Roots Summit 2021 Prague

The advent of MTA two decades ago brought about a significant change in the clinical practice of endodontics: a material that suited our workspace and the periradicular tissue perfectly. It has been extensively investigated in in vitro, animal and clinical studies. It has been used from the coronal-most application in the tooth as a pulp capping material to the apical end as a root end filling material. With due diligence in the literature, the material has our academic and investigative endorsement. However, there are limitations to the use of MTA, for example the inability to use it for routine obturation, its handling properties and its tendency to cause discoloration. Materials scientists in recent years have introduced several new and improved versions of bioceramics to the field. The lecture will provide an overview of the current research in the literature on bioceramics. Clinical cases will be presented, demonstrating application, advantages and disadvantages in various aspects of endodontics.

After this lecture, participants should be:

1. able to understand the concept of bioactivity especially as an obturation material;
2. aware of key literature on bioceramics pertaining to use in endodontics; and
3. able to recognize various clinical scenarios where the material can be used effectively.

Lesions are the result of the evolution of apical periodontitis and are due to bacterial proliferation. Sometimes, root canal disinfection allows, with endodontic treatment only, healing with a suspension of clinical signs and complete tissue regeneration. However, when a large periapical lesion is diagnosed radiographically, most of the time, the first idea is to ask how to eliminate it and then who can remove it surgically: the general practitioner, the oral surgeon or possibly the endodontist.

But could we consider that a simple endodontic treatment can solve this problem, without any surgery? In fact, faced with this situation, the first step is a precise diagnosis to determine the origin of the lesion and ensure that it is a lesion of endodontic origin, in order to avoid treating endodontically vital teeth or performing unnecessary surgery. Different tests will be necessary (vitality tests, CBCT and clinical examination) and the analysis of the results and their comparison with the patient’s perception will allow us to make this diagnosis and to determine our therapeutic choice between an endodontic or surgical treatment or both. Throughout this presentation, the participants will learn to diagnose and treat large periapical lesions on the basis of many clinical cases.

After this lecture, participants should

1. know how to make a differential diagnosis of large lesions;
2. know how to choose the right treatment planning; and
3. know how to decide on the use of bone tissue regeneration.

Literature has shown that there is a tendency in the endodontic community to avoid challenging conditions owing to factors associated with a lack of surgical training and practice, the perception of the surgical endodontic procedures by our referrals and other specialists, and financial aspects. Over the last 20 years, the practice of endodontic surgery has changed dramatically. The development of microsurgical procedures, the capability of diagnosing, treatment planning and assessing our surgical cases with the use of computed tomography, the constant development of guided tissue/osseous regeneration techniques, and the use of 3- D printed surgical guides have allowed us, as clinicians, to confront the most challenging cases. The purpose of this lecture is to provide a clinical discussion of multiple challenging conditions faced during the daily practice of surgical endodontics based on a solid literature review.

After this lecture, participants should be able to

1. evaluate and discuss the impact of microsurgical endodontics in challenging cases such as mandibular second molars, anatomically complex mandibular premolars and palatal roots of maxillary molars;
2. evaluate the significance of CBCT as a tool for the surgical endodontic management of complex cases, from diagnosis and treatment planning to the final outcome; and
3. describe and discuss multiple GTR and GBR techniques associated with surgical endodontic complex cases (allografts with membranes, PRF, Emdogain).

The treatment alternatives for apical periodontitis include nonsurgical endodontic retreatment, surgical endodontic treatment, or tooth extraction, and in certain cases, a follow-up protocol may be considered. The long-term prognosis, the alternatives in case of treatment failure, post-treatment quality of life, and patient’s preferences should all be recognized and incorporated in the treatment choice considerations. A decision on intervention for an endodontically treated tooth with a periapical radiolucency should be based on the technical feasibility of the treatment, systemic factors and patient values. This presentation will discuss a patient-focused clinical decision-making process regarding the management and preservation of natural teeth based on the principles of evidence-based medicine.

