Pulp is soft tissue that holds the blood vessels and nerves of the tooth. The root canal is the section that joins with the pulp cavity and runs down into the gum and bone, in a tube-like section that also protects the nerves and blood vessels as they run down to the bottom of the roots. This is the section that surgical root canals deal with.

What is a Surgical Root Canal?

Surgical root canals are procedures that are used to repair severely damaged, or infected, teeth. The procedure is used to remove the pulp and nerves inside a tooth. Its main purpose is to remove, and further prevent, infection within the pulp cavity. Quite simply, the root canal is accessed through the tooth and any infected pulp tissue, along with the contents of the root canals, is removed.

What to Expect

Surgical root canals often require multiple visits to the dentist’s office. An x-ray is taken to determine if there is an infection and the shape of the canals. If an infection is present, the dentist may start the patient on an antibiotic regimen for a few days and schedule the procedure for another date. Without signs of infection, the dentist begins the surgical root canal by administering a local anesthesia to the tissue surrounding the tooth. In some cases, the dentist may also recommend using a sedative for the patient’s comfort.

After anesthesia is given, a hole is drilled through the tooth. This can be done by one of two methods. The dentist can choose to place a small incision in the gum to expose the side of the tooth, or a hole can be drilled directly into the top of the tooth. Existing tooth damage plays a large role in which method is used.

Once the hole is drilled, the dentist uses canal files in different diameters to clean out the affected pulp and canal contents. The dentist starts with the thinnest diameter canal file and increases, going down the length of the canal with each one. During this cleanout, water is used periodically to flush out the debris that is removed.

Following the canal cleanout, the dentist will apply a sealer to the tooth. In some cases, sealing is postponed for about a week, particularly if infection is present. Temporary fillings are applied if sealing does not occur in the same visit as the procedure.

Sealing usually involves two materials. The dentist will use a paste-like sealer and a rubbery material to fill the root canal. A filling is used to fill the drilled hole. If the gum was cut, the dentist may stitch the opening depending on the size of the incision.

Another visit is often necessary for the final tooth repairing efforts. During this visit, it may be necessary for the dentist to apply a crown or other type of tooth restoration to provide extra protection against bacteria contamination or tooth damage. The dentist will determine the best restoration method.

After the Procedure

Patients may experience some tooth sensitivity or discomfort for the first few days following a surgical root canal. This sensitivity is typically due to inflammation. Pain medication can be used to help reduce discomfort. Until the final restoration is completed, it is often recommended to avoid using the tooth for chewing. Following the final restoration, patients can usually resume normal eating and oral hygiene habits within a few days.

Potential Complications

One of the most common complications is the development of infection. This is often a result of undetected tooth cracks, broken temporary fillings, or a deterioration that allows bacteria to enter the pulp cavity and root canals. It is important for patients to follow their post-procedure instructions to avoid this complication.

Surgical root canals are often the last efforts used to save a tooth from complete extraction. Ideally, the dentist’s ultimate goal is to use extractions as the last thing possible, when teeth are completely beyond saving. While proper oral hygiene is essential to maintaining teeth, it is not always possible to prevent all tooth problems from occurring all of the time. When a surgical root canal is the recommended course of action, it is important for patients to thoroughly discuss all aspects of the procedure with the dentist.