Endodontics in the technological era

Nanotechnology

Nanoparticle technology has made a tremendous impact on the medical field, and its application to dentistry has been especially prominent in endodontic circles. What once sounded like science fiction to the layman has quickly become a revolutionary reality. From application in regenerative therapies, to irrigation strategies and photodynamic therapy,[i] the promise of nanoparticle use grows by the day.

At the core of root canal treatment failures is biofilm, and nanotechnology could effectively provide antimicrobial action to manage infected systems.[ii] Endodontic irrigation is a staple in root canal treatment. In theory, the irrigation liquid can remove pathological cells from all areas of the canals; though existing technologies cannot guarantee the complete disinfection of the root canal space, nor the complete removal of endodontic biofilms. Antimicrobial nanoparticles are proving to be a promising alternative to the convention in vitro, with better penetration, and a slow and controlled release of active ingredients on target sites.[iii]

Further research is needed into the hazards of nanotechnologies, including the risks they could pose to patient health and practitioner safety. For the moment though, studies glow with potential for a radical change in endodontic treatment over the next decade.[iv]

Lasers

Various dental specialties have made use of the healthcare capabilities of laser treatment, from periodontics to endodontics. In endodontic treatment, lasers may not have completely replaced the “gold standard” conventional endodontic therapy techniques, but they have been proven to improve care when used as an adjunctive solution.[v]

Endodontic failure is commonly caused by insufficient root canal disinfection.[vi] Laser supported treatments have developed to aid a more complete antimicrobial irrigation whilst also being minimally invasive.[vii] Laser-activated irrigation generates small cavitation bubbles in irrigation solutions, creating rapid movements which can remove the content attached to the root canal walls, which may otherwise be difficult to target. The movements subsequently flush the debris out of the canals, reducing the risk of further infection.[viii]

The process requires the tip of the laser equipment to enter just the coronal area, without needing to approach the apical area, leading to a minimally invasive procedure.[ix] This could make patients more comfortable, whilst also presenting more successful results.

Lasers have been adapted for other endodontic uses, not limited to root canal shaping, decreasing dentinal hypersensitivity, and diagnosing pulp vitality.[x] The instrument looks to be a key part of treatment in the future, and its effective abilities will only improve with time.

CBCT (and AI)

Whilst nanotechnologies and lasers are fundamentally changing the way endodontic therapies will be performed in the future, the transformation of treatment timelines has already begun. Most diagnoses can be well informed with the aid of a parallel and clear 2D radiographic image, and a well-trained diagnostic eye, but cone beam computed tomography (CBCT) provides a third dimension – and in turn, significant benefits.[xi]

CBCT imaging is growing in influence, and it’s no surprise why. The technology allows for a 3D analysis that prevents issues associated with traditional 2D radiographs such as artefact distortion, anatomical overlaps, or difficulties differentiating structures.[xii]

Practitioners could change their professional opinions on aetiologies and recommendations for treatments when presented with information from CBCT scans; in some studies, this is, on average, in nearly every other case.[xiii] Making effective use of CBCT scans in this way requires the appropriate training. The European Society of Endodontology recommends that with justification and sensible optimisation, CBCT scanning can be an essential tool for successful diagnosis or management of endodontic problems.

Throughout the entire treatment workflow, from diagnosis till prediction of prognosis, artificial intelligence (AI) is transforming the capabilities of analysing CBCT scans. Various models have displayed accuracy in both diagnostic and prognostic evaluations, consequently providing the potential to increase the success rate of endodontic treatment. However, before immediately implementing an AI system into a clinical workflow, it’s important to perform adequate research on the dependability and relevance of the judgements many AI programs can make.[xiv]

Endodontology is in the midst of exciting change, and there is no better way to experience it than being a member of the British Endodontic Society (BES). The BES encourages and facilitates the lifelong education of practitioners that are part of this vital field of dentistry. As a member you will be amongst a network of passionate endodontists who are at the forefront of the field’s clinical and technological developments. You’ll also receive a monthly copy of the International Endodontic Journal for leading information and findings within the field, and you’ll be joining a community of like-minded individuals who are regularly exploring new products, materials and technologies to enhance the delivery of endodontics for all.

