DOCSLIB.ORG

Evaluation of the Paper Point Technique for Locating the Root Canal Apical Exit

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evaluation of the Paper Point Technique for Locating the Root Canal Apical Exit Evaluation of the Paper Point Technique for Locating the Root Canal Apical Exit Jose Luis Marcos -Arenal A thesis submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Master of Science in the School of Dentistry (Endodontics) Chapel Hill 2007 Approved by: Dr Martin Trope Dr Eric M Rivera Dr Daniel J Caplan ABSTRACT Jose Luis Marcos -Arenal: Evaluation of the Paper Point Technique for Locating the Root Canal Apical Exit (under the direction of Drs Martin Trope, Eric M Rivera and Daniel J Caplan) A new method for determining root canal working length ( WL ), the paper point technique (PPT) , has been claimed to be accurate and reproducible , but has not been formally evaluated. Hypothesi s: WL determination is more accurate when the Electronic Apex Locator Technique (EALT) is supplemented with PPT compared to EALT alone . The lengths of 84 root canals of unsalvageable human teeth were measured first using EAL T, then PPT. Endodontic files were cemented to the position indicated by PPT . The teeth were extracted and microCT - scanned . In 71 canals that provided adequate readings for both EAL T and PPT , the RCAE to file tip distance was measured to 20 µm resolution . Both techniq ues showed (1) moderate agreement and (2) excellent repeatab ilities . There was (3) a significantly greater accuracy in locating the RCAE when PPT was used compared to EALT alone (p ≤0.0 051 ). Conclusion: It may be advisable to supplement the EALT measurement with PPT. ii dedicated to the dentists of the Future iii ACKNOWLEDGEMENTS Dr T ro pe , Dr Rivera and Dr Caplan , you support ed me throughout this project and were patient with my innumerable questions . Every one of the pati ent patient s who participated in the study . And t he students and Admissions Desk staff (Sh irley †, Cynthia, Monty and Jean ) wh o referred them to us . Wallace Ambrose taught me how to use the m icro -CT machine . Hyuns oon , Lin and Dr G Koch from the UNC Biometric Co nsulting Lab oratory analyzed our data expecting no thing in return . The UNC Department of Endod ontic provided funds and premises for this project. Thank you. I will never forget it. JLM A iv TABLE OF CONTENTS LIST OF TABLES ................................ ................................ ................................ ................................ ......... viii LIST OF ILLUSTRATIONS ................................ ................................ ................................ ............................. ix LIST OF ABBREVIATIONS ................................ ................................ ................................ ............................. x CHAPTER 1: INTRODUCTION ................................ ................................ ................................ ................ 1 CHAPTER 2: REVIEW OF THE LITERATURE ................................ ................................ ........................ 3 2.1 APICAL THIRD OF A ROOT ................................ ................................ ................................ ....... 3 2.1.1 Anatomy and Histology ................................ ................................ ................................ .. 3 2.1.1.1 Of the tooth hard tissues ................................ ................................ ........................ 3 2.1.1.2 Of the tooth soft tissues: the dental pulp ................................ ............................... 6 2.1.1.3 Of the periodontal tissue surrounding the root canal exit. ................................ ...... 7 2.1.2 Physiology & Pathology ................................ ................................ ................................ .7 2.2 WORKING LENGTH DE TERMINATION IN ENDODONTICS ................................ ..................... 8 2.2.1 Definition ................................ ................................ ................................ ........................ 8 2.2.2 The importance of a correct WL determination. ................................ ............................. 8 2.2.2.1 Biological reasons ................................ ................................ ................................ .8 2.2.2.2 Philosophical Reasons. ................................ ................................ ......................... 9 2.2.3 The apical reference p oint in WL determination. ................................ ........................... 9 2.2.4 Methods to determine WL: description, degree of accuracy and shortcomings ........... 11 2.2.4.1 Periodont al sensitivity/Patient response. ................................ ............................. 11 2.2.4.2 Tactile Method. ................................ ................................ ................................ .... 12 2.2.4.3 Radiographic ................................ ................................ ................................ ....... 12 2.2.4.4 Electronic ................................ ................................ ................................ ............. 16 2.2.4.5 Combined use of EAL and radiographs ................................ ............................... 20 2.2.4.6 New method: the Paper Point Technique ................................ ............................ 20 2.3 MICRO COMPUTED TOMOGRAPHY (CT) IN EXPERIMENTAL ENDODONTICS .................. 22 2.3.1 Introduction ................................ ................................ ................................ .................. 22 2.3.2 Resolution of micro -CT (for measurement of teeth length). ................................ ......... 22 2.3.3 Limitations of micro -CT. ................................ ................................ ............................... 23 v CHAPTER 3: MANUSCRIPT ................................ ................................ ................................ .................. 25 3.1 INTRODUCTION, LITERATURE REVIEW and RATIONALE for this PROJECT ...................... 25 3.2 HYPOTHESIS ................................ ................................ ................................ ............................ 27 3.3 PURPOSE and SPECIFIC AIMS ................................ ................................ ............................... 27 3.4 MATERIALS and METHODS ................................ ................................ ................................ ..... 28 3.4.1 Overview of design. ................................ ................................ ................................ ..... 28 3.4.2 Subjects and Teeth ................................ ................................ ................................ ...... 28 3.4.2.1 Inclusion/exclusion criteria ................................ ................................ ................... 28 3.4.2.2 Collected data ................................ ................................ ................................ ...... 29 3.4.2.3 Sample size calculation: ................................ ................................ ...................... 29 3.4.3 In vivo part of the study: ................................ ................................ ............................... 30 3.4.3.1 Assessment of patients and teeth ................................ ................................ ........ 30 3.4.3.2 Anesthesia, operating field isolation and tooth decoronation ............................... 30 3.4.3.3 Obtaining the EAL -length ................................ ................................ ..................... 31 3.4.3.4 Obtaining the PPT -length ................................ ................................ .................... 32 3.4.3.5 Cementing an endodontic instrument to PPT -length ................................ ........... 35 3.4.3.6 Tooth extraction ................................ ................................ ................................ ... 35 3.4.4 Ex vivo part of the study. ................................ ................................ ............................. 35 3.4.4.1 Specimen preparation and storage ................................ ................................ ...... 35 3.4.4.2 Micro -CT image acquisition ................................ ................................ ................. 36 3.4.4.3 Volumetric reconstruction of the tooth apex ................................ ......................... 38 3.4.4.4 Analysis of reconstructed apices: measuring the file -tip to RCAE distance ......... 38 3.4.4.5 Observations and Measurements ................................ ................................ ........ 39 3.4.5 Data Analysis ................................ ................................ ................................ ............... 40 3.4.5.1 Definition of Variables ................................ ................................ .......................... 40 3.4.5.2 Analysis of the data ................................ ................................ ............................. 40 3.4.5.3 Reliability of the Image Analysis. ................................ ................................ ......... 41 3.5 RESULTS ................................ ................................ ................................ ................................ .. 42 3.5.1 Accuracy (n=71): ................................ ................................ ................................ ......... 43 3.5.2 Repeatability (n=9): ................................ ................................ ................................ ..... 46 3.5.3 Agreement (n=71): ...............................
