Molar root canal treatment is much more complicated than root canal treatment in other teeth. In fact, molar root canal is one of the most difficult of all procedures for a dentist! There are four main reasons for this;
Add these factors together, and the degree of difficulty is not just double that of a front tooth, it's 4x or 6x as difficult to carry out a good treatment!
Here are three pictures of the same tooth, from different angles. It is an upper molar tooth. Each picture is rotated a quarter turn clockwise from the one before. You can see the curved roots. Also that 2 of the 4 roots are joined. This tooth has at least 4 root canals inside it, maybe more!
So, how good does it have to be for a successful result? And how long should it last? Are there any other issues?
To answer these questions, I'll have to give you a short intensive course on root canal treatment!
Let's start at the beginning. What is the point of a root canal treatment? The whole point is to treat the tooth so that bacteria cannot breed inside it and cause an infection in the bone around the root.
The only way to do this is to clean, disinfect and seal up all the little spaces inside the tooth where the nerve used to be. ALL the spaces. If any spaces (root canals) are not disinfected and sealed up, bacteria will be able to breed.
Here are 2 photos of molar root canal treatment that I performed a while ago to save a molar tooth.
The first photo shows the molar with a big filling in it. The nerve in the tooth was starting to die, and causing a lot of toothache. The second photo shows the final result, with the root fillings extending all the way to the tips of the roots, ensuring that there is no space for bacteria to breed.
What things can go wrong with molar root canal?
The most common reason for problems is not finding all the spaces inside the tooth - not finding all the root canals. Remember, some of the root canals can be the size of a human hair. Not easy to find!
If a root canal is missed, it will be a hiding place for bacteria. Because molar teeth have more root canals, AND they are smaller, it can be easy to miss one.
The next most common reason for problems is not disinfecting the canals completely. There are many types of bacteria that can infect a tooth. The usual disinfecting agents are sodium hypochlorite (dilute bleach) and chlorhexidine gluconate.
Both solutions should be used when cleaning the root canals inside a tooth. But it is important to rinse out the hypochlorite with sterile water before using the chlorhexidine, as they react if they come into contact with each other!
The use of a chelating agent such as EDTA or citric acid also helps to clean out the canals. Because molar teeth have narrower root canals, it is more difficult to be sure that the disinfectants have reached all parts of each canal.
The final problems come with trying to seal the spaces that have been found and cleaned. Each root canal must be sealed for its whole length, all the way to the tip of the root.
If any tiny spaces are left unsealed, it may be possible for bacteria to get in. In molar teeth, we are again faced with multiple root canals that are smaller and frequently curved.
As you can see, molar root canal is more complicated for several reasons. Basically, the canals are smaller and harder to find, they are usually curved or bent, and there are more of them.
Here is a radiograph (X-ray) of a molar root filling with very
curved roots on the left side of the picture. These two root canals
were very difficult to work on! And even with all my gadgets I couldn't
get all the way to ends of the roots there, so you can see that the
root fillings on the left side are a millimeter or so short.
Also, just for fun, molar teeth are at the back of the mouth, where they are harder for a dentist to get to and see clearly. All these factors add up to the dentist needing more time to do a thorough job. And that is why a molar root canal treatment costs more than other teeth!