Saving Teeth for Life

The importance of saving tooth structure is becoming increasingly clear as the population ages, as replacements for lost teeth are having to function for decades. While dental implants are a good option for missing teeth, their long-term success is not guaranteed, and saving the natural tooth ought to be the first consideration.¹ In a patient’s lifetime restorative cycle, where each treatment eventually breaks down with time and must be fixed with something more complex, it is the dentist’s duty to maximize the useful life of each procedure.² This can be accomplished by helping patients maintain their current dentition as much as they can with the most predictable and conservative treatment possible.

This collection of articles focuses on how the discipline of endodontics aims to preserve teeth in all stages of life. It explores advances in technology that aid in maintaining pulp vitality and conserving tooth structure, care for older patients who require endodontics, and how the specialty plays a role in restorative treatment planning.

The opening article by Keith Boyer, DDS and Jan Nguyen, DDS presents updated recommendations for vital pulp therapy based on current evidence, in line with the 2021 position statement from the American Association of Endodontists.³ The indications and applications have expanded from the traditional approach to vital pulp therapy, allowing more patients to benefit from these procedures. One of the key principles of this new paradigm is complete caries removal to promote pulpal healing. This concept contrasts with the recent clinical practice guideline published in the Journal of the American Dental Association, which advises selective caries excavation to prevent pulp exposure.⁴ The article by Boyer and Nguyen, however, describes how pulp exposure need not be avoided, as exposed pulp can be managed very successfully when using methods that combine the latest understanding of pulp biology along with modern biocompatible materials.

Yaara Berdan, DDS, MBA and Elisa Chavez, DDS then review significant age-related changes in the geriatric population. They discuss medical management, patient comfort, and technical challenges, and offer strategies practitioners can adopt to customize care for well and frail older endodontic patients.

David Kelliny, DDS follows with a discussion of how endodontic guides are used to access teeth with pulp canal calcification. He provides a detailed step-by-step workflow on how to design 3D printed endodontic access guides using planning software. Case examples demonstrate the clinical application of 3D printed guides.

Finally, Keith Boyer, DDS and James Ywom, DDS, MS share a case for which CBCT aided in diagnosing and treatment planning a case of compromised teeth fused by concrescence. They performed a decoronation procedure to root bank a tooth that could not be extracted, and instead used it to support the tissues for a fixed partial denture.

This issue highlights the important role technology plays in the changing field of endodontics and there continues to be many more advancements than can be discussed here.^5,6 The current trends in endodontic therapy include leveraging technology to maintain healthy tooth structure and achieve the best possible outcomes. Patients of all ages can benefit from their dental providers having the knowledge and techniques that improve the effectiveness of saving teeth for life.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Keith R. Boyer

Keith R. Boyer, DDS, is an associate professor of endodontics at the Western University of Health Sciences College of Dental Medicine in Pomona, California. He is a diplomate of the American Board of Endodontics.