Sponsored Lecture

This presentation will provide an evidence-based framework for diagnosing, managing, and predicting the prognosis of cracked teeth. Participants will gain practical insights to confidently address this complex condition in clinical practice, ultimately enhancing patient care and treatment success.

Understanding the endodontic-periodontic lesion

The removal of bacterial biofilms and their byproducts is critical for apical periodontitis healing.
A detailed knowledge of the root canal anatomy, the endodontic microbiome, the periodontal
condition, the restorative prognosis and the overall patient’s health should be considered to
determine the endodontic prognosis. Multiple anatomical and iatrogenic pathways can
communicate these tissues in both health and disease. These pathways include furcation
canals, dentinal cracks, and vertical root fractures.  In other cases, a cemental root fracture
(cemental tear) can mimic periapical pathosis. It is generally agreed that the dental pulp and its
necrotic content affect the periodontal tissues. A controversy exists over the ability of
periodontal disease to affect the dental pulp.  During this presentation, we will review diagnostic
techniques, the prognosis, and treatment alternatives for endo/perio lesions.
Aims and Objectives:
This series of lectures will provide participants with a current update on the basic and clinical
science of non-surgical root canal treatment. The main goals are:
1. Evaluate the characteristics and clinical presentation of endo-perio lesions.
2. Discuss the clinical presentation of cracked teeth, vertical root fractures and cemental
tears.
3. Discuss the endodontic prognosis in cases with complex endo-perio involvement.

From Pre to Post-Endo Restorations / Optimizing adhesive restorations in endodontically treated teeth

Endodontically treated teeth require special attention in terms of restorations as they are often related with extensive structural damage, endodontic procedures and lack of vitality. With the use of contemporary adhesive systems, materials and techniques we can predictably restore endodontically treated teeth, providing them with long lasting protection, functionality and excellent esthetics while preserving healthy tooth structures.

Intentional replantation

Intentional replantation (IR) is a surgical procedure designed to address apical or marginal
infections following an accidental tooth extraction. The procedure involves extraction and
reimplantation of the tooth after thorough debridement of the infection site and subsequent
splinting to stabilize the tooth. Initially considered a treatment of last resort by Grossman, IR
represents a critical option between saving natural dentition and opting for a dental implant.
Recent systematic reviews indicate survival rates for IR ranging from 80% to 95%,
depending on clinical variables.
Optimal candidates for intentional replantation include teeth for which surgical endodontics is
contraindicated due to technical challenges, such as those located in the lower molar region,
near vital structures (e.g., mental foramen or maxillary sinus), or with inaccessible external
cervical resorption. Additionally, IR may be indicated for teeth with complex endodontic
lesions, suspected vertical root fractures following repeated endodontic treatments, or
anatomical peculiarities combined with periodontal involvement, such as gingivo-palatal
grooves.
In the context of this presentation, we will explore a broader spectrum of indications for IR,
including fractured teeth, cases where vertical root fracture is suspected, and extensive
endodontic lesions. From the author’s clinical experience, preoperative splinting significantly
enhances postoperative splinting procedures, while intrasulcular incisions promote a more
favorable healing environment for the supracrestal attachment.
Overall, intentional replantation is a cost-effective procedure associated with minimal
postoperative pain and a low incidence of complications, provided the procedure is
performed with careful preoperative planning and atraumatic tooth extraction techniques.

Adaptive instrumentation and calcium silicate sealers: a synergistic combination

The introduction of engine-driven nickel-titanium instruments has significantly simplified
and expedited the clinical shaping process. These instruments are highly appealing in a
clinical setting as they enable the treatment of certain canals in remarkably short time
frames. However, their use has also overshadowed crucial aspects of the cleaning and
three-dimensional obturation procedures, and introduced several issues that rarely arise
with conventional shaping techniques. Adaptive instruments present an elegant solution
that addresses some of these challenges. Additionally, integrating this shaping method
with the well-established advantages of calcium silicate cements supports a more
biological and minimally invasive approach to endodontic treatments. It is now more
important than ever to utilize engine-driven instruments correctly to maximize their benefits
and enhance clinical performance. This presentation will focus on the optimal utilization of
virtual core instruments, supplemented by the appropriate application of bioceramics in
daily clinical practice.

Endodontic Microsurgery: What you need to know based on Evidence (The Best Evidence)

Clinicians should possess current knowledge about the prognosis and expected outcome of endodontic treatment, including apical surgery. This knowledge cannot be acquired by indiscriminate review of the many available studies because they vary in the level of evidence they provide.
With regard to intra-operative factors, the choice of the root-end filling material and the quality of the root-end filling may influence the outcome, while the retrograde retreatment procedure clearly offers a better outcome than the standard root-end filling. In summary, the expected outcome of apical surgery is good and therefore, before considering tooth extraction and replacement, apical surgery, or intentional replantation should be attempted when it is feasible.

