During patient treatment, the clinician needs to consider a multitude of factors that will affect the ultimate outcome. In simple terms, these factors can be grouped into 3 categories: the operator needs, the restoration needs, and the tooth needs. The operator needs being conditions the clinician needs to treat the tooth. The restoration needs being the prep dimensions and tooth conditions for optimal strength and longevity. The tooth needs being the biologic and structural limitations for a treated tooth to remain predictably functional. In this article we want to discuss failures of endodontically treated teeth that occur, not because of chronic or acute apical lesions, but because of structural compromises to the teeth that ultimately render the tooth useless.
A NEW MODEL FOR ENDODONTIC ACCESS
As we deconstruct endodontic access, it is crucial to understand the “Big 5” catalyst forces that will change the future of endodontic access and coronal shaping. They are: (1) implant success rates (The bar is raised); (2) operating microscopes and microendodontics; (3) biomimetic dentistry; (4) minimally invasive dentistry; and (5) aesthetic demands of patients, combined with manufacturer recommendations for axial reduction for all-ceramic crowns.
In both of our practices, our endodontic goals and armamentarium have been in a constant state of flux for nearly a decade as we have collaborated to bring the EERP continuum to maturity. The goal? To satisfy the demands of the above-mentioned Big 5 forces for change. In so doing, when preparing endodontic access, we have come to realize that our previous needs as dentists were often in conflict with the needs of the tooth
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