Anca Virtej
Associate Professor, DDS, PhD, Department of Clinical Dentistry, Faculty of Medicine, University of Bergen and Postdoc at Department of Oral Surgery, Haukeland University Hospital, Bergen, Norway.
Emma Wigsten
DDS, PhD, Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Dag Ørstavik
Professor Emeritus, Dr. Odont. Department of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway.
Sivakami Rethnam Haug
Associate Professor, DDS, Dr. Odont, Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway.
Headlines
Dental practitioners should have better communication with the patients about treatment goals and prognosis or refer to a specialist at the appropriate time without delays to achieve optimal treatment outcome.
Research must not only concentrate on innovations which may interest stakeholders with short-term benefits but on randomized studies, to compare with existing materials, to prove their superiority in clinical outcomes.
We need better knowledge to understand dental pain mechanisms, management of pain sensation, control and eradicate infection.
Recruitment of students with outstanding performances by educational institutions in a competitive job market is a challenge that needs to be addressed.
The cost of dental treatment, including endodontics, may call for increased third-party payment by government or private insurance schemes. By studying the cost-effectiveness of treatment, current systems may need to be reviewed.
Preserving a tooth with root canal treatment (RCT) has a positive impact on the patient's oral health-related quality of life. However, cross-sectional studies show that technical quality of root fillings is less than optimal. In the future, more dental practitioners need to evaluate case difficulty and decide on whether they want to treat a tooth or refer to a specialist. The concept of minimally invasive treatment has been advocated during cavity preparation, instrumentation, and regenerative procedures. Unfortunately, long-term clinical outcome studies are lacking in this area. Research in pain mechanisms, inflammatory processes, the impact of systemic health on disease progression, and healing mechanisms is scarce. Infection control, antibiotic resistance and new antibacterial treatment regiments are issues to address in the future. We may anticipate increased regulation and administration of dental, including endodontic, services through insurance schemes and government involvement. Improved quality of service provision through a high standard of dental education is the most important investment to shape endodontics in the future. Health authorities and media may then present endodontic treatment as a safe, reliable, and effective option that is performed to benefit patients.
Declare the past, diagnose the present, foretell the future - Hippocrates, ca. 460 BC.
Future refers to that will happen or exist after the present time. A direction is the general way in which something develops or progresses (Fig. 1). In this article, we present the current status in endodontic treatment, recent developments and the authors' opinions on in which direction the endodontic discipline ought to develop in the future. This article has organized future directions into three parts, namely, the patient, the dental practitioner, and national or societal level.
The patient
In recent decades, oral health has generally improved in the Nordic countries. At the same time, life expectancy has increased, which means that more and more people retain their natural dentition into old age and fewer become edentulous. More teeth therefore risk having a history of dental treatment causing injury to the dental pulp with subsequent pulp disease []. Root canal treatment (RCT) is mostly undertaken in general dental practice. In the Swedish Social Insurance Agency's (SSIA's) data register, 217,047 residents above 20 years of age were registered as receiving RCT on at least one tooth in 2009 []. Ten years later, almost 190,000 teeth were registered as root filled in the same data register, pointing at a decrease in endodontic treatments []. A similar trend was also observed in Denmark (Danish Civil Registration System) during the period 1997-2009. In addition, Razdan et al. (2022) [] observed that while the number of root filled teeth decreased, the incidence of apical periodontitis in non-root filled teeth increased. National registries on dental treatment combined with epidemiological studies have the potential to detect trends in endodontic treatment needs in a population, which is helpful to identify changes relevant to education and insurance systems, and thereby promote dental health.
Preserving a tooth with RCT has a positive impact on the patient's oral health-related quality of life. Endodontic treatment ought to be promoted as a safe, reliable and effective alternative that patients can benefit from and for this, the health authorities and media are of great importance. Patients are generally satisfied with their endodontic treatment and prefer to keep their natural dentition whenever possible . When treatment was evaluated by studying the patient's experience more specifically, through so-called patient satisfaction [], patients who underwent treatment, both in specialist and general dental care were satisfied with their choice and their treatment The factor showing the least degree of satisfaction was the cost. It is important to involve the patient in their treatment plan and process, along with identifying common goals for the clinical outcome (Fig. 2). The success or failure of the treatment should be determined on the basis of predefined goal(s) for each individual [], where communication plays a key role. Patients need to be aware that seeking treatment at the appropriate time (without delays) is vital to achieve optimal treatment outcome.
Dental Practitioners
RCT can be perceived as technically demanding, stressful and frustrating, and associated with loss of control []. Almost half of the cases that were referred to a specialist clinic in Västra Götaland, Sweden, were previously root filled molars needing additional endodontic treatment []. RCT of molar teeth in general dental practice are often reported to have a poorer technical quality of the root filling, higher incidence of periapical disease, and lower survival rate compared to other tooth groups There can be many reasons for this: molar teeth usually have more roots, a more complex root canal anatomy and a placement in the dental arch which is difficult to access. Molars are not only technically demanding, but also often associated with complications during treatment thereby requiring more resources []. However, an anterior tooth or a premolar can also pose difficulties when the pulp chamber and root canal system is reduced in dimension, or when the root is severel
