Root canal treatment (RCT) is necessary when the inside of the tooth has been affected by disease or a crack inside the tooth. Inside every tooth is a nerve and blood vessels. If the nerve gets infected and swells, it can cause very acute pain. Think of a root canal as a disinfecting procedure. During the procedure we remove the nerve, blood vessels and clean the inside of the tooth.
Once RCT is completed then a build up and crown is placed over the top of the tooth to protect it from forces of chewing, grinding, and occlusion. The final crown and build up is very important and time sensitive procedure. Without it, the tooth will hopelessly fracture or get infected again allowing the pain to return.
In the rare event that a root canal fails and a retreat is not possible, sometimes a root amputation or apicoectomy is recommended. A root amputation is when a multi rooted tooth, typically a molar, has one of its diseased roots removed.
Apicoectomy is when the just the tip of the root is removed. Once the root or the root tip is removed and the tooth is cleaned from the bottom, it is closed up with a biocompatible material. These procedures are used much less often due to the success of implants. Many times it is more beneficial to invest in the placement of a new implant that will have a higher degree of success.
When a young adult tooth has gotten a large cavity that extends to the root canal space, apexification may be required to treat the tooth. Young teeth do not have fully formed roots and the tip of the root is very large. We cannot do root canals on these teeth until they have finished developing. Therefore, we do a procedure called apexification which places calcium hydroxide (medicine) on the tooth to promote apical (tip of root) closure of the root.
Pulpotomy is the removal of the part of the nerve that is in the pulp chamber or coronal pulp (the area inside the crown – not the root). This is typically done on baby teeth when decay has reached the root canal's space. We cannot do conventional root canals on baby teeth because of the complex root systems. This is typically a very successful treatment option for saving baby teeth when coupled with a stainless steel crown.
Remember, many baby teeth do not come out until the child is around 12 years of age. For that reason, they are very important to keep clean so that the child can properly chew, speak, and concentrate without dental pain.
When a tooth is painful and root canal is necessary but time or amount of infection does allow for the ability to complete treatment, a pulpectomy is recommended. This is just the removal of the nerve in the tooth without the cleaning and shaping of the canals.