often years after the initial root canal procedure.[citation needed]

However, the survival or functionality of the endodontically-treated tooth is often the most important aspect of endodontic treatment outcomes, rather than apical healing alone. Recent studies indicate that substances commonly used to clean the root canal space incompletely sterilize the canal. A properly restored tooth following root canal therapy yields long-term success rates near 97%. In a large scale Delta Dental Study of over 1.6 million patients who had root canal therapy, 97% had retained their teeth 8 years following the procedure, with most untoward events, such as re-treatment, apical surgery or extraction, occurring during the first 3 years after the initial endodontic treatment. Endodontically treated teeth are prone to extraction mainly due to non-restorable carious destruction and to a lesser extent to endodontic-related reasons such as endodontic failure, vertical root fracture, or perforation (procedural error).