West John
University of Washington School of Graduate Endodontics, Tacoma, WA, USA.
J Esthet Restor Dent. 2006;18(5):280-300. doi: 10.1111/j.1708-8240.2006.00039.x.
The past 10 years have witnessed more significant changes in the art and science of endodontics than the previous 100 years. This observation is no surprise, given that change is our only constant. The rate of change, however, has been anything but constant. The rate has accelerated so fast that all clinicians in the field of dentistry need a reliable source to guide us in what works. What works today in endodontics is the theme of this update. The discoveries and advancements in endodontic technology, instruments, and materials enable practitioners to achieve treatment outcomes that were previously considered unattainable. For example, in nonsurgical endodontic treatment, nickel titanium technology consistently can produce predictable radicular preparations that can be easily obturated. In nonsurgical re-treatment, the previous endodontic obturation attempt frequently can be removed and successfully re-treated largely because of enhanced vision and coaxial lighting from the operating microscope. Importantly, careful nonsurgical re-treatment usually can be accomplished without disruption to the existing restorations and without risk to ferrule integrity. In endodontic surgery underfilled foramina, and the isthmi between them, predictably can be connected and obturated with state-of-the-art miniature instruments. CLINICAL SIGNIFICANCE This article reviews the clinical endodontic breakthroughs encountered during the last decade and focuses on three primary topics: (1) finding canals; (2) following canals; and (3) finishing canals. Every day, dentists are faced with the interdisciplinary treatment planning question of to "save or not to save a tooth?" Dentists must routinely make the decision of whether to remove or restore the tooth based on biology, structure, function, esthetics, and value.(1) Occasionally, the endodontically treated tooth can be the weakest link in the restorative and esthetic sequence. This article examines the current state of endodontic technology, as well as the fundamentals of endodontic mechanics needed to achieve the most predictable endodontic outcome with the highest degree of success.
过去10年牙髓病学的技术与科学领域所发生的重大变化比此前100年还要多。鉴于变化是唯一不变之事，这一观察结果并不令人意外。然而，变化的速度绝非恒定不变。其加速之快，以至于牙科领域的所有临床医生都需要一个可靠的来源来指导我们哪些方法有效。牙髓病学中当下有效的方法就是本次更新的主题。牙髓病学技术、器械和材料方面的发现与进步使从业者能够实现以前认为无法达到的治疗效果。例如，在非手术牙髓治疗中，镍钛技术始终能够制作出可轻松进行根管充填的可预测的根管预备。在非手术再治疗中，由于手术显微镜增强了视野和同轴照明，之前的牙髓充填尝试通常能够被取出并成功再治疗。重要的是，仔细的非手术再治疗通常可以在不破坏现有修复体且不危及桩核完整性的情况下完成。在牙髓手术中，未充满的根管口及其之间的峡部可以用先进的微型器械进行可预测的连接和充填。临床意义 本文回顾了过去十年中牙髓病学的临床突破，并重点关注三个主要主题：（1）寻找根管；（2）追踪根管；（3）完成根管。每天，牙医都会面临“保存还是不保存一颗牙齿”的跨学科治疗计划问题。牙医必须根据生物学、结构、功能、美学和价值常规做出是否拔除或修复牙齿的决定。（1）偶尔，经过牙髓治疗的牙齿可能是修复和美学序列中最薄弱的环节。本文探讨了牙髓病学技术的现状，以及实现最可预测的牙髓治疗结果和最高成功率所需的牙髓力学基本原理。
