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{{Multiple issues|{{Expert needed|1=Dentistry|date=August 2013}}
{{Technical|date=January 2019}}}}


{{Infobox occupation
| name= Endodontist
| image= US Navy 040324-N-8213G-148 Lt. Cmdr. David Craig, of Brilliant, Ohio, performs a root canal on his patient.jpg
| caption= An endodontist operating on his patient.
| official_names=
| type= [[Specialty (dentistry)|Specialty]]
| activity_sector= [[Dentistry]]
| competencies=
| formation= [[Dental Degree]], Specialty certificate in endodontics
| employment_field= [[Hospitals]], Private Practices
| related_occupation= [[Oral and Maxillofacial Surgery]]}}


1. AN INTRODUCTION TO ENDODONTICS
'''Endodontics''' (from the [[ancient Greek|Greek]] roots ''endo-'' "inside" and ''odont-'' "tooth") is the [[Specialty (dentistry)|dental specialty]] concerned with the study and treatment of the [[dental pulp]].<ref>{{Cite web|url=https://www.merriam-webster.com/dictionary/endodontics|title=Definition of ENDODONTICS|website=www.merriam-webster.com|language=en|access-date=2019-01-19}}</ref>
2.The DEFINITION: Branch of dentistry concerned with the: Morphology Physiology Pathology of the human dental pulp and periradicular tissues. Abscess

3. SCOPE OF ENDODONTICS Its study and practice encompass: Biology of the normal pulp Etiology Diagnosis Prevention Treatment of diseases and injuries of the pulp and associated peri-radicular tissues.
== Overview ==
4. PRINCIPLES OF ENDODONTIC THERAPY: Diagnosis Patient education Local anaesthesia Isolation Rubber dam isolation Access cavity Working length Instrumentation Obturation Final restoration
Endodontics encompasses the study (practice) of the basic and clinical sciences of normal dental pulp, the [[etiology]], diagnosis, prevention, and treatment of diseases and injuries of the dental pulp along with associated [[wikt:periradicular|periradicular]] conditions.
5. DIAGNOSIS: According to Ingle, diagnosis is the procedure of Accepting a patient Recognizing that he has a problem Determining the cause of the problem and Developing a treatment plan that will solve or alleviate the problem

6. DIAGNOSIS Chief Complaint History [Medical/Dental] Objective Examination Subjective Examination Radiographs
In clinical terms, endodontics involves either preserving part, or all of the dental pulp in health, or removing all of the pulp in irreversible disease. This includes teeth with irreversibly inflamed and infected pulpal tissue. Not only does endodontics involve treatment when a dental pulp is present, but also includes preserving teeth which have failed to respond to non-surgical endodontic treatment, or for teeth that have developed new lesions, e.g., when root canal re-treatment is required, or [[periradicular surgery]].<ref>{{cite journal|title=Levels of Evidence for the Outcome of Nonsurgical Endodontic Treatment|journal=Journal of Endodontics|date=1 September 2005|volume=31|issue=9|pages=637–646|doi=10.1097/01.don.0000153593.64951.14|pmid=16123698|language=en|issn=0099-2399|last1=Torabinejad|first1=Mahmoud|last2=Kutsenko|first2=Diana|last3=Machnick|first3=Tanya K.|last4=Ismail|first4=Amid|last5=Newton|first5=Carl W.}}</ref>
7. PATIENT EDUCATION Patient should be informed about the condition of his teeth and the treatment options available. Instructions to the patient about improvement of the oral hygiene.

8. LOCAL ANAESTHESIA Similar to the local anesthesia given for various other dental procedures. Supplemental anesthesia may be required for certain cases – "Hot Tooth"
Endodontic treatment is one of the most common procedures. If the [[dental pulp]] (containing [[nerve]]s, [[arteriole]]s, [[venule]]s, [[lymphatic tissue]], and fibrous tissue) becomes diseased or injured, endodontic treatment is required to save the tooth.{{citation needed|date=September 2019}}
9. ISOLATION Rubber Dam isolation - usually a single tooth isolation. Isolation is very important not only for maintaining a sterile field but also to prevent aspiration of irrigation materials and instruments

10. ACCESS CAVITY
== Procedures ==
11. WORKING LENGTH The distance from a coronal reference point to the point at which canal preparation and obturation should terminate.

