How long does a root canal procedure take? | How many appointments?
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How long does a root canal take?
Appointment length.
As a ballpark estimate, you can expect that any one root canal appointment will take somewhere between 30 and 60 minutes. With more involved cases, the time needed might extend to as long as an hour and a half.
The amount of time that’s needed varies according to case complexity.
For a more precise answer about how much time is usually required, we were able to locate a study (Wong 2015) that investigated this issue. It measured endodontic therapy treatment times as a function of the type of tooth being treated, with the number of root canals How this varies by tooth type. being the primary determinant.
Here’s what this study reported:
a) Treatment time for teeth that have single root canals –
Included kinds of teeth: Incisors, canines (eyeteeth, cuspids), and some premolars (bicuspids).
Study findings: On average, it took 37 minutes to complete the tooth’s endodontic therapy (with 68% of cases [one standard deviation unit] lying within plus or minus 18 minutes).
Conclusions: Performing endodontic treatment for teeth that have just a single root canal (incisors, canines, and some premolars) typically takes between 19 and 55 minutes.
b) Treatment time for teeth that have multiple root canals –
Included kinds of teeth: Molars and some premolars (bicuspids).
Study findings: On average, it took 74 minutes to complete the tooth’s endodontic therapy (with 68% of cases lying within plus or minus 32 minutes).
Conclusions: Performing endodontic treatment for teeth that have more than one root canal (molars and some premolars) typically takes between 42 and 106 minutes.
FYI: Do longer appointments require additional dental shots?
Usually not. The local anesthetic your dentist chooses for your procedure can be expected to maintain adequate numbness throughout the duration of your procedure.
If needed, you may be able to opt for shorter appointments.
For complex cases that require a comparatively longer treatment period, if you have a preference or a need for shorter appointments (with the understanding that more than one will be required for your treatment), you should let your dentist know. This option may be amenable to them.
Patients who may have this need include people who have TMJ (jaw joint) dysfunction or have difficulty sitting still for extended periods of time.
How do multiple appointments affect total procedure time?
Even when multiple visits are the plan, your overall treatment time will probably only increase modestly. The Wong study cited above found that on average the total procedure time (for all types of teeth grouped together) only increased from 56 minutes to 63 when multiple visits were involved. (An additional 7 minutes.)
FYI: It’s generally expected that a root canal specialist can complete cases more rapidly than a general dentist (especially more difficult or complex ones). So if the amount of time your tooth’s work will take is a significant factor for you, and the services of an endodontist Root canal specialist. are available, you might consider that option.
How many appointments will your root canal therapy take?
The number of visits it takes to complete your root canal treatment may be as few as one. With some cases, however, two or more scheduled appointments may be required.
a) The two-visit approach.
If two appointments are needed for your tooth’s treatment, here’s what you can usually expect to take place:
1) During your first appointment –
Disinfecting the inside of your tooth.
During your first visit your dentist will focus on the task of cleaning and shaping The steps. your tooth’s root canal system (pulp chamber + all of its root canals). Ideally, they will be able to fully complete this process in full during this visit.
What does this work involve?
After using a local anesthetic to numb up your tooth and its surrounding gum tissue, your dentist will drill a small hole in your tooth (an “access cavity“). They’ll perform your tooth’s work through this opening.
Using a file to clean a tooth’s nerve space.
They’ll then use a series of root canal files (tiny needle-like rasps) up and down inside your tooth to remove all remnants of its pulp tissue. The use of these tools, along with periodically rinsing out the inside of the tooth, cleans and disinfects its nerve space.
Why is this needed?
Endodontic therapy is a dental treatment that provides a way for a dentist to save teeth that have unhealthy nerves (e.g. severely inflamed or infected pulp tissue) from requiring tooth extraction.
The exact condition that exists will vary from case to case but typically involves a situation where advanced tooth decay (cavities), cracks, or dental trauma have led to pulp tissue inflammation, infection, or even death. These kinds of nerve problems frequently lead to a person experiencing symptoms such as sensitivity, soreness, pain, infection, and/or soft tissue swelling in the region of their tooth. Performing endodontic therapy remedies this.
