History of endodontics

Definition of endodontic
In the later part of the 19th and the first part of the 20 century endodontic

was referred to as:

root canal therapy or pathodontia.

Dr. Harry B. johnston coined the term endodontics from the Greek word

en, meaning in or within, and odous meaning tooth :

the process of working within the tooth.

Definition of endodontic
American association of endodontist AAE :
Endodontics is that branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periapical

tissues.

Scope of endodontics
Differential diagnosis and treatment of oral pain of pulpal and/or periapical origin, or refer pain. Vital pulp therapy (pulp capping, pulpotomy, apexogenesis, and apexification). non-surgical treatment of root canal systems with or without periapical pathosis of pulpal origin. Surgical procedure:root-end resection, hemisection,bicuspidization,root resection,and root-end filling. Root repair procedures related to pathologic or iatrogenic pathosis/damage. Intentional replantation Management of traumatic tooth injuries. Interrelationship between pulpal and periodontal disease. Endodontic endosseous implant (diodontic tooth implant). Bleaching of discolored dentin and enamel.

Revision of previosly treated root canal systems-both non-surgical and surgical.

Coronal restorative procedures

 Differential diagnosis and treatment of oral pain of pulpal and/or periapical origin, or refer pain.

 Vital pulp therapy (pulp capping, pulpotomy, apexogenesis, and apexification).

 non-surgical treatment of root canal systems with or without periapical pathosis of pulpal origin.

 Surgical procedure:root-end resection, hemisection,bicuspidization,root resection,and root-end filling.

 Root repair procedures related to pathologic or iatrogenic pathosis/damage.

Root repair procedures related to pathologic or iatrogenic pathosis/damage.

 Intentional replantation

 Management of traumatic tooth injuries.

Management of traumatic tooth injuries.

 Interrelationship between pulpal and periodontal disease.

 Endodontic endosseous implant (diodontic tooth implant).

 Bleaching of discolored dentin and enamel.

 Revision of previosly treated root canal systems both non-surgical and surgical.

 Coronal restorative procedures

Cure of toothache
Ebers Papyrus 1500 BC
curing the gnowing of the blood in the tooth The fruit of the gebu plant one thirty second part Onion- one sixty fourth part

Cake one sixteenth part

Dough one eighth part Anest plant one thirty-second part Water one-half part

Cure of toothache
Archigenes of Apamea first century
Remedy for odontalgia made by:
Boiling gallnuts

Hallicacabum in vinegar
Concoction of roasted earth-worm Spikenard ointment

Egg of spiders

Cure of toothache
Middle ages Strong belief that tooth decay was caused by tooth worms 1700 Leeuwenhoek identified the source of the tooth worm

as "worm infected cheese".

Andrew Boorde 15 century deworming technique

Abulcasis (abbas al-Zahrowi)

Use of cautery

Other mixture to kill worms, oil of cloves, .

 The Five Periods Pre Science : 1776 to 1826 Age of Discovery : 1826 to 1876 The Dark Age : 1876 to 1926 The Renaissance : 1926 to 1976 Innovation Era : 1977 to 1998

Pre Science period

Pierre fauchard
1728 founder of modern dentistry Trepanation of the teeth Pierre Fauchard wrote The Surgeon Dentist in which he described pulp extirpation using a trepan and the use of oil of cloves-opium for pain relief. Rinsing the mouth every morning & before going to bed with a spoonful of ones own rinse (urine) so unpleasant !!!

1756 Phillip Pfaff dentist to Frederick the Great used gold or lead for
pulp capping.

Age of Discovery : 1826 to 1876

establishment of the science of dentistry publication of a dental journal and formation of proper dental schools. Discovery of anaesthesia barbed broaches and Gutta percha points became available Medications were created for treating pulpal infections and cements were discovered to fill them.

The Dark Age : 1876 to 1926

discovery of the X-ray and advancement of general anaesthesia to local anaesthesia, dentistry and endodontics took a total back seat and mostly moved in reverse gear. 1888 WD Miller believed that the decomposed infected pulp caused dental alveolar abscesses. He described the mouth as a focus of infection. Later emphasized by GV Black in 1890.

Focal infection theory elective localization

Historical thought processes impacted over time on the development of

endodontic. The issues of science do no harm, and rational therapeutics William hunter septic suppuration as complication of various medical desease Teeth with any possibility of chronic inflammation or infection were considered as the primary source of systemic disease. 1910 William Hunter attacked American dentistry and described the gold crown

as "A mausoleum of gold over a mass of sepsis". This helped popularize the
"Theory of Focal Infection" that was directed at the pulpless tooth for some 25 years.

Focal infection theory elective localization

These concept have devastating effect on the dental profession Suggest to ruthless extraction to eliminate medical

problems(throughout first half of the 20 century)

Oral sepsis ; teeth and supporting structures as seat of sepsis Chronic apical periodontitis as sleeping dogs lie

Changing concept in oral sepsis

1913 ,logan ; Tx of chronic dentoalvolar abcess without extraction to
prevent the spread of sepsis 1927,Roesnow ; ext necessary in the presence of systemic disease

Hatton mouth and teeth are easily examined due to their position
Pulpless teeth are not dead teeth , embeded in a highly vascular fibrous membrane, can be Tx it.

