Conservative Endodontics: A Historic Shift In How We Save Teeth

How many times throughout your career have you had to tell a patient that their root canal treated tooth is cracked and can’t be saved? These uncomfortable conversations seem all too common with the prevalence of vertical root fractures being somewhere between 11-20% of root canal treated teeth, depending on the study evaluated. With approximately 1 out of 10 root canal treated teeth enduring this fate it has become clear that we as a profession must figure out the etiology of this condition so that we can find ways to prevent it from affecting more teeth. This lecture will review the major tenets of conservative endodontics. Special attention will be paid to understanding what pericervical dentin and the maximum flute diameter of a file are and why they matter to the long-term survivability of the root canal treated tooth. Further, we will discuss why conservative endodontics matters to you and your patients and how it affects outcomes from both patient and disease centered perspectives. The lecture will then move to an overview of core/restoration placement, aka coronal endodontics, and why this often-overlooked step is so vital to the long-term success and survival of a case. Throughout all this there will be numerous well documented cases presented to highlight certain aspects of this approach and to display the success that one can have via its implementation. Finally, we will put it all together in a review that will allow time for questions and answers.