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Success of endodontic treatment depends upon adequate cleaning and shaping of root canals. Over past 40 years, a number of studies have confirmed that despite strict length control of endodontic instruments during root canal preparation dentinal filings, pulp tissue fragments, necrotic tissue, micro-organisms and intracanal irrigants may be extruded from apical foramen which cause inter-appointment flare-ups. Proper measures should be employed for reducing apical extrusion of infected debris by practicing crown-down instrumentation techniques, using instruments in rotational motion rather...

In twenty first century greater emphasis should be placed on assessing caries risk, shifting patients to low caries risk status, remineralising noncavitated lesions, abandoning the surgical approach to caries management and repairing rather than replacing the old restorations. There is a clear need to improve the sensitivity of diagnostic methods and site specific indicators for future caries risk assessment.