Recent endodontic advancements – Dr Boota Uhbi

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  Posted by: probe-admin      16th March 2019

Root canal treatment is sometimes regarded with trepidation, but where a patient is suitable it can give their tooth a second lease on life. This is a preferable outcome for many patients, not just out of attachment to their natural teeth, but by enabling a shorter treatment duration than extraction and replacement.

Once the dental pulp has been compromised by bacteria, patients are generally faced with a choice between root canal treatment or an extraction (with the additional possibility of an implant). While some patients recount unfortunate horror stories, for many endodontic care is the preferable choice. It preserves as much of the irreplaceable natural tooth as possible, enjoys a favourably high success rate and avoids potential painful complications like dry socket which can be a risk following tooth extraction. Additionally, endodontically treated teeth retain a significantly stronger level of mastication than implants are capable of.[1]

Endodontics has come a long way since the first root canal was performed in 1838 by Edwin Maynard using a filed watch spring.[2]Nearly two centuries later, new techniques and technologies continue to be developed, the following are some key areas of innovation.

 

Imaging

Anatomical differences can frustrate root canal procedures, with success rates lowered in multi-rooted teeth compared to single rooted teeth. Likewise the shape of the roots can make the procedure more complicated and raises the risk of failure.[3]By gaining a better pre-operative understanding of the specific morphology of the patient’s roots, a more accurate prognosis can be made and potentially a higher rate of long-term success. The advent and application of imaging technologies that can capture three-dimensional views of the anatomy, such as cone beam computed tomography (CBCT), has facilitated superior diagnostic and treatment planning.

CBCT can facilitate the early diagnosis of apical periodontitis (AP). Using conventional radiographic technologies, AP is generally diagnosed when it has reached a fairly advanced stage (when the tooth is 40% demineralised or more). CBCT allows smaller lesions to be caught more often, allowing for earlier interventions.[4]

While CBCT offers significant improvements over older methods in a number of areas, it does involve a somewhat larger radiation exposure than conventional radiographs (though the dose is still substantially less than regular CT scanning).[5]The exact exposure does vary quite significantly between different machines, and this is an area that will see continued refinement over time.

 

Tools

Research indicates that reciprocating single-file instruments are less likely to cause pain than other types. This can be particularly advantageous for patients being treated for asymptomatic necrotic pulp with periapical lesions, as they are more likely to have pain following endodontic treatment than other patients.[6]

Evidence suggests that endodontic microsurgery has a significantly higher rate of success than resin-based endodontic surgery (94% versus 82%), however, larger scale studies are required to confirm these findings.[7]A key driver of the success of microsurgery has been the substantial advances in surgical operating microscopes, providing endodontists with a considerably improved view of the site and the infected canals. The nature of microsurgery requires specially designed tools as older designs are simply too big for the technique. This, combined with the improved optics, enables treatment of irregular and narrower canals that would be inaccessible with older instruments. Improvements in filling materials have also contributed to the favourable success rate of microsurgery.[8]

 

Dentine preservation

Retention of more dentine. It is understood that removing too much of the dentine during a root canal can leave the tooth weakened, and more susceptible to fracturing following the procedure.[9]Techniques are being developed to address this such as limiting coronal flaring. Research is ongoing on alternative means of canal disinfection, including the usage of ultrasonic technology – however, it is still far too early to predict whether this avenue will prove successful.[10]

 

Experience

BPI Dental is well equipped to handle even the most complex endodontic cases. The team of specialists bring a wealth of experience to diagnosis and treatment and BPI Dental’s dedicated endodontic facilities and high quality, cutting-edge equipment including the Carl Zeiss Extaro and Global Dental Microscopes and an advanced ultra low dose CBCT imaging scanner to ensure safe and predictable treatment. Whether you need to refer a patient or just want a second opinion, BPI Dental is ready and willing to help.

Endodontic treatment continues to advance not only in improving success rates, but also in broadening the number of cases that can be treated, as more and more teeth formerly considered untreatable become viable candidates. Meanwhile, patient demands to save their natural teeth will undoubtedly continue to mount, particularly with the twin drivers of an aging population and increasing rates of systemic diseases that can result in compromised oral health.[11]

 

For more information on the referral service available from Birmingham Periodontal & Implant (BPI) Dental, visitwww.bpidental.co.uk, call 0121 427 3210 or email info@bpidental.co.uk

 

 

REFERENCES

[1]Parirokh M., Zarifian A., Ghoddusi J. Choice of treatment plan based on root canal therapy versus extraction and implant placement: a mini review. Iranian Endodontic Journal.2015; 10(3): 152-155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509120/ December 19, 2018.

[2]Castellucci, A. A Brief History of Endodontics. Endodontics. 1: 2-5. http://www.endoexperience.com/filecabinet/Texbook%20Exerpts/Castellucci%20Text/chapter_01.pdfDecember 14, 2018.

[3]Elemam R., Pretty I. Comparison of the success rate of endodontic treatment and implant treatment. ISRN Dentistry. 2011; 2011: 640509. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168915December 7, 2018.

[4]Venskutonis T., Plotino G., Juodzbalys G., & MickevičienėL. The importance of cone-beam computed tomography in the management of endodontic problems: a review of the literature. Journal of Endodontics. 2014; 40(12): 1895-1901. https://www.jendodon.com/article/S0099-2399(14)00481-6/fulltextDecember 14, 2018.

[5]Kishen A., Peters O., Zehnder M., Diogenes A., Nair M. Advances in endodontics: potential applications in clinical practice. Journal of Conservative Dentistry.2016; 19(3): 199-206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872571December 7, 2018.

[6]Brignardello-Petersen R. Reciprocating single-file and multifile rotary instrumentation techniques likely to result in less pain after endodontic treatment of asymptomatic necrotic mandibular molars with periapical lesions. The Journal of the American Dental Association. 2017; 148(5): e51. https://www.ncbi.nlm.nih.gov/pubmed/28449755December 14, 2018.

[7]Kohli M., Berenji H., Setzer F., Lee S., Karabucak B. Outcome of endodontic surgery: a meta-analysis of the literature – part 3: comparison of endodontic microsurgical techniques with 2 different root-end filling materials.Journal of Endodontics. 2018; 44(6): 923-931.

https://www.sciencedirect.com/science/article/pii/S0099239918301341December 19, 2018.

[8]Ananad S., Soujanya E., Raju A., Swathi A. Endodontic microsurgery: an overview. Dentistry & Medical Research. 2015; 3(2): 31-37. http://www.dmrjournal.org/text.asp?2015/3/2/31/159172December 19, 2018.

[9]Haralur S., Al-Qahtani A., Al-Qarni M., Al-Homrany R., Aboalkhair A. Influence of remaining dentin wall thickness on the fracture strength of endodontically treated tooth. Journal of Conservative Dentistry.2016; 19(1): 63-67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760017December 14, 2018.

[10]Kishen A., Peters O., Zehnder M., Diogenes A., Nair M. Advances in endodontics: potential applications in clinical practice. Journal of Conservative Dentistry.2016; 19(3): 199-206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872571December 7, 2018.

[11]Nayak D., Roma M., Sureshchandra B., Majumdar A. Endodontic considerations in the elderly – case series. Endodontology.2014; 26(1): 204-210. http://medind.nic.in/eaa/t14/i1/eaat14i1p204.pdfDecember 19, 2018.


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