Geriatric endodontics powerpoint presentation

Geriatric endodontics

1. GERIATRIC ENDODONTICS ATHULYA B MOHAN SECOND YEAR POST GRADUATE DEPT OF CONSERVATIVE DENTISTRY AND ENDODONTICS You can’t help getting older but you don’t have to get old —George Burns

2. Introduction classification Age changes in the tooth Endodontic challenges Diagnosis and treatment planning Treatment procedure Post endo restoration & challenges Retreatment Endodontic surgery Conclusion References

3. INTRODUCTION Geriatric is a Greek word where “ geras ” means old and “ iatro ” means doctor. Geriatric dentistry is providing dental care to older adults involving diagnosis, prevention, management and treatment of problems associated with older age. Geriatric dental treatment starts at the age of 65 years . DCNA 1989 defined geriatric dentistry as the provision of care for adults with one or more chronic, debilitating, physical or mental illness with associated medication and psychosocial problems.

4.   The World Health Organization categorizes aging population into four classes: Aging individuals : 45-60 years old Older individuals : 61-75 years old Old individuals : 76-90 years old Very Old individuals : 91-100 years old According to the WHO, the global population is increasing at the annual rate of 1.7%, while the population of those over 65 years is increasing at a rate of 2.5%. Currently the old age population in India is 8% of its population (80 million) In 2025 we will reach 12% ( 830 million) Out of every 7 aged person in the world , one will be an Indian

5. In-depth theoretical knowledge, clinical skills, and behavioral management  successful management of the elderly patients . Textbook of operative Dentistry – Vimal.K.Sikri 4 th edition.

6. SYSTEMIC HEALTH T he growing desire of elderly patients to maintain their teeth and oral health has led to an increased need for the performance of complex dental treatment in elderly patients. Endodontic therapy is an essential phase of such treatments. Textbook of operative Dentistry – Vimal.K.Sikri 4 th edition.

7. 85 years & above Gerontologists divide the geriatric population into different age groups Classification by Ghom (2014) : CLASSIFICATION Textbook of operative Dentistry – Vimal.K.Sikri 4 th edition.

8. Textbook of operative Dentistry – Vimal.K.Sikri 4 th edition. Classification by Sheldon Winkler : Hard Elderly : Excellent physical and psychological condition Senile Elderly (Senile Aged Syndrome): Disabled physically and emotionally and may be described as handicapped, chronically ill, disabled and truly aged.

9. Depending on the degree of disability, the aged have also been classified into four categories as (According to D.C.N.A.) Well elderly : One or two minor chronic medical conditions; independent Frail elderly : Simultaneous minor and major chronic, debilitating medical conditions, with drugs; self- sufficient living with support, a minority institutionalized Functionally dependent elderly : S ame as category Ⅱ, but patient is incapacitated to the extend that independence is not possible; homebound or institutionalized Severely disabled, medically compromised elderly : Health status depreciated to the extent of requiring steady maintenance; sanatorium or skilled nursing facility Textbook of operative Dentistry – Vimal.K.Sikri 4 th edition.

10. AGE CHANGES IN THE TEETH ENAMEL CEMENTUM DENTIN PULP Recession in the size of pulp chamber More fibers and less cells Blood supply decreases Decreased nerve supply Reduced sensitivity More incidences of calcification In older patients, pulp recession is accelerated by reparative dentin and complicated by pulp stones and dystrophic calcification. Deep proximal or root decay and restorations may cause calcification between the observable chamber and root canal. Allen PF, Whitworth JM. Endodontic considerations in the elderly. Gerodontology 2004; 21: 185–194.

11. Presence of calcifications: Two types of calcifications found in dental pulp ( Kronfield et al ): Discrete Calcification According to location, Free denticle: freely lying in pulp chamber Attached denticle: attached to the dentinal walls Interstitial denticle: surrounded by secondary denticle Characteristic features: • Common feature of old teeth - > 45 years • Located in root pulp or coronal pulp or both. • They are usually first seen in root pulp as an isolated calcified masses, coalesce to form large mass that fuse with dentin. • The calcified masses in the coronal pulp may become larger in size and fuse - obliterate the normal pulp architecture. Allen PF, Whitworth JM. Endodontic considerations in the elderly. Gerodontology 2004; 21: 185–194.

12. Diffuse Calcification Inappropriate biomineralization of the pulp in the absence of mineral imbalance. These are generally a pulpal response to trauma that is characterized by deposition of hard tissue within the root canal space . Act as an impediment during endodontic treatment Pain of idiopathic nature may be caused if pulp stones impinge on nerve Nupura Aniket Vibhute , Vibhute Aniket H, Daule RajendraT , Bansal Puja P and Mahalle Aditi (2016) Hard Facts about Stones: Pulpal Calcifications: A Review.

