ENDO, 02/2007

This paper reviews periapical surgery with a special focus on the root-end cavity, which remains a key feature of the apicectomy procedure. Contemporary techniques mainly use ultrasonic instruments to prepare these cavities, which are filled with recently introduced materials. A review of the literature was undertaken using the PubMed database with the following terms: endodontic surgery, apicectomy, root-end cavity, and retrograde cavity. A manual search using references from this source followed. Contemporary endodontic textbooks were also reviewed, and a historic perspective was gained from a number of older books and references. Keywords: apicectomy, endodontics, periapical surgery, root-end cavity

Aim: To review relevant ethical principles in dentistry and relate them to endodontic practice. Summary: In dentistry, as in other areas of healthcare, the clinician has to deal with various legal and ethical issues. Whilst legal issues are often discussed, comparatively little is known about the ethical issues that govern a clinician's actions. In this article, an attempt is made to clarify the distinctions between ethical principles and legal rules, and to highlight their relationship. In general, five main ethical principles in dentistry have been outlined: autonomy, non-maleficence, beneficence, veracity and justice. Since there are specific ethical issues in daily endodontic practice (such as informed consent to endodontic treatment, the increasing use of implants instead of root canal treatment and the relationship between oral and general health), an attempt is made to co-relate these general principles to endodontics. Additional discussion and examples are suggested including guidelines on decision-making based on ethical principles. Key learning points: • Endodontic treatment is governed by ethical and legal principles. • The foundations for both law and ethics were laid out in ancient times but are constantly modified by society. Keywords: endodontics, ethics, principles

Teeth with aberrant root morphology present the endodontist with diagnostic and treatment challenges. This review of the literature is focused on the classification, aetiology, prevalence and diagnosis of different types of double teeth, namely fused or geminated teeth. Cases are included to illustrate the various treatment considerations when managing these variations of dental anatomy. Keywords: concrescence, dental anatomy, double tooth, fusion, gemination

Rotary root canal nickel-titanium (NiTi) instruments are particularly suitable for preparation of curved root canals. Numerous NiTi systems are available. The RaCe system, with design features such as short, twisted cutting edges alternating with straight debris transporting spaces, promises good results. In addition, RaCe files require less torque and higher rotational speed. Other design features, like sharp cutting edges and electrochemical surface treatment, increase the cutting efficiency and reduce the number of instruments needed. Keywords: crown-down technique, NiTi instruments, RaCe system, rotary root canal treatment

An accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment. A review of the literature reveals a low incidence of three root canals. Diagnostic means, such as pre-operative radiographs and examination of the pulp chamber floor, are helpful in locating root canal entrances. This case report describes the successful treatment of maxillary second premolars with three root canals. Keywords: anatomical variation, maxillary premolar, root canal anatomy