As we navigate dental school, explore various specialties and consider potential residencies, we learn about the increasing complexity of cases that specialists handle. Fortunately, technology and research have also progressed to help specialists achieve these new goals and set higher standards.
For example, in endodontics, there is an increasing emphasis toward minimally invasive procedures as well as a search for new irrigation devices for more complete disinfection. The 2019 president of the American Association of Endodontics (AAE), Dr. Patrick E. Taylor, predicted that advances in technology, such as improved cone beam computed tomography (CBCT) software and irrigation protocols, would help increase the success rate of endodontics treatment.
Two years later, CBCT and irrigation techniques have definitely proved to be two central themes at this year’s AAE Annual Meeting. Here are some of my takeaways from the meeting in terms of future technologies in endodontics.
Immunomodulation in vital pulp therapy
Recently, there has been some groundbreaking research on human organ regeneration (i.e., heart valves, bladder, trachea, skin, muscle, blood, ear, digits). Could regeneration be applied to endodontics to form pulpal tissue from dental stem cells?
Dr. Avina Paranjpe emphasized the importance of eliminating bacteria. Bacteria can prevent pulp regeneration since they interact with dental stem cells and activate host immune cells to kill them. Because stem cells are undifferentiated, they are more sensitive to immune cells. The current goal is to introduce factors (scaffolds, nanoparticles, growth factors, miRNA, exogenous compounds) to stem cells to encourage their differentiation, therefore desensitizing them to immune cells, prolonging their survival and, hopefully, encouraging regeneration.
Endodontics instruments could break inside the tooth, simplifying techniques could make lives easier for both dentists and patients, and the search is still ongoing for an irrigation technique that completely disinfects root canals. So, what if we could clean and shape canals without instruments?
Dr. Asgeir Sigurdsson discussed GentleWave technology, which is essentially a handpiece that only enters the pulp chamber but not the root canals. The handpiece’s high-speed tip emits sound waves that help clean the whole root canal system. Although studies so far have demonstrated that GentleWave doesn’t remove all debris from the tip of the root, I think Gentlewave could still hold promise as it requires less concentrated irrigation, less invasive technique and has few adverse effects (<1 in 50,000 cases).
Ozone as irrigation
With its antimicrobial, immunostimulating, analgesic and biosynthetic properties, ozone has gained interest in endodontics as a potential alternative to traditional sodium hypochlorite irrigation. However, Dr. Bill Kahler discussed current limitations. In preliminary studies, ozone decreased bacteria significantly but less than sodium hypochlorite, and it was ineffective in increasing the antimicrobial effect of sodium hypochlorite when given together. Therefore, it can neither replace nor complement sodium hypochlorite. However, it still seems potentially useful for other applications, such as internal bleaching or encouraging bone regeneration for implants.
For both CBCT and MRI technologies, Drs. Asma Khan, Frank Setzer and Don Nixdorf discussed developing more sophisticated software to diagnose fractures and periapical lesions. Training technology to help with diagnosis could improve efficiency and accuracy and, thus, promote improved treatment success.
All in all, what does the future look like for endodontics? Based on the technology track of the AAE Annual Meeting, it seems geared toward regenerative therapy, non-instrumental techniques, and enhanced use of artificial intelligence in diagnosis and treatment planning. Like many specialties of dentistry, the future of endodontics seems exciting and bright, and something to continue keeping up to date with as we head into our residency programs and careers.
~Eileen (Zeming) Zheng, Columbia ’23, ASDA Electronic Editor