The importance of respecting the original endodontic anatomy in nonsurgical endodontics

Part I: How to avoid missing canals?

Shaping, cleaning of the root canal system are essential phases of orthograde root canal treatment. Their correct execution allows the clinician to hit the goals of endodontic treatment and achieve the success of the therapy. In nonsurgical endodontics the difficulties encountered by the practitioner are almost exclusively of anatomical type, and the risk of missing anatomy during root canal treatment is high because of the complexity of the root canal system. Missing canal is one of the most common possible cause of failure, the clinical impact of missed anatomy can be clearly demonstrated with a large number of re-treatment case reports available in the literature; in the majority of these cases, failure of endodontic therapy is associated with untreated canal space. Localization and treatment of this missed anatomy typically leads to complete clinical and radiographic healing. Aim of the lecture is to highlight how important is that the clinician knows all the possible anatomical variations to prevent missed anatomy and to get the positive outcome of the therapy. Diagnostic imaging is an essential component of the preoperative diagnosis to prevent missed anatomy. CBCT offers great advantages compared to the traditional two-dimensional examination thanks to the three-dimensional visualization of the periradicular and endodontic space, allowing the clinician the perfect visualization of the real anatomy endodontic. In most cases, however, the operator must interpret the endodontic anatomy with a correct reading of the traditional 2D radiograph thanks to the knowledge of the anatomy of the root canal system; in the absence of diagnostic doubt the use of the CBCT solely for the anatomy endodontic visualization is a biological high cost for the patient in terms of radiation exposure. Aim of the lecture is to highlight how important is that the clinician knows all the possible anatomical variations to prevent missed anatomy and to get the positive outcome of the therapy and how the operator can make a rational and synergistic use of 2D and 3D imaging in order to provide the best service to the patient with the least possible biological cost.

The importance of respecting the original endodontic anatomy in nonsurgical endodontics

Part II: How to respect the root canal anatomy during the shaping

During the shaping, the original anatomy respect allows the operator to prepare the endodontic space saving radicular dentine, with an ideal shape for receiving an efficient volume of irrigant and the three-dimensional obturation. The execution of shapes that fit and meet the original anatomy decreases the risk of creating alterations in the morphology of the root canal itself, such as ledges or transport, regarded by the international scientific literature as factors predisposing to failure of the therapy; at the same time a well-shaped canal is easy to fill without extrusion of cement and gutta-percha. NiTi rotary files help a lot the clinician, but the most important thing to get a respectful shaping of the root canal system is to use them following a rational for treatment that works in each kind of canal: the knowledge of technical features of rotary files is really important, but the knowledge of the shaping technique is still more important than the rotary files. This lecture has two main goals: the first one is to underline how rotary NiTi files can create alterations that may result in a failure of the endodontic therapy if misused. The second goal is to highlight how nowadays in nonsurgical endodontics, thanks to the new system, a totally mechanical shaping can be safely performed by the clinician, getting high quality and original anatomy respectful shaping, even in complex
anatomies and even using a reduced number of instruments.

CLEANING: how to obtain the better results?

The cleaning and shaping of the root canal is a key procedure in root canal treatment. The aim of cleaning is the removal of tissue remnants and bacterial biofilms in order to allow 3d close adaptation of the root filling to the canal walls. In fact the complexity and variability of the endodontic system is often inaccessible to mechanical instrumentation and only the cleaning greatly depending on the action of sodium hypochlorite could dissolve and remove all of the remaining tissues and bacterial biofilms. Traditional irrigation with syringe and needle is often ineffective in cleaning such inaccessible areas. Newer irrigation methods allow for better cleaning by facilitating a more effective flow of irrigants. Adequate instrumentation is, however, a prerequisite for all cleaning methods. The purpose of the communication is to indicate, through a critical review of the new disinfection methods, a correct protocol to maximize the action of the irrigants and get the most out of this step.

Costs and benefits of non surgical retreatment and the new role of surgical approach

In the last years, modern techniques and new instruments have widened the role of endodontic retreatment, making possible to treat and solve complex clinical cases and multiple pathologies. Nevertheless, this does not mean that the use of endodontic surgery has decreased.

Perhaps indications have narrowed, but ultrasonic tips, magnification, microinstruments and new root-end filling materials have dramatically increased the success percentage; a success rate of over 90% has been reported. The use of a modern Endodontic microsurgery protocol represents one of the most important procedures in endodontic treatment.


Restodontics: Obturation and restoration protocols for everyday endodontics

All aspects of endodontic treatment are very important. Obturation of the canal system is a key to prolonged success. Choosing a proper technique depends on clinical conditions. First part of the lecture will discuss in critical way different methods of obturation of the 3d canal space. Proper procedures will be suggested in order to avoid mistakes.

Second part of the lecture will focus on post endodontic restorations. Clinicians are faced with lots of difficult decisions. Material choice and preparation technique are key factors to achieve success in everyday work. However there is a lack of simple procedures which can be implemented in the protocol. Lecture will show simple but efficient procedures both for obturation and restoration techniques. Every participant of the lecture will get lots of important clinical tips to be introduced to their practices.


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