Transformative era of root canal therapy

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Dr. David Jaramillo opens this issue by recognizing the people and concepts that have encouraged progress in endodontics.

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David Jaramillo, DDS

The future of endodontics holds a pivotal role in the preservation of teeth and the prevention of unnecessary extractions. Root canal treatment stands as a cornerstone in dentistry, aiming to eliminate pain and effectively restore dental health.

In recent years, the landscape of dentistry has witnessed a significant surge in dental implant advancements, overshadowing the importance of preserving natural dentition. While dental implants serve a crucial role in tooth replacement, it is imperative not to overlook the significance of retaining existing teeth whenever possible.

Throughout the decades, the field of endodontics has made substantial progress in understanding and refining treatment approaches for infected teeth. From seminal works such as Miller’s papers to groundbreaking studies like those of Kakehashi and colleagues1 on the role of bacteria in root canal systems, the discipline has continuously strived to enhance patient outcomes.

Innovations in instrumentation techniques (Schilder2), ranging from traditional hand files (Roane3) to modern NiTi rotary files (Walia4), have revolutionized root canal procedures. The evolution of obturation methods, including lateral condensation (Allison and colleagues5) and the Continuous Wave of Condensation (CWC) technique (Buchanan6), the use of the clinical microscope (Gartner,7 Pecora8), and micro-surgical endodontics (Kim,9 Rubinstein10) underscore the commitment to achieving optimal treatment results.

Moreover, advancements in root canal sealers, irrigation methods, and disinfection technologies have further elevated the standard of care in endodontics. The adoption of ultrasonic-activated irrigation, Er:YAG laser application (Divito,11 Jaramillo12), and multisonication (Jaramillo,13 Molina,14 Kim9) techniques has paved the way for enhanced pulp tissue debridement and disinfection, ultimately improving treatment efficacy.

As we embrace newer technologies like hydrodynamic cavitation and light-curing hydrogel root canal materials, we stand on the brink of a transformative era in endodontics. The ongoing innovations and research endeavors in the field underscore our collective commitment to advancing patient care and redefining the future of root canal therapy.

Together, let us continue to push the boundaries of knowledge, embrace emerging technologies, and uphold the principle of preserving natural dentition for the benefit of our patients and the future of root canal therapy.

Lasers have allowed for much progress in endodontics. Read “Unlocking the power of dental lasers in endodontics here: https://endopracticeus.com/ce-articles/unlocking-the-power-of-dental-lasers-in-endodontics/.

David Jaramillo, DDS, is a tenured professor at the Department of Endodontics at UTHealth School of Dentistry, having joined the faculty in 2014. Dr. Jaramillo became a full-time professor in 2004 when he accepted two positions, one at the University of Southern California (USC) and the other at Loma Linda University in California. He worked under direct supervision of Dr. Jim Simon and Bill Costerton at the Center for Biofilms at USC, and under supervision of Dr. Leif K. Bakland and Yiming Li at the Center for Dental Research and the Advanced Imaging and Microscopy Core at Loma Linda School of Medicine and at Center Facility for Advanced Microscopy and Microanalysis at UC Riverside. Dr. Jaramillo’s main research focus is in the irrigation of the root canal system. He has spoken at more than 100 conferences worldwide, published over 22 peer-reviewed papers, written seven book chapters, and was recently inducted into the International College of Dentists. Dr. Jaramillo is also a very active member of the International Federation of Endodontic Associations.

  1. Kakehashi S, Stanley HR, Fitzgerald RJ. The Effects Of Surgical Exposures Of Dental Pulps In Germ-Free And Conventional Laboratory Rats. Oral Surg Oral Med Oral Pathol. 1965 Sep;20:340-349.
  2. Schilder H. Cleaning and shaping the root canal. Dent Clin North Am. 1974 Apr;18(2):269-296.
  3. Roane JB, Sabala CL, Duncanson MG Jr. The “balanced force” concept for instrumentation of curved canals. J Endod. 1985 May;11(5):203-211.
  4. Walia HM, Brantley WA, Gerstein H. An initial investigation of the bending and torsional properties of Nitinol root canal files. J Endod. 1988 Jul;14(7):346-51.
  5. Allison DA, Michelich RJ, Walton RE. The influence of master cone adaptation on the quality of the apical seal. J Endod. 1981 Feb;7(2):61-65.
  6. Buchanan LS. The art of endodontics: cleaning and shaping the root canal system. The apical preparation. Part IV of a four-part series on cleaning and shaping root canals. Dent Today. 1994 Jan;13(1):50, 52.
  7. Gartner AH, Dorn SO. Advances in endodontic surgery. Dent Clin North Am. 1992 Apr;36(2):357-378.
  8. Pecora G, Andreana S. Use of dental operating microscope in endodontic surgery. Oral Surg Oral Med Oral Pathol. 1993 Jun;75(6):751-758.
  9. Kim KH, Lévesque C, Malkhassian G, Basrani B. Efficacy of the GentleWave System in the removal of biofilm from the mesial roots of mandibular molars before and after minimal instrumentation: An ex vivo study. Int Endod J. 2024 Jul;57(7):922-932.
  10. Rubinstein RA, Kim S. Long-term follow-up of cases considered healed one year after apical microsurgery. J Endod. 2002 May;28(5):378-383.
  11. DiVito EE, Colonna MP, Olivi G. The Photoacoustic Efficacy of an Er:YAG Laser with Radial and Stripped Tips on Root Canal Dentin Walls: An SEM Evaluation. J Laser Dent. 2011;19(1):156-161.
  12. Jaramillo DE, Aguilar E., Arias A, Ordinola-Zapata R, Raydolfo M, Ibarolla A and JL. Root canal disinfection comparing conventional irrigation vs photon-induced photoacoustic streaming (PIPS) using a buffered 0.5 % sodium hypochlorite solution. -based Endod. 2016;1:6.
  13. Jaramillo DE, Arriola AR. Histological Evaluation of Multisonic Technology for Debridement of Vital and Necrotic Pulp Tissues from Human Molar Teeth. An Observational Study. Applied Sciences. 2021; 11(22):11002.
  14. Molina B, Glickman G, Vandrangi P, Khakpour M. Evaluation of Root Canal Debridement of Human Molars Using the GentleWave System. J Endod. 2015 Oct;41(10):1701-1705.

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