What does the future hold for endodontics? It is a question that many of you are contemplating, so let's address it.
The future of endodontics is very bright, indeed! In this first of two columns, we will address this issue from the following perspectives: type of cases, magnification, instrumentation demands, and obturation materials.
The types and difficulty of cases we are seeing, both as GPs and specialists, are changing. This is due to a number of factors, notably an aging population. More geriatric patients are seeking endodontic treatment. This is good news for the profession. Consequently, we are treating more "calcified" cases than ever before. Additionally, the use of advanced restorative techniques, such as posterior resins, has contributed to more coronal calcification, and, therefore, more difficult cases.
The increasing heterogeneity of our patient base also will be a contributing factor. We will be confronted with more challenging anatomy, such as fourth canals and C-shape molars. We also will regularly face the "Spectre of Retreatment." Russian paste retreatment cases are particularly difficult. This is a result of the high concentration of zinc phosphate cement in the paste.
The dental industry is addressing these issues. A perfect example is the creation of "smart" ultrasonic units. Dentists will be using these "smart" piezo electric ultrasonics to retreat failed cases and find calcified canals. Count on it!
Enhanced magnification, using either a microscope or loupes, is a must when performing challenging endodontic procedures. In the future, as these tools become more affordable, we will observe more general practitioners performing dental procedures under a microscope or with a good set of loupes and an external light source.
Instrumentation also will evolve dramatically. We will see more sophisticated design features on rotary files to increase efficiency, yet maintain safety, as with the new K3 file by SybronEndo.
We also can anticipate a change in the alloy itself (nickel titanium). Expect a change to either a more super-elastic alloy, or, perhaps, an improvement in the current nickel titanium. The need to make the alloy more predictable will be addressed. The goal is to do excellent endodontics with the least number of instruments. When dentists realize that canals can be machined predictably, not merely filed, a real paradigm shift will occur. These improvements will affect not only instrumentation, but obturation as well.
Engine design also will become more sophisticated, with features such as file recognition and irrigation lines that do not clog with sodium hypochlorite. Some manufacturers are realizing that simplicity is a salient feature of a good electric engine. Design engineers should not design engines for other engineers. They should design engines for dentists!
Obturation has benefitted from major changes in the past 10 years; the next 10 should be no different. Expect the introduction of new materials, and also a change in sealer characteristics. Most likely, more "resin dentistry" will be introduced into endodontics. Hopefully, the art of filling a root canal will progress scientifically and not be subject to the "politics of obturation." However, future obturation improvements will continue to be contingent upon good cleaning and shaping. Some things never change.
Techniques and material advancements make the future of endodontics exciting and profitable for all dentists. Keeping up with all the changes will be a challenge, but one which will be very worthwhile. Having "Just the facts - Nothing but the facts," makes it possible to remain on the cutting edge. Next month, we will again peer into the crystal ball to gain a glimpse of what the future holds. We see retreatment challenges, increased profitability, implant controversies…
Dr. Dennis Brave is a diplomate of the American Board of Endodontics and was the senior managing partner of a group specialty practice for 27 years.
Dr. Kenneth Koch is the founder and past director of the new program in postdoctoral endodontics at the Harvard School of Dental Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic education company. They can be reached at (866) RWE-ENDO, or visit their Web site at RealWorldEndo.com.
