Page 40 - The Beauty and Sorrow in Endodontics-Chapter 1

Conclusion

Dr. Schilder has always stressed the importance of confirming the diagnosis
and etiology of the patient’s symptom is of endodontic origin prior to treatment;
ensuring complete isolation and infection control of the root canal system during

treatment; and rigid and regular follow-ups to ensure healing of the lesion and
reformation of the lamina dura in each case. If lesions are not healing as expected, or
any new lesions or symptoms appear, further treatment options including apical

surgery should be considered. However, apical surgery should not be utilized as a
correction for improper obturation, if the reason for the failed root canal treatment can
be corrected, retreatment should be considered first.

Dentists need to differentiate between overfilling and overextension. All the

lesions presented in this chapter has healed with reformation of its lamina dura,
demonstrating that overfilling is to be expected, since any material used as the retrofill
material during apical surgery is basically achieving the same result as overfilling.

Even when amalgam was the material of choice in the 1990s and researchers were
concerned about its biocompatibility properties, as long as dentists were able to
eliminate pathogens and achieve proper apical and coronal seal, a successful outcome
is to be expected. On the other hand, even with a three-dimensional apical seal of the
complex root canal system in place, treatment can fail for the following reasons: 1)

incorrect diagnosis and 2) inability to achieve and maintain the coronal seal. No matter
how nicely the root canal system is obturated, if there is recontamination of the system
from coronal leakage, one cannot maintain a predictably successful outcome.

Dr. Schilder’s Remark:

Any tooth can be treated successfully endodontically if it is periodontally sound
(or can be made so) and if its foramen or foramina can be sealed, with or without

a surgical approach.

If you still have questions regarding whether or not a tooth with gross caries,

or have intermittent abscess, swelling, sinus tract can be saved with root canal
treatment, or how to complete coronal seal to ensure isolation, please continue reading the
next chapter.

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