Dentaltown August 2017 - 48

Contemporary
Endodontics
A less invasive strategy for long-term success

T
by Dr. Daniel J. Boehne
Dr. Daniel J. Boehne is a
Diplomate of the American
Board of Endodontics. He is a
part-time lecturer at the UCLA
School of Dentistry, Section
of Endodontics and maintains
full-time private practice in
Dana Point, California. Email:
drboehne@danapointendo.com

48

AUGUST 2017 // dentaltown.com

o oversimplify the complicated,
the gist of endodontics is getting
bacteria out of teeth and sealing
them to prevent bacterial recurrence. Shape, clean, pack-the endodontic
triad. Decades of research by smart,
thoughtful clinicians and researchers
have led us to an understanding of our
procedural goals, and completing those
goals is believed to lead to our highest
possible rates of success.
When we talk about an endodontic
shape, we're talking about the hollow
shape that we impart in the root by
drilling and scraping the walls of the
naturally existing canal, making it larger.
The evolution of common endodontic
shapes is the product of both research
and clinical convenience. It's our belief
that we must create a certain amount of
shape to physically debride the canal walls
and to create room for the penetration
of irrigants and proper obturation.1-6
The degree to which we enlarge
the canal at the apex has been debated
among endodontists for decades, but
the consensus is that the apical canal
should be enlarged at least to some
degree, and then the remainder of the
canal should be increasingly enlarged
coronally to create a continuous taper
to the orifice.1,5 This approach allowed

better access for irrigants and obturation
instruments available at the time, such
as spreaders and pluggers, to reach to
the apical preparation. Greater taper
is also advocated to increase lateral
obturation forces with warm vertical
compaction of gutta percha. This design
was well thoughtout, but doesn't come
without risk.
Bacteria are the main cause of
endodontic pathosis,7,8 so eliminating
them and preventing their recurrence
becomes the goal of endodontics. It
makes sense to use bacteria removal as
a metric in an attempt to predict clinical
outcomes. A simple study design used is
to inoculate extracted teeth with bacteria,
then compare the efficacy of different
techniques in their ability of removing
the bacteria.3 The conclusions are used
to predict that the superior technique
will lead to superior success rates, and
the technique is adopted clinically.
This type of inference is problematic
when we realize that many endodontically
treated teeth are lost because of structural
failure, not just persistent infection.
Root durability doesn't appear to be a
significant variable within the relative
short scope of our outcome studies,
but it may be more important than we
realize for long-term success.



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Table of Contents for the Digital Edition of Dentaltown August 2017

Dentaltown August 2017 - Intro
Dentaltown August 2017 - Cover1
Dentaltown August 2017 - Cover2
Dentaltown August 2017 - 1
Dentaltown August 2017 - 2
Dentaltown August 2017 - 3
Dentaltown August 2017 - 4
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