Root Canal Therapy: Improvements Over the Years

I learned about root canal therapy in dental school and many years ago.  Early in my career I practiced dentistry in the Army and honed my endodontic skills.  In recent years I have referred root canal cases to an endodontist (root canal specialist)

I personally needed a root canal a couple of months ago, and I want to report on the changes and the improvements that I noticed.

For one thing, this endodontist  had a microscope so that he could better see inside the tooth and not miss canals. He had a good size TV in his treatment room, not to watch a sporting event but to see what was going on with his treatment.  The instrumentation that he used has also improved, doing a better job in less time.

This particular doctor is interested in saving more tooth structure, which was not the idea back when I was first learning the treatment. Back then, we were taught to access the canal orifices (that is where the canal starts in the root) so that there is no doubt that you have located them,  and you don’t want the files (that’s what he uses to clean out the inside of the canals which are very narrow).  This approach seems fine for the procedure, but there are consequences for later on.

When a tooth has a root canal it tends to become more brittle because there is no longer any liquid provided to the tooth. Placing a crown on the tooth is helpful to secure the tooth, but is not needed if the tooth is intact.  However, as a patient ages, the teeth are more prone to fracture even with a crown on top.  The more modern paradigm for root canal specialists is to make the access the canals while saving as much tooth as is possible, thereby providing more tooth structure and dentin.

Because of this approach, patients receiving root canal therapy from this endodontist are more likely to save the tooth much longer.

Fortunately, if someone loses a tooth because of a fracture, we have other restorative techniques to restore their ability to chew. But, wouldn’t you just like to keep your own tooth?