- We must preserve as much tooth as possible consistent with rendering the tooth as free of bacteria and the tissue that supports bacterial growth as possible. Any other reason for removing tooth structure is counterproductive, particularly applied to straight-line access, preflaring and crown-down preparations for the sake of reducing the incidence of instrument separation.
- We must employ techniques of tissue and dentin removal that are as benign as possible. The removal of dentin and tissue via the rotary motion of instruments has been shown by the majority of studies to be far more damaging to the remaining dentin than hand instrumentation or instrumentation confined to short arcs of motion.
- Obturation should be accomplished in the most passive way possible. Active obturation of any sort has been shown to coalesce and propagate the micro-cracks produced in the dentin via rotary endodontics.
- A single point obturation combined with a highly flowable room temperature epoxy resin cement flooding the canal will entirely fill three-dimensionally the space prepared previously without producing stresses that further weaken the integrity of the root.
- These 4 simple rules clarify our goals and give us direction on the best means to attain them. Without these rules, we lose focus emphasizing aspects of endodontics that can lose sight of the central goal we are attempting to attain.
I believe much progress can be gained if we use these rules as a starting point for a discussion on the most beneficial techniques to adopt for successful endodontic therapy.