Root Canal

What is root canal treatment and why do I need it?

  • Root canal treatment (endodontic therapy) is when the nerve and blood vessels inside a tooth is removed
  • RCT is required when the nerve inside a tooth becomes infected or dies, this can occur due to decay, cracks or trauma
  • The purpose of RCT is to remove all bacteria and debris from within the tooth

What does RCT involve?

RCT comprises of 3 main stages/appointments

Stage 1: Access/Emergency Extirpation

  • Stage 1 is performed to get you out of pain and to initiate RCT
  • After anaesthesia, the pulp where all the nerves and blood vessels are is accessed and most of the infected tissue is removed
  • Medication which has an anti-bacterial and an anti-inflammatory effect is placed inside the tooth for pain relief and to start cleaning out the tooth
  • A temporary filling is placed on top to keep the medication in and the bacteria out

Stage 2: Instrumentation

  • The anaesthetised tooth is re-accessed and all the canals are cleaned and re-shaped to the end of the tooth to ensure that all infected tissue is removed and that the canals can be filled properly
  • New anti-bacterial medication is placed and the temporary is replaced

Stage 3: Obturation

  • The anaesthetised tooth is re-accessed and thoroughly flushed clean and dried
  • With the aid of a sealer, the canals are filled with an inert rubbery material called Gutta Percha and finally sealed with a harder filling material on top

Root canal treated teeth become brittle because the blood vessels have been removed, so after several months when we are sure that the tooth has settled down, a crown is recommended to reduce the risk of the tooth breaking.

Example Case


  • Constant pain - throbbing ache
  • Swelling
  • Tenderness with any pressure


  • Extraction
  • Root Canal Treatment

Root canal treatment was commenced to try and save the tooth as it is the last tooth in the arch and functionally important.

Stage 1 - Emergency Treatment:

  • The tooth was accessed, the pus from the infection was able to drain through the tooth allowing for the release of pressure and subsequently relief from pain
  • Anti-bacterial irrigants were used to flush the tooth well
  • Medicament with anti-bacterial and sedative effects was placed into the canals and the tooth sealed with a temporary filling

Stage 2 - Preparation:

  • The tooth was re-accessed and the canals were prepared to the end of the root to ensure removal of all infected tissue
  • Preparation of the canals also allows for effective sealing of the canals during the final stage
  • Anti-bacterial irrigants were used to flush the tooth well and a new medicament placed into the canals
  • This stage is to ensure that the tooth is bacteria free before commencing the final stage

Re-dress of tooth:

  • Sometimes when the infection around the tooth is as significant as in this case, the medication inside the canals needs to be replaced a few times to ensure the canals are bacteria-free
  • This is because the medicament used in root canal treatment begins to reduce in effectiveness after ~2weeks
  • The final stage of the root canal is often delayed until symptoms resolve completely and signs of healing are seen, sealing the tooth when bacteria remains can cause the root canal treatment to fail
  • For this tooth the medication was replaced twice and by the final stage the tooth felt like normal

Stage 3 - Filling:

  • The non-symptomatic tooth is accessed again and very thoroughly flushed to ensure the canals are very clean and then dried
  • Rubbery gutta-percha points are used in combination with a sealer paste to fill the canals
  • This seals the canals otherwise bacteria could easily re-infect the canals
  • Excess filling material is removed and a harder temporary filling is placed on top

After 4-6 months once we are sure the tooth has settled down a long term restoration will be placed to protect the tooth