Hi. Today, I want to talk about endodontics. This has been my passion for many many years. So, I have been as an endodontist since 1995 in Colombia and I came to Michigan and get start working here at the university. I want to talk about what is in the science and practice of dentistry in the 21st century. So, to talk about endodontics, I have to give you a definition. So, is the study of the biology of the dentin-pulp complex. The endodontics component is pretty much to understand what is the etiology, diagnosis, prevention, and treatment of the disease and the injuries that are happening inside of the tooth. So, in these complex studies, the dentin-pulp complex and how it goes into the periapical tissues. So, for this I have to tell you that the root canal treatment that is what we do, the endodontic treatment, is pretty much what it goes to remove all the tissue that is being infected, because most of the times these bacteria will cause the problems in teeth. Most of this is because of caries lesions or trauma. This tissue that is really infected needs to be removed. Then, with the root canal treatment, what we do is to clean, disinfect, and then seal this root canal. What you see here, the space that we have inside of the tooth. That's why the endodontist is removing and then treating those patients to get what the problems get after because the infection goes to the periapical tissues. You see here, we have periapical lesions around the teeth, and those periapical lesions can be even connected with the rest of the body. So, if we treat the root canal treatment, then we can have healing of these periapical lesions, and that's why the endodontists is the dentists who specializes in doing root canal treatment. Endodontic treatment then is going to save teeth. if we save teeth, we're going to be having really healthy teeth, healthy patients, and happy patients. That is the goal, the final goal of endodontics is saving teeth. So, what is a healthy tooth? So, when we talk about the healthy tooth we need to talk about the healthy pulp. I just mentioning that the dentin-pulp complex is what we have here inside of the tooth, is really these tissue that is conformed just with all these connective tissue fibers cells. We have the blood vessels, we have the nerves, but all these tissues maintaining the vitality of these teeth. Even if they'll get infected, we need to remove the tissue because get decay, get bacteria in, we remove the tissue but we're going to try to preserve it completely healthy. Even though the problems as I mentioned earlier, can come directly in communication through the apex portion here at the end of the tooth. Keeping these tooth completely healthy maintains the tooth in the patient's mouth. So, the pulp tissue has to be there, and then we, I mentioned has a lot of cells, and between those cells we have stem cells. So, the pulp contains stem cells with the potential to maintain the vitality, but sometimes the vitality because it's been infected, we need to go and then do the root canal treatment. Even though doing root canal treatments, we can preserve and maintain those teeth in patient's mouth. But endodontics is not really new. There's a lot of history behind. We can tell even from the second or the third century BC, with the Egyptians, there's a lot of evidence that the treatment was done inside the teeth. But took longer in many many centuries down to the 18th and 19th century, when big discoveries like local anesthetic and X-rays, came to give more of the chances for endodontics. So, we can say that probably just late in the 1939 is when they're first Club in endodontics was founded in Philadelphia. So, people were already thinking we're going to just practice on endodontics as part of these dental treatment and for patients. So, the first association that we have, and is the association that we still have here in the United States, is the American Association of Endodontics was founded in 1963. Thus, is pretty new is only 55 years ago. But it was just recognized when endodontics was really recognized as a specialty. So, we just become as a specialty really young, but there's many things that we know from the history of endodontics, and that we are now practicing really differently that it was 50 years ago. So, because endodontics has a really broad spectrum, is not only just to go in, clean, disinfect and seal the canals. Really endodontics has much more, as an endodontic person and in working in endodontics, we have to more impatience like, for example, differential diagnosis. Is important because patient come with pain and can be just as an emergency case or patients are having problems for pain for a long time. So, sometimes chronic pain is the type of patients that we are treating, or just we want to try to preserve the pulp vitality, so we do a lot of treatments as vital pulp therapy for patients or sometimes even immature teeth. We also treat kids with adult patients. So, really endodontics has a lot of a spectrum and there's a lot of applications in dentistry. So, importantly also is because we only not going to be just doing the real canal treatment, we also follow up those cases because things can get some complications afterwards. Sometimes we need to go and retreat the cases or going into an apical surgery for those cases where are not really healing properly. So, endodontics is really has a lot of applications and has a lot of spectrum into the dental component. But the dentistry has been changing quite rapidly and I can say in inside all of that, endodontics has had a lot of changes basically with a lot of new things coming in the modern endodontics, especially operating microscope, rotary instrumentation, digital radiography and CBCT, and regenerative endodontics. I'm going to talk a little bit about what is the sense of all of those new concepts for endodontics, and as you can see here, in a regular setting, an endodontist here in the United States has been always train using always a microscope. That is great because we have a lot of vision of what we're doing inside of the tooth. Microscopes have given as much more chances to give better treatment for patients, so this is been revolutionary