Almost a century ago, Walter Hess showed the world the amazing complexity of root canal systems.1 It took nearly a century for technology to definitively confirm that root canals are every bit as complex as that displayed by Hess. Dye-stained teeth and micro-computed tomography have shown that isthmi, loop systems, webs, and fins make up tertiary anatomy that is universally present rather than the exception.2 This deeper understanding of three-dimensional (3D) anatomy comes with the recognition and challenge that there is much more to treat deep down in the root canal system. Just as technology has allowed us to see our world in more detail, it has also given us the capability of providing predictable and consistent therapy, from diagnosis to obturation.
Narrow-field cone-beam computed tomography (CBCT) has allowed practitioners to visualize the tooth and root canal system in an elaborate 3D environment, elevating our ability to diagnose endodontic pathology, identify canals, and modify intraoperative treatment.3
Enhanced magnification and illumination achieved with the microscope and loupes with a headlight has forever changed the field of endodontics, taking the invisible and making it visible.4 Very simply put: the more we can see, the more we can treat, and with today’s technology we can see much more. With improved vision and a greater sense of our microscopic environment, new technology in the form of access burs and ultrasonics has allowed us to more delicately and conservatively remove dentine that encompasses the pulp chamber and canals.5
It has been four decades since Herbert Schilder described endodontic therapy as a chemomechanical process, with instruments shaping and irrigants cleaning.6 Today we see new file designs, new file movements, and rapidly changing metallurgy that allow practitioners to more efficiently shape the root canal system and maintain complex 3D anatomy, all while decreasing the incidence of instrument separation.7 More efficient canal shaping has given us a unique opportunity to maximize new irrigation systems that utilize energy to drive disinfecting irrigants into untouched areas of the canal.8 New science and products have revolutionized our ability to successfully clean this anatomy, but have also introduced novel methods for sealing it. Today we see advancing technology that continues to build on the concepts of 3D obturation that were born over half a century ago.
We find ourselves in an incredibly exciting time, with endodontic science and technology advancing at an exponential rate. Our capacity to deliver endodontic services at the highest levels continues to expand, making this period of time quite possibly even more exciting for our patients.
1. Hess W. Formation of root canal in human teeth. J Natl Dent Assoc. 1921;3:704-734.
2. Vertucci F. Root canal morphology and its relationship to endodontic procedures. Endo Topics. 2005;10:3-29.
3. Cotton TP, Geisler TM, Holden DT, et al. Endodontic applications of cone-beam volumetric tomography [published online ahead of print July 19 2007]. J Endod. 2007;33(9):1121-1132.
4. Selden HS. The role of the dental operating microscope in endodontics. Pa Dent J (Harrisb). 1986;53(3):36-37.
5. Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: a review of the literature. J Endod. 2007;
6. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am. 1974;18(2):269-296.
7. Shen Y, Zhou HM, Zheng YF, et al. Current challenges and concepts of the thermomechanical treatment of nickel-titanium instruments. J Endod. 2013;39(2):163-172. doi: 10.1016/j.joen.2012.11.005.
8. Gu LS, Kim JR, Ling J, et al. Review of contemporary irrigant agitation techniques and devices. J Endod. 2009;35(6):791-804. doi: 10.1016/j.joen.2009.03.010.
About the Author
Christopher Joubert, DDS, is an assistant professor in the department of endodontics and director of predoctoral endodontics at Stony Brook University School of Dental Medicine in Stony Brook, New York. He is also a diplomate of the American Board of Endodontics.