Problem Solving in Endodontics: Prevention, Identification and Management, 5e
The discipline of endodontics seems to be at the crossroads in its evolutionary process and growth as a specialty of dentistry. Over the past few years, the practice of endodontics has been enhanced by remarkable technologic innovations and evidenced-based research. A wealth of new information has led to a better understanding of the biological basis for treatment, which has resulted in improved clinical treatment and more predictable outcomes. Interest in the provision of quality endodontic procedures and tooth retention remains foremost with many dental practitioners.
At the same time, however, our educational processes within this discipline are ailing. Recruitment to full-time faculty positions in endodontics has been a major challenge, especially from the ranks of recent graduates of endodontic specialty programs in the United States and Canada. The same is true in many countries around the world. The modest success of filling some teaching positions from the ranks of the retired military is offset by the comparatively short career potential of these people. Furthermore, many of these individuals are choosing a more lucrative “second career” in private practice. Moreover, whereas part-time faculty do play a role in the educational process, most do not possess pedagogic expertise. Teaching, therefore, may often be empirically- based, which at times can undermine even the most sophisticated and well-structured curricula. Despite the addition of many foreign trained educators in the United States and elsewhere, numerous faculty positions remain unfilled with no prospects in the offing. In some schools, endodontic departments have lost autonomy and have been consolidated into megadepartments, which ultimately weakens the position of endodontics in the competition for curriculum time. Who then will teach the students of tomorrow? The astute observer will also note that over the course of recent years there has been the loss of many enduring and influential figures in endodontic education. Not only are these individuals remembered for their inspirational teaching but also for their self-sacrificial commitment to excellence in all aspects of endodontics. An attempt at a complete list would be futile as the definition of “great” is elusive. Nevertheless, today one wonders who are the leaders that can replace Irving Naidorf, Gerry Harrington, I.B. Bender, Sam Seltzer, Hank Van Hassel, Don Arens, Harold Gerstein, Tom Mullaney, Gene Natkin, Thom Dumsha, and Ed Osetek? Who will be the stalwarts of the future or have we seen the twilight of the “endodontic professor?” Who will be remembered for their intellects, the rigor of their educational programs, and their enduring influence on students? Who will bring the necessary passion to the teaching of endodontics and the inquisitive energy to the research that is essential within this discipline?
Unlike many popular novelists or screen writers of our time, we did not conclude the previous editions of this book with visions of a “sequel” or plans for the “next installment.” The impetus for the creation of a fifth edition arose gradually during many think tank endeavors and reflective sessions in the years since the publication of the fourth edition. It is obvious that there have been significant contributions from research that have impacted on current practice. Some concepts that were novel at the time of the fourth edition are now fully integrated into modern theory and practice. Other prompts came from readers and commentaries on our previous efforts. Our own experience and observations have led to certain additions and changes as well as an increasing need to present the information within from a global perspective. For example, tooth numbering systems differ widely throughout the world. Since this book has achieved a surprising and gratifying international presence, revisions were required to rename each tooth using international standardized terminology, e.g., maxillary first molar, etc. In the same way, we have attempted to use diction that will be as clear as possible to nonnative English
Many excellent endodontic texts currently available are anthologies of chapters written by a multitude of different and varied authors. A distinct disadvantage of this approach is the paucity or lack of communication among writers. The fifth edition of Problem Solving in Endodontics is the product of two of the original authors. The intense collaboration during the long creative process has resulted in a uniquely cohesive and integrated text. For example, concepts and figures are frequently cross referenced from other chapters where additional information will be helpful. A cursory examination of the table of contents will reveal a complete restructuring of the text material into sections of related topics. There are several completely new chapters. Every chapter carried forth from the previous edition has been almost completely rewritten.
In terms of content, the first obvious change is the expansion of diagnosis in this edition. It has become clearer that problem solving must include a more complete process of diagnosis. Observations of referred cases in the private practice experience of the authors underscore diagnostic and treatment planning errors which in some cases, have led to a succession of calamities in treatment. Occasionally, endodontic treatment was completely unwarranted. Our objective in expanding the diagnostic section is to give the reader a diagnostic process that can confirm or rule out pathoses related to issues of the pulp and supporting periodontium in the vast majority of clinical situations. Likewise, it was not our intention to be encyclopedic. Rare conditions are omitted as we believe the practitioner provides better service by ruling out the most common possibilities and referring the patient when a diagnosis cannot be reached. For our international audience, we have included as many alternate diagnostic and treatment procedures as possible so that proper diagnosis can be done with the materials available.
A second major expansion is the section on surgical procedures. The ability to treatment plan and perform a multiplicity of surgical procedures are hallmarks of the specialty of endodontics, and therefore it will be obvious that tooth retention is a paramount objective of this text. The discussion of periapical surgery is intentionally limited to the anterior teeth and it is presumed that readers who will use this text for acquiring surgical techniques will be novices. The text is written with this in mind and with increased attention to detail. Periapical surgery on posterior teeth is a subject that requires extensive surgical experience and is not within the scope of this text.
A third addition in content consists of references throughout the text. The amount of research since the previous edition is staggering. We have endeavored to include as many of the relevant sources as possible to support the advocated philosophy. Whenever possible, evidence-based or best evidence references are cited to support the clinical choices. Furthermore, because textbooks can often be out of date by the time they go through the gymnastics and gyrations of publishing, a recommended additional reading list is included with updates added as close as possible to the final process of publication. It is anticipated that references will be website based and usable for academicians and lecturers.
Fourth, entire chapters are spent on irrigation and disinfection and on working length determination, with extensive literature assessments and clinical directives, because of the importance that these two entities play in the achievement of success. Furthermore, issues of diagnosis and treatment of tooth hypersensitivity along with vital pulp therapy have been expanded and put into clinical perspective, as well as techniques to revitalize the compromised tissues in teeth with immature apical development—often referred to erroneously at this early stage of its evolution as “regenerative endodontics.” In doing so it should be understood by the reader that endodontic therapy does not equal root canal treatment, as this discipline encompasses many diagnostic and treatment modalities.
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