for us working under a microscope, increasing division for our treatments in what we do for patients. Also, we have new instruments, they're all super flexible. We have rotary instrumentation where before, we use to file with hands, and it was just really tedious, long periods and we could never do something like this as you see here. This very curved canals, and the anatomy gets very complex sometimes for treating our patients. So here, we can see the modern endodontics using new instruments, rotary instruments, flexible instruments, get better treatment for patients, and we can save more teeth that before we used to extract. Also, modern endodontics are the new tools. We have equipments as digital radiography. We reduce the amount of radiation for patients. We also use these CBCT scanning that give us the chance to have a 3D imaging of the tooth, and then we can just see better diagnosis. We can find out measurements and stuff that before we couldn't with a regular X-rays. So, those are some of the important tools coming for a better diagnostic process, a better treatment for patients and even though saving teeth. But more than that, I want to say that in endodontics, regenerative protocols have becoming something quite interesting and new for us. Like has being said here in some of the papers quoted by its meeting collaborators in 2016 when we see how we're going to try to preserve the vitality of the pulp, because I mentioned before, we have a stem cells is a very rich tissue and what we do with the protocols by now is to try to preserve the vitality of the tooth. But in cases where the tooth got necrosis as we've seen these, that is the cartoon, that is in newspaper and one of the publications we gave in this chapter book. When the patients get necrosis and is completely damaged, is infected, there's chances that we can try to even with the same body cells the tissue that we have here at the apical popular, we have some of these stem cells. We're going to try to induce these cells to come and then just repopulate the canal, and then re-vascularized and then start forming a new tissue and complete the formation of the tooth. Or we can also in the process of the research that we're doing right now, trying to bring the cells, stem cells inject inside of the canals, and then give the chances for even the same instances from our patients, to put it inside the tooth and continue the tooth growth and tooth formation. So, this is really revolutionary nowadays that we're thinking much more to instead of just putting [inaudible] inside the canals, is just thinking about placing and the putting inside just stem cells for the patients. So, that's why regenerative endodontic procedures are nowadays recognized by the American Association of Endodontics, and also the European Society of Edeontology. They're both are now combining recognize those protocols and they are just recommended to the endodontists to do it. For example, in this case, where you have a very mature tooth, we do these protocols, we induce the cells that are stem cells, from the same patient to come inside the tooth and keep forming. I'm going to show here a case that it had the chance to share with one of my collaborators back home in Colombia, and treating this patient, is a very young patient, who has a trauma, tooth got death, inside giving some of these protocols. We induce the cells that are here inside the tooth to just migrate, is they're proliferating and making all continuing deformation of the root. So, given this chance, we are just getting the same tools that it was just like a very mature open tooth, becoming a fully formed completely as you see after eight years of follow-up. We can see here with our CBCT scan some breaching of the tooth in root formation. So, this is what endodontics is nowadays, trying to go forward for a much more modern techniques and even using this same potential of the stem cells that the patients had in their mouth. We can say that the research in endodontics come from these small inside of the cell type molecular science. This is part of the research we have done here at the University of Michigan, trying to recognize the receptors for bacteria in some of the dental pulp stem cells, In Vivo experiments that we do in animal studies, trying to see how is the reaction to the protocols that we do in teeth or nowadays that we are researching with clinical research. So, we are coming from bench, top, experimental design to a clinical research to put all what we're learning in our patients to treat and to save teeth. You see here, this is the research I'm conducting here at the University with my grad students. At the Endo Department is a clinical randomized trial that we are trying to safety that good necrosis, they're immature, and with this protocol, we induce the formation of the new tissue and completion of the roots. Here, I will say endodontics is our great field, is my passion, is what I've been doing for more than 30 years. I think is a great specialty as part of the dental. But as a dentist, I always recognize and have to be a full general dentists to recognize my patient to do a full diagnosis. But when I can treat and save teeth, I think I'm making patients happier. So, if you are as an undergrad student or if you are being thinking that you may be want to be an endodontist, you need to start thinking that you are going to study four years to get your dental degree first. Then, you come to the grad programs to do two or three years program, depends if you want to get a masters or a certificate. Here at the University of Michigan School of Dentistry, we have a graduate program with three years where you can get a master's degree or you can also do postgraduate programs for six, nine or 12 months. In those programs, you get a certificate of assistance. But I have to tell you endodontics is changing rapidly and is an amazing special part of the dental training that you'd have as a general dentists and to become really a master's in endodontics doing these programs. You learn much more and you do better treatment to save teeth in your patients. So, I hope you enjoyed what I just explained to you. Thank you for being with us today.
