CE Hours: 1.0

Description: The decision to treat or extract a tooth in the esthetic zone is one of the more complex decisions that a practitioner must make. It is a test of the team’s knowledge and ability to reach the ultimate goal of an esthetic and functional restoration that will last for years to come. All this must be done with the patient’s emotional and financial status considered. This session will focus on the latest challenges in diagnosing endodontically treated teeth that may require surgery to assist in dental dam isolation, apical surgery and/or intentional replantation. This will be both a “why to” presentation focusing on the decision-making process and a “how to” presentation.

Learning Objectives: 

• Obtain a 3D diagnostic database for successful endodontic treatment planning and case acceptance.
• Review Digital Transformation and how we collaborate through new encrypted data opportunities.
• Identify the benefits of collaborative studies

CE Hours: 2.0

Description: Endodontic surgery has become a predictable and highly successful way of solving recurrent endodontic infections. Even with the technologies such as operating microscope, CBCT, piezotome, ultrasonics, etc, still there are many situations that arise that require special approaches. This presentation will focus on achieving access to difficult areas, such as palatal roots, or areas covered by thick cortical bone. We will also discuss safe management of the sinuses and mental nerve, as well as a newer concept called selective curettage. When all else fails, then intentional replantation must be considered, and we will discuss techniques to perform replantation with success rates approaching 90%. The presentation is clinically oriented, showing many cases with clinical tips to successful microsurgery.

Learning Objectives: 

• Demonstrate proper positioning of microscope/patient/doctor
• Troubleshoot potential complications involving the mental nerve and sinuses and palatal roots
• Become comfortable performing Intentional Replantation

CE Hours: 1.25

Description: As the demand for endodontic surgery continues to rise, the significance of soft tissue management becomes increasingly important, particularly in the anterior area where achieving esthetically successful outcomes is paramount. Emphasizing prevention as the optimal strategy, this session will delve into the best practices for minimizing esthetic complications. It is equally imperative to know how to resolve issues such as gingival recession or papilla loss. This comprehensive session will cover crucial aspects including the esthetic considerations in anterior zones, advanced flap and suturing techniques addressing high-risk scenarios and shed light on soft tissue grafting procedures to correct post-op recession using various grafting materials.

Learning Objectives: 

• Analyze the key factors influencing the esthetic outcome in endodontic surgery.
• Assess and prioritize these parameters for optimal results.
• Describe advanced flap design techniques and suturing techniques designed to minimize the risk of esthetic complications.

CE Hours: 0.75

Description: In recent years, dynamic navigation (DN) technology has been increasingly applied in the field of endodontics. This presentation presents the research and application of a novel approach of DN used in Endodontic Microsurgery (EMS), which can be divided into two parts. In the first part of in vitro study, we explore the accuracy and efficiency of DN-assisted EMS in a surgical simulation model, with the comparison of different guided methods[1], registration methods, and field of view and voxel size of CBCT. In the second part of in vivo study[2], we investigated the accuracy[3] and prognosis outcomes of DN-assisted EMS, with an analysis of potential prognostic factors. Based on our results, DN technology could improve the accuracy and efficiency for guided osteotomy and root-end resection and achieve a favorable prognosis in EMS. In conclusion, DN-aided-EMS could be considered an effective and reliable treatment strategy.References:[1]Chen C, Wang FS, Zhang R, Bian Z, Meng L. An in vitro model study of computer‑guided endodontic microsurgery. Chin J Stomatol 2022, 57:44-51[2]Fu W, Chen C, Bian Z, Meng L. Endodontic microsurgery of posterior teeth with the assistance of dynamic navigation technology: A report of three cases. J Endod 2022;48:943-50[3]Chen C, Zhang R, Zhang W, Wang F, Wang Z, Qin L, Bian Z, Meng L. Analysis of the accuracy of a dynamic navigation system in endodontic microsurgery: A prospective case series study. J Dent 2023;134:104534.

Learning Objectives:  

• Discuss the accuracy and efficiency of static and dynamic navigation technologies with different levels of experience in endodontics in vitro.
• Describe accuracy and efficiency of DN-assisted endodontic microsurgery based on different registration methods (U-shaped tube and tooth cusp registration method) and different field of view and voxel size in vitro.
• Evaluate the accuracy and prognosis outcomes of DN-assisted endodontic microsurgery in vivo, with an analysis of potential prognostic factors.

CE Hours: 1.5

Description: The virtuous trend towards Minimally-Invasive Endodontics, like all new concepts of treatment, has left confusion, fear, and chaos in its wake. The mission statement of this presentation is to explore the history, the conceptual development, and the best-in-class procedures that define MIE RCT, so that course attendees can better preserve their patient's tooth structure after the procedure is done.

Learning Objectives:  

• Define--for themselves--how MIE principles can best be brought chairside, in the next RCT they do.
• Definitively clean MIE canal preparations without major capital investment.
• Conefit and three-dimensionally obturate MIE preparations without frustration.

