ROEN0410

I 03 editorial _ roots I roots4_2010 Prof José F. Siqueira Jr. _Endodontics is fascinating. I will put aside the romantic view that endodontics is an art and assume that it is an ever-growing science that requires a great deal of study and training to reach a high-level clinical performance. I dare say that no other clinical discipline in dentistry requires such a vastknowledgeofandintegrationwithsomanyotherclinicalandbasicdisciplines. Asaclinicalhealth-carediscipline,endodonticsisconcernedwiththepromotionoforalhealthand primarilydealswithpreventionandtreatmentofapicalperiodontitis.Everypatientwhoentersouroffice isconfidentthatwearewellpreparedtoapplythemosteffectivetreatmentprotocolavailabletoreach thatgoal.Unfortunately,thismaynotbetrue.Epidemiologicalstudiesrevealaverylowsuccessrate(40 to 60%) of endodontic treatment in the general population. The majority of failed (or diseased) teeth are poorly treated. The need for a complex background of knowledge and the technically demanding natureofendodonticproceduresmayhelpexplainsuchanoverallpoorperformance.However,thepo- tentialforsuccessisveryhigh(85to95%),asdemonstratedbywell-controlled,university-basedstud- ies.Thisrateisamongstthehighestforanytreatmentinanyhealth-carediscipline.Thiskeepsourhopes high.Thechallengeforthespecialtynowistotransferthishighsuccessratetothegeneralpopulation. Oneofthepossiblesolutionsistoencouragethedevelopmentoftreatmentproceduresorprotocols that are user-friendly and effective in order to allow more clinicians to be able to offer optimal out- comes. This would make endodontics more ‘democratic’ in terms of predictability. In a thought- provoking paper by Morgan and Alexander published in roots2/10, the authors discuss the issue of applyingscientificknowledgetoimproveclinicalpractice.DrIrvingNaidorfhaddiscussedthis40years ago and it is still significant today. Integrating scientific knowledge and clinical practice is certainly requiredtomaximisethesuccessrate,butthisapproachmightwellalsobeusedtodevelopalternatives toimprovethequality(andconsequentlytheoutcome)oftreatmentintheoverallpopulation. In spite of the huge amount of scientific information about the aetiology and pathogenesis of apicalperiodontitisgeneratedoverthelastthreedecades,thisknowledgehasnotbeentranslatedinto a significant improvement in endodontic treatment outcomes. This is because clinical technology and treatment protocols have not been devised or even slightly modified on the basis of this booming biologicalknowledge.Sciencehasprovidedagreatdealofinformationonthenatureoftheproblem,so thetimehascomeforthisknowledgetobeusedbyendodonticscientistsandclinicianstofindabetter, affordable and less technically demanding approach that can still predictably treat our patients. In an idealworld,thereshouldbenodichotomyordisputebetweenresearchandclinicalpractice.Inaclinical disciplinelikeendodontics,researchshouldbemostlyintendedtofindandtestwaysforthebesttreat- mentandtoimprovethequalityoflife,whilecliniciansshouldusethisscientificknowledgetoimprove their practices. Denying the importance and advances of the other is arrogant, nonsense, selfish and counterproductive. In contrast to the many Doomsday prophets, we can foresee a bright future for endodontics. It’suptous. Yoursfaithfully, ProfJoséF.SiqueiraJr. ProfessorandChairperson,DepartmentofEndodontics,EstáciodeSáUniversity RiodeJaneiro,RJ,Brazil Dear Reader,