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This issue of Rewind will take you down memory lane and reveal some interesting details of how endodontics was practiced in the yesteryears and twists and turns it took to become an established and well practiced science. Read on to find out what Dr. Ajay Kakar discovered in the literature. ENDODONTICS - YESTERDAY, TODAY & TOMORROW It is always interesting and enjoyable to sometimes go back and look into how a science developed and reached a current state of art. The same applies to the science and art of Endodontic therapy. Endodontics has been termed a science as well as an art because in spite of all the factual scientific foundation on which current endodontics is based, completing an ideal endodontic job is an art in itself. Dr. Grossman, the pioneer of endodontics, published an excellent history of endodontics in the July 1976 issue of JADA in which he divides the evolution of the science of endodontics over four half centuries from 1776 to 1976. As it has happened with all technology, the rate of progress has shot up considerably over the last 50 years or so and is progressing still faster due to the excellent communication facilities available. What we discover, learn and master now is available globally in a matter of days versus the past in which it would take months and probably years before a certain knowledge base could be shared. The Five Periods Pre
Science : 1776 to 1826 Pre-Science: In the era of Pre-Science, endodontic therapy consisted mainly of crude modalities like large abcesses being treated with various poultices or leeches, and pulps being cauterized with red hot cauteries. Note must be made that in this period there are instances of entire root canals filled with gold foil. Age of Discovery: The next half century saw an establishment of the science of dentistry as a whole, publication of a dental journal and formation of proper dental schools. The discovery of anaesthesia gave a big fillip to dental treatment and made it so much more easier and possible to carry out procedures. Gutta percha points were created to fill root canals and barbed broaches became available for cleaning and enlarging canals. Medications were created for treating pulpal infections and cements were discovered to fill them. At the same time, an entire lot of dental practitioners were driving wooden pegs into the pulp to debride the canal. The Dark Age: Even though this era saw the discovery of the X-ray and advancement of general anaesthesia to local anaesthesia, dentistry and endodontics took a total back seat and mostly moved in reverse gear. The theory of focal infection which gained momentum and ground, saw wholesale extraction of teeth and very little endodontics being practiced. Hardly any innovation took place and it was well after the Second World War that we saw some logic and reason return to endodontics. The Renaissance: This is the golden period of endodontics which saw it being firmly established as a science and therapy. Better anaesthesia, better radiographs and a host of root canal medicaments appeared on the scene. The focal infection theory started dying out and more and more of endodontics was being practiced. This era saw the first text book on endodontics becoming available "Root Canal Therapy" by Dr. Grossman. Root canal instruments got standardized and became available more readily. This era also saw the establishment of the American Association of Endodontics and the American Board of Endodontics. After seeing Endodontics firmly entrenched and established, this era also saw a second generation advancement per se. One of the prime movements of paradigm shifs in endodontics took place with the coming of Angelo Sargenti to the US. The entire Sargenti story is a classic example of science being politicized and going haywire. Sargenti was a very successful endodontist in Europe with many advocates of his method citing numerous examples of his success. Even though Sargenti introduced concepts beyond the N2 and RC2B pastes, he became famous and in some way infamous for the pastes alone. Today any endodontist who practices any form of power driven root canal preparation, has to give credit to Sargenti for creating the concept for dentistry. Today any endodontist who practices single visit endodontics, has to give credit to Sargenti for first introducing this concept. The Renaissance Era also saw the establishment of numerous dental schools worldwide, teaching the science of endodontics as a dental speciality. It also saw the establishment of a number of journals solely devoted to this speciality and a huge number of research projects being taken up as part of the post graduate curriculum. It also saw the introduction of the Gyromatic handpiece and still further forms of rotary instruments for enlargement and debridement of canals. It also saw the introduction, rise and then the decline of the silver point for filling of root canals. Gutta percha in its various forms became the material of choice for obturation. A variety of techniques became established as the norm: vertical condensation by Dr. Herb Schilder, lateral condensation, softened gutta percha and thermoplastic gutta percha. Innovation Era: The period from 1976 onwards has seen a breathtaking advancement happening in Endodontic therapy at a very rapid pace. Improved and better forms of biomechanical preparation are being churned out. Obturation techniques are becoming simpler, easier and faster. The single visit endodontic therapy concept is almost globally being accepted by all schools of thought. Improved visibility is now available with the advent of the endo microscope. Newer, better and more reliable apex locators are challenging the need for radiographs. Even though not a replacement, apex locators are excellent tools to make life much more easier for the dentist practicing endodontic therapy. In any era of a science undergoing such monumental changes, totally innovative changes usually originate from a handful of people. With the fantastic communication networks, it is now fascinating to observe events which would ultimately go down as historical phases. Dr. John Jacklich is one such innovator living in present times and making history which we can observe during our lifetimes. To use Dr Jacklich's own words, he is essentially a "molar mechanic" and "calcium miner". Thrust into a situation wherein he had to do dozens of root canal therapies day in and day out, within ever decreasing chair side times, his grey cell machinery was set ticking into creating what was not available. Couple this with an astonishing ability to absorb factual data and a very highly logical reasoning mental capacity and the net resultant is simplification of endodontic therapy, simple but ingenious devices to get better root canal fillings done in short periods of time. Dr. Jacklich, by 1977, had created his own unique Obturation equipment and technique, wherein he discarded with the solid cores and started filling root canals with just cement. The problem he pondered over was not in the cement, but in the ability to get the cement (not a paste), into the root canal. He created the Precision Endodontic Syringe which made it possible to do so. He soon started talking about it and voila, there were so many who wanted to know and learn more about it. This prompted him to start the Advanced Endodontic Training Program which saw him travel the length and breadth of the US of A and within a few years, create a totally innovative system of endodontic therapy and shortly appear in the new edition of the bible of Endodontic Science i.e Ingle's textbook. The innovative mind was, however, not at rest. The Syringe constantly improved and became easier and simpler to use. Dr. Jacklich got into some high level physics to innovate and create a whole paradigm shift in root canal instrumentation. An in depth study of mechanics saw the creation of the Fine Cut Endo Filing system and an absolutely stunning improvement in preparation and an almost nonsensical reduction in preparation time. He shows molars being prepped in about a couple of minutes. The wonderful science behind his positive rake angle files, the cirucumferential filing technique and his fascinating handpiece based on these principles are just mind boggling. Dr. Jacklich has an advantage of living in times when communication around the globe takes a few minutes at the most. This saw his system rapidly move into countries as distant as Australia and India. The latest to churn out of Dr. Jacklich's den, his research laboratory, is a cyber-pneumatic syringe. Imagine a device which is microprocessor controlled, attached to an ordinary carbondioxide mini-cylinder (the kind used to make soda for drinks), and contains cement which will obturate the root canal. A sensor in the device will measure the volume of cement required to obturate the canal and at the press of a foot switch, sufficient pressure will be applied and an exact amount of cement will be extruded so as to perfectly obturate the canal. Dr. Jacklich who for the last decade or so has been constantly pottering in his den (the personal research lab) has now been convinced to spend some more time outside it. He is now making a tour to India and will be almost continuously lecturing and impart training on his brand of endodontics all along.
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