CE Hours: 1.0

Description: Treating significant bone loss around teeth (apico-marginal defects) is a challenge for dentists, particularly endodontists who focus on the root canal and surrounding tissues. Deep pockets often indicate a connection between this bone loss and complete exposure of the tooth's root surface. This significantly impacts treatment planning and management. Studies have investigated methods to stimulate bone regrowth and improve patient well-being. A recent approach utilizing platelet concentrates demonstrated encouraging results in reducing pocket depth and promoting some bone formation. However, it fell short in effectively regenerating the bone on the side facing the cheek (facial or buccal bone). This presentation will explore a novel technique using collagen crosslinking. This method aims to improve healing and quality of life for patients with severe bone loss around their teeth. We'll compare the results of this new approach with traditional methods, analyzing both 2D and 3D healing outcomes to assess its effectiveness in bone regeneration and overall treatment success.

Learning Objectives:  

• Review the mechanisms by which root canal infections impact periodontal tissues and identifying strategies for effective healing.
• Describe guided tissue regeneration and autologous products used alongside root canal surgery. These techniques aim to prevent the apical migration of junctional epithelium.
• Assess the effectiveness of regenerative techniques in promoting healing of bone loss around teeth (apicomarginal defects) caused by root canal problems.

CE Hours: 0.75

Description: Cemental tears can be difficult to diagnose and sometimes even harder to treat. Even the best clinicians can miss diagnose them unless familiar with what to look for. The clinical signs, symptoms, and radiographic appearance of cemental tears are not always obvious even on a CBCT. However, a cemental tear can be the reason why some of those flawless non-surgical root canal therapies or apical surgeries may not heal. Unnecessary endodontic treatment can sometimes be the result of misdiagnosis. Management with a surgical approach is required to save teeth with cemental tears. We will review the etiology, diagnosis, and treatment options of cemental tears.

Learning Objectives:  

• Describe the etiology of a cemental tear.
• Diagnose a cemental tear and determine the classification based on radiographic and clinical findings.
• List the treatment options of cemental tears based on their classification.

CE Hours: 0.75

Description: Managing large cystic periapical lesions presents significant challenges for clinicians, especially when non-surgical treatment or retreatment options prove ineffective. Surgical intervention involving debridement and apical resection may be deemed contraindicated due to factors such as the proximity to vital anatomical structures, the risk of damage to adjacent teeth, and compromised healing associated with significant bony defects. Despite these challenges, decompression offers a minimally invasive treatment alternative that is frequently overlooked in modern dentistry. This presentation aims to explore the indications and advantages of decompression in treating large cystic periapical lesions. Through clinical case studies and follow-ups, we will demonstrate essential steps, including pre-operative assessment using cone-beam computed tomography (CBCT) scans, needle aspiration-irrigation techniques, and the placement of a Penrose drain. Furthermore, we will review pertinent literature to highlight the biological principles, clinical efficacy, and long-term outcomes associated with decompression.

Learning Objectives:  

• Describe the clinical indications for decompression and conduct a preoperative assessment using conebeam computed tomography (CBCT) scans.
• Perform aspiration irrigation techniques and utilize a Penrose drain for decompression.
• Evaluate the outcome of decompression in treating large cystic periapical lesions.

CE Hours: 1.5

Description: Cemental tear is an important condition of relevance to Endodontics and Periodontics but is often overlooked. The diagnosis of cemental tear is often challenging, even for the experienced clinician. In practice, it is common for a cemental tear to be misdiagnosed as a vertical root fracture, an endodontic–periodontal lesion, or a failed periodontal or endodontic treatment. Dentists may treat these clinical cases as pure periodontal and periapical lesions due to misdiagnosis of cemental tears. In some cases, the presence of cemental tears was realized after the extraction of non-healing teeth. Some failed cases, for unknown reasons, are due to the presence of cemental tear. The limited attention received is most likely due to the unawareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. In this lecture, we will review 1) the etiology, 2) clinical, radiographic, and histological features, (3) classification, 4) recommended treatment strategies linked to the classification 5) treatment outcomes of cemental tear.

Learning Objectives:  

• Explain the different etiology of cemental tear.
• Elaborate clinical and radiographic presentation of cemental tear.
• Demonstrate different treatment strategies for cemental tears depending on the classification.

CE Hours: 1.25

Description: In the era of ‘white’ and ‘pink’ esthetics,  the primary objective of preserving the natural dentition is no longer acceptable, if we do not consider esthetic consequences. When we do an endodontic surgery we may solve the endodontic problem, but we may create an esthetic problem noticeable by the patient. Knowledge of essential anatomical landmarks, blood vasculature and would healing are mandatory in order to obtain an excellent soft tissue healing outcome postsurgically. This presentation will address incisions and flap designs for all tooth locations, as well as criteria for proper flap design selection. At the same time, atraumatic flap manipulation and suturing techniques under the microscope can enhance the clinician’s surgical skills and will be thoroughly discussed throughout this presentation.

Learning Objectives:  

• Describe indications of different flap designs in endodontic surgery.
• Familiarize with atraumatic manipulation, proper predictable suturing of the mucosal tissues under the microscope.
• Expand their knowledge in mucogingival surgical procedures.

CE Hours: 1.0

Description: The presentation will focus on endodontic surgery and its peculiarities. It will begin with a brief introduction and a simple step-by-step clinical case. Then various clinical cases will be shown in which the endodontic lesion will be in contact with or within the sinus. This will be followed by a brief description of how to manage clinical cases near the alveolar nerve, and finally the periodontal part and its importance in endodontic surgery will be discussed.

