Читать книгу Endodontic Materials in Clinical Practice - Группа авторов - Страница 11

In the last 70 years or so, our understanding of dental materials has progressed from the more or less purely pragmatic to a more structure–function design‐based science. This process is not yet complete. That is, despite the currency of ‘evidence‐based dentistry’ – which has its own Wikipedia entry and an eponymous journal – there remains much work to be done to make everyone appreciate the value of the science of those materials. Inadequate teaching and dogmatic schools of thought are also manifest in endodontics to no lesser extent. It is my understanding that this book represents an attempt to begin the essential process of modernization in this field. Accordingly, I shall attempt to provide some foundations for the necessary insight.

Once the vitality of the dental pulp becomes compromised, endodontic intervention is necessary to preserve a functional natural dentition, with natural alveolar (as opposed to ankylosed) bone attachment, and thus the preservation of that very bone. More, perhaps, than in some other areas of dentistry, the materials used in endodontic work have an intimate relationship with tissues. Most obviously, the dentine is subject to exposure to a variety of more or less aggressive irrigants as well as fillers and (putative) sealers, often involving calcium hydroxide. Another possibility is of a strong oxidizing agent in the form of hypochlorite. Whilst the need for microbial elimination is not disputed, it is appropriate to be aware of the implications of such treatments: the chemistry demands that if a reaction is possible, it will occur, whether you like it or not, whether you meant it or not, and whether you are aware of it or not. Of course, apical extrusion of almost all materials can have very unfortunate consequences. Such intimacy is quite undesirable. At the least, a foreign body reaction will be elicited; at the worst, destruction of periapical bone – but the risk of infection is always high, with potentially wider implications.