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ISSN (Print) 1013-9052
EISSN 1658-3558
The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
| Tel. |
966-1-467-7328 |
| Fax. |
933-1-467-7308 / 966-1-467-7534 |
| Email |
saudidj@ksu.edu.sa |
|
Editorial
On the essential qualities of endodontics
It was with great delight I participated in the 11th Saudi International Dental Meeting as one of the guest speakers. The friendly atmosphere, the professionalism and the efficient organisation, by which the meeting was run, impressed me. My exposure, albeit brief, to the Saudi dental environment gave me also a very positive feeling. Among the young colleagues, who I met, there was a refreshing enthusiasm and dedication to achieve excellence in both dental research and patient care. The leadership also seemed to be in place to guide and to facilitate for the young generation to excel. This was truly an encouraging experience and I believe that dentistry in the Kingdom of Saudi Arabia is not only at a high level but also has a bright future. My lecture was on clinical procedures in endodontics and I am glad for the opportunity, given me here, to dwell on some of the points that were raised. Endodontics, in the year 2000, is on a virtual success wave brought about by a remarkable technological boost of this field of dentistry. In past years, dentists had to contend with far less than an optimal armamentarium to negotiate the many times, slender and curved root canals of teeth in need of endodontic therapy. Missed, straightened or blocked out root canals, perforations, apical over-instrumentation are but few of the downfalls colleagues all over the world have experienced and still endure in their efforts to achieve high quality endodontics. In the most recent years, several, very significant technological advancements have emerged which have made endodontics much more feasible than it used to be. To mention just a few, the introduction of the super-flexible nickel titanium alloy brought about the manufacturing of instruments apt for engine driven root canal instrumentation. Perse engine driven instrumentation of root canals is not new. But with the new alloy, instruments have become available to allow us to carry out the instrumentation procedure more predictable and even faster than before. The introduction of the surgical microscope to endodontics is yet another significant innovation, as the microscope brings light and enlargement and thereby enhances efficacy and predictability of all parts of endodontic therapy. Along with these improvements of the endodontic armamentarium, important new concepts and approaches evolved to carry through with the technical part of endodontics. We owe gratitude to all of those who have taken the lead in this technological development, which, if carefully utilised and properly taught, should improve the quality of endodontic care, world-wide. Yet, I am concerned about the strong focus we now see on the technical aspects of endodontics and the tendency, there is, to loose sight of the fact that endodontics is about disease processes of the pulp their diagnosis, treatment and prevention. Hence, endodontics is much more than a mere mechanical exercise. Of course, when indicated, root canal therapy should be conducted with the highest quality possible. But the task is primarily curative. It is to bring pulpal infections under control so that they no longer pose a threat to the patient either locally or systemically. Some of the lesions, e.g. asymptomatic pulpal exposures, do not invariably need invasive endodontic therapy and can be managed by conservative approaches. Others are indeed irreversible and require endodontic intervention. The formidable tasks for the dentists are then:
Endodontics is primarily an infection problem where the ultimate goal is to exclude the root canal system as a source of microbial exposure of the organism. On carrying out invasive endodontic therapy, dentists need to recognise that there is a vast difference in the approach to achieve this objective depending on whether the pulp is vital or non-vital. Hence, in a pulpectomy procedure of a vital pulp, the problem is basically to prevent bacterial contamination of the root canal system in conjunction with or subsequent to the procedure. In a non-vital pulp, on the other hand, the root canal system is primarily most often already infected. Therefore the emphasis of that procedure is on bacterial elimination and killing. The critical steps to accomplish effective treatments from a microbiological point of view have been outlined and well tested over many years of scientific research in the field of endodontics. Today "the biological foundation of endodontics is better and more clearly defined than ever before'1 (Larz Spangberg: Bure Engstrom Memorial Lecture at the European Society of Endodontology Congress, Goteborg, 1997; 1). However, that knowledge seems to be overlooked and/or disregarded by many of the proponents of the new endodontic technology. Emphasising cleaning, shaping and filling root canals in all their dimensions seems to have taken the upper hand rather than stressing the fact that instrumentation and proper fills are important tools to combat root canal infections. This is a most unfortunate development, as it tends to trivialise endodontics. For the good future of this discipline and for the quality of patient care, endodontic education should stress the means by which root canal infections can be prevented or managed. Reference Spangberg L Contemporary endodontology. Australian Endodontic Journal 1998; 24:11-16. Gunnar Bergenholtz, DDS, Odont Dr Professor and Chairman, Department of Endodontology and Oral Diagnosis, Faculty of Odontology, Goteborg University, Goteborg, Sweden |