12. INSTRUMENTATION May be done using hand instruments or rotary instruments. Simultaneous irrigation and lubrication are essential.
=== Root canal treatment ===
13. OBTURATION Many techniques: Hot/ Cold Lateral/ Vertical Single Cone/ Multiple Cone
{{Main|Root canal treatment}}
14. FINAL RESTORATION Many options. Ideally should provide strength to the remaining tooth structure. Should promote physiological function of the tooth and the surrounding tissues.
Root canal treatment is a dental procedure used to treat infected tooth pulp which would be otherwise extracted. The pulp is the soft tissue core of the tooth which contains nerves, blood supply and connective tissue necessary for tooth health.<ref name=":1">{{Cite journal|last=Carrotte|first=Peter V.|date=March 2006|title=Vital guide to Endodontics|journal=Vital|language=en|volume=3|issue=1|pages=21–25|doi=10.1038/vital378|issn=1741-7511|doi-access=free}}</ref> This is usually caused when bacteria enter the pulp through a deep cavity or failed filling.<ref name=":1" />
15. INDICATIONS Carious teeth [caries involving pulp] Teeth with irreversible pulpitis Necrotic pulps Treatable periodontal conditions [endo-perio lesions] Salvageable resorptive defects Supra-erupted teeth with good bone support Fractured teeth involving pulp Intentional endodontics for FPD's or over-dentures

16. Insufficient periodontal support. CONTRAINDICATIONS
Root canal treatment is required when the dental pulp is irreversibly damaged and involves both coronal and apical pulp.<ref name=":2">{{Cite book|last=Garg, Nisha, 1977-|title=Textbook of endodontics|others=Garg, Amit, 1977-|isbn=978-93-5090-952-2|edition=Third|location=New Delhi|oclc=881001658|date=2013-12-30}}</ref> Root canal treatment can also be carried out on teeth with doubtful pulpal state before placing post-retained crowns and overdentures.<ref>{{Cite book|title=Advanced operative dentistry : a practical approach|date=2011|publisher=Elsevier|others=Ricketts, David (David Nigel James), Bartlett, David W.|isbn=978-0-7020-3126-7|location=Edinburgh|oclc=745905736}}</ref> Root canal therapy is not only performed when pain relief from an infected or inflamed pulp is required. It is also done to prevent adverse signs and symptoms from the surrounding sequelae and promote the healing and repair of the surrounding periradicular tissues. An example of which is if there is trauma to a front tooth which has caused it to be avulsed from the bony socket; endodontic treatment is required following re-implantation to preserve the aesthetics and function of the tooth, even though there may be no adverse symptoms of the dental pulp, or pain present at the time.<ref>{{cite journal|last1=Andersson|first1=Lars|last2=Andreasen|first2=Jens O.|last3=Day|first3=Peter|last4=Heithersay|first4=Geoffrey|last5=Trope|first5=Martin|last6=Diangelis|first6=Anthony J.|last7=Kenny|first7=David J.|last8=Sigurdsson|first8=Asgeir|last9=Bourguignon|first9=Cecilia|last10=Flores|first10=Marie Therese|last11=Hicks|first11=Morris Lamar|date=2012|title=International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth|journal=Dental Traumatology|volume=28|issue=2|pages=88–96|doi=10.1111/j.1600-9657.2012.01125.x|issn=1600-9657|pmid=22409417|last15=Tsukiboshi|first14=Alex J.|last14=Moule|first13=Barbro|last13=Malmgren|first12=Antonio R.|last12=Lenzi|first15=Mitsuhiro}}</ref><ref>{{cite web|url=https://dentaltraumaguide.org/free-dental-guides/permanent-teeth/avulsion/|title=Avulsion – Dental Trauma Guide|website=dentaltraumaguide.org}}</ref>
17. Canal instrumentation not practical: Calcification of the canal Sharp dilacerations/curvature of the roots CONTRAINDICATIONS

18. Non restorable teeth CONTRAINDICATIONS
Prior to root canal treatment, clinical examination and radiographic examinations are carried out to diagnose and plan treatment. Local anaesthesia is delivered to make the procedure pain free. The tooth to be treated is then isolated using a rubber dam, which prevents saliva entering the tooth during treatment and protects the airway from the fine files and strong chemicals used. The root canal treatment procedure is often carried out over single<ref name=":1" /> or multiple appointments.<ref name=":2" /> Root canal treatment involves:<ref>{{Cite book|title=Cohen's pathways of the pulp|others=Hargreaves, Kenneth M.,, Berman, Louis H.,, Rotstein, Ilan|isbn=978-0-323-18586-8|edition=Eleventh|location=St. Louis, Mo.|oclc=931533556|date = 2015-09-23}}</ref>
19. CONTRAINDICATIONS Inadequate crown root ratio Vertical tooth/root fracture

