Essential for dentists: a summary of the seven experiences of root canal treatment!

Endodontic treatment

Root canal therapy is a special instrument used by doctors for root canal therapy to completely remove the infected pulp, infected dentin, and toxic decomposition products, tightly pack the root canal, isolate bacteria from entering the root canal, and re-infect, and prevent the occurrence of periapical lesions. Or promote the healing of periapical disease. Perfect root canal treatment can ensure the healing of the tooth, so as to save the tooth as much as possible and exercise the chewing function.

Accurate measurement of root canal length (accurate to within 0.1 mm)

Thoroughly remove spoiled substances, and strictly disinfect to aseptic (prepared to be cleaned and thoroughly disinfected)

Complete and tight filling of the root canal (film inspection of the root canal filling is accurate to within 0.1 mm)

Preparation before treatment

Through comprehensive medical history, clinical examination, and X-ray filming, combined with the patient’s subjective symptoms and physical and mental state, a treatment plan is drawn up. Doctor-patient communication is fully conducted and detailed records are taken.

X-ray film

A total of three dental films, including preoperative film, main apex film, and complete root filling film, are required to be taken.

Painless technique and aseptic technique

The entire treatment process emphasizes painless technology and aseptic technology to eliminate the pain and fear of patients and prevent cross-infection.

Root canal treatment steps

Tooth preparation: including removing caries, adjusting occlusion, ligating cracked teeth or restoring temporary crowns.
Opening the pulp: It is required to uncover the roof of the whole pulp chamber, so that the instrument enters the root canal straight without resistance, and damages the hard tissue of the tooth as little as possible.
Determine the position of the root canal orifice.
Pulp extraction: The necrotic pulp is removed gradually, and the non-necrotic pulp is removed at one time.
Determine the working length.
Root canal preparation: It is required to achieve a thorough cleaning of the root canal system, forming a shape along the original root canal direction, with a certain taper, and ending at the base point of the root tip. It is recommended to use the reverse technique.
Flushing: Lubrication and flushing run through the whole process of root canal preparation. Requires no pressure flushing.
Root canal medication: calcium hydroxide is recommended, and the sealing time is 1-2 weeks.
Root canal filling: The root filling is required to be tightly filled, 0.5-2.0mm away from the root tip of the x-ray film.

Complete dental restoration

X-ray film shows that the root canal is well filled, and temporary or permanent tooth restoration should be performed. Depending on the condition of the affected tooth, a full crown or post crown restoration is recommended.

Follow-up visit

The return visit period can be 3 months, half a year, 1 year, 2 years or longer.

Efficacy evaluation criteria

(1) Success:

Self-conscious symptoms: no discomfort, normal chewing function, and satisfaction with the treatment result, process, function and appearance of the affected tooth.
X-ray: periodontal ligament space is normal or slightly thickened, and the original root apical lesions have shrunk or disappeared; the root apex is not fully developed, and gradually formed 3-6 months after surgery; three-dimensional root canal filling, root filling 0.5-2.0mm from the root tip.
Clinical examination: no percussion pain, no sinus tract or sinus tract closed within 1-2 weeks after treatment.

(2) Failure: any one of the above does not meet the requirements

Root canal treatment must be mastered

Maxillary central incisor: The length from the incisal end to the root tip is about 22.5mm, and the crown-to-root ratio is 1:1.25 24% with collateral root canals.

Maxillary lateral incisor: average length 22mm crown-root ratio 1:1.47

26% had collateral root canals.

Maxillary canine: average length 26.5mm

Crown-root ratio 1:1.82 30% have lateral root canals.

Maxillary first premolars: 87% had double canals, followed by single canals, and 2.4% had three canals. The average length of 49.5% of root canals with side branches was 20.6mm. The ratio of the crown to root was 1:1.51.

Maxillary second premolars: 75% of single root canals, 59.5% of collateral root canals, with an average length of 21.5mm. Crown-root ratio 1:1.86.

Maxillary first molar: 2 buccal roots and 1 palatine root. Few buccal roots have two subbuccal root canals with an average length of 20.8mm. The buccal roots are 2-3mm shorter than the palatal roots. Crown-root ratio 1:1.71.

Maxillary second molars: mostly three canals with an average length of 20.2mm and a crown-to-root ratio of 1:1.80.

Mandibular incisors: average length 20.5mm. Crown-root ratio 1:1.34. 20% have collateral root canals.

Mandibular lateral incisors: The average length is 21mm. The ratio of the crown to root is 1:1.32.

Mandibular canines: The average length is 25.5mm, the crown-to-root ratio is 1:1.48, and 30% have collateral crown roots.

Mandibular first premolars: 25% have double canals with an average length of 21.6mm. The ratio of the crown to root is 1:1.79, and the incidence of collateral root canals is 44.3%

Mandibular second premolars: The average length is 22.3mm. The crown-to-root ratio is 1:1.83.

Mandibular first molar: usually there are 3 root canals, two mesial and one distal. The average length is 21mm. The ratio of the crown to root is 1:1.72. The incidence of collateral root canals is about 30%.

Mandibular second molars: 10% will fuse into C-shaped roots and root canals, with an average length of 19.8mm. The ratio of the crown to root is 1:1.86.