28.03.12 Ahead of the Curve: Future Directions in Endodontics

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Ahead of the Curve: Future Directions in Endodontics

Written by L. Stephen Buchanan, DDS Wednesday, 01 April 2009 00:OO

The demise of endodontic treaiment as a credible procedure in dentisby has been greatly exaggerated, to paraphrase Mark Twain. This is ironic in light of the fact that

nearlyeveryendodontic instrumentand technique has been radically improved over the last 15 years. The concurrent rise of implant dentistry has occurred for many similar reasons, notthe least being the greatlyenhanced aesthetic and functional success rates seen overthe same time period. However, to categoricallysaythat placing an implant is better than saving a tooth with endodontic therapy is either na'ive or self-serving bythose who onlydo implant surgeryor sell irnplantfixbres. k an

endodontistwho also does implant surgery, the question becomes verysimple: Whatisin the patient's bestinterest?

To answer this question requires an understanding of the current advances and limitations of endodontic therapy. So, this article will present a viewpoint informed bywhat is technologically possible and biologicallyadequate in orderto help our patients make the best decisions as to whether a tooth should be saved or replaced. In the end, I always ask myselfwhat I would want done for me, or a loved one, and then the answer becomes prettystraightforward. The greatestdifficulties in that regard come in

treatment planning for teeth that have failing endodontic treaiment begging the question, "Whydid this fail?" Without an answer to that question, there is no wayto conscientiously decide whetherto save or sacrifice a tooth.

DIAGNOSIS AND CBCT IMAGING

Perhaps the greatest improvement in the specially, relative to beaiment planning endodonticfailures, is the advent of cone beam computed tomography (CBCT) imaging. The traditional projection radiograph is a 2-dimensional (2-D) shadow of a Z Plane object. Three-dimensional (3-D) imaging overcomes this major limitation byallowing

us to visualize the third dimension, while atthe same time eliminating superimpositions. CBCT, also called digital ~ l u m e tomography, is a new technique that produces 3-D digital imaging at reduced cost with less radiation forthe patient in comparison to traditional CTscans.1 It also delivers faster and easier image acquisition. The first

endodontist in the world (that I know of) to have his own CBCT machine is Dr. Yoshi Terauchi in Tokyo, Japan. Four years ago, he installed a CBCT machine in his office