Endodontic Technology: Rubber Dam, Rotary Instruments and Apex Location
This page explains the equipment used in root canal treatment: rubber dam, rotary nickel-titanium files, electronic apex locators, magnification, irrigation and imaging. UK guidance calls rubber dam mandatory, while research support for the other items varies in strength. It also lists equipment on site at Deepcar Dental Care.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, the practice's principal dentist and a General Dental Practitioner (GDC 301711), reviewed this page. His qualifications are BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
What is endodontic technology?
Endodontic technology is the equipment used in root canal treatment to isolate, measure, shape, disinfect, see and image the inside of a tooth.
Root canal treatment, a form of endodontic treatment, clears infection from inside a tooth so the tooth can be kept. Its steps are described in our guide to what happens during root canal treatment.
What equipment is on site at Deepcar Dental Care?
Equipment on site at Deepcar Dental Care includes:
- Rotary endodontic system
- Apex locator
- Digital X-rays
Across the practice, rubber dam is used routinely.
Why is rubber dam isolation used in root canal treatment?
A rubber dam is a thin sheet fitted around the tooth being treated, and British Endodontic Society guidance calls it mandatory for root canal treatment.
The society says it lowers the risk of saliva bacteria contaminating canals, stops materials, solutions and instruments being swallowed or inhaled, and gives a controlled, clearer working area.
The European Society of Endodontology's 2023 guideline also recommends dental dam on expert consensus, as part of a meticulous aseptic technique with good light and magnifying devices.
Outcome evidence is observational. A 2014 study of 517,234 teeth in a nationwide Taiwanese database (Lin and colleagues) found 90.3% of teeth treated with rubber dam still in place after an average of 3.43 years, against 88.8% without, and concluded rubber dam could provide a significantly higher survival rate.
How do rotary nickel-titanium instruments shape root canals?
Rotary instruments are nickel-titanium (NiTi) endodontic files turned by a motor to shape root canals, so cleaning solutions can reach the end of the canal.
British Endodontic Society guidance says NiTi files are more flexible and fatigue-resistant than stainless steel, but finds no evidence that one shaping technique is better than another.
The European Society of Endodontology's 2023 guideline weakly suggests engine-driven NiTi instruments over stainless steel for apical periodontitis (inflammation at the root tip), rating the evidence moderate for tooth survival and post-treatment pain and low for healing on X-rays. Its commissioned review (Bürklein and Arias, 2023) found better healing on X-rays with contemporary instruments than stainless steel in such patients followed for at least a year, on low-quality evidence, and no other differences.
How does an electronic apex locator measure root canal length?
An electronic apex locator measures root canal length by detecting where the canal ends and the tissue around the root begins.
British Endodontic Society guidance warns that a canal prepared too short may leave dead tissue that keeps infection going, and one too long may irritate tissue beyond the root. It ranks the apex locator first among length checks.
A 2014 systematic review (Martins and colleagues) concluded apex locators reduce radiation exposure and may measure length better than X-rays, on evidence it called short and at considerable risk of bias, and advised at least one X-ray check for device errors. A 2015 meta-analysis (Tsesis and colleagues) found average distances of 0.25 mm to 1.35 mm from the canal's narrowest point, depending on the device and irrigating solution.
To ask about root canal treatment, book online or call 0114 288 2121.
How does magnification help in root canal treatment?
Magnification, from a dental operating microscope or magnifying loupes, helps a dentist find root canal openings inside the tooth.
British Endodontic Society guidance recommends magnification when locating canals.
Outcome evidence is limited. A 2015 Cochrane review found no trials that met its criteria and concluded it is unknown if and how the type of magnification device affects the outcome. A 2017 retrospective US study of 195 upper first molars re-treated at a graduate clinic (Khalighinejad and colleagues) found a lesion at the tip of one root three times as likely where the first treatment had not used a microscope. A 2025 randomised trial of 100 patients with dead (necrotic) teeth found a microscope did not significantly reduce pain after treatment.
How are root canals disinfected?
In general, root canals are disinfected by irrigation, washing them through with antibacterial solutions such as sodium hypochlorite while they are shaped.
British Endodontic Society guidance says irrigation is the only way to reach canal walls the files do not touch. It recommends stabilised sodium hypochlorite at 0.5% to 5.25%.
The society warns that sodium hypochlorite pushed out beyond the root can cause a hypochlorite accident, and lists precautions such as a side-venting needle.
On activation, evidence is mixed. The 2023 European guideline suggests not adding extras such as passive ultrasonic activation to syringe irrigation for apical periodontitis, on low-quality evidence, but a 2024 meta-analysis of three randomised trials (Gobbo and colleagues) found more healing at the root tip with it, with moderate certainty, despite few high-quality trials.
What imaging is used in root canal treatment?
Periapical X-rays, which show a tooth's roots and the bone around them, are essential for root canal treatment in British Endodontic Society guidance.
The society lists X-rays before treatment, sometimes during it, after filling and at review, each justified and at a dose as low as reasonably practicable. Our dental X-rays page covers doses.
Cone beam CT (CBCT) gives three-dimensional images. The 2023 European guideline strongly recommends periapical X-rays as the routine way to diagnose apical periodontitis, with CBCT an additional measure that may be considered where the diagnosis is in doubt, and notes that dense materials such as root fillings may affect its accuracy.
What does endodontic technology mean for treatment outcomes?
Endodontic technology helps a dentist isolate, measure, shape and disinfect the canals, but evidence that any one device improves outcomes varies in strength.
British Endodontic Society guidance ties success to accurate diagnosis and completing each stage to a high standard, and the 2023 European guideline stresses case evaluation, aseptic technique, training and re-evaluation during and after treatment.
The society also links the outcome to the tooth's condition before treatment, the root filling and the seal over it, as our page on root canal success rates and how long treated teeth last explains.
Where can you read more about restorative dentistry technology?
Digital scanning and design are covered among the options in this section.
Root canal treatment belongs to restorative dentistry, which focuses on saving natural teeth rather than replacing them with implants.
Frequently asked questions
Should a rubber dam be used for every root canal treatment?
Yes, in British Endodontic Society guidance, which calls rubber dam mandatory for root canal treatment. If a dam cannot be fitted, the society says the tooth's restorability and the reason for treating it must be challenged. It recommends isolating only the tooth being treated in most cases.
Why is a non-latex rubber dam advised?
British Endodontic Society guidance advises a non-latex rubber dam, given the prevalence and severity of natural rubber latex allergy. The society still calls rubber dam itself mandatory for root canal treatment. Tell your dentist about any allergy before treatment starts.
What happens if a file breaks inside a root canal?
Evidence suggests a file fragment left in a canal does not significantly reduce the chance of healing. A 2010 meta-analysis of two case-control studies (199 cases) found 91% of teeth with a retained fragment healed. Overall, 80.7% of lesions at the root tip healed, while 92.4% of lesion-free teeth stayed healthy.
Is a CBCT scan needed for every root canal treatment?
No, in British Endodontic Society guidance. Citing the European Society of Endodontology's 2019 position statement, it says CBCT should only be considered after conventional X-rays, for specific indications. These include non-specific signs or symptoms with inconclusive X-rays, complex canal shapes, treatable resorption and heavily blocked canals. Every CBCT scan must be reported on.
Is an apex locator safe if you have a pacemaker?
Research suggests it can be, with precautions. A 2019 systematic review of seven studies, five of them laboratory studies, found apex locators could be used safely with implanted heart devices when general precautions were followed, but still advised consulting the patient's cardiologist. Tell your dentist about any implanted device.
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You can contact Deepcar Dental Care by phone or online, and the practice is open 8am to 8pm, Monday to Sunday. Our patient reviews show what patients say.
At the practice, root canal treatment is carried out by a dentist with a special interest in root canal treatment.
334 Manchester Road
Deepcar, Sheffield S36 2RH
0114 288 2121
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