Recent advances in endodontics include improved methods for diagnosis using tools like pulse oximetry and laser Doppler flowmetry. Cone beam CT and newer apex locators provide more accurate determination of working length. Advances in instrumentation include nickel-titanium rotary files and self-adjusting files. New irrigants and devices improve cleaning and disinfection of the root canal. Regenerative endodontic procedures aim to regenerate damaged tissues through stem cell therapy and tissue engineering.

1. RECENT ADVANCES IN
ENDODONTICS
By
Dr. Hope Inegbenosun

2. OUTLINE
• Introduction
• Recent advances in diagnosis
• Recent advances in radiography
• Recent advances in endodontic visualization
• Recent advances in working length determination
• Recent advances in instrumentation
• Lasers in endodontics
• Newer irrigating solutions
• Recent advances in irrigation devices
• Recent advances in root canal sealers
• Advances in obturation techniques
• Regenerative endodontics
• Conclusion
• References

3. INTRODUCTION
•The practice of endodontics have witnessed
several changes and advances in the past
decades and this has resulted in better
diagnosis and improved treatment outcome.

4. •The main steps in endodontics affected are;
o Diagnosis
o Working length determination
o Biomechanical preparation
o Obturation

5. RECENT ADVANCES IN DIAGNOSIS
A. RECENT ADVANCES IN PULP VITALITY TESTING
•The assessment of pulp vitality is a crucial diagnostic
procedure in dentistry.
•Current routine methods rely on stimulation of A delta
fibres and give no direct indication of blood flow within the
pulp. These include thermal stimulation, electrical or direct
dentine stimulation.
•These testing methods have the potential to produce an
unpleasant and occasionally painful sensation and
inaccurate results. In addition, each is a subjective test that
depend on the patient’s perceived response to a stimulus
as well as the dentist’s interpretation of that response

6. • Recent studies have shown that blood circulation and not innervation
is the most accurate determinant in assessing pulp vitality as it
provides an objective differentiation between necrotic and vital pulp
tissue.
• The recent available pulp vitality tests are:
1. Pulp oximetry
2. Laser Doppler flowmetry (LDF)
3. Dual wavelength spectrophotometry
4. Measurement of temperature of tooth surface
5. Transillumination with fibre-optic light
6. Plethysmography
7. Detection of interleukin-1 beta
8. Xenon-133
9. Hughes probeye camera
10. Gas desaturation
11. Radiolabelled microspheres
12. Electromagnetic flowmetry

7. 1. DENTAL PULSE OXIMETRY
•Pulse oximetry is a non-invasive device for determining
pulp vitality.
•The principle of this technology is based on modification
of Beer’s law and the absorbency characteristics of
haemoglobin in red and infrared range

8. 2. LASER DOPPLER FLOWMETRY
•The technique depends on Doppler principle in which light
that contacts a moving object is Doppler shifted and a
portion of that light will be back scattered out of a tooth
into a photodetector.
•Since RBCs represents the majority of moving object
within the tooth, measurement of Doppler shifted back
scattered light may be interpreted as an index of pulpal
blood flow

9. B. RECENT ADVANCES IN RADIOGRAPHY
•Newer advances in endodontic imaging include:
1. Tuned aperture computed tomography (TACT)
2. Magnetic resonance imaging (MRI)
3. Ultrasound (US)
4. Optical coherence tomography (OCT)
5. Cone beam computerized tomography (CBCT)
6. Micro computed tomography (Micro CT)
7. Spiral computed tomography (SCT)

10. CONE BEAM COMPUTERIZED TOMOGRAPHY (CBCT)
•More sensitive in detecting periradicular images compared
with periapical radiographs (PARs)
•A reliable method to detect the MB2 canal in the maxillary
first molars
•Effective for detecting vertical root fractures
•Has a better diagnostic performance in evaluating
inflammatory root resorption
•Invaluable in determining the prognosis of an endodontic
treatment.
•May be the future standard to determine if periapical
disease has resolved after completion of RCT.

12. C. RECENT ADVANCES IN ENDODONTIC VISUALIZATION
• The use of optical magnification instruments enables the endodontist to
magnify a specified treatment field beyond that perceived by the naked eye.
• Examples of the magnification instruments include:
- Endoscopes
- Orascopes
- Dental loupes
- Operating microscope

13. RECENT ADVANCES IN WORKING LENGTH DETERMINATION
ELECTRONIC APEX LOCATOR - AN ENDODONTIC ADJUNCT
FIFTH GENERATION APEX LOCATORS
• It uses multiple frequencies rather than the dual
frequencies of the third and fourth generations of apex
locators, so it works in dry or wet canals and requires no
calibration. Eg :RAYPEX

14. SIXTH GENERATION APEX LOCATORS
• Also called adaptive apex locators
• Multi-frequency Operating System
• Sound operated switching device can produce different
kinds of sound to indicate the different positions of file in
the root canal.
•Dry and wet condition are also available for accurate
reading

15. COMBINATION OF APEX LOCATORS & ENDODONTIC
HANDPIECES
1. ENDY 7000
•Endodontic handpiece connected to an endy apex locator
•Reverses the rotation of the instrument when it reaches a
point in the apical region preset by the clinician.

16. (i.e. Contrary to manufacturer claims, Apex
Locators can only reliably determine when the
file is actually touching the PDL at the apex. Set
your working length 1 to 1.5 mm back from this
length to avoid over-instrumentation)
[Ounsi HF, Naaman A, 1999].
2. TRIAUTO ZX
o Is cordless electric endodontic handpiece with built in
RootZx apex locator. The handpiece uses Ni-Ti rotary
instruments that rotate at 280±50 rpm.
o The Root ZX is not capable of detecting the '0.5 mm
from the foramen' position and thus, should only be
used to detect the major diameter.

