Irrigation
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Includes Credits
CE Hours: 0.75
Description: Evidence-based research consistently demonstrates the correlation between microbial contamination of the root canal system and apical periodontitis. Cleaning and disinfection of the apical third remains one of the most critical factors leading to healing and favorable endodontic outcome. Besides the microbiological challenges, from a clinical perspective, the root canal system imposes physical and anatomical complex challenges that are difficult to overcome. The development of new technologies and new evidence from the literature has only widened the already existing debate. The purpose of this presentation will be to provide a clinical perspective on how to overcome these challenges in order to obtain a predictable and efficient disinfection of the apical third.
Learning Objectives:
- Review the clinical challenges for disinfection of the apical third.
- Describe the advantages and disadvantages of contemporary techniques.
- Discuss new clinical protocols to enhance disinfection and increase predictability.
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Includes Credits
CE Hours: 1.5
Description: Dr. John Olmsted and Katie Panikian, JD, CPCU, ARM will present case studies of several real endodontic malpractice cases to the audience. They will highlight endodontic procedures that became issues for dentists, and also endodontic procedures that developed problems for endodontists. A discussion will follow each case, giving the audience a chance to discuss the risk management issues involved in each case. The audience will then be asked to act as a jury, reaching a verdict on the case, and a dollar amount on a judgment. The audience will then be given the real-life verdicts and awards.
Learning Objectives:
- Describe how errors in record keeping, diagnosis, treatment planning, and endodontic treatment will affect the claims handling and legal process.
- List the cost in terms of judgments rendered against dentists/endodontists through the discussion of real life malpractice case examples.
- Outline the steps of risk management.
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Includes Credits
CE Hours: 1.5
Description: Protocols and standards in root canal treatment should always allow for the ability of the operator to function in context, always practicing within a legal standard of care. The context for endodontists will change as knowledge and technology create new pathways to improve patient outcomes and become tools for communication between stakeholders, including peer professionals and patients. The utilization of needle delivery of anesthetics and medication in dentistry is universal. Unfortunately, improper utilization of needle delivery in dentistry can have serious and injurious outcomes in patient care. This presentation will discuss and consider the untoward events that can occur in the use of needle delivery of solutions and pastes in the practice and delivery of endodontic care.
Learning Objectives:
- Recognize the advantages of imaging technologies in identifying key neurovascular structures and their proximity to the root canal systems of teeth.
- Appreciate the hydraulic outcomes of common syringe methodologies and their potential for injury and mishaps
- Identify safe protocols for avoiding extra-radicular overfill of the root canal space or confined tissues spaces using needle irrigation or paste delivery
Alan Gluskin, D.D.S.
Professor of Endodontics
University of the Pacific
Alan H. Gluskin DDS is currently Professor, Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific in San Francisco, California. He is at present a Fellow of the International College of Dentists and the American College of Dentists. Dr. Gluskin is a member of numerous societies including the American Association of Endodontists, the American Dental Association and the San Francisco Dental Society. Dr. Gluskin has completed his tenure on the Executive Board of Directors of the American Association of Endodontists as a Past President of the AAE. He additionally functions on the editorial boards of the Journal of Endodontics and the International Journal of Endodontics. Dr. Gluskin is the 2017 recipient of the University of the Pacific’s Eberhardt Teacher-Scholar Award and was awarded the Distinguished Faculty Award in 2023 by the dental school faculty. He is co-editor of the textbooks Decision Making in Dental Treatment Planning and Practical Lessons in Endodontic Treatment.
Disclosure(s): No financial relationships to disclose
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Includes Credits
CE Hours: 1.0
Description: The objective of this in vitro study was to evaluate the shear bond strength (SBS) of several universal adhesives to dentin treated with sodium hypochlorite (NaOCl), and NaOCl followed by ethylenediaminetetraacetic acid (EDTA).
At the conclusion of this article, the reader will be able to:
- Examine the effect of endodontic irrigants (NaOCl and NaOCl + EDTA) on the shear bond strength of mild universal adhesives in self-etch and total-etch modes.
- Identify the mechanisms by which NaOCl and EDTA influence the dentin matrix and the bonding process of adhesives.
- Evaluate strategies to optimize bond strength when using universal adhesives after root canal irrigation with NaOCl and EDTA.
