Minimally invasive endodontics (MIE) joins a movement in dentistry which emphasises the preservation of natural tooth structure while ensuring successful treatment outcomes.[i] The aim of this approach is to reduce chair time, prevent complications, while minimising patient discomfort.[ii]
The conservative root canal treatment (RCT) approach is driven by advancements in technology, material science, and a deeper appreciation of the biomechanical properties of natural teeth.[iii]
The core principle of MIE is to minimise any processes that might compromise the integrity of a patient’s tooth structure due to the removal of infected or necrotic pulp tissue, as well as through access cavity preparation and canal instrumentation.i Excessive removal of dentine and enamel increases the risk of fractures and reduces the longevity of the treated tooth. MIE aims to address this concern by employing techniques that minimise unnecessary removal of healthy tooth material while still eradicating infection and preparing the tooth for restoration.i
The technological advancements driving the minimally invasive approach
The success of MIE is closely tied to advancements in technical training and expertise, as well as technology and materials. Innovations like cone-beam computed tomography (CBCT), magnification, irrigation devices and heat-treated Nickel-Titanium (NiTi) instruments have revolutionised diagnostic capabilities, treatment planning, and procedural accuracy.[iv]
CBCT is an enhanced digital imaging technology that provides detailed three-dimensional images of root canal anatomy, allowing clinicians to precisely map complex canal systems and identify pathology. It is the only imaging system that ensures the early and predictable detection of periapical lesions, with a minor risk of false positives.[v]
Electronic apex locators (EALs) are increasingly effective and often used in combination with intraoral periapical radiographs to establish working length (WL). Establishing WL is considered an important factor in ensuring the success of RCT, and supports MIE principles by reducing the risk of under or over-instrumentation of a root, both of which can lead to RCT failure or post-operative pain. [vi]
Dental operating microscopes and magnification loupes have improved visibility, enabling clinicians to create smaller, more precise access cavities and perform delicate procedures.[vii]
NiTi rotary and reciprocating files have revolutionised canal instrumentation. NiTi can be classified as an intermetallic alloy with low plasticity, meaning it resists permanent deformation after mechanical stress. These flexible files adapt to the natural curvature of canals, reducing the need for excessive shaping and preserving dentinal walls.[viii]
Advanced biocompatible sealing materials, such as bioceramics, ensure complete canal obturation even with conservative shaping. These materials have been engineered to offer superior sealing properties and promote periapical healing.[ix] There is also exciting potential in the quickly developing field of regenerative endodontic procedures (REPs), which uses advanced biomaterials or the patient’s own blood clots to revitalise necrotic pulp.x Currently only available as a treatment for immature permanent teeth, research on its efficacy for mature teeth is promising.[x]
Due to reduced dependence on extensive instrumentation, minimally invasive approaches rely heavily on effective cleaning and disinfection of canals. Irrigation systems like sonic and ultrasonic activators enhance the penetration of irrigants, ensuring thorough decontamination without aggressive mechanical preparation.[xi]
The future of minimally invasive endodontics
The future of MIE lies in continued technological innovation that supports the precise removal of infection while optimising the integrity of the remaining natural tissue. Advances in artificial intelligence and machine learning may further refine diagnostic accuracy and treatment planning. New materials with enhanced bioactivity and regenerative potential hold promise for healing and tooth preservation. Ongoing research into biomimetic principles will likely influence the design of restorative solutions that work harmoniously with natural tooth structure.
Lasting tooth preservation has always played a central role for COLTENE, which provides all the technology needed for modern conservative endodontics. For example, the CanalPro Jeni endomotor provides total digital assistance for canal preparation, assisted by an integrated apex locator and precise software that works with four NiTi file systems, including the HyFlex EDM NiTi files, which are made using electric discharge machining (EDM) to create a unique surface that makes them stronger, more fracture resistant, and more flexible than other files.
Minimally invasive endodontics represents a transformative approach in dental care, emphasising a balance between effective treatment and tooth preservation. As technology continues to advance, MIE will create a more sustainable and patient-centred future.
For more on COLTENE, visit https://colteneuk.com/
email info.uk@coltene.com or call 0800 254 5115.
Nicolas Coomber COLTENE National Account & Marketing Manager
[i] Marvaniya J, Agarwal K, Mehta DN, Parmar N, Shyamal R, Patel J. Minimal Invasive Endodontics: A Comprehensive Narrative Review. Cureus. 2022 Jun 16;14(6):e25984. doi: 10.7759/cureus.25984. PMID: 35859953; PMCID: PMC9287844.
[ii] Ericson D. What is minimally invasive dentistry? Oral Health Prev Dent. 2004;2 Suppl 1:287-92. PMID: 15646587.
[iii] Gulabivala, K. & Ng, Y.L. (2023) Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. International Endodontic Journal, 56(Suppl. 2), 82–115. Available from: https://doi.org/10.1111/iej.13897
[iv] Silva EJNL, Versiani MA, Souza EM, De-Deus G. Minimally invasive access cavities: does size really matter?. Int Endod J, 54, 153–155, 2021.
[v] Cotti E, Schirru E. Present status and future directions: Imaging techniques for the detection of periapical lesions. Int Endod J. 2022 Oct;55 Suppl 4:1085-1099. doi: 10.1111/iej.13828. Epub 2022 Sep 20. PMID: 36059089.
[vi] Kaur G, Thomas AR, Samson RS, Varghese E, Ponraj RR, Nagraj SK, Shrivastava D, Algarni HA, Siddiqui AY, Alothmani OS, Srivastava KC. Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis. BMC Oral Health. 2024 May 4;24(1):532. doi: 10.1186/s12903-024-04259-w. PMID: 38704529; PMCID: PMC11069301.
[vii] Bud M, Jitaru S, Lucaciu O, Korkut B, Dumitrascu-Timis L, Ionescu C, Cimpean S, Delean A. The advantages of the dental operative microscope in restorative dentistry. Med Pharm Rep. 2021 Jan;94(1):22-27. doi: 10.15386/mpr-1662. Epub 2021 Jan 29. PMID: 33629044; PMCID: PMC7880065.
[viii] Grande, N., Castagnola, R., Minciacchi, I., Marigo, L. and Plotino, G. (2023), A review of the latest developments in rotary NiTi technology and root canal preparation. Aust Dent J, 68: S24-S38. https://doi.org/10.1111/adj.12998
[ix] Drukteinis S, Rajasekharan S, Widbiller M. Advanced Materials for Clinical Endodontic Applications: Current Status and Future Directions. J Funct Biomater. 2024 Jan 26;15(2):31. doi: 10.3390/jfb15020031. PMID: 38391884; PMCID: PMC10889336.
[x] Scelza P, Gonçalves F, Caldas I, Nunes F, Lourenço ES, Tavares S, Magno M, Pintor A, Montemezzi P, Edoardo ED, Mourão CFAB, Alves G, Scelza MZ. Prognosis of Regenerative Endodontic Procedures in Mature Teeth: A Systematic Review and Meta-Analysis of Clinical and Radiographic Parameters. Materials (Basel). 2021 Aug 6;14(16):4418. doi: 10.3390/ma14164418. PMID: 34442940; PMCID: PMC8398537.
[xi] Plotino G, Grande NM, Mercade M, Cortese T, Staffoli S, Gambarini G, Testarelli L. Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals. J Appl Oral Sci. 2019 Jan 7;27:e20180045. doi: 10.1590/1678-7757-2018-0045. PMID: 30624461; PMCID: PMC6322636.
