Page 6 - The Beauty and Sorrow in Endodontics-Chapter 2

Chapter 2

Endodontic Treatment is Essentially Carrying out Infection

Control of the Root Canal System

By the end of this chapter, you should be able to answer the following questions:

1. How to create adequate coronal seal in cases with gross caries to ensure the
effectiveness of the root canal treatment?
2. What are the differences in treatment modality in cases where there is pre-existing
abscess (gumboil) or draining fistula?
3. Are sealers essential in obturation? Does sealer extrusion cause any adverse tissue

reaction? What are the specific requirements for sealers in warm vertical compaction
technique?

The Importance of Coronal Seal

Dentists often focus on creating an ideal apical seal hoping that will ensure treatment
success, however, the importance of a coronal seal is often overlooked. Dr. Schilder
always reminded his students that the prevention of any pathogen from entering and

exiting the root canal system (via creation of apical and coronal seal) is as vital as the
elimination of the pathogens in the system (via cleaning, shaping, and disinfection). One
would need to start the process of preventing the pathogens from entering the root canal

space even before root canal treatment commencement.

Pre-treatment is Vital to the Success of Infection Control

The purpose of completing pre-treatment is to ensure proper coronal seal throughout
the entire root canal treatment procedure. The goal for isolation is to prevent any
contamination into the root canal system once access cavity preparation has been initiated.
Often the teeth that require root canal treatment either have large caries or have lost

significant coronal tooth structure due to trauma, therefore, even with rubber dam,
adequate isolation may not be guaranteed. In some cases, dentists are forced to place the

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