Here is how a root canal works in this office, in one line.
We work out whether you actually need one. An endodontist does the root canal. We build the tooth back afterward, usually with a crown, and we plan both halves as one sequence from the start.
If you are still trying to work out whether your symptoms point to a root canal at all, that has its own article, including the tooth that stops hurting and has not gotten better. This page is about what happens once it looks like one.
First, making sure it is a root canal
Several things imitate a tooth that needs root canal treatment: a cracked tooth, pain referred from the other jaw or a sinus, grinding, or simply a filling that sits a little high. Treating the wrong tooth, or treating a tooth that did not need it, is worth avoiding.
So we test rather than guess. Cold testing on the suspect tooth and on its neighbors, tapping to check the tissue around the root, and digital X-rays to look for the dark area at the root tip that appears once infection has affected bone. Where a standard X-ray cannot show enough, 3D CBCT imaging can.
Comparing against the neighboring teeth is the part that matters. A tooth that responds differently from the ones beside it is telling you something. A tooth that responds the same way probably is not the culprit, however much it hurts.
Why the root canal itself goes to an endodontist
An endodontist is a dentist who has done additional specialty training in exactly this, and who does root canals all day. Root canal systems are small, curved and often more complicated than an X-ray shows, and endodontists typically work under an operating microscope.
It is the same reasoning we apply to surgery: some cases that look routine are not, and you often cannot tell which until you are in the middle of one. Rather than doing the easy ones and referring the hard ones, it all goes to someone who is better at it, and we keep the diagnosis and everything that gets built afterward.
What goes with you
- What we found and why we think a root canal is the answer.
- Your X-rays, and 3D imaging where we took it.
- The restorative plan, so the endodontist knows the tooth is going to be crowned and when.
The endodontist then does their own examination and makes their own treatment decisions. Occasionally they conclude the tooth cannot be predictably saved, and when that happens we would rather know before treatment than after it.
The part that decides whether it lasts: the crown
A back tooth that has had root canal treatment nearly always needs a crown, and it is worth hearing that at the start rather than as a separate surprise later. The treatment hollows out the inside of the tooth, and the tooth had usually already lost structure to whatever decay or fracture made the root canal necessary. What is left is more likely to split under chewing.
And the crown should not wait. A study of back teeth treated at a university endodontic clinic over eight years found two things worth knowing:
- Teeth restored with only a filling or buildup were about 2.3 times more likely to be extracted than teeth that received a crown.
- Teeth that got their crown more than four months after the root canal were more than three times as likely to be extracted as teeth crowned within four months.
Pratt I, Aminoshariae A, Montagnese TA, et al. Eight-year retrospective study of the critical time lapse between root canal completion and crown placement: its influence on the survival of endodontically treated teeth. J Endod. 2016;42(11):1598-1603. Hazard ratios 2.29 and 3.38. A retrospective study from a single graduate clinic, so it shows an association rather than proving that the delay caused the losses.
This is a common way a successful root canal still ends in an extraction. The treatment works, the tooth stops hurting, life gets busy, and a tooth with a temporary filling on top cracks through months later. That is why we plan the crown before the root canal starts, not after.
Front teeth are a different calculation. A front tooth that has lost little structure and does not take heavy chewing load does not always need a crown, and that is something we decide tooth by tooth.
How long a root canal treated tooth lasts
Well, generally. A systematic review pooling fourteen studies put tooth survival after root canal treatment at 86% at two to three years, 93% at four to five years, and 87% at eight to ten years.
Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J. 2010;43(3):171-189. Most included studies were retrospective and differed substantially in design, which the authors noted makes direct comparison difficult. Read the figures as a broad range rather than a precise prediction.
That matters because the alternative to a root canal is usually losing the tooth. Keeping your own tooth keeps something no replacement fully reproduces, which is the ligament that suspends it in bone and the feel of your bite that comes with it. Our article on implants makes that case even while arguing implants are the best replacement.
If the tooth cannot be saved
Sometimes the crack runs too deep, too little tooth is left to restore, or an old root canal has failed in a way that retreatment is unlikely to fix. Then the conversation turns to what replaces it, and it is much better to have that conversation before the extraction, because the plan for the space can change what the surgeon does on the day. How we plan implants.
About cost
The endodontist sets and bills their own fee. The root canal and the crown that follows are one sequence with a real combined cost, and we would rather you see the whole number at the start. That pairing is also one of the most common ways people exhaust a dental insurance annual maximum in one go. How insurance works here.
In pain right now?
If you have tooth pain today, call 702-734-0776 and we will get you in as quickly as we can. Facial swelling spreading toward your eye or into your neck, trouble swallowing or breathing, or fever with swelling belongs in a hospital emergency department. Our emergency page explains why.
Root canal treatment is referred to endodontists; diagnosis, planning and the restoration afterward are provided here. Survival figures are pooled or single-study results and do not predict the outcome for any individual tooth. General education, and not a substitute for an exam.