Minimally Invasive Endodontics: The Expectations
and Reality
Nawras Maher Mostafa*
Specialist Restorative and Endodontics in private sector, Iraq (PHCC\QATAR)
*Corresponding author: Nawras Maher Mostafa, BDS, MSc, Specialist Restorative and Endodontics in private sector, Iraq (PHCC\QATAR), E-mail:
@
Received: December 15, 2020; Accepted: December 24, 2020; Published: December 31, 2020
Citation: Nawras Maher Mostafa (2020) Minimally Invasive Endodontics: The Expectations and Reality. J Dent Oral Disord Ther
8(3): 1- 2 DOI: 10.15226/jdodt.2020.001119
Keywords Top
Minimal intervention dentistry, Minimal Invasive Endodontics,
root canal system
Minimal intervention dentistry isa concept of delivering the
professional care with the first occurrence, earliest detection and
earliest possible cure of disease on molecular levels, followed
by minimally invasive and patient-friendly treatment to repair
irreversible damage caused by such disease which enabling
the professionals from preserve the tissues with minimum loss
without causing any damage to adjacent tissue[1-3].
The endodontics as a branch of dentistry also involved in the Technological revolution in optics, instruments, materials, and computer systems that make the application of minimal invasive approaches are possible in endodontic field[4].
The main targets of the successful endodontic treatment are achieved by eliminating all organic substrate from the root canal system and fill this system in way that ensure the biological goals for long-term success of endodontic treatment. This success is reached by an adequate knowledge about the conservation and elimination of tooth structure during endodontic procedure.5moreover the effective endodontic therapy emphasis on accessing, shaping andcleaning the system in a manner that will enable efficient and total filling of the root canal space, while leaving the tooth with sufficient strength to function successfully, that making minimally invasive endodontics philosophy based on maximum preserve the healthy coronal, cervical and radicular tooth structure during the endodontic treatment[5,6].
For this reasons a lot of traditional methods to access prepare the root canal system changed to cope with this development in enhanced lighting and magnification and highly flexible rotary instruments[7].For instance the traditional straight-line access cavity preparation which structurally compromise the tooth by removing an excessive amount of dentin that’s will affect the long-term survival of the endodontically treated tooth, while the contracted access cavity design which focusing on the minimal removal of the tooth structure that could increase tooth survival and fracture strength by dentin preservation[8]. Also the root canal shaping according to the minimal invasive concept should be conservative as much as possible and avoid over-flaring in order to make the root strong enough to cope with the obturation compressive strength and maintain the tooth in functioning and withstanding the mastication forces which can be achieved efficiently with flexible rotary flexible nickeltitanium instruments[9,10].
The apical preparation still controversial point in the literatures. The smaller apical preparation whereas can create a tight apical seal, adequate resistance form with continuous tapering that can maintain good disinfection[11,12].While the larger apical canal diameters are important to shape the apical canal wall, remove the debris, deeper irrigation to the terminus will be allowed and reducing remaining bacteria in the root canal system[13,14].However it was appeared form the evidences there were no any apical preparation methods could make the apical terminus free from bacteria, so that the smaller apical preparation advocated because it conservative technique and reduce the apical distortion and can adequately eliminate the bacteria in comparable way to the large apical preparation[15,16].It was clearly appeared the total elimination of biofilm and bacteria from the root canal system did not achieved by any current cleaning and shaping techniques that lead the both researchers and clinicians to focus on increasing the disinfection efficacy by using different techniques such as; manual , sonic , ultrasonic and laser activation[17].
TheMinimal Invasive Endodontics(MIE)as a concept and philosophy based on preserving sound tooth structure during access cavity opening, canal scouting, glide path, and instrumentation[18]which required sophisticated devices and instruments such as; surgical microscope, ultrasonic-assisted preparation techniques , modern flexible file systems and irrigation activation systems, beside the clinician deep knowledge in root canal anatomy to achieve its goals in good predictable outcome and reduce the errors and emphasis on safe endodontics practice. In conclusion theMIE remain a controversial issue regarding the disinfection efficiency but it could represent the future in contemporary endodontics with the huge development in devices and materials. However more researched are needed to show its efficiency in compared with traditional methods in endodontics.
The endodontics as a branch of dentistry also involved in the Technological revolution in optics, instruments, materials, and computer systems that make the application of minimal invasive approaches are possible in endodontic field[4].
The main targets of the successful endodontic treatment are achieved by eliminating all organic substrate from the root canal system and fill this system in way that ensure the biological goals for long-term success of endodontic treatment. This success is reached by an adequate knowledge about the conservation and elimination of tooth structure during endodontic procedure.5moreover the effective endodontic therapy emphasis on accessing, shaping andcleaning the system in a manner that will enable efficient and total filling of the root canal space, while leaving the tooth with sufficient strength to function successfully, that making minimally invasive endodontics philosophy based on maximum preserve the healthy coronal, cervical and radicular tooth structure during the endodontic treatment[5,6].