CE Hours: 1.5

Description: Endodontic Microsurgery is often used as the ultimate solution to remove a persistent apical lesion and address the endodontic disease, especially if a conventional retreatment might compromise the prognosis of the tooth. In the Area of “minimally invasive dentistry” saving the bone while offering a valid exposure of the surgical target and improving bone healing is highly recommended. Thus, the use of piezo and ultrasonic instrumentation should be parts of the responses. It might present considerable advantages such as increasing hemostasis during the surgery and the “quality of life” after. The “Bony Lid” approach can be a minimally invasive solution. On lower molars, traditional access must be very invasive with a thick mandibular bone and on upper molars the sinus apical projection may make the access more complex, thus with a bony lid the visibility and the access of the lesion for the root preparation and filling would be more predictable. Precise and thin osteotomies for outlining the bony window can be obtained with piezo surgery and facilitates the removal of the bony segment and enables its exact fit at the end of the surgery. Adding PRF or collagen preparations (clots and membranes), will favor a stable re-seating of the lid and allow a better and quicker bone healing. On Endodontic Microsurgery, Piezo Surgery and particularly the “Bony Lid” technique may allow the operator an easier surgery and a quicker healing with a high regenerative healing potential, especially on molar operative site.

Learning Objectives:  

• Analyze the indication of the "Bony Lid" technique on Endodontic Microsurgery.
• Describe the Minimally Invasive surgical approach of the Piezo Endodontic Microsurgery.
• Give benefits of the Piezo Endodontic Microsurgery and "Bony Lid" technique added to a PRF or collagen preparation.

CE Hours: 0.75

Description: Prevention and/or elimination of pulpal pathology and apical periodontitis is the ultimate goal of endodontic treatment. The success rate of primary non-surgical root canal treatment is >90%.Root canal retreatment might also fail or may not be feasible, on those cases root end surgery is the procedure of choice in those cases. The success rate of the micro-surgery was reported to be (94%) as shown in the systematic review and meta-analysis by Setzer et al. Despite its very high success, micro-surgery may be difficult to perform in certain cases. The combination of artificial intelligence (AI) and digital workflow has the potential to revolutionize endodontics. AI can be used to improve diagnosis, treatment planning, and patient care, while digital workflow can improve efficiency and accuracyIn this lecture, the advancement of AI and digital workflow in the field of Endodontic microsurgery, intentional replantation , and autotransplantation  will be discussed, including the use of guided and navigation systems technology to perform the highest standard procedure with a predictable outcome.

Learning Objectives:  

• Learn how to use artificial intelligence (AI) to improve the diagnosis and treatment planning.
• Perform precise and accurate guided Root-end surgeries.
• Discuss the use of digital workflows in Endodontics to maximize the outcome of Auto transplantation for different clinical presentations.

CE Hours: 1.5

Description: Team endodontic microsurgery has different procedural goals to non-surgical treatment. Although the aim of achieving a favourable patient centred outcome is the same – to preserve a tooth without any functional impairment, where the parameters are those valued by the patient – the entire mindset with a microsurgical approach requires a refocused treatment strategy for the team. Because extended treatment time and associated factors (an open surgical wound, prolonged bleeding) are critical in affecting healing outcomes and morbidity, the microsurgical team needs to be even more efficient than the non-surgical team in order to provide the same level of care. This means two chairside assistants are needed, each with different roles. The operatory setup also requires some changes to ensure both assistants are able to perform at the highest level of teamwork and efficiency. The instruments and materials are also different, but similarly to non-surgical treatment, are arranged in the sequence of use to ensure time is not wasted and the procedure occurs in a logical order.

Learning Objectives:  

• Describe how to provide apical microsurgery in a fast, efficient and predictable way.
• Describe how to ergonomically design a surgical operatory.
• Describe basic patient positioning.

CE Hours: 1.5

Description: Endodontic microsurgery is taking a growing part in our practices. However it is not always easy to determine in which case surgery is the best option. The goal of the presentation will be to give guide lines to help you decide when surgery should be done. We will also review the major technical steps to ensure a safe and predictable procedure. In addition we will carefully assess, with the most current scientific information, the need for a grafting material.

Learning Objectives:  

• Identify the different criteria which will help you choose the correct surgical approach.
• Master the most important technical aspects to obtain predictable results.
• Evaluate the different outcomes with or without grafting.

CE Hours: 1.0

Description: Histological examination of the periradicular pathologic soft tissues excised during apical surgery intervention is usually recommended, especially in those circumstances in which a neoplastic condition is suspected. Microscopic examinations of the root tip and the surrounding soft tissue have also been used in an attempt to evaluate the causes of root canal treatment failure. However, the studies conducted up to the ‘90s were plagued by methodological limitations, such as use of unsuitable specimens, random sections instead of serial sections, lack of bacterial staining, and insufficient criteria of analysis. Consequently, the role of residual infection in causing treatment failure was grossly underestimated. In this presentation, the procedures for obtaining suitable biopsies, adequate laboratory processing and tissue sections are illustrated. It is demonstrated how the most common cause of root canal treatment failure is the presence of bacterial biofilms in the apical canal, in the intricacies of the root canal system, or in the extraradicular compartment.

Learning Objectives:  

• Describe the surgical procedures for obtaining adequate biopsies.
• Recognize the limitations of previous research studies on the etiology of treatment failure.
• List the prevalent causes of root canal treatment failure.