Chapter 1 Modern Endodontic Therapy

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Chapter 1 MODERN ENDODONTIC THERAPY
John I. Ingle, Leif K. Bakland, Edward E. Beveridge, Dudley H. Glick, and Anthony E. Hoskinson

“Because I’ll have you know, Sancho, that a mouth without teeth is like a mill without its stone, and you must value a tooth more than a diamond.” – Miguel de Cervantes, Don Quixote

The newspaper headline read, “Ancient Root Canal Filling Found.” Datelined Jerusalem, the article went on to state that “a green tooth containing the oldest known root canal filling was discovered in the skull of a Nabatean warrior who was buried in a mass grave 2,200 years ago.” Joseph Zias, curator of the State of Israel Department of Antiquities, later reported on this historic archeologic finding in the Journal of the American Dental Association.1 The tooth in question—a maxillary right lateral incisor—dated from the Hellenistic period (200 BC). Radiographic examination of the ancient skull “disclosed a 2.5 mm bronze wire that had been implanted in the root canal—the earliest known archeologic example of a tooth filled with a metal object” (Figure 1-1). Professor Zias went on to explain the probable reason for the primitive “endodontics”: “The accepted cause of tooth disease in the Mediterranean—a worm burrowing inside the tooth— may give a clue as to why this tooth was filled with a metal wire. It is possible that the wire was implanted into the tooth canal to close the passage and prevent ‘toothworms’ from burrowing into the tooth and causing further dental pain.” The first mention of the “toothworm” theory is found in the Anastasia Papyrus of the thirteenth century BC.1 Somewhat earlier in China, the ancient Chinese subscribed to the “toothworm” theory of dental caries as well. According to Tsai-Fang, “The oracle bone inscription, excavated from the ruins of the Ying Dynasty (fourteenth century BC), clearly shows a character meaning ‘caries.’”2 Since the cause of tooth decay was

Figure 1-1 Oldest known root canal filling. Radiograph of skeletal remains showing maxillary incisor with bronze wire implanted in the root canal of a Nabatean warrior buried in the Negev desert 2,200 years ago (200 BC). Reproduced with permission from Dr. Joseph Zias, State of Israel Department of Antiquities, and J Am Dent Assoc 1987;114:665.

thought to be an invasion of “worms” into teeth, the Chinese language character for “caries” was composed of a worm on top of a tooth2 (Figure 1-2). Fifteen hundred years later, by the year 200 AD, the Chinese were using arsenicals to treat pulpitis, preceding Spooner, who was the first to do so in Europe, by

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Endodontics advent of local anesthetics, and the acceptance of antisepsis as a part of endodontic therapy. In 1891, for example, Otto Walkhoff introduced camphorated monoclorophenol (CMCP) as an intracanal medicament. It was this same Dr. Walkhoff who took the first dental radiograph in 1895.3 Beginning about 1912, dentistry in general and endodontics in particular were set back by the wide acceptance of the theory of focal infection. Wholesale extraction of both vital and pulpless teeth took place. The professions were not to recover their senses until well after World War II. The final 50-year period, 1926 to 1976, saw improvements in radiographs, anesthetics, and procedures as well as the introduction of new methods and agents. Calcium hydroxide made its appearance, as did ethylenediaminetetraacetic acid (EDTA) for chelation. Many root canal medications appeared, and arsenic finally disappeared from the dental pharmacopeia. This same period saw the publication of the first major text devoted to endodontics, Dr. Grossman’s Root Canal Therapy, as well as the introduction of standardized instruments and cavity preparation.5–7 The period also witnessed the rise and decline of the silver root canal

A

B

Figure 1-2 A, A piece of “oracle bone” inscribed with Chinese character meaning “caries” (fourteenth century BC). B, Chinese characters for “worm” and “tooth” combined to...
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