Should the Endodontic Concept of Success Be Reconsidered?

The technological development involving treatment of root canals has elevated the endodontic specialty over the few years to a level of technical uniqueness not seen in its entire history.

This haslead to two distinct philosophies in clinical conduct, representing two schools of thought that disseminate and teach the speciality. The first school of thought uses the technological advances and incorporate them into the daily practice of modern Endodontics, and is represented by professionals and endodontist who are more interested in how to perform root canal treatment as quick as possible, generally in a single session / visit.

The second school of thought is concerned more about how, when, why, and in which manner to perform root canal treatment. Thus, we can reason that the first operate on the basis of the technical principles of the treatment, wheras the latter adopt the same principles, but base them on biological ideology.

Therefore, at present there are two categories of educator and endodontists. The first are considered disciples of the strictly technical school and can be referred as Technologist. These professionals and educator disseminate information and operate using modern techniques, new equipment, innovative materials and new treatment methods, with the goals to perform a root canal treatment much faster than could be done some years ago. For the disciples if the technical development in endodontics,the apical limit of instrumentation and root canal filling is not always respected, and the majority of them appreciate a little extrusion of the filling material, the “apical puff”.

For the Technologist the main support for therapeutic decision-making is based on clinical and radiographic evaluations of the results of treatment, performed at different post-treatment observation periods, and mainly a reliance on long professional experience. These results therefore generate data that are based on non-controlled studies, mostly without the support of comparative data, (histopathological results), which must be retrieved from the clinical observations during and after treatment.

In root canal treatment of teeth with pulp necrosis and with evident radiographically chronic periapical lesions, histological findings compared with radiographs are frequentlydifferent.Considering that after endodontic treatment the histopathological findings do not always coincide with the clinical/radiographic results the latter alone should not be considered a parameter for determining the success of this therapy.

TECHNOLOGIST PRINCIPLES OF ROOT CANAL TREATMENT

“TECHNOLOGIST”SCHOOL

AIM

• Make use of the technically advances in Endodontics,
• Make use of many years of clinical experience.
• Perform root canal treatment in one single session in all cases.
• As general rule do not use temporary dressings; that is, do not use calcium hydroxide as intra-canal topical medications between sessions.
• Shorten the time if root canal filling as much as possible.
• Perform treatment as fast as possible, with greater comfort for the patients and less professional stress.
• Use irrigation solution and filling materials, without considering biocompatibility issues.
• Determine SUCCESS of treatment based only on clinical and radiographically evidence.

“BIO-TECHNOLOGIST” SCHOOL

The school in which the professor and professionals apply the technology ,but respect the biological principles and concepts, is known as “BIO-TECHNOLOGISTS”. This school subscribe to the notion that in an era of full fledged health promotion, clinical procedure should not be carried out without scientific histopathological evidence. For these professionals, clinical guidance must always be packed by knowledge from laborotary, clinical, radioghrapic, tomographic and microscopic histological research that provides scientific evidence.

According to Spangberg“The majority of therapeutic procedure in Endodontics are based on philosophical considerations, and in what is worse, on personal opinions and/or on clinical experience of different authors, instead of on scientific evidence”(1995).

According to this school of thought, the success of root canal treatment is defined not only by post-treatment clinical and radiographic evaluation, but also by correlating treatment observation with histological findings from experimental research.

This approach will contribute to a quiet post-operative treatment, and particulary, to a large percentage of clinical, radiographic and histological success, and to post-treatment apical and periapical repair. Histological success, compared to clinical conditions of treatment, is the best possible success one can obtain from in vivo conducted experiments.

BIO-TECHNOLOGICAL PRINCIPLES OF ROOT CANAL TREATMENT

• Make use of technical advances in Endodontics.
• Attempt to attain the biologically ideal apical limit of instrumentation and filling, usinglatest generation of electronic apex locater.
• After tooth length determination, verify the anatomical diameter of the root canal at the level of real working length of instrumentation.
• Make an apical safe stop.
• Use biologically compatible irrigation solutions .
• Detoxify the toxic content of the root canal in crowndown direction ,without pressure ,in cases of pulp necrosis without or with evident radiographically peripical lesions.
• Control infection throughout the root canal systems
• Promote cleaning, shaping
• Combat the micro-organism that causes apical bacterial biofilm.
• Use bactericidal, but biocompatible irrigation solutions, inaccess of teeth with pulp necrosis and periapical lesions.
• Use temporary dressings that in topical medications between sessions, when indicated.
• Attempt to limit canal filling to the dentinal root canals
• Use biologically compatible root canal filling materials.

BIOLOGICAL PRINCIPLES ASSOCIATED WITH THE NEW ENDODONTIC TECHNOLOGY

“BIO-TECHNOLOGICAL SCHOOL”

Objectives

• Silent painless stages.
• Greater comfort for the patient.
• Less professional stress.
• Biological sealing of the apical foramen by mineralized tissueand /or fibrous tissue repair.
• Higher percentage of clinical, radiographic and histological post-treatment success.
• Transform the conventional perception that root canal treatment is synonymous with pain, by replacing it with a concept of being painless.
• Raise the prestige of the professional.
• Raise the prestige of the specialty itself.

In view of the fact that there are two schools of thought that teach Endodontics, each school assume a responsibility of fundamental importance .In sharing of knowledge each school needs to apply the biological principles that governs the treatment.

As in all medical specialties , a diagnosis must be based in conjunction with clinical experience which will establish the fundamentals basis for the theapyenabling more precise prognosis, and consequently a higher percentage of clinical, radiographic and histological success.