Shaping your tooth’s root canal system.
While cleaning out the inside of your tooth, your dentist will simultaneously use their files to shape (widen and flare) the contours of its root canal system.
The tooth’s root canal is widened and flared.
Why is this needed?
After disinfecting its interior, another important step of performing endodontic therapy is filling in and sealing off the tooth’s root canal system using a biocompatible material termed gutta-percha.
Doing so prevents the tooth from becoming reinfected by bacteria and causing further tooth pain or other complications. Shaping a tooth’s canals properly helps in creating the best seal possible.
Additional steps.
For the period between your two root canal appointments, your dentist will place some type of medication inside your tooth. Possibly one that will aid with further disinfecting its interior. (Historically the use of formocresol or monochlorphenol was common. Today, the use of calcium hydroxide paste is becoming ever more prevalent.)
Following that, they will place some type of temporary filling that will seal off and protect the work they have just completed.
How long between root canal appointments?
In most cases, second visits are typically scheduled somewhere between 1 and 3 weeks following the first.
The time period chosen is typically based on what medication has been placed inside your tooth and the period of time it will continue to be effective in aiding the disinfection process.
2) During your second appointment –
Sealing your tooth.
With a two-appointment approach, your second visit will be focused on filling and sealing The steps. the previously cleansed nerve space inside your tooth.
What does this involve?
After evaluating the effectiveness of their work completed during your first appointment, your dentist will then fill in and seal off your tooth’s disinfected root canal system by filling it with a biocompatible material termed gutta-percha.
This material is typically added and compacted one piece at until your tooth’s interior has been completely filled in.
Sealing a tooth’s root canal system using gutta-percha.
After your tooth’s endodontic therapy has been completed, your dentist will place a temporary filling to seal and protect its just-finished work.
▲ Section references – Tronstad
What are the advantages of two-visit root canal treatment?
- Especially when calcium hydroxide is placed inside the tooth between appointments, the effectiveness of the disinfection process is typically enhanced.
- The time period between the two visits (usually 1 to 3 weeks) gives the dentist an opportunity to evaluate the tooth’s healing progress before its treatment is finally completed.
- A two-visit approach tends to make the management of endodontic flare-ups that may occur easier and more predictable. (See next section.)
Endodontic flare-up.
A flare-up is generally defined as severe pain or swelling that develops after any type of scheduled root canal appointment that necessitates the need for an unscheduled dental visit to address it.
Factors responsible for flare-ups can include bacterial infection or chemical or mechanical injuries to tissues (possibly caused while performing the steps of the root canal process). A study by Tsesis (2008) found the incidence rate for endodontic flare-ups to be about 8% of cases.
b) Single-visit treatment.
As opposed to using a two-visit procedure, when a single-appointment approach is utilized your dentist will simply complete all of the steps of the root canal process for your affected tooth in one sitting.
The idea of performing single-visit root canal treatment first started to gain widespread acceptance in the 1990s. A part of this change in the mindset of clinicians can be attributed to advancements in dental technology that made it easier to complete a tooth’s endodontic procedure within a single sitting (increased treatment speed and efficiency), without concerns about compromising the quality of the tooth’s work.
Advantages of performing single-appointment root canal therapy.
For the patient.
The obvious benefit is that all of the patient’s treatment is completed during a single sitting. (Although with multi-rooted teeth, molars in particular, that visit might need to be fairly extended, possibly running on the order of 90 minutes or so.)
Beyond just time considerations, some patient’s dental anxiety is triggered by getting dental shots. Using a one-visit approach means that local anesthesia will only need to be administered during one appointment.
For the dentist and the success of your procedure.
Your dentist’s familiarity with the peculiarities of the anatomy of your tooth’s root canal system is easier to keep in mind if just one sitting is involved. Also, there’s no risk of the complication of bacterial leakage into the tooth between appointments (failure of the temporary restoration that’s been placed).
COVID-19 considerations.
The COVID-19 pandemic has had and will continue to have an impact on the way in which dentistry is treatment planned and performed. And, in the field of endodontics, performing one-visit root canal therapy is one way by which a dentist can help to limit their patients’, as well as their dental facility and staff’s, potential exposure to pathogens.