20. Patient's general medical condition: Patients general medical condition is never an absolute contraindication to endodontic therapy However, management of other medical conditions may take precedence over endodontic therapy for eg: pregnancy, diabetes, hypertension. CONTRAINDICATIONS
* Removing the damaged and infected pulp
21. BEFORE UNDERTAKING ENDODONTICS Relating to the tooth in question: Is the tooth needed or important? Does it have an opponent? Could it some day serve as an abutment for prosthesis? Is the tooth salvageable, or is it so badly destroyed that it cannot be restored?
* Shaping the entire root canal system
22. BEFORE UNDERTAKING ENDODONTICS Relating to the patient’s general dentition: Is the tooth serving esthetically, or would the patient be better served by its extraction and a more cosmetic replacement? Is the tooth so severely involved periodontally that it would be lost soon for this reason?
* Cleaning and disinfecting the entire root canal system
23. The future of endodontics is very bright, indeed! Techniques and material advancements make the future of endodontics exciting and profitable for all dentists. Instrumentation also will evolve dramatically. We will see more sophisticated design features on rotary files to increase efficiency, yet maintain safety, as with the new K3 file by SybronEndo. FUTURE OF ENDODONTICS
* Filling and sealing the root canal system
24. FUTURE OF ENDODONTICS Enhanced magnification, using either a microscope or loupes, is a must when performing challenging endodontic procedures. In the future, as these tools become more affordable, we will observe more general practitioners performing dental procedures under a microscope or with a good set of loupes and an external light source.
* Placing a direct restoration such as composite filling or indirect restoration such as a crown
25. Obturation has benefitted from major changes in the past 10 years. Expect the introduction of new materials, and also a change in sealer characteristics. Most likely, more "resin dentistry" will be introduced into endodontics. The art of filling a root canal will progress scientifically. However, future obturation improvements will continue to be contingent upon good cleaning and shaping. FUTURE OF ENDODONTICS

Instrument fractures are common procedural mishaps in root canal treatment. It is essential to prevent instrument fractures. The success of removing of broken instrument depends on the location, direction and type of instrument.<ref name=":3">{{Cite book|last=Rao, R. Nageswar.|title=Advanced endodontics|date=2009|publisher=Jaypee Briothers Medical Publishers|isbn=978-81-8448-746-6|location=New Delhi|oclc=720640774}}</ref> A sodium hypochlorite accident can result in long-term functional and aesthetic complications. Extrusion of sodium hypochlorite irrigating solution during a root canal procedure can cause a severe inflammatory reaction and tissue damage. Treatment is provided based on the severity of the injury.<ref>{{Cite journal|last=Farook|first=S. A.|last2=Shah|first2=V.|last3=Lenouvel|first3=D.|last4=Sheikh|first4=O.|last5=Sadiq|first5=Z.|last6=Cascarini|first6=L.|date=December 2014|title=Guidelines for management of sodium hypochlorite extrusion injuries|journal=British Dental Journal|language=en|volume=217|issue=12|pages=679–684|doi=10.1038/sj.bdj.2014.1099|pmid=25525012|issn=1476-5373|doi-access=free}}</ref> Tooth discolouration as a result of root canal treatment can occur if the pulpal tissue remnants are not completely removed or if a root canal sealer material containing silver is used.<ref name=":3" />

=== Periradicular surgery ===
{{Main|Periradicular surgery}}
Periradicular surgeries involve the root surface. These include apicoectomy (removal of a root end), [[root resection]] (removal of an entire root), repair of an injured root due to perforation or [[Tooth resorption|resorption]], removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.<ref>{{Cite web|url=https://www.aae.org/patients/root-canal-treatment/endodontic-treatment-options/endodontic-surgery/endodontic-surgery-explained/|title=Endodontic Surgery Explained|website=American Association of Endodontists|language=en-US|access-date=2019-12-14}}</ref><ref name=":6">{{Cite web|url=https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/aae_2017guidetocdt.pdf|title=Endodontists’ Guide to CDT 2017|date=2017|website=American Association of Endodontists|pages=11–14|access-date=2020-03-14}}</ref>

==== Apicoectomy ====
{{Main|Apicoectomy}}
An apicoectomy is a surgical procedure through which the apex of a root is resected, and a root-end filling is placed, preventing bacterial leakage into the root canal system from the [[Periapical|periradicular]] tissues.<ref name=":4">{{Cite journal|last=von Arx|first=Thomas|date=January 2011|title=Apical surgery: A review of current techniques and outcome|journal=The Saudi Dental Journal|volume=23|issue=1|pages=9–15|doi=10.1016/j.sdentj.2010.10.004|issn=1013-9052|pmc=3770245|pmid=24151412}}</ref> A microsurgical technique is used to carry out apicectomy, which improves post-operative healing.

