Invitcd Author
By Professor Larz S. W. Sphngberg DDS, PhD.
Head, Department of Restorative Dentistry and Endodontology,
School of Dental Medicine, University of Connecticut Health Centre,
263 Farmington Ave, Farmington, CT, ClSA 06030-1715
Contemporary Endodontology
Editor's Note:
The 8th Biennial Congress of the European Society of
Endodontology was held in Goteborg, Sweden, June
12- 14, 1997. A comprehensive report is published in
this issue of the journol. The opening lecture of the
Congress was the Bure Engstrom Memorial Lecture
and was delivered by Professor Lan Spingberg.
Sincere thanks to Professor Spingberg for allowing
me to publish his fascinating lecture.
Abstracl
Clinical endodontics has made significant progress during this
century This lecture will cntically review the major bii?akthroughs
that have taken place during this period The final judgement of the
value of this progress, however, is the quality of care we can deliver
to our patients Although the advances have been imprmive. there
are also major disappointments and problems that need to be
recognised Looking at clinical endodontics today. thew is clearly a
dissonance between sound scientific knowledge and empirical
clinical practice It is important that these problems are recognised
and that endodontic research and teaching are refocused Only by
decisive action can progress be assured for clinical endodontics and
the prospect will be bright
Introduction
Endodontics has today a very sound biological founcation based
on good scientific information This foundation has not been built
dunng the last ten year3 but is the result of a slow evolution
throughout this centurv Looking back to the eaily days of
endodontic history during this period. we find some very valuable
publications of fundamental importance These 2arly. veiy
thoughtful and well-publishedfindings are not often read and theie
is therefore a tendency, especially among the younger endodontists
to overlook this information and to reinvent the wheel History will
reveal an amazing amount of facts established at a very early stage
of modern endodontics Therefore, I have chosen as L subject for
this lecture. in honour of Professor Bure Engstrom. to review
important achievements in endodontics which have led us to the
contemporary view we now hold Naturally, this will be my
assessment of the literatiire but I am sure you will agiee that the
few publications I am referring to here have in one way or another
changed endodontics and have contributed to our present view of
contemporary endodontology
The Early Years
One of the very early publications which became one of the
important cornerstones of endodontology, was Hc:ss' ( I 9 I 7)
publicationon root canal dnatomy. Although many additimal studies
AUSTRALIAN ENDODONTIC JOURNALVOLUME 24 No I APRIL 1998
on the vanability of root canal anatomy have been published
throughout the years since. Hess was a pioneer by opening up our
eyes to the fact that the root canal system is a very complicated
anatomical structure. This fact has come to guide clinical
endodontics since in selecting treatment options
The first 35 years of this century were dark years for clinical
endodontics The theory of focal infection was established by
Hunter ( I9 I I ) and later further documented by Billings ( I9 18)
This led to some 25 very dark years for clinical endodontics leading
to the unnecessary extraction of millions of teeth, which could have
been saved wlth endodontic treatment
Desplte the lack of interest for the treatment of the necrotic pulp
there were some rather interesting conceptual advances in the
treatment of the vital pulp duringthe same time period The person
who had most to contribute during this penod was W C Davis at
the University of Nebraska He carefully analysed the issues around
pulp extirpation, partial pulpectomy and pulpotomy and published
his findings in a number of very succinct papers dealing with the
techniques and clinical concerns (Davis I922 a, b. c)
"Pulp extirpation. or attempted extirpation. is time honoured,
but that is about the only honourable mention which can be
made of it That practice has been followed literally by millions
of diseased areas about the apices of teeth".
Davis 1922
Thus, he suggests, considenng Hess' anatomical findings. that it
must be very difficult to do a pulp extirpation. Therefore the
treatment of choice. he argued, was "pulpectomy"
"I therefore wish to contend that no pulp should be
devitalized. as with arsenic. The operations should be
performed with nerve block. . "
"The remaining pulp stumps. should not be brought in contact
with caustic. escharotc. or other tissue destroying agents The
pulp stumps should not be contused. lacerated. nor
mechanically injured as by broaching subsequent to the
operation of pulpectomy ".
