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 Age of Discovery : 1826 to 1876 The Dark Age : 1876 to 1926 The Renaissance : 1926 to 1976 Innovation Era : 1977 to 1998 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.
HISTORY OF ENDODONTICS JC Baumgartner DDS, MS, PhD In a development of a sound philosophy of endodontic practice and rationale for the use of specific types of therapy, we look for support from scientific investigations and from critically evaluated clinical experiences. The last few decades has seen an avalanche of literature in the field of endodontics. This explosion of scientific and clinical data has, in some ways, made the practice of endodontics confusing. Coolidge has stated that "just as research opens doors, it also closes doors". It may also be added that there still remains many doors to be opened or closed as the case may be. The following is a much abbreviated chronological review of the more significant highlights and low points in the history of endodontics since the first English-language dental textbook was published by Charles Allen in 1687 to the recognition of endodontics as a specialty by the ADA in 1963. Hopefully, this outline may help you place more recent developments in the field of endodontics in proper prospectus. 1687 1700 Charles Allen discussed transplantation in the first English-language dental text. Leeuwenhoek identified the source of the tooth worm as "worm infected cheese".

1728 Pierre Fauchard wrote The Surgeon Dentist in which he described pulp extirpation using a trepan and the use of oil of clovesopium for pain relief. 1756 1757 1766 1800 1809 1819 1821 Phillip Pfaff dentist to Frederick the Great used gold or lead for pulp capping. Bourdet filled root canals with gold or lead before replanting the teeth. Robert Woofendale of NY alleviated pain by cauterizing the pulp and then stuffed the open canal with cotton. Frederick Hirsch used percussion as a diagnostic aid. Edward Hudson of Philadelphia is credited with placing the first root canal fillings. Charles Bew of London described pulp circulation as through the apex then dental wall to the periodontal ligament. Leonard Koeker of Philadelphia popularized pulp capping with lead.

1829 Fitch promoted "vitalistic theory" that stated that the crown was nourished by the pulp but the root by both the pulp and the periodontal membrane. 1830 1834 1836 1837 1838 1847 1847 1851 1857 1857 1864 1865 1867 1867 Reichenbach introduced use of creosote in canals. Runge introduced use of phenol in canals. Spooner of NY used arsenic to devitalize pulp before removing it. Jacob Linderer recommended a narcotic oil to render pulp insensible. Edwin Maynard of Washington DC developed first root canal instruments. Hill patented gutta-percha stopping. Wetzel used arsenous acid for vital pulpotomies. SP Hullihen described apical trephination. Watt recommended use of gutta- percha as a root canal filling. Thomas Rogers reviewed pulp capping techniques. If they failed, prescribed 3 leeches and a laxative. SC Barnum of NY demonstrated the use of rubber dam. EL Clarke of Dubuque filled roots with hot baseplate gutta percha. GA Bowman of Missouri demonstrated the use of gutta-percha points to fill root canals. JF Hodson designed a set of rubber dam clamps.

1867

Joseph Lister introduced idea of antiseptic treatment.

1867 M'Lain criticized use of creosote-cotton root canal filling. Also recommended removal of all pulp remnants and canal filling when the tooth is asymptomatic. 1867 1870 1873 1882 1883 Magitot used electric current for pulp testing. GV Black recommended zinc oxychloride for pulp capping for preservation of the pulp. Adolph Witzel in Germany used phenol to sterilize canals. Arthur Underwood popularized use of caustic antiseptic agents to sterilize contents of the pulp chamber and canal. PA Hunter described a 98% success rate using a pulp-capping mixture of English-sparrow droppings and sorghum molasses.

1883 GA Mills would drive a hickory splinter into root canals to extirpate the pulp. This was recommended to avoid the toxic effects of arsenic. M Richmond later used orange wood. 1884 1884 1885 1885 J Farrar reported on the use of root amputation as a treatment technique. Karl Koller introduced cocaine as an anesthetic. Hall and Halstead used cocaine solutions for dental anesthesia. GA Bowman introduced chloropercha technique. Lepkowski introduced Formalin to fix pulp stumps.