An apicoectomy can be carried out when a previous root canal treatment fails, and re-root canal treatment is not possible.<ref name=":4" /> This may be as a result of anatomical features, such as root dilaceration, which can compromise the completion of cleaning and obturating the root canal system. Procedural errors including ledges or perforations, may also be indications for an apicectomy.

Local anaesthetic is utilised to achieve anaesthesia as well as [[Hemostasis|haemostasis]] for improved visualisation. A [[Flap (surgery)|flap]] in the gum is designed, and then raised to allow for exposure of the periapical lesion.<ref name=":5">{{Cite web|url=https://sdsjournal.com/article/view/1747|title=A case of periradicular surgery: apicoectomy and obturation of the apex, a bold act|website=sdsjournal.com|language=en-us|access-date=2020-03-05}}</ref> Bone removal ([[osteotomy]]) is carried out to enable access to root apex, and diseased tissue is removed at this point through [[curettage]].<ref name=":5" /> The root end resection is carried out, removing 3mm apically. The canal(s) is then obturated, and the flap is sutured. There are a number of root-end filling materials available, including [[zinc oxide eugenol]] cements, and [[mineral trioxide aggregate]].

Complications that may arise include:

* pain: anti-inflammatory agents or analgesics should be taken
* swelling: intermittent ice will aid in eradicating this. Swelling resolves usually within 24-48 hours ):.
* [[Bruise|ecchymosis]] (discolouration): this will often occur distant from the surgical site
* [[Paresthesia|paraesthesia]]: usually transient as a result of inflammatory swelling, and sensation will return to normal in 4 weeks
* serious infection is rare, but can be treated with antibiotics, which should be administered with caution to avoid bacterial resistance <ref>Siqueira JF, Rôças IN. Microbiology and treatment of endodontic infections. In: Hargreaves KM, Cohen S, Berman LH, editors. Cohen’s pathways of the pulp. 11th ed. St Louis: Mosby Elsevier;
2016. p. 599.</ref>
* [[maxillary sinus]] perforation <ref>{{Cite journal|last=Hauman|first=C. H. J.|last2=Chandler|first2=N. P.|last3=Tong|first3=D. C.|date=February 2002|title=Endodontic implications of the maxillary sinus: a review|journal=International Endodontic Journal|volume=35|issue=2|pages=127–141|doi=10.1046/j.0143-2885.2001.00524.x|issn=0143-2885|pmid=11843967}}</ref>

=== Other procedures ===
Other non-surgical endodonic procedures include [[pulp capping]], [[pulpotomy]], [[apexification]], and [[Regenerative endodontics|pulpal regeneration]]. [[Tooth hemisection|Hemisection]], where a root and its overlying portion of the crown are separated from the rest of the tooth and optionally removed, is another (non-periradicular) endodontic surgery.<ref name=":6" />

== Tools ==
[[Microsurgical endodontics]], the use of magnification devices such as microscopes, and dental loupes, has been widely accepted among endodontists and practitioners;<ref name=":0">{{cite journal|last=Arens|first=Donald E.|date=2003|title=Introduction to magnification in endodontics|journal=Journal of Esthetic and Restorative Dentistry|volume=15|issue=7|pages=426–439|issn=1496-4155|pmid=15000913|doi=10.1111/j.1708-8240.2003.tb00970.x}}</ref> its use is believed to increase accuracy and visualization in the operating field.<ref>{{cite journal|last=Hegde|first=Rashmi|last2=Hegde|first2=Vivek|date=2016-05-01|title=Magnification-enhanced contemporary dentistry: Getting started|journal=Journal of Interdisciplinary Dentistry|language=en|volume=6|issue=2|pages=91|doi=10.4103/2229-5194.197695}}</ref> However, a Cochrane review in 2015 found no evidence to determine whether there is a difference in the outcome of a procedure done by magnification devices or a conventional procedure done with no magnification.<ref>{{cite journal|title=Magnification devices for endodontic therapy |journal=Cochrane Database of Systematic Reviews|issue=12|pages=CD005969|language=en|doi=10.1002/14651858.cd005969.pub3|pmid=26650099|year=2015|last1=Del Fabbro|first1=Massimo|last2=Taschieri|first2=Silvio|last3=Lodi|first3=Giovanni|last4=Banfi|first4=Giuseppe|last5=Weinstein|first5=Roberto L.|hdl=2434/434134|hdl-access=free}}</ref> The [[American Association of Endodontists]] strongly encourages its members to pursue the use of an oral microscope to ensure the highest level of excellence.<ref>{{Cite web|url=https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/microscopesstatement.pdf|title=Use of Microscopes and Other Magnification Techniques - Position Paper|date=2012|website=www.aae.org}}</ref>

