Does ‘elective’ or ‘pre-emptive’ endodontics have a role in Restorative Dentistry?

It almost feels dirty to me as I try my best to PRESERVE pulp vitality!

But sometimes this bites you, and you wish you had carried out root canal treatment before cementing that crown.

At what point can pre-emptive root canal be justified in a world where MTA and biodentine exist?

https://youtu.be/9Gc_yik9fDU

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In this episode, Jaz sits down with renowned endodontist Dr. Brett Gilbert to delve into the intriguing world of elective or pre-emptive endodontics. Together, they explore challenging cases where teeth with uncertain pulpal health may require root canal treatment, whether due to caries or crown prep. Dr. Gilbert sheds light on patient communication strategies, the role of bioactive materials like biodentine and bioceramic sealers, and how to make crucial decisions about preserving pulp vitality.

Protrusive Dental Pearl: Dr. Pav Khaira suggests using Alvogyl, commonly used for dry sockets, to treat pericoronitis! After cleaning and disinfecting the area, place a small amount under the operculum for immediate relief and to soothe inflammation.

Need to Read it? Check out the Full Episode Transcript below!

Highlights of this Episode:

3:01 Protrusive Dental Pearl

03:55 Dr. Brett Gilbert's Journey and Philosophy

07:17 Elective or Pre-emptive Endodontics

11:06 Radiographic Measurement

11:40 Real-Life Encounters 

15:29 Discussing Treatment Options and Patient Communication

20:28 Can Biodentine Prevent Root Canal?

22:45 Materials and Techniques in Endodontics

26:16 Death of Gutta-percha?

This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes B and C.

AGD Subject code: 070 Endodontics (Endodontic infections, microbiology and treatment)

Dentists will be able to: 

1. Learn what elective or preemptive endodontics entails and recognize scenarios where root canal treatment may be required due to caries or crown preparation, and how to approach them.2. Discover effective strategies for explaining treatment options to patients, improving trust and decision-making.3. Gain insights into the use of bioactive materials like biodentine and bioceramic sealers, and their benefits in preserving pulp vitality.

If you liked this episode, you’ll love Post Operative Pain after Endodontics – Prevention and Management – GF017

Click below for full episode transcript:

Teaser: I do believe in these instances, you are justified to recommend the treatment. You're not demanding it. You're not saying it's dogma, but you're having a conversation so the patient understands. Because what happens if you don't is you do your work, you're doing it in best faith. Patient winds up in pain, and they become very angry.

Teaser:They become agitated, and they want to blame the dentist. And without a conversation, without a dialogue, they're clueless, and all of a sudden, they just think you did something wrong. You are a human, and you are the doctor. Speak to yourself. Let the words flow out so that you can explain all the different possibilities in a way that the patient feels heard, understood, but also nurtured, and at the same time you realize this is biology. We are not in control.

Jaz's Introduction:In a world where we want to do everything to preserve pulp vitality, is it ever appropriate to carry out elective endodontics? Another terminology that our guest today, Dr. Brett Gilbert shared with me is preemptive endodontics.

For example, you have a tooth with dubious pulpal prognosis. And you know that by prepping it for a crown or by removing the caries, this tooth may need root canal treatment. Is it okay to just go ahead and do the root canal so it doesn't bite you in the behind in the future? You see, I was always taught to do everything possible to preserve pulp vitality.