Program

This lecture will discuss what we need to do to get adequate disinfection of the root canal system with subsequent healing of periapical lesions. The most important aspect in this context is neither new tools nor special disinfectants, but a thorough understanding of the actual case we are treating. It will be shown that not all endodontic cases are equal, and how we can address the more difficult cases by choosing our approach wisely. One core issue is timing. How much time are we prepared to spend on a case, and what is best for our patient? In this context, the effectiveness and compatibility of the means we use to debride and disinfect are key. The other core issue is anatomy. Whilst many clinicians are aware of the macro anatomy of root canal systems, fewer consider micro anatomy.

Learning objectives:

• Appreciate the importance of diagnostics and anatomy in current and future treatment concepts.
• Understanding the efficacy versus the effectiveness of different protocols under different conditions.
• Knowing the core characteristics and interactions of the main chemical agents used in root canal cleansing.

An accurate diagnosis is fundamental for the determination of an appropriate treatment plan. The majority of cases can be resolved in a simplified way, however, in others its characteristics can cover the diagnosis needing more invasive complementary tests to understand the etiology. In fact, the use of diagnostic tests can actually present a high level of doubt. Therefore, when faced with cases of complex diagnosis it is important to implement scientific knowledge and common sense unified with the capacity to interpret results of the complementary tests, decide the prognosis and to do an appropriate selection of the case within the first phase towards a successful treatment.

Management of dental trauma is a team sport, involving a coordinated multi-disciplinary approach to benefit our patients. Optimum and timely management becomes more critical when trauma involves growing individuals. This case-based presentation will cover a variety of scenarios such as lateral luxation, crown root fractures, intrusion, and avulsion in growing individuals. Preparation and a systematic checklist can reduce the incidence of complications resulting from inappropriate management.

Learning objectives:

• Learning about the role of inter-disciplinary treatment planning for optimum management of dental trauma.
• Understanding different treatment trauma scenarios, treatment options, and limitations of the same.
• Participants should be able to develop a dental trauma management checklist.

Vertical root fractures in endodontically treated teeth were considered for a long time a vexing and frustrating issue both for the clinician and the patient alike. In recent years this complication of root canal treatment had showed both advances in VRF diagnosis and in saving from extraction in some of these teeth.

The diagnosis of a vertically fractured tooth has to be done accurately and in timely manner due to the destructive results in the supporting bone if not achieved in time. The use of CBCT as an additional diagnostic tool, enhances the possibility to achieve accurate VRF diagnosis, although some drawbacks in this imaging modality still exists.

When considering saving a tooth with a vertical root fracture (VRF), it's important to take into account endodontic, periodontal, and prosthetic considerations. Treatment options of a VRF tooth vary from simple root amputation in multirooted teeth to a more complex surgical management in order to retain the fractured tooth.

Learning objectives:

• Describe the importance of achieving accurate and timely manner VRF diagnosis.
• List the recent advances in VRF diagnosis imaging modalities.
• Discuss the various considerations to save a vertically fractured tooth.

This presentation will explore the objectives of restorative treatment for endodontically treated teeth, focusing on the essential goals such treatments should achieve. Criteria used to select the most suitable restorative treatment based on various clinical scenarios will be discussed. Additionally, the lecture will provide a detailed, step-by-step overview of different restorative alternatives for compromised endodontically treated teeth, along with their respective advantages and limitations.

This presentation will show the effects of radiation therapy on dental structures and its implication on endodontic treatment and will provide new perspectives for endodontic therapy in irradiated patients. Additionally, the ideal time frame in which to perform endodontics in order to obtain a more effective endodontic treatment with a greater chance of success will be discussed.

The replacement of a failing anterior tooth by means of a dental implant is one of the most challenging treatments clinicians face nowadays, as the aesthetic expectations of patients are increasing. Nevertheless, the timing of extraction of a failing anterior tooth in relation to the placement of a dental implant and its impact on aesthetic outcomes has been extensively evaluated. The aim of this lecture is to depict an evidence-based analysis, illustrated with clinical cases, of the aesthetic outcomes that can be expected depending on the alveolar architecture present at the time of extraction, the need for regenerative therapy and the timing of implant placement.

Learning objectives:

• Understanding the importance of alveolar architecture in the aesthetic outcome of a single tooth replacement.
• Comparing aesthetic outcomes of implant placement in the aesthetic zone based on the time of extraction.
• Understanding the aesthetic outcome of preservative and regenerative treatment philosophies.

In complex implant treatment plans, the option of autotransplantation of teeth (ATT) is often overlooked. When recipient sites present challenges for implant placement, necessitating additional time, costs, and specialised techniques, ATT can emerge as a more suitable alternative, especially if there is a viable donor tooth available within the same mouth. For instances requiring sinus lifting or ridge augmentation, ATT can be a preferable and advantageous choice. Particularly for patients under twenty years of age, implants are hardly indicated. This presentation will explore the indications, benefits, and techniques essential for successful ATT, and will be enriched with numerous clinical case studies, including those involving intentional replantation.

Learning objectives:

• Learning about wound healing in ATT.
• Learning the techniques and indications of ATT.
• Learning when intentional replantation works.

The triad of success in modern clinical endodontics is magnification, 3D radiographic visualisation and microsurgery. These, along with the most recent technological advancements in instrumentation, antimicrobial disinfection as well as the modern bioceramic sealing materials, can turn cases with a guarded prognosis into success. A correct diagnosis based on CBCT and a careful case selection can lead to a predictable healing for lesions of endodontic origin. At the same time, under certain anatomical or biological circumstances and/or after iatrogenic interference, conventional endodontic treatment or retreatment might not result in a positive outcome. This may necessitate the execution of surgical retreatment. This comprehensive lecture aims to highlight the clinical approach for challenging cases with previous failed endodontic intervention, iatrogenic mishaps and persistent periradicular pathology. A rationale for the management of this kind of cases will be thoroughly discussed.

Learning objectives:

• Understanding the reasons for failure and persistence of apical pathology in complex endodontic cases.
• Developing a strategy for management of challenging cases by selecting non-surgical or surgical endodontic treatment or a combination thereof.
• Comprehending the rationale for proper case selection in the treatment of lesions of endodontic origin.

This presentation will explain the difference between the radiographic appearance of normal versus the appearance of abnormal or pathologic structures. The significance of various radiographic modalities, along with the potential for mishaps and misdiagnoses inherent to each modality, will be examined and the methods for preventing radiographic mishaps will be discussed.

Learning objectives:

• Learning the technical factors contributing to an ideal radiographic image.
• Understanding the anatomical considerations affecting endodontic radiographic diagnosis and treatment.
• Spotting dental anomalies and radiolucent lesions of nonodontogenic origins.
• Learning about mishaps during postoperative endodontic radiographic examination.
• Understanding the use of CBCT to minimise mishaps during endodontic radiographic diagnosis and treatment planning.

Occasionally, instruments cannot be advanced to full working length during root canal instrumentation. This may be due to calcifications, ledge formation, or canal blockage by foreign objects such as separated instruments. All these clinical scenarios and accidents might affect treatment outcomes if the canals below the blockages are infected. Bypassing calcifications, ledges and broken files will re-establish the previously blocked canal pathway enabling full-length disinfection procedures to take place. This lecture is designed to highlight the instruments, techniques and skills required for a successful bypassing procedure.

Learning objectives:

• Understand the problem of calcified canals.
• Understand the mechanism of ledge formation and file breakage.
• Understand how to manage calcified canals.
• Understand how to bypass and eliminate ledges.
• Understand how to bypass and remove broken files.
• Take away tips and tricks to use in the everyday practice.