Root Canal Treatment İstanbul

Scientific editor: Dentapolitan Clinical Science Board · Multidisciplinary review: Prof. Dr. Mehmet Oğuz Öztoprak – Specialist in Orthodontics and Dentofacial Orthopedics
Last updated: 24 July 2026

Root canal treatment is an endodontic procedure performed when the pulp tissue inside the tooth becomes irreversibly inflamed or infected, and it aims to keep the natural tooth in the mouth. The outer part of the tooth is made up of enamel and dentin, and beneath these lies the pulp, which contains the tooth's blood vessels, nerve and connective tissue. A tooth whose root development is complete can continue to function after the pulp is removed, nourished by the surrounding tissues.

In root canal treatment the inflamed or infected pulp is removed; the root canals are cleaned, disinfected, shaped and sealed. This treatment is often one of the most important options for avoiding extraction of the tooth; after a successful treatment and a suitable final restoration, the tooth can remain in the mouth for many years.

At Dentapolitan, root canal treatment is not viewed simply as "removing the nerve." Whether the tooth truly needs root canal treatment, its restorability, the root and canal anatomy, any crack/fracture, the surrounding bone and gum support, previous fillings and crowns, the load at the bite and the need for a permanent restoration after treatment are all evaluated together.

What Is Root Canal Treatment?

Root canal treatment is the process of removing the inflamed or infected pulp tissue inside the tooth, cleaning the canal system by mechanical and chemical methods, and then sealing it with biocompatible filling materials. Its main aims are to eliminate the inflamed pulp that causes pain, to reduce the bacterial infection in the root canals, to prevent the infection from spreading to the jawbone, to seal the canal system against renewed bacterial entry, and to restore chewing function without extracting the natural tooth. During treatment the entire root of the tooth is not removed; only the narrow canal spaces inside the root are cleaned and filled.

What Is the Tooth's Nerve (Pulp)?

The structure commonly called the "tooth nerve" is actually the pulp tissue, which contains nerve fibers, blood vessels, connective tissue and defense cells. The pulp contributes to dentin formation as the tooth develops and allows stimuli such as heat, cold and pressure to be felt. As a result of deep decay, cracks, trauma or repeated procedures, the pulp may first become inflamed; if the damage progresses, the blood supply can be disrupted and pulp necrosis (loss of vitality) may develop.

Why Is Root Canal Treatment Done?

Root canal treatment is performed when the pulp is inflamed or infected to a degree that it cannot heal on its own. The main causes are:

• Deep tooth decay: When decay passes through the enamel and dentin and reaches the pulp, bacteria gain access to the inner tissue; as the inflammation progresses, hot-cold pain lasts longer and night pain may begin.
• Cracked or fractured tooth: Some cracks are not visible; they may show up as pain on biting or as tenderness at a particular spot. How far the crack has extended along the root determines whether the tooth can be saved.
• Trauma: Even without a visible fracture, a blow can injure the pulp's blood vessels; darkening of the color and lack of response to a cold test may appear even months or years later.
• Ill-fitting/leaking fillings and crowns: Bacterial leakage underneath them can lead to deep decay and pulp infection.
• Advanced wear and erosion: Teeth clenching (bruxism), acid erosion or a traumatic bite can thin the protective dentin layer.
• Advanced periodontal disease: In some cases the infection can connect with the root canal (endodontic-periodontal lesion) and may require combined treatment.

Symptoms and Pain-Free Situations

The need for root canal treatment can show up with symptoms such as severe toothache or pain that wakes you from sleep at night, pain that increases with heat, sensitivity that persists after the cold is gone, pain on biting and chewing, swelling of the face or gum, a pimple-like drainage point on the gum, a bad taste in the mouth, a change in tooth color and a radiographic lesion in the jawbone. However, none of these symptoms on its own is enough to make a definitive decision; similar pain can also be caused by gum disease, a jaw joint problem, sinusitis, a cracked tooth or teeth clenching.

The absence of pain does not always mean there is no problem: when the pulp has completely lost its vitality the pain may temporarily subside, but bacteria in the dead tissue can advance from the root tip into the surrounding bone and cause an apical infection, bone loss, a chronic abscess or a fistula on the gum. For this reason, root canal treatment may also be needed in a pain-free tooth when a radiographic lesion or loss of vitality is detected.

