Endodontic therapy is one of the major share of dental therapy carried out in any private dental setup. Making endodontic therapy simple and predictable has been the driving force behind the entire philosophy of "Automated Endodontics". Dr. Mona Kakar in this series of articles will take you through the entire journey of the principles, working and science of "Automated Endodontics" - the creation of Dr. John Jacklich.

Introduction to the concept of Automated Endodontics - Origins, History and Rationale

Endodontic Therapy, specifically Root Canal Treatment, has long ago established itself in the annals of Dentistry, as a valid, predictable treatment modality for a dead or dying pulp. Gone are the days when the durability of the therapy was in question and extraction of a tooth with a dead pulp was an option with the balance tilting equally in its favor as opposed to saving it.

However, this therapy is one of the many treatments in Dentistry, which is very technique sensitive and even more so, tool sensitive. Winding down a wiry little itty-bitty tube and cleaning it out with predictability and then sealing it so that no bacteria can get into the space and make a home, requires very highly sophisticated tools and their very skillful use!!

The early nineteen hundreds were graced with the introduction of a variety of tools: path finders, barbed broaches, reamers, files, lentulo spirals, etc.. A number of medicaments and "sealing agents" also made their appearance. Every clinical picture presented, was tackled with unique formulae, utilizing permutations and combinations of tools, medicaments and sealants available. Experimentation was varied and failures abundant.

The year 1958 was a hallmark year in the history of Endodontic instrumentation. Manufacturers came together and a consensus was reached on instruments and obturation materials for Root Canal Treatment. Instrument tapers, instrument sizes and instrument nomenclature were standardized. The same sequences were applied to instruments that were to be used for obturation as well as the obturating materials (gutta percha points). Specificity came into the science of instrumentation for Root Canal Treatment. Predictability of therapy was an automatic fall out.

A while elapsed before mechanization was introduced in the form of the Giromatic Handpiece. Techniques and working sequences with hand instruments were well documented by this time. Gutta percha entrenched itself as the favorite core material to be used along with a sealer for obturation. Techniques for the latter also came to refinement. The era of mechanization in Root Canal preparation saw the introduction of several paradigms and related equipment. Quarter turn mechanization brought in the Giromatic, and sonic & ultrasonic energy brought in the variants of scalers and the Micromega. Much later, rotational energy was utilized with nickel titanium for specialized files, with high torque handpieces.

Jack Jacklich graduated from the Loyola School of Dentistry in the year 1968. He joined a group practice where nine other dentists were already present. He was called upon to perform all of the Root Canal Treatment necessary in the teeth of the patients under treatment in the practice. The tedium of hand instrumentation and its inefficacy and ineffectiveness soon resulted in what he still calls "the scourge of digital hyperkeratosis". The patience required in the handling of gutta percha points for the then well established lateral condensation technique, set him thinking and asking questions. This set him on a path of discovery that led to many an innovation in technique and invention of tools. The result was a huge paradigm shift in the logic and technique, with the same end result of predictably treated Root Canal Systems. The followers of this technique reveled in the wake of this tidal wave of innovations and inventions.

The first irritation factor that Jack wanted to tide over was the obturation. There had to be a simpler way to seal the cleaned Root Canal System! The sealer was doing the actual sealing and the gutta percha was just an inert core packing the sealant against the walls of the canals for a good seal. To top that, was the fact that there were three sealers on the list of the ADA, which were also accepted as "fillers" for Root Canal obturation. Several dentists performed experimentations with syringes to introduce sealer cement into canals. However, none hit upon a truly accurate delivery system. Moreover, the cement used, was almost always soft, lacking the body and strength to remain in the canal for long as a filler. One company was on the right path, using the micrometer principle to gain the force required to extrude thickly mixed cement from the bore of a thin needle. The failure there was, that the cement tangled in the threads of the screw and made it tedious to clean each time. Cement extrusion accuracy was also in question. With the introduction of the Precision Endo Syringe in 1978, Jack ironed out these problems. Incorporating suggestions from users, and his own ideas, the fine tuned product for the obturation of Root Canals was introduced in 1994 as the Multi Mode Syringe.

This eliminated gutta percha from the inventory of the users of the Syringe. Four canal systems could be obturated in as many minutes. The ease of the system outclassed most, and introduced an elevated accuracy level in obturation. Further, a convenience was available for teeth slated to receive posts. Since the obturation was being performed apex to orifice, the coronal zone could be left unfilled, eliminating the need to clean it out again for the post. Skeptics derided the use of only cement as a sealer cum filler, convinced that the cement would breakdown or "dissolve" from the canals in time, leaving them empty. The logical explanation that a thick mix of cement, when set, cannot dissolve in tissue fluid, eluded them. Jack, unfazed, only commented, "It is the clinicians who find out what works; the academicians later discover how and why".

The obturation aspect well established, Jack turned his attention to the other aspect of Root Canal therapy - the cleansing and preparation of the canals. Debriding and preparation instruments intrigued him. He wanted to know about the designing and the working of the instruments used for Root Canal therapy and lamented the paucity of available research material and documentation available on instrumentation. A firm believer of the "a carpenter is as good as his tools" tenet, he set out to arm himself with the mechanics knowledge and the materials knowledge needed. He promptly worked out an efficient and effective design of files. These came to be known as the Fine Cut files. Simultaneously, the Fine Cut Handpiece for mechanized preparation of the Root Canal system was also born. The precursors of this handpiece were adaptations for use with ultrasonic scalers and prior to that, with battery operated toothbrushes!!

Evolution has not halted at Jack's mind factory. Ideas are churned out with regularity, tried, tested and then adapted, adopted or discarded. As soon as an improvement is proven workable and superior to the previous one, it is immediately incorporated into the next line of production of that item. Improvement suggestions are welcome - here's one person who accepts wish lists with a smile as they pose a challenge to him and set him thinking.

The idea behind the creation of all these techniques has always been that Root Canal Treatment should be simple and predictable at the hands of all kinds of operators. In the words of the inventor himself, "Root canals should be boring - they must be done in the exact same way each time." The logic of the single sitting therapy as introduced by Sargentii several years ago, also appealed to Jack even as controversies raged around the topic. He doggedly stuck to the ideology following it in practice and teaching and now, single visit Root Canal therapy is accepted as a valid treatment option.

In the following series, the author intends to elucidate on all of the ideologies, materials and techniques mentioned.