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38 I I feature _ lecture review remains, particularly in the apical portion of the root. This may explain why endodontic success rates have not improved greatly in over a century. Existing treatment protocols, with their technical bias do not address these problems effectively. Thefundamentalsoftreatmenthavenotchanged in many years: remove as much of the necrotic and infected material from the root-canal system as is possible, and obturate the root-canal system in its entirety to prevent bacterial recontamination and to incarcerate residual bacteria, without extrusion beyond the apical terminus. Our understanding of the nature of the root-canal infection may be devel- oping, but unless this is followed by development of treatment strategies, which are based on this new knowledge, then treatment outcomes are unlikely toimprove.Onehighlydesirabledevelopmentwould betheabilitytoidentifybacteriapersistingintheroot canal with a simple chairside test. Culture testing was once a common part of endodontic treatment; as molecular testing improves, hopefully it can be introduced into the clinical environment to better inform the clinician of his treatment options. Chemical disinfection plays a large part in the overall preparation phase of root-canal treatment, yet its importance is overlooked by a large number of practitioners, who instead look to the contin- ually evolving file systems with which canals are prepared to improve their treatment. Whilst these file systems may make treatment more efficient, do theymakeitmoreefficacious?Onlyifthetimesaved in the shaping of the root canal is then devoted to its thorough disinfection, generally by chemical means. The study of irrigation dynamics and the chem- istryofexistingandnovelirrigantshasonlyrecently come under the spotlight. This area of research may give us insight into the way to better to disrupt and deactivate root-canal biofilms and in doing so improve our outcomes. For the research to be relevant, robust experi- mental models must be developed that closely approximate to the clinical environment. It is an area that has been the subject of much study at the Eastman Dental Institute, with a number of papers recently published in the endodontic literature. So, do we have the answer to our question? Success rates for endodontics, as evidenced by contemporary literature have stayed largely con- stant over the last century. Treatment objectives have remained similar within that period. If we are to improve our outcomes, then we need to let the science better inform our treatment procedures. To summarise where science has brought us, we can return to the conclusions drawn by Prof Gulabivala at the end of his ESE lecture: _The nature of intra-radicular infection is complex in its diversity and biological interactions within it and with the host. _The nature of the infection and the host’s reaction to it probably dictate the nature of clinical and radiographic presentation. _The nature of infection strongly influences the clinician’s efforts to control it, and therefore the outcome. _Theclinicalpresentationmayprovideastrongclue to the probable outcome of contemporary root- canal treatment. _The link between the technical aspects of contem- poraryroot-canaltreatmentandbiologicalevents is non-specific at best. _Improvement of treatment success will require a better understanding of the nature of infection and ways to control it apically. Theanswerthenisyes;thebiologydoesmatter._ roots2_2010 Dr Alyn Morgan gradu- ated from the Leeds Den- tal Institute in 1995,and worked in private practice for twelve years.He was awarded an MSc in En- dodontics from the UCL Eastman Dental Institute with distinction in 2009. He currently works both in private practice and as a specialty doctor/clinical teacher in endodontics at the UCL Eastman Dental Institute.He can be con- tacted at alyn.morgan@eastman.ucl.ac.uk. Dr Ian Alexander gradu- ated from the University of Newcastle UponTyne in 1991,and has worked in private practice for nine- teen years.He attended the Eastman Certificate course in Endodontics in 2005 and was awarded an MSc in Endodontics from the UCL Eastman Dental Institute with distinction in 2009.He currently works both in private practice and as a specialty doctor/clinical teacher in endodontics at the UCL Eastman Dental Institute.He can be contacted at ian.alexander@eastman.ucl.ac.uk. roots_about the authors

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