Manor Haas, DDS, discusses how new instruments enhance endodontics.
Q: Have endodontic outcomes really improved over the years?
A: A quick glance at outcome studies may demonstrate how success rates of endodontic treatments have not improved significantly over the past couple of decades. However, this may be the wrong way to consider enhancements in endodontics.
Q: Then, how should we view new endodontic instruments and techniques as they relate to enhancing endodontics?
A: One should look at this differently than just from the success and failure perspective that studies present. We must keep in mind that procedures can now be done better and more easily, and new technologies let clinicians make more accurate diagnoses. For example, you should ask yourself the following: if not for the new tools and techniques, could difficult canals be negotiated as well and as efficiently as before? Could you diagnose complex cases as well as in the past? Could you manage an endodontic emergency and perform a pulpectomy as quickly and as well, in the little time you have available, if not for the many new NiTi file choices?
Q: How do instrumentation advances matter?
A: Instrumentation really matters to clinicians. This is thanks to the many potential pitfalls of improper instrumentation, such as canal ledging, blocking, and file separation. We need to remind ourselves that sometimes it’s not only the outcome of an endo procedure that matters. It’s important to note that what may have been extracted or treated only by endodontists in the past can now also be managed by GPs, while doing so more easily and predictably. This is thanks, to a large extent, to the many new instruments available to all clinicians. We do not get as nervous about treating challenging canals when the proper files are available.
Q: What are some clinical benefits of the new instrumentation systems?
A: NiTi files are now front and center in endodontic advances. We now have newer NiTi files that are engineered to instrument canals in less time, are able to maintain canal curvatures (transport canals less), and will fracture less, making them far better than older NiTi, or stainless steel, files.
Q: What are a couple of key trends in endodontic instrumentation?
A:The current generation of NiTi files is increasingly flexible and more fracture resistant, and, depending on the system, they require fewer files to instrument a canal. The recent advent of mechanized reciprocating NiTi files has been gaining recognition, as some of them may perform the bulk of, if not all, the required instrumentation with one file. Also, narrow and flexible NiTi files are increasingly replacing the need for small stainless steel hand files.
Q: How has the industry helped clinicians?
A: The industry has recognized the need for and the desire from clinicians to manage more complex cases. In turn, they have researched, engineered, and brought to market many tools to assist clinicians. Furthermore, competition amongst endodontic companies has only benefited clinicians and patients, as the manufacturers are constantly developing and introducing newer and better instruments. Certainly, endodontics is big business but, in the end, it’s a win-win for patients and the industry.
Q: What has enhanced magnification and illumination meant to endodontics?
A: The incorporation of quality loupes with headlights and/or dental microscopes into endodontic procedures has gained so much traction that it’s now almost considered a necessity. This is especially true in an aging population with calcified canals. Who would have thought just 10 to 15 years ago that microscopes would be used so much by GPs now? Enhanced magnification and illumination help us to look inside the endo access, diagnose hairline fractures, and find calcified canals better and faster. Furthermore, the clinician can keep the endodontic access opening smaller, thanks to improved visibility, and this conserves coronal tooth structure.
Q: What has 3-D imaging meant to endodontics?
A: This is a huge advance, and it is one of the most significant innovations we have ever seen. While many tools keep tweaking our clinical treatments, CBCT is often completely altering it.
Q: Could you discuss some examples of how CBCT is changing endodontics?
A: In many scenarios, CBCT is replacing the need for exploratory endodontic surgery or exploratory endodontic accesses. For instance, we can now determine exactly what canals have and have not been treated (including the infamous MB2 canal). We can diagnose resorptions and vertical bone loss (often indicative of a vertical fracture) better than ever before. And, best of all, this can be done without having to touch the patient, often saving patients from unnecessary surgical and nonsurgical endodontic treatments. With this in mind, we can treatment plan cases more accurately than ever before.
Q: Having practiced dentistry for 20 years, what do you find most impressive about endodontics now versus when you started?
A: The combined use of dental microscopes and CBCT means that the clinician can now see almost everything inside and outside a tooth, no matter how complex the site may be. The marriage between enhanced magnification and 3-D imaging means that we can diagnose, treatment plan, and treat potential endodontic cases unlike ever before.
Q: Any advice on new endodontic instruments?
A: If there’s a product that is new to you, then do your homework and see if it suits your style of practice, if it’s clinically relevant to your patients, and if the return on investment makes sense. Also, start using any new instrument or technique on easier cases, allowing yourself a bit of extra time and appreciating that anything new has a learning curve. All these things are important to consider and are simply common sense. You may think, “If it ain’t broke, don’t fix it!” But, if there’s something new that is truly better, one should seriously consider it.
Dr. Haas is a certified specialist in endodontics and is extensively involved in continuing education. He maintains a private practice in Toronto limited to endodontics and microsurgery. He can be reached at manor@haasendoeducation.com.
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