Authors: Seltzer S, Bender IB.
Title: Cognitive dissonance in endodontics.
Journal: Oral Surg Oral Med Oral Pathol
Date: Oct 1965
Citation: 20(4):505-16
Category: Success and Failure
Evidence-based Ranking: 5
Purpose/Objectives: To determine if cognitive dissonance is present in endodontics

Discussion: Cognitive dissonance is the existence of views, attitudes, or beliefs which are inconsistent or incompatible with one another but, nonetheless are held simultaneously by the same person. It is believed that if the three basic principles, the “endodontic triad”, are followed faithfully treatment must be successful. These “principles” are; a) thorough debridement of the root canal, b) sterilization of the root canal, and c) complete obturation of the root canal. Dissonance begins to occur when the principles are followed and failure results or through intention or neglect the formula is not followed and success results. One of the examples cited was the technique of culturing canals. Many false negative cultures exist yet many endodontists state, “a poor evaluation tool is better than no evaluation tool at all”. Any success obtained from treatment in the positive canals cultured is ascribed to a significant reduction in the number of microorganisms and removal of most of the inflamed or necrotic tissue. Complete obturation should yield a good result, assuming the root canal is well debrided and sterilized. Again cognitive dissonance occurs when inadequately obturated canals are evaluated as being successful. The “hollow tube theory”, proposed by Rickart and Dixon in 1931 has been cited as definite evidence that complete obturation of the root canal is essential for periapical repair. As long as this is accepted as evidence there is no dissonance. However, doubts increase when in routine full mouth radiographs teeth with partially filled root canals and complete absence of PA pathosis exist. How these areas regress and disappear if the canals are not filled does not follow the triad. How can failures be explained rationally when we have faithfully followed an acceptable formula for success? Is success based on radiographic criteria, clinically asymptomatic patients, or histological evaluation?

Conclusions: In spite of faithful adherence to a basic principle a failure can still result. The “endodontic triad” has some dissonance inherently. To obtain the questions that remain unanswered more research is needed and re-evaluations of previously accepted “facts” are in order. One must be willing to stop ignoring the dissonance and admit that treatments sometimes fail, for there can be no attempt, at solution, of a nonexistent problem.