Endodontics: Root canal treatment “RCT”

To begin root canal treatment several points should be considered:
Preoperative radiograph
•A preoperative radiograph is important to examine the full root(s) and approximately 2–3 mm of periapical region.
Local anaesthesia
•Local anaesthesia could be needed.
Tooth preparation
•The tooth should be in a normal periodontal condition without any inflammation and should be ready for the endodontic treatment.
•Any caries and defective restoration need to be removed.
•In addition, the occlusion of the tooth is adjusted to prevent its fracturing during the treatment period.
Isolation of the tooth
•Isolation of the tooth by a rubber dam is necessary to prevent canal contamination by saliva and bacteria. Furthermore, this rubber dam prevents ingestion of instruments and avoids irrigation solutions escaping into the oral cavity.
Access opening
•Entrance into the cavity takes place through the crown of the tooth, gaining entry to the pulp chamber and removing the roof of the pulp chamber. Two handpieces are usually required for this task, which have low- and high-speed ranges of rpm.
•For the initial entrance through the enamel surface or resin, metal and ceramic restoration, the ideal cutting instrument is the round-end carbide fissure bur with the accelerated speed handpiece. For porcelain fused to metal or metal-ceramic crowns, the extra coarse dome ended cylinder is effective.
•While, for drilling through dentine, dropping into the pulp chamber and removal of roof of the pulp chamber, round burs sizes 1, 2, 4 and 6 with 2 lengths (regular and surgical lengths) are usually used. This drilling through dentine is done with slow-speed handpiece (3,000-8,000 rpm).
•The chamber is then cleaned, the vital and inflamed haemorrhagic pulp tissue is extirpated with barbed broach and excellent visibility can be obtained with direct access of the root canal instrument, without bending of the instrument. After that, the radicular cavity preparation can be started.