Davis 1922
Since then. there have been numerous papers that have
demonstrated to us that the thought of pulp extirpation IS a practical
impossibility in most patients Another suggestion of Davis was the
careful preservation of the pulp after surgery forty - fifty years later
this issue was once again brought up through work by Nygaard-
Bstby ( 1944). and Nyborg ( 1960). Nyborg & Halling ( 1963) and
Mejare et a/ ( 1970) who explored the possibility of finding better
extirpation instruments Instrumentation technique and the
procedure of performing an atraumatic pulp removal IS still an
important and unsolved problem in endodontics There IS no
perfect instrument for an exact pulpectomy
Davis also told us, 75 years ago, that asepsis is essential for
success In the name of expedience it is often forgotten today that
PAGE I I
asepsis is one of the more important issues of vital pulp therapy.
This old concept, still very valid in endodontics today is imperative
in successful endodontic therapy.
"So much of our pulpotomy in the past has been done with
such lack of surgically clean precautions that few pulps have
been able to survive the infection introduced at the time of
operation".
Davis 1922
~ ~~ ~~~~ ~~
Another pioneering American endodontist was C.]. Grove.
During the 1920s he published a series of papers starting with
"Nature's method of making perfect root fillings following pulp
removal . . ." ( I92 I ) which was a verification and clinical application
of Hess' anatomical work some years earlier. "A new departure in
root-canal practice" was published in 1929. This was a novel work
in which he proposed the first reasonable clinical classification of
pulp diseases.
Class I. Exposed non-infectedpulp
Class II. Infected pulp
Class 111. Acute periapical infection
Class IV: Partially filled canals, non-infected periapical tissue
Class V: Chronic periapical infection or rarified area
Grove 1929
During this time period, for example, a Class V case was ai
automatic extraction case as they were considered as clear nsks and
a source of focal infection. Class I and II were the major cases
treated during that time period. Grove outlines some very
interesting rules on treating these cases, especially if they are put
into the perspective of today's clinical discussion.
Today's idea. suggesting that Class I cases should be completed
in one visit, was contemporary endodontics established more than
65 years ago. In Class II cases, however, Grove clearly advocates at
least a two visit procedure. This means that this is a multi-visit
procedure. That was a very important early observation for the
treatment of the necrotic tooth and so well documented in modem
literature.
sitting . . .*'
"In class II cases . . . If dressing is free from odour and culture
is negatie. proceed . . ."
Grove 1929
Grove was also the first to describe how to work with
measurements during endodontic treatment and to suggest a re-
assessment of instrumentsizes. He also suggested a better standard
for root canal instrument dimensions. The concept of dentine
infection and control of the dentine infection was also discussed in
Grove's work
"The means of measuring root canals opens new
possibilities in root canal work."
"By standardising the size of root canal filling materials to
the size of root canal instruments. a perfect fming filling can
be produced."
"The use of impermeable non-irritating materials in filling
root canals prevents the migration of bacteria from the
dentinal tubules to the periapical tissues . . ."
Grove 1929
PAGE I 2
These issues. very much of interest during the last 25 years in
contemporary endodontics, were thus very carefully assessed in the
distant past.
Another very important development in the early part of this
century was the introduction of calcium hydroxide in endodontic
treatment. Through a number of experiments Hermann (1920)
showed the value of calcium hydroxide as an antimicrobialintracanal
dressing. Considering the limited resources in microbiological
research techniques of that time period. his research was a
significant contribution to endodontics. Hermann continued to
publish on calcium hydroxide and in a later publication (I 930). he
also suggested the use of calcium hydroxide in vital pulp therapy. In
this way, Hermann had developed the whole modem concept of
using an antimicrobial agent for root canal disinfection and a mild
antiseptic as a pulp capping and pulpotomy wound dressing.
Unfortunately Hermann's work was not well understood during his
lifetime and it would take at least another 25 years before calcium
hydroxide would become a relatively common agent in endodontic
treatment. This was a European development, however, and it took
a very long time before calcium hydroxide would influence North
American endodontic thinking.
Another important contribution from Germany during this time
period was the study by Greth ( 1933) on the lack of correlation
between clinical and histological findings of pulp pathology in
diseased teeth. Greth demonstrated that the clinical symptoms of
pulp disease and the histopathological picture of pulp changes
correlate poorly with each other. This fact is still often forgotten in
our desire to create clinical diagnoses that are based on histological
descriptions.