1888 WD Miller believed that the decomposed infected pulp caused dental alveolar abscesses. He described the mouth as a focus of infection. Later emphasized by GV Black in 1890. 1889 GV Black tested a number antiseptics and stated "the greater the range of antiseptic value, the more dangerously poisonous the drug". 1890 1890 1891 1891 1891 1891 1893 1894 1894 1894 1895 1896 Funk used a cocaine solution for direct pressure anesthesia on the pulp. CT Cramm used copper points for the root canal filling. GV Black emphasized the fact that "septic matter" may be poisonous to periapical tissue in addition to "infectious matter". AW Harlan stressed the importance of thorough canal debridement and advocated the use of a diffusible root canal antiseptic. JS Marshall popularized the use of the electric pulp tester. Otto Walk off recommended chlorophenol to sterilize canals. Later Herman Pring introduced it in the US. Emil Schreier used a mix of sodium and potassium to clean and disinfect root canals. JR Callahan used 20-40% sulfuric acid in root canals. John Wessler (Swedish) recommended "Pulpol" (90% ZnOE) for pulp capping. Breuer in Vienna is credited with using electrosterilization of canals and ML Rhein brought technique to NY. WC Roentgen discovered x-rays and Walkoff took first dental x-ray. Edmund Kells of New Orleans used x-rays to study canals filled with lead wires.

1898 RH Peck tested the toxicity of several medicaments. He recommended continued use of Beechwood Creosote, oil of cloves, oil of bay, Black's 1,2,3 (Cassia, phenol, gualtheria) and warned against stronger drugs. 1899 1900 1901 1904 1905 1906 1908 JP Buckley introduced formocresol as a canal medicament. Price used the term "blind abscess" to describe a periapical radiolucency with no evidence of clinical drainage. TW Onderdonk recommended culturing of root canals. Frank Billings related oral sepsis to endocarditis. Alfred Einhorn developed Novacaine. Shepley Part introduced Novacaine to the US. ML Rhein of NY used a diagnostic wire and x-ray to determine canal length.

1909

EC Rosenow and Frank Billings developed the "Theory of Focal Infection".

1910 William Hunter attacked American dentistry and described the gold crown as "A mausoleum of gold over a mass of sepsis". This helped popularize the "Theory of Focal Infection" that was directed at the pulpless tooth for some 25 years. 1911 1912 1912 1916 1919 1919 JR Callahan advocated his rosin-chloroform technique. ML Rhein recommended aseptic techniques as a rebuttal to focal infection. Guildo Fisher published first comprehensive study of root canal anatomy. Callahan and Hess later made major contributions. Carl Grover showed that toxic chemicals could produce apical lesions. Coolidge, LaRoche, Appelton and others promoted an aseptic clinical technique and culturing as a scientific method. Commercial dental x-rays machines are available.

1920 Hermann used Calxyl (calcium hydroxide) to fill canals. By 1930 he used it for pulp capping, pulpotomies and for treating infected canals. 1921 1925 1925 1926 1928 1929 1929 1931 1933 1935 1936 1936 1937 1938 1939 1939 1940 1943 1943 1951 1953 1957 1959 1959 1963 1963 Rosenow (Mayo Clinic) adhered to belief that once a tooth was infected, it was always infected. UG Rickert recommended the use of sealer with a gutta percha cone. Lentulo develops his rotary spiral bur for inserting paste. E Kells recommended leeches for post-treatment pain. HB Johnson of Atlanta limits his practice to endodontics Greek en (within) odontus (tooth). Carl Grove recommends filling to D-C junctions. Also calls for standardization of instruments. Balint Orban showed microscopic evidence that the pulp has the same cells as other connective tissues. Rickert and Dixon promote their "Stagnation theory" for unfilled root canals (Hollow Tube Theory). EA Jasper developed silver points. Okell and Elliott found bacteremias in 70% of cases following extraction of "pyorrhetic teeth". Fish and McLean found no bacteremias if sulcus is cauterized first. Walker recommended the use of sodium hypochlorite as a canal irrigant. Logan stated that the presence of microorganisms does not imply infection. Zander and Teuscher used calcium hydroxide for vital pulp capping. Fred Adams used sulfa drugs in the canals and later penicillin (1944). Fish separated foci of infection into zones. Rohmer used calcium hydroxide to cement gutta percha into canals and claimed a cementum-like barrier formed. American Association of Endodontists was formed. Grossman recommended irrigation of canals with sodium hypochlorite and peroxide. Hedman related absence of bacteria in a root canal to status of periapical tissue. Auerbach reemphasized the importance of thorough canal preparation. Nygaard stby introduced the use of EDTA for canal irrigation.

Sargenti and Richter introduced N2 to American dentistry. Winkler and Van Amerogen studied root canal flora. Seltzer, Bender et al questioned the use of culturing as an indicator of when to fill a root canal. Endodontics is recognized as a specialty by the ADA.