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: 0.75

Description: To prevent and eliminate apical periodontitis, adequate obturation is paramount for successful non-surgical endodontic treatment.  Gutta percha and sealer are two needed components, and bioceramic obturation is the newest application to address this.  The worldwide use of calcium silicate-based sealers continues to increase along with new obturation techniques.  The single cone technique (hydraulic condensation) has become a time-saving, efficient obturation method using bioceramic sealers. But does this technique predictably provide a bacterial tight seal?  How does its application affect the performance of these materials?  What influence does the single cone technique have on case outcome?  This presentation will explore the predictability of the single cone technique, allowing the listener to make an informed decision on whether, and in what situations, to employ it.

Learning Objectives:  

• Describe the properties of bioceramic sealer that make the single cone technique possible.
• Discuss how the application of bioceramic sealer affects its performance.
• List the strengths and limitations of bioceramic obturation using the single cone technique.

CE Hours: 1.0

Description: Pulp canal obliteration is a significant risk factor for endodontic insufficiency, and the clinical treatment approach is challenging even for specialists. Accessing root canals that may be calcified can present complications in locating, penetrating, and negotiating pulp spaces. Efforts to reduce the risk of technical errors and treatment time using new technologies, such as intraoral scanners and their software and 3D printers, have resulted in the development of a therapeutic approach to locate calcified root canals: endodontic guides or guided endodontics. During the present lecture, it will be described the therapeutic approach used in a series of cases of endodontic pathology requiring endodontic treatment of root canals, with different degrees of pulp canal obliteration. In all cases, virtually planned guided endodontics allowed access to obliterated pulp spaces. Once the canals were negotiated, endodontic treatment could be performed adequately. The present results showed static guided endodontics to be a safe accurate treatment approach in these clinical cases and a valuable tool to negotiate calcified root canals, reducing working time, risk of excessive removal of tooth structure, and iatrogenic damage to the root.

Learning Objectives:  

• Evaluate different treatment options for clinical management of calcified canals.
• Describe the steps to carry out the guided endodontics procedure, in cases of obliterated canals.
• Perform static guided endodontics as a safe and predictable procedure to manage calcified canals.

CE Hours: 0.75

Description: Maxillary sinusitis of endodontic origin refers specifically to sinusitis secondary to periradicular disease of endodontic origin. This pathology requires an accurate diagnosis followed by appropriate endodontic treatment to remove the source of endodontic pathogens associated with the periapical disease and secondary sinus infection. The use of CBCT imaging significantly improve the ability to detect mucosal soft tissue changes, sinus membrane thickening and odontogenic sources for sinusitis, such as untreated canals. In this presentation, several cases of maxillary sinusitis of endodontic and dental origin, with different manifestations, diagnostic challenges, treatment and outcomes will be described. All of them with inflammatory sinus changes represented by mucositis, osteoperiostitis or partial obstruction; that showed sinus signs and symptoms which disappeared after dental management. In most of them, the sinus condition had an endodontic origin, however, in one case, sinusitis was caused by trauma to the face. All cases had a satisfactory response of the periradicular tissues and maxillary sinus to treatment that consisted of root canal therapy or trauma management.

Learning Objectives:  

• Describe classification of maxillary sinusitis of endodontic origin.
• Diagnose through CBCT maxillary sinusitis associated with endodontic infection.
• Evaluate different treatment alternatives for teeth causing maxillary sinusitis.

CE Hours: 1.0

Description: Nonsurgical root canal retreatment (NS-RCRT) becomes necessary when primary endodontic procedures fail. This study evaluates the efficacy of NS-RCRT using 2% chