Understanding Common Obstacles to Endodontic Therapy

Posted by THE NEXTDDS on Thu, May 04, 2017 @ 11:31 AM

root-canal-obstacles.jpgRoot canal therapy requires the clinician to carefully satisfy a host of requisites through each phase (e.g., access, preparation, disinfection, and obturation, sealing) of treatment. As Dr. Gary Glassman explains in Part 1 of his four-part virtual training series on endodontic therapy, not only does the process require diligent examination, shaping, and disinfection, but no two therapies are the same. This becomes a factor due to the differing anatomy of teeth in patient’s mouths. For some, this may come as a great challenge, working with what is present and tackling it through the necessary precautions and treatment. Dental students and practitioners know that several complications often come into play, including:

Calcifying Root Canals

Sometimes calcium deposits make a canal too narrow for endodontic instruments to reach the apex of the root. If teeth have this calcification, the practitioner may perform endodontic surgery to clean and seal the remainder of the canal.1 Calcified root canals can be caused by a whole host of reasons, such as caries, trauma or infection, drugs, or simply because of the natural aging of the tooth.2

Obstructions and Ledges

Instrument obstruction is another common obstacle to successful endodontic therapy. Because of complications such as calcified root canals, sometimes a practitioner does not have both a good visual and/or physical space to achieve the intended access into the root canal. This leads to the stubborn approach of forcing therapy, which may lead to broken or fractured instruments. However, there are many approaches, such as proper radiography and pre-curved files, that can be used around these obstructions.3 If the practitioner is unsure about access, then alternatives should be the main focus.

Soft or hard tissue blockages can present clinical challenges as well. A ledge is created when the working length can no longer be negotiated and the original pathway of the canal has been lost. Don’t force the instruments by instead using passive step-back and balanced force techniques, instrumenting the canal to its full length to help prevent ledge formation.4

MB2 Canal

Though a real challenge, finding the MB2 canal in endodontic treatment means that you have finally arrived as a clinician. More often than not, the MB2 is identified in maxillary first molars, and being able to clean the root canal system here is of the utmost importance. Patient examination is critical here, with steps that include checking for apical palpations as well as sensitivities to biting, percussions, and on/off swelling. Three-dimensional (3D) imaging provides optimal evidence of the canal location, and provides the practitioner with sufficient information to begin treating the canal. The future of 3D imaging, therefore, looks very bright for endodontic treatment.5

While root canal therapy can often be complex, dental students know that such difficulties are expected. The obstacles and hurdles that are common with the treatment provide a challenge that requires focus, patience, and much, much practice. Endodontic therapy requires diligence and repetition, but can be rewarding as one's skills and experience develop over time. Building one’s skills is key in all aspects of dentistry, but for the endodontic specialty, it’s even more so. If you treat endodontics with the right mindset, you’ll be more confident in performing consistent root canal therapy.


[1] Krasner P, Rankow HJ, Abrams ES. Access opening and canal location. Endodontics Colleagues for Excellence. 2010. Accessed December 27, 2016.

[2] Garg N, Garg A. Cleaning and shaping of the root canal system. In: Textbook of Endodontics. Westminster, London, England: JP Medical Ltd; 2013:277.

[3] Carrotte P. Endodontic problems. Brit Dent J. February 2005:127-133.

[4] Jafarzadeh H, Abbott PV. Ledge formation: Review of a great challenge in endodontics. J Endo 2007;33(10):1155-1162. Accessed December 21, 2016.

[5] Glassman G. Advances in Endodontic Treatment: Part 1--Diagnosis and Treatment Planning. Accessed December 21, 2016.

Tags: root canal, root canal therapy, endodontic therapy, obstacles of root canal therapy

The Fundamentals of Root Canal Therapy

Posted by THE NEXTDDS on Wed, Apr 19, 2017 @ 10:00 AM

proper-root-canal-access-thumb.jpgRoot canal therapy is an important requirement during your dental school training and a mainstay of clinical practice. Root canal therapy is often classified according to three main requirements: proper preparation, disinfection, and obturation. As you focus on developing your treatment planning and hand skills for your future in the profession, understanding the nuances of endodontic therapy is important.

Dr. Gary Glassman, a leading educator and authority in the field, recently presented a four-part virtual training continuum on endodontic treatment, discussing such topics as proper diagnosis, shaping, disinfection, obturation, and key variables to treatment. In Part 1, Dr. Glassman begins his instruction with these fundamentals to root canal therapy.

The Basics

A principle goal with endodontic therapy is to sustain the vitality of the affected tooth. However, if the tooth has been committed to root canal treatment, then the pulp tissue needs to be removed. Canals need to be shaped to accomplish disinfection and, once that is complete, the root canal system is to be cleaned and obturated in three dimensions, finished with a restoration and crown if necessary.

First and Second Appointments

Whether a root canal takes one appointment or two depends on a practitioner’s level of expertise, as well as the status of the dental pulp. Make sure that you are focusing on the quality of the endodontic care, rather than the number of the appointments you need to make with the patient.

accessing-root-canal-systems.pngTake a radiograph to visualize the anatomy of the tooth and aid in the diagnostics. Sedate the patient using locally administered anesthesia, or conscious sedation for patients with anxiety. It’s important to use rubber dam isolation, for moisture control at the site as well as to prevent the inadvertent aspiration of endodontic instruments and/or debris. Access and locate the canals, shape them, and irrigate to clean. If a second appointment is needed, provide the patient with a temporary restoration (e.g., calcium hydroxide) to protect the affected tooth, and/or a temporary restoration to seal.

In the second appointment, re-access the affected tooth and apply the final irrigation protocol for 3D disinfection. Dry the root canal and fully obturate it in three dimensions as well. Restore the tooth with a restoration and crown if necessary.

Postoperative Care

It is important to equip the patient with all the necessary information that he or she needs to know after therapy. Prescribe the patient with any medication that will manage his or her pain, and emphasize the importance of a regular antibiotic schedule if need be, fulfilling and refilling prescriptions as directed. Provide additional oral health instructions to the patient to allow time to heal, stressing his or her need to avoid chewing in the affected areas but allowing brushing and flossing as usual.


No matter where you stand with endodontic treatment, root canal therapy is a very sophisticated aspect of daily practice that has a lot of dentists intrigued. With its rich history of research and continued exploration of advances in the future, endodontic therapy continues to evolve and provide greater efficiency for dental professionals. Based on attendee feedback from the virtual training continuum, the importance for additional hands-on learning in this facet of dentistry is much needed, as many attendees plan to have endodontics become a big part of their practices down the road.

To start watching the endodontic therapy continuum, click here for our complete YouTube playlist.Watch the Continuum Now

Tags: root canal, root canal therapy, endodontic therapy

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