04 July 2022

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Interview with Dr. William J. Nudera

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Advancements in knowledge, techniques, and technologies have shaped dentistry. Endodontic therapy has significantly evolved over the past two decades, but in the end, endodontics is about clinician decisions. 

Today we talk about it with Dr. William Nudera, an American Board-Certified Endodontist and author of the book: NuEndo – ReThinking Endodontics (Edra Publishing US LLC).

Dr. Nudera, you are an extremely respected and recognized endodontist, but not everyone may know that your first great passion was music. First, an artist and then a dentist, do playing music and performing dentistry have similarities?

Dentistry is intrinsically an artistic field. Many dental professionals I speak with have hobbies or backgrounds that involve something associated with the creative arts — music, drawing, painting, cooking, photography, etc. Although music and dentistry seem as if they should fall on two separate ends of the spectrum, there are similarities. Both disciplines involve hand-eye coordination, pattern recognition, and precision dexterity; they both follow a well-composed arrangement of steps and sequences, and they both require timing and contain group choreography. 

There is another tool in your kit. You are also a writer. Tell us what it is like to write a book and what that experience meant to you
The chance to write a book is an opportunity few get offered, and even fewer see to fruition. Writing a book is an exercise in patience and discipline. You must first have a well-defined idea and a message. Then, you must be able to meticulously articulate your idea and message into words, words that can be clearly understood by those seeking the knowledge. In addition, all of this must be done within a specific timeframe. So, setting a schedule that outlines reasonable goals and achievable benchmarks is critical. Writing a book that describes what is naturally innate forces one to deeply reflect on every finite detail of their daily routine; the experience for me was an exercise in mental gymnastics.

What will we find in this book, and who should read it?
It’s a map, a series of flow charts designed to guide clinical decision-making. It provides evidence-based narratives and logical reasoning to help dentists fully understand diagnosis and case selection from the perspective of a clinically practicing endodontist. It was written for dentists of all experience levels, and it should not be read, it should be used!

What do you consider to be the most significant challenges for an endodontist? Will this book help in overcoming these challenges?
The biggest challenge for an endodontist is helping patients (and referring doctors) understand the reasonable expectations for a pulpally compromised tooth. Most are taught that root canal treatment comes with an extremely high success rate; most quote literature ranges between 90-95%. Although high success rates are possible, the popular quoted success ranges are only applicable to teeth in ideal starting conditions and treated in healthy patients. The reality is that most teeth (and patients) requiring endodontic treatment do not fall under these “ideal” conditions. Therefore, it is critical to communicate expectations with respect to the prognosis before moving forward with treatment. This book does just that.

What do you think is most valuable in an endodontist – excellent technique or superior knowledge of the science?
There is no doubt that a clinician’s technique — their physical ability to perform root canal treatment— plays a significant role when it comes to the overall long-term prognosis. However, if the procedure is performed on the wrong tooth or for the wrong reasons, then the mechanical execution of treatment becomes moot. Knowledge of the science (more specifically, how to interpret and apply it), represents the cognitive arm of endodontics. This knowledge can play a much larger role in determining the overall “success” of treatment, but unfortunately, it’s also the most misunderstood. The best doctors are those who fully appreciate the science behind their diagnoses and treatment recommendations, regardless of their skill (or desire) to physically perform the treatment. The best endodontists are competent and knowledgeable in both the technique and science.

How do you envision endo as we move into the future?
I envision a future of endodontics where files become obsolete, where the materials used to seal the root canal system leverage nanotechnology and stem cells to promote healing of the dentin. I envision advanced volumetric imaging that is increasingly more sensitive for detecting early problems without the need for radiation. I envision significant advances in computer-assisted guided treatment protocols. I see the use of artificial intelligence to help supplement diagnosis and treatment planning. And hopefully, within my lifetime, I envision the ability to surgically implant a tooth bud to regrow a brand-new tooth when an existing tooth cannot be saved.

Is there a new book in your future? If so, what are some possible focus areas or themes you are interested in?
I am currently in the process of writing my second book. It’s a continuation of the endodontic process and picks up where my first book leaves off. Where the first book helps clinicians understand when and what to treat, the second book outlines how to treat. It’s a map that describes every aspect of the root canal technique. And, just like my current book, it uses easy-to-follow flow charts and logical narratives to help dentists think like an endodontist.

William J. Nudera DDS, MS

Specialized in Endodontics. Diplomate of the American Board of Endodontics. Active Member of the American Dental Association, Chicago Dental Society, Illinois Dental Society, and the American Association of Endodontists. Endodontic Advocate and Key Opinion Leader for Dentsply Tulsa Dental Specialties.