Topic

Dilemmas in Managing Immature Teeth

Synopsis

Immature teeth with pulpless, infected root canal systems and apical periodontitis or apical abscesses pose significant management dilemmas for clinicians. These cases may result from caries, developmental defects (e.g., dens evaginatus, dens invaginatus), or trauma to the tooth at a young age (typically maxillary incisors). These three scenarios are quite different and will have different possible healing responses. Traumatized teeth may also be associated with trauma to the periapical tissues, whereas the developmental defect cases do not have periapical damage. Clinicians have three options to manage such teeth – apexification using calcium hydroxide, placing an “apical plug” (such as MTA or other bioceramic material), or a repair procedure (often called “regeneration” or “revascularisation” but these terms are usually not applicable to the trauma situation). This presentation will explore the concepts behind these options and discuss the findings reported in the literature. Dr. Abbott will compare the outcomes of the three options, their longevity, practical aspects, and suitability for re-treatment to enable clinicians to choose the appropriate management option for individual cases.

At the conclusion, participants should be able to:

• Describe the management options for pulpless, infected immature teeth.
• Evaluate the advantages and disadvantages of three management options for pulpless, infected immature teeth.
• Choose the appropriate management option for the various situations where immature teeth have become pulpless and infected.

Topic

Outcomes of Vital Pulp Therapy

Synopsis

The goals of endodontic treatment for mature and immature teeth include prevention and/or elimination of apical periodontitis. Additional goals for endodontic treatment of immature teeth with vital pulps and an open apex are broader. They include tooth vitality preservation and root development promotion to maturity, thus rendering them amenable to vital pulp therapy. The advantages of vital pulp therapy are significant. Robust criteria for outcome assessment are an essential determinant for any measure of treatment success.

Dr. Chugal will review this topic and discuss recent findings from the outcomes study of the vital pulp therapy conducted at UCLA.

At the conclusion, participants should be able to:

• Describe the rational for preserving the pulp in immature teeth.
• Identify clinical cases that would benefit from vital pulp therapy.
• Identify and discuss factors that affect treatment outcomes of vital pulp therapy.

Title

The Tooth “Implant”: Intentional Replantation and Autogenous Transplantation

Synopsis

When orthograde retreatment and apical microsurgery are considered unfeasible, fail to resolve persistent endodontic infection, or when the remaining tooth structure is deemed non-restorable, the tooth is usually extracted and replaced with an implant or another prosthetic device. Alternatively, when clinical conditions permit, the tooth can be extracted, manipulated extra-orally, and replanted (Intentional Replantation, Surgical Extrusion), or a non-strategic tooth can be transplanted into the socket of the extracted tooth (Autogenous Transplantation). These seemingly radical but rather simple procedures offer predictably good outcomes when the biological principles of tooth replantation are respected.
This lecture will review the procedures of Intentional Replantation/Transplantation in a contemporary context as a predictable means for retaining otherwise “untreatable” teeth to greatly benefit patients. Strict guidelines for case selection, a step-by-step protocol, and various clinical applications will be outlined and illustrated in the context of typical cases. Treatment outcomes will also be highlighted for the different clinical applications of both procedures, as reported in case reports, cohort studies, and systematic reviews.

At the conclusion, participants should be able to:

• Describe the procedural guidelines and steps for Intentional Replantation, Surgical Extrusion, and Autogenous Transplantation aimed to prevent external root resorption and persistent infection.
• Outline the indications for Intentional Replantation and Autogenous Transplantation.
• Summarize the long-term outcomes of Intentional Replantation, Surgical Extrusion, and Autogenous Transplantation.

Topic

Diagnosing the non-odontogenic toothache

Synopsis

The diagnosis of non-odontogenic dental pain presents a challenge to the clinician. This lecture reviews the prevalence of non-odontogenic toothaches, the “predictors” that should alert the clinician to patients at risk, and the strategies for establishing the diagnosis.

At the conclusion, participants should be able to:

• Identify the mechanisms for referred pain and how this can lead to a mis-diagnosis of non-odontogenic pain.
• Describe the prevalence of the various forms of non-odontogenic toothache.
• Recognize and diagnose the non-odontogenic toothache.

Topic

Nanoparticles Guided Treatments for Endodontics: What Is It and Why It Matters

Synopsis

Therapeutic options to eliminate root canal biofilm have been the primary focus for innovations in recent years. Despite significant technological advances in the past two decades, the root canal environment remains a challenging niche in which to eliminate surface-adherent bacterial biofilms predictably. Also, there has been a growing interest in dentin preservation to maintain the mechanical integrity of endodontically treated teeth. However, the question remains: Can the current strategy of utilizing minimally invasive access cavity, root canal preparation, and sealer-based obturation improve the mechanical integrity of root-filled teeth while maintaining the efficacy of root canal disinfection?

