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n Vince Lombardi so eloquently stated, “Practice does not make per- fect. Only perfect practice makes per- fect.” In other words, we can perform a procedure repeatedly over and over again and not obtain the expected out- comeforsuccess.Wemustcontinually advance in all disciplines of dentistry in order to provide our patients with the most predictable treatment regi- mens possible, understanding the greatest variable that stands in our way is the human variable. Elevating the standards of endodontic care is in- exorablytiedtoanimportantdynamic in our armamentaria.48,50 The objective of endodontic treat- ment has continue to be a constant since root canal treatment was first performed; the prevention or treat- ment of apical periodontitis such that there is complete healing and an ab- sence of infection,1 while the overall long-termgoalistheplacementofade- finitive, clinically successful restora- tion and preservation of the tooth. Af- ter all, the main objective in dentistry is to retain what nature has created! From about 1985 to 1995 there was more change in clinical endo- dontics than in perhaps the previous 100yearscombined.Inthese10years, clinical endodontics changed forever with the emergence and development of four very important technologies: the dental operating microscope (DOM),ultrasonics,nickel-titaniumro- tary file systems and mineral trioxide aggregate (MTA).2,3,50 Where We Were TheDentalOperatingMicroscope Superiorvisionbecameattainable withtheintegrationofthedentaloper- ating microscope (DOM). Diagnosti- cally,theoperatingmicroscopeisanin- dispensable aid in locating cracks and trackingverticallyfracturedteeth.2,4 It allows a more detailed view of root canal intricacies, enabling the opera- tor to more efficiently examine, clean and shape complex anatomy.5 It pro- vides superior resolution, thereby aid- ing the removal or bypassing of sepa- rated canals.6 A microscope provides an improved surgical technique allow- ing for smaller osteotomies, shallower bevels and the location of isthmi and other canal irregularities,7 thereby al- lowing unprecedented success rates of up to 96.8 per cent.8 A DOM has sig- nificantlyshowntoimprovetheproba- bility of locating a second mesial buc- cal canal in maxillary molars. Baldas- sari-Cruz et al.9 showed that the MB-2 canal was located in 90 per cent of maxillary molars with the operating micro-scope but only 52 per cent with unaided vision.50 Sonics Piezoelectric ultrasonic energy, in conjunction with the DOM, drove mi- crosonic (sonic and ultrasonic) instru- mentation techniques that are mini- mally invasive, efficient and precise.2 Refinement of access openings in a controlled and predictable manner, locating calcified canals with a re- duced risk of perforation, removal of attachedpulpstones,removalofintra- canal obstructions (separated instru- ments, root canal posts, silver points and posts) and removal of the smear layer, biofilm and remaining debris are just some of the many uses that microsonics are capable of doing.2,10,11 In surgical endodontics, specially designed retro tips are used ultrasoni- cally for superior root-end cavity preparation. This allows minimal re- moval of root structure down the long access of the root canal without the creation of a bevel for surgical access. This subsequently reduces the num- ber of exposed dentinal tubules and minimizes apical leakage.10,50 Nickel Titanium Instruments Canal preparation procedures be- came more predictably successful withtheemergenceofnickeltitanium files (NiTi) files.2 This super-elastic alloy has shape memory, allowing for better maintenance of the original canal anatomy. These files produce less extrusion of debris, allow greater cuttingefficiencyandreducethetime for canal shaping compared to stain- less-steel files. They are biocompati- ble, anticorrosive and do not weaken following sterilization.12,13 Although full rotary has been the mainstay for nickel-titanium systems for years, re- ciprocating motors have taken the market by storm by allowing less de- brisextrusionandquickernegotiation to the apices and less file fatigue. Mineral Trioxide Aggregate This decade of extraordinary change concluded with the introduc- tion of mineral trioxide aggregate (MTA).2 This remarkable and biocom- patible restorative material has be- come the standard for pulp capping and has salvaged countless teeth that previously had been considered hope- less.2 In vital pulp therapy, when MTA isusedasadirectpulpcaptomaintain pulp vitality, studies have shown that these areas were free of inflammation and all of them had calcified bridge formation after five months.49 MTA has proved to be the ideal pulpotomy agent in terms of dentin bridge formation and preserving nor- mal pulpal architecture.49 MTA pro- duces favourable results when it is used as a root-end filling material in terms of lack of inflammation, pres- ence of cementum and hard-tissue formation.49 It is used to repair both furcal and lateral perforations with a relatively high degree of success and to seal both internal and external re- sorptive defects from an orthograde and retrograde approach.49 The treatment of teeth with open apices and necrotic pulps has always been a challenge for the dental practi- tioner. MTA can effectively be used as anapicalbarrierinteethwithnecrotic pulps and open apices.49, 50 Where We Are Irrigants and Irrigant Delivery Systems Perhaps the greatest internation- al attention in recent years has fo- cused on methods to improve en- dodontic disinfection in the root canal system.2 The desired attributes of a root canal irrigant include the ability to dissolve necrotic and pulpal tissue, bacterial decontamination with a broad antimicrobial spectrum, the ability to enter deep into the dentinal tubules, biocompatibility and lack of toxicity, the ability to dissolve inor- ganic material and remove the smear layer, ease of use and moderate cost. The combination of sodium hypochlo- rite and EDTA has been used world- wide for antisepsis of root canal sys- tems.15 Sodium hypochlorite has the unique ability to dissolve necrotic tis- sue and the organic components of the smear layer.16–18 It also kills ses- sile endodontic pathogens organised in a biofilm.19,20 There is no other root canal irrigant that can meet all theserequirements,evenwiththeuse of methods such as increasing the temperature21–25 oraddingsurfactants to increase the wetting efficacy of the irrigant.26, 27 Demineralizing agents such as EDTA have therefore been recom- mended as adjuvants in root canal therapy in combination with sodium hypochlorite20,28 as they dissolve inor- ganicdentinparticlesandaidinthere- moval of the smear layer during in- strumentation.29 Itisveryimportantto note that while sodium hypochlorite has unique properties that satisfy most requirements for a root canal ir- rigant, it also exhibits tissue toxicity that can result in damage to the adja- cent tissues, including nerve damage should sodium hypochlorite incidents occur during canal irrigation.15 It is therefore very important that irrigant deliverydevicesareusedthatnotonly allow voluminous exchange right to theapexbutalsodelivertheminasafe an deffective manner without apical extrusion. Root canal irrigation systems can bedividedintotwocategories:manual agitation techniques and machine-as- sisted agitation techniques.11 Manual irrigation includes positive pressure irrigation, which is commonly per- formed with a syringe and a side- vented needle. Machine-assisted irri- gation techniques include sonics and ultrasonics, as well as newer systems science & practice18 Show Preview IDS Cologne 2013 ITALIAN QUALITY AND DESIGN www.lascod.com Hall 10.1, Stand D068/E069 SAMEPAVILLON DIFFERENTPOSITION BIGGERSTAND AD 5 Dr Gary Glassman Raising the bar for endodontic success: Where we were,where we are and where we are going By Dr Gary Glassman,Canada ➟ 5 The operating microscope has become an indispensable aid in the field.