What's Cutting Edge in Endodontic Technology Today

Laura Dorr

Laura Dorr is the former executive editor of DPR's Modern Dental Network and a regular contributing author.

Technology in endodontics is evolving every day to provide better tools and techniques in dentistry.

At one point, the microscope was considered a cutting-edge tool. Motorized dental drills were novel and unique. Digital x-rays were the next best thing. Now, we don’t think twice about them. A new generation of technology has taken the place as the latest and greatest—and it’s evolving every day.

But how have these technologies shaped dentistry, and endodontics in particular? Endodontically diseased teeth that would have been deemed unsavable are now being saved and restored, thanks to new technologies, treatments, and approaches. As the arsenal of tools has grown, so, too, has endodontic predictability. From lasers and 3D imaging to microsurgery and dynamic navigation, there have been developments in tools and techniques.

The trend towards minimally invasive

Advances in minimally invasive treatment have perhaps been what has shaped endodontics the most in recent years. Departing from manual files and other tools, many clinicians are exploring lasers and acoustic energy as alternatives, for quicker and more effective treatment as well as faster healing times. And Dr Richard Mounce, an endodontist practicing in Pacific City, Oregon, sees many areas of new innovation.

“Some of the big trends in endo today include minimally invasive shaping philosophy, improvements in activated irrigation, improved bioceramic sealers, the use of come beam computed tomography (CBCT) in targeted endodontic microsurgery and canal location, and reciprocated endodontics, to name a few,” he says. “While there are several partisan camps in endodontics; one camp advocates minimally invasive approaches using the Sonendo GentleWave System for canal cleaning. It could be argued that GentleWave is changing the specialty.”

The GentleWave procedure provides standard root canal treatment, but with a minimally invasive process that is reported to preserve tooth structure and promote rapid healing.1 By utilizing fluid dynamics and broad-spectrum acoustic energy, the GentleWave minimizes—and even replaces—much of the need for manual instrumentation in root canal procedures, preventing the removal of extra tooth structure while providing effective cleaning through its fluid-delivery system, which distributes fluid throughout the canal system. Reportedly, this procedure is, in most cases, a single-visit treatment option.2

Other advances in canal cleaning and disinfection include nanotechnology, which Dr Mounce thinks is a noteworthy area of study in endodontics. He predicts that commercial products and clinical techniques are likely to soon emerge using these particles.

Advancements in imaging

In addition to this technology, other options have become attractive, made possible largely by the development of CBCT. Many clinicians, including Dr Mounce and Dr Rebekah Lucier-Pryles, agree that CBCT has made a huge difference in endodontics in the previous decade. In fact, much of the advancement in endodontic treatment and technologies stems from CBCT’s capabilities, particularly for dynamic navigation and targeted endodontic surgery.

“CBCT-guided surgery and non-surgical root-canal therapy are at the forefront of endodontic care,” Dr Lucier-Pryles, an endodontist in White River Junction, Vermont, and cofounder of Pulp Nonfiction Endodontics, says, noting that non-surgical therapies are attractive to patients who balk at the idea of surgery. Even when surgery is the only option, however, Dr Lucier-Pryles finds advances that have made the process easier.

“Technologies associated with CBCT-guided nonsurgical and surgical root canal therapy are now available and facilitating the delivery of endodontic care thought impossible years ago,” she says.“For instance, palatal apical surgery can be readily performed with the aid of CBCT-developed surgical stents. Additional surgical innovation beyond CBCT guidance now includes the use of piezoelectric devices to remove bony windows prior to accessing root apices. This approach offers more predictable postoperative healing than older techniques.”

Dr Mounce agrees. With these technologies, and the development of targeted endodontic microsurgery, guided dynamic navigation, and lasers with multiple applications, he believes the field has been pushed forward immensely.

“We now have techniques that are advancing our clinical capabilities well beyond previous limits by allowing treatment of previously untreatable clinical scenarios,” he summarizes. “Lasers have provided excellent results, and GentleWave partisans would likely argue that their technology is the most cutting-edge the industry has seen.”

Looking forward

The technology gains of the past few years have been impressive, but there’s more to come down the road. As innovative companies continue to do their research and develop cutting-edge products, treatment will be further simplified and care will be improved. Trends look to continue toward medical treatment over surgical, and future regenerative endodontic materials will change how we think about growth factors and material matrix designs—all benefiting patients and the field of endodontics. As these developments progress, Dr Mounce hopes to see these technologies become more accessible and affordable to clinicians.

“At some point, the technology is priced out of the range of the general dentists (and possibly some endodontists), even in the most advanced economy,” he says. “Every clinician must decide for themselves if the clinical result obtained is superior and/or justifies the expense based on the literature. The same cost, risk and benefit analysis should be made for all technology decisions. Right now, prohibitive costs mean treatment hasn’t been simplified for many clinicians; but has the technology improved endo care? Most probably, yes.”

But while some advances are currently cost-prohibitive, the growth continues (hopefully becoming more affordable in the future, Dr Mounce says), and opportunities for development continue to present themselves across the board.

“I see room for continued advancement in CBCT-guided technologies, in disinfection, and in restorative care following endodontic therapy,” Dr Lucier-Pryles summarizes. “As technology improves, our treatment strategies become more appropriate.”

Dr Mounce agrees that big things are just around the corner.

“While I don’t have any inside information, I suspect that we will see a GentleWave-like handpiece that facilitates obturation of the canal using some form of sonic or ultrasonic vibrational waves,” he says. “I’m confident that this concept--putting a handpiece over the access, cleaning and obturating all the clinical anatomy, and placement of a coronal seal via a robotic console--is being developed now.

“It's the Holy Grail of endodontic treatment,” he continues, “and would, for practical purposes, make endodontics as we know it obsolete.”

References
1. Molina B, Glickman G, Vandrangi P, Khakpour M. Evaluation of root canal debridement of human molars using the GentleWave System. J Endod. 2015;41(10):1701-1705. doi:10.1016/j.joen.2015.06.018
2. Sigurdsson A, Garland RW, Le KT, Woo SM. 12-month healing rates after endodontic therapy using the novel GentleWave System: a prospective multicenter clinical study. J Endod. 2016;42(7):1040-1048. doi:10.1016/j.joen.2016.04.017