Technology continues to revolutionise endodontics, creating a dynamic space for clinicians in the field to broaden their skills and further enhance the patient experience. Endodontics is, rather excitingly, growing and transforming day-by-day.

For more information about the BES, or to join, please visit the website www.britishendodonticsociety.org.ukor call 01494 581542

[i] Wong, J., Zou, T., Lee, A. H. C., & Zhang, C. (2021). The potential translational applications of nanoparticles in endodontics. International Journal of Nanomedicine, 16, 2087.

[ii] Jhajharia, K., Parolia, A., Shetty, K. V., & Mehta, L. K. (2015). Biofilm in endodontics: a review. Journal of International Society of Preventive & Community Dentistry, 5(1), 1.

[iii] Boitsaniuk, S., Kochan, O., & Levkiv, M. (2022). Applications of Nanotechnology in Endodontics: Narrative Review. Universal Journal of Nanoscience, 1(1), 17-31.

[iv] Zakrzewski, W., Dobrzyński, M., Zawadzka-Knefel, A., Lubojański, A., Dobrzyński, W., Janecki, M., … & Rybak, Z. (2021). Nanomaterials application in endodontics. Materials, 14(18), 5296.

[v] Anagnostaki, E., Mylona, V., Parker, S., Lynch, E., & Grootveld, M. (2020). Systematic review on the role of lasers in endodontic therapy: valuable adjunct treatment?. Dentistry Journal, 8(3), 63.

[vi] Jurič, I. B., & Anić, I. (2014). The use of lasers in disinfection and cleanliness of root canals: a review. Acta Stomatologica Croatica, 48(1), 6.

[vii] Olivi, G. (2013). Laser use in endodontics: evolution from direct laser irradiation to laser-activated irrigation. J Laser Dent, 21(2), 58-71.

[viii] Huang, Q., Li, Z., Lyu, P., Zhou, X., & Fan, Y. (2023). Current Applications and Future Directions of Lasers in Endodontics: A Narrative Review. Bioengineering, 10(3), 296.

[ix] Miranda, T. C., Andrade, J. F., Gelfuso, G. M., Cunha-Filho, M., Oliveira, L. A., & Gratieri, T. (2023). Novel technologies to improve the treatment of endodontic microbial infections: Inputs from a drug delivery perspective. International Journal of Pharmaceutics, 635, 122794.

[x] Vasishta, P. A., Anjaneyalu, K., Sivaswamy, V., & Anjaneyalu, K. (2020). Lasers in Endodontics-A Review of Literature. Indian Journal of Forensic Medicine & Toxicology, 14(4), 4544-4550.

[xi] Johnson, B. R., & Rossman, L. E. (2017). CBCT technology: How has it impacted clinical endodontic care?. Compendium, 38(11).

[xii] Schmidt, J. C., Gutekunst, C. J., Dagassan-Berndt, D., Schmidlin, P. R., & Walter, C. (2019). Comparison of two-dimensional and three-dimensional radiographs using clinically relevant parameters. Dentistry journal, 7(2), 50.

[xiii] Chogle, S., Zuaitar, M., Sarkis, R., Saadoun, M., Mecham, A., & Zhao, Y. (2020). The recommendation of cone-beam computed tomography and its effect on endodontic diagnosis and treatment planning. Journal of endodontics, 46(2), 162-168.

[xiv] Karobari, M. I., Adil, A. H., Basheer, S. N., Murugesan, S., Savadamoorthi, K. S., Mustafa, M., … & Almokhatieb, A. A. (2023). Evaluation of the Diagnostic and Prognostic Accuracy of Artificial Intelligence in Endodontic Dentistry: A Comprehensive Review of Literature. Computational and mathematical methods in medicine, 2023.