KeystoneExplorer | Fall 2023 1 Endodontics seems to enjoy a cycle of popularity in the history of fixing teeth. Root canal therapy was once a revolutionary alternative to extracting a painful tooth (or at least a way to buy time before extraction). The earliest endodontics simply involved “breaching” a tooth to relieve the pain of pulpitis. Rudimentary root canals were done without X-rays, much less an understanding of pulp biology. New instruments were developed over time to help remove ever more of that painful pulp. Eventually, occasional successes led way to a legitimate treatment option to keep a tooth in service after the pulp had been damaged. The introduction of the X-ray must have been one of the true turning points in endodontics. Finally, there was some type of road map for avoiding the nerve. (When showing a patient an X-ray, I always refer to the pulp as the living part of the tooth rather than the “nerve,” in an attempt to get them to grasp the importance of this tissue.) Hess first showed dramatic anatomy that even a radiograph couldn’t detect, and for the first time we could appreciate that the pulp system was far more complex than just a tube-like canal. I remember the first time I saw slides of these vulcanized teeth I felt hopeless; negotiating, cleaning, and filling this anatomy seemed impossible. Histologically, we never remove one hundred percent of the pulpal system, but modern techniques in instrumentation, irrigation protocol, and imaging have allowed us to advance clinical endodontics to an extremely predictable level. Later, as tooth replacement and especially implants became more sophisticated, endodontics began to be seen as unpredictable, time consuming, and financially inefficient. We’ve all heard comments (or perhaps harbored belief) that endodontics is a “dying specialty.” Endodontics in dental education certainly seems to have taken a backburner to other disciplines. I can see a future where endodontics once again takes the spotlight from implant therapy. Regenerative medicine (and specifically endodontics) has continued to make promising strides in recent decades. Some of these are sensationalized and oversold and admittedly we are decades away from being able to regrow teeth. Nonetheless, our understanding of the pulp and periodontal tissues continues to develop. Regeneration of more complex dental structures could become a key addition to our toolkit. The general dentist continues to play a key role in endodontics and with proper training and case selection this should be an area of service we offer to our patients. The ability to deliver patients from pain never goes out of vogue. from the editor’s desk | The Dying Specialty That Keeps Regenerating Alex Frisbie, DMD, FAGD “I can see a future where endodontics once again takes the spotlight from implant therapy.”
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