Interview: How to handle complex endodontic cases

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Interview: How to handle complex endodontic cases

Dr Ruth Pérez-Alfayate will be a speaker at ROOTS SUMMIT 2024, which will be held from 9 to 12 May in Athens. (Image: ROOTS SUMMIT)

Registration for ROOTS SUMMIT 2024 is open, and the organisers would like to introduce some of the great speakers and their lecture topics for next year’s event. One of them is Dr Ruth Pérez-Alfayate, an associate professor at the Faculty of Biomedical and Health Sciences at Universidad Europea in Madrid in Spain. In this interview, she introduces her lecture, titled “Complex diagnosis in endodontics”, and explains why she decided to speak at the congress.

Dr Pérez-Alfayate, in some of the more complex endodontic cases, dental professionals have to use invasive tests in order to be able to make a clear diagnosis. For which cases are these invasive tests appropriate, and how do dental professionals keep a balance between invasive treatment measures and the desire to keep the treatment minimally invasive?
These tests might be appropriate when there is doubt about a vertical root fracture, when there is severe pulpitis, when more than one tooth is suspected of this pathology and is radiated, or when pulp necrosis needs to be identified in a patient presenting with a low pain threshold.

The balance, in my opinion, can be found when we understand the expectations of our patients in the first instance. Patient safety, the concept of “do no harm” and minimally invasive treatment should prevail and must be a priority for us. All of these concepts can still be applied even when we need to use invasive tests for diagnosis.

In some cases, even after the use of diagnostic tests, the dental professional can be left with a high level of doubt. What is the reason for this?
The reality is that currently we do not have any test that is 100% objective. This means that one or two tests are not sufficient. We need to find a diagnostic protocol that gives us as much information as possible.

What are some of the endodontic diagnostic tests for complex cases, and why can they be challenging?
The diagnostic tests include exploratory surgery, selective anaesthesia and cavity testing. Deciding when or when not to use them is the challenge.

Are there any future developments in endodontic diagnostics that you can tell us about?
Some researchers are working on various devices, such as pulse oximeters, real-time ultrasound and ways to evaluate the actual pulp status before conducting treatment.

What will be the main learning objectives of your lecture at ROOTS SUMMIT 2024?
I will describe a diagnostic protocol for endodontists to enable them to understand which clinical situations require a complex diagnosis, and I will propose how they should act in these specific situations.

What made you decide to participate in the upcoming ROOTS SUMMIT?
I have attended this congress many times, and I have to say it is one of my favourites. Also, the organisers of ROOTS SUMMIT are three people whom I admire greatly, and when they ask you to come to their congress, it is impossible to say no—it is an immense privilege.

I know I will learn a great deal from the best and humblest endodontists in the world. I am sure this will be a great congress, and I hope to see as many people as possible there. Do not miss it!

Editorial note:

The lecture by Dr Pérez-Alfayate, titled “Complex diagnosis in endodontics”, will be held on 10 May 2024 from 11:00 a.m. to 12:30 p.m.

More information on the programme and registration can be found on the ROOTS SUMMIT website.

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