From Access To Apex; Current Concepts In Contemporary Endodontics - 2024 DentAlliance Workshop

ROUTE TO THE ROOT AND BEYOND- NAVIGATING ENDODONTIC ACCESS AND CANAL MEDICATION SELECTION

SYNOPSIS:

An appropriate endodontic access lays the foundations for the subsequent steps in endodontic treatment. This lecture will discuss the rationale and evidence of various types of endodontic access cavity designs and highlight common pitfalls. It will also explore commonly used intracanal medicaments and their indications.

OUTLINE OF TOPICS:

ENDODONTIC ACCESS

• Suggestions to deal with difficult-to-isolation cases- Broken down teeth, deep margins, teeth without undercuts, orthodontic wires, severely crowded teeth (split dam, specific clamps, clamping gingiva, resin composite/RMGIC buttons, gingivectomy for deep margins, superglue, stainless-steel band).
• Common pitfalls in endodontic access- insufficient removal of old restoration and caries, no removing pulp chamber calcifications, relying on tactile sensation of ‘drop’ into pulp chamber, attempting to introduce instruments into the canal too early, missing canals (e.g. mid-mesial canal in lower molars, lingual of lower molars).
• Traditional vs conservative vs ninja vs truss- biomechanical differences, impacts on achieving chemomechanical disinfection of the root canal system, risks associated with the ‘ultra-conservative’ approaches.

INTRACANAL MEDICAMENTS

• Types and effects of medicaments: calcium hydroxide (effect of water-based vs PEG vehicle, effect on dentine strength), antibiotic/steroid containing.
• Medicaments for dental trauma- effect of combining medicaments, rationale/evidence for steroid-based medicaments.
• Technique for placement of medicament- hand files vs paper points vs engine-driven vs injection, wet vs dry canals.
• Literature (briefly)- limitations of in vitro studies on bacterial killing, outcomes of in vivo studies.

UNDERSTANDING THE ROOT CANAL SYSTEM: HOW TO MAKE DIFFICULT ROOT CANAL TREATMENTS SIMPLE

SYNOPSIS:

The understanding of the complexity of the root canal system is essential for the correct planning of endodontic treatments, this lecture will show how to use Periapical Radiographs and Cone Beam Computed Tomography
to help in the detection of, and access to difficult root canals including calcified canals, MB2s, isthmuses, lingual canals of mandibular incisors and how to use this information to choose the appropriate rotary files and irrigation techniques for the preparation and disinfection of challenging root canals.

ROTARY NITI INSTRUMENTATION – PRINCIPLES AND PRACTICAL CONSIDERATIONS

SYNOPSIS:

This lecture will describe the biological basis for root canal instrumentation and practical aspects that should be considered.

PENETRATING DEEP INTO THE CHEMICAL SIGNIFICANCE OF ENDODONTIC IRRIGANTS

SYNOPSIS:

This lecture will highlight the indispensable role of root canal irrigation, emphasising its equal importance alongside the mechanical aspect of debridement. Our aim is to explore the biological underpinnings and multifaceted functions of endodontic irrigants, with a focus on microbial eradication, debris dissolution, and delivery methods. Discussions will encompass potential complications, activation methods, and future innovations, underscoring the paramount importance of chemical dynamics in comprehensive endodontic debridement.

FILLING THE ROOT CANAL SYSTEM FOR A PREDICTABLE TREATMENT OUTCOME

SYNOPSIS:

Following an optimal access, debridement, and disinfection of the root canal system, we aim to fill this space 3-dimensionally with close adaptation of the filling material to dentinal walls. This lecture will examine traditional concepts and evaluate contemporary techniques and materials, to propose a strategy to achieve predictable treatment outcome for our patients.

CONTEMPORARY CONSERVATIVE OPTIONS FOR RESTORING AN ENDODONTICALLY TREATED TOOTH WITH EMPHASIS ON DIGITAL ENDODONTICS AND PRESERVATION OF TOOTH

SYNOPSIS:

The final act of the technical aspect of root canal treatment is restoring the tooth to limit coronal leakage and to return the tooth to its proper form, function and aesthetics. The remaining structural integrity of the endodontically treated tooth has been established to be a key marker for its survival. Hence with the advances in resin adhesives and tooth-coloured restorative materials, there is less reliance on retentive and resistance features of tooth preparation and more on bonding and preservation of the tooth especially enamel and the peri cervical dentine. This lecture will discuss concepts reflecting a conservative restorative approach retaining as much natural tooth structure as possible and its impact on endodontic and restorative outcomes.

OUTLINE OF TOPICS:

• This lecture will discuss the pre-operative restorative considerations that include restorability assessment and using digital aids in patient education to discuss treatment options, prognosis and obtaining informed consent.
• Explore evidence-based concepts for restoring anterior and posterior endodontically treated teeth.
• The lecture will examine the application of computer-aided design/computer-aided manufacturing for post-endodontic restorations. Its advantages and limitations will be discussed compared to a more traditional method.
• This presentation aims to discuss the impact of the preservation of teeth on endodontic and restorative outcome.

Hands-On Workshop

Timetable:

08:30 – 09:00    Registration

09:00 – 09:15   Welcome and Q&A session

09:15 – 10:30    Demonstrate the clinical protocol for using ProTaper Ultimate, TruNatomy and WaveOne Gold files using a blend of theory, video and live demonstrations.

10:30 – 10:45    Morning break

10:45 – 12:45    Hands-on exercises on plastic and extracted teeth.

12:45 – 13:30    Lunch

13:30 – 15:00   Lecture and demonstration of obturating root canals with Gutta-Smart System and using calcium silicate sealers. Hands-on obturating root canals on extracted teeth.

15:00– 15:15    Afternoon break

15:15 – 16:00   Hands-on obturating root canals on extracted teeth.

16:00 – 16:30   Q and A and Certificate of Attendance