Page 63 - The Beauty and Sorrow in Endodontics-Chapter 2

Conclusion

Dr. Schilder often reinforced the idea that coronal seal is as important as the apical
seal. If the tooth in question has large caries or missing structure, in addition to the
regular crown lengthening procedure, coronal build-up, and temporary crown, a copper

band can easily be placed to provide pre-treatment coronal seal. Otherwise, even with the
utmost perfect obturation, coronal leakage can still result in recontamination of the root
canal system. In cases where pre-existing gumboil or fistula are present, other than a

pre-op sonogram with a gutta percha cone through the gumboil or fistula to identify the
problematic tooth, cavity tests without anaesthetics can often be used to further confirm
the pulpal diagnosis. No matter which obturation technique is utilized, sealer is often
required as a medium between the canal walls and gutta percha, therefore the use of a
biocompatible material that can be resorbed in reasonable time is required. If the material

resorbs too fast, then concerns arise regarding the apical seal and microleakage.
Overfilling of the sealer often shows the location of lateral canals, with regular
follow-ups, one can see the sealer puffs slowly being resorbed over time and lamina dura

being reformed.

Schilderian endodontics philosophy provides predictably successful root canal
treatment if stringent protocols are followed. In addition, Dr. Schilder often encouraged
us to elevate our diagnostic and treatment skills and learn from each case.

Dr. Schilder’s Remark:

Coping with the root canal system is dependent upon two things:
A dentist’s desire (skill) plus a cooperative and understanding patient.

If you are wondering if the apical lesions are of periodontal or endodontic etiology,

or if it’s possible to save a highly mobile tooth, or how to formulate a recall/follow-up
schedule for the patient, please continue reading through the next chapter.

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