The use of a [[Cone beam computed tomography|CBCT]] is also becoming the standard of care.<ref>{{Cite web|url=https://www.aae.org/specialty/2018/04/03/cbct-new-standard-care/|title=CBCT: The New Standard of Care?|date=2018-04-03|website=American Association of Endodontists|language=en-US|access-date=2019-10-21}}</ref><ref>{{Cite journal|last=Patel|first=S.|last2=Brown|first2=J.|last3=Pimentel|first3=T.|last4=Kelly|first4=R. D.|last5=Abella|first5=F.|last6=Durack|first6=C.|date=2019|title=Cone beam computed tomography in Endodontics – a review of the literature|journal=International Endodontic Journal|language=en|volume=52|issue=8|pages=1138–1152|doi=10.1111/iej.13115|pmid=30868610|issn=1365-2591|doi-access=free}}</ref>

==Training==
Endodontists are specialist dentists with additional training, experience and formal qualifications in endodontic treatment, apicectomies, microsurgery, and dental emergency and trauma management.<ref name=":0" /> Endodontics is recognized as a specialty by many national dental organizations including the Dental Board of Australia, British [[General Dental Council]], [[American Dental Association]], [[Royal College of Dentists of Canada]], [[Indian Dental Association]], and [[Royal Australasian College of Dental Surgeons]].

=== Australia ===
In [[Australia]], endodontics is recognized as one of the thirteen registered dental specialties. In addition to a dental degree, Endodontists have an additional three years of postgraduate University training in the area of Endodontics to be recognized and registered by the Dental Board of Australia. A general dentist is permitted by law to perform endodontic treatment, but must be competent in the skills required for the endodontic treatment, and refer complex cases for specialist management.{{citation needed|date=March 2019}}

=== United States ===
In the [[United States]] after finishing a [[dental degree]], a dentist must undergo 2–3 additional years of postgraduate training to become an Endodontist. [[American Dental Association]] (CODA) accredited programs are a minimum of two years in length. Following successful completion of this training, the dentist becomes Board eligible to sit for the [[American Board of Endodontics]] examination. Successful completion of board certification results in Diplomate status in the American Board of Endodontics.<ref>{{Cite web|url=https://www.aae.org/board/get-board-certified/|title=Get Board Certified|website=American Board of Endodontics|language=en-US|access-date=2019-01-19}}</ref>

Although general dentists can perform endodontic treatment, there are several things which set endodontists apart. Endodontists use [[microscope]]s during treatment to better treat the small internal [[anatomy of teeth]] without taking away too much tooth structure, or causing [[iatrogenic]] damage. Also, endodontists use [[cone beam computed tomography|CBCT]] (3D imaging) to assess case difficulty and for diagnosis and treatment planning of endodontic cases.

==See also==
{{Portal|Medicine}}
*[[American Association of Endodontists]]
*[[Dental implant]]
*[[Endodontic therapy]]
*[[Journal of Endodontics]]
*[[Oral and maxillofacial surgery]]
*[[Ralph Frederick Sommer]], an early developer of endodontics
*[[Regenerative endodontics]]
*[[Root canal]]

==References==
{{Reflist}}

==External links==
{{Wikiversity|Endodontics}}

===Organizations===
*[https://www.aae.org/ American Association of Endodontists]
*[https://www.aae.org/certboard/ American Board of Endodontics]
*[http://www.britishendodonticsociety.org.uk/ British Endodontic Society]
*[http://www.caendo.ca/ Canadian Academy of Endodontics]
*[http://www.e-s-e.eu/ European Society of Endodontology]
*[http://www.iacde.in/ Indian Association of Conservative Dentistry and Endodontics]
*[http://www.ifeaendo.org/ International Federation of Endodontic Associations]

===Publications===
*[http://www.endodonticsjournal.com/ Journal of Endodontics Research (JofER)]
*[https://onlinelibrary.wiley.com/journal/13652591 International Endodontic Journal]

