My First Root Canal… On a Fake Plastic Tooth

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First Root Canal Radiograph

Fake plastic teeth do a lot of the heavy lifting in dental school. With them we learn to do all of our restorative dentistry including veneers, crowns, fillings, and of course, root canal treatments. We burn, melt, fracture, gouge, and generally abuse our fake plastic teeth. Each one, a blank canvas awaiting the finesse or the blundering ineptitude of a burgeoning student.Virgin plastic toothBut they, along with the dental school faculty, are the guardians at the gates. Together, they ensure that each dental student competently cuts and shapes teeth before ever touching a patient’s enamel.

My first root canal treatment

Today I completed my first root canal treatment (RCT) on one sacrificial plastic tooth, which shall henceforth be referred to as Ruth (the tooth). My brief encounter with Ruth was not a good one in the world of humans. Tearing into her with my tungsten round bur, removing her innards, and exposing her root canals to the open. It all sounds very gruesome.

Endo Access Oblique View

And really, everything about RCT is pretty barbaric when you stop to think about it. Tearing into teeth and removing their vital essence—it all sounds positively primeval. And maybe it is, but hey it works!

Keeping things clean and moving

Thanks to modern irrigation methods, RCT is more efficacious than ever before. With root canal treatment, your primary aim is to expand and debride the root canals. To remove necrotic tissue and open up the canals for proper sealing we use a variety of files. We keep the files lubricated with EDTA which also acts as a chelator. We irrigate with NaOCl (antibacterial) and an ultrasonic device.

Getting the proper depth

Probably the hardest part about RCT is going to the proper depth. Modern dentists use apex locators to electronically detect when they have reached the apical constriction. For our first root canal in a transparent plastic tooth, we went by feel and visual inspection.

Establishing Working Length
The 10 file should extend about 0.5 mm beyond the apical constriction…
Measuring the Working Length
The 10 file does extend about 0.5 mm beyond the apical constriction. Phew!

Go too deep with a file and you may cause irreversible nerve damage or a serious infection. Root canal treatments should not be taken lightly, which is why I am glad that we will complete five of them this year before heading over to the clinic.

Expanding the canals

After you have established your working length (the distance to the apical foramen) it is time to expand the canals. We do this gradually with a series of files which increase in size as we complete the procedure. We irrigate as directed in our protocol and use our files until they move freely in the canal.

Completed Root Canal ExpansionSealing things up

After establishing patency in the canal, we place about 6 mm of gutta-percha and sealant into Ruth’s canal to seal things up. It is important to prevent voids in the material where bacteria could establish an infection and then proliferate. Packing the material down into the canal forcefully is important.

After packing it in and letting it cool for a bit, we add more layers incrementally. Each layer should be melted into the one before it and then packed in tightly to prevent voids. Once the canal is full and you can no longer feel the entrance with your condenser, you know that you are done.

Checking your work

Our final step is to take an X-ray and see how we did. I was very happy with the result of my very first root canal. I only did the palatal root, and ideally I should keep the buccal root patent with a file. You can see from the following radiograph that I probably blocked the entrance to the buccal root with some excess gutta-percha. Because we only had to fill one canal for this first endo rotation, that wasn’t a big concern this time around.

First Root Canal RadiographOur next endo rotation will include a real tooth. Slowly but surely, we are moving beyond the realm of simulation and plastic to blood and bone. Every bit of progress we make comes with the endorsement and trust of our future patients and the faculty who instruct us. Ruth may just be a fake plastic tooth, but she taught me a lot. My future patients will be grateful that I cut my teeth on plastic before bone.

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