Advances in Endodontic Diagnostics: An Interdisciplinary Approach to Dentistry

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Emerging research into the diagnostic phase of endodontics has exciting implications for emergency care, structural restoration, function, aesthetics, and most importantly–interdisciplinary care. Multidisciplinary dentistry has become essential for optimizing the patient outcome as well as the comfort and confidence of the clinician. The advances in technology afforded by thoughtful research allow for enhanced endodontic predictability.

Learning endodontics techniques is an important method for general dentists to improve upon their restorative techniques, thereby achieving the ultimate outcome–saving the tooth rather than resorting to removal and implants. It’s important for the entire dental team to be educated on the newest techniques in endodontics to aid in patient education.

Of course, multidisciplinary dentistry that incorporates endodontics begins with the Endodontic Triad: Cleaning, shaping, and obturation of the root canal. Recent and ongoing research has translated into vastly improved instruments to achieve vastly improved results.

A sampling of the most intriguing innovations to date include:

Surgical Microscopic Imaging–The outcome of a non-surgical root canal is just one example of the improved accuracy of employing microscopic imaging in endodontic and dental procedures. Enhanced visualization allows the practitioner to “focus” on technique rather than attempting to discern anatomical structures with an unaided eye. While not widely used in dentistry, the surgical microscope is proven to improve outcomes in ophthalmic surgeries.

Tooth Atlas 3-D Imaging– This may seem a bit unreal, but there is “an app for that.” eHuman has developed downloadable software that allows the clinician to study a patient’s unique dental anatomy in a virtual environment before treating a patient. “Measure twice, cut once” is not only for carpenters anymore. An older study, conducted in 2010 found that practicing 3-D virtual imaging while still in dental school is likely to lead the future dentist to confidently use this tool in the actual practice of dentistry.

Digital Imaging–Offers more detail than traditional X-ray. Digital imaging, such as CT and MRI have long been used in general medicine. Digital radiography (DR) is finding its way into endodontics and dentistry due to several factors. Principle among these is the ability to see inside a patient’s tooth system with greater precision. The ability to enhance digital images for greater diagnostic precision. Another wow factor with the use of digital imaging is the ability to digitally share images among practitioners in an interdisciplinary setting. No need for the patient to cart around X-ray upon X-ray to the different specialists involved in restoration.

Electronic Apex Locators–These instruments have been used to accurately determine root length/working space for quite some time. Previously, the rate of accuracy between various manufacturers was statistically insignificant. That research is further born out in this study. There have been leaps and bounds in the user-friendliness of EAL in the past few years. 6th generation EAL’s are available that are designed for use in a wet and dry environment. Also, the 6th generation EAL’s are capable of detecting a range of considerations from tooth vitality to horizontal fractures.

Nickel Titanium (NiTi) Shaping Instruments–These too have been conventionally used for shaping, ongoing research and the adaptation of technology have improved the diagnostic and clinical functionality of these instruments too. Specifically, the implementation of offset mass rotation versus the standard conventional centered mass rotation has enabled clinicians to achieve more accurate centering ability. There are several “5th generation” NiTi files on the market; each different offering features to suit the preferences of the clinician. A basic overview of the evolution of 5th generation instruments with a comparison of models can be found in this study.