Controversias en endodoncia

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Critical Reviews http://cro.sagepub.com/ in Oral Biology & Medicine

Controversies in Endodontics
G. Bergenholtz and L. Spångberg CROBM 2004 15: 99 DOI: 10.1177/154411130401500204 The online version of this article can be found at: http://cro.sagepub.com/content/15/2/99

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CONTROVERSY
In light of the technical procedures often encountered in endodontic therapy, it is not surprising that research in endodontics has focused on the development of effective tools and materials to facilitate root canal treatment.While the technological advances in endodontics have been impressive, the biological basis for root canal therapy has received comparatively little attention. This article, authored by two clinician-scientists, discusses several controversial and as-yet-unresolved biological issues relevant to endodontics. — Olav Alvares, Editor

CONTROVERSIES IN ENDODONTICS
G. Bergenholtz* Department ofEndodontology and Oral Diagnosis, Faculty of Odontology, The Sahlgrenska Academy at Göteborg University, Box 40530, Göteborg, Sweden; *corresponding author, Gunnar.Bergenholtz@odontologi.gu.se L. Spångberg Department of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA ABSTRACT: Diseases of the dental pulp often have an infectious origin, and treatments areaimed to control infections of the root canal system. Endodontic treatment principles originally evolved on the basis of trial and error, and only in recent decades have scientific methods been adopted to support clinical strategies. Yet, relevant research on the disease processes, their diagnoses, and efficient treatment are rare in the endodontic literature. Hence, the advancement ofbiologically based knowledge significant to clinical endodontics has been slow. Therefore, many differences of opinion still prevail in this field of dentistry. This review highlights and analyzes the background of some of the more heavily debated issues in recent years. Specifically, it deals with disagreements regarding the clinical management of pulpal exposures by caries in the adult dentition,definitions of success and failure of endodontic therapy, and causes of and measures to control infections of the root canal system. Clearly, a most apparent gap in the published endodontic literature is the lack of randomized clinical trials that address the more significant controversial matters relating to the management of pulpal wounds, medication, and the number of appointments required for thetreatment of infected root canals. However, trials in endodontics require extremely long follow-up periods if valid conclusions are to be generated. Therefore, it is not to be expected that there will be rapid solutions to these issues in the foreseeable future. Key words. Pulpal disease, apical periodontitis, pulp capping, pulpotomy, pulpectomy, root canal treatment.

(I) Introduction

Lesions of the pulp are often infectious, and treatments involve several critical steps that are aimed to restrain infections of the root canal system in teeth. Originally, treatment methodologies in endodontics, like those in many other dental disciplines, evolved based on trial-and-error observations, and only in recent decades have scientific methods been adopted to support clinical strategies....
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