Load more

Recommended publications
  • In Vitro Evaluation of the Ability of Three Apex Locators to Determine
    Basic Research—Technology In Vitro Evaluation of the Ability of Three Apex Locators to Determine the Working Length During Retreatment Fernando Goldberg, DDS, PhD, Benjamı´n Brisen˜o Marroquı´n, DMD,† Santiago Frajlich, DDS, and Cristian Dreyer, DDS Abstract The purpose of this in vitro study was to evaluate the he retreatment of endodontic failures has become a routine procedure in a clinical accuracy of three apex locators in determining the Tendodontic practice. Procedural errors that lend themselves to intracanal leakage working length during the retreatment process. Twenty and latent infection appear to be one of the major factors associated with endodontic extracted single-rooted human teeth with mature api- failures (1, 2). ces were used in this study. The root canal length of Sjo¨gren et al. (3) observed 62% success in roots with periapical lesions that were each tooth was measured placing a #15 file until the tip previously filled and were retreated. was visible at the apical foramen. The direct visual Bergenholtz et al. (4) reported a 94% success when the cause for retreatment was measurement was reduced by 0.5 mm and recorded. attributed to technical inadequacy. Retreatment is considered to be least complicated The root canals were instrumented and filled to the when the failure of the primary endodontic treatment is because of the underfilling of direct visual measurement using lateral compaction the root canal. technique. After 7 days the teeth were retreated using Sundqvist et al. (5) provided evidence that microorganisms harbor themselves in three apex locators: ProPex, NovApex, and Root ZX, for anatomic branches of the root canal system and may even reside in areas that were determining the retreatment working length.
    [Show full text]
  • Review Electronic Apex Locators
    J Med Dent Sci 2007; 54: 125–136 Review Electronic Apex Locators —A Review Aqeel Khalil Ebrahim, Reiko Wadachi and Hideaki Suda Pulp Biology and Endodontics, Department of Restorative Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan The establishment of a correct working length is the success of root canal treatment: cleaning, adequate one of the fundamental parameters for endodontic shaping and complete filling of the root canal system success. Traditionally this has been determined cannot be accomplished unless the correct working using radiography, but electronic apex locators length is established, and if the canal length is known, are increasingly being used. Electronic apex loca- damage to the periapical tissues and procedural acci- tors reduce the number of radiographs required dents such as ledging can be avoided by confining and assist where radiographic methods create dif- instruments and root filling materials within the root ficulty. The use of an electronic apex locator in canal system. combination with the radiograph is greater preci- The radiograph is one from the traditional method for sion in the determination of root canal length. The the determination of the root canal length, but it is diffi- aim of this paper is to review the electronic deter- cult to achieve accuracy of canal length because the mination of the length of the root canal. apical constriction (AC) cannot be identified, and vari- ables in technique, angulations and exposure distort Key words: Electronic apex locators, endodon- this image and lead to error1-2. Thus, in addition to radi- tics, root canal length. ographic measurements, electronic root canal working length determination has become increasingly impor- Abbreviations and acronyms: tant.
    [Show full text]
  • Influence of the Maxillary Sinus on the Accuracy of the Root ZX Apex Locator
    dentistry journal Article Influence of the Maxillary Sinus on the Accuracy of the Root ZX Apex Locator: An Ex Vivo Study Roula El Hachem 1,*, Elie Wassef 2, Nadim Mokbel 2, Richard Abboud 3, Carla Zogheib 1, Nada El Osta 4 and Alfred Naaman 1 1 Department of Endodontics, Faculty of Dentistry, Saint Joseph University, P.O. Box 11-5076 Riad el-Solh, Beirut 1107 2180, Lebanon; [email protected] (C.Z.); [email protected] (A.N.) 2 Department of Periodontics, Faculty of Dentistry, Saint Joseph University, P.O. Box 11-5076 Riad el-Solh, Beirut 1107 2180, Lebanon; [email protected] (E.W.); [email protected] (N.M.) 3 Department of Maxillo-Facial Radiology, Saint Joseph University, B.P. 11-514 Riad el-Solh, Beirut 1107 2050, Lebanon; [email protected] 4 Department of Prosthodontics, Saint Joseph University, B.P. 11-514 Riad el-Solh, Beirut 1107 2050, Lebanon; [email protected] * Correspondence: [email protected]; Tel.: +961-3836040 or +961-5452805 Received: 15 October 2018; Accepted: 11 December 2018; Published: 2 January 2019 Abstract: This study evaluated the accuracy of the Root ZX (J. Morita, Tokyo, Japan) electronic apex locator in determining the working length when palatal maxillary molar roots are in a relationship with the sinus. Seventeen human maxillary molars with vital pulp were scheduled for an extraction and implant placement as part of a periodontal treatment plan. The access cavity was prepared, and a #10 K file (Dentsply Maillefer, Ballaigues, Switzerland) was inserted into the palatal root using the Root ZX apex locator in order to determine the electronic working length (EWL); then, the teeth were extracted.
