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Figs. 1a & b_An example of technically high-quality endodontics in which biological imperatives have not been met: despite the location and preparation of the second root canal and the well-condensed obturation of the root-canal system to length, the lesion associated with the tooth has increased in size. 36 I I feature _ lecture review _Root-canal treatment is the most technically demanding procedure in dentistry. In order to pre- pare and obturate successfully the labyrinthine root-canalsystemsthatwearefacedwithonadaily basis, relying purely on tactile sensation, takes great skill, developed over many years to even come close to mastery of the art. Since the technical difficulties are considerable, it is perhaps understandable that great pride can be taken in the production of an aesthetically pleasing post-operative radiograph. Equally understandable perhaps, if we judge the success of our procedure this way, is that much of theteachingandpracticeofendodonticsfocuseson the technical skills required to achieve good results. Doesitmatterthenthatwearetreatingadisease?In order to achieve good outcomes, do we really need to understand the disease we are treating, or simply be proficient at preparing and obturating canals? Apical periodontitis is the disease that, as en- dodontists, we spend most of our practising lives treating.Somewouldarguethatathoroughunder- standing of the aetiology, pathogenesis and micro- biology of the disease should be a prerequisite to successful treatment, and essential knowledge for any student or practitioner of endodontics. It is, however, quite often the case that those under- taking root-canal treatment simply view the pro- cedure as a technical exercise—a series of steps that must be undertaken in order to obtain the desiredobturationradiograph.Ifthesuccessofthis approach, in terms of healing, is equivalent to that reported in contemporary literature, then can it be argued that a biological approach to root-canal treatment is not necessary. These issues were amongst those discussed by Prof Kishor Gulabivala in his keynote lecture to the European Society of Endodontology Congress in Edinburgh last year. As one of the leading resear- chers and teachers in the field of endodontics, Prof Gulabivala was able to address the subject from severalangles.Firstly,hepresentedasynthesisofthe existing literature on the aetiology and pathogene- sis of apical periodontitis, and thereafter an exami- nation of several of the microbiological aspects of the disease. Next, he discussed the manner in which clinical intervention influences the disease process. Lastly, he presented a number of conclusions based on his personal insight, along with a discussion on roots2_2010 Endodontics—Does the biology matter? Authors_ Dr Alyn Morgan & Dr Ian Alexander, UK Fig. 1a Fig. 1b