Questioning the spot light on Hi-tech endodontics

Endodontics as a field of dentistry has made giant leaps in the past two to three decades. Pioneering technological advancements include magnification, innovative material science, designs and techniques for instrumentation and obturation of the root canal systems. Contrary to this ascent in endodontic material, technique, and equipment innovations, a number of treatment outcome data reveal no statistically significant improvement in overall endodontic success in the corresponding period. The answers to this debate could be fairly uncomplicated but have been widely overlooked in the race for sophisticated technology and innovation in endodontics. The foremost factors that have repeatedly been documented to significantly impact the outcome of primary root canal treatment are pre-operative pulpal and periapical status, root anatomy with complex canal systems, achievement of patency to the canal terminus, mid-treatment complications including perforation and instrument separation, root filling with no voids that extends upto 2 mm of the radiographic apex and a leakage free coronal restoration. Other than the first two aspects, which are beyond the direct control of the treating clinician, all other factors are directly dependant on the operator’s performance. Objective analysis and diagnosis of pulpal and periapical preoperative status is critical for long term success of adequately treated teeth. The ability of routinely used diagnostic tools to accurately determine the health or disease status of the pulp or periapical tissues is at best questionable. Traditional techniques for pulpal diagnosis primarily assess neural response (electric and thermal pulp tests), instead of the true vitality of the tooth like the pulse oximeter or Laser Doppler Flowmetry, which have been shown to be more objective and accurate in making a clinical diagnosis. Unfortunately, the latter are inaccessible to a large number of dentists, and are neither cost effective nor simplified enough for widespread clinical use. An accurate clinical diagnosis of the pulpal condition could possibly enable managing initial irreversible pulpitis with vital pulp therapy instead of the radical devitalization approach of root canal treatment. The clinical inefficiencies of traditional pulpal diagnostic methods hinder accurate, scientific decision making ability regarding noninvasive, preservative, preventive, therapeutic or biologic endodontic procedures like pulp capping or pulpotomies with mineral trioxide aggregate (MTA) versus invasive, synthetic, non-biologic based orthograde root canal procedures. As for intra-treatment factors affecting endodontic outcome, it has been frequently reported that the material of the instrument and their design and taper or motion of instrumentation have had no significant impact. Neither has the type of sealer, material, method or equipment used for obturation been of consequence to overall ISSN 2234-7658 (print) / ISSN 2234-7666 (online) http://dx.doi.org/10.5395/rde.2016.41.1.80 Letter to editor