FUTURE OFDENTISTRY
pits and fissures can be treated in this way. When lasers
remove early cavities, conditions can then be changed to
treat the walls of the cavity preparations, thereby inhibit-
ing secondary caries around restorations (Konishi et al,
1999). Controlled clinical trials are needed to make this
technology fully accepted. New lasers with different
wavelengths are currently in development that will be
even more efficient and effective at removing caries.
These lasers can be selective in carious tissue removal,
leaving the surrounding tissue intact and much stronger
than is the case for a conventional amalgam preparation.
Flowable composites can be used to fill these cavity
preparations, and better materials will become available
for this purpose.
New approaches to remineralization of limited
carious lesions represent an important future
approach to the clinical management of caries.
The process of tooth remineralization has received
significant attention over the past four decades
(Koulourides et al, 1961; Silverstone et al, 1981;
Larsen et al, 1987; White, 1988; Geiger et al, 1992;
and Linton, 1996) although the concept was docu-
mented in the early 1900's (Head, 1912). There exists
some controversy regarding the extent to which dem-
ineralized tissues can be remineralized and the means
by which demineralization should be diagnosed in the
clinic (Thylstrup and Fejerskov, 1994).
The visual signs of white spots that may disappear
or reduce in size may be attributable to wear and
polishing of the partially dissolved external surface
of an active lesion. However, several studies have
demonstrated an increase in hardness and mineral
content and reduced subsequent demineralization at
the surface of tooth tissues that were remineralized
(Shannon and Edmonds, 1978; Retief et al, 1983;
Vissink et al, 1985; Larsen and Fejerskov, 1987;
White, 1988; and Linton, 1996).
Restorative materials are continually being im-
proved. In the future, they will be able to:
u Release antibacterial agents or fluoride on de-
mand. The so-called "actively smart materials"
represent a potential approach if they will release
sufficient concentrations of therapeutic agents at
specific times when they are needed, i.e., when the
disease is active.
u Be readily placed in very small conservative cav- ity
preparations. For temporization of cavitated teeth in
individuals at a high risk of caries, "actively smart mate-
rials" similar to glass ionomer, but with greater fracture
resistance, must be developed to increase the survival
times. Highly viscous glass ionomer materials have been
used for this purpose, but approximately 20% of these
temporary restorations fail over a period of three
years when used for the atraumatic restorative treat-
ment technique. Currently, these materials are used pri-
marily in developing countries where electricity and
pressurized air and water are not available.u Remain durable and flexible and become an inte-
gral part of the tooth.u Stimulate growth of new or reparative dentin.uBe utilized with the increased application of CAD-
CAM technology. This will reduce cost and time
require for extensive rehabilitation of severely
involved dentitions.Extension of coronal or root caries into the pulpal
tissue requires endodontic therapy for the affected
tooth. The recent focus on improved instrumentation
and use of magnification during endodontic therapy
will improve the effectiveness of treatment. The use of
lasers in endodontic therapy, including indirect and
direct pulp capping, vital pulp amputation and prepa-
ration of the root canal system, will see increased
emphasis, with attention to specific approaches to clin-
ical application (Matsumoto, 2000). The future will
also see new emphasis on treatment of disease process-
es that affect the periradicular tissues, including persist-
ent apical disease, tooth perforations and fractures, and
internal and external resorption. Definition of the
importance of growth factors in pulpal repair will like-
ly be an important area of future research, with a focus
on clinical application (Roberts-Clark and Smith,
2000). Concern has been raised, however, about deliv-
ery of these agents to injured pulp tissue (Tziafas et al,
2000). The potential impact of untreated endodontic
disease as a risk factor to certain systemic diseases needs
to be explored (Grau et al, 1997).IMPLANTOLOGYThe use of osseointegrated dental implants will
expand in the future. Improved understanding of
wound healing associated with implant placement, with
a particular emphasis on the implant-bone interface,
will be a focus of future research. Relying on both met-
allurgical and biological science, these studies will lead
to improved implant surface coatings. As the demandDental and Craniofacial Research