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CONTROVERSIES IN ENDODONTICS

Department of Endodontology and Oral Diagnosis, Faculty of Odontology, The Sahlgrenska Academy at Göteborg University, Box 40530, Göteborg, Sweden;

L. Spångberg

Department of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA

^* corresponding author, Gunnar.Bergenholtz{at}odontologi.gu.se

CONTROVERSY In light of the technical procedures often encountered in endodontic therapy, it is not surprising that research in endodontics has focused on the development of effective tools and materials to facilitate root canal treatment. While the technological advances in endodontics have been impressive, the biological basis for root canal therapy has received comparatively little attention. This article, authored by two clinician-scientists, discusses several controversial and as-yet-unresolved biological issues relevant to endodontics. — Olav Alvares, Editor

 

Diseases of the dental pulp often have an infectious origin, and treatments are aimed to control infections of the root canal system. Endodontic treatment principles originally evolved on the basis of trial and error, and only in recent decades have scientific methods been adopted to support clinical strategies. Yet, relevant research on the disease processes, their diagnoses, and efficient treatment are rare in the endodontic literature. Hence, the advancement of biologically based knowledge significant to clinical endodontics has been slow. Therefore, many differences of opinion still prevail in this field of dentistry. This review highlights and analyzes the background of some of the more heavily debated issues in recent years. Specifically, it deals with disagreements regarding the clinical management of pulpal exposures by caries in the adult dentition, definitions of success and failure of endodontic therapy, and causes of and measures to control infections of the root canal system. Clearly, a most apparent gap in the published endodontic literature is the lack of randomized clinical trials that address the more significant controversial matters relating to the management of pulpal wounds, medication, and the number of appointments required for the treatment of infected root canals. However, trials in endodontics require extremely long follow-up periods if valid conclusions are to be generated. Therefore, it is not to be expected that there will be rapid solutions to these issues in the foreseeable future.

Key words. Pulpal disease, apical periodontitis, pulp capping, pulpotomy, pulpectomy, root canal treatment