13. Pulpal calcifications, influence the nerves supplying the pulp . Decrease in sensitivity of teeth of individuals more than 40 years of age. 90% of the pulps of patients aged 45–63 - pulpal calcifications present histologically . 7% of pulps from patients aged 22–44.

14. Maeda H. Aging and senescence of dental pulp and hard tissues of the tooth. Frontiers in cell and developmental biology. 2020 Nov 30;8:605996. Aging alterations of the tooth structure. Constriction of the DP cavity Occlusion of DTs in increased Thickening of the Ce Size reduction of Ods Decreased distribution of nerve fibers with advancing age.

15. Age Changes in Oral Mucosa Oral mucosa becomes increasingly thin, smooth and dry with loss of elasticity and stippling ---becomes more susceptible to injury. Tongue exhibits loss of filiform papillae and deteriorating taste sensation and occasional burning sensation. Age Changes in Salivary Glands Diminished function resulting in: xerostomia, mouth soreness, burning or painful tongue, taste changes, chewing difficulty, problems with swallowing and talking. Age Changes in Periodontal Connective Tissue Gingival connective tissue becomes denser and coarsely textured Decrease in the number of fibroblasts and fiber content Evidence of calcification on and between the collagen fibers Age Changes in Bone Tissue Cortical thinning Loss of trabeculae Cellular atrophy Sclerosis of bone

16. DIAGNOSIS AND TREATMENT PLAN Chief Complaint of Geriatric Patients Medical History Past Dental History Examination of the Patient Pulp Vitality Tests Radiographs Treatment Plan

17. CHIEF COMPLAINT These patients usually have fewer complaints and dental pain usually is indicative of either pulpal or periodontal pain. Patients must be allowed to explain in their own words at which time one must note for visual /auditory handicaps, patient’s dental knowledge and his/her ability to communicate. Singh SK, Kanaparthy A, Kanaparthy R, Pillai A, Sandhu G. Geriatric Endodontic. J Orofac Res 2013;3(3):191-196.

18. MEDICAL HISTORY The Physicians’ Desk Reference (PDR) should be consulted, and any precaution or side effect of a medication noted. The PDR is available online ( www.pdr.net/). Several other websites (e.g., Epocrates [www.epocrates.com]) have been developed specifically to be consulted about drug interactions and dental treatment. (Cohen 11 th Edition) A thorough medical history is more important in these patients because they are likely to suffer from chronic diseases and take more medications. Previous dental history also helps to take judgement calls. Sensitivity to medications, drug intolerance and potential interactions with drugs prescribed for dental treatment are to be anticipated

19. Cardiovascular Disease Medications that treat cardiovascular disease often: Reduce salivary flow or cause xerostomia , Cause an overgrowth of gingival tissues (calcium channel blockers), Altered taste (ACE inhibitors) Risk for bleeding gingiva or excessive postoperative bleeding (anticoagulants) Discontinuation of anticoagulants is not typically required-- Curtis et al Journal of Thrombosis and Haemostasis . 2025 Jan 1;23(1):47-72. Prone to orthostatic hypotension , epinephrine-impregnated packing cords should be avoided Using epinephrine in Local Anesthetics carries a low risk of adverse effects- -- ( Brown RS et al Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2005 Oct 1;100(4):401-8. However, epinephrine at 1:100,000 solutions should be limited to 2 or fewer cartridges .

20. Edds et al., suggested that 74% of patients with reported cardiovascular disease had detectable pulp stone, while only 39% of patients without a history of cardiovascular disease had pulp stones.

21. Cancer The oral mucosa and salivary system are especially susceptible to the effects of chemotherapy and radiation treatment. Mucositis, xerostomia, dysgeusia, trismus, pain, dysphagia, rampant caries, dehydration, and malnutrition. Osteoradionecrosis (ORN): Bone remodeling becomes impaired, and following surgery or trauma or sometimes spontaneously, the bone becomes necrotic. Precancer treatment : stabilize or eliminate /minimize oral disease before the initiation of cancer treatment . Intracancer treatment : palliative treatment (not including dental extractions); frequent recall visits to manage pain, mucositis, trismus, dysgeusia, xerostomia, and fungal infections.

