Root Canal Treatment explained is simple is the removal of infected pulp tissue which is replaces by an inert material to prevent infection or to treat an already infected tooth. In you daily practice you will encounter many cases which can be treated without RCT and most of the times there are patients who are not willing to go for Root Canal Treatment. So alternative methods should be used to save the tooth and to help the patient.
Here we are going to discuss about the Alternative treatment methods to Root Canal Treatment, but first we need to know in which conditions these treatments are possible:
- When there is no Periapical Radiolucency
- In case of Pulpitis which is close to Irreversible Pulpitis but not completely Non Vital
- The Tooth in Vital
- Tooth should give a Positive result to Pulp Vitality Tests
- In Young Permanent teeth where the Radicular pulp is Vital
- When patient is not willing for Root Canal Treatment
- Indirect Pulp Capping
- Direct Pulp Capping
- Step wise Excavation
Indirect Pulp Capping:
In presence of even little amount of unaffected Dentin between the Pulp chamber and the Carious Dentin. In this case Calcium Hydroxide paste is used to cover the remaining dentin after removal of sufficient Carious Dentin without leading to pin point exposure of Pulp chamber. This is a preventive alternative to Root Canal Treatment which can be tried before going for RCT.
Direct Pulp Capping:
This is done as an alternative to RCT in case of any Pin point Exposures of Pulp seen during Caries removal either by Excavators or Rotary instruments. In this case also Calcium hydroxide is used if there is no remaining dentin and the pin point exposure is sealed and left for 30 days to see for formation of Secondary Dentin. Only in case of Pin Pint exposure can we use this technique and avoid RCT.
Step Wise Excavation:
In case of Caries which is extending close to the pulp chamber, we have to use this technique to remove as much as caries as possible and protect the pulp chamber. Use a Small Spoon Excavator and slowly remove Carious Dentin layer by layer taking care not to cause exposure of Pulp chamber. When all the carious Dentin is removed we can do Direct or Indirect Pulp capping depending on the amount of Dentin present on the roof of Pulp Chamber.
This is a step most often done in Decidious teeth and in young permanent teeth, where the Coronal portion of Pulp is affected by carious but the Cervical and Root part of the Pulp is normal. Here we open the pulp chamber and carefully remove the affected part of the pulp and leave the unaffected or Radical part of the pulp and seal it with Calcium Hydroxide and Restoration is done over that.
This is the last step which has to be taken in case a patient is not willing for Root Canal Therapy, the patient should be counseled stating the advantages of saving ones tooth with RCT, and if the patient is not willing to accept RCT then the last option would be to Extract the tooth.
All these steps which are mentioned should be done depending on the situation the tooth, its surrounding structures, the amount of caries, that amount of sound tooth left etc. Clinical Diagnosis is important before you determine a Treatment Plan.