Endodontic Outcomes

Endodontic Outcomes

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  • Includes Credits

    CE Hours: 1.75

    Description: When a patient has persistent pain after root canal treatment it can be disruptive to a practitioner’s schedule and psyche. The first part of this two-part session will give practitioners a review of practice-based research outcomes on persistent pain, differential diagnosis for persistent pain following root canal treatment, pharmacologic management of persistent pain on the neurobiology of pain. The second part of the session will present cases of patients with persistent post-treatment pain, diagnostic and treatment considerations, and pharmacologic management, with opportunities for audience questions.

    Learning Objectives: 

    • Discuss treatment options for managing persistent pain following endodontic treatment.
    • Discuss pharmacologic management of persistent pain.
    • Discuss how endodontists can work with facial pain practitioners to manage patients with persistent pain.


    Alan S. Law, DDS, PhD

    Dr. Alan Law received his Doctor of Dental Surgery and Certificate in Endodontics from the University of Iowa College of Dentistry, Iowa City, Iowa. He also completed his PhD, “Mechanisms and Modulation of Orofacial Pain”, with the Department of Pharmacology at the University of Iowa. Dr. Law has published over 40 articles in scientific and clinical journals, and has co-authored chapters on The Non-Odontogenic Toothache and Regenerative Endodontics in Pathways of the Pulp, and has lectured at over 300 local, national and international meetings. Dr. Law is a member the American Dental Association, American Association of Endodontics, and Omicron Kappa Upsilon Dental Honor Society, and a Fellow of the American College of Dentists and the International College of Dentists. He is a Past President of the American Association of Endodontists, Past President of the Minnesota Association of Endodontists, and Past President of the American Board of Endodontics. He is in full –time practice in the Twin Cities, and President of The Dental Specialists, a multi-specialty dental practice with over 35 specialists. He is also a Research Professor in the Division of Endodontics at the University of Minnesota.

    Speaker Disclosure

    In accordance with this policy, I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: National Dental Practice-Based Research Network and the American Dental Association.

    Karen Baker, BSRPh, MS

    Professor Karen Baker has been on the Dental College faculty at the University of Iowa for over 40 years and occupies a unique role in dental practice and education. She is a clinical pharmacist with a Master’s degree in clinical pharmacology and therapeutics and is focused on patient-specific dental drug therapy. She has given well over 1000 invited programs nationally and internationally and holds memberships in many dental and clinical pharmacology and therapeutics organizations. Her dental education-based pharmacy and drug therapy consultation center is the only one in the United States. She has authored many articles and abstracts and lectures extensively in pre-doctoral and graduate courses at the University of Iowa.

    Speaker Disclosure 

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

  • Includes Credits

    CE Hours: 1.25

    Description: When a patient has persistent pain after root canal treatment it can be disruptive to a practitioner’s schedule and psyche. The first part of this two-part session will give practitioners a review of practice-based research outcomes on persistent pain, differential diagnosis for persistent pain following root canal treatment, pharmacologic management of persistent pain on the neurobiology of pain. The second part of the session will present cases of patients with persistent post-treatment pain, diagnostic and treatment considerations, and pharmacologic management, with opportunities for audience questions.

    Learning Objectives: 

    • Discuss the frequency of persistent pain following root canal treatment based upon results of recent practice-based research.
    • Discuss potential predictors of persistent pain following root canal treatment based upon results of recent practice-based research.
    • Discuss a differential diagnosis for persistent pain following root canal treatment


