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Endo trends & concepts

Sept. 1, 2006
The troubadour Bob Dylan aptly describes what is currently happening in the world of endodontics.

The troubadour Bob Dylan aptly describes what is currently happening in the world of endodontics. Women have made great progress within the specialty, in fields ranging from clinical practice and research, to volunteer leadership and charitable giving. Consider the current endodontic professional landscape:

For the times, they are a changin’ …

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✿ Dr. Sandra Madison, of Asheville, N.C., served as the first female president of the American Association of Endodontists in 2004-05. The 63-year-old Association represents the endodontic specialty nationwide and boasts three additional female leaders who serve as district directors on its board and one who serves as an officer on the Executive Committee.

✿ Two women serve as trustees, and one is an appointed officer of the AAE Foundation, the largest endodontic philanthropic organization in the country.

✿ One female endodontist is an examiner for the American Board of Endodontics, the certifying board for the specialty.

The increasing leadership roles women play within their professional associations are indicative of their larger numbers in the endodontic specialty. Al-ready, women represent 19 percent of the total number of endodontists in the United States, and their ranks continue to grow each year. Nearly 25 percent of students enrolled in an ADA-accredited, graduate endodontic program are women. These statistics signify a positive trend for the specialty and dentistry in general, as women bring new talents, perspectives, and priorities to a field that historically has been dominated by men.

But the endodontic specialty has changed in more ways than just its demographic make-up. It has embraced the relatively new concept of evidence-based endodontics. This process begins with a specific question, examination and evaluation of all relevant literature, and integration of that information with clinical expertise to make sound clinical decisions.1

The ADA defines the term, “Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences.2

This concept allows endodontists and general dentists to make the best treatment choices based on scientific data while they can keep the needs of their patients at the forefront. According to the ADA, U.S. general dentists performed more than 11 million endodontic procedures last year. Proficiency in endodontics is a must for all general dentists, and the role of endodontists cannot be overstated in their providing the most up-to-date scientific evidence and consultation.

Endodontics therapy has been shown to have a survival rate of 97 percent. To achieve this result, properly diagnose the case, adequately disinfect, clean, and shape the canal, obturate the canal in three dimensions, and place a suitable restoration.

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Accurate diagnoses are paramount for optimal patient outcomes. Listening to patients, assessing their chief complaints, and using and interpreting all the diagnostic tests available will allow practitioners to arrive at the diagnoses for correct treatment and follow-up care.

The role of endodontists on the dental team has been enhanced during the past decade through their integration of sophisticated techniques and instrumentation into daily practice. Rotary instrumentation using nickel titanium files allows for improved canal debridement that helps prevent procedural errors through more efficient preparation of the root canal system.

Another tool in contemporary endodontics is apex locators. They accurately assist in determining canal length, and detect root perforations and fractures.6 Apex locators, along with hand files, copious irrigation, and proper instrumentation techniques, ensure clean, disinfected canals that are ready to be obturated. Sufficient obturation of the root canal system is necessary to prevent re-infection. Nonhealing following root canal treatment has largely been attributed to incomplete obturation.3 This includes missed canals, especially in the mesio- buccal roots of maxillary molars, distal roots of mandibular molars, and unaddressed canals in anterior teeth and bicuspids. Most canals are obturated using gutta percha in a lateral-condensation or vertical-compaction technique.

After obturation, place a coronal seal that prevents leakage.4 Temporary restorations often use cotton as barriers under restorations. When restoring a tooth, remove all of the temporary restorative material, as well as the cotton left in the chamber. This is one of the most common errors in restoration noted by endodontists when performing endodontic retreatment. The final restoration is the cornerstone for ensuring future success of the tooth. Whether it is placement of a crown or restoration of endodontic access, it is necessary to place a restoration that completely seals the margins and restores the functional integrity of the tooth.

New materials used in endodontics such as Mineral Trioxide Aggregate have greatly improved the prognosis of teeth that at one time were considered hopeless. MTA induces hard tissue formation when used as an artificial barrier in apexification of the immature tooth, it also provides an excellent root end seal in endodontic surgery, while not being affected by blood contamination and eventually leading to cementum growth over the MTA retrofill.8 Research continues on many new and exciting products to constantly improve outcomes in all facets of endodontics.