Clinton D. Stevens, DDS
Steven Schiffenhaus, DMD, MS
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Includes Credits
CE Hours: 0.75
Description: The goal of root canal treatment is to prevent or reverse apical periodontitis by removal of necrotic/infected or irreversibly inflamed tissues, followed by obturation of the root canal space. Mechanical instrumentation and irrigation play a key role in the removal of pulp tissue, contaminants, debris, and microorganisms from the root canal system. Different adjunctive agitation techniques have been developed to help irrigating solutions penetrate the complexities of the root canal system. Passive ultrasonic irrigation, apical negative pressure irrigation systems, sonic activation, multisonic agitation, and laser activation have been reported to be superior to conventional positive pressure needle irrigation in regards to smear layer removal, antimicrobial effect, and decreased post-operative pain. Minimally invasive canal preparation has been promoted with the activated irrigation approaches. However, what is not known is the effect of minimally invasive instrumentation, in conjunction with an activated irrigation approach on clinical outcomes (retention/longevity, healing of apical periodontitis). Can infected root canals be predictably disinfected following conservative root canal preparation? Based on a review of the current literature and personal clinical experience, appropriate preparation sizes for root canal treatment will be explored.
Learning Objectives:
- Describe how apical preparation size during root canal treatment affects the clinical outcome.
- Evaluate the current best available evidence to support minimal invasive canal preparation with different irrigation protocols.
- Choose the appropriate preparation size for root canal treatment upon irrigation protocol.
Qian Xie, D.D.S., Ph.D.
Dr. Qian Xie received her BDS and PhD degrees from Sichuan University, Chengdu, China. After a few years of practice, Dr. Xie returned to graduate school at the University of Illinois at Chicago College of Dentistry, where she received her Certificate of Specialty in Endodontics. Dr. Xie is a Diplomate of the American Board of Endodontics. Dr. Xie has been a member and an active participant in the American Association of Endodontists, the American Dental Association, the Chicago Dental Society, and the Edgar D. Coolidge Endodontic Study Club. She is a fellow of the International College of Dentists. Dr. Xie has a broad background in oral science and clinical dentistry, with specific training and expertise in oral microbiology research and clinic experience in endodontics. Her research background includes caries research, oral biofilm and endodontic irrigation.
Disclosure(s): No financial relationships to disclose
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Includes Credits
CE Hours: 1.0
Description: This study aimed to evaluate the removal of a biofilm-mimicking hydrogel from isthmus structures in a simulated complex root canal system consisting of 2 curved root canals by Laser-activated irrigation (LAI, AdvErl Evo, Morita) and mechanical activation techniques.
At the conclusion of this article, the reader will be able to:
- Describe various techniques for root canal irrigation and activation and their main characteristics
- Evaluate the efficiency of laser-activated irrigation, ultrasonic and sonic irrigation in complex root canal morphologies
- Discuss the influence of rod flexibility and oscillation frequency of mechanical activation devices on root canal irrigation
David Donnermeyer, PD Dr.med.dent.
Dr. Donnermeyer is board-certified specialist for Endodontology of the German Association of Endodontology and Dental Traumatology (DGET) and certified member of the European Society of Endodontology (ESE). He currently serves as assistant professor in the Department of Periodontology and Operative Dentistry, University Hospital Münster, Germany, with the perspective of relocating to the Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Switzerland. Dr. Donnermeyer graduated and obtained his PhD at University of Münster, Germany, before focussing his research on various fields of endodontology including root canal obturation and irrigation. Dr. Donnemeyer published 35 peer-reviewed manuscripts.
Patricia Claire Dust, Cand.med.dent
Patricia Dust is a student and PhD candidate in the medical faculty at the University of Münster in Germany. Her research focuses on different irrigation techniques in simulated roots canals.
Edgar Schäfer, Prof.Dr.med.dent.
Dr. Schäfer obtained his PhD at the University of Münster Germany. He is head of the Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Germany.
Dr. Schäfer has published more than 250 peer-reviewed manuscripts, more than 50 textbook chapters and edited 5 textbooks. He is a certified specialist for Endodontology of the German Association of Endodontology and dental Traumatology (DGET), an active and certified member of the European Society of Endodontology (ESE) and an associate member of the American Association of Endodontists (AAE). From 2014 – 2016 Dr. Schäfer was President of the German Association of Operative Dentistry (DGZ) and since 2023 he is President of the German Association of Endodontology and dental Traumatology (DGET). He received more than 30 national and international academic awards.
Sebastian Bürklein, Prof.Dr.med.dent.