After this lecture, participants should be able to

1. identify the main reasons for the persistence of endodontic disease and possible treatment alternatives;
3. recognize the possibilities and limitations of modern endodontic treatment; and
4. incorporate an evidence-based approach in the decision-making process on treatment choice.

Long-term data show that survival of nonvital teeth has always been a challenge. Both endodontic and restorative dentistry contribute critically to the treatment outcome. The presented concept of care has been developed by both endodontists and prosthodontists over 18 years of cooperation. It is based on four main ideas common to both fields: tissue preservation (unnecessary hard dental tissue loss should be prevented); replacement with similar materials (lost tissue should be replaced with material of similar physical properties); adhesion (all components of reconstruction should adhere to each other) and safety (when failure occurs, it should not be catastrophic).Over the years, the protocol has been extended from nonvital teeth only to teeth with compromised integrity and challenged vitality. The endodontist delivers a ready-to-use abutment tooth free of pathology for the final reconstruction regardless of the tooth vitality. In this lecture, the decision-making process, material selection, complete workflow and long-term outcomes will be presented.

After this lecture, participants should be able to

1. identify clinically relevant factors for reconstruction of nonvital teeth and teeth with challenged vitality;
2. indicate the need for different adhesive tools to construct the build-up of the abutment tooth with fiber posts and various resin composites; and
3. describe critical details of ideal final restoration of nonvital teeth.

Clinical studies demonstrate that long-term prognosis of root filled teeth is influenced by the quality of the restoration, as well as by the quality of the root canal therapy itself. The most recent trends in the restoration of endodontically treated teeth follow the concept of minimally invasive dentistry, proposing more conservative, less expensive and bioeconomic restorations, based mostly on adhesive dentistry and the introduction of new materials and technologies. Following these trends, access procedures in endodontics and root canal preparation are changing in a conservative way, sometimes drastically if compared with the traditional concepts of cavity outline opening and coronal straight-line access to reach the apical region. The endodontic literature appears to be poor on demonstrating how these minimally invasive access procedures can influence the quality and prognosis of root canal therapy. This lecture will analyze the technical procedures of minimally invasive access and preparation in different clinical situations and the possible mechanical improvements derived from these. Moreover, the limits of these procedures will be critically analyzed to define how minimally invasive clinicians should be in order to ensure gold standard endodontic treatments.

After this lecture, participants should

1. understand the basic concepts of minimally invasive endodontic procedures;
2. be able to apply new strategies to optimize minimally invasive endodontic procedures; and
3. be able to evaluate critically the advantages and disadvantages of present technologies, instruments and techniques.

In recent years, primary endodontic treatment, nonsurgical retreatment and microscopical surgery have achieved success rates of around 90 percent. However, there are situations in which the tooth cannot be saved using these techniques. The first part of this lecture will discuss intentional replantation. This is an accepted endodontic treatment procedure in which a tooth is extracted and treated outside the oral cavity and then reinserted into its socket to correct an obvious radiographic or clinical endodontic failure. It should not be considered a last-resort treatment prescribed only for “hopeless” teeth as proposed by Grossman. Although intentional replantation is not a frequently performed procedure, it yields a tooth survival rate of 88 percent according to a recent meta-analysis. In addition, the new advances in computer-aided rapid prototyping (CARP) models (tooth replicas) and 3-D printed guiding templates allow us to apply this technique in a much more predictable way.

In situations where the tooth cannot be saved, there is the option of performing an autotransplant (both open and closed apex). The complications observed in the past can be overcome thanks to advances in diagnostic and surgical techniques, particularly CARP models and 3-D printed guiding templates. The digital planning not only allows for selection of the most suitable donor tooth according to tooth morphology, but also shows the ideal 3-D position and the required dimensions of the alveolus during surgery. Moreover, the use of tooth replicas can reduce the additional socket time and possible donor tooth injury during the procedure. Through the results of two in vivo investigations, as well as clinical cases and videos, we will teach the digital step by step to plan all types of cases.

