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Endodontic 199 144
Endodontic 199 144
Why it works
My husband is an attorney, the corporate kind, not the slip and fall kind. He doesnt go to
court, and has never sued anyone. He interprets fine print all day long. His world is very
different from mine as an endodontist. While he patiently listens to me jibber jabber about
the marvelous cutting efficiency of the latest rotary file, the number of pixels in the newest
imaging system, anecdotes about nutty patients and the fact that I did not have time today
topowder my nose, I can see that he is baffled. Baffled somewhat by my enthusiasm
after all these years, but more so by the dogma that drives my beliefs about endodontics,
which clearly leaves no room for interpretation.
Endodontics
is alive and well.
So to get to the actual root of the problem (pun intended), the pulp and its
diseased remnants must be removed since they are the source of the problem
in the bone. The leaking root canal system must be eliminated. Extraction
is certainly one way to accomplish this, and once the tooth is gone the clear
evidence of healing is bone regeneration. But, if you have a hang nail, would
you cut your finger off? Doing the most expedient thing is not necessarily the
same as doing the right thing. A rule of thumb (pun intended) would be to ask
yourself what you would do if it were your own tooth. Honoring the answer to
that question helps me sleep at night.
If the tooth is restorable, if the periodontal condition is stable or can be made
so, and if the root is intact, I would chose the root canal every time. It is more
conservative, and less traumatic to the patient both physically and mentally. Yes,
a root canal system must be shaped, cleaned and sterilized properly. And, the
tooth structure must be maintained by using conservative preparation methods.6
But when all goes well, and it should, the POEs can be sealed extraordinarily
well. Then sit back and watch those LEOs heal (Figure 2). Problem solved.
pre-op
post-op
2 year follow-up
Figure 2: Digital image illustrating the results of
root canal therapy on tooth #19, with peri-radicular
healing of the bone around several POEs.