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As in other areas of dentistry, many things have changed in the field of
endodontics and will continue to do so into the future. Minimally invasive dentistry (MID) seems to be the ‘buzz’ in dentistry in recent years.
Phillip Mouret introduced the term ‘minimally invasive’ in 1987 when
he performed the first truly minimally invasive laparoscopic cholecystectomy. Endoscopic surgery began to progressively replace a more
invasive open surgery, with minimal or no damage to surrounding
healthy tissues, and a more favorable post-operative period. Since
then, the concept has influenced many other medical disciplines,
including dentistry and consequently, endodontics.
Endodontic regenerative procedures can be definitely considered
minimally invasive. The endodontist of the future will probably have to
deal more with scaffolds and growth factors than NiTi instruments and
gutta-percha. However, the actual concept of minimally invasive
endodontics is still strongly related to the preservation of sound tooth
structure during access cavity opening, canal scouting, glide path,
and instrumentation.
The topic is still controversial and the concept is accounted responsible for a less efficacious disinfection of the root canal system. However, new irrigation protocols and devices, and antibacterials which
are emerging from research on nanotechnology seem to be the
answer to those accusations.
Minimally invasive endodontics is definitely more than just a fancy
trend. It is the way to shape the future.
MINIMALLY INVASIVE ENDODONTICS (MIE):
SHAPING THE FUTURE OF ENDODONTICS
Considerations for minimally invasive endodontics:
One’s familiarity with the anatomy of the tooth to be treated should be as
complete as possible. Apart from clinical observation, such familiarity may
be acquired from close examination of preoperative radiographs taken with
at least two different views.
The clinician must also be aware of the possible anatomical variants of
each tooth, since his eye will perceive what his brain knows, and he will
see what he wants to see, but he will not see what he does not know.
The use of high magnification and illumination (ideally dental microscope),
are essential to retain as much sound dentin as possible.
Recent instrument design has been inspired by a minimally invasive
philosophy to develop better methods of canal cleaning and disinfection
that can be used in the presence of retained, sound tooth structure.
Restoring the tooth to function using bonded core materials that will seal
and strengthen the tooth prior to crown placement would help to tie the
components of the tooth together to resist both functional forces and
occlusal leakage.
Excellence in occlusal adjustments to prevent adverse functional forces is
essential for all dental practitioners, including endodontists.
The following cases are examples of MIE. Note in the post-op radiographs
the careful access design and the predictable shapes obtained on these
three cases, which would be classified as moderate to severe complexity.
Case #1 & #2
45 y.o. caucasian patient referred with extreme temperature sensitivity after
a filling that had been replaced due to recurrent decay. The pain was present
before the filling was replaced and had been gradually getting worse. During
clinical evaluation, we were able to reproduce the patient’s symptoms on the
mandibular first molar. After discussing all the different treatment options,
opted for root canal therapy.
After careful evaluation, decided that the classic modified access was the
access design that would allow us to keep more “critical” dentin.
One year later, the patient presented with pressure sensitivity on the second
molar. The tooth did not respond to cold and was very tender to percussion.
This tooth received a crown 3 years ago due to a small fracture. The patient
was also informed of the impacted wisdom tooth. During access cavity preparation, did notice a small fracture line on the M aspec ]Y