    Alan S. Law, DDS, PhD

    Dr. Alan Law received his Doctor of Dental Surgery and Certificate in Endodontics from the University of Iowa College of Dentistry, Iowa City, Iowa. He also completed his PhD, “Mechanisms and Modulation of Orofacial Pain”, with the Department of Pharmacology at the University of Iowa. Dr. Law has published over 40 articles in scientific and clinical journals, and has co-authored chapters on The Non-Odontogenic Toothache and Regenerative Endodontics in Pathways of the Pulp, and has lectured at over 300 local, national and international meetings. Dr. Law is a member the American Dental Association, American Association of Endodontics, and Omicron Kappa Upsilon Dental Honor Society, and a Fellow of the American College of Dentists and the International College of Dentists. He is a Past President of the American Association of Endodontists, Past President of the Minnesota Association of Endodontists, and Past President of the American Board of Endodontics. He is in full –time practice in the Twin Cities, and President of The Dental Specialists, a multi-specialty dental practice with over 35 specialists. He is also a Research Professor in the Division of Endodontics at the University of Minnesota.

    Speaker Disclosure

    In accordance with this policy, I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: National Dental Practice-Based Research Network and the American Dental Association.

    Karen Baker, BSRPh, MS

    Professor Karen Baker has been on the Dental College faculty at the University of Iowa for over 40 years and occupies a unique role in dental practice and education. She is a clinical pharmacist with a Master’s degree in clinical pharmacology and therapeutics and is focused on patient-specific dental drug therapy. She has given well over 1000 invited programs nationally and internationally and holds memberships in many dental and clinical pharmacology and therapeutics organizations. Her dental education-based pharmacy and drug therapy consultation center is the only one in the United States. She has authored many articles and abstracts and lectures extensively in pre-doctoral and graduate courses at the University of Iowa.

    Speaker Disclosure 

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

  • Product not yet rated Includes Credits

    CE Hours: 1.0

    Description: This epidemiological analysis used procedure codes from dental insurance claims data to identify apexification cases and evaluate survival at the toothlevel.

    At the conclusion of this article, the reader will be able to: 

    • Describe the survival of apexification procedures, with an average follow-up time of 64 months, performed in a United States population.
    • Compare survival rates of apexification reported in this study to success rates of apexification previously reported in the endodontic literature.
    • Describe potential barriers to access to care for treatment for immature permanent teeth, as discussed in this manuscript.

    Lorel E. Burns, D.D.S.

    Dr. Lorel Burns is a clinician-investigator and assistant professor at New York University (NYU) College of Dentistry. She is a Diplomate of the American Board of Endodontics. Dr. Burns earned her DDS degree at NYU College of Dentistry, completed her specialty training in Endodontics at the University of Pennsylvania School of Dental Medicine and was awarded her master’s degree in Clinical Investigation by NYU School of Medicine. In 2019, she was selected as the American Association of Endodontists (AAE) Foundation’s Endodontic Educator Fellow. In 2022, she recognized with the American Dental Education Association (ADEA) Junior Faculty Award. Dr. Burns’ research interests include endodontic treatment outcomes, access to dental care, clinician decision-making, and dental education. Her research has been funded by the National
    Institutes of Health (NIH)/ National Institute of Dental and Craniofacial Research (NIDCR), the Robert Wood Johnson Foundation (RWJF), and the American Dental Education Association, ADEAGies Foundation. Her work has been published in peer- reviewed journals including the Journal of Endodontics (JOE), the International Endodontic Journal (IEJ), the Journal of the American Dental Association (JADA), and the Journal of Dental Education (JDE). Dr. Burns maintains part-time private practice limited to Endodontics in New York, USA.

    Speaker Disclosure:

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

    Nihan Gencerliler, MPH

    Nihan Gencerliler has a master’s degree in public health, with an advanced certificate in applied biostatistics. She participated in this study as an Assistant Research Scientist in the Department of Endodontics and New York University College if Dentistry.

    Kelly Terlizzi, MS

    Kelly Terlizzi has a master’s degree in clinical research. She participated in this study as an Analyst at New York University Health Evaluation and Analytics Lab.

    Claudia Solis-Roman, MSc, MPA

    Claudia Solis-Roman has master’s degrees in public administration and applied statistics. She participated in this study as a Lead Analyst at New York University Health Evaluation and Analytics Lab.

    Asgeir Sigurdsson, D.D.S., M.S.