In the late 1930s culturing was a very important part of
endodontic treatment in the United States and it was shown that it
might be possible to improve the outcome of endodontic treatment
if culturing was used to assess the level of remaining infection in the
pulp space during treatment ('fates and Morse 1938. Coolidge
1940, Sommer and Crowley 1940, Morse and Yates I94 I ). It is
important to remember that culturing in endodontics has been
around for nearly a century and already in 1901, Onderdonk,
described how to use culturing during endodontic procedures.
". . . a culture should be made from the cotton dressing; also
from a fresh specimen taken after thorough disinfection when
we think the root is ready to fill."
Onderdonk I90 I
Formative Years
Modem endodontics started to develop in the middle of the
1950s. Endodontic microbiology improved and already in I955 it
was possible for Leavitt et ol to point out that the presence of strict
anaerobic bacteria in the necrotic pulp might be a future problem
for endodontic culturing. They showed that there was much more
anaerobic infection than we ever previously considered when
dealing with infected necrotic pulps. Thus, from this time on
endodontic culturing was steadily undergoing improvements to
allow for optimal culture results.
The healing process of the vital pulp was carefully studied in
extensive studies by Nyborg ( I 955) in his pioneering work on
calcium hydroxide and wound healing. He described in detail the
various stages of the healing process of pulp tissue. Several more
recent studies have confirmed Nyborg's findings and today, calcium
hydroxide has become the standard wound dressing for superficial
vital pulp surgery. This decade also saw publication of one of the
AUSTRALIAN ENDODONTICJOURNALVOLUME 24 No. I APRIL 1998
major studies on the outcome of endodontic treatment. Thus, the
Strindberg prognosis study ( 1956) has become "the mother of all
prognosis studies." It was. at the time of its presentation. a
remarkable piece of work. It was the first well controlled long-term
study of endodontic cases. Strindberg used sophisticated statistics.
as it was clearly demonstrated for the first time in this pioneering
work that statistical analysis was an important tool for the complete
understanding of clinical data. In addition to the contribution of this
work to the scientific literature it also clearly showed the clinician
that posterior teeth are no bigger treatment risk than anterior teeth.
As a matter of fact it was shown that molars, in most cases. had a
better success rate than incisors if properly treated. This was quite
a revelation in clinical endodontics at that time.
Although this penod was a splendid time for advances in
endodontics. it was also possible to find some significant warts on
the surface of endodontics. One of these became known as N2 and
the inventor and advocate was Angel0 Sargenti (I955). The root
canal filling material N2, which was very toxic and tissue damaging.
contained mercury, lead and paraformaldehyde. Later. steroids
were added. Because of its ability to temporarily "prer.erve" tissue
in poorly instrumented root canals, it opened up the possibility for
poor endodontics with no immediate negative consequences. As
the tissue "preserving" agents decrease in concentrationwith time,
later failures will increase. Sargenti started to publish in the mid
1950s and his disciples are still today causing serious damage to the
practice of responsible endodontics.
The 1960s followed and this decade offered great advances in
the understanding of pulp and periapical disease. It was an
interesting time period but few, at this time, fully grasped the
importance of published information. Rosengren ( I 962)
demonstrated that a streptococcal infection of the necrotic dental
pulp in the cat resulted in an increased antibody titre to the bacteria.
These findings, in combination with the findings by Kakehashi et 01
( 1965). led endodontics into a new era of understanding. Bames
and Langeland ( 196611 further demonstrated th'lt antigens
introduced into the root canal could result in the devalopment of
circulating antibodies. Periradicular tissue responses could now be
understood as immunological tissue responses and not as reactions
to various "toxic products.'' Tragically, however, it would take
another ten years before this concept would be fully understood
and generate more interest.
