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Root canal treatment, also called endodontic treatment, should be initiated if the pulpa is severely inflammed or has already died off. The unhealthy pulpa is removed, the inflammation is healed, and further advances of the bacteria into the jawbone are prevented. A further reason for root canal treatement would be damage to the tooth and pulpa caused by accidents.

Root canals which are too severely contorted can rule out root canal treatment because the dentist may not be able to penetrate into the base of the roots even with fine instruments.

In your first treatment appointment, three things should occur: a thorough clinical examination of your teeth, documentation of your medical history, and a sensitivity test. X-rays are also required at this stage. The condition of the pulpa, the dental casings, the jawbone, and the integrity of the dental structure will be determined through various examinations. The information that is gleaned from these will be used to determine whether root canal treatment is appropriate for you.

Root canal treatment consists of several stages: root canal conditioning (localisation, cleaning, and formation of an inlet canal for bacterial aborticide) and root canal filling. The first step involves the complete isolation of the affected tooth with a kofferdam (dental dam). This guarantees that no bacteria-carrying saliva enters into the root canal and also further protects the patient from accidently swallowing the disinfectant liquid used for rinsing. Then local anaesthetic is administered so that treatment progresses relatively free of discomfort. In the next step, the dentist drills a direct access inlet to the pulpa and attempts to the make the root canal visible. Through the use of finely constructed extirpation needles and files, the inflammed or necrotic nerve tissue is removed. With a precise measurement of the canal length at hand, the working length of the instruments used to perform the procedure is also established. The canal is periodically rinsed with a disinfecting solution. Depending on the condition of the root canal, this stage of the procedure may require multiple sessions. After every session, the dentist administers an antibacterial medication which remains underneath the temporary filling in the canal until the next session. This medication serves to comprehensively remove bactreria and disinfect the target area. The last session involves the final filling of the root canal. The canal is dried and filled with a special paste and/or rubber-like substance (guttapercha). The canal filling's tissue-compatible material serves as a long-term sealant which prevents the spread of bacteria to the jawbone. A further x-ray is subsequently made, which provides the operating dentist with a means of monitoring the length and composition of the root canal filling.

In some cases, instruments can fracture and leave fragments in the root canal. Depending on the situation, these can be removed with special instruments in outpatient treatment, or, in severe cases, in an operation. Another possible complication is the accidental perforation of the dental wall while drilling due to the use of instruments that are too large or rigid. Whether the tooth can be retroactively corrected and preserved depends on the location of the perforation. There is the further risk of overfilling the root canal. This can affect the upper jaw by opening the maxillary sinus and the lower jaw by damaging the nerves. Infections or disruptions in the healing process can also occur. In some cases, pain in the affected tooth may emerge long after the root canal treatment when bacteria penetrate into the jawbone via side canals and cause inflammation.

For the first few hours after treatment, only water should be imbibed. Alcohol and coffee should be avoided in the days following treatment. Smoking likewise negatively affects the healing process. After every meal, the mouth should be rinsed and the treated area should be cleaned with a cotton swab. When brushing your teeth, be careful to avoid the treated area and brush carefully when close to it. It is necessary to attend root canal treatment check-up sessions regularly in the four years following treatment. This includes clinical examinations as well as assessments made with the aid of x-rays.