CE Hours: 1.0

Description: This study aimed to assess the effect of cavity designs on instrumentation, obturation and fracture resistance for mandibular first premolars with Vertucci V canal.

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

• Discuss which cavity design is appropriate for mandibular first premolars with Vertucci V canal. 
• Compare the effectiveness of different cavity designs in instrumentation, obturation and preservation of dentin and fracture resistance. 
• Describe the steps of preparing an access cavity for premolars with Vertucci V canal. 

CE Hours: 0.75

Description: Calcium hydroxide has a long history of applications in endodontics and dental traumatology.  The material has strong disinfectant and osseo-inductive properties. With regard to dental traumatology, the use of calcium hydroxide has applications in vital pulp therapy of complicated crown fractures, pulp necrosis following trauma, avulsions with extended dry time, apexification, MTA barrier techniques and regenerative endodontics.  However, the use of calcium hydroxide in apexification has become controversial.   Cvek identified a high incidence of transverse root fractures for immature teeth treated with long-term calcium hydroxide dressings. In vitro studies have reported calcium hydroxide has decreased the fracture strength of root dentine over time. However, this finding is also controversial with inconsistent and conflicting observations reported. Calcium hydroxide has been used for 50 years and now some authors and organizations advocate for the use of MTA barrier techniques rather than calcium hydroxide.  The purpose of this presentation is to discuss the science around calcium hydroxide, its use of and concerns with calcium hydroxide in dental traumatology.

Learning Objectives:  

• Critically appraise the calcium hydroxide literature.
• Follow fracture mechanics principles of root fracture mechanics.
• Appraise the different approaches to treat immature permanent teeth with pulp necrosis and infection.

CE Hours: 1.5

Description: “Cracked teeth” is one of the most widely debated, disputed and misunderstood topics in dentistry. The confusion and misunderstandings stem largely from early work on cracks and the lack of a good definition of a crack. Many dentists are confused about cracks and fractures, and they use these terms interchangeably even though they represent different problems. The confusion and misunderstanding also stem from traditional approaches to dealing with cracks in teeth which has largely been a mechanical approach. Whilst cracks are a weakness in the tooth structure, they are also a pathway for bacteria to enter the tooth and cause pulp disease. Symptoms associated with cracks in teeth come from the pulp and therefore it is essential to diagnose the pulp status and then manage the bacterial aspect of cracks rather than just dealing with them as a mechanical problem. This lecture will define cracks, explore the effects of cracks on teeth and provide guidelines for the diagnosis and management of teeth with cracks – especially teeth with reversible pulpitis, which can be managed conservatively.

Learning Objectives:  

• Define cracks and fractures and differentiate between them.
• Explain that cracks are an etiology of various diseases, and not a disease or a syndrome.
• Outline the consequences of cracks in teeth.

CE Hours: 1.5

Description: Management of cracked teeth is a daily endeavor in endodontic practice.  Understanding the multiple variables that impact cracked teeth longevity and employing specific modifications to treatments will maximize successful outcomes.  New outcomes data is yielding increased optimism for saving more cracked teeth.  This evidence-based presentation aims to answer the poignant questions:   “which cracked teeth are treatable?” , “what is the success and prognosis of endodontically treated cracked teeth and those with radicular extension?”, “what is CBCT’s role with cracked teeth”, "How does crack-associated periodontal pocketing (CAIPP) impact these teeth?", and “how can I increase my success when managing cracked teeth generally, and those with radicular extension?”.

Learning Objectives:  

• Describe specific, evidence-based treatment and post-treatment modifiers that increase the success of endodontically-treated cracked teeth.
• Describe the prognosis of endodontically-treated cracked teeth compared to non-cracked endodontically treated teeth, based on outcomes studies.
• Describe which variables are most impactful in cracked teeth treatment and management.

CE Hours: 0.75

Description: CBCT has superior sensitivity in detecting periapical pathosis compared with conventional periapical radiographs. However, CBCT may not always be able to discern vertical root fractures and cracks due to the overlapping structures and fracture’s variability. Nevertheless, there are some pathological CBCT manifestations as secondary changes that aid us detecting these fractures/cracks. Several factors influence the diagnosis of cracks using CBCT such as those related to the device used, patient-related -and operator-related factors. The diagnostic accuracy detecting fractures / cracked teeth can be improved using certain strategies in clinical practice.

Learning Objectives:  

• Discuss different types of cracked teeth.
• Discuss the secondary pathological changes using CBCT by correlating the clinical signs and symptoms with their CBCT manifestations.
• Discuss how to improve the diagnostic accuracy of CBCT in finding fractures / cracked teeth.

