“Give the tooth a chance”
Successful management of Acute Pain – Prof. Ken Hargreaves
Today’s patients are under the impression that only classic methods of pain control apply to endodontics. We now have “molecular approaches” that offer us different methods of pain control.
This evidence-based session is designed to provide effective and practical strategies for managing acute dental pain emergencies. The latest information on nonsteroidal anti-inflammatory drugs, acetaminophen-containing analgesics and local anesthetics will be provided with the objective of having immediate application to your next patient emergency. Want to know how to anesthetize that hot tooth? How to predictably manage severe acute pain after surgical or endodontic treatments? How to combine common medications to improve analgesia? This session will provide these practical tips and more using a lecture style that emphasizes interactions with the audience in answering common pain problems with useful solutions.
- Describe a fast and efficient routine for managing dental pain in emergency patients.
- Select the best combination of analgesics to manage dental pain.
- Provide effective local anesthesia to the classic “hot” molar case.
Endodontic treatment options of immature developing tooth – Prof. Ken Hargreaves
Trauma or carious exposure of premature, developing permanent tooth provides a challenge in dental practice. Treatments decisions should be made urgently and a proper follow-up regime must be maintained. In the past the only treatment modality in teeth with necrotic, infected teeth was endodontic procedures which would leave the tooth at high risk of fracture. There has been considerable development in fields of regenerative endodontics and revascularization procedures. Where do we stand today and what future holds for us. Professor Ken Hargreaves’ lecture will review the current clinical studies evaluating regenerative pulpal procedures, and discuss the design parameter necessary to develop and evaluate clinical trials on regenerative endodontic therapies.
- Understand the parameters identified in initial clinical studies on regenerative endodontic procedures that influence clinical outcome.
- Describe experimental parameters likely to influence the design and evaluation of future regenerative endodontic procedures.
- Understand outcome measures of clinical significance for regenerative endodontic procedures.
Micro-surgical Endodontics: the State of the Art. – Prof. Arnaldo Castellucci
In the last 15-20 years several important developments have been introduced in surgical endodontics: the surgical operating microscope, the ultrasonic root end preparation, and a new biocompatible material.
The introduction of the surgical operating microscope represents a very important development in surgical endodontics. For many years periapical surgery has been performed without any magnification, using the dental light as the only light source to illuminate the surgical field. No surprise therefore if until recentely the success rate after surgery was much lower compared to nonsurgical endodontics.
For many years the root end has been surgically prepared drilling a class 1 preparation into the dentin, using a straight slow-speed handpiece or a so called “miniature” contra-angle handpiece with small round or inverted-cone carbide burs. This approach has many disadvantages. The introduction of the ultrasonic root end preparation made possible to obtain what is defined as the ideal retropreparation: a class 1 preparation at least 3 mm into the root dentin with walls parallel to and coincident with the anatomic outline of the pulpal space. In order to do this, special ultrasonic tips were developed to enable the clinician to reach every root in all clinical situations.
The use of the specifically designed retrotips allows the operator to clean the root canal from an apical approach, leaving clean dentinal walls not only on the lingual or palatal side, but also on the buccal aspect, which was impossible to clean with the previous techniques. The cavity now can be madeat least 3 mm deep, without the necessity of making undercuts, since there is no need of further retention. The retrotips are of the same size or even smaller compared to the original size of the root canal, so that the retropreparation can be easily and predictably sealed in the maximum respect of the original anatomy. The isthmus area can now be included into the preparation, without damaging or weakening the root, while being extremely conservative in the mesio-distal dimension.
This session is extremely important for both operators who still perform “root-end resections” and for dentists who refer cases to surgeons. The session shall provide the concept and basis for a more predictable routine that must be incorporated in modern day endodontic procedures. The long-term success rate of surgical endodontics is much higher , more predictable and even more fun!