    [Show full text]
  • History of Endodontics
    AN IN VITRO COMPARISON OF WORKING LENGTH ACCURACY BETWEEN A DIGITAL SYSTEM AND CONVENTIONAL FILM WHEN VERTICAL ANGULATION OF THE OBJECT IS VARIABLE by Shane R. Christensen Submitted to the Graduate Faculty of the School of Dentistry in partial fulfillment of the requirements for the degree of Master of Science in Dentistry, Indiana University School of Dentistry, July, 2009. ii Thesis accepted by the faculty of the Department of Endodontics, Indiana University School of Dentistry, in partial fulfillment of the requirements for the degree of Master of Science in Dentistry. ______________________________ Joseph Legan ______________________________ Kenneth Spolnik ______________________________ Susan Zunt ______________________________ Edwin Parks ______________________________ Mychel Vail Acting Chair of the Research Committee and Program Director Date __________________________ iii ACKNOWLEDGMENTS iv When I was seven years old, I explained to my parents that I wanted to be an orthodontist and drive a semi on weekends. I have yet to go over the road with anything larger than my pickup, and my dream of moving teeth has transformed into a passion for saving them, but not a bad prophecy at seven. The completion of this chapter in my life represents the efforts of so many. I would like to thank my father. The pride of being your son simply cannot be measured. To my mother, for your unconditional love, compassion and support that through the years of my higher education sustained and focused me, I thank you. I thank my sister, Kettie, whose own accomplishments have pushed me professionally, and thanks also to her boys, Ethan and Tyler, whose spirit, energy and innocence have reinforced the importance of family.
    [Show full text]
  • The Use and Predictable Placement of Mineral Trioxide Aggregate® In
    By 'l'orsten H. Steinig I)I)S, Dr med denl. ADEC Cert.", John D. Regan BDcntSc. MSc. MS* and James I,. Gutmann DDS**. * Department of Endodontics, Baylor College of Dentistry. ** Specialist Endodontist in Private Practice, Dallas, Texas, [JSA. Address for correspondence: Dr Torsten H. Steinig, Department of Endodontics, Texas A&M University System Health Science Center, Baylor College of Dentistry, Room 335, 3302 Gaston Ave, Dallas, TX 75246, 1JSA. Email: [email protected] The Use And Predictable Placement Of Mineral Trioxide Aggregate@In One-Visit Apexification Cases Abstract Introduction Endodontic treatment of the pulpless tooth with an Root canal treatment aimed at the retention of pulpless teeth immature root apex poses a special challenge for comprises thorough cleaning and shaping, followed by three- the clinician. The main difficulty encountered is the dimensional obturation of the root canal system (I, 2) Treatment lack of an apical stop against which to compact an of immature teeth poses challenges for the clinician one of which is interim dressing of calcium hydroxide (Ca(OH),), the lack of an apical stop, which makes controlled obturation in three dimensions demanding if not impossible (3) In addition, or the final obturation material. In these situations the dentinal walls of an immature root may be very thin, thereby the unpredictability of the result, the difficulty in subjecting the tooth to the risk of fracture (4, 5) creating a leak-proof temporary restoration for the Various ways of managing the pulpless tooth with a wide open duration of treatment, and the difficulty in protecting apex have been suggested These include obturation of the root the thin root from fracture may lead to complications canal with a customised blunt-ended gutta-percha cone (6), filling when using traditional (Ca(OH),-based) apexification the root canal short of the apex with gutta-percha (7), or peri- techniques.