17. 3. SAFY ZX
• New development of ultrasonic systems
• Handpiece + apex locator
• Uses Root ZX to monitor location of file during instrumentation
• Minimizes danger of over instrumentation

18. RECENT ADVANCES IN INSTRUMENTATION
•Innovation in instrument shape, design and
standardization.
•Change in material of manufacture i.e NiTi Alloy
•Use of engine driven instrument and instrument
motion.

19. Rotary NiTi instruments
Light speed instrument e.g. canal master U, light
speed LSX
Profile instrument
GT rotary instrument
K3 instrument
Hero(high elasticity in rotation) instrument
RACE(Reamer with Alternating Cutting Edges)
instrument
Pro Taper instrument (mostly readily available
and widely use)

20. Self – adjusting file (SAF)
•First introduced in April 2010.
•This action has a scrubbing, sand paper like effect
on the canal walls.
•Research showed that SAF operation resulted in RC
walls that were free of debris and smear layer to a
large extent.

21. Apexum Device
• Based on minimally invasive removal of chronically inflamed
periapical tissues through a RC access.
• Consists of 2 instruments:
• an Apexum NiTi ablator and
• an Apexum polyglycolic acid (PGA) ablator.

22. LASERS IN ENDODONTICS
•Diagnosis – Laser Doppler flowmetry (LDF) detects blood
circulation in pulp tissue
•Pulp capping and pulpectomy – CO2 lasers
•Nd: YAG – shown to significantly reduce the number of
bacteria
- Reduced apical leakage after RC obturarion
- Can soften gutta percha for retreatment
•Er: Cr: YSGG – Used to remove smear layer and debris
from the RC and reduce bacteria.
•Er: YAG – might be suitable for clinical application as a
suppressive and removal device of biofilms in endodontic
treatments.

23. NEWER IRRIGATING SOLUTIONS
•Ozonated water irrigant
•Ruddle’s solution – introduced in an attempt to visualise
the microanatomy of the canal system.
–Composition- 17% EDTA, 5% NaOCl, Hypaque – an
aqeous solution of Iodide salts ( Ditrizoate and sodium
iodide).
•MTAD : Contains 3% doxycycline hydrate, 4.25% Citric acid
and 0.5% polysorbate-80 detergent (Tween80).
•Tetraclean:
•Similar to MTAD but differs in antibiotic concentration
and the type of detergent
•150mg/5ml for MTAD but 50mg/5ml for Tetraclean
•Detergent for MTAD is Tween80 while it is
polypropylene glycol for Tetraclean.

24. RECENT ADVANCES IN IRRIGATION
i) Endo Activator
ii) Endo Vac
iii) Light – activated Disinfection (LAD)
Iv)Safety irrigator

25. RECENT ADVANCES IN RC SEALERS
•Meta SEAL – 4th generation resin based sealer
- An etchant, a primer and a sealer are all combined into an
all – in – one self etching, self adhesive sealer
•Calcium phosphate sealer : still in the experimental stages ,
yet to be commercialised
•MTA based sealers: produces calcium hydroxide in solution
and induces formation of hydroxyapatite structures in
simulated body fluid. Currently , 3 types are available; Endo
CPM sealer, MTA Obtura and ProEndo Sealer
•Calcium enriched mixture: A new biomaterial recently
introduced. CEM releases calcium hydroxide during and
after setting.

26. RESILON
a) The Resilon core material – a thermoplastic synthetic
polymer based RC core material containing bioactive
glass, bismuth oxychloride and barium sulphate filler
b) The Resin sealer – a dual curing resin based composite
sealer.
•Resilon forms a monoblock consisting of
Filling material – resin sealer – bonding agent/ primer –
dentin
•The monoblock concept means the creation of a solid,
bonded, continuous material from one dentine wall of the
canal to the other. This has been shown to strengthen the
root by≈ 20%

27. ADVANCES IN OBTURATION TECHNIQUES
Obtura III technique
•The obtura III system consists of a hand gun that contains
a chamber surrounded by a heating element into which
pellets of GP are loaded.
•Other new techniques are:
Ultrafil 3D
Simplifill
Thermalfil obturation
Successfil

28. REGENERATIVE ENDODONTICS
•Regenerative endodontic procedures (REPs) are
biologically based procedures designed to replace
damaged, diseased or missing structures such as dentin,
root structures and cells of pulp dentine complex.
Objectives
•Regenerate pulp – like tissue
•Regenerate damaged coronal dentine e.g. following a
carious exposure
•Regenerate resorbed root, cervical or apical dentine

29. •It comprises research in adult stem cells, growth factors,
organ tissue culture and tissue engineering
•REPs
•Pulp capping and partial pulpotomy
•Root canal revascularisation
•Apexogenesis and Apexification
•Stem cell therapy
•Tissue engineering

30. CONCLUSION
•Advances in the field of endodontics are ongoing
,revolutionizing the specialty improving the
treatment outcome thus making endodontic
procedures less stressful.

31. REFERENCES
• Bahcall J, Barss J. Orascopic visualization technique for
conventional and surgical endodontics. IntEndod J 2003: 36:
441–447.
• Detsch S, Cunningham W, Langloss J. Endoscopy as an aid to
endodontic diagnosis. J Endod 1979: 5: 60–62.
• Ounsi HF, Naaman A. In vitro evaluation of the reliability of
the Root ZX electronic apex locator. Int Endod J 1999;32:120-
23.
• Patel S, Dawood A, Whaites E, Pitt Ford T. New dimensions in
endodontic imaging: part 1. Conventional and alternative
radiographic systems. Int Endod J. 2009 Jun;42(6):447-62.

32. THANKS FOR LISTENING