Each endodontic step, executed to perfectionFeatured Products Promotional Features
Posted by: The Probe 17th March 2020
When patients ask if endodontic therapy has a good chance of success, you can answer that, yes, the data supports a predictably positive outcome. It has even been suggested that the success rate is as high as 90 per cent, if treatment has been carried out to the required high standard.[i] Proper risk assessment and management are essential for a good and stable long-term result, which is why experience and great technical skill is required by practitioners who are using quality tools and materials.
Dispelling the myths around this treatment is essential for acceptance,[ii] but it does get bad press – last Halloween, the American Association of Endodontists found that 77% of adults would rather go a day without their smartphone than get a root canal. The procedure to keep an infected tooth in function is based on a sequence of steps, which can be clearly explained to patients, to help them make an informed choice.
After the canal is accessed, cleaned and shaped, obturation ensures that the endodontic space is filled and sealed. Good obturation is central to treatment success and any analysis into endodontic failure or retreatment will consider the quality of obturation. The consequences of poor filling (either under or over filling) is reason enough for patients to return, or for them to file an official complaint about the dentist and practice.[iii],[iv] A well-obturated system will prevent the leakage/percolation of microorganisms or periapical/periodontal fluids, as well as entombing any “residual microorganisms that have survived the debridement and disinfection stages.”[v] So, it’s about preventing microorganisms entering and also isolating what remains inside from what’s left outside, to stabilise outcomes.
There are different techniques for obturation, which have been assessed and
re-assessed and some specialists may have developed their own hybrid system. Depending on what technique is employed, materials will be selected to suit. Good materials really are the key to becoming a great dentist in this modern era because they both work in tandem with treatment delivery.
For filling material, guttapercha (GP) is still the popular choice, even though it’s been around since the late 19th Century. A naturally occurring rubber, GP was used as a restorative material before endodontic specialists discovered it could be indispensable for their work. Why has it been used for so long? Well, it can be employed in combination with various obturation techniques and it has a number of necessary qualities. It is inert yet easy to manipulate, being so flexible, with generally minimal tissue irritability. It can be compressed and dissolved in certain solvents. The biocompatibility and low-toxicity of GP is also well known. Offered as both cones or pellets, the different forms of GP materials can be used with a range of techniques, from warm vertical compaction (its rubbery nature is enhanced at warm temperatures), cold or warm lateral compaction and the single-cone technique, where only a master cone is used, with the aim of delivering a faster treatment time. The various GP materials available are the result of evolution and development, and a “reflection of technologic advancement and sophistication, which help in ease of work and improved efficiency in root canal obturation”.[vi]
GP does have some limitations, however. For example, because it cannot bond to dentine it will not reinforce roots that have been compromised.[vii] As well as lacking adhesive qualities, it has a rigidity too and, with pressure, it may become displaced. Specialists can balance the limitations of GP by using a sealer alongside it. Again, there is a choice of sealant material available, including silicone sealers, calcium silicate-based sealers and glass ionomer sealers.
There are also obturation materials that combine GP with a sealer. To complement its range of GP-based materials, such as ROEKO Guttapercha Points, HyFlex™ Guttapercha Points and HYGIENIC™ Guttapercha Points, COLTENE supplies ROEKO GuttaFlow™ bioseal, an intelligent obturation material that will both fill and seal the canal. When it comes into contact with fluids, specific biochemical processes are activated, further supporting regeneration. Curing time is short – just 12-16 minutes – and with a five-minute working time, efficient treatment delivery is possible. Looking for an obturation material that combines a sealer allows clinicians to offer the gold standard of endodontics.
As with any specialist treatment, endodontic therapy is not without risks which must be managed. Technique and material selection are fundamental, ensuring that the appropriate selection has been made for each unique case. Good obturation is a solid marker for the eventual success of root canal therapy so care must be taken when deciding what material(s) to use. When all the steps have been completed to a high standard, the risk of failure or retreatment can be reduced. Despite its reputation, endodontic therapy is a safe and efficient procedure. By breaking it down into steps, then explaining these steps and how each will be performed, clinicians can assure their patients that it is nowhere near as scary as its reputation.
[i] British Endodontic Society. The myths about root canal treatment. Link: https://britishendodonticsociety.org.uk/patient-public/further-information/ (accessed November 2019)
[ii] What’s scary this Halloween? American Association of Endodontists. Link: https://www.prnewswire.com/news/american-association-of-endodontists (accessed November 2019)
[iii] Akbar I. Radiographic study of the problems and failures of endodontic treatment. International Journal of Health Sciences. 2015 Apr; 9(2):111.
[iv] Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. European Journal of Dentistry. 2016 Jan; 10 (01):144-7.
[v] British Dental Journal. 2014 Mar; 216 (6):315.
[vi] Prakash R, Gopikrishna V, Kandaswamy D, Student P. Gutta-percha – an untold story. Endodontology. 2005;17(2): 32-6.
[vii] Shashidhar J, Shashidhar C. Gutta percha verses resilon: an in vitro comparison of fracture resistance in endodontically treated teeth. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2014 Jan 1; 32(1):53.