Perio - Restorative Relationships: from Deep Margin Elevation to Crown lengthening

Subgingival restorative margins in dental treatments present unique challenges and considerations for both clinicians and patients. These margins, located beneath the gum line, require precise management to ensure both function and periodontal health. This report explores the factors influencing the design and placement of subgingival margins, including the impact on soft tissue and potential risks of inflammation. The report emphasizes the need for a careful, individualized approach to treatment planning to achieve optimal long-term results in restorative dentistry.

Autonomous robotic systems ante portas: application guided endodontics for ReEndo treatments. Possibilities and limitations.

Autonomous robotic systems ante portas: application guided endodontics for ReEndo treatments. Possibilities and limitations.

In the last decade, different methods - like static and dynamic navigation - used for guided endodontic purposes- became more and more affordable, even for general practitioners.
However, tools for haptic-guided endodontics, robot-assisted endodontic retreatmenst ,micro robots and autonomous robotic systems also became the part of the conversation.
Number publications arraised in this topic to support these concepts. Giving the idea, how to carry out more conservative endodontic treatments and retreatments and how to minimize iatrogenic complications.

In my presentation I would like to share my own experience about guided endodontics for non-surgical retreatments. Showing successful cases and failures, pointing out the possibilities and limitations of the present affordable technics and hint the benefit for the future inventions.

Participants will be informed about:

- how to plan and use static guides
- how to plan and use dynamic navigation
- the possibilities of robot-assisted endodontic retreatment, haptic-guided endodontics
- micro robots and autonomous robotic systems.
- pros and cons of this technologies.

Microbial insights and disinfection
strategies in root canal retreatment

Microorganisms are the primary cause of endodontic infections, which arise from microbial
invasion of the root canal system and periapical tissues. In cases of endodontic failures, these
microorganisms often survive initial treatment efforts due to their organization in biofilms in
the anatomical complexities. Studies of the microbiome reveal that the microbial composition
of these biofilms is polymicrobial and highly heterogeneous, with significant inter-individual
variability. Persistent infections often involve specific microbial species with enhanced
virulence or resistance mechanisms, making eradication particularly challenging. The ultimate
goal of endodontic treatment in cases of persistent infection is to disrupt and eliminate
intraradicular and extraradicular biofilms while preventing reinfection. Advanced disinfection
strategies are critical for addressing these resilient microbial communities. The objectives of
this presentation are to describe:
• The microbial factors involved in cases of endodontic failure
• The endodontic microbiome
• The different strategies to eliminate biofilms from infected dentine

The Retreatment Pandemic - Why Are We Obsessed With Reaching The Apex

Much can be said about the way we now perform our endodontic treatments; recent years have seen an upsurge in our technical abilities and as such new beliefs and philosophies have been contoured. Most of them unfortunately are centred around the usage of certain instruments which (mostly) due to commercial reasons are perceived as being “better”. Most dentists using them are having a difficult time in enunciating what makes them “better”. A repetition of information printed on company flyers have drawn the attention away from the biological ideas that the dentist should follow. This has happened to such a degree, that the endodontic retreatment procedures today are belittled, as being just about removal of previously placed filling materials. Obviously, the complete removal of gutta-percha and sealer is important, as is our attempt to reach the apex and properly disinfect the entire endodontic system. But what happens when dogmatic beliefs shared on social media are not replicated in your own clinic? What then? Talking about dogmatic beliefs, what about the need for retreatment? Is every “short” root canal an indication for revision? How about a 20-year-old “radiologically unappealing” treatment? Is that in need of revision as well? Especially if you’re planning a new crown. You saw that I used quite a lot of quotation marks, and that’s because, I have the feeling that in todays convoluted endodontic environment, dominated by financial wants and insecurities, some decisions such as “when should I retreat a tooth” are mostly based on empirical factors. In this presentation I will try to raise the curtain on endodontic retreatments, sharing with you my honest beliefs, presenting my version of the truth, not “contaminated” by commercial interests, and not perverted by social media trends. The presentation will address the following 3 aspects:
1. When do I start a Nonsurgical Endodontic Retreatment
2. What are my goals during a Nonsurgical Endodontic Retreatment
3. What happens when thing don’t go as planned.

Nickel Titanium in retreatment procedures: what to choose and when

Retreatment in endodontics presents a daily challenge for the endodontist. Therefore, it's crucial to select the appropriate instrument at the right time.Following coronal disassembly and the removal of any existing posts, we proceed to radicular disassembly. Identifying the material within the canal dictates the choice of instruments used for its removal. The required function of the file determines the appropriate shape and alloy for each stage of disassembly.Complete removal of the sealer, gutta-percha, and/or carrier is essential.The next step involves regaining access to the canal apical to the previous seal and establishing a new patency. This enables the shaping of the remaining endodontic system and necessitates the use of files with different characteristics. Accurate assessment of the clinical situation and selection of the correct instruments are paramount for successful endodontic retreatment.

Broken File Removal…How to make it an easy practice.

