Dental News - A year in review (Part 1): Endodontics

Prof. Beena Rani Goel, India

Wed. 28. December 2011

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Many new technologies have been emerging during the last twelve months which made 2011 an interesting year for dentistry. In this first part of an exclusive commentary series, Prof. Beena Rani Goel from India speaks about the field of endodontics.

The single most important development that was a giant leap for endodontics is micro-computed tomography, by giving us a 3-D view of the area in which we have to work. Without this technology, the basis for many endodontic procedures was just empirical. For example, enlarging the root canal three sizes beyond the first file that binds, or arbitrarily deciding the final apical size with tapered rotary use during hand instrumentation does not have any scientific basis at all.

The work of Prof. Marco A. Versiani on the root-canal anatomy project has provided us with a micro-CT study guide that has demystified many old concepts. Now we know that all root canals are curved, apical diameters are not as small as perceived, and root canals do not have large tapers.

Regenerative endodontics, though in the infant stage, can hold significant implications for the management of necrotic immature teeth. This applies to the advances in tissue engineering and the regeneration of the pulp–dentine complex. Multiple studies have shown that continued root development can be accomplished after disinfection of the root-canal system, evoked bleeding inside the root canal, and adequate coronal seal. These treatment protocols can result in radiographic and clinical evidence of healing and subsequent root development that has been attributed to regeneration of tissue.

Until recently, the clinical presence of stem cells in the canal space after this procedure had not been proven. New findings by Tyler W. Lovelace et al. demonstrated that the evoked-bleeding step in regenerative procedures triggers the significant accumulation of undifferentiated stem cells in the canal space, where these cells might contribute to the regeneration of pulpal tissues. Future developments may see wider application of these tissue-engineering principles, which have the potential to revolutionise the field of endodontics.

The use of lasers in endodontics may be common procedure soon with a number of applications in access preparation, root-canal shaping, and decontamination of the root-canal system. The improved technology has introduced endodontic fibres and tips of a calibre and flexibility that permit insertion up to 1 mm from the apex. Laterally emitting conical fibre tips were found to be safe under defined conditions for intra-canal irradiation without harmful thermal effects on the periodontal apparatus.

The EndoVac irrigation system (Discus Dental) is one of the best things that has happened to endodontics in recent years. While sodium, hypochlorit is the only endodontic irrigant capable of significantly eliminating the biofilm associated with endodontic infections, it has the tendency to cause catastrophic tissue damage when extruded. With EndoVac, fortunately, it can now be safely delivered to full working length. A SEM image taken at 0.75 mm from the apical termination demonstrates completely clean walls at this level, which has not been achievable with other irrigation systems. Research has also shown that the use of EndoVac can result in a significant reduction of post-operative pain levels in comparison with conventional needle irrigation.

According to the latest micro-CT studies, the apical thirds are not cleaned with tapered systems of small tip size. In addition, they showed that instruments with a flat widened tip determine apical cross-sectional diameter better than round tapered instruments. The coming years are bound to see an increased acceptance of LightSpeed LSX instruments (Discus Dental) to obtain biologically optimal preparations.

At a time when dental professionals have a choice between root-canal treatment and implant placement after extraction, it is heart-warming to see that recent developments in endodontics can maintain the tooth in a functional state for many years, if incorporated into the surgery.

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