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RO0211

I 37 opinion _ marketing I roots2_2011 Theory and stimulated the annihilation of millions of salvageable teeth and put dentistry firmly back in the Dark Ages of science (Fig. 1). The second, the use of micro-CT technology to map the inner space of teeth, replicated the Hess studies using digital tools (Fig. 2). Unfortunately, the outcome of this renewed awareness has not resulted in a more sophisticated approach to preservation of natural teeth using a century of evolutionary advances in material and technique, but has fostered a “simpler is better” mentality, which will inevitably be as devastating to retention of the natural dentition as Dr Hunter’s egregious dental witch hunt of the early 1900s.6 The hard-tissue repository of the human dental pulp takes on numerous configurations and shapes. A thorough knowledge of tooth morphology, careful interpretation of angled radiographs, use of small FOV CBT, proper access preparation and detailed exploration of the interior of the tooth are essential prerequisites for a successful treatment outcome. A thorough understanding of the complexity of the root-canal system is essential for understanding the principles and problems of debridement, disinfection and root filling for determining the apical limits and dimensions of canal preparations, and for per- forming successful microsurgical procedures when necessary. Andyet,thepastfewdecadeshavebeenentombed in the most egregious nihilistic “Mad Men” descrip- tion of the technological wizardry and biological understanding necessary to ensure long-term pre- dictable prognosis of the endodontically treated tooth: “clean, shape, pack”. This has produced a plethora of product launches that has now reached its crescendo with the arrival of a “single file that does all”. From a metamorphosis of instruments borne of angioplasty materials to the enhanced elasticity of NiTi and its reformulation in newly ground shapes and its use in reciprocating rather than rotary feed rates,themarketisonceagaindrivingscienceandour patients and ultimately our profession will pay the price for the oversimplification and obtuse denial of the reality we know for the expediency we are being trained to crave. Sealers based on restorative fundamentals were to be the sine qua non of monobloc creation in the root-canal space. Unfortunately, one of the most exhaustive studies done to evaluate evidence-based support on the merits of their clinical use concluded that “on the basis of the in vitro and in vivo data available to date, there appears to be no clear benefit with the use of methacrylate resin-based sealers in conjunction with adhesive root filling materials at this point in their development”.7 Science has shown that the direction for eradica- tion of refractory and chronic disease related to biofilm elimination lies in photodynamic therapy, which has provided clear evidence of clinical efficacy andapplicabilitycontinuestobedemonstrated.8 And yet, an array of sonic and ultrasonic products have infused the market with specious claims to optimise microbial control through innovations in irrigation protocolsdesignedtodisinfectandremovethesmear layer of the prepared root-canal space in spite of the Fig. 1_Images of perfusion studies to illustrate the complexities of the root- canal system of all tooth types.10 Fig. 1