Dentaltown July 2020 - 40

"Our goal in endodontic
treatment is to reduce
bacteria counts to
the lowest that we
possibly can and to
create the right set
of circumstances in
the root canal system
that, proven through
scientific studies,
will allow the body's
natural biological
processes to take over
and resolve pathology."

Essential equipment for endo
Now that we understand what we're
actually trying to accomplish, how can we
best get there today?
Rotary instrumentation and operating
microscopes were introduced to endodontics
within the past 30 years and revolutionized
the way endodontic treatment was performed. They've become the standard of
care for any endodontist and should be the
standard for anyone performing root canal
treatment today. It's also quickly becoming
the standard to have a cone-beam scan of
all teeth we intend to treat. Because we
know that we can't treat what we can't see,
having a preoperative CBCT scan that aids
in the identification of all the canals, and a
microscope to physically locate those canals
during treatment, is essential to adequately
treat complex tooth anatomy.
This doesn't apply just to molars! Premolars and mandibular anterior teeth are
some of the most difficult teeth I treat-and
some of the most common for me to see
in my office as re-treatment procedures.
Virtually any tooth in the mouth can
bifurcate or trifurcate into multiple canals
or have branched apical anatomy that often
is untreatable (Fig. 1). And these are the
cases that will look great on postoperative
radiographs because we obturated all of the
main canals beautifully and completely,

Fig. 1: In this molar, the mesial apex
has four separate portals of exit as well
as a lateral canal at the midroot level.

40

but come back to us with persistent pain or
pathology. They're our head-scratchers and,
many times, before or after re-treatment
these teeth get replaced with implants. It's
an all-too-common occurrence, and one
that may be preventable with the right
technology.

Expensive-but valuable
I don't generally consider myself an early
adopter of technology-not in my personal
life or my professional life. I was skeptical
about GentleWave when it was brought to
me for an introduction, but I warmed up
quickly after consulting with classmates
from my endodontic residency at Temple
University who had already started to use
it and whom I trust very much. It involved
a leap of faith for me, because moving to
this system was antithetical to many of the
principles of my first 11 years in practice.
To colleagues unfamiliar with GentleWave, what I usually hear from them is, "I'm
not paying all that money for a different
irrigation system" or, "There isn't enough
research to show better results or improved
efficacy, so I'm not buying in yet." I felt
the same way-until I knew better. While
the latter statement is true at this time, the
former couldn't be further from the truth.
Yes, the system is very expensive-and
the price has risen since I bought my two
units. But to me, it's much more than just an
irrigation system. And regarding the science,
it's true that there aren't many long-term
studies to demonstrate improved efficacy
and success rates, but empirically, in my own
office, in the short term, we're absolutely
seeing improved success, faster healing of
apical lesions and quicker regeneration of
osseous tissue.
(By the way, yes, I did say "two units."
I started with one, but when I brought on
an associate in late 2018, we were both
using GentleWave so often that each of us
needed to have our own unit to keep the
schedule flowing.)

JULY 2020 // dentaltown.com

DT0720_Axx_Endodontics_MM.indd 40

6/22/20 12:36 PM


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Dentaltown July 2020

Table of Contents for the Digital Edition of Dentaltown July 2020

Dentaltown July 2020 - Intro
Dentaltown July 2020 - Cover1
Dentaltown July 2020 - Cover2
Dentaltown July 2020 - 1
Dentaltown July 2020 - 2
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