22. Diabetes Mellitus Symptoms: Candida Dysphagia Taste disorders Burning mouth Poor wound healing Increased risk of infection Periodontal disease caries Diminished salivary flow Consider: Frequent dental evaluations Caries risk assessment Avoid dry or acidic foods Rx Oral antibacterial Fluoride Xylitol Calcium/phosphate and pH neutralizing products

23. Chronic Obstructive Pulmonary Diseases Chronic bronchitis and emphysema Providing proper anesthesia Using pulse oximetry to monitor oxygen saturation if the patient has severe COPD Providing low-flow oxygen, 2 to 3 L/min Avoiding elective dentistry if the patient has an upper respiratory infection Avoiding a reclined chair position to ease the burden of breathing Avoiding rubber dams in the severely affected patient Avoiding nitrous/oxygen in the patient with severe COPD and use with caution in mildly affected individuals Avoiding several drug classes, including narcotics, antihistamines, and anticholinergics , which have the potential for producing respiratory depression and/or thickened mucus.

24. Cerebro -Vascular Decrease or occlusion of blood flow to the brain . Atherosclerosis may lead to a transient ischemic attack (TIA) or if completely blocked by a clot or an air bubble, may result in an ischemic stroke. The risk for another stoke is higher in the first 6 months , so elective care and definitive treatment planning should be delayed during this recovery period.

25. Dementia Disease progressively destroys cognitive skills. Pre-dependent stages Advanced stages Restorative and prosthodontic treatment should be completed Prevention and the preservation of comfort and dignity Medication or rinses to relieve pain or discomfort

26. Renal Diseases Xerostomia pigmented oral mucosa dysgeusia; candida Petechiae uremic stomatitis lichen planus hairy tongue increased risk of pyogenic granulomas Radiolucent jaw lesions (hyperparathyroidism) Liver Diseases Hyposalivation Xerostomia Gastric reflux Erosion Poor wound healing prolonged bleeding periodontitis Increased oral infections

27. Poly-Pharmacy Refers to taking multiple medications at once or taking 1 or more medications incorrectly Some patients will have prescriptions that are needed during an emergency ; that is, nitroglycerin for angina or inhalers for shortness of breath, due to COPD. These patients must bring these medications to their appointments and they should be readily available in an emergency drug kit. Possibility of some adverse event Potential for side effects on the oral cavity Adverse drug interactions

28. Dental History To assess patients dental status and plan future treatment plan Also helps to know patients dental knowledge and psychological attitude, expectation from dental treatment. The diagnostic process is directed toward determining the vitality of the pulp, whether pulpal or periapical disease is present, and which tooth is the source Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

29. Subjective Symptoms Pain associated with vital pulps (i.e., referred pain; pain caused by heat, cold, or sweets) seems to be reduced with age, and its severity seems to diminish over time. Heat sensitivity that occurs as the only symptom suggests a reduced pulp volume, such as that occurring in older pulps. Overall, symptoms of pulpitis do not seem to be as acute in the older patient. Most irreversible pulpal and apical pathosis are asymptomatic at any age. Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

30. Objective Findings Common observations: Missing teeth Hyposalivation Gingival recession & root caries( interproximal) Attrition, abrasion and erosion Compensating bites – T.M.J dysfunction Multiple restorations– further care while restoring Periodontal problems like deep pockets Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

31. Pulp Vitality Often very difficult to quantify the response to a stimulus applied to a tooth. The pulp becomes less responsive to stimuli with age . Electric stimulus in patients with pacemakers is not recommended. Percussion (biting and tapping) and palpation tests indicate periapical inflammation but are not particularly useful unless the patient reports significant pain . Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

32. Radiographs Common Radiographic Observations in Geriatric Patients Receded pulp cavity which is accelerated by reparative dentin Presence of pulp stones and dystrophic calcification Receding pulp horns can be noted in the radiograph Deep proximal or root decay may cause calcification of pulp cavity A midroot disappearance of a detectable canal may indicate bifurcation rather than calcification In cases where the vitality tests do not correlate with the radiographic findings, one should consider the presence of odontogenic and nonodontogenic cysts and tumors In teeth with root resorption along with apical periodontitis, shape of apex and anatomy of foramen may change due to inflammatory osteoclastic activity In teeth with hypercementosis , the apical anatomy may become unclear Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

33. Differential Diagnosis Non-endodontic symptomatic disorders that may mimic endodontic pathosis include sinus infection, muscle spasm, headache, temporomandibular joint dysfunction, and neuritis and neuralgia . The incidence of these tends to increase somewhat with age, particularly in patients who have specific disorders, such as arthritis, that may affect the joints Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

