DentaltownUK Winter 2017 - 35

Continued from p. 33
Like most endodontists, my
natural reaction is to feel a little offended
when my dental colleagues tell me that
endodontically treated teeth break easier
than non-endodontically treated teeth. Or
maybe the feeling I have is guilt, because
they are right. In 2014 my practice averaged
almost one patient per day for evaluation of
an endodontically treated tooth that had a
longitudinal root fracture (split tooth or
vertical root fracture), while in the same
year I saw only four virgin teeth (free of
caries or restoration) that had longitudinal
root fractures.
It's a common misconception that endodontically treated teeth break more because
they become dehydrated and brittle.9,10
One reason they break more is because
our endodontic shaping objectives come
at the expense of nonreplaceable tooth
structure-at the expense of the strength
of the tooth.11,12 The reason why these teeth
require endodontics in the first place is because
they present to us with cracks, fractures, large
carious lesions or restorations, so preserving
what tooth structure we have remaining
becomes imperative.
Is it possible that larger shapes might
be more efficient at removing bacteria to
potentially increase the observed short-term
outcomes, but actually decrease long-term
outcomes because of root fractures? I think so.
It's also evident that blind one-size-fits-all root
preparations can cause immediate iatrogenic
failure in certain cases. Fortunately, with cone
beam computed tomography (CBCT), we now
have technology that enables the planning
of sophisticated, customized root shapes
for individual cases. We also have irrigation
technology that allows us to irrigate to the
apex without additional coronal enlargement,
and obturation devices and techniques that
can adequately fill smaller shapes.

Case 3

T

his case demonstrates my technique for infected necrotic cases. Tooth #30
presented with a necrotic pulp and symptomatic apical periodontitis. My
go-to root canal shape for this case type is a V-Taper 30, taken 0.5mm
long to give an apical diameter of 0.33mm. This allows for the placement of the
0.32mm EndoVac microcannula at the apex. Notice how these files avoid needlessly
removing excess dentin in the coronal half of the root, creating enough apical
shape to complete successful endodontics, while leaving a stronger root. Healing
is complete at the one-year recall.

Conclusion
Advocating minimally invasive endodontics should absolutely not be misconstrued
as license to be a lazy clinician; in fact, the
opposite is true. Using conservative root shapes
is a more arduous path to canal disinfection
because extra steps need to be taken to
supplement instrumentation. By relying less
on instrumentation for debridement, extra
emphasis must be placed on irrigation or the
use of an interappointment medicament to
make up for the difference.

Remember, the goal of endodontics is not
to get white lines to the apex on a radiograph,
or to achieve radiographic aesthetics; it's to
eliminate bacteria to cure or prevent apical
periodontitis. Advancements in imaging,
magnification, instrumentation, irrigation
and obturation have made endodontics
predictable with conservative shapes ... as
long as clinicians are willing to properly
embrace the technology to thoroughly and
thoughtfully treat these teeth. ■

dentaltownuk.com \\ WINTER 2017

35
http://www.dentaltownuk.com
Table of Contents for the Digital Edition of DentaltownUK Winter 2017
