by Better technology means more accurate diagnosis and treatment.
Advancements in technology have made it easier for dental professionals to deliver successful endodontic treatment. Nevertheless, endodontics continues to be a specialty that’s best handled by trained experts. “It is appropriate for a general dentist to perform endodontic treatment on a patient when he or she is properly trained to perform the said procedure, has the appropriate equipment and the treatment is within the skill set of that individual clinician,” says Gary Glassman, DDS, FRCD(C). If there’s any doubt the clinician can perform the procedure to the same standard of practice as an endodontic specialist, however, the case should be referred out, he points out. The American Association of Endodontists (www.aae.org) offers its Case Difficulty Assessment Form and Guidelines to help dentists with case selection, he adds.
Indeed, endodontic cases may present a number of challenges, notes Glassman, including:
- The diagnosis of endodontic versus non-endodontic issues.
- Anaesthetizing endodontically treated teeth, especially those that exhibit irreversible pulpitis with or without apical periodontitis.
- Preparing the access cavity while avoiding procedural accidents, such as perforations, gouging or the removal of unnecessary tooth structure.
- The location of root canal orifices, particularly the MB2 canal of the maxillary molar, lingual canals of mandibular incisors and premolars. With the appropriate equipment, clinicians can better locate canals and treat teeth appropriately.
- Negotiating blockages and ledges, and avoiding apical transportation and separated instruments within the canal confines.
- Obturation challenges, specifically well-condensed homogeneous fills, underfills, overfills and impingement on normal anatomic structures, such as the maxillary sinus and mandibular canal.
- Restorative challenges to prevent coronal leakage into a root-canal-treated tooth.
By staying current on the latest technology and techniques, endodontists can better address these challenges, Glassman says. “Rapid advancements in endodontic technology have permitted us to enjoy higher success rates. Patients can retain their teeth for as long as possible, reducing the need for retreatment and/or extraction and thereby limiting the high costs they once faced.”
The dental operating microscope is a prime example, he notes. “The dental operating microscope enables clinicians to visualize the anatomy of the pulp chamber. As a result, they can locate the canal anatomy more proficiently and offer minimally invasive treatment by keeping access openings as small as practical while maintaining the structural integrity of the tooth. In addition, practitioners are able to maintain a more ergonomically favorable position, thereby reducing any stress on their back and neck.”
Ultrasonic instruments with specially designed endodontic tips allow clinicians to uncover calcified canals, remove pulp stones, refine access preparations and remove post and cores, he continues. They aid in the debridement of the root canal system during irrigation protocols in a controlled and predictably safe manner.
Cone beam computerized tomography (CBCT) offers practitioners unprecedented accuracy and acuity. “Clinicians can visualize the tooth in three dimensions, providing them with a road map to the anatomy of the root canal system,” Glassman explains. “In addition, the resolution of the CBCT is higher than traditional radiography, allowing the detection of periradicular pathology, which may have otherwise gone undetected. The type, location and extent of internal/external resorption can now be definitively diagnosed and the relationship of normal anatomic structures can be assessed with ease.”
An opportunity
Dental service organizations offer specialists like endodontists an opportunity to connect with general dentists and their patients, who may require advanced care. An open dialogue between endodontists and their general dentist colleagues will help ensure that patients receive the best possible treatment, Glassman points out. Plus, the accessibility of the patients within their general dentist’s office is often more practical and convenient, both for the patients and the practitioners, he adds.
Communication and continuing education are a key component of the endodontic-general dentist relationship, he continues, noting that a true partnership between practitioners ultimately leads to better patient care.
Editor’s note: Dr. Gary Glassman, an inspirational mentor, educator and philanthropist, is a leading endodontic expert with a successful downtown Toronto, Canada, practice. Working hard to help smiles internationally, Gary continually travels around the world, with extensive work in Jamaica, teaching the latest techniques and technologies in dentistry and oral health to developing countries. As a specialist in his field, Dr. Glassman provides his professional opinion and has produced easy-to-follow videos that will engage, while allowing you to learn about how oral health affects overall health and the preventative measures that can be taken to prevent unwanted problems. With a globally recognized reputation for having extensive knowledge in his field, Dr. Glassman is known as an oral health expert throughout the health industry.