    [Show full text]
  • Clinical Reproducibility of Three Electronic Apex Locators
    doi:10.1111/j.1365-2591.2011.01897.x Clinical reproducibility of three electronic apex locators V. Miletic, K. Beljic-Ivanovic & V. Ivanovic Department of Restorative Odontology and Endodontics, School of Dentistry, University of Belgrade, Belgrade, Serbia Abstract analysed using paired t-tests with the Bonferroni correction, Bland–Altman plot and Linn’s concordance Miletic V, Beljic-Ivanovic K, Ivanovic V. Clinical reproduc- correlation coefficients at a = 0.05. ibility of three electronic apex locators. International Endodontic Results Mean and standard deviation values mea- Journal, 44, 769–776, 2011. sured by the three EALs showed no statistically Aim To compare the reproducibility of three elec- significant differences. Identical readings by all three tronic apex locators (EALs), Dentaport ZX, RomiApex EALs were found in 10.4% of root canals. Forty-three A-15 and Raypex 5, under clinical conditions. per cent of readings differed by less than ±0.5 mm and Methodology Forty-eight root canals of incisors, 31.3% exceeded a difference of ±1 mm. canines and premolars with or without radiographi- Conclusions The clinical reproducibility of Denta- cally confirmed periapical lesions required root canal port ZX, RomiApex A-15 and Raypex 5 was confirmed treatment in 42 patients. In each root canal, all three with the majority of readings within the ±1.0 mm EALs were used to determine the working length (WL) range. However, the small number of identical zero that was defined as the zero reading and indicated by readings suggests that EALs are not reliable as the sole ‘Apex’, ‘0.0’ or ‘red square’ markings on the EAL means of WL determination under clinical conditions.
    [Show full text]
  • Advancement and Role of Electronic Apex Locators © 2020 IJADS Received: 10-02-2020 Dr
    International Journal of Applied Dental Sciences 2020; 6(2): 504-506 ISSN Print: 2394-7489 ISSN Online: 2394-7497 IJADS 2020; 6(2): 504-506 Advancement and role of electronic apex locators © 2020 IJADS www.oraljournal.com Received: 10-02-2020 Dr. Nisha Dubey, Dr. Sanjeev Tyagi and Dr. Raghvendra Kumar Vidua Accepted: 12-03-2020 Abstract Dr. Nisha Dubey The electronic apex locators are the devices that are used in measuring the working length of canal which MDS, Peoples Dental Academy is very much needed for root canal treatment in the practice of endodontics. Apart from this, they also Bhopal, Madhya Pradesh, India play important role for other conditions of tooth. They have passed through the evolution from 1st generation to 6th generation with their own merits and demerits. These devices are very much needed Dr. Sanjeev Tyagi before starting the treatment the root canal treatment in the practice of endodontics and reduce the MDS, Dean and head of the department, Peoples Dental requirement of taking multiple radiographs for the same. Though they can’t replace radiograph for the Academy Bhopal, Madhya purpose measuring working length with much accuracy but of course they do support to a great extent for Pradesh, India the same. Dr. Raghvendra Kumar Vidua Keywords: Apex locator, RCT, working length (WL), generations MD, Associate Professor, AIIMS Bhopal, Madhya Pradesh, India Introduction One of the most important part of root canal treatment (RCT) is canal preparation, with removal of all soft tissues and microorganisms from the root canal which can be accomplished [1, 2] by correct determination of the working length .
