Page 5 - The Beauty and Sorrow in Endodontics-Prologue

Introduction

The Ultimate Goal of Root Canal Treatments

Dr. Herbert B. Schilder (1928~2006) always emphasized that the purpose of
performing root canal treatment is to maintain the health of the attachment apparatus
around the tooth (as opposed to simply removing the diseased pulp). The ultimate goal of
completing treatment, consequently, is to preserve the tooth and allow it to continue to

play its role in mastication and occlusion instead of just pain relief. How, then, can we
determine if a tooth indeed requires endodontic treatment? Whether it is a case of
irreversible pulpitis, necrosis, or periodontal lesions of endodontic origin (LEO), a correct
diagnosis is required prior to treatment initiation. If the diagnosis was incorrect, even
with proper root canal treatment, the disease or lesion will remain, and may even worsen

over time.

The Cause of Pulpal Inflammation

Pulpal inflammation is mostly caused by dental caries, but can also be a result of
thermal stimuli during restoration, chemical stimuli from dental materials, or from
traumatic tooth fractures resulting in pulpal exposure, infection, and ultimately necrosis.

Reasons for Failed Root Canal Treatment

The following are the main reasons why root canal treatments fail:

1. Diagnostic Error: For example, the pain originated from a non-odontogenic source or
from a different tooth;
2. Complications During Treatment: For example, perforations, separated files, ledges,
or extruded infectious substances;
3. Underestimated the Complexity of Root Canal Systems: For example,

missed/untreated canals or incorrect working length determination;
4. Lack of Coronal Seal: For example, failure to restore the root canal treated tooth to
prevent coronal leakage and the resultant recurrent infection;

5. Occlusal Trauma: For example, the failure to correct existing parafunctional occlusion
on that tooth.

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