Operating microscopes are also now part of the magnification standard required in endodontic graduate programs. They are used in locating and negotiating calcified canals and retrieving separated instruments, and they are invaluable in providing surgical root canal treatment.5 They are invaluable in retreatment cases and may lead to improved outcomes in surgical cases.7

Of course, this is a sampling of the latest con-cepts available in the art and science of endodontics. Additional information in any of these areas and others is available to general dentists through consultation with reliable endodontic peers who can and should be indispensable players on the dental team. In taking advantage of their skills, knowledge, and advice, general dentists are sure to have satisfied patients who receive the highest comfort, function, and esthetics and therefore can maintain their natural dentition throughout their lives.

References:

1 Jadad A.In: From trials to decisions: the basis of evidence based health care. Randomized controlled trials. London: BMJ Books; 93-107.

2 http://www.ada.org/prof/resources/topics/evidence based.asp.

3 Ingle JL. The Washington study of success and failure. In: Ingle JL, Bakland LK, eds. Endodontics. 5th ed Hamilton, Ontario, Canada: BC Decker: 2002, 748.

4 Swanson K. Madison San evaluation of coronal microleakage in endodontically treated teeth part I - time periods. J Endod 1987;13(2) 56-59.

5 Mines P, Loushine RJ, West LA, Lievrchr FR, Zadinsky JR, Use of the microscope in endodontics: a report based on a questionnaire. J Endod 1999;25(11): 755-758.

6 Fouad AF, Reid LC. Effect of using electronic apex locators on selected endodontic treatment parameters. J Endod 2000;26(6):364-367.

7 Rubinstein RS, Kim S. Long-term follow-up of cases considered healed one year after apical microsurgery. J Endod 2002;28(5): 378-383.

8 Shabahang S. State of the art and science of endodontics. JADA 2005 136(1): 41-52.

Clara M. Spatafore, DDS, MS

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Dr. Spatafore resides in Sewickley, Penn. She is an assistant professor at Allegheny General Hospital where she teaches in the general practice residency program and is the staff endodontist. She maintains a private practice limited to endodontics. Reach her at (724) 940-3963.

Board-Certified, female Endodontists out of approximately 700

  • Catherine E. Wurm
  • Lisa R. Wilcox
  • Lesley A. West
  • Leslie A. Werksman
  • Deborah E. Tung
  • Patricia A. Tordik
  • Kathryn G. Stuart
  • Laurie L. Southard
  • Clara M. Spatafore
  • Colleen C. Shull
  • Susan R. Sheldon
  • Beth A. Sheridan
  • Michelle A. Schaeffer
  • Julie A. Saviano
  • Ellen Sachs
  • Paula Russo
  • Heidi Ray
  • Cindy R. Rauschenberger
  • Martha E. Proctor
  • Maria A. Rabbio
  • Leigh A.R. Pickenpaugh
  • Antoinette M. Pettitt
  • Elizabeth S. Perry
  • Mary T. Pettiette
  • Pamela Pappas
  • Debra J. Pace
  • Darlene R. Hachmeister
  • Susan E. Hagel-Bradway
  • Virginia Karapanou
  • Stella M. Kitzenberg
  • Bernice T. Ko
  • Kimberly A. Kochis
  • Jenny G. Kopp
  • Jan M. LaCombe
  • Sandra A. L. Laturno
  • Linda G. Levin
  • Deborah C. Loth
  • Sandra Madison
  • Sandra R. Makkar
  • Donna J. Mattscheck
  • Debra A. Meadows
  • Darlene C. Melton
  • Leslie I. Miller
  • Christen J. Nielsen
  • Ina L. Griffin
  • Lisa P. Germain
  • Kathleen T. Frankle
  • Kathleen R. Craig
  • Melanie W. Burns
  • Jeanette L. Brandal
  • Lynne A. Baldassari-Cruz
  • Joyce L. Awramik
  • Sondra L. Avant
  • Anita Aminoshariae