The New Endodontics

Classically, the “endodontic triad” for successful treatment outcomes has represented the cornerstone of masterful endodontics. Nothing’s changed; only the methods.

Specifically the triad refers to 1) cleaning (or debridement); shaping (which facilitates cleaning and creates a receptacle for predictable three-dimensional root canal system obturation); and 3) oburation.

The endodontic practitioner of the future is a clinician, scholar, manager, communicator, collaborator and advocate. But the overwhelming goal is to begin to take advantage of the latest technologies and timeless endodontic biologic principles.

The Endodontic Triad Update

In order to achieve the endodontic triad, dentists must first be able to see. As dentists, if we can see it, we can diagnose it, and if we can diagnose it, we can treat it. Digital radiography coupled with the endodontic operating microscope has brought endodontics out of the dark ages and into the light. Digital radiography makes images hundreds of times larger than a periapical radiograph, allowing the operator to get closer to the truth—to get it right.

CBCT instruments, such as the CS 9000 3D extraoral imaging system, enable the endodontic clinician to actually dissect the tooth in three-dimensions—much like a CAT scan in medicine—and “see” the actual root canal system that was previously only imagined in two-dimensions.

What’s happening with the endodontic triad? What do I need to know?

First, cleaning: In short, cleaning—or, better yet, sterilization of bacteria, remaining collagen or necrotic debris—has been shown to be impossible. So far, that is. While new devices and irrigants have improved our root canal system cleaning ability, sterilization is not yet proven possible on a consistent basis. Lasers and special machine cleaning/sterilization devices are being tested and in the market place and are anticipated to be launched into the endodontic market place. While early adopters may be using cumbersome and expensive instruments at first, it is expected the delivery systems will eventually be miniaturized and affordable for all.

Shaping: Endodontic canal shaping just gets better and better. The metals and designs of Nickle Titanium (NiTi) technology are making shaping for endodontists and restorative dentists alike more predictable, safer and easier. Just remember, one of the most important elements for NiTi technology is the quality and consistency of manufacturing. So like all dental instruments beware of cheap (and sometimes dangerous) imitations or copy cats.

Oburation: The quality of endodontic obturation is dependent on the quality of the first two of the endodontic triad: cleaning and shaping. The more effective the cleaning of root canal system sterilization, the more precise the shaping, the less significant is the obturation part of the triad. However, obturation and access hermetic seal appears that it will still be critical in the foreseeable future in order to prevent coronal microleakage and prevent migration of entrapped bacteria and/or necrotic debris in still uncleaned labyrinths of the root canal system.


In summary, the world of preventing and curing lesions of endodontic origin from endodontically diseased teeth is becoming even more predictable and success rates continue to rival those of dental implants. Healthy natural teeth can ultimately be more esthetic, make economic sense and are easier and more enjoyable for dentists to restore.

John West, DDS, MSD Contributor