During this period there was also great interest in continuing
Strindberg's prognosis work by studying the outcome of
endodontic treatment and how this was affected bi remaining
bacteria in the root canal system. Moller ( 1966) refined the system
of culturing bacteria from the root canal. Engstrom and co-workers
( 1964) presented an extensive prognosis study wit? significant
microbiological components. This. and similar papers, of which
there were a number at this time, were later severely criticised
because of the lack of a reliable anaerobic culturing technique
measured by today's standards. The result of this lack in
sophistication is not that important, however. There were certainly
false negative samples in these studies. but the positive cultures are
not affected by the deficiency. even if it was not possibe to culture
some part of the microflora. Thus, if it is true that the prognosis was
negatively affected by the presence of bactena, which was observed
in these earlier studies, a more sensitive culture technique for
anaerobes would only further strengthen these results. New
literature surely affirms these results (Sjogren et ol 1997). Thus,
these breakthrough results from this early time period were actually
very correct. There were also several publications, very critical of
culturing as a method (Bender et 01 1964. Seltzer et ol 1964).
These were papers written by authornies who sufgested that
AUSTRALIAN ENDODONTIC JOURNALVOLUML 24 No I APRIL IS98
culturing was a worthless undertaking It is my opinion. that these
publications did a substantial amount of damage to endodontic
research setting the profession back more than ten years These
arguments in the literature were often heated (Morse I97 I ).
". . the removal from the canal of clean white shavings is a
better indicator of the thoroughness of instrumentation than
cultunng"
Morse 1971
The clinician, however, had found an acceptable reason to
discontinue culturing It was also often suggested that in a well
obturated root canal remaining bacteria would be isolated and die
These beliefs were founded on an erroneous interpretation of a
paper by Matsumiya and Kitamura (I960). This was a very large
study, in the dog. of the healing pattern of infected root canals
treated with various conventional antimicrobial agents. The root
canals were finally packed with calcium hydroxide and closed This
was interpreted as a root filling The results were followed with
histological techniques The study showed that although the root
canals still contained bacteria after disinfection. these bacteria died
and disappeared with time This study was far ahead of its time and
not until I985 would the clinical benefits of this be fully understood
The work by Matsumiya and Kamura is nothing but a beautiful
demonstration of the healing effect of a long term dressing with
calcium hydroxide
Thus, although the 1960s was a penod of severe breakdown in
the belief of the importance of microorganisms for treatment
outcome. there were many important developments laying the
base for the progress made in the next decades.
Modern Time
The 1970s was the decade of very important advances in the
understandingof the role of microorganisms in the development of
pulp and periapical diseases. Bergenholtz ( 1974) studied the
bacteriological status of traumatised teeth. Even though it was still
too early to isolate the very delicate anaerobes, this publication
moved forward the understanding of root canal ecology in a
substantial way. It served as an initial verification of the relationship
between the presence of a periapical lesion and an infected pulp.
Despite the limitation in the techniques used it was demonstrated
that pulp infection consisted of up to 78% strict anaerobic bacteria.
Most of the infections were multi-strain infections. These findings
have later been confirmed in other studies.
In d series of publications Cvek ( I 974) showed how calcium
hydroxide could be effectively used in a number of very complex
treatments of traumatised teeth and/or immature roots. This was an
important advancement in treatment of these very difficult cases.
In 1972 Holdeman and Moore at the Virginia Polytechnic
Institute published a manual on how to culture strict anaerobes.
These advances laid the foundation for modern endodontic
microbiology.The technique was adapted for endodontic culturing
(Berg & Nord 1973). The most important result of this new
anaerobic sampling and culture technique was the findings by
Sundqvist in 1976. He showed, without much doubt, that the
periapical lesion was the result of bacteria located in the pulp space.
The larger the periapical lesion the larger was the number of
bacterial species or strains found.
Applying this anaerobic technique to a study of root canal
debridement. Cvek et a/ ( 1976) showed how ineffective sodium
hypochlorite was as an intracanal antiseptic, even in high
concentration (Table I). This finding, which has been confirmed
PAGE 13
many times later, showed us that instrumentation and irrigation of
root canal systems are not complete ways of eliminating
microorganisms. They are only the start to the treatment.
Brannstrom and Nyborg (1971) made us aware that many
inflammatory responses in the dental pulp may be due to bacterial
effects on the pulp. Bergenholtz (1977) carefully studied this
interaction. through the dentine, between bacteria and the pulp.
These studies showed that pulp inflammationis a result of microbial
infection of the dentine and its surface. Thus, immunological
reactions can take place in the dentine or in the pulp as a result of
external infection.