34. Treatment Planning and Case Selection Prior to any clinical treatment planning, the following determinants to be considered. Patient desires and expectations. Type and severity of patients dental problems after evaluating the four domains of need such---as function, symptoms, pathology, and esthetics . Impact on patient’s quality of life in terms of ability to eat, comfort level, and esthetics that could affect self- image. Probability of positive treatment outcome. Availability of reasonable and less extensive alternatives. Ability to tolerate treatment stress. Patient’s capability to maintain oral health, whether he or she is well motivated and can carry out independently or require assistance. Patient’s financial resources. Life span. Family support - physical, psychological or financial. Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

35. Bannet and Cramer have suggested staged treatment planning for the maintenance of the oral health of the elderly patients. Stage I : Emergency care Stage II : Maintenance and monitoring- includes management of chronic infection, root canal therapy, root planing and curettage, restorations of carious lesions, work related to dentures, patient education to improve oral health. A further period of evaluation is required before proceeds further. Stage III : Rehabilitation phase – includes implants, surgical endodontics, surgical periodontics, esthetic rehabilitation, reconstruction of occlusal plane and restoration of vertical dimension Gautam R. Geriatric Endodontics-An Overview: Diagnosis and Treatment Planning (Part–II). Dates. 2022;2:1-7.

36. Appointments There are no advantages of single appointments overall to multiple appointments relating to post treatment pain or prognosis . Single appointment procedures are beneficial in elderly patients because : Longer appointments may be less of a problem than several shorter appointments Allen PF, Whitworth JM. Endodontic considerations in the elderly. Gerodontology 2004; 21: 185–194.

37. Impact of Restoration Generally the larger and deeper the restoration, the more complicated the root canal treatment. The old tooth is more likely to have a full crown. There are two concerns when there is a crown: (1) potential damage to retention or components of the crown (2) blockage of access and poor internal visibility Allen PF, Whitworth JM. Endodontic considerations in the elderly. Gerodontology 2004; 21: 185–194.

38. Preservation of teeth in elderly patients provides several benefits like maintenance of intact dental arch increased retention of removable dentures provision of abutments for FPD preservation of occlusion and alveolar bone AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Med J. 2019 Mar;40(3):217-223.

39. AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

40. Anaesthesia Less anxious : low conduction velocity of nerves, limited extension of nerves into dentin and dentinal tubules are more calcified The width of periodontal ligament is reduced which makes the needle placement for intra- ligamentary injection more difficult. Only smaller amounts of anesthetic should be deposited and the depth of anesthesia should be checked before repeating the procedure Intra pulpal anesthesia is difficult in older patients as the volume of pulp chamber is reduced Rajan DV, Jeph DV, Sharma DD, Bansal DM, Jani DM. Endodontic consideration in geriatric patients. Int J Appl Dent Sci. 2022;8(2):404-8.

41. Isolation Rubber dam is the best method of isolation Isolation should be carried out for single tooth preferably. Multiple tooth isolation should be carried out only if adjacent teeth can be clamped and saliva ejector placement tolerated. Extended clamp known as Silker - Glickman clamp is used for severely broken tooth . Allen PF, Whitworth JM. Endodontic considerations in the elderly. Gerodontology 2004; 21: 185–194.

42. ACCESS TO CANAL ORIFICE One of the most difficult parts: identification of the canal orifices In calcified canals ---Ultrasonic tips can be used. Use of C-pilot files/ D-finders to negotiate canal (calcified) and create proper glide path. Use of DG-16 Endodontic explorer which will not stick in solid dentin, but it will resist dislodgment in the canal After canal location, negotiation with SS No. 8, 10 or 15 K files Ni- Ti Files lack strength in the long axis and are contra indicated for initial negotiation AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

43. C+ FILES (DENTSPLY) Strong buckling resistance compared with K files, which allows easier location of the canal orifices Pyramid shaped tip facilitates insertion during negotiation of canal, and the square cross section provides better resistance to distortion Polished surface allows smoother insertion into the canal

44. Another aid in the treatment of geriatric patients is the use of transillumination. Turn off all the lights in the treatment room the light on the dental unit Proceed to shine the fiber optic light through the tooth at the CEJ level. Calcified canals will appear as dark dots, not as wide canals. Singh SK, Kanaparthy A, Kanaparthy R, Pillai A, Sandhu G. Geriatric Endodontic. J Orofac Res 2013;3(3):191-196.

45. WORKING LENGTH CDJ is the ideal place to terminate the canal preparation. This point may vary from 0.5 to 2.5 mm from the radiographic apex and may be difficult to determine clinically. Calcified canals reduce the clinician’s tactile sense in identifying the constriction clinically and reduced periapical sensitivity in older patients reduces the patient’s response that would indicate penetration of the foramen. Use of electronic apex-finding devices is avoided in heavily restored teeth Singh SK, Kanaparthy A, Kanaparthy R, Pillai A, Sandhu G. Geriatric Endodontic. J Orofac Res 2013;3(3):191-196.