    DDS from University of Iceland. Graduated from University of North Carolina (UNC) in 1992, with certificate in endodontics and MS. Full time faculty at UNC 1992-2004, was the Graduate Program Director of Endodontics 1997 to 2004. From 2004 to 2012 in a private endodontic practice in Reykjavik, Iceland and London, UK and Honorary Clinical Teacher in Endodontology, UCL Eastman Dental Institute, UK. In 2012, he became the Chairman and tenured Professor at NYU Dentistry, Department of Endodontics. Additionally, he is an adjunct Professor at UNC. Dr. Sigurdsson is past President of the International Association for Dental Traumatology and 2014 he was appointed as a Director of the American Board of Endodontics and served as the President of the Board 2019-20. He is currently on the editorial board of Dental Traumatology. Dr. Sigurdsson has been invited numerous times to lecture in 47 countries all over the world, on the topics of pain, endodontics, dental trauma and/or forensic sciences. He has written or co-written over 85 per-reviewed articles and 23 textbook chapters on same topics. 

    Speaker Disclosure:

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

    Heather T. Gold, PhD

    Dr. Heather T. Gold is a Professor in the Department of Population Health and NYU Langone Health. She has a health economist and health services researcher.

  • Includes Credits

    CE Hours: 1.0

    Description: This presentation will review recent endodontic outcomes literature on initial, non-surgical root canal therapy and discuss how changes in endodontic treatment, over time, have impacted outcomes. Barriers and proposed solutions to assessing endodontic treatment outcomes will be discussed.

    Learning Objectives:  

    • Describe how endodontic treatment outcomes for initial, non-surgical root canal therapy have changed over time
    • Describe the most significant factors contributing to outcomes of non-surgical root canal therapy
    • Articulate methodological barriers to researching endodontic treatment outcomes

    Lorel E. Burns, D.D.S.

    Dr. Lorel Burns is a clinician-investigator and assistant professor at New York University (NYU) College of Dentistry. She is a Diplomate of the American Board of Endodontics. Dr. Burns earned her DDS degree at NYU College of Dentistry, completed her specialty training in Endodontics at the University of Pennsylvania School of Dental Medicine and was awarded her master’s degree in Clinical Investigation by NYU School of Medicine. In 2019, she was selected as the American Association of Endodontists (AAE) Foundation’s Endodontic Educator Fellow. In 2022, she recognized with the American Dental Education Association (ADEA) Junior Faculty Award. Dr. Burns’ research interests include endodontic treatment outcomes, access to dental care, clinician decision-making, and dental education. Her research has been funded by the National
    Institutes of Health (NIH)/ National Institute of Dental and Craniofacial Research (NIDCR), the Robert Wood Johnson Foundation (RWJF), and the American Dental Education Association, ADEAGies Foundation. Her work has been published in peer- reviewed journals including the Journal of Endodontics (JOE), the International Endodontic Journal (IEJ), the Journal of the American Dental Association (JADA), and the Journal of Dental Education (JDE). Dr. Burns maintains part-time private practice limited to Endodontics in New York, USA.

    Speaker Disclosure:

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

  • Includes Credits

    CE Hours: 0.75

    Description: Operative field isolation is the standard of care for root canal treatments even in complex cases as prosthetic abutments, teeth with a severely damaged crown or during combined endodontics and restorative open-flap procedures. 

    The presence of leakage is recognized to be an unfavorable prognostic factor for therapy outcome. A proper isolation has to be carefully planned and it can affect the whole treatment plan for the recovery of the tooth. According with techniques and available materials, generally the clinician has many possibilities to get a proper isolation: before starting the treatment a deep and a proper analysis of pro and cons has to be done to decide the more convenient technique to apply.
    The aim of this case-based presentation is to provide a practical guide for a fruitful isolation of challenging situations in endodontics, sharing protocols to get easily the leakage control, saving time and number of appointments for the recovery of the tooth.