Hollow tube theory

1931 Rickert & Dixon hallow of irritation around the open ends of implanted platinum and steel hypodermic needles. Circulating element diffusing out of the opening of these tubes were not well tolerated by vital tissue. This was analogous to pulpless teeth.

Root canal systems must be tight seal to prevent the irritation

& inflamation oe the periradicular tissues.

The Renaissance : 1926 to 1976

the golden period of endodontics(established as a science and therapy) Better anaesthesia, better radiographs and a host of root canal medicaments first text book on endodontics becoming available "Root Canal Therapy" by Dr. Grossman Root canal instruments got standardized 1943 American Association of Endodontists was formed. 1963 Endodontics is recognized as a specialty by the ADA.

kakehashi study
1965 The most important study in endodontic which change our concept. role of bacteria

Innovation Era : 1977 to 1998

advancement happening in Endodontic therapy at a very rapid pace Improved and better forms of biomechanical preparation Obturation techniques are becoming simpler, easier and faster. Improved visibility is now available with the advent of the endo microscope. Newer, better and more reliable apex locators

Focal infection is not dead

Although have been severely dissembled over the years , but existed when diagnosis cannot be made or successful treatment achieved.

Quality & success of endodontic practice, control of microbiologic populations have impact on lessening the intensity of the focal infection concept.

References
Pathway of the pulp 2011 s.cohen Principle and practice of endodontic 2008 torabinejad

Thank you

1888 WD Miller believed that the decomposed infected pulp caused dental alveolar abscesses. He described the mouth as a focus of infection. Later emphasized by GV Black in 1890. 1909 EC Rosenow and Frank Billings developed the "Theory of Focal Infection". 1910 William Hunter attacked American dentistry and described the gold crown as "A mausoleum of gold over a mass of sepsis". This helped popularize the "Theory of Focal Infection" that was directed at the pulpless tooth for some 25 years. 1921 Rosenow (Mayo Clinic) adhered to belief that once a tooth was infected, it was always infected. 1943 American Association of Endodontists was formed. 1963 Endodontics is recognized as a specialty by the ADA.

 Pre-Science: In the era of Pre-Science, endodontic therapy consisted mainly of crude modalities like large abcesses being treated with various poultices or leeches, and pulps being cauterized with red hot cauteries. Note must be made that in this period there are instances of entire root canals filled with gold foil.

 Age of Discovery: The next half century saw an establishment of the science of dentistry as a whole, publication of a dental journal and formation of proper dental schools. The discovery of anaesthesia gave a big fillip to dental treatment and made it so much more easier and possible to carry out procedures. Gutta percha points were created to fill root canals and barbed broaches became available for cleaning and enlarging canals. Medications were created for treating pulpal infections and cements were discovered to fill them. At the same time, an entire lot of dental practitioners were driving wooden pegs into the pulp to debride the canal.

 The Dark Age: Even though this era saw the discovery of the X-ray and advancement of general anaesthesia to local anaesthesia, dentistry and endodontics took a total back seat and mostly moved in reverse gear. The theory of focal infection which gained momentum and ground, saw wholesale extraction of teeth and very little endodontics being practiced. Hardly any innovation took place and it was well after the Second World War that we saw some logic and reason return to endodontics.

 The Renaissance: This is the golden period of endodontics which saw it being firmly established as a science and therapy. Better anaesthesia, better radiographs and a host of root canal medicaments appeared on the scene. The focal infection theory started dying out and more and more of endodontics was being practiced. This era saw the first text book on endodontics becoming available "Root Canal Therapy" by Dr. Grossman. Root canal instruments got standardized and became available more readily. This era also saw the establishment of the American Association of Endodontics and the American Board of Endodontics.

 Innovation Era: The period from 1976 onwards has seen a breathtaking advancement happening in Endodontic therapy at a very rapid pace. Improved and better forms of biomechanical preparation are being churned out. Obturation techniques are becoming simpler, easier and faster. The single visit endodontic therapy concept is almost globally being accepted by all schools of thought. Improved visibility is now available with the advent of the endo microscope. Newer, better and more reliable apex locators are challenging the need for radiographs. Even though not a replacement, apex locators are excellent tools to make life much more easier for the dentist practicing endodontic therapy.

Vital pulp therapy

Phillip pfaff
first to mention pulp capping Controversy to doing VPT due to: unreliable /complication

Key issue in VPT:

kakehashi study 1965 , role of bacteria pulpal diagnosis(odor/supporation/)

seltzer & bender , discourage the use of VPT for carious exposure
Cvek , use of VPT for immature teeth (apexogenesis)

 Preservation of amputated pulp Bodecker 1886 Prieiswrerk 1900

Herman 1930 , Hess ,Teucher & zander 1938 use of

Ca(OH)2 for VPT Dr. Alfred L. Frank frank technique or apexification

Heithersay 1975 other application of Ca(OH)2