- Understand the difference between root resections of the past and modern day surgical-endodontics
- Learn treatment modality of surgical endodontics and understand the concept that renders this as much more predictable and successful treatment protocol
Endodontic Treatment Decisions – Prof. Arnaldo Castellucci
Everyone with anything to do with clinical dentistry needs to make treatment decision regarding future of the tooth. Most of the dentists face these question every day of their professional career. Should I save this tooth or should I remove it? What is the prognosis of certain treatment modality? Is it worth undergoing long endodontic procedure? Should I do retreatment? Is it beneficial to provide NSRCT (nonsurgical root canal treatment) or Surgical RCT? Or should I prefer implants. All these questions plague the minds of the dentists and many times decisions are made according to one’s own experience, schooling, surroundings and abilities. But are those decisions always based on scientific evidence?
Many reports provide evidence indicating that the major factors associated with endodontic failures is the persistence of bacterial infection in the canal space. In this situation, the retreatment becomes mandatory even in the absence of acute symptoms, since a flare up could happen in any moment, compromising the function, esthetics and even the general health of the patient.
Faced with a case requiring retreatment, it may not be clear whether it is better to seal the apex surgically with a retrograde filling or to remove the old obturating material from the root canals and repeat the cleaning, shaping, and three-dimensional obturation with a nonsurgical approach.
Once treatment failure has been diagnosed, the most important thing to do is a correct treatment plan, to evaluate which approach can give the clinician the higher success rate, the surgical or the nonsurgical approach.
Professor Castellucci has published a text book which has been translated in English “Endodontics”, which has received widespread acclaim. He is the perfect speaker to provide us with a clearer picture and share his experience and guidelines in making a treatment decision in endodontics.
- Understanding the importance of diagnosis before initiation of treatment.
- Learn to differentiate between a hopeless tooth and a tooth that requires special treatment protocol.
- Learn evidence based knowledge in predicting and fulfilling modern day endodontic treatment.
State of the art in post-endodontic restoration: How? When? What to use? – Prof. Michael Naumann
It is important to plan the end before initiating endodontic treatment, “begin with end in mind”. Endodontic treatment is truly completed once a predictable and durable restoration is provided. A large portion of post endodontic failures are due to fractures or failed restorations as opposed to failed endodontics. It is, therefore, important to thoroughly evaluate tooth prognosis once endodontics and restoration has been made.
Endodontically treated teeth can be maintained in function for a long period of time. However, a key factor for long-term clinical success of an endodontic treatment is the post-endodontic restoration, which must provide a bacteria-tight seal, has to withstand functional forces on its’ own or as a reliable abutment for a variety of prosthetic treatment options. Adhesive approaches play a key role in regard to post-endodontic restoration, and may be more important than specific aspects as post length or an endodontic post itself. Today post materials of choice are glass- or quartz-fibre based. They are free of metal, able to be re-treated, have superior aesthetics, easier to prepare build-ups during abutment preparation compared to casted post-and-cores or prefabricated zirconia and titanium posts. Therefore, adhesive procedures for post-endodontic restorations have become increasingly popular and clinical data support the recommendation to use adhesive core build ups with and without glass fiber posts. Aspects as being metal-free, easy to remove, pleasant aesthetical appearance, application as one-stage procedure without the need of provisional restoration and easy abutment preparation after endodontic post placement are obvious advantages. However, adhesive restorations and post placements may be more technique sensitive than conventional protocols. Which materials provide a bacterial tight seal, which materials are compatible and in which indication is a post placement necessary are just a few questions. This session will elucidate defect dependent solutions for a predictable post endodontic restorative treatment. The talk also highlights important aspects of post-endodontic restoration as defect extension, application of adhesive technique within the root canal, and possible final restoration. In particular, knowledge of pros and cons of direct vs. indirect restoring endodontically treated teeth shall be highlighted.
- Understand the concept of remaining tooth structure after endodontic treatment and how to predict it even before endodontic treatment is initiated.
- When and where to place post and when not to.
- What material and in which situation is ideal for endodontic restoration.
How oral infections affect systemic health – Prof. Jukka H. Meurman
Epidemiological evidence is accumulating in showing the importance of good oral health in health in general. Particularly periodontal disease and apical periodontitis seem to associate with a number of systemic diseases and even link to mortality. Atherosclerosis, diabetes and rheumatic diseases are classical examples in this regard, but even risk for cancer is increased in patients with oral infections. However, the scientific evidence of these associations is still weak and causality, in particular, cannot be established.