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Dubrow responds
annual scientific session: seven den tists p resented scientific session lec tures and eight fem ale students held table clinics. In addition D r. Jane Selbe served as chairperson of the pedodontic section of the session. W e are extrem ely proud also of the seven w om en w ho w ere elected to the A m erican College of D entists at the L as V egas C onvocation this year, setting another record for involve m ent. O ur push is on to increase the activity o f w om en in the profession, to reduce the passivity that has so long been a hallm ark of the w oman pro fessional, and to spur h er on to scien tific study and lecturing, to volunteer ing for dental society com mittee assignm ents, and to persuade her that w om en have the talent to lead as well as to follow. I t is a notable fact that if a w oman com plains to h er physician that she is always tired, he tells h er to stick out h er tongue; so w e plan to capitalize on this well-developed and generously w orked muscle. W e hereby serve notice on the A D A that w om en can and do belong in th e higher echelons o f the adm in istration and at the lectern. O ur time h as com e, and our m otto is “ R un for anything—but not for coffee!” HELEN LUECiHAUER, DDS PRESIDENT ASSOCIATION OF AMERICAN WOMEN DENTISTS HOLLYWOOD, CALIF
D u b r o w responds m I w ould like to reply briefly to com m ents m ade by D r. Louis I. G ro ss m an and by D r. H arold G erstein con cerning my article in th e N ovem ber 1976 issue o f T h e Journal (page 976). T h eir com m ents w ere printed in the Jan uary 1977 issue. A s far as D r. G erstein ’s com m ents are concerned, I would like to say th at I have found in my practice that it is unnecessary to replace silver p oints w ith gutta-percha in order to m ake p o st preparations if there is ad equate visibility fo r the preparation o f the p o st holes w hich occurs with m ost anterior teeth and many bi cuspids. I m ake th e post holes approx
im ately 6 mm deep as m easured by a periodontal probe. A t presen t, I m ake the holes oval shaped. A t one tim e, I m ade them cross shaped. T he posts are cast from direct wax-ups. I note that h e agrees th at b oth gutta percha and silver points do not p ro duce herm etic seals. I agree with D r. G erstein that w e should try to debride and seal as well as possible and that the closer to the ideal our techniques are designed, the closer to the ideal our success rate climbs. H ow ever, before we can design o u r techniques closer to th e ideal, w e have to know w hat the ideal is. I would like to elaborate on D r. G ro ssm an ’s com m ents. I have a great deal of adm iration for D r. G rossm an’s contributions to endodontics. In 1942, I w as aw arded one of his early books as a dental school prize and used it as a reference for organizing my endodontic procedures. I have been reading his publications through the years. H ow ever, his com m ents may not apply to the them e o f the article w hich is th a t “ herm etic seals,” and perhaps ro o t canal fillings, may not be the crux of, or even essential for, suc cessful root canal therapy. T h e article attem pts to indicate that it is unlikely th at “ herm etic seals” can be pro duced b y root canal fillings; th at suc cess o r failure attributed to the quality o f the root canal fillings m ay be due to other factors; that tissue fluids may not en ter the canals after healing has occurred, suggesting the possibility o f natural periapical o r apical seals and questioning th e occurrence of anachoresis after healing has taken place; and th at ro o t canal fillings are not necessary for healing as it occurs after debridem ent and sterilization w ithout the root canal fillings. D r. G rossm an states th at in the w ork done by G all on dogs in 1936, areas of rarefaction and root resorption oc curred, except w here infection did not develop. T he treatm ent th at I cite was on hum ans. T here w ere areas o f rare faction w hen treatm ent was begun w hich probably w ere due to bacterial infections o r due to protein degrad ation products in the canals. T h e teeth w ere treated in conform ance with the endodontic principles which we use today and the canals w eren’t filled until the areas healed.
