Biomimetic endodontics: the final evolution?

: We are seeing a gradual evolution by a small but growing number of endodontists and general dentists toward delicate biomimetic, microscope-based shaping. This old-fashioned respect for periradicular dentin is paired with microscopes, ultrasonics, and an appreciation for root morphology. Although no 2 roots are the same, general anatomic patterns allow the microscope-equipped clinician to search for major pulpal regions that will yield a high probability of cleaning and shaping the clinically available pulpal zones. There are complex, anatomically improbable, and clinically impossible areas of pulp that are beyond the reach of even the most gifted hands. Regardless, the clinician has the responsibility to begin each procedure seeking perfection and joyfully finishing with excellence. The shapes that were introduced during the Schilder (crown-down) era have served as a transitional technique to allow the first real 3-dimensional compaction of gutta-percha. Nonetheless, endodontics is in the end a restoratively driven procedure. Large, arbitrary, round shapes create beautiful endodontics but can dramatically weaken the tooth. The shaping philosophy advanced in this treatise allows perfectly adequate shapes to achieve the hydraulics needed for modern obturation. It will require different skills and materials to shape, pack, and restore the exotic architecture of nature. (See Tables 1 to 3.).