What Is Root Canal Treatment? Procedure, Pain and Recovery (2026)

Root canal treatment is the procedure performed when the pulp — the vascular and nerve tissue inside the tooth — has become infected or damaged. The goal is to save the tooth rather than remove it.

A tooth is made up of three layers from the outside in:

1. Enamel — the outermost protective layer
2. Dentine — the hard tissue beneath the enamel
3. Pulp — the innermost region containing blood vessels, nerves and connective tissue

When bacteria reach the pulp through decay, a fracture or trauma, an infection develops. At this stage a filling alone is not sufficient, and root canal treatment becomes necessary.

Root canal treatment is indicated in the following situations:

• Deep decay — bacterial infection that has reached the pulp
• Tooth fracture or crack — if the pulp is exposed
• Repeated fillings — when the same tooth has been filled multiple times and the pulp has been damaged
• Trauma — pulp necrosis (death of the nerve) following a blow
• Abscess formation — a collection of infection at the root tip

Symptoms That May Indicate Root Canal Treatment

Important: If you are experiencing any of these symptoms, see your dentist without delay. Early intervention increases the chance of saving the tooth.

1. Diagnosis and Radiographs

At the first visit, the tooth is assessed with radiographs. A 3-D CBCT scan may also be taken to examine the root canal anatomy in detail. The number of canals and the extent of infection are determined.

2. Local Anaesthesia

The procedure is carried out under local anaesthesia. The tooth and surrounding tissues are completely numbed. You do not feel pain.

3. Isolation (Rubber Dam)

The tooth being treated is isolated with a rubber-dam sheet. This:

• prevents saliva contamination
• provides a sterile working field
• stops small instruments being swallowed

4. Pulp Removal and Canal Cleaning

An access cavity is made through the top of the tooth, and the infected pulp tissue is removed with special instruments. The canals are widened and irrigated with disinfectant solutions.

5. Canal Shaping

The canals are shaped to ensure the filling material seats completely. Modern rotary (Ni-Ti) systems speed up this stage while improving precision.

6. Canal Obturation

The cleaned and shaped canals are filled with a biocompatible material called gutta-percha. The canal entrances are sealed with a specialised sealer.

7. Restoration (Filling or Crown)

Once root canal treatment is complete, the top of the tooth is restored:

• With minimal tooth loss → a composite filling is sufficient
• With significant tooth loss → a crown is recommended

Clinical note: For molars, I strongly recommend a crown after root canal treatment. Under chewing forces, a tooth restored only with a filling carries a risk of fracture.

No. Thanks to modern local anaesthesia, you do not feel pain during root canal treatment. The procedure is no different from having a filling placed.

Mild post-treatment sensitivity and tenderness for a few days is normal:

Ibuprofen or paracetamol are usually sufficient. Use them at the dose recommended by your dentist.

Most root canal treatments can be completed in a single visit. However, in advanced infections your dentist may place medication in the canal and wait a few days before obturation.

First 24 Hours

• Avoid hot food and drinks until the anaesthesia wears off (to prevent biting the tongue or lip)
• Avoid hard foods
• Take painkillers before pain begins

First Week

• Do not chew hard food on the treated side
• Avoid very hot and very cold foods
• Continue brushing normally
• Complete any antibiotic course prescribed by your dentist

Long Term

• Do not delay the crown on a root-filled tooth
• Keep every six-month check-up
• Contact your dentist immediately if pain or swelling returns

Saving the tooth is always the priority. A natural tooth preserved with root canal treatment is more advantageous — both biologically and economically — than an implant or bridge following extraction.

However, in some situations the tooth cannot be saved:

• Severe root fracture
• Massive tooth loss (non-restorable)
• Repeated failed root canals where apical surgery is not feasible

Endodontics is the dental specialty dealing with the pulp (nerve-vessel tissue) and the tissues surrounding the root tip. The word comes from the Greek endo (inside) and odont (tooth). An endodontist is a dentist with 3–4 years of additional specialist training in root canal treatment.

When Is an Endodontist Needed?

• Teeth with complex canal anatomy (multi-rooted, curved canals)
• Retreatment after a failed first root canal
• Apical surgery (surgery at the root tip)
• Calcified (obliterated) canals
• Saving a tooth after trauma

Although root canal treatment has a success rate of 87–95%, retreatment may occasionally be required:

Why Is Retreatment Needed?

• Canals that were inadequately cleaned or missed
• Insufficient quality of the previous root filling
• New decay allowing bacteria to re-enter the canal
• Tooth fracture and leakage because a crown was not placed
• Complex canal anatomy (for example the MB2 canal)

The Retreatment Process

1. The existing crown and root filling are removed
2. Access to the canals is re-established
3. The old filling is removed with specialist instruments
4. The canals are reshaped and disinfected
5. A new root filling is placed
6. A new crown is planned

Retreatment fee: 1.5–2 times that of standard root canal treatment.

In modern endodontics, the dental operating microscope significantly increases success:

• 25× magnification reveals canal orifices and anatomical detail clearly
• Missed canals (such as MB2) can be located
• Separated instrument fragments can be retrieved
• Perforations can be repaired precisely
• Powerful illumination is provided during the procedure

💡 At our clinic, every root canal treatment is carried out with modern equipment and rubber-dam isolation.

Systematic reviews report a success rate of 87–95%; placing an appropriate restoration (a crown) afterwards is the single most important factor improving this rate. If the treatment does not succeed:

1. Retreatment — the old filling is removed and the canals are recleaned
2. Apicoectomy — the root tip is surgically cleaned
3. Extraction — considered only as a last resort

For more information on endodontics and dental health:

• Root Canal vs Extraction — Choosing the right option
• Pain After Root Canal Treatment — Is it normal and when will it pass?
• What Is Endodontics? — The root canal specialty
• Dental Abscess Treatment — Infection management

1. Ng YL, Mann V, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature — Part 1. International Endodontic Journal. 2007;40(12):921–939. PubMed
2. Drescher A, et al. Outcomes of primary root canal therapy: An updated systematic review. J Endod. 2022;48(8). PMC
3. Yamaguchi T, et al. Long-term tooth survival and success following primary root canal treatment: a 5- to 37-year retrospective observation. International Endodontic Journal. 2023;56(7):802–815. PMC

This content is for informational purposes only and does not replace medical diagnosis or treatment. Please consult a specialist for decisions about your oral and dental health.