Selection of Teeth for Root Canal Treatment

Abstract

1. Correct diagnosis is essential in the selection of cases for root canal therapy. Although pulp-involved teeth which are valuable may be saved by root canal therapy, this form of treatment is not always possible. 2. The prognosis in root canal therapy is often influenced by variables introduced by both patient and dentist. 3. Teeth can be divided from the standpoint of ease of treatment into two groups: (a) those relatively simple to treat and (b) those difficult to treat. The degree of difficulty which will be encountered often varies with the operator. 4. Local or systemic conditions which seriously interfere with the capacity of periapical tissues to defend themselves from injuring agents, or to heal, contraindicate root canal treatment. 5. Six conditions affecting the tooth are described which contraindicate root canal therapy. Root canal treatment coupled with root resection may succeed in some of these instances. 6. Root canal treatment often can be successfully carried out in (a) teeth with a history of an acute dento-alveolar abscess; (b) teeth with root apices which appear eroded in the roentgenogram; (c) teeth with non-vital pulps which show extensive bone loss involving one-third or more of the root surface; (d) teeth in which previous treatment has failed as evidenced by the appearance of acute infection or periapical rarefaction; (e) teeth so badly broken down that they cannot be isolated with the rubber dam during treatment. 7. Root canal treatment is contraindicated during the active or uncontrolled phase of certain serious constitutional diseases because tissue resistance and the patient’s capacity to heal are considerably below normal. 8. Certain precautions should be observed during root canal treatment in patients who have a history of rheumatic heart disease or congenital heart disease in order to give added protection in the event a transient bacteremia should occur. 9. Rheumatoid arthritis, closely allied collagen diseases and advanced age do not contraindicate root canal therapy.