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May 17-23, 2010United Kingdom Edition FenderMate® is a trademark registered by Directa AB. Registered Design and Patent pending. Form Contact Point Flexible wing exerts pressure for maintained separation and cervical adaption Inserts like a wedge Tight cervical marginal adaptation prevents overhangs World’s Fastest Composite Matrix? 3108-1001©DirectaAB Matrix Distributed in the UK by Trycare, Tel. 01274-88 10 44 More Designs by Dentists www.directadental.com FenderMate tryKit for only £ 9.00* (value £ 26.00) *Redeemable against your next purchase of FenderMate. Promotion code DP02 to be mentioned on order. dodontists since the late 1970s. The first reflected what is now an anachronistic view of emergency procedures and the standard of care defining non-surgical thera- py during that period (7) ; the sec- ond, done prior to the technologic advances of the last decade of the 20th century, was hallmarked by a dramatic decrease in leaving pulpless teeth open in emergency situations and a significant de- cline in the use of culturing prior to obturation (8) . The report indi- cated that the concept of “debri- dement and disinfection” versus “cleaning and shaping” was now the focus of the biologic thera- peutic imperative and the need for expansive microbial strate- gies was recognised as being of paramount importance (Fig 3). The primary patho-physiologic vectors of pulpal disease and the myriad complexity of the root ca- nal system had always been un- derstood; as the century closed, clinicians were provided with new tools and technology to ex- pand the boundaries and limi- tations of endodontic treatment procedures (Fig 4a, 4b). Root canal infections are pol- ymicrobic, characterised pre- dominantly by both facultative and obligate anaerobic bacteria (9) . The necrotic pulp becomes a reservoir of pathogens, toxic consequences and their result- ant infection is isolated from the patient’s immune response. Eventually, the microflora and their by-products will produce a periradicular inflammatory response. With microbial inva- sion of the periradicular tissues, an abscess and cellulitis may develop. The resultant inflam- matory response will initiate ei- ther a protective and/or immun- page 20DTà Figs 2a, 2b – Tooth #1.5 (4) was determined to be non-salvageable. It was removed, the socket stimulated to regenerate and in four month’s time an ANKYLOS® implant inserted, a sulcus former placed and the tissue closed over the site to allow for osseo-integration to occur. Figs 2c, 2d – The choice of a natural tooth versus an orthobiologic replacement will increasingly be a powerful force in dental treatment plans. The temptation to choose one or the other based on expediency versus complexity, on marketing versus science is going to be the sine qua non of the standard of comprehensive care. Fig 3 – The degree of complexity of the root canal system has been understood for most of the past century. The failure to negotiate the labyrinthine ramifications of the root canal system has purportedly been a func- tion of technical limitation rather than comprehension and yet, it took until the mid 70’s to appreciate that thermolabile condensation of an obturating material could demonstrate a greater occlusive de- gree of the system than any other modality. Fig 4a – Panel of anatomic preparations from the classic work by Professor Walter Hess of Zurich – The Anatomy of the root canals of teeth of the permanent dentition, London, 1925, John Bale, Sons & Danielsson. Fig 4b - Vertucci FJ – 1984.Two thousand four hundred human permanent teeth were decalcified, injected with dye, and cleared in order to determine the number of root canals and their different morphology, the ramifications of the main root canals, the location of apical foramena and transverse anastomoses, and the frequency of apical deltas.