    [Show full text]
  • Original Article Clinical Evaluation of Apex Locators and Cone-Beam Computed
    Sherwood et al Working Length Estimation in Calcified Canal Original Article Clinical Evaluation of Apex Locators and Cone-Beam Computed Tomographic for Working Length Determination in Pulp Canal Obliterated Traumatized Maxillary Incisors I Anand Sherwood 1, Lucila Piasecki2, Pavula S3, Pradeepa MR3, Divyameena B3, Nivedha V3, Ramyadharshini T3, Valliapan CT3 From,1Professor and Head, Department of Conservative Dentistry and Endodontics, CSI College of Dental Sciences, Madurai, Tamil Nadu, India. 2Clinical assistant Professor, Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, New York, US,3Post graduate student, Department of Conservative Dentistry and Endodontics, CSI College of Dental Sciences, Madurai, Tamil Nadu, India. Correspondence to: Dr. I. Anand Sherwood, Anand Dental Clinic, No 1 Meenakshi Towers, P T Rajan Road, Bibikulam, Madurai – 625002, Tamil Nadu, India. Email ID: [email protected] Received - 07 April 2021 Initial Review –10 May 2021 Accepted – 19 June 2021 ABSTRACT Aim: This clinical study evaluated pre- and intra-operative working length (WL) determination in incisors presenting with pulp canal obliteration (PCO), with cone beam computed tomography (CBCT) images measured by three softwares (3D Endo, SICAT and Horos), five electronic apex locators (EALs) (Apex ID, Canal Pro, E-Pex Pro, iPex II, and Root ZX Mini), and periapical radiographs. Materials and Methods: 24 maxillary incisors with history of trauma and PCO were included. Pre- operative CBCT WL measurements were performed using the softwares. Five EALs according to manufacturer’s instructions, followed by the radiographic method. Results: Pre-operative CBCT measurements (n=16) were similar among the different software (P>.05). Radiographic WL strongly correlated with CBCT measurements (P<.001).
    [Show full text]
  • Electronic Apex Locators- an Overview
    Review Article Electronic Apex Locators- An overview Amruta Khadse1,*, Pratima Shenoi2, Vandana Kokane3, Rajiv Khode4, Snehal Sonarkar5 1,4,5Senior Lecturer, 2Professor & HOD, 3Reader, Dept. of Conservative Dentistry & Endodontics, VSPM Dental College, Nagpur, Maharashtra *Corresponding Author: Email: [email protected] Abstracts Successful root canal treatment depends on thorough cleaning & shaping and 3- dimensional fluid impervious obturation of tooth within the confines of canals. To achieve this objective the apical constriction must be detected accurately during canal preparation and precise control over working length during the procedure must be maintained. There are many methods of working length determination including electronic method. Introduction of apex locators have definitely served as an effective adjuvant to radiographs. This article highlights the details of electronic apex locators which are available till now including development, generations, historical background, mode of action, classification, problems associated with the use and clinical acceptance. Keywords: Apex locators, Apical constriction, Endodontics, Resistance, Working length Introduction point at which the file leaves the tooth and enters the It is generally accepted that root canal treatment periodontium.(3,5) procedures should be confined within the root canal An electronic method for root length determination system. This can only be achieved if the length of the was first investigated by Custer (1918). The idea was tooth and the root canal is determined with accuracy.(1) revisited by Suzuki in 1942 who studied the flow of Several techniques have been used for determining the direct current through the teeth of dogs. He registered apical canal terminus. Traditionally, the point of consistent values in electrical resistance between an termination for endodontic instrumentation and instrument in a root canal and an electrode on the oral obturation has been determined by taking radiographs.
    [Show full text]
  • A Comparative Assessment of the Accuracy of Electronic Apex Locator
    J Clin Exp Dent. 2014;6(1):e41-6. A comparative assessment of the accuracy of electronic apex locator Journal section: New technologies in Dentistry d oi:10.4317/jced.51230 Publication Types: Research http://dx.doi.org/10.4317/jced.51230 A comparative assessment of the accuracy of electronic apex locator (Root ZX) in the presence of commonly used irrigating solutions Osama Khattak 1, Ebadullah Raidullah 2, Maria-Louis Francis 3 1 Assistant Professor of Endodontics and Co Ordinator Dental Clinics, RAK College of Dental Scineces, Ras al Khaimah, UAE 2 Junior Instructor, RAK College of Dental Sciences, Ras al Khaimah, UAE 3 Intern dentist, RAK College of Dental Sciences, Ras al Khaimah, UAE Correspondence: RAK College of Dental Sciences P.O Box Number 12973 Ras Al Khaimah United Arab Emirates [email protected] Khattak O, Raidullah E, Francis ML. A comparative assessment of the Received: 28/07/2013 accuracy of electronic apex locator (Root ZX) in the presence of com- Accepted: 29/09/2013 monly used irrigating solutions. J Clin Exp Dent. 2014;6(1):e41-6. http://www.medicinaoral.com/odo/volumenes/v6i1/jcedv6i1p41.pdf Article Number: 51230 http://www.medicinaoral.com/odo/indice.htm © Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488 eMail: [email protected] Indexed in: Scopus DOI® System Abstract Objectives: This study aimed to evaluate the accuracy of Root ZX in determining working length in presence of normal saline, 0.2% chlorhexidine and 2.5% of sodium hypochlorite. Material and Methods: Sixty extracted, single rooted, single canal human teeth were used.
