Friday, September 16, 2011

Endodontics — a series overview

ENDODONTICS 1. The modern concept of
root canal treatment 2. Diagnosis and treatment
planning 3. Treatment of endodontic
emergencies 4. Morphology of the root
canal system 5. Basic instruments and
materials for root canal treatment
6. Rubber dam and access activities
7. Preparing the root canal 8. Filling the root canal
system 9. Calcium hydroxide, root
resorption, endo-perio lesions
10. Endodontic treatment for children
11. Surgical endodontics 12. Endodontic problems


Stock and Nehammer's BDJ textbook Endodontics in Practice was first published in 1985, and almost immediately became a standard text for both undergraduate students and general practitioners. In the first sentence of the first chapter the authors observed ‘during the last three decades research in the field of endodontics has modified the approach to treatment’, and that observation was retained in the extensively revised second edition, published in 1990.
With an inordinate amount of research of an increasingly high standard taking place, the changes in the field of endodontics during the last decade have been even greater, and a third edition was required to keep practitioners up to date with current thinking and practice. Sadly, because of their research and other commitments, Chris Stock and Carl Nehammer did not have the time to devote to such a task, and I am therefore honoured and delighted to have edited this edition of their text and converted it to the new BDJ Clinical Guide format.
In some aspects of the subject there has been little change, whilst the developments in others have been immense. I may be criticised for retaining some historical material which could seem outdated to the modern practitioner using the latest canal preparation techniques. However, few dental schools have the resources necessary to introduce many of the recent developments, and undergraduate students still learn conventional techniques. It is important that they understand how these have developed, and it is essential, as with most things in life, that they develop basic skills before advanced ones!
The subject is covered in 12 parts. The first part emphasises the modern concept of endodontics, surprisingly founded upon research published almost forty years ago. Root canal treatment must be seen as essentially the treatment of a disease process. The procedures must both remove all infection from the root canal system, and prevent contamination by other pathogenic organisms. Failure to achieve either of these aspects may compromise success and lead to eventual failure. Parts 2 and 3 consider the importance of diagnosis in treatment planning, and how emergency events may be quickly diagnosed and treated. Part 4 shows how research into root canal morphology continues, knowledge of which is essential for effective shaping and cleaning.
Parts 5 to 9 cover the technical procedures, but the wise reader will realise that there is no ‘best way' to clean, shape and obturate a tooth. Various manufacturers make claims that their own product is the latest and best. The emphasis in the series is the understanding of the objectives of treatment. The actual technical procedures must be secondary to this. Dentists are clinicians, not technicians, and should use whichever procedure works best in their own hands to resolve the diagnosed disease process. ‘Step-back and apical stops’ may be old-fashioned, one brand of rotary instruments may have been around longer than another, but if the technique works for you then why change it?
As in Stock and Nehammer's original text, the final three parts of the series consider some wider aspects of endodontic treatment. These subjects are not considered in great detail, but hopefully direct readers to deeper study of the subjects concerned in texts dedicated to that specific aspect.
However, it is hoped that readers will consider this is a practical series written for the practice of endodontics. The research which underpins this practice is discussed where necessary, but the prime aim of the series is to guide practitioners through their everyday treatment of teeth with endodontic problems.