Dentaltown June 2014 - (Page 42)

second opinion column What Exactly is "Modern Endodontics"? Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a "second opinion." Perhaps some of these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. - Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine A key review paper was published in 2007 by a team at the Eastman Dental Institute in London, UK.1 Their work was of tremendous magnitude and attempted to pool the vast array of outcomes studied in primary endodontic therapy from the previous 40 years. Part of their conclusion states: "The reported success rates have failed to improve over the last four or five decades." How could anyone say our success rates haven't improved? Because they probably haven't. The reason we're not improving in our overall success rates is because we focus too much on the things that matter the least. This is going to require a little explaining on my part, so bear with me as I take a slightly circuitous course to a place I call "modern endodontics." The Foundation: Science The reality is we don't completely understand endodontic disease, nor do we fully understand how our endodontic treatments affect teeth long term (for good and for bad). Is it possible that some of the things we do clinically to "fix" teeth might harm them over time? Don't we have literature to guide us-clinical science? The purpose of science is to explain and predict. It's like drawing a map. Listening to the messages in endodontics today, it's clear that many of our teachers have mistaken the "map" for the "terrain." That is, they think the way they understand things is the way things actually are. The 20th century physicist E.T. Jaynes describes this as the Mind Projection Fallacy. The map will never be the terrain and any inconsistencies between the two are always the map's fault! At a recent endodontic meeting here in the U.S., a well-known educator was asked, "What is the explanation for [the high success rates of ] the millions of maxillary first molars that have never had an MB2 canal uncovered or instrumented?"2 The answer: "I don't know and I don't care." Apparently explanation and prediction take a back seat when you think you've got things figured out! Specifically, you and I are interested in clinical research/science. We were all taught certain principles of endodontics in dental school and these were presented as doctrine. Straight-line access. X number of file sizes beyond the first file to bind. Minimum apical file size. All canals visible at the same time with one eye closed. (This could be a long list if we all got together and reminisced.) 1. 2. by Dr. Scott T. Weed 42 JUNE 2014 » dentaltown.com "Outcome of primary root canal treatment: systematic review of the literature - part 1. Effects of study characteristics on probability of success." Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Int Endod J. 2007 Dec;40(12):921-39. Kulild and Peters showed 95% of these teeth to have 2 MB canals! "Incidence and configuration of canal systems in the mesiobuccal root of maxillary first and second molars." Kulild JC1, Peters DD. J Endod. 1990 Jul;16(7):311-7. http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown June 2014

Dentaltown.com Highlights
Howard Speaks
Professional Courtesy
Continuing Education Update
Insurance Changes--Buyer Beware (and Be informed)
The Art of Hand Filing
The Value of Magnification, Documentation and Ergonomics
Currently In-network with a Lot of Plans
High Tech, Low Overhead
Second Opinion: What Exactly is Modern Endodontics?
Patency and Profound Anesthesia
Eliminating the Ding of Endodontics
You Should Know: EdgeEndo
Improved Dentistry through Advanced Digital Radiography
Black and White: Diagnosing Doesn’t Have to be Gray Area
Ways to Make the Internet Your Best Source for New Patients
Digital Microscopy
You Should Know: Dentyzion
Poll: Implants
Function Meets Aesthetics: Advanced Materials for Posterior Restorations
Disability Insurance, Another Look…
Inside United Concordia
Ad Index
Perio Reports
Excuse Me, I’m Talking Here
Dentally Incorrect

Dentaltown June 2014