From the Root Canal to the Petri Dish

By Dr. Kortnie Strother

For those of you that have already completed endodontic residency and the obligatory research that is part of the experience, you may be thinking of how happy you are to be done with it. When conducting research to fulfill residency requirements, one may ask themselves, “Why is this important?” or “Why would anyone be interested in this?” To answer these questions, I’ve interviewed Dr. Ariadne Letra, chair of the Research and Scientific Affairs Committee and Associate Professor at the University of Texas Health Science Center at Houston.

Kortnie Strother: To begin, how did you first get involved in endodontics?

Ariadne Letra: It wasn’t until three years after I graduated from dental school, had completed an AEGD program in restorative dentistry, and worked in private practice that I realized endodontics was an obvious choice for me given my satisfaction when practicing and my desire to learn more and take on challenging cases. I am so glad that I chose endodontics! Now, I cannot think of another specialty that would be a better fit.  The work of an endodontist in the art of saving natural teeth is very rewarding.

KS: How did you become interested in endodontic research and what path led you to research?

AL: Research has been an essential part of my career from the beginning. My first research experience was during dental school. I began by joining ongoing research projects before having a project of my own, always under the guidance of many talented people.

I became fascinated by academic dentistry and the opportunity to have a mix of clinical and didactic teaching, patient care, and research in my daily work. I decided that I needed to pursue additional training to succeed in my academic pursuit, so I enrolled in strong research-oriented graduate programs and I guess the rest, as they say, is history!

While my earlier graduate studies focused on more clinical and technical aspects of endodontics, it was during my PhD and postdoctoral training years that I was immersed in basic sciences. This allowed me to integrate aspects of molecular biology and human genetics in endodontic research as a patient-centered approach to better understand the conditions we treat.

KS: Why is research important to endodontics?

AL: Research is important in all fields as it allows us to advance knowledge and provide a scientific foundation for new developments and improvements that ultimately drive the field forward.

Over the years, numerous studies focusing on understanding root canal anatomy, dentin, pulp and bone development, physiology, and immunology, as well as on new endodontic instruments, materials, and technologies have provided the basis for the development of better diagnostic and clinical procedures.

More recently, technological advancements have prompted the integration of state-of-the-art basic, clinical and translational research approaches to further our knowledge of the underlying mechanisms and treatment outcomes of many conditions we see in clinic. Importantly, these integrated approaches have the potential to aid the development of more effective, patient-centered treatment strategies in the near future. For example, the promising results obtained through endodontic regeneration studies with the identification of stem cells of the apical papilla and various scaffolds and growth factors as critical elements for the potential formation of new pulp/dentin (-like) tissues comprise one example of the integration of basic, clinical and translational research approaches that one day will have a significant positive impact in the lives of endodontic patients. In addition, the identification of both microbial and human molecular markers that may impact individual predisposition to endodontic pathologies and/or treatment response is another example of promising advances in the field.  Science is evolving very rapidly so it won’t be long before endodontists have chair-side diagnostic tests based on a patient’s genetic profile available to aid in diagnosis and determination of the best course of treatment. The future is here!

As in many fields, there are always challenges associated with conducting research, and not all research will yield substantial evidence to motivate paradigm-shifting approaches or changes in clinical procedures. Nevertheless, the benefits of conducting high-quality endodontic research far outweigh the efforts involved and will keep moving our specialty further!

KS: What are the benefits of making a career out of endodontic research?

AL: There are so many benefits… and I really feel that I have the best of both worlds! As an endodontic educator, I am constantly moved by my passion to improve a patient’s oral health and have the privilege to teach and be around the next generation of endodontists, who further motivate me in my lifelong learning journey to be a better professional.

I also feel very fortunate to have had many wonderful opportunities that have allowed me to shape my career as a clinician-scientist. Along the way and throughout the years, I have had incredible mentors and role models that have supported and encouraged my work. This is especially important when we consider the challenges most women face in achieving work/life harmony while trying to build a career and raising a family at the same time. Having a wonderful and supportive family also played a significant impact on my ability to make the choice to be a full-time educator/scientist in endodontics.

The most meaningful gift now is to be able to give back and serve as a mentor to many talented dental students and endodontic residents in their own pursuit of happiness.