    Learning Objectives:  

    • Evaluate the role of isolation in the outcome and in the treatment plan
    • Implement strategies to get a proper leakage control in complex cases
    • Perform a very effective and easy technique for leakage control in endodontics and / or conservative open-flap procedures

    Filippo Cardinali, D.D.S.

    Graduate summa cum laude in Dentistry and Dental Prosthesis at the University of Ancona in 1992. Vice-President and Active Member of the Italian Society of Endodontics. Certified Member of the European Society of Endodontology. Associate Member American Association of Endodontists. Gold Member of Styleitaliano Endodontics. Co-author of the book “Testo Atlante di Anatomia Endodontica" published by Tecniche Nuove in 2011. Co-author of the book “Isolamento del campo operatorio" published by ANDI Servizi in 2013. Co-author of the book "Manuale di Endodonzia" published by Elsevier Masson Italy in 2013. Co-author of the iBook “The Isolation Game” published in Apple iBook Stores Co-author of the book “Ritrattamenti: soluzioni per le patologie apicali di origine endodontica" published by EDRA in 2018 available even in English and Spanish language. Lecturer in theoretical and practical courses on subjects related to the isolation of the operative field and endodontics, has participated as a speaker at courses and conferences in Italy and abroad. Private practice, concentrating mainly in Endodontics and Restorative Dentistry and author of publications on journals of national and international sector.

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

  • Product not yet rated Includes Credits

    CE Hours: 1.5

    Description: When orthograde retreatment and apical microsurgery are considered unfeasible, when they fail to resolve persistent endodontic infection, or when the remaining tooth structure is deemed non-restorable, the tooth is usually extracted and replaced with an implant or another prosthetic device. Alternatively, when clinical conditions permit, the tooth can be extracted, manipulated extra-orally and replanted (Intentional Replantation, Surgical Extrusion), or a non-strategic tooth can be transplanted into the socket of the extracted tooth (Autogenous Transplantation). These seemingly radical but rather simple procedures offer predictably good outcomes when the biologic principles of tooth replantation are respected. 

    This lecture will discuss the procedures of Intentional Replantation/Transplantation in a contemporary context, as predictable means for retaining otherwise “untreatable” teeth to greatly benefit patients. Strict guidelines for case selection, a step-by-step protocol and a variety of clinical applications will be outlined and illustrated with typical cases. Reported outcomes will also be highlighted for various clinical applications of both procedures.

    Learning Objectives:  

    • Describe the procedural guidelines and steps for Intentional Replantation, Surgical Extrusion and Autogenous Transplantation aimed to prevent external root resorption and persistent infection
    • Outline the indications for Intentional Replantation and Autogenous Transplantation
    • Summarize the long-term outcomes of Intentional Replantation, Surgical Extrusion and Autogenous Transplantation

    Shimon Friedman, D.M.D.

    Dr. Shimon Friedman is Professor Emeritus, former Head of Endodontics and Founding Director of the M.Sc. Endodontics Program at the Faculty of Dentistry, University of Toronto, Canada. He received the D.M.D. degree (1975) and endodontics certificate (1983) from the Hebrew University in Jerusalem, Israel. He is board-certified in endodontics in Israel and had served as Chairman of the Israel Endodontic Society from 1985 to 1988. With over 250 peer-reviewed articles, textbook chapters and research abstracts, and over 330 international lectures, Dr. Friedman has acquired extensive experience in endodontic practice, research and education. He is the recipient of several awards, culminating in the AAE’s 2008 Louis I. Grossman Award, as well as the AAE's 2018 I.B. Bender Lifetime Educator Award, for outstanding contributions to endodontic science and education. Though now retired, Dr. Friedman continues following the research and lecturing extensively on endodontic treatment outcomes, management of post-treatment endodontic infection, and impacts of contracted endodontic cavity designs on nonsurgical treatment efficacy and biomechanical responses of teeth. 

