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Lecture Synopses


Contracted endodontic cavities for extended tooth survival - is less more? (Shimon Friedman, DMD)

Although survival rates after endodontic treatment are high, occurrence of tooth/root fractures is a concern, attributed to tooth structure removal during endodontic cavity preparation. Novel contracted endodontic cavity designs discard traditional principles of outline and convenience form and emphasize directed dentin conservation, in line with the contemporary concept of minimally invasive dentistry. While the proposed benefit of contracted endodontic cavity may be increased fracture strength of teeth potentially extending long-term survival, its potential risk is compromised canal disinfection, potentially impairing periapical healing. This lecture will outline recent research that suggests different biomechanical and instrumentation efficacy impacts of contracted endodontic cavity in specific tooth types. The potential benefits and risks associated with contracted endodontic cavity will be debated.

At the conclusion, participants should be able to:

  1. Explain the rationale for contracted endodontic cavity designs.
  2. Describe how contracted endodontic cavity designs differ from traditional designs.
  3. Discuss the current refereed literature on the biomechanical and instrumentation efficacy impacts of contracted endodontic cavity designs.

Challenges and strategies to disinfect the apical canal zone (José Siqueira, DDS)

The apical segment of the root canal system is a critical zone for infection control, because microorganisms located therein are in a strategic position to obtain nutrients from and cause damage to the periradicular tissues. In the majority of cases with apical periodontitis, a successful outcome of the endodontic treatment depends on adequate infection control in this zone. For infection control in the apical canal, two concepts are of utmost relevance: the length and size of the apical preparation. Special strategies to improve chemical disinfection in the apical canal zone are required. This presentation will discuss the best current evidence about the approaches to clean and disinfect the apical zone, and enhance treatment success.

At conclusion participants should be able to:

  1. Describe the main features of the apical root canal zone, including anatomy, microbiota, frontline of infection, ecological conditions, and pathological implications.
  2. Select the appropriate chemomechanical preparation methods and apply them in the apical canal zone for optimal results.
  3. Describe the scientific evidence about the effects of apical preparation size and length on root canal cleaning and disinfection.

Dental Drugs: Do’s and Don’ts (Nikita B, Ruparel, DDS, MS, PhD)

Pharmacological management of pain and infections in endodontics is a critical adjunct to providing appropriate treatment. Pain is the number one reason why patients seek endodontic treatment and despite the high efficacy of the currently available analgesics, many are misused and incorrectly prescribed. This contributes to the upward trend in the opioid crisis. Such is the case also with over prescription of antibiotics. This presentation will discuss the appropriate indication, contraindications and case-based scenarios to better understand dental drug prescriptions and recommendation.

At conclusion, participants should be able to:

  1. Describe indications, contraindications, interactions and adverse effects of analgesics commonly used in dentistry.
  2. Describe indications, contraindications, interactions and adverse effects of antibiotics commonly used in dentistry.
  3. Select the appropriate dental drugs in case-based scenarios supported by current evidence.

Dilemmas in managing immature teeth (Paul V. Abbott, BDSc, MDS, FRACDS (Endo))

Immature teeth that have pulpless and infected root canal systems with apical periodontitis, or apical abscesses, pose significant management dilemmas for clinicians. These cases may be a result of caries, dens evaginatus (typically mandibular premolars) or trauma to the tooth at a young age (typically maxillary incisors). These scenarios are quite different and will have different possible healing responses. The traumatized tooth may also be associated with trauma to the periapical tissues whereas dens evaginatus cases do not have the same periapical damage. Clinicians have three options to manage such teeth: (1) apexification using calcium hydroxide; (2) placing an “apical plug” (such as MTA or other bioceramic material); or (3) 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 will discuss the findings reported in the literature. The outcomes of the three options, their longevity, practical aspects and suitability for re-treatment will be compared to enable clinicians to choose the appropriate management option for individual cases.

At conclusion, participants should be able to:

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

The Dilemma of the ‘Hot' Mandibular Molar (Stanley F. Malamed)

Effective pain control is essential to ensure patient comfort during the endodontic procedure. This presentation will describe how to achieve effective pain control with local anesthesia in the patient presenting with symptomatic irreversible pulpitis - the ‘HOT’ mandibular molar. Following a review of technique, the buffering of local anesthetic solutions and the use of the local anesthetic articaine HCl by infiltration in the adult mandible will be discussed.

At conclusion, participants should be able to:

  1. Describe the science of buffering of local anesthetic solutions.
  2. Discuss the efficacy of articaine when administered by mandibular infiltration in adults.
  3. Compare the following mandibular block techniques: IANB, Gow-Gates, and Akinosi-Vazirani.

Are you planning properly your apical surgeries? (Adham Azim, BDS, DDS)

The success rate of endodontic surgery has shown significant improvement over the past two decades. With the implementation of micro-surgical techniques, the procedure of complete surgical retreatment became easier and more predictable. As a result, apical surgery became the treatment of choice to address many cases with persistent apical periodontitis. However, are we doing a disservice to our patients by limiting our surgeries to only managing the periapical disease? Should we broaden our treatment planning to consider the supporting structure?

In this presentation, we will present some novel approaches for surgical management of endodontic infections using complete surgical retreatment. We will also discuss the importance of addressing the supporting structure through guided tissue regeneration (GTR) and the impact it may have on the patient’s quality of life and future treatment options.

At conclusion participants should be able to:

  1. Apply the concept of complete surgical retreatment.
  2. Assess shortcomings when limiting apical surgery only to the root.
  3. Use appropriate approach for guided tissue regeneration.

Root canal treatment or implant? (Mahmoud Torabinejad, DDS, PhD)

Advances in endosseous implants have had a significant impact on treatment planning in dentistry. This has affected treatment planning for surgical and non-surgical root canal treatments. The purpose of this presentation is to discuss factors involved in decision-making regarding selection of non-surgical and surgical root canal treatments or dental implants and compare the outcomes of initial non-surgical root canal treatment with those of non-surgical retreatment, surgical retreatment, and alternative treatments such as replantation, transplantation and single tooth implants. Current data indicates similar levels of clinical functionality over time for these procedures. Retention or removal of teeth should be based on thorough knowledge related to risk factors and the long-term prognosis of these treatment modalities.

At conclusion participants should be able to:

  1. Enumerate the factors involved in treatment planning for teeth with pulp and periapical diseases.
  2. Know the factors affecting decision-making for selection of non-surgical and surgical root canal treatments or dental implants.
  3. Assess outcomes of non-surgical and surgical root canal treatment as well as alternative treatments such as replantation, transplantation and single tooth implants.

The John I. Ingle International Endodontic Symposium

Live Online Symposium

November 12-13, 2021

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