This lecture will provide an overview of a newly developed multimodal therapy based on engineered bioactive biomaterials to solve the long-standing problems in non-surgical root canal treatment.

At the conclusion, participants should be able to:

• Recognize the role of nanoparticles in root canal treatment.
• Know how engineered nanoparticles can improve the mechanical integrity of endodontically treated teeth.
• Understand how engineered nanoparticles can regulate cellular functions and enhance rapid wound healing.

Topic

Diagnosis and treatment of internal and external cervical root resorption

Synopsis

Internal root resorption (IRR) and external cervical resorption (ECR) are often confused because they share similarities. However, their differences are more significant. This lecture covers their key features, distinguishing them from each other and caries, and choosing the proper treatment. Dr. Marvidou will use clinical examples to guide diagnosis and treatment decisions.

At the conclusion, participants should be able to:

• Identify characteristics of internal root resorption and external cervical resorption.
• Highlight the differences between these two pathologies.
• Use clinical examples illustrating treatment approaches for both pathologies.

Title

Challenging Clinical Scenarios and the Piezosurgical Approach: A Cut Above!

Synopsis

Technologies continually evolve to satisfy the demands of emerging microsurgical techniques but are not limited to the classical endodontic surgical armamentarium. The most recent example is implementing the Piezosurgical technique for root-end surgery. Heightened awareness of significant vascular elements via pre-surgical CBCT surveys mandates cautious sectioning processes. Restrictive soft tissue access hampers adequate retraction for conventional surgical handpieces. Substantial cortical plate thicknesses and unusual anatomy can confound the most experienced surgeon. All these factors present the dichotomy of visualization/manipulation versus post-surgical regeneration. The featured clinical cases highlight the adaptability and versatility of this new technology in this challenging surgical arena.
At the conclusion, participants should be able to:

• Be familiar with the history and principles of the Piezosurgical method, including indications and contraindications.
• Appreciate the visibility and precision of root end procedures performed using Piezo versus conventional handpiece.
• Assess the adaptability of this technology for “novel” surgical corrections.

Topic

Saving Teeth Labeled Hopeless or Non-Restorable

Synopsis

Endodontists encounter many teeth with challenges, such as “Endodontic-Restorative-Periodontal” issues. Unfortunately, many of these teeth get labeled as non-restorable or hopeless. These include teeth with deep sub-gingival caries, cracks, resorptions, and coronal micro-leakage. This presentation will discuss many clinical “tips and tricks” to successfully and predictably save these teeth long-term.

At the conclusion, participants should be able to:

• Describe the “deep margin elevation” technique and its role in reducing the need for surgical crown lengthening.
• Discuss techniques to treat resorption defects successfully.
• Perform adhesive techniques that enable successful outcomes.

Topic

Potential of Bacteriophage Therapy in Controlling Bacterial Infections

Synopsis

The standard of care for treating localized dental infections is removing the causative agent(s). Antibiotics are the most common adjunctive therapy when systemic infection signs and symptoms are present, such as cellulitis or fever and malaise. The development of antibiotic resistance has raised concerns regarding the misuse and overuse of antibiotics. Furthermore, antibiotic therapy can lead to disruption of the microbial flora, which may have long-term effects on the immune health of the patient. For these reasons, novel approaches that are more targeted and less susceptible to developing resistant strains are gaining interest.
Bacteriophages have been studied for decades. They are highly specific to bacterial species and are viruses infecting bacteria but not human cells. Thus, bacteriophage therapy can be targeted to fight a particular pathogen without impacting the normal flora or host cells. Efforts are underway to evaluate phage therapy as a new approach to fighting bacterial infections. This lecture will highlight the properties of bacteriophages, their potential utility in fighting bacterial infections, and challenges that must be addressed to develop practical products for clinical use.

At the conclusion, participants should be able to:

• Appreciate the concerns and limitations associated with antibiotic therapy.
• Understand the main features of bacteriophage.
• Gain knowledge in the pursuit of novel approaches such as bacteriophage therapy to address bacterial infections.

Topic

Navigating the Root Canal Maze: Endodontic Approaches for Complex Tooth Anatomy and Anomalies

Synopsis

Complex root anatomy can present a clinical challenge. Dr. Silberman will explore endodontic cases and treatments that showcase a variety of complex challenges. He will discuss their prevalence in the general population and share his approach to managing them. The scope of the presentation will include case selection, clinical methodology, and treatment goals. The cases presented will reflect the range of treatments clinicians can encounter in the dental practice.
At the conclusion, participants should be able to:

• Identify and assess complex endodontic cases and how to approach them.
• Establish a clear hierarchy of processes to address challenging cases effectively.
• Apply biological principles to clinical decision-making.