Present status and future directions: Minimally invasive root canal preparation and periradicular surgery

Abstract

Inspired by several other surgical disciplines, the quest for treating diseases through minimally invasive procedures has permeated endodontics, but not without controversy. Indeed, pulp amputation/excision and root-end resection are akin to surgical procedures elsewhere in the body and therefore, an increasing number of studies have addressed the "potential" to adopt such minimally invasive procedures in root canal treatment, with the larger goal of conserving tooth tissue for long-term survival of treated teeth. Yet, it is undeniable that this "trend" has been met with immense resistance with unclear evidence to strongly support or refute this philosophy. One may view root canal treatment as having two important procedural parts: (i) gaining access to the root canal and (ii) achieving clean root canals to remove the necrotic/infected or irreversibly inflamed tissues and then fill the space that was occupied by the pulp tissue and subsequently enlarged during cleaning and shaping, which should result in two key long-term outcomes: (i) healing of periradicular periodontitis and (ii) survival/retention of the tooth. Whilst a lot of interest has been directed towards gaining access through minimally invasive cavity designs, it is surprising that little effort has been expended on studying minimally invasive root canal preparation or surgical intervention. The aim of this review is not to promote or denigrate these philosophies, but to provide a balanced overview of the concepts, currently available evidence and future perspectives on minimally invasive endodontics from the context of root canal preparation and surgical endodontics. Specific attention is given to the role of modern irrigation strategies in potentially improving canal cleanliness even when canals are minimally prepared and the areas of research that are currently lacking in this topic.

The effect of root canal preparation tapers on planktonic bacteria and biofilm reduction in the apical third: A correlative microtomography and microbiological laboratory study

“…Factors such as internal anatomy and solution agitation techniques affect the penetration ability of the irrigation solution (Gu et al., 2009). In addition, different irrigation parameters such as concentration, volume and irrigation time can influence the cleaning of the canal (Neelakantan et al., 2022).…”

Efficacy of a novel remotely‐generated ultrasonic root canal irrigation system for removing biofilm‐mimicking hydrogel from a simulated isthmus model

“…Minimally invasive approaches have been permeated in endodontics with the goal of tooth preservation (Neelakantan et al, 2022). They are primarily applied to access cavity preparation (Clark & Khademi, 2010) but have been extended to canal instrumentation (Gluskin et al, 2014; Krishan et al, 2014; Neelakantan et al, 2022).…”

“…Minimally invasive approaches have been permeated in endodontics with the goal of tooth preservation (Neelakantan et al, 2022). They are primarily applied to access cavity preparation (Clark & Khademi, 2010) but have been extended to canal instrumentation (Gluskin et al, 2014; Krishan et al, 2014; Neelakantan et al, 2022). Conventional endodontics includes a traditional access cavity requiring straight line access (Silva et al, 2022) and conventional instrumentation with a minimum canal size of #25/0.06 or larger (Wang et al, 2018).…”

“…In contrast, conservative endodontics uses a conservative access cavity, maintaining as much of the pulp chamber roof and the pericervical dentin as possible (Silva et al, 2022), with minimal instrumentation of an apical size less than #20–25 (Boutsioukis & Gutierrez Nova, 2021; Molina et al, 2015). Compared to conventional endodontic treatment, which creates enough space to deliver irrigants to the root canal system, conservative endodontics pursues preserving dentin as much as possible without neglecting adequate canal cleaning (Neelakantan et al, 2022). The restricted space within such a minimally shaped root canal may compromise the efficacy of syringe irrigation (Boutsioukis & Gutierrez Nova, 2021) and sonic or ultrasonic activation of the irrigant (Jiang et al, 2010; Roy et al, 1994).…”

The Efficacy of Er:YAG Laser-Activated Shock Wave-Enhanced Emission Photoacoustic Streaming Compared to Ultrasonically Activated Irrigation and Needle Irrigation in the Removal of Bioceramic Filling Remnants from Oval Root Canals—An Ex Vivo Study

“…In a recent study by Baumeier et al [ 19 ], there were no differences between UAI, EndoActivator, and XP-endo Finisher R in additional cleaning of filling remnants from a flattened root canal. Regardless of the stated possible shortcomings, UAI is still considered a “gold standard” in activated root canal irrigation; hence, every new irrigation system has to be compared to it [ 20 ].…”