He graduated in 2003. From 2003–2006 he worked as a dentist in the Department of Operative Dentistry, University of Münster, Germany. In 2005, he completed his doctorate in dentistry. From 2006–2010 he made his graduation as a specialist in oral surgery in the Dental Clinic of Bochum, Germany (Head: Prof. Dr. H.-P. Jöhren). In 2009, he became a certified specialist in endodontology (German Society of Endodontology and Dental Traumatology) and in 2010, he appointed Specialist in Oral Surgery. Since 2011 he is deputy head of the Central Interdisciplinary Outpatient Clinic in the School of Dentistry (Head: Prof. Dr. E. Schäfer), University of Münster, Germany. In 2015, he became an adjunct professor. He also held various positions in different national scientific societies. From 2014-2020 he was member of the Board of the German Society of Restorative Dentistry (DGZ). Since 2021, he is member of the Board of the German Society of Endodontology and Dental Traumatology (DGET). He had over 20 years of academic and research experience and published numerous scientific papers in world-leading peer-reviewed endodontic journals. Additionally, he had book contributions in national and international reference books and lectures at national and international congresses in the field of endodontics. Since 2022, he is associate editor of the International Endodontic Journal.
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Includes Credits
CE Hours: 1.5
Description: The lecture will present a logical series of evidence based researches that support the clinical relevance of this technique, highlighted by clinical case evidences. Studies on the fluid dynamics of fluids will explain how to modify the concept of shaping for cleaning in minimal shaping for an effective cleansing and decontamination. High resolution videos will greatly help in understanding how to optimize the cleansing and disinfecting phases while maintaining minimal preparation of the canals.
Learning Objectives:
- Describe the limitations of the use of conventional systems for endodontic irrigation.
- List the difference among sonic, ultrasonic, multisonic and laser activated irrigation.
- Explain the main advantages of laser activated technology for root canal irrigation.
Giovanni Olivi, MD, DDS
Giovanni Olivi graduated cum laude in Medicine and Surgery (MD) at ”La Sapienza” University of Rome, and in Dentistry (DDS) at ”Tor Vergata” University of Rome. In 2002 Giovanni achieved the postgraduated diploma in ”Laser Dentistry” from the University of Florence; in 2004, He achieved the laser certification from ISLD; in 2006 the Advanced Proficiency from the Academy of Laser Dentistry and in 2009, the Master status, always from ALD.
Giovanni in 2007 has been awarded with the “Leon Goldman Award” for clinical exellence. He autored over 80 peer-reviewed papers, and 4 books on Laser Dentistry and Endodontics, in different languages, italian, english and chinese.
Active member of Italian Society of Endodontics (SIE), Giovanni is also member of several italian and international laser academies. Giovanni Olivi is a founder member and currently the 2021-2023 President of the International Academy of Innovative Dentistry (IAID) and the scientific coordinator of the ”Laser Dentistry” Master courses at Catholic University of Sacred Hearth of Rome.Disclosure(s): FOTONA d.o.o.: Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Ongoing)
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Includes Credits
CE Hours: 1.0
Description: Considerable advances have been made to optimize root canal disinfection but there have been few direct comparisons of different modalities such as Gentlewave, Waterlase or passive ultrasonic irrigation. This presentation will review the perceived advantages and disadvantages of each modality based upon utility, cost and effectiveness. Data from an ongoing randomized controlled clinical trial will be presented based on surveys of user preferences and patient outcomes.
Learning Objectives:
- Describe the limitations of syringe irrigation to debride and disinfect the root canal space.
- Describe the scientific principles governing the reputed effectiveness of Gentlewave, Waterlase and ultrasonic devices to clean and disinfect the root canal space.
- Compare Gentlewave, Waterlase and passive ultrasonic irrigation based upon cost, utility, operator and patient preferences.
Glen A. Karunanayake, BDS MSc
Glen Karunanayake currently serves as an Associate Professor in Endodontics at the University of North Carolina (UNC). He trained in dentistry at Guys Hospital Dental School, London and completed a Master's programme in Endodontology, at the Eastman Dental Institute, University College London, in 2004. He maintained a private practice limited to Endodontics for 14 years, in London, before joining UNC in 2018. He is a registered specialist in Endodontics within the UK and contributed to the training of more than 80 endodontic residents spanning a period of 14 years.
Disclosure(s): No financial relationships to disclose
Francesco DeMayo, DMD, MPH
Dr. Francesco DeMayo is in his final year of residency in endodontics at the University of North Carolina at Chapel Hill Adams School of Dentistry. Throughout his academic training, he has had a passion for research that advances clinical endodontics. The topic for his master's thesis is a single-blinded, randomized control trial comparing Biolase, GentleWave and passive ultrasonic instrumentation as adjuncts for root canal disinfection. The outcomes of this study include patient, assistant, and operator preferences through survey and interview data, cost analysis, and radiographic healing at 1-year follow-up.