    Speaker Disclosure

    In accordance with this policy, I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: Sonendo Inc.: Ownership Interest (stocks, stock options, patent or other intellectual property or other ownership interest excluding diversified mutual funds) (Ongoing), Scientific Advisory Board member (Ongoing)

  • Includes Credits

    CE Hours: 1.5 

    Description: The regenerative endodontic protocol is a unique option for immature necrotic teeth and brings the opportunity to the endodontist to enable the mesenchymal stem cells healing potential. Although there are some clinical situations that still need stronger evidence when selecting the cases, the current research supports the key factors that influence the outcome. Nevertheless, when the pulp is still vital, the evidence emphasizes the importance of its preservation. This presentation will focus on discussing the variables and protocols to apply in your practice, and the future directions to overcome current challenges in regenerative endodontics.

    Learning Objectives:  

    • Explain and support the basic concepts behind the regenerative endodontic procedures and adverse events
    • Describe the expected outcomes in regenerative endodontics based on key predisposing factors
    • Discuss the future direction of regenerative endodontic procedures to overcome the current challenges

    Tatiana M. Botero, D.D.S., M.S.

    Dr. Botero received her dental degree (DDS, 1987) from CES University in Medellin, Colombia, Specialty training in Endodontics at Pontificia Universidad Javeriana in Bogotá, Colombia (1995) and the advanced Specialty Certificate in Endodontics from University of Michigan in 2005. She was Clinical Assistant Professor at CES University and had her private practice in Colombia (1989-2000). Dr. Botero joined the University of Michigan in 2001 and presently she is full time Clinical Professor and teaches Endodontics to graduate and undergraduate students. She is the director of the dental postgraduate fellowship program in endodontics. She also practices Endodontics at a private Dental clinic in Michigan. In 2012 Dr. Botero became a Diplomate of the American Board of Endodontics and she joined the Regenerative Endodontic committee from the American Association of Endodontics since 2013 and chair 2014-2020. She is Past-president of the Pulp Biology and Regeneration group of the American Association and International Association of Dental Research. Dr. Botero has authored and co-authored numerous scientific peer reviewed articles and book chapters. She serves as reviewer for several endodontic and dental journals. Her research of interest and publications are on caries-induced angiogenesis and Regenerative Endodontics.

    Speaker Disclosure

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

  • Includes Credits

    CE Hours: 1.0

    Description: The oral cavity is home to hundreds of bacterial species living in complex microbial communities commonly referred to as oral biofilms. Increasing evidence suggests that interactions among members of these communities play an important role in common oral diseases such as dental caries and periodontal disease. This presentation's goal is to highlight some recent advances in oral microbiome research as it relates to endodontic research.

    Learning Objectives:  

    • Discuss how the oral microbiome can affect systemic health
    • Describe different "omics" approaches and how they can provide new insight into factors contributing to endodontic infections
    • List at least one of the key take-home points from at least one recent study that has used metagenomics to assess an endodontic problem

    Bruno P. Lima, DDS, PhD

    Bruno Lima, DDS, PhD, is an assistant professor at the University of Minnesota, School of Dentistry in the Department of Diagnostic and Biological Sciences. Dr. Lima received his dental degree from the Federal University of Rio Grande do Norte in Brazil before moving to the US to pursue his PhD in Microbiology and Immunology at Loyola University Chicago. His research focuses on understanding how bacteria interact with their environment and the consequence of these interactions on their physiology. As a dentist, Dr. Lima is particularly interested in studying how different environmental interactions affect dental plaque development and whether these interactions can be manipulated to promote oral health. Dr. Lima has authored several peer-reviewed articles and has received funding from the National Institute of Dental and Craniofacial Research (NIDCR) since 2018. In 2020 he was selected as the recipient of the 2020 American Association of Dental Research (AADR)/Procter & Gamble Underrepresented Faculty Research Fellowship and the AADR Mentoring an Inclusive Network for a Diverse Workforce of the Future (MIND the Future). He currently serves as a member of the American Association for Dental Oral and Craniofacial Research (AADOCR) Committee on Diversity and Inclusion.