Tslbk I. Result of irrigation and instrumentationof infected root canals. Culture results at the end of the first treatment visit using three
different irrigation fluids. In cases with a mature root canal one third of all cases still harbour bacteria after instrumentationand irrigation,
regardless of irrigation fluid. When the root canal is larger, the disinfection is even less effective. (Cvek et ol 1976).
Mature root
Irrigation fluid
Bacteria No Bacteria
Saline 33.3% 67.7%
0.5% NaOCl 28.6% 7 I.4%
5% NaOCl 30.8% 69.2%
Wthin a few years the endodontists were now given very
comprehensive information on the mechanisms involved in pulp
and periradicular disease. Still. today, however. we have not yet
been able to fully carry this information into more significant
changes of therapy. Endodontics is still a very crude clinical art as
there is only one generally accepted form of therapy - that is
amputation of the organ. Hopefully,the continuous advance in pulp
and microbial research will offer more sophisticated therapy forms
in the future.
Related to the advanced studies of root canal ecology it is worth
mentioning the very pioneering work by the group Fabricius,
Dahlen. Holm. and Moller ( 1982). They demonstrated elegantly
how the endodontic microflora in closed pulp spaces, with time,
will change from a mixed flora to an obligate anaerobic microflora.
The relationship between certain bacteria is also well established
and difficult to alter.
Bystrom ( 1986) studied the effectiveness of various treatment-
disinfection steps that are normally used in infected root canals. Like
Cvek et ol in 1976. Bystrom very nicely demonstrated that
instrumentation and irrigation are inadequate procedures in
achieving predictable disinfection of root canals. Additional
disinfection steps must be taken. Bystrom ( 1986)found that calcium
hydroxide well packed into root canals could safely disinfect the
dentine. This is the clinical verification of the histopathological
findings by Matsumiya and Kitamura (I 960). The fact is that calcium
hydroxide is still the only medicament that consistently eliminates
microorganisms in the dentine body. Bystrom also showed that
with the suggested regimen with calcium hydroxide an assured
disinfection could be achieved resulting in a very high (93.7%) rate
of treatment success.
During this period some very exciting electron microscopic
studies were published on the presence of microorganisms in the
periapical tissues and within the root canal (Nair 1987). These
studies allowed us to visibly observe the microorganisms located in
the root canal and in special cases even in the periradicular tissue
lesions. This provided a better understanding of the three-
dimensional pcture of endodontic infection.
The 1980s was also the beginning of a new era in endodontic
instrumentation. In 1988 Walia et 01. demonstrated the new
PAGE 14
exciting properties of prototype root canal instruments made of a
superelastic nickel-titanium alloy The nickel-titanium hand
instruments, however, have had some difficulties in winning
acceptance due to their substantially higher price and yet ten years
later, many practitioners are still using stainless steel hand
instruments
The nickel-titaniumalloy, however, has had a revolutionary effect
on the development of efficientand reliable rotary instrumentation.
Presently there are three major market leaders in this field. They
are Tulsa Dental's ProFile 29 instruments. Lightspeed Technology's
Lightspeed instruments and Tycom Quantec instruments. All of
Immature root Total
Bacteia No Bacteria Bacteria No Bacteria
61.5% 38.5% 44.1% 65.9%
50.0% 50.0% 37.0% 63.0%
73.3% 26.7% 53.6% 46.4%
these instruments have their advantages and disadvantages.
Although seemingly useful there is still little information available
regarding their ability to debride and thoroughly clean root canals
and thereby reduce the microflora. With hand instrumentation.
although time consuming. we know pretty well what they are doing
for us. There is still no information on what a 30 second use of a
rotary instrument might do, except for creating a tapered hole.
Therefore, the final verdict regarding the usefulness of rotary
instruments and their value is still unknown.
There is still much unknown in endodontic science which needs
much research effort and time. Of central interest is a better
understanding of the pathogenesis of the periapical lesion. Major
work has been done in this field by Stashenko and co-workers over
the last decade (I 987. 1989, I99 I , 1992, 1993).Thus, it has been
shown that bacteria and/or bacterial metabolic byproducts are
involved in the development of the periapical lesion. The healing
process, however, is rather unchartered. It is known that the lesion
heals when we reduce the number of bacteria but the threshold is
unknown as are the initiating events. These questions are
fundamental to making further progress in the treatment of
periradicular inflammation.