Which approach is better, one or two sessions?
As you might expect, research studies suggest that case factors should play the biggest role in determining which approach (one or multiple visits) makes the most appropriate choice for a tooth’s treatment. One of the most important ones is the degree to which the tooth’s pretreatment root canal system harbors infection.
That’s because a two-visit approach that involves the placement of medication inside the tooth between appointments (like calcium hydroxide, mentioned above) is probably more effective in disinfecting its canal system than a single-visit one that by nature would not include this step.
Examples of when each approach might make the most sense.
A) Single-appointment cases.
If a tooth’s pathology is primarily limited to pulp tissue occupying just a portion of its root canal system (meaning much of the tooth’s nerve tissue is still alive, referred to as “vital” cases), then a single-visit approach probably makes the best, even preferred, treatment choice.
Examples.
This type of scenario could include teeth that require root canal treatment due to the exposure of their nerve tissue during a dental procedure, or exposure that has resulted from tooth fracture. Or teeth that are still in the early stages of nerve tissue degeneration.
B) Multi-appointment cases.
In those cases where the entire root canal system harbors bacteria, single-visit treatment may, or may not, make an appropriate choice. As case examples, this would include teeth whose pulp tissue has died (non-vital, necrotic teeth), teeth with active infections, and retreatment cases.
Common guidelines.
As a general rule, if the patient is experiencing pain, tenderness, or swelling at the time of their appointment, the dentist will be less likely to choose single-visit treatment.
They will also be more likely to choose a multi-appointment approach for complex cases because they simply take more time to complete. This might include teeth that have multiple root canals (molars), or teeth that have canals that are generally difficult to find, access, or negotiate.
As mentioned above, in cases where extensive microbial contamination of the tooth’s root canal system has occurred, a two-visit approach offers the substantial advantage of allowing further disinfection of the tooth between visits via the placement of calcium hydroxide.
How pregnancy can affect root canal appointments.
Women who are expecting can undergo root canal treatment. However, the timing of their appointments, and the way their treatment is performed, may need to be altered in consideration of their pregnancy.
In all cases, any woman who is pregnant, or even anticipates that she is, should advise her dentist of such before any type of dental treatment is begun.
Issues that must be considered.
Here are some of the issues that must be taken into consideration when root canal treatment is planned for a pregnant woman:
» The use of radiographs (x-rays).
When utilizing modern radiographic techniques, and standard radiation protection (including the use of a leaded apron and thyroid collar), the dental X-rays needed to perform root canal treatment should not place a patient’s fetus at risk.
As a further precaution, the treating dentist will strive to keep the number of X-rays taken to a minimum.
» Appointment length and number of visits.
It may be difficult for a pregnant patient to remain physically comfortable while sitting in their dentist’s dental chair. Instead of one relatively longer appointment, their root canal treatment may need to be divided into two or more shorter visits.
» Treatment timing.
In those situations where the patient is experiencing discomfort or has signs of an active infection, immediate attention may be required. In cases where urgency is less of an issue, the treating dentist may prefer to delay the patient’s endodontic therapy until a particular trimester (typically the second) or wait until after their child has been delivered.
» The use of medications.
A patient’s pregnancy will influence the selection of medications used for their treatment.
As an example, root canal treatment typically requires the use of a local anesthetic (the medicine that is used to “numb up” a tooth). A few different types of anesthetics have been approved by the FDA for use with pregnant women. And, in fact, they are common ones and are typically found and routinely used in essentially all dental offices.
Some endodontic cases will also require the use of an antibiotic and/or analgesic (pain reliever). Once again, products approved by the FDA for use with women who are pregnant are readily available.
▲ Section references – Ingle
What’s next?
We have a lot more information about root canal treatment …
Page references sources:
Ingle JI, et al. Ingle’s Endodontics. Chapter: Modern Endodontic Therapy: Past, Present and Future.
Tronstad L. Clinical Endodontics. Chapter: Conservative endodontic treatment.
Wong AW, et al. Treatment time for non-surgical endodontic therapy with or without a magnifying loupe.
All reference sources for topic Root Canals.