46. Use of broaches for pulp tissue extirpation is avoided in older patients, because very few canals of older teeth have adequate diameter to allow safe and effective uses of broaches Achieving and maintaining apical patency is more difficult . Apical root resorption associated with peri apical pathosis further changes the shape, size and position of the constriction. CLEANING AND SHAPING AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

47. PREPARATION OF CANALS Calcification of older canals - more concentric and linear and this allows easier penetration once canals are found. Flaring of canal using ultrasonic tips - to provide reservoir for irrigation solution and to reduce binding of instruments. NiTi rotary instrumentation provides a more efficient and reliable shaping of the calcified and curved root canals. Use of instruments with crown down technique preferred. The root canals associated with the elderly can be sufficiently cleaned and shaped if one can take the preparation to a fully tapered 0.04 taper. Singh SK, Kanaparthy A, Kanaparthy R, Pillai A, Sandhu G. Geriatric Endodontic. J Orofac Res 2013;3(3):191-196.

48. DIFFICULTIES IN CANAL PREPARATION Longer canals seen because of increased cementum deposition Difficulty of locating apical constriction 0.5 to 2 mm from radiographic apex Clinicians tactile sense reduced Reduced periapical sensitivity in older patients Use of electronic apex locator limited in heavily restored teeth Penetration into calcified canal is difficult Singh SK, Kanaparthy A, Kanaparthy R, Pillai A, Sandhu G. Geriatric Endodontic. J Orofac Res 2013;3(3):191-196.

49. OBTURATION Use of single-cone with bio ceramic sealers, cold lateral technique are advocated . Coronal seal plays an important role in maintaining an apically healthy environment. When mechanical retention is not ensured with preparation , GICs are recommended Permanent restorative procedures should be scheduled as soon as possible The success in geriatric patients is better compared to other age groups as one third area of root canal is fully obstructed by secondary cementum and root canal ramification is much reduced. -Cohen 11 th Edition AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

50. POST ENDO RESTORATION Permanent restorative procedures should be scheduled as soon as possible. Post space preparation should be kept as conservative as possible to avoid any risk of root fracture Fiber post preferred in the aged tooth as it occupies one-third to one-half of the length of the canal and also the radicular extension is about the coronal length of the core In 1980, Nayyar and Walton described the amal -core or the coronal-radicular restoration. Advantage: Predictable & cost effective modality for posterior endodontically treated teeth AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

51. Root Caries Root caries is a major cause of tooth loss in older adults, and tooth loss is the most significant negative impact on oral health-related quality of life for the elderly. Causative org:  S. mutans , lactobacilli,   Actinomyces  , Atopobium ,  Olsenella ,  Pseudoramibacter ,  Propionibacterium , and  Selenomonas . Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel , which may accelerate the onset of demineralisation .

52. Classification of root caries

53. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralization tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed. Active decay may be inactivated using professional application of fluoride varnishes/solutions or self-applied high-fluoride toothpaste.

54. PROGNOSIS In case of vital pulp, the prognosis depends on many local and systemic factors. In case of nonvital pulp, the repair is slow because of arteriosclerotic changes in blood vessels Aging causes arteriosclerotic changes of the blood vessels which alters the viscosity of the connective tissue, making repair more difficult Rate of bone formation and normal resorption decreases with age, and the aging of bone results in greater porosity and decreased mineralization of the formed bone AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

55. RETREATMENT Factors that lead to failure tend to increase with age; thus retreatment is more common in older patients. Retreatment at any age is often complicated and should be approached with caution; these patients should be considered for referral. Retreatment procedures and outcomes are similar in both older and younger teeth AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

56. ENDODONTIC SURGERY Considerations and indications for surgery are similar in elderly and younger patients. Medical history is important in older patients Following local anatomic considerations should be considered in elderly patients: • Increased incidence of dehiscence of roots and exostoses • Apically positioned muscle attachment • Less resilient tissue • Decreased resistance to reflection • Ecchymosis and delayed healing are common postoperative findings AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

57. HEALING AFTER SURGERY Hard and soft tissues will heal as predictably , although somewhat more slowly. Outcomes depend more on oral hygiene than on age One problem --more prevalent in older patients is ecchymosis after surgery . This is hemorrhage that often spreads widely through underlying tissue and commonly presents as discoloration . AlRahabi MK. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Medical Journal. 2019 Mar;40(3):217.

58. CONCLUSION Geriatric endodontics will gain a more significant role in complete dental care because of the “aging society”. Faster and successful dental services including root canal procedures, for the elderly population of the future are anticipated.

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