Stephen Claffey considers how technology can help improve care.
Endodontics, as a field, is evolving rapidly. As is digital dentistry. While many clinicians are now becoming accustomed to using these solutions in their day-to-day work, it’s important to consider whether they are always the best option.
In some cases, the expected use of hi-tech solutions trickles down to patients. A US study revealed that the majority (65 per cent) of dental patients are open to receiving treatment or diagnosis using artificial intelligence (AI) technology, with some even willing to pay extra for it to be used. At times, this expectation that new technology will be used is realistic. For example, popular treatment types, such as clear aligners, are strongly associated with the use of intraoral scanners. However, digital solutions may not always be the right answer.
Which digital dental solutions might apply to endodontics? Why might conventional methods prevail in some circumstances?
What are the digital options for endodontists?
Digital imaging
Radiographs are an invaluable aspect of endodontics. Used in diagnosis, treatment planning, and review, dental imaging allows endodontists to establish the working length of the root canals and locate intracanal objects. They can also be used to evaluate the resulting filling and soft tissue healing.
Regardless of whether digital or conventional, 2D systems produce a 2D image of a 3D object, and with that comes limitations in diagnostic capabilities. As such, cone-beam computed tomography (CBCT) is a much more effective option for endodontists. It must be kept in mind, however, that CBCT imaging produces higher doses of radiation compared to other methods and should only be used when clinically necessary.
Computer aided diagnosis and AI
No matter the imaging type used, whether conventional or cutting-edge digital solutions, ultimately, the diagnosis is made by the clinician. Digital dentistry is starting to support this part of the process with computer-aided diagnosis, which aims to produce an objective report using algorithms. This technology is widely used in medicine but is still relatively new in dentistry.
Within endodontics, AI technology has been developed to detect root canal orifices in real time. This could be a very useful piece of technology for those who are less experienced in the field, including dental students.
Guided endodontics
When tackling particularly challenging cases, guided endodontics can facilitate more accurate treatment. In some cases, the identification of root canals and subsequent negotiation might result in accidental perforation of the root, or unnecessary removal of healthy dentine. Guided procedures aim to reduce the risk of complications, as well as shorten treatment times and improve success rates. Guides are produced through the combined use of CBCT, 3D printing, and digital impressions. Data collected is used to fabricate the template, which is then placed on the teeth prior to treatment.
By utilising a digital workflow such as this, clinicians may be able to offer their patients more predictable treatment, which carries a lower risk of complications.
Impression and restoration
Ultimately, the success of the endodontic treatment relies on the overall quality of the restoration. The aim here should always be to restore both function and aesthetics, to support the remaining dentition and boost patient satisfaction. Dental impressions must contain great detail to produce an accurate restoration. But should clinicians use a digital or analogue approach?
There has been much debate about the efficiency of intraoral scanners compared to traditional impressions, with studies producing conflicting results. Research suggests that, while intraoral scanners save time and offer patients a more comfortable experience, they have particular trouble registering gingival margins and subgingival areas, ultimately leading to restoration failure. This suggests that clinicians should think carefully about which technology they employ. Should the restoration produced not fit properly, it may lead to further infection and treatment failure. Certainty is key.
Where are the drawbacks?
While all of the dental technologies listed above are used in endodontic workflows, they may not necessarily offer the best outcomes for every patient. Endodontists should always carefully consider which digital systems they integrate into their treatment workflow to ensure they are able to produce the best possible.
While strides are very quickly being made in digital dentistry, not every aspect of a digital workflow will enhance the treatment you already provide. Whether you’re looking to implement AI in your diagnostic process, use a guided approach to endodontics, or digitise impression-taking, be sure that this will offer your patients an improved treatment journey and enhance their experience.
Final thoughts
In short, there are a number of systems that may enhance endodontic care. Endodontists should make use of digital solutions to improve the quality of their treatments. However, this should only be the case if each solution actually does make an improvement when compared to a traditional method. Clinicians should pick and choose which technologies work for them based on accuracy, efficiency, and patient comfort, and only implement solutions when they will actually upgrade the services they deliver.
References available on request.