    [Show full text]
  • The Standard of Practice in Contemporary Endodontics
    ENDODONTICS Colleagues for Excellence Fall 2014 The Standard of Practice in Contemporary Endodontics Published for the Dental Professional Community by the American Association of Endodontists and the AAE Foundation www.aae.org/colleagues Cover artwork: Rusty Jones, MediVisuals, Inc. ENDODONTICS: Colleagues for Excellence s we approach the third decade of our advancing millennium, one of the realities of American dentistry is the expanding A shift in the delivery of patient care. The private practice model is shrinking and giving way to corporate and group models promoting interdisciplinary treatment planning. This shift promises competence, reliability and cost control, all demanded by the corporate and industry structures that deliver the care (1). As dental schools graduate novice practitioners trained and educated in a “generalist model” of care, many young practitioners will seek opportunities within these groups that provide patient services involving more and more complex endodontic procedures under an interdisciplinary umbrella. Thus, it is increasingly important for the generalist and the specialist to participate in concerted patient management with the overriding value of quality and patient safety at its core (2). A sustainable practice model that promotes high-quality, collaborative treatment has been a hallmark of American dentistry for decades, and newer practice models must maintain this high standard in order to provide value for patients and manage the complex dental problems that will regularly arise. The practice of endodontics has concurrently experienced a shift in the delivery of services and the advancement of scientific discovery within the field. Emergent technologies in instrumentation, magnification and imaging aimed at treating and salvaging the natural dentition with consistent outcomes, are all hallmarks of contemporary endodontic practice.
    [Show full text]
  • Treatment Standards
    Treatment Standards 180 N. Stetson Ave. Suite 1500 Chicago, IL 60601 aae.org Introduction disparities exist in the levels of knowledge, Endodontics is the branch of dentistry that is competencyDespite similar and predoctoral skill, and clinical educational experiences curricula, of concerned with the morphology, physiology general dentists. Over the past two decades there and pathology of the human dental pulp and periradicular tissues. Its study and practice materials and endodontic treatment procedures. encompass the basic clinical sciences including Thesehave been include significant but are advancesnot limited in totechnology, microscopy, biology of the normal pulp, and etiology, diagnosis, prevention and treatment of diseases and injuries solutions and technologies, digital radiography, of the pulp and associated periradicular tissues as CBCTrotary three Ni-Ti dimensionalfiles, ultrasonics, imaging, enhanced bioceramics, irrigation etc. These changes have created a disparity in the American Association of Endodontists. quality of care provided by specialists versus defined by The American Dental Association and general dentists on teeth with complicated The American Association of Endodontists serves anatomy and morphology. as a trusted and credible source for information on diagnosis of pulp and periapical pathosis, treatment The effect of these developments on the Standard planning, urgent/emergent treatment, vital pulp of Care remains unknown. Currently general therapy, nonsurgical root canal treatment, surgical dentists perform approximately 75% of all endodontics, regenerative endodontic procedures, nonsurgical endodontic procedures. While and outcome assessment. endodontists perform only 25% of the total root canal procedures, they treat 62% of the molars. Treatment by the general dentist is expected to With generalists performing the majority of meet minimum standards as set out in guidelines.
    [Show full text]