After this lecture, participants should

1. know the main indications for intentional replantation, as well as how to digitally plan the whole process;
2. know the advantages and possible complications of tooth autotransplantation; and
3. know the indications for the different types of autotransplantation: fresh extraction sockets, early extraction sockets with soft-tissue healing, early extraction sockets with partial bone healing, and surgically created sockets.

This lecture will focus on some decision-making steps during endodontic clinical procedures in the dental office. The current standard of care requires dentists to base their actions on scientific evidence and to be able to put that evidence into clinical practice while keeping in focus the patient’s quality of life during the treatment. We will follow some important guidelines for clinical endodontics and will exemplify them with clinical cases that reflect the diagnosis and treatment spectrum of a general dental office.

After this lecture, participants should:

1. have a clearer decision-making algorithm for their clinical work;
2. be able to understand how to start making their own clinical decision flowcharts for different endodontic procedures; and
3. have a better understanding of the possible outcomes of different treatment paths.

Music by Stephane Browet aka DJ ZeVoize & Bojidar Kafelov aka DJ DocOne.
Tickets include buffet and unlimited beer, wine, or soft drinks.

Irrigation is very much in the forefront of endodontic research and critical to successful patient outcomes in endodontics. In his lecture, Dr. Buchanan will go in depth to show you the advances and advantages of closed system negative pressure irrigation. He will also provide a full analysis of the effectiveness of the various devices available ranging in cost from the equivalent of a pack of endodontic files, to the price of a new sports car.

After this lecture, participants should be able to understand

1. advances and advantages of closed system negative pressure;
2. effectiveness of the various devices; and
3. how best to apply the various irrigation technologies.

This lecture will address the use of CBCT in endodontics for diagnosis, the treatment plan, access cavity design, working length determination, management of complex cases, obturation, restoration, follow-up and surgery. The various steps of the dental treatment will analyze the differences between 2-D and 3-D radiographs to demonstrate the benefits of routine use of CBCT technology. There will also be a focus on the use of clinical software for case assessment and navigation systems using 3-D CBCT images.

After this lecture, participants should

1. understand the advantages of CBCT in all the phases of endodontic treatment;
2. know how CBCT can be associated with endodontic and static/dynamic navigation software; and
3. be able to evaluate the possible use of dynamic navigation systems in surgical and nonsurgical endodontic treatment.

Clinical management of calcified teeth provides an endodontic treatment challenge and makes up a significant portion of current endodontic practice. Searching for calcified root canals can be challenging and time-consuming and may create a huge loss of tooth structure that is associated with a high risk of fracture and perforation, compromising the prognosis of the tooth. Nowadays, the use of new technologies has increased the predictability of the treatment of calcified teeth. A new clinical approach to a tooth with pulp canal obliteration, called guided endodontics, has been introduced. This technique uses a guiding template, which facilitates the localization of severely calcified root canals. In this lecture, the approach to this clinical challenge will be discussed on the basis of clinical cases, and tips and tricks will be provided in order to achieve the mechanical and biological goals of endodontic treatment.

After this lecture, participants should

1. understand the pulp canal obliteration process and know how to address this endodontic challenge clinically;
2. know how to perform root canal access through the freehand approach; and
3. know how to perform root canal access through the static guided approach.

This lecture will discuss what we need to do to obtain adequate disinfection of the root canal system with subsequent healing of periapical lesions. The most important aspect in this context are 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. While many clinicians are aware of the macroanatomy of root canal systems, fewer consider microanatomy.

After this lecture, participants should be able to

1. appreciate the importance of diagnostics and anatomy in current and future treatment concepts;
2. understand the efficacy versus the effectiveness of different protocols under different conditions; and
3. understand the core characteristics and interactions of the main chemical agents used in root canal cleansing.