Another technical advancement of significant clinical value was
the development of accurate devices to measure the length of root
canals based on Sunada's early findings ( I96 I ). Much work has
gone into the development of this idea and today there are apex
locators with a high degree of accuracy significantly reducing the
need for x-ray exposure (Fouad et ol 1993).
Empirically much has been leamed about the rational and
predictable treatment of teeth with periapical lesions. Thus, calcium
hydroxide treatment for one week (Sjogren et ol I99 I ) has been
shown to be as effective as the one month dressings earlier used by
Bystrom (I 986). In addition to I& antimicrobialeffect in VIVO. calcium
hydroxide has been found to hydrolyse bacterial lipopolysaccarides
(LPS) (Safavi & Nichols 1993. 1994). In doing so it inactivates the
biological function of LPS, which when present in bacterial cell walls,
is as effective in living bacteria as in dead bacteria. This is very
important as our disinfection process may kill all bacteria in the root
canal system but still leave gram-negative bacterial cell walls
preventing the bone lesion from healing. Therefore, calcium
AUSTRALIAN ENDODONTIC JOURNALVOLUME 24 No. I AF'FUL 1998
hydroxide is a very effective intracanal medication as it efectively kills
bacteria and simultaneously inactivates the osteolysis-inducing LPS
In a comprehensive study of penapical lesions Sjogren (I 996)
evaluated the effect of bactena and other factors on the outcome of
endodontic treatment It was concluded that reasons for failures are
mostly microbial in the form of persisting intra-radiculai infection It
was also suggested that non-microbial factors asscoated with
failures were foreign body reactions from finely dispersed filling
materials and residual cholesterol crystals The preoperative
diagnosis determines the rate of success to be expected The
prognosis of treating a vital pulp without extensive infection. if done
correctly, is going to be much better than the result of treating a
tooth with an infected necrotic pulp Extrusion of filliy materids
into the periapical tissues will impair healing of apical periodontitis
The Future?
So what will the future bring to endodontics?Where will the
speciality go?
I believe the foundation of contemporaryendodontics is cracked.
There is a dissonance between the biologic scientific base of
contemporary endodontology and trends in h.9w clinical
endodontics is practised. This division appears to be w.dening with
time. We need to come to grips with this problem and time is
running out. At this moment the biological focndation of
endodontics is better and more clearly defined than ever before.
This includes the importance of infection. the difficulties of
eliminating infection and the fact that asepsis and infection control
are important issues. Against this stands a clinical "pop" culture
where speed and expedience are the important measurement
tools and the differentiation between right and wrong is based on a
majority decision arid not on the biological facts. One visit treatment
for everything is becoming a standard procedure. For the last 25
years we have collected sufficient informationto clearly suggest that
an infectedroot canal cannot be disinfected in one treatment (Cvek
et ol 1976, Bystrom 1986. Sjeren et ol 1997). Overfilling of the
root canal is also becoming a desirable treatment objective in the
attempts to do "three-dimensional obturations". There are
numerous publications demonstrating the negative effect on
outcome of excess root filling materials. most recently by Sjogren
( 1996).
At least 80-90% of all endodontic treatment is provided by
general practitioner3.Several recent studies of treatment results, in
the general population of developed countries, sJggest that
previously root filled teeth have periapical pathology in more than
25% of the cases (Buckley & SpAngberg 1995. Eckerbom et ol
1987. 1989; lmfeld 1991). Although these studies are cross-
sectional populationstudies and may not totally reflect the outcome
of treatment, it is still an unacceptable rate of failure of endodontic
treatment. This also suggests that the average quidity of the
treatment is unsatisfactory. It is difficult to determine if this
inadequacy is in the area of disinfection efforts or in the manual
technique. Much time and effort have been spent on endodontic
training of pre-doctoral dental students. The outcoine analysis
shows poor results of these efforts. Therefore, we must critically
review our educational process in order to revitalise the
programmes and improve the education. The understanding of
fundamental concepts in endodontics cannot be postponed to
continuing education in motels and hotels. It must be thoroughly
taught in dental school. Therefore. one of our major gaals for the
future of endodontics must be improved endodontic (dental)
education.