    Speaker Disclosure 

    I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.

  • Includes Credits

    CE Hours: 0.75

    Description: Apical periodontitis (AP) is the inflammatory response to the endodontic infection advancing within the root canal, and is normally resolved with a correct instrumentation, disinfection and obturation of the endodontic system.

    Nevertheless, according to recent reports, the incidence of persistent AP (PAP) in treated teeth is increasing. The most important clinical factors related to persistent AP, have to do with residual infection in uninstrumented volumes of the root canals. In recent years, it has become evident that also systemic conditions affecting the patients, on one hand, and individual genetic predisposition to sustain a stronger immune-inflammatory response, on the other hand, may influence the development and presentation of AP and its healing response to endodontic treatment. 

    Taking into account the patient's health may help predicting the outcome of endodontic treatment, future protocols may enhance healing by complementing treatment of AP with medications.

    Learning Objectives:  

    • Explain the increased prevalence of AP and of persistent AP in the western world
    • Describe impact of some autoimmune diseases, and of the individual immune system on the development, presentation and healing of apical periodontitis
    • Evaluate the impact of immune-modulatory drugs and of of other medications on healing of apical periodontitis

    Elisabetta Cotti, D.D.S., M.S.

    Elisabetta Cotti, DDS, MS, received her DDS from the University of Cagliari – Italy and the specialty and MS in Endodontics from the University of Loma Linda- California. She is Full Professor of Conservative Dentistry and Endodontics, and the Chairman of the Department of Conservative Dentistry and Endodontics at the School of Dentistry, University of Cagliari- Italy. She is currently the Director of the Post Graduate programme (Master) in Clinical Endodontics at the University of Cagliari. She teaches in the Advanced Education Programs in Endodontics at the University of Bologna and she is lecturer in the Department of Endodontics at Loma Linda University, USA. She is the Treasuree for IFEA, active member of the AAE, of the Italian Association of Endodontics (SIE), Italian Academy of Endodontics (AIE), of the European Association (ESE). She is the Past President of the Italian Society of Dental Traumatology (SIDT). She practices limited to Endodontics, She is author of several articles and chapters in the field of Endodontics with has a specific interest in apical periodontit

  • Product not yet rated Includes Credits

    CE Hours: 0.75

    Description: Root Canal Treatment is a predictable and highly successful procedure. So, why are we extracting teeth that could be saved in favor of a dental implant? During this lecture Dr. Mortman will present clinical cases of successful root canal treatment, retreatment, and surgery in teeth that may have been extracted. Long term follow-up and case discussion will be presented.

    Learning Objectives:  

    • Evaluate teeth that have a good prognosis for endodontic treatment, endodontic retreatment, and endodontic surgery. The practitioner may currently be extracting these teeth
    • Perform a self-evaluation to determine if they can save one more tooth, maybe out of their comfort level, or recommend an extraction
    • Discuss with their patients the risks and benefits of root canal treatment and offer realistic expectations for treating teeth that may be extracted

    Rory E. Mortman, D.D.S.

    Dr. Mortman received his dental degree and endodontic certificate from NYU College of Dentistry. He completed his general practice residency at the VA Medical Center in Miami, Florida. He has been in private practice for 26 years, and is a fellow of the Pierre Fauchard Academy, the American College of Dentists, and the International College of Dentists. He has served two terms on the board of the Central Palm Beach County Dental Association. Each term consisted for 6 years starting as member at large and cumulating as president. He is past Chairman, Co-Chairman, and President of the Atlantic Coast Dental Research Clinic. The Endodontic section of the clinic trains dental assistants and general dentists in endodontics. It also offers significantly reduced fees to the underserved dental population of Palm Beach County, Florida. Dr. Mortman has lectured and published in the field of endodontics and is a participant and co-founder of the "Save A Molar Program". A partnership with the local health department to provide free Root Canal Treatment for children under 18 whose parents, guardian, or caregiver have demonstrated limited financial resources.