The incidence of file separation during root canal instrumentation is considered one of the most annoying accidents that may happen to any dentist. As it will prevent proper disinfection of the remaining parts of blocked canals leading to higher potential of endodontic treatment failure.
Understanding metallurgy, instrumentation principles, and endodontic files kinetics will decrease this accident highlighting “prevention is better than cure”.
The use of microscopic magnification with special design ultrasonic tips made broken file removal possible, taking into consideration the proper training and experience needed.
On the other hand, not all types of broken files can be removed with the same manner. Length, size, amount of engagement, and location of broken files are critical factors to decide the proper removal technique which has to be used whether it was by ultrasonic tips, loop devices, grasping kits, or tube technique.
The aim of this presentation is to understand why files could separate during root canal instrumentation and how to avoid, focusing on making broken file removal an easy practice by suggesting a new category that makes the removal much more efficient with better outcome.

Orthograde retreatment with a reciprocating file: Case selection, technique and outcome

Prognosis depends largely on the extent of the crack and the measures taken to prevent its further propagation. Crack extension essentially determines the extent of damage to the pulp and periodontal tissues. Historically, teeth presented with crack-associated pulp necrosis and concomitant apical periodontitis as well as endodontically treated cracked teeth were considered to have a guarded prognosis, with cracks with radicular extension negatively impacting tooth retention. While the negative influence of crack depth and periodontal pocketing on long-term treatment success and tooth survival cannot be overlooked, emerging clinical evidence highlights the positive role of refined treatment protocols in preserving compromised cracked teeth.

Calcification management in endodontics

Hard tissue apposition along the root canal walls is a slow, normally occurring physiological aging process. In response to tooth wear, local deposition of hard tissue may also occur in the pulp at a slow pace. Sometimes, the rate of hard tissue deposition acceleration may seem to be uncontrolled after dental trauma, autotransplantation, and orthodontic therapy, leading to rapid partial or total obliteration of the root canal space. This situation is called calcific metamorphosis (CM) or pulp canal obliteration (PCO). Although the incidence of pulpal necrosis in these teeth is believed to be infrequent, conventional endodontic therapy in severely calcified canals poses extreme difficulties and a higher risk for procedural accidents. This lecture aims to review the available approaches for the predictable negotiation of calcified canals and to introduce the buckling resistance activation test (BRAT) technique

Navigating crown-originating fractures: a comprehensive insight into the diagnosis, prognosis and treatment of cracked teeth.

Crown-originating fractures (COF) are longitudinal cracks that begin in the crown and extend to varying depths, including craze lines, fractured cusps, cracked teeth, and split teeth. Cracked teeth present a particular challenge in endodontics due to the complexity of diagnosis, treatment planning, and prognosis. Early and precise identification is crucial for improving outcomes, requiring a thorough assessment of dental history, clinical symptoms, and periodontal status. Advanced imaging, such as CBCT, is often essential for evaluating crack progression and bone loss. Management strategies are tailored to the presence and severity of symptoms. While asymptomatic cracked teeth may warrant only close monitoring, symptomatic cases require invariably intervention. Treatment protocols can range from conservative restorative approaches to more invasive interventions, including root canal treatment and full-coverage restorations. Ultimately, treatment decision-making is influenced by the severity of pulpal and periodontal damage, with the contemporary integrated endodontic and restorative protocols factoring in the balance between preserving tooth structure and mitigating further damage.
Prognosis depends largely on the extent of the crack and the measures taken to prevent its further propagation. Crack extension essentially determines the extent of damage to the pulp and periodontal tissues. Historically, teeth presented with crack-associated pulp necrosis and concomitant apical periodontitis as well as endodontically treated cracked teeth were considered to have a guarded prognosis, with cracks with radicular extension negatively impacting tooth retention. While the negative influence of crack depth and periodontal pocketing on long-term treatment success and tooth survival cannot be overlooked, emerging clinical evidence highlights the positive role of refined treatment protocols in preserving compromised cracked teeth.
This presentation will provide an evidence-based framework for diagnosing, managing, and predicting the prognosis of cracked teeth. Participants will gain practical insights to confidently address this complex condition in clinical practice, ultimately enhancing patient care and treatment success

CBCT and Dental Imaging: Pathology Detection and Radiation Safety 

This course provides a comprehensive exploration of the diagnostic power of CBCT and other dental imaging modalities in identifying both local and systemic pathologies. Through case-based analysis, participants will enhance their ability to detect critical pathologies, including malignancies, using CBCT volumes and traditional 2D imaging. The course also delves into the biological effects of ionizing radiation and compares the risks associated with various dental imaging techniques. Attendees will engage in discussions on the latest ADA evidence-based guidelines, gaining practical knowledge to implement radiation safety and protection policies in clinical practice. This course is ideal for clinicians aiming to elevate their diagnostic precision while prioritizing patient safety.

Learning Objectives:
1. Analyze case-based applications of CBCT to diagnose local and systemic non-odontogenic pathologies impacting the dentition.
2. Identify signs of critical pathology and malignancies in CBCT volumes and 2D images.
3- Learn about radiation risk from different dental imaging modalities and ways that ionizing radiation affects the biological tissues and tissues.
4- Discuss the latest evidence-based ADA guidelines on dental radiation safety and protection policies.