How does one tell good from poor root canal treatment?

Well, first, it’s important to understand the purpose of Root Canal Treatment (RCT).

RCT is a a microsurgical clean-out of infected and inflamed tissue in of pipe-like areas of the tooth root followed by filling and sealing of those areas.

So what differentiates “good” RCT treatment from “poor” RCT-- Well, many things, but very simply, poor RCT has incomplete clean out and disinfection and/or incomplete sealing of the root canal areas.

The first X-ray, labeled “Poor Endodontics”, shows several millimeters of root that was not cleaned out in both roots. The root canal filling (the white line in the center of the root) is “short”, ending before the end of the root. (In fact, the x-ray really shows that each root is really a double root....one part of each of the roots wasn’t cleaned out or sealed to the end at all!)

In the second X-ray, labeled “Good Endodontics” shows several things. In the both roots, the root canals are cleaned and sealed to the proper lengths. Additionally, you can see that the filled canals (the white filled lines) are more defined due to more complete shaping and cleanout.

The theory and practice has changed over the 30 years that I’ve been doing RCT. In the past, we wouldn’t necessarily clean or fill past the end of the root. Research has shown that this leads to problems, since too much bacterial and tissue remain. Now we clean about 1/2 mm beyond the end of the root and seal the canals.

So what happens if the end of the root isn’t properly cleaning, shaped and disinfected? This will be the subject of our next article.




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