Pulpitis, Root Infection and Abscess

Inflammation of the pulp is called pulpitis. In reversible pulpitis the pulp is only mildly affected; if the cause (e.g. decay) is removed and the tooth is properly restored, it may heal. In irreversible pulpitis, on the other hand, there is spontaneous pain, night pain and prolonged sensitivity to cold; root canal treatment, or extraction if the tooth cannot be restored, comes onto the agenda. When the infection reaches the root tip, apical periodontitis develops; pain on biting, a feeling that the tooth is raised, and a radiographic darkening at the root tip may be seen. A dental abscess is a collection of pus in the tooth or the surrounding tissue; it can present with severe throbbing pain, swelling and a bad taste.

Antibiotics are not a substitute for root canal treatment. Antibiotics do not mechanically clean the dead and infected tissue in the root canal; the source of infection is controlled by removing the pulp, cleaning and disinfecting the canal, and filling it. Antibiotics are used only as an adjunct in situations such as fever, widespread facial swelling, lymph node involvement, cellulitis or a suppressed immune system. Rapidly spreading swelling of the face, fever, difficulty swallowing or difficulty breathing require urgent medical evaluation. Advanced abscesses and cases needing root-tip surgery can be planned together with oral and maxillofacial surgery.

How Is the Decision for Root Canal Treatment Made?

The decision is not made simply by looking at an X-ray or because someone says "it hurts a lot." A detailed history (onset of the pain, whether it is spontaneous, its relationship to heat and cold, whether it wakes you at night, trauma), clinical examination (decay, fillings/crowns, gum, cracks, mobility, bite tests), pulp vitality tests (cold, heat, electric pulp test), percussion-palpation and radiographic evaluation (periapical, bite-wing; CBCT in selected complex cases) are all interpreted together. Vitality tests do not directly show the histological state of the pulp; they assess the nerve response and are compared with neighboring teeth.

How Is Root Canal Treatment Performed?

Depending on the structure of the tooth and the state of the infection, treatment can be completed in a single session or in more than one session. The stages are:

• Examination and plan: The root structure, number of canals, restorability and prognosis are assessed. The fact that a canal can technically be performed on a tooth that cannot be saved does not mean the treatment is the right choice.
• Local anesthesia: The tooth and surrounding tissues are numbed; additional anesthesia techniques may be needed in advanced inflammation.
• Rubber dam (cofferdam) isolation: The tooth is isolated from the oral environment; bacteria in the saliva are prevented from entering the canal and instruments from being swallowed. Aseptic isolation is a fundamental element of quality endodontics.
• Access cavity and removal of the pulp: The pulp chamber is reached, the canal entrances are located, and the inflamed/infected pulp is removed.
• Working length, shaping and disinfection: The root canal length is determined with an electronic apex locator and radiography; the canals are enlarged in a controlled way with hand instruments or rotary systems and disinfected with chemical irrigation solutions.
• Inter-appointment medication (if needed): In widespread infection or drainage, a temporary medicament is placed inside the canal and the tooth is closed with a temporary filling.
• Canal filling and final restoration: Once the canals are clean and dry, they are sealed with gutta-percha and canal sealer; then the access opening is restored with a permanent filling, an onlay/overlay or a crown.

Is It Painful, How Many Sessions, How Long Does It Take?

Root canal treatment is usually performed under local anesthesia, and the aim is that no significant pain is felt during the procedure; the patient may sense pressure, vibration or the sound of water but sharp pain is not expected. Contrary to a common belief, root canal treatment is mostly not the cause of pain but the treatment that eliminates pain. The number of sessions varies according to factors such as whether the tooth is vital or necrotic, the presence of an abscess, the canal anatomy and number, and whether it is a first treatment or a retreatment. A single session can last from roughly 45 minutes up to two hours; molars can take longer because of their greater number of canals and complex anatomy. It cannot be said that a single session is always better or that multiple sessions are always more successful; the decision is made according to the clinical situation.

Microscope, Laser and CBCT

A dental operating microscope can be useful by magnifying the treatment area for finding hidden canal entrances, narrow/calcified canals, retreatment, separated instruments and investigating cracks; however, on its own it does not guarantee success. Lasers may assist with disinfection in some procedures but do not replace canal instruments, mechanical cleaning, irrigation solutions or the canal filling; expressions such as "a definitive root canal in a single session with a laser" are misleading. CBCT (three-dimensional imaging) is not routinely required in every treatment; it is used in selected situations such as complex anatomy, suspicion of a hidden canal/root fracture, a non-healing lesion or surgical planning, with the radiation dose taken into account.