CE Hours: 1.0

Description: Tooth autotransplantation, intentional replantation and surgical extrusion are different treatment options with a similar principle; the preservation of the periodontal ligament (PDL) in order for the tooth to heal and be newly articulated with the bone. Tooth autotransplantation is defined as the surgical movement of a tooth from one alveolar socket to another, either after extraction or by surgically preparing the recipient site in the same patient, it is a viable option to replace lost teeth or poor prognosis teeth. Thus, both function and preservation of the alveolar bone crest is maintained. Its success is associated with healing of the PDL and pulp tissue, absence of root resorption, soft tissue healing, and radicular formation. Intentional replantation is the atraumatic extraction of a tooth enabling the clinician to do a procedure (mostly endodontic microsurgery, or cervical resorption treatment) in less than 15 minutes (extra-alveolar time) in teeth in which, otherwise, access would not be possible. Surgical extrusion consists of atraumatic luxation and coronal repositioning of a tooth with in its same socket, this with the purpose of exposing root resorption, root fractures or decay and treat it, leaving sound tooth structure subgingival.Over the last 15 years these techniques have had a great evolution due to the introduction of cone beam computed tomography (CBCT), intraoral scanning, 3D planning software, 3D printers and computer aided dynamic navigation devices. All this technology enables a more predictable, faster and safer procedure with lower extra-alveolar times. In this lecture several clinical cases, with a proper follow up period, show the rapid progress of the technique always based in the best scientific evidence available and trying to inspire Endodontists to have this type of treatments as valid options to help their patients.

Learning Objectives:  

• Evaluate if a patient is a potential candidate for Tooth Autotransplantation, Surgical Extrusion or Intentional Replantation.
• List the digital work flow necessary to perform computer guided Tooth Autotransplantation.
• Introduce these type of treatments as possible options for clinical cases that otherwise would be hopeless.

CE Hours: 1.0

Description: Crown fractures, and cusp fractures in particular, are relatively common findings in clinical practice. Treatment depends on the nature of the fracture location, severity, depth and whether the pulp is exposed. The majority of crown fractures do not require extraction, but do require clinical management. One particular challenge is a deep subgingival fracture involving maxillary teeth. Cuspidization is a technique that provides a conservative and non-invasive approach to manage deep cuspal fractures in the maxillary arch. This technique also presents an important biologic phenomenon (periodontal reattachment) that makes this approach possible. The result is a non-invasive, predictable treatment that meets our patient’s esthetic demands and can be implemented in everyday clinical practice.

Learning Objectives:  

• Diagnose different types of crown fractures.
• Describe how to conservatively manage cusp fractures.
• Recognize periodontal soft tissue re-attachment.

CE Hours: 1.0

Description: This will be an update on diagnosis, treatment, prognosis and restoration for cracked teeth.

Learning Objectives: 

• Diagnose cracked teeth with available technology
• Treat cracked teeth with the latest techniques
• Explain outcomes to patients based on the Iowa Staging Index

If you have any questions for Dr. Krell, you can email him at keithvk@aol.com with the subject line "AAE Webinar"

CE Hours: 1.5

Description: Vertical root fractures in endodontically treated teeth were considered a vexing –frustrating issue both for the operator and the patient alike. In recent years, this complication of root canal treatment had showed both advances in VRF diagnosis and in saving from extraction in some of these teeth.

VRF diagnosis has to be done accurately and n timely due to the destructive results in the supporting bone if not achieved in time. The use of CBCT as an additional diagnostic tool, enhances the possibility to achieve accurate VRF diagnosis, although some drawbacks in this imaging modality still exists. Treatment options vary from root amputation in multirooted teeth to a more complex surgical management.

Learning Objectives:  

• Describe the importance of achieving accurate and timely manner VRF diagnosis
• List the recent advances in VRF diagnosis imaging modalities
• Discuss the various considerations to save a vertically fractured tooth

CE Hours: 1.25

The relationship of the pulp and the periodontium is dynamic. Multiple anatomical and iatrogenic pathways can communicate these tissues in both health and disease. These pathways include furcation canals, dentinal cracks, and vertical root fractures. In other cases, a cemental root fracture (cemental tear) can mimic periapical pathosis. It is generally agreed that the pulp and its necrotic content affect the periodontal tissues. A controversy exists over the ability of periodontal disease to affect the dental pulp. During this presentation, we will review diagnostic techniques, the prognosis, and treatment alternatives for endo/perio lesions.

Learning Objectives: 

• Evaluate the characteristics and clinical presentation of endo-perio lesions.
• Discuss clinical presentation of cracked teeth, vertical root fractures and cemental tears.
• Discuss the endodontic prognosis in cases with complex endo-perio involvement.