Disclosure(s): No financial relationships to disclose
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Includes Credits
CE Hours: 1.0
Description: It appears we are in the middle of an endodontic revolution of sorts. Today's endodontists are trying to preserve as much root dentin as possible while removing as much bacterial biofilm as possible. Enhanced irrigation, whether laser or multisonic, claims to disrupt and debride the smaller shapes we are creating with our files and the hidden spaces that those files never touch. Both technologies are expensive, require ongoing maintenance, and add steps to the clinical workflow. Proponents of both laser and multisonic procedures have strong opinions as to which technology is "better", but the jury is still very much out on the answer to that question. I have chosen to incorporate both technologies into my practice, and find myself preferring one or the other depending on the case type, the tooth, and even how my schedule is running at the time. In my personal experience, there are pros and cons to both technologies, and I will discuss these in detail during my presentation.
Learning Objectives:
- Breakdown the main differences in the mechanisms of action between laser and multisonic technology in the debridement and irrigation of root canal systems.
- Describe the advantages/pitfalls, opportunities/difficulties, and joys/frustrations that are associated with incorporating each technology into the everyday treatment of endodontically compromised teeth.
- Distinguish between which cases can be treated more efficiently with a laser assisted approach vs. a procedure involving multisonic energy and activation.
S. Kirk Huffaker, DMD, MDS
Dr. Huffaker is a full-time, clinical endodontist and the owner of Mountain View Endodontics. He graduated from CWRU School of Dentistry in 2006 and completed a 3-year endodontic residency at the University of Connecticut Health Center in Farmington in 2009. He lives with his wife and 7 children in Queensbury, NY where he spends most of his "non-endodontic" time trying to keep up with all of his children's activities. He is a fellow of the International Academy of Endodontics and has lectured around the country on a variety of endodontic topics.
Disclosure(s): No financial relationships to disclose
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Includes Credits
CE Hours: 0.75
Description: Effective irrigants, irrigant delivery and agitation are pre-requisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. Antagonistic interactions between irrigants dictate that multiple endodontic irrigation solutions must be used in a specific, carefully prescribed sequence with intermediate flushes to avoid dangerous chemical reactions and that they cannot be mixed together. A novel root canal irrigation protocol, the continuous chelation, was introduced, whereby gentle, soft chelators combined with NaOCl are administered during the whole course of root canal therapy for simultaneous antimicrobial action, tissue dissolution and smear layer and debris removal. Continuous chelation is simpler than standard irrigation and some authors have also reported an improved antimicrobial effectiveness, enhanced smear layer and dentinal debris removal, effective tissue dissolution and improved bonding of endodontic materials to dentin. This oral presentation aims to present how the continuous chelation protocol may provide advantages compared to standard irrigation protocols to improve cleaning and disinfection of the endodontic space. The integration of new technologies, coupled with enhanced techniques and solutions, may help everyday clinical practice.
Learning Objectives:
- List new technologies and innovations in root canal disinfection
- Describe the most innovative irrigation techniques
- Perform an effective and technologically advanced irrigation protocol
Gianluca Plotino, D.D.S., Ph.D., M.S.
Gianluca Plotino was born in 1978 in Rome, Italy. He graduated in dentistry from the Catholic University of Sacred Heart of Rome in 2002. He received the “Alfred Bean Memorial” prize from the Chicago Dental Society for the best Italian research graduate thesis 2001-2003, the "Hans Genet Award" from the European Society of Endodontology for the best European Researcher in 2013, the Top 100 Doctors award class 2022 and several other research prizes and awards. Dr. Plotino obtained his PhD in 2009 at the Catholic University of Rome, in 2017 he received the certification to be Professor of II level and in 2018 to be Professor of I level in Italy. Gianluca Plotino is a Specialist Member of the European Society of Endodontology (ESE), International Specialist Member of the American Association of Endodontists (AAE), active member and President Elect (2025-26) of the Italian Academy of Endodontics (AIE) and active member of the Italian Society of Endodontics (SIE) and the Italian Society of Conservative Dentistry (SIDOC). Dr. Plotino published more that 130 articles in scientific peer-reviewed journals on different endodontic and restorative topics reaching a h-index of 38, 3 textbooks on Endodontics and contributed with numerous chapters in other textbooks. He is Associate Editor of the European Endodontic Journal and part of the Editorial Board of the Journal of Endodontics and several other international journals. Dr. Plotino owns 4 patents and a start-up and since 2004 has extensively lectured worldwide on endodontic and restorative topics giving courses and workshops. He is currently working in his own private practice in Rome, Italy, focused on endodontics and restorative, esthetic and interdisciplinary dentistry.
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.
