Changing Paradigms: “Restorative Endodontics”
A revolutionary concept shifting our approach to root canal therapy
We have witnessed only a handful of truly revolutionary changes in dentistry. A revolutionary concept doesn’t necessarily fulfill an unmet need—it actually changes our thinking and the way we approach a problem. It makes us question currently accepted standards and often begins a new era of technology and techniques. True paradigm shifts in clinical care require reproducible scientific and clinical evidence and often take years to develop. Case in point, the migration of our profession from the use of amalgam fillings with retentive forms to bonded composites with minimally invasive preparations.
Endodontics has evolved over the past half century. However, to a large degree obturation has remained the same. The physical and chemical properties (limitations) of historical materials (specifically sealers) led to time-consuming and inefficient procedures to condense gutta percha in an attempt to minimize the sealer interface.
Because previously available sealers would shrink upon setting, the condensation of gutta percha has been considered necessary to minimize the sealer interface between the gutta percha and the canal walls.
The techniques required to condense gutta percha (pluggers, spreaders, and carriers) insidiously led to the removal of excessive coronal radicular dentin to facilitate compaction. The result has been the weakening of the structural integrity of many endodontically treated teeth, making them more susceptible to fracture.
With the development of a new class of endodontic sealers known as nanoparticle bioceramic cements, we are now looking at a paradigm shift. This change in philosophy mimics that which we have seen in the past with bonded composites replacing amalgam.
BC Sealer (Brasseler USA) is a premixed medical-grade pure bioceramic sealer that exhibits absolutely zero shrinkage, is hydrophilic, forms hydroxyapitite upon contact with moisture, and bonds chemically to dentin.
Restorative endodontics is a new biologic standard of care that allows us to “shift” our thinking so that root canal therapy can now be considered an integral part of the restoration of a tooth. Instrumentation can now be limited to a size necessary only to achieve debridement and disinfection. Shaping (especially coronal shaping) is no longer dictated by obturation—a revolutionary concept.
With the introduction of bioceramic root canal sealers and bioceramic coated gutta percha (BC Sealer™ and BC Points™) we are seeing a revolutionary change in endodontics and restorative dentistry. These advancements have shifted and elevated our thinking allowing us to recognize a new modern biologic standard of care known as “restorative endodontics.”
About the Authors
Martin Trope, DMD, is clinical professor of endodontics at University of Pennsylvania School of Dental Medicine and maintains a private practice in Philadelphia, Pennsylvania. Ronald E. Goldstein, DDS, a pioneer in modern esthetic and restorative dentistry, maintains a private practice in Atlanta, Georgia.
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