May 1, 2011
by Carlos Ochoa, DDS, Gary Glassman, DDS, FRCD(C)
Endodontic treatment is already a very predictable procedure that shows very high success rates. In addition to proper shaping, obturation, and subsequent coronal restoration, it is the successful irrigation and decontamination of the root canal space to the apices and anatomic irregularities that is the sine qua non to achieving these results.
We must continue to improve our endodontic techniques so that our patients will benefit from the continued quality of life that the natural dentition has to offer. We must not fall back on the ease and simplicity that implants are marketed to offer our patients as tooth replacements just because the practitioner may not be up on the most current endodontic techniques and technology and may not have the confidence to provide appropriate treatment. We must offer our patients ALL options for treatment and provide them with the risks vs. benefits, advantages and disadvantages, and success vs. failure for each treatment alternative. We must NOT be dogmatic with respect to one treatment modality over the other. We should always have our patients’ best interest at heart when discussing different treatment options and guide them in the right direction. Endodontic treatment and implant replacement both have an important place in dentistry and it’s education and common sense that will provide our patients with the best treatment possible.
Even with the use of rotary instrumentation, the nickel-titanium instruments currently available only act on the central body of the root canal, resulting in a reliance on irrigation to clean beyond what may be achieved by these instruments. The root canal system has a complex anatomy that consists of arborizations, isthmuses, and cul-de-sacs that harbor organic tissue and bacterial contaminants. In addition, Enterococcus faecalis, implicated in endodontic infections as well as in endodontic failure, penetrate deep into the dentinal tubules, making removal through mechanical instrumentation impossible.
It is for these reasons that endodontic irrigation MUST be considered a treatment unto itself. Copious irrigation during instrumentation is crucial to dissolve the organic tissue and allow the dentin debris that is created to be kept in suspension and evacuated coronally. It is the FINAL IRRIGATION PROTOCOL that will make or break a case.
When speaking to dentists around the world with respect to what they would like to see improved in the endodontic treatment that they are providing for their patients, a common response is “I want to do it faster.” Well, that’s all fine and dandy but I say, “Lets do it better!! It’s not a contest, nor a race! Ultrasonic instruments and magnification allow better localization of canals, rotary instrumentation has made shaping quicker, and digital radiography has shortened treatment time. But, to properly irrigate the root canal system and take full advantage of the tissue dissolving and antimicrobial effects then it will take some slowing down at the completion of the endodontic treatment to provide the best possible result.
The May ‘Endodontic’ issue of Oral Health offers several articles on endodontic irrigation. Read them carefully and take to heart what they have to offer. They will be the stepping stone to providing your patients with a better chance for long term success and provide them with the quality of care and the quality of life that they demand and that they deserve.OH
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