The aim of root canal treatment is to eliminate bacteria from the root canal system, and to

seal the canal and tooth to prevent re-entry. It is well proven that if bacteria are absent,
periradicular pathology does not develop. Conversely, if infection is not controlled, the root
filling will fail, no matter how skilled the operator is.

The Aseptic Technique

Treatment is aimed at eliminating bacteria already present in the canals by mechanical and
chemical means, and ensuring that new bacteria are not introduced during the procedure by
using an aseptic technique.

Rubber Dam
Use of rubber dam is mandatory. It may be necessary to seal the dam to the tooth using caulk
to achieve an aseptic field. Dam will :

• Prevent saliva contamination

• Improve visibility
• Protect soft tissues
• Confine excess irrigants
• Improve patient comfort
• Reduce medico-legal liability

Mechanical Instrumentation
Much pulpal tissue and infected dentine is removed from the canal system by mechanical
filing, reaming, and drilling. However, infected tissue will remain no matter how good the
mechanical preparation is, in the form of lateral canals, inter-canal pulp bridges, and intra-
tubular spread of bacteria.

In practice, mechanical preparation of a canal will usually leave grooves and scores on the
canal walls which will retain shavings of infected dentine and pulp tissue. Additionally,
mechanical instrumentation can never remove all the pulp.

Bleach
1% - 3% Sodium Hypochlorite is the irrigant of choice. If the canal is regularly irrigated during
preparation, the bleach will

• Kill bacteria
• Dissolve organic remnants (dentine shavings, pulp tissue)
• Lubricate instruments in the canal
• Wash out debris

The bleach is introduced into the canal using a syringe with a narrow (28g) side-
venting needle.

Calcium Hydroxide
If a canal is to be left unfilled between visits, the canal should be temporarily filled with
Calcium Hydroxide paste (Hypocal), and the orifice sealed with a good thickness (at least
3mm) of Kalzinol (ZOE).
Calcium Hydroxide provides the best conditions for periapical healing after instrumentation
by inhibiting bacterial growth in the root canal between visits.

Coronal Seal
When the root filling is completed, oral bacteria must not contact the root filling. Depending
on the quality of the root filling, it takes between 1 and 6 weeks for coronal bacteria to 'soak
through' a root filling and reach the apex.

Accordingly, a carefully planned coronal restoration must be provided to completely seal the
tooth from oral bacteria, and allow maintenance of the restoration in years to come without
exposing the root filling.

Total Seal
A good coronal seal is essential for long term survival of a root filling. However, the concept
of "Total Seal" is sometimes overshadowed by the interest on coronal seal.

Infection in the periapical tissues can spread back into a cleaned root canal, especially if the
apical diameter is large: we rely on the sealing abilities of the root canal sealant paste to
prevent bacterial re-entry. Similarly, infection associated with lateral canals, or furcation
canals must be blocked by sealer paste.

Also, it is not possible to remove all bacteria from a canal system - the 3D shape is too
complex. But by sealing these bacteria off from nutrients, we can "entomb" them in their
nooks and crevices, and cause them to die.

So coronal seal is very important, but a Total Seal is a major objective in root canal
obturation.