For this reasons a lot of traditional methods to access prepare the root canal system changed to cope with this development in enhanced lighting and magnification and highly flexible rotary instruments[7].For instance the traditional straight-line access cavity preparation which structurally compromise the tooth by removing an excessive amount of dentin that’s will affect the long-term survival of the endodontically treated tooth, while the contracted access cavity design which focusing on the minimal removal of the tooth structure that could increase tooth survival and fracture strength by dentin preservation[8]. Also the root canal shaping according to the minimal invasive concept should be conservative as much as possible and avoid over-flaring in order to make the root strong enough to cope with the obturation compressive strength and maintain the tooth in functioning and withstanding the mastication forces which can be achieved efficiently with flexible rotary flexible nickeltitanium instruments[9,10].
The apical preparation still controversial point in the literatures. The smaller apical preparation whereas can create a tight apical seal, adequate resistance form with continuous tapering that can maintain good disinfection[11,12].While the larger apical canal diameters are important to shape the apical canal wall, remove the debris, deeper irrigation to the terminus will be allowed and reducing remaining bacteria in the root canal system[13,14].However it was appeared form the evidences there were no any apical preparation methods could make the apical terminus free from bacteria, so that the smaller apical preparation advocated because it conservative technique and reduce the apical distortion and can adequately eliminate the bacteria in comparable way to the large apical preparation[15,16].It was clearly appeared the total elimination of biofilm and bacteria from the root canal system did not achieved by any current cleaning and shaping techniques that lead the both researchers and clinicians to focus on increasing the disinfection efficacy by using different techniques such as; manual , sonic , ultrasonic and laser activation[17].
TheMinimal Invasive Endodontics(MIE)as a concept and philosophy based on preserving sound tooth structure during access cavity opening, canal scouting, glide path, and instrumentation[18]which required sophisticated devices and instruments such as; surgical microscope, ultrasonic-assisted preparation techniques , modern flexible file systems and irrigation activation systems, beside the clinician deep knowledge in root canal anatomy to achieve its goals in good predictable outcome and reduce the errors and emphasis on safe endodontics practice. In conclusion theMIE remain a controversial issue regarding the disinfection efficiency but it could represent the future in contemporary endodontics with the huge development in devices and materials. However more researched are needed to show its efficiency in compared with traditional methods in endodontics.
Conflict of interest
The authors don’thave any conflict of interest.
References
- NovshebaShowkat, Geetanjali Singh, KunalSingla. Minimal Invasive Dentistry: Literature Review. Journal of Current Medical Research and Opinion. 2020;03(9):631–636.
- Mickenautsch S. An introduction to minimum intervention dentistry. Singapore Dent J. 2005;27(1):1-6.
- Ericson D, Kidd E, Mc Comb D, Mjor I, Noack MJ. Minimally invasive dentistry- Concepts and Techniques in Cariology. Oral Health Prev Dent. 2003;1(1):59–72.
- AH Gluskin, CI Peters, OA Peters. Minimally invasive endodontics: challenging prevailing paradigms. BRITISH DENTAL JOURNAL. 2014;216(6):347-353.
- Mukherjee P, Patel A, Chandak M, Kashikar R. Minimally Invasive Endodontics a Promising Future Concept: A Review Article. Int J Sci Stud. 2017;5(1):245-251.
- AH Gluskin, CI Peters, OA Peters. Minimally invasive endodontics: challenging prevailing paradigms. BRITISH DENTAL JOURNAL. 2014;216(6):347-353.
- Silva E, Rover G, Belladonna F, Gustavo D. Impact of contracted endodontic cavities on fracture resistance of endodontically treated teeth: a systematic review of in vitro studies. Clin Oral Invest. 2018;22:109–118.
- Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin N Am. 2010;54:249–273.
- Sedgley CM, Messer HH. Are endodontically treated teeth more brittle? J Endod. 1992;18:332-325.
- Huang TJ, Schilder H, Nathanson D. Effects of moisture content and endodontic treatment on some mechanical properties of human dentin. J Endod. 1992;18:209-215.
- Buchanan LS. The standardized-taper root canal preparation - Part 1. Concepts for variably tapered shaping instruments. IntEndod J. 2000;33:516-529.
- Buchanan LS. The standardized-taper root canal preparation - Part 2. GT file selection and safe handpiece-driven file use. IntEndod J. 2001;34:63-71.
- Chow TW. Mechanical effectiveness of root canal irrigation. J Endod. 1983;9:475-479.
- Siqueira JF Jr, Lima KC, Magalhães FA, Lopes HP, de Uzeda M. Mechanical reduction of the bacterial population in the root canal by three instrumentation techniques. J Endod. 1999;25:332-335.
- Yared GM, Dagher FE. Influence of apical enlargement on bacterial infection during treatment of apical periodontitis. J Endod. 1994;20:535-537.
- Orstavik D, Qvist V, Stoltze K. A multivariate analysis of the outcome of endodontic treatment. Eur J Oral Sci. 2004;112:224-230.
- Klyn SL, Kirkpatrick TC, Rutledge RE. In vitro comparisons of debris removal of the endoactivator system, the F file, ultrasonic irrigation, and NaOCl irrigation alone after hand-rotary instrumentation in human mandibular molars. J Endod. 2010;36:1367-1371.
- Pasqualini D. Minimally Invasive Endodontics: A Fancy Trend or A Clear Road for the Future? Int J Oral Dent Health. 2015;1(1):002e.