Learning Objectives:  

• Manage modern endodontic surgery.
• Manage endodontic survey involving maxillary sinus.
• Manage periodontal approach to modern endodontic surgery.

CE Hours: 0.75

Description: This session aims to provide a comprehensive overview of intentional replantation and surgical repositioning in endodontics, blending historical perspectives, evidence-based guidelines, and clinical expertise to empower attendees in making informed decisions. Beginning with an exploration of their origins and early usage as a last-resort option to a recognized treatment alternative. By synthesizing current literature and guidelines, the session will delve into the latest recommendations and evidence-based data pertaining to intentional replantation and surgical repositioning. Participants will develop a nuanced understanding of the efficacy, indications, and limitations of these techniques within modern endodontic practice. The presentation will feature a selection of clinical cases showcasing intentional replantation and surgical repositioning in practical scenarios. Through detailed case analyses and interactive discussions, attendees will have the opportunity to examine the decision-making process, treatment outcomes, and complexities encountered in these intricate procedures.

Learning Objectives:  

• Evaluate the historical evolution of intentional replantation and surgical repositioning techniques in endodontics, tracing their development from early practices to contemporary standards.
• Critically examine clinical cases, illustrating the decision making process, treatment outcomes, and challenges associated with intentional replantation and surgical repositioning, understanding of their practical application.
• Be familiar with current literature, guidelines, and evidence based data to assess the efficacy, indications, and limitations of intentional replantation and surgical repositioning in modern endodontic practice.

CE Hours: 1.25

Description: Real-time dynamic navigation and dental lasers are often hailed as groundbreaking innovations in various fields. Real-time dynamic navigation systems, particularly in non-surgical and surgical procedures provide enhanced precision and safety by continuously adapting to changing conditions. Dental lasers offer precise, minimally invasive treatments that can enhance patient outcomes and reduce recovery times. 

But are these technologies truly as transformative as they seem, or are they just advanced iterations of existing tools? This evidence based presentation will delve into the real impact of these innovations, assessing their effectiveness, adoption, and the extent to which they are changing the future non-surgical and microsurgical Endodontics. In this lecture, for the first time, the integration of real-time laser guidance with microsurgical techniques will be presented. Real-time laser guidance represents a significant leap in enhancing precision, safety, and outcomes in endodontic microsurgery.

Learning Objectives:  

• Demonstrate the workflow, and application of real-time dynamic navigation in minimally invasive endodontic procedures as locating calcified canals and microsurgical procedures in close proximity to vital structures.
• Describe the different laser systems, wave lengths available in laser technologies and its different applications in non-surgical (disinfection of root canal systems) and surgical procedures (surgical incisions, osteotomies, root resection and photo-biomodulation).
• Demonstrate the integration of real-time laser-guided technology in Endodontic microsurgery. 

CE Hours: 1.5

Description: Endodontic Microsurgery can be the only treatment option to remove a persistent apical lesion and address the endodontic disease, especially if a nonsurgical retreatment attempt might compromise the prognosis of the tooth.  Missed apical anatomy,  resorptive areas along the root, complete canal blockage,  multiple iatrogenic mishaps on a single tooth and anatomical irregularities are some of the conditions that can be efficiently managed with modern microsurgical protocols.  At the same time, cases with persistent infections caused by severe endodontic-periodontal pathology or  a failed previous surgery can turn into success if a strict microsurgical protocol is applied. A correct diagnosis based on the CBCT and a careful case selection to implement microsurgery can lead to a predictable healing for lesions of endodontic origin.   Execution of surgical retreatment might be very challenging for certain complex cases. This comprehensive lecture aims to highlight the clinical approach for challenging cases with previous failed endodontic intervention and persistent periradicular pathology. A rationale for the management of this kind of cases will be thoroughly discussed.

Learning Objectives:  

• Describe the reasons for failure and clinical findings during surgery in complex endodontic cases.
• Provide an answer to clinical dilemmas and develop a strategy for management of surgical endodontic treatment in challenging cases.
• Explain the rationale for proper case selection ιn the surgical treatment of lesions of endodontic origin.

CE Hours: 1.5

Description: Can we achieve a 1.5% lower failure rate in root-end surgery akin to Mariano Rivera’s success in baseball? Despite high success rates published in outcome studies, endodontists are facing extraordinary challenges when planning surgical procedures: roots with proximity to critical anatomical structures, diverse root resorptions, and instruments lodged at and beyond the apex. Typically, outcome studies have overlooked these challenges due to case standardization protocols. Despite this, patient demands compel us to persevere. Furthermore, improper surgical planning and execution can result in aesthetically displeasing scar tissue, post-operative numbness, and even vertical root fractures. Success in root-end surgery is multifaceted: the tooth must function, the bone must heal, and the patient must feel good. Therefore, success hinges on knowledgeable decision-making and precise execution before, during and after surgery. This presentation explores handling these complexities, utilizing clinical cases and critical reviews to provide insights for achieving optimal outcomes in root-end surgery.

Learning Objectives:  

• Identify challenges in rootend surgery, including nine critical anatomies, before the surgical process.
• Develop strategies for managing clinical complexities through knowledgeable decision making and precise execution throughout the surgical process.
• Apply insights from clinical cases and critical literature reviews to establish recall protocol to best optimize treatment outcomes.