Endodontics

 

Endodontics has a long history.  From silver points of  the past, to hand insrumentation, to today’s rotary instrumentation, every advancement seems to be a reaction to the limitations of the previous modality of treatment.  It’s important to be critical of every method, to understand why it is being used, and to understand the strengths and limitations of each method.   Starting with more recent history, the shift away from hand instrumentation to rotary endodontics was a response to apical failures associated with lateral condensation.  When rotary endodontics got started, the primary focus was on satisfying the biological requirement better than failures past, to seal the apex.  Rotary systems do this well by making the canal wide at the top, hence it is easier to irrigate and seal these canals at the apex.  With rotary instrumentation came thermoplastic obturation, and pretty x rays with nice white cones going down the canals, and even a tiny puff of cement through the foramen and accessory canals.  Biological requirement satisfied.  But with this, we saw an increase in coronal fractures, because these wide open holes meant less radicuar and coronal dentin; fragile teeth.  So there is the biological requirement, but there is also the subsequent restoration of the tooth, and the long-term prognosis of the tooth.   So right now, I’m using Brasseler USA’s endosequence system, and I think Dr. Dennis Brave and Dr. Ken Koch at realworldendo.com make a lot of sense in their approach to satisfy both.  They have a system that is synchronized from beginning to end, that has the benefits of rotary endo, but maintains conservative preps reminiscent of hand instrumentation.  They also have a post and core system that requires no drilling of post spaces.  The post space, in theory, is prepared already when the root canal is done.  (Okay, you have to burn out some gutta percha)  But as far as preparation, your post space was finished with your last endodontic instrument.  I’ve returned to this system after using many other systems in my training, and I find it to be the most simple and streamlined technique.  The important thing is to use it all the way through.  The paper points, and gutta percha points correspond exactly to the instruments, therefore, they fit perfectly in the canals.  They also have an injectable bioceramic sealer that is hydrophilic.  I’m getting ahead of myself, and sounding like an infomercial.   

At school, I learned basic hand-instrumentation, and the Brassler Endosequence system.   Then in residency, I used the GT Series X system.  In both environments, I was a trainee, and I had to use what I was told to use.  What killed me was that both in school and residency, to manage cost, there would be one set of supplies for the instrumentation, and another for the obturation, so there was no consistency with any particular manufacturer.  Sure, manufacturers will try to sell tons of components, but at the very least, the obturation system should match the one used for cleaning/shaping.  The gutta percha, whether you’re using single cone or heated, is made to correspond to your instruments.  So in school and residency, I championed this cause and created a black market of gutta percha points that matched the files we were using.  Yeah, I’m a rebel.  (No I’m not.)  Everybody loved them, and my gutta percha helped many people pass their boards, and is probably why many people are enjoying pain-free teeth for a longer time.   So if you want to debate with me at all, stick to your agrument and be consistent all the way from instrumentation to filling your canals.  If it works in your hands, okay, fine.  Let’s sort out what’s out there today, and that should show why I’ve returned to the system I’m using now.

 

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