The Process After Root Canal Treatment

After treatment there may be mild-to-moderate tenderness (to pressure, when chewing) for a few days; this is related to the previous inflammation of the surrounding tissues or to temporary irritation and decreases over time. In case of increasing pain, large facial swelling, fever, loss of the temporary filling, or severe pain lasting longer than a week, you should contact the clinic. Do not eat until the numbness wears off; until the permanent restoration is complete, avoid hard/sticky foods and, if possible, use the opposite side.

The restoration is critical: the success of the canal does not mean the final restoration can be postponed, because a leaking or fractured restoration leads to reinfection of the canal. Not every tooth automatically needs a crown; the decision is made according to the remaining healthy tooth structure, the position of the tooth and its load. While a composite filling may be sufficient in some front teeth with enough structure, cusp-protecting restorations such as an onlay, overlay, endocrown or crown may be needed in back teeth with extensive loss of tooth structure. Since the outer surface of a root-canal-treated tooth is not immune to decay, it can decay again; because there is no nerve, the decay may not cause pain in its early stage, so regular examinations and radiographs are important. Some teeth may darken over time; in selected cases internal whitening, composite, veneers or a crown are considered.

Failure, Root Canal Retreatment and Apicoectomy

As with every dental procedure, failure or unexpected healing can also occur in root canal treatment (a missed canal, inadequate disinfection, leakage of the final restoration, new decay, a root crack, a resistant infection, etc.). Pain that later develops in a tooth that has previously had root canal treatment does not necessarily mean the tooth must be extracted. Root canal retreatment is the reopening of the tooth, removal of the old canal fillings, the search for missed canals, and the recleaning and refilling of the canals; it is usually more difficult because of old fillings, posts, separated instruments and calcification, and may require a microscope, an ultrasonic device and advanced experience. Apical resection (apicoectomy), on the other hand, is the procedure in which the inflammation at the root tip is surgically cleaned and, if necessary, a root-end filling is placed; it is considered in selected cases where the root-tip lesion does not heal after root canal treatment/retreatment.

Root Canal Treatment or Tooth Extraction?

When it is possible to preserve the natural tooth, root canal treatment is generally one of the preferred options; the natural tooth is preserved, neighboring teeth are not cut, the bone and gum architecture is maintained, and the need for an implant/bridge can be postponed. However, not every tooth can be saved: extraction may be needed in cases of a vertical fracture extending along the root, decay well below the gum line that cannot be restored, insufficient bone support, advanced periodontal disease, or an infection that cannot be controlled despite treatment. In addition, if the pulp is reversibly affected, cleaning the decay and placing a suitable filling may be enough; in selected deep-decay cases the vital pulp can be preserved with vital pulp treatments (indirect pulp capping, direct capping, partial/full pulpotomy). Not every deep cavity requires root canal treatment; nor is every painful tooth suitable for vital pulp treatment.

Root Canal Treatment in Children and During Pregnancy

In children, treatment differs according to whether the tooth is a primary (milk) tooth or a permanent tooth. In primary teeth, pulp capping, pulpotomy or pulpectomy is used to try to preserve the tooth until its natural exfoliation time. In young permanent teeth whose root development is not complete, keeping the pulp alive is especially important, and in suitable cases apexogenesis, regenerative endodontics or apexification is considered; these processes are carried out together with pediatric dentistry. Necessary root canal treatment does not have to be postponed during pregnancy; untreated pain and infection can adversely affect the mother's health. In planning, the week of pregnancy, the medications used, the obstetrician's recommendations and radiation-protection measures are taken into account. For elective procedures the second trimester may be more comfortable; however, when acute treatment is needed it is not delayed solely because of the trimester.

The Root Canal Treatment Approach at Dentapolitan

At Dentapolitan, root canal treatment is not viewed merely as removing the nerve of a painful tooth. The true source of the pain is identified; a correct diagnosis is made for the pulp and the tissues around the root; whether the tooth can be preserved without root canal treatment and its long-term restorability are examined; the root and canal anatomy is analyzed radiographically and, in cases that require it, three-dimensional imaging is evaluated. Treatment is performed under local anesthesia and suitable isolation, the canals are cleaned mechanically and chemically and sealed, and a permanent final restoration is planned. In cases of extensive loss of tooth structure the risk of fracture is assessed, clinical and radiological follow-ups are carried out after treatment, retreatment or surgical options are considered for failed previous treatments, and procedures with a poor prognosis are avoided in teeth that cannot be saved. Evaluation and treatment are carried out at our Istanbul clinics.

This content has been prepared for general health information purposes; it does not replace an examination, radiological investigation, diagnosis or a personalized treatment plan. If there is rapidly spreading swelling of the face, fever, difficulty swallowing or difficulty breathing, urgent medical evaluation should be sought.