Dear reader,
In your hands you are holding a unique textbook, put together by an exceptionally dedicated individual, who has a passion for the microscopic features of the disease processes of the dental pulp and the periapical tissues. Dr Domenico Ricucci 's ambition in producing this text is to demonstrate how the dentine/pulp/periapical tissue complex responds to bacterial elements and how that response may vary with clinical parameters. In this book he shares with you his findings in numerous cases accumulated and followed over many years and recorded in meticulous progress notes. In 20 chapters covering 700 pages with well over 3000 color illustrations, he takes you through the effects on the pulp of caries and other injuries, how they may or may not cause the pulp to succumb and allow bacterial organisms of the oral microbiota to enter and colonize the pulp chamber, thereby inducing and maintaining a variety of periapical tissue responses. Alongside this journey he addresses treatment concepts and the response patterns to the procedures used in endodontics to manage pulp exposures and irreversible manifestations. In the final chapter he discusses the intricacies in restoring the endodontically treated tooth. Though many descriptions on these events and procedures have been given before, none has been able to accompany the story with such an out of the ordinary set of histological illustrations that are put on display in this book.
I met Dr Ricucci for the first time well over 10 years ago. He came to Göteborg to approach me for advice as to whether his treated cases could serve as a basis for clinical research. The perfectionism by which they were treated and recorded was truly astonishing and we finally ended up in authoring several publications and a textbook chapter together. Concomitantly he had organized and set up a complete histological laboratory in his sterilization room of his practice in Cetraro to allow him a detailed analysis of the tissue reactions in and around those teeth that for various reasons had to be extracted. Within a very short period of time he developed extreme skills in handling and staining tissue sections. Especially he became a master of the rather difficult modification of the Brown and Brenn method according to Taylor for staining bacteria. Incalculable evenings and week-ends were then spent on processing, sectioning and analyzing tissue that he had secured from his own treated cases and which now has resulted in this amazing text.
For me personally, I consider the portions of the book relating to the effects on the pulp of caries are the most interesting. Surprisingly little information is available in our literature on how this key disease in dentistry affects the tissue organ inside the tooth. Especially which conditions are relevant in clinical decision making as to when a pulp should be removed and replaced with a root filling or be subject to a conservative treatment measure have escaped thorough analysis. In Chapter 5 Dr Ricucci demonstrates very clearly that the extent bacteria penetrate the pulp in a given lesion cannot be predicted by clinical means. Patients report of pain is normally an important lead. Yet, many times that may prompt erroneous removal of pulps that nonetheless have a great potential for survival. In chapter 8 Dr Ricucci makes pertinent recommendations as to how to manage deep caries lesions, when and why pulp capping/pulpotomy procedures should be considered, and how to explain to the patient there always is a risk for failure of these procedures. Dr Ricucci draws here on his rich clinical experience of this kind of clinical cases.
A piece of caution: "Patologia e Clinica Endodontica" is not aimed to serve as a hand book where you will find the latest on endodontic techniques or how to isolate teeth with rubber dam or to carry out proper root canal instrumentation and fillings with modern devices. The book is not even all-inclusive in terms of the structures and development of the dentine/pulp organ or the mechanisms as to how it may respond to microbial challenges. Yet clinical concepts are presented, illustrated by great cases and discussed on the basis biological principles. From this aspect the book offers a wealth of information. Students on both undergraduate and graduate levels as well as all of us, who carry a special interest in endodontology are to be congratulated for having been offered this masterful piece of work.
Gunnar Bergenholtz
Professor emeritus
Department of Endodontology and Oral Diagnosis,
Faculty of Odontology, Göteborg, Sweden