The effortsin education are very important. but as there are very
AUSTMLIAN ENDODONTIC JOURNALVOLUMF 24 No I APRIL 1938
few scholars in advanced endodontic research there is a desperate
need for a broadening of the base of qualty endodontic research
The future of endodontic expansion and preservation lays in the
capture of the healing potentials of the dental pulp Within reach is
the non-destructive detailed diagnosis of pulp inflammation
Achieving this will lead to a whole new era of therapeutic treatment
of the diseased pulp and it might even be possible to perform trans-
dentine pharmacological pulp therapy There is also a desperate
need for an improved understanding of periapical diseases With
such understanding active therapy for improved and accelerated
healing will be within reach Therefore, it is imperative that the
endodontic community actively supports an aggressive recruitment
of young researchers who are interested and willing to conduct
advanced research in this area.
Presently endodontics is a passive healing art We instrument.
disinfect and fill root canals but we have no active tissue pharmaco-
therapy that would assure and accelerate healing I believe that the
twenty-first century will bring such active therapy choices to the
endodontic treatment arena
Future Goals For Clinical Endodontology
Review and improve endodontic dental education
Develop methods to enhance recruitment of endodontic
scholars
Use molecular biology to diagnose. in detail and without
exposure, the various stages of disease in vital pulp
Develop methods to treat early stages of vital pulp disease
through dentine
Improve the understandingof the development and healing
of periapical disease.
Develop therapeutic methods for the treatment of the
periapical sequel to the necrotic infected pulp
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Bergj-0ond Nord C-E. A method for isolation of anaerobic bacteria
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Bergenholtz G. Microorganisms from necrotic pulp of traumatized
teeth. Odont Revy 1974; 25: 347.
Bergenholtz G. Experimental pulpitis in the monkey. University of
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Billmngs R. Chronic focal infections and their etiologic relations to
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Buckley M and SpSngbeig LS.W The prevalence and technical
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Coolidge E.D. Methods of testing for bacterial growth during the
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1998 General Dentist Case Report Competition
The Federal Executive of the Australian Society of Endodon-
tology (Inc.) is pleased to announce the 1998 case report
competitionfor general dentists. All members of the ASE (Inc.) who
are in general dental practice are invited to submit a case report.
Eligibility:
(I) All entrants must be members of the ASE Inc. and
(2) All entrants must be in general dental practice.
Topic:
A case report regarding endodontic treatment or of relevance to
endodontics.
A specific tale should be chosen by the author to demonstrate
the scope of the report.
Prize:
The winning entrant will receive $200.00.
Closing Date:
September 30,1998
Conditions and Notes:
Case reports should not exceed 1.500 words and should
journal if invited.
have a maximum of I 5 references. Reports should include
photographs. radiographs and other diagrams where relevant.
Radiographs and photographs should be presented as either
black and white or colour prints with appropriate labelling on
AUSTRALIAN ENDODONTICJOURNALVOLUME 24 No I APRIL 1'398
the back of each photograph to indicate the figure number
and the TOP of each print. Original radiographs and 35mm
slides are preferred.
Entries should conform to the "Guidelines for Contributors"
as published in the Austrolion Endodonticjournol.
All manuscripts. photographs and other material should be
submlned in duplicate to the Editor of the Austrolion
Endodonticjournal before September 30, I998 at the Editorial
office. as follows:
Or. Peter Parashos
Editor. Australian Endodontic Journal
I Ith Floor, 20 Collins Street,
Melbourne. Mc 3000
Entrants' names should not appear on the manuscript as all
entries will be coded for anonymity prior to judging. Names
and addresses should be supplied on a separate page
accompanyingthe entry.
The competition will be judged by two judges appointed by
the Editor of the Austrolion Endodonticjournal. All decisions of
the judges shall be final and all entrants will be notified of the
results. No correspondence will be entered into concerning
the result. Should no entry be considered of suitable merit no
prize will be given.
The winning entry will be published in the Austrolion
Endodonticjournal and other entries may also be published at
the discretion of the journal's Editor. In submitting an entry to
this competition. all entrants must agree to publication in the
Any queries regarding this competition should be directed to
the Editor of thejournol.
PAGE 17