Lecture Synopses

 The influence of biomechanics in periapical healing and survival outcomes after root canal treatment (Dr. Kishor Gulabivala)

The biomechanics of the tooth plays a crucial role, not only in its survival but also influencing periapical healing. This lecture takes the “less heard” route to consider the tooth from the perspective of its make-up and biomechanical properties. The tooth design for lasting a lifetime without repair and the factors that might compromise that potential are considered from a materials science and practical perspective. It will consider the tooth design features that prevent cracking and crack propagation. The factors that potentially weaken teeth and compromise its integrity will be explained as well as how they may be clinically identified and assessed. Biomechanics also affects the tooth/restoration interface through the degree and distribution of tooth structure loss and its loading characteristics, as influenced by static and dynamic occlusion and restorative design. A multitude of factors dictate the presence of micro-movements and “leakage” through the tooth structure and the restorative interface, influencing the internal micro and nano-environment. The environment may have a direct impact on the nature of the ecological microbiota niche and thus its impact on apical pathosis or periapical health.

The biomechanical, clinical and biological data are synthesized to generate a coherent picture of how the various factors probably interact. It explains how biomechanics plays a critical role in periapical healing and why the restoration design and quality are of interest to the endodontist from the perspectives of prognostication and outcomes. 

 At the conclusion, participants should be able to:

1. Gain familiarity with the nature of tooth biomechanics.
2. Recognize the importance of tooth biomechanics for tooth survival.
3. Appreciate the association between tooth biomechanics and periapical healing.

 Contemporary thoughts on vital pulp therapy and regenerative endodontic therapy (Dr. Ashraf Fouad)

Recent outcome studies have provided evidence for the effectiveness of vital pulp therapy and regenerative endodontic therapy, and appropriate biological approaches. New research seeking to better identify the true nature of irreversible pulpitis is underway. In addition, recent trials have illustrated important parameters for the success of regenerative procedures. This presentation will identify contemporary findings in this area and outline future directions in these areas.

 At the conclusion, participants should be able to:

1. Identify current clinical and molecular approaches for diagnosing irreversible pulpitis..
2. Discuss optimal approaches for disinfecting the root canal system in regenerative procedures.
3. Understand future directions in biological approaches to treatment in these areas. 

 Endodontic 3D disinfection (Dr. Clifford Ruddle)

Predictably successful endodontics is dependent on active irrigation and the role it plays in cleaning both the instrumentable and non-instrumentable aspects of the root canal system. This presentation will emphasize the influence of shape-shifting schemes on fluid dynamics, then focus on comparing the safety, effectiveness, ease, cost, and time when utilizing mechanical, or multi-sonic, or light energy for 3D disinfection. 

 At the conclusion, participants should be able to:

1. Appreciate the role endodontic anatomy plays in success vs. failure.
2. Recognize how the final shape influences 3D cleaning and filling.
3. Compare the various methods utilized for cleaning root canal systems.

Extraradicular infection: The most challenging condition that a clinician may face (Dr. Domenico Ricucci)

Within this presentation, the progression of the pulp degeneration process after pulp penetration by caries biofilm is illustrated on the basis of histologic analyses. It is stressed how the apical pulp tissue remains vital for long time. In time, however, bacterial biofilms are established on the walls of the apical root canal and may grow on the external apical surface. Following deposition of calcium salts, these biofilms may become calcified. Some bacteria extending beyond the limits of the root canal space may also form cohesive colonies in the body of the apical periodontitis lesion. Actinomyces species have been demonstrated in tissue biopsies of failed root canal cases. The mechanisms by which bacteria invade the periapical tissue and become established extraradicularly, preventing healing of the periapical pathology following root canal treatment, will be explained and discussed. The role of apical surgery vs. conventional treatment for refractory lesions will be emphasized.

 At the conclusion, participants should be able to:

1. Describe important aspects of the pulp necrosis process and periapical lesion formation.
2. Recognize the mechanisms by which bacteria trespass the limits of the root canal and become established extraradicularly.
3. List the types of extraradicular infection and their impact on the failure of conventional endodontic treatment.

 Pulp response to stimuli: from science to practice (Dr. Sivakami Haug)

The dental pulp resides in a rigid capsule surrounded by dentin, enamel, and cementum. This encasement creates a low-compliant environment. The pulp is highly vascular and richly innervated mainly by myelinated and unmyelinated nerve fibers. It also houses a wide variety of immunocompetent cells. Nerves fibers release biologically active neuropeptides that influence the inflammatory process. Increasing the release of neuropeptides results in “neurogenic inflammation”. Structural changes of nerve fibers and recruitment of inflammatory cells occur in response to tooth injury. This presentation will review the dental pulp response to various stimuli and its implications in a clinical setting.

 At the conclusion, participants should be able to:

1. Appreciate the uniqueness of the pulp’s low-compliant environment.
2. Describe disease progression in the dental pulp and its clinical manifestation.
3. Apply biological and physiological knowledge for clinical decision-making.

 Biomimetic restoration of the endodontically-treated tooth: the no post no crown approach (Dr. Pascal Magne)

Severely broken-down and endodontically-treated teeth that offer only a minimal ferrule represent such a challenge in clinical practice that clinicians are tempted to not restore them, relying instead on implant-supported restorations. A number of clinicians and patients, however, still have preferences and convictions toward preserving the original root and periodontal ligament to avoid or postpone more invasive surgical procedures. This presentation will investigate the restoration of broken-down, endodontically treated ferruleless teeth using various crowns and endocrowns as well as different core buildups.

 At the conclusion, participants should be able to:

1. Understand the importance of the ferrule effect.
2. Recognize the problems related to the use of endodontic posts.
3. Explore alternatives to endodontic posts using adhesive dentistry and innovative CAD/CAM restorations.

  Endodontic surgery and the maxillary sinus (Dr. Roderick Tataryn)

The proximity of the maxillary posterior root apices to the maxillary sinus predisposes many endodontic surgical interventions to maxillary sinus communication. In this lecture, Dr. Tataryn discusses sinus anatomy, root morphology and the variety of dental root relationships to the maxillary sinus floor, as well as the effects of endodontic disease on the sinus tissues. Effective surgical treatment based on these anatomic variations will be discussed with detailed case examples, including management of sinus perforations, healing of sinus wall osteotomies, and best approaches for palatal root resection.

 At the conclusion, participants should be able to:

1. Understand the anatomy and physiology of the maxillary sinus and the effects of periapical inflammation on sinus tissues.
2. Recognize the anatomic complexity and various root forms of maxillary molars and understand their potential relationships to the maxillary sinus floor.
3. Describe modern surgical techniques for avoiding sinus wall defects and managing sinus perforations during periapical surgery in the posterior maxilla.