432 ■ LETTERS TO THE EDITOR I JADA, Vol. 94, March 1977
H e states also that healing of periapical tissues will occu r if the canals are m edicated over a prolonged period of tim e, even though no root canal filling is present and th at this was com m on practice 50 years ago. T he p rocedure th at I used was not one that depended on the m edicam ents alone. T h e m edicam ents may have been helpful by being a secondary barrier to the invasion of oral b acteria and by decreasing the bacterial count in the canals b u t I do n ot believe th a t heal ing w ould have occurred with the 95% success rate th at I experienced if the canals had n o t been thoroughly debridëd. T h e third point th at D r. G rossm an m ade is that I sealed the canals despite thé implication that the canals might be left unsealed. T h e reason w hy I fill root canals now is because I believe the fillings may serve as oral seals, th at they m ay isolate any residual debris, and that they indicate th a t th e canals w ere treated. H ow ever, we do not know w hether the fillings are essential to th e long term success of the therapy or w hether other procedures could be devised w hich would accom plish the sam e long-term results less expensive ly and perhaps m ore effectively. T here is a possibility that th e seals w hich we would like to accom plish by o u r fillings are being form ed by nature as a result of healing in the apical and periapical regions. Bio logical mechainisms exist by which these seals can be established. R e p o rts in th e literature support th e view th at these m echanisms are active. T he dryness w hich occurs in canals w hen areas have healed and the m any cases of v ery long standing w here th ere has been no recurrence of areas indicate th e form ation of natural seals. N a tu re ’s prim ary long-range defense af te r healing has taken place m ay be these seals. Experim ents can be de signed to investigate their nature and quality. I f these seals are being form ed, root canal fillings should be designed so th a t they d o n ot im pede their form ation and perhaps proce dures could be developed which would encourage it. HYMAN DUBROW, DDS FAR ROCKAWAY, NY
D u b r o w responds m I w ould like to reply briefly to com m ents m ade by D r. Louis I. G ro ss m an and by D r. H arold G erstein con cerning my article in th e N ovem ber 1976 issue o f T h e Journal (page 976). T h eir com m ents w ere printed in the Jan uary 1977 issue. A s far as D r. G erstein ’s com m ents are concerned, I would like to say th at I have found in my practice that it is unnecessary to replace silver p oints w ith gutta-percha in order to m ake p o st preparations if there is ad equate visibility fo r the preparation o f the p o st holes w hich occurs with m ost anterior teeth and many bi cuspids. I m ake th e post holes approx
im ately 6 mm deep as m easured by a periodontal probe. A t presen t, I m ake the holes oval shaped. A t one tim e, I m ade them cross shaped. T he posts are cast from direct wax-ups. I note that h e agrees th at b oth gutta percha and silver points do not p ro duce herm etic seals. I agree with D r. G erstein that w e should try to debride and seal as well as possible and that the closer to the ideal our techniques are designed, the closer to the ideal our success rate climbs. H ow ever, before we can design o u r techniques closer to th e ideal, w e have to know w hat the ideal is. I would like to elaborate on D r. G ro ssm an ’s com m ents. I have a great deal of adm iration for D r. G rossm an’s contributions to endodontics. In 1942, I w as aw arded one of his early books as a dental school prize and used it as a reference for organizing my endodontic procedures. I have been reading his publications through the years. H ow ever, his com m ents may not apply to the them e o f the article w hich is th a t “ herm etic seals,” and perhaps ro o t canal fillings, may not be the crux of, or even essential for, suc cessful root canal therapy. T h e article attem pts to indicate that it is unlikely th at “ herm etic seals” can be pro duced b y root canal fillings; th at suc cess o r failure attributed to the quality o f the root canal fillings m ay be due to other factors; that tissue fluids may not en ter the canals after healing has occurred, suggesting the possibility o f natural periapical o r apical seals and questioning th e occurrence of anachoresis after healing has taken place; and th at ro o t canal fillings are not necessary for healing as it occurs after debridem ent and sterilization w ithout the root canal fillings. D r. G rossm an states th at in the w ork done by G all on dogs in 1936, areas of rarefaction and root resorption oc curred, except w here infection did not develop. T he treatm ent th at I cite was on hum ans. T here w ere areas o f rare faction w hen treatm ent was begun w hich probably w ere due to bacterial infections o r due to protein degrad ation products in the canals. T h e teeth w ere treated in conform ance with the endodontic principles which we use today and the canals w eren’t filled until the areas healed.
432 ■ LETTERS TO THE EDITOR I JADA, Vol. 94, March 1977
H e states also that healing of periapical tissues will occu r if the canals are m edicated over a prolonged period of tim e, even though no root canal filling is present and th at this was com m on practice 50 years ago. T he p rocedure th at I used was not one that depended on the m edicam ents alone. T h e m edicam ents may have been helpful by being a secondary barrier to the invasion of oral b acteria and by decreasing the bacterial count in the canals b u t I do n ot believe th a t heal ing w ould have occurred with the 95% success rate th at I experienced if the canals had n o t been thoroughly debridëd. T h e third point th at D r. G rossm an m ade is that I sealed the canals despite thé implication that the canals might be left unsealed. T h e reason w hy I fill root canals now is because I believe the fillings may serve as oral seals, th at they m ay isolate any residual debris, and that they indicate th a t th e canals w ere treated. H ow ever, we do not know w hether the fillings are essential to th e long term success of the therapy or w hether other procedures could be devised w hich would accom plish the sam e long-term results less expensive ly and perhaps m ore effectively. T here is a possibility that th e seals w hich we would like to accom plish by o u r fillings are being form ed by nature as a result of healing in the apical and periapical regions. Bio logical mechainisms exist by which these seals can be established. R e p o rts in th e literature support th e view th at these m echanisms are active. T he dryness w hich occurs in canals w hen areas have healed and the m any cases of v ery long standing w here th ere has been no recurrence of areas indicate th e form ation of natural seals. N a tu re ’s prim ary long-range defense af te r healing has taken place m ay be these seals. Experim ents can be de signed to investigate their nature and quality. I f these seals are being form ed, root canal fillings should be designed so th a t they d o n ot im pede their form ation and perhaps proce dures could be developed which would encourage it. HYMAN DUBROW, DDS FAR ROCKAWAY, NY