If the cavity is all empty and painful, apical radiographs can be taken before treatment. If the tooth has a hard texture and solid roots, the root pulp needs to be removed under local anesthesia when there is recurrent bacterial infection in the long-open root canal causing pain. Root canal preparation is followed by root canal irrigation and disinfection, completion of root canal filling, and placement of fiber piles to create a pile core to complete the metal or all-ceramic crown restoration. If the X-rays show a large shaded area in the apical region of the decayed tooth, accompanied by root loosening or the presence of intracanal resorption, the decayed tooth needs to be extracted and the restoration will be done at a later date after the socket has healed.