Interview: "It's critical to understand Endo-systemic connection better" —Dr. Elisabetta Cotti

1. As the newly appointed president of the International Federation of Endodontic Associations (IFEA), what are your primary goals for advancing endodontic education and collaboration on a global scale?

Thanks for this opportunity. IFEA, in my perception, is mostly connecting our world. The world of endodontic speciality is a small place already, and IFEA is meant to make it smaller. This represents opportunities to keep members updated in this field – but more so, to enable endodontists to interact with people doing the same job at a global level in an easy and pleasant way, mainly during the World Endodontic Congress.

I actually discovered the opportunity to become an endodontist, enrolling in a speciality training on the other side of the world many years ago, because I belonged to an international association of dental students. Further, IFEA promotes endodontic education through the institution of a research grant and by sponsoring endodontic education in developing countries. With the increasing number of societies in IFEA, these goals should be achieved at a broader level. My proposal for the next step would be to institute an international guidelines sharing session on our website.

2. Your lectures have shed light on invasive cervical resorption. Could you elaborate on the challenges in diagnosing this condition and the advancements in its management?

It is a very sensible topic at the moment. The work of many clinicians and researchers over the last 20 years, combined with the advent of CBCT, has enabled dentists to understand better and diagnose the disease. Now we need to shed better light on the predisposing individual factors, which in turn will lead to the development of preventive and treatment alternatives.

The main problem in this field is that the other specialities involved do not seem to share the same interest in invasive cervical resorption.

3. Your research has explored the link between apical periodontitis and cardiovascular diseases. How do you perceive the relationship between endodontic infections and systemic health?

I think it is crucial, as it places an overall burden that does not help the system. Being aware of this connection also helps ageing patients to have a better quality of life.

Lastly, but not least, the systemic health–endodontic connection is helping us better understand the role of systemic medications in apical periodontitis, which presents a wide range of opportunities for future treatment adjuncts.

4. With the evolution of imaging technologies, how have modalities like CBCT and MRI transformed the diagnosis and treatment planning in endodontics?

CBCT has already changed the diagnosis, treatment planning and follow-up of endodontic disease. MRI and ultrasound imaging aim to fill the gap in understanding the dynamic presentation of apical periodontitis, including the degree of inflammatory response, histopathologic presentation, and real-time response to treatment.

5. In your recent clinical trial comparing calcium silicate-based sealers with traditional zinc oxide–eugenol sealers, what were the significant findings, and how might they influence clinical practice?

According to the study, in my opinion, the most relevant finding is that these sealers, when used in conjunction with a simple obturation technique, perform at least as well as one of the most accredited and effective classic techniques.

6. What inspired you to pursue a career in dentistry, and what led you to specialise in endodontics? Was there a particular moment or mentor that influenced your decision?

As stated above, it was an international encounter with Prof. Leif Bakland, chairman of the Endodontic Department at Loma Linda University (US), when I had just finished dental school in Italy.

7. Balancing roles in Italy and the United States, how do you approach harmonising endodontic curricula and training methodologies across different educational systems?

It is not easy, especially in this moment of significant changes in education, but the world connection is helping, and programmes are coming closer, as far as I can see.

8. As the director of the postgraduate programme in clinical and surgical endodontics, what core competencies do you emphasise to prepare students for the evolving demands of endodontic practice?

Both clinical and scientific approaches – going through as much discussion as possible.

9. Your systematic review on dental management for patients undergoing cardiovascular procedures highlights the importance of interdisciplinary care. What protocols do you recommend for dental professionals collaborating with cardiology teams?

The protocols suggested are outlined in the articles, but – most importantly – maintaining open communication between dentists, cardiologists, and cardiac surgeons is key.

10. Reflecting on your career, how have you witnessed the transformation of endodontic practices, and what emerging trends do you foresee shaping the future of the field?

Endodontics has become simpler, in a way, due to technological advancements (such as rotary and reciprocating instruments, microscopes, CBCT, and hydraulic cements), but also more complex due to its connections with systemic health and genetics. This trend is likely to continue as a growing field.

Notably, over the last 20 years, endodontics has expanded its scope to include the treatment of vital pulp and the restorative aspect. This opening will help us gain a better understanding of the potential of regenerative techniques.

11. What advice would you offer to young dental professionals in South Asia who aspire to specialise in endodontics and contribute meaningfully to both clinical practice and research?

Find the right programme and follow it with passion.

12. What are your top book recommendations for endodontics?

• Ingle’s Endodontics
• Pathways of the Pulp

13. Top 3 journal recommendations in endodontics

• International Endodontic Journal
• Journal of Endodontics
• Australian Endodontic Journal

About:

Elisabetta Cotti, DDS, MS, received her DDS from the University of Cagliari, Italy and the speciality and MS in Endodontics from the University of Loma Linda, California. She is a Full Professor of Conservative Dentistry and Endodontics, and the Chairman of the Department of Conservative Dentistry and Endodontics at the School of Dentistry, University of Cagliari- Italy. She is currently the Director of the Postgraduate programme (Master's) in Clinical Endodontics at the University of Cagliari and a lecturer in the Department of Endodontics at Loma Linda University, USA. Elisabetta Cotti is currently the president-elect of IFEA (International Federation of Endodontic Associations). She practices limited to endodontics and is the author of several articles and chapters in the field of Endodontics, with a specific interest in apical periodontitis, imaging, and trauma.

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