Longevity of root canal treated teeth
Featured Products Promotional FeaturesPosted by: Dental Design 9th September 2023
Endodontic treatment aims to remove the harmful bacteria which colonises the complex surfaces of the root canals. This is an essential treatment type, allowing clinicians to remove infected tissues, restore the function of the affected tooth, and reduce pain for the patient. However, it is important that this procedure is carried out conservatively, taking care to treat the unique anatomy of each individual root canal. Research suggests that 93% of root canal treated teeth survive over 4-5 years, and 87% survive over 8-10 years.[i] There are a number of factors which have an impact on the long-term survival of endodontically treated teeth, and it is important that clinicians understand how best to maximise results for their patients.
Accessing the root canal
When treating each new case, it is important to respect the unique form of each root canal. Some cases may be more complex than others, requiring very precise methods to access extremely curved canals, for example. When gaining access to the tooth, it is important to take a minimally invasive approach where possible. This is because removing excessive amounts of tissue can have an impact of the life of the tooth, and its restorative cycle. Loss of root canal dentine could make the tooth weaker, as a result of root canal dentine loss, stress can affect the tooth differently, potentially resulting in cracks or vertical root fractures.[ii] So, whether you are accessing the coronal area, or the apical part of the root canal, it is essential to remove as little tissue as possible to help retain the tooths’ strength.
Thorough cleaning
This is true when removing the pulp too. It is important to be thorough here, to ensure any infected tissue has been removed, and to reduce the risk of reinfection. However, you should be careful not to widen the root canals excessively, especially when there are more curved canals, or narrow areas of the canal. To do this, it is important to use high-quality and reliable endodontic files which enable precision, and are resistant to cyclical fatigue.
Smear layer removal is also essential. This layer comprises of dentine chips, microbial colonies, salivary protein, and dentinal collagen. This has the potential to cause problems during obturation and restoration, as it could affect bond strength and sealing capacity, making the canals susceptible to reinfection.[iii]
Effective disinfection for longevity
It is vital that root canals are thoroughly disinfected during treatment. Endodontic microbiota should be completely removed to reduce the risk of reinfection, and therefore reduce the need for endodontic retreatment or extraction.[iv] Complete removal of bacteria is challenging, however, as persistent microbes may survive in anatomically complex canals, and apical areas. This biofilm is able to survive in unfavourable conditions, and the root canal favours biofilm formation.[v] Because of this, it is important to use techniques and equipment which facilitate effective disinfection, to ensure a successful result and reduce the risk of reinfection.
A strong and stable restoration
Providing patients with a high-quality restoration is also essential, contributing to a long-lasting outcome. This can be challenging, and requires comprehensive knowledge of endodontics, periodontics, and prosthodontics. Clinicians should aim to produce a strong and stable restoration, which restores function and aesthetics for optimal outcomes. Root canals should be obturated and sealed, respecting their unique anatomy, to prevent leakage.[vi]
Because endodontically treated teeth often experience a considerable loss of structure, in some cases it may be appropriate to carry out a restoration using a post and core, to strengthen the restoration, and further extend the life of the tooth.[vii] This provides a secure base for the restoration, helping to maximise the function of the tooth, and therefore extend the endodontically treated tooths’ life.
By taking a conservative approach to your endodontic cases, you are able to maximise the lifespan of the tooth, and reduce the risk of fracture and reinfection, therefore minimising the need for endodontic retreatment in the future.
The Micromega One RECI file from COLTENE is the ideal instrument for your endodontic cases. The file facilitates minimally invasive treatment, as its 1mm wire works to preserve the peri-cervical part of the canal, as well as the surrounding dental tissue. It offers the perfect balance between flexibility and cutting efficiency, allowing you to respect the root canal anatomy, while effectively removing debris. Additionally, Micromega One RECI makes safety a priority, with its reciprocating motion facilitating resistance to cyclic fatigue.
Understanding the processes required at each stage that can extend the life of endodontically treated teeth is essential, as this will help to increase the survival rates for your cases, and boost patient satisfaction. By extending the restorative cycle of the tooth, you help your patients to retain more of their natural teeth for longer.
For more on COLTENE, visit www.coltene.com, or call 0800 254 5115.
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Mark Allen
Author: Mark Allen, General Manager at COLTENE
[i] Ng, Y‐L., V. Mann, and K. Gulabivala. “Tooth survival following non‐surgical root canal treatment: a systematic review of the literature.” International endodontic journal 43.3 (2010): 171-189.
[ii] Neelakantan, Prasanna, et al. “Present status and future directions: Minimally invasive root canal preparation and periradicular surgery.” International Endodontic Journal 55 (2022): 845-871.
[iii] Al-Qahtani, Yasser M., and Mohammed I. Al-Shehri. “Evaluation of Photosensitizers on Root Canal Disinfection and Bonding Interface of Fiber Post Cementation System: An In Vitro Study.” The Journal of Contemporary Dental Practice 22.11 (2022): 1287-1291.
[iv] Al-Qahtani, Yasser M., and Mohammed I. Al-Shehri. “Evaluation of Photosensitizers on Root Canal Disinfection and Bonding Interface of Fiber Post Cementation System: An In Vitro Study.” The Journal of Contemporary Dental Practice 22.11 (2022): 1287-1291
[v] Narayanan LL, Vaishnavi C. Endodontic microbiology. J Conserv Dent. 2010 Oct;13(4):233-9. doi: 10.4103/0972-0707.73386. PMID: 21217951; PMCID: PMC3010028.
[vi] Al-Qahtani, Yasser M., and Mohammed I. Al-Shehri. “Evaluation of Photosensitizers on Root Canal Disinfection and Bonding Interface of Fiber Post Cementation System: An In Vitro Study.” The Journal of Contemporary Dental Practice 22.11 (2022): 1287-1291.
[vii] Al-Qahtani, Yasser M., and Mohammed I. Al-Shehri. “Evaluation of Photosensitizers on Root Canal Disinfection and Bonding Interface of Fiber Post Cementation System: An In Vitro Study.” The Journal of Contemporary Dental Practice 22.11 (2022): 1287-1291.