{{Endodontology}}
{{Dentistry}}

[[Category:Endodontics| ]]

Revision as of 23:09, 12 March 2021

hsfjksf


1. AN INTRODUCTION TO ENDODONTICS 2.The DEFINITION: Branch of dentistry concerned with the: Morphology Physiology Pathology of the human dental pulp and periradicular tissues. Abscess 3. SCOPE OF ENDODONTICS Its study and practice encompass: Biology of the normal pulp Etiology Diagnosis Prevention Treatment of diseases and injuries of the pulp and associated peri-radicular tissues. 4. PRINCIPLES OF ENDODONTIC THERAPY: Diagnosis Patient education Local anaesthesia Isolation Rubber dam isolation Access cavity Working length Instrumentation Obturation Final restoration 5. DIAGNOSIS: According to Ingle, diagnosis is the procedure of Accepting a patient Recognizing that he has a problem Determining the cause of the problem and Developing a treatment plan that will solve or alleviate the problem 6. DIAGNOSIS Chief Complaint History [Medical/Dental] Objective Examination Subjective Examination Radiographs 7. PATIENT EDUCATION Patient should be informed about the condition of his teeth and the treatment options available. Instructions to the patient about improvement of the oral hygiene. 8. LOCAL ANAESTHESIA Similar to the local anesthesia given for various other dental procedures. Supplemental anesthesia may be required for certain cases – "Hot Tooth" 9. ISOLATION Rubber Dam isolation - usually a single tooth isolation. Isolation is very important not only for maintaining a sterile field but also to prevent aspiration of irrigation materials and instruments 10. ACCESS CAVITY 11. WORKING LENGTH The distance from a coronal reference point to the point at which canal preparation and obturation should terminate. 12. INSTRUMENTATION May be done using hand instruments or rotary instruments. Simultaneous irrigation and lubrication are essential. 13. OBTURATION Many techniques: Hot/ Cold Lateral/ Vertical Single Cone/ Multiple Cone 14. FINAL RESTORATION Many options. Ideally should provide strength to the remaining tooth structure. Should promote physiological function of the tooth and the surrounding tissues. 15. INDICATIONS Carious teeth [caries involving pulp] Teeth with irreversible pulpitis Necrotic pulps Treatable periodontal conditions [endo-perio lesions] Salvageable resorptive defects Supra-erupted teeth with good bone support Fractured teeth involving pulp Intentional endodontics for FPD's or over-dentures 16. Insufficient periodontal support. CONTRAINDICATIONS 17. Canal instrumentation not practical: Calcification of the canal Sharp dilacerations/curvature of the roots CONTRAINDICATIONS 18. Non restorable teeth CONTRAINDICATIONS 19. CONTRAINDICATIONS Inadequate crown root ratio Vertical tooth/root fracture 20. Patient's general medical condition: Patients general medical condition is never an absolute contraindication to endodontic therapy However, management of other medical conditions may take precedence over endodontic therapy for eg: pregnancy, diabetes, hypertension. CONTRAINDICATIONS 21. BEFORE UNDERTAKING ENDODONTICS Relating to the tooth in question: Is the tooth needed or important? Does it have an opponent? Could it some day serve as an abutment for prosthesis? Is the tooth salvageable, or is it so badly destroyed that it cannot be restored? 22. BEFORE UNDERTAKING ENDODONTICS Relating to the patient’s general dentition: Is the tooth serving esthetically, or would the patient be better served by its extraction and a more cosmetic replacement? Is the tooth so severely involved periodontally that it would be lost soon for this reason? 23. The future of endodontics is very bright, indeed! Techniques and material advancements make the future of endodontics exciting and profitable for all dentists. Instrumentation also will evolve dramatically. We will see more sophisticated design features on rotary files to increase efficiency, yet maintain safety, as with the new K3 file by SybronEndo. FUTURE OF ENDODONTICS 24. FUTURE OF ENDODONTICS Enhanced magnification, using either a microscope or loupes, is a must when performing challenging endodontic procedures. In the future, as these tools become more affordable, we will observe more general practitioners performing dental procedures under a microscope or with a good set of loupes and an external light source. 25. Obturation has benefitted from major changes in the past 10 years. Expect the introduction of new materials, and also a change in sealer characteristics. Most likely, more "resin dentistry" will be introduced into endodontics. The art of filling a root canal will progress scientifically. However, future obturation improvements will continue to be contingent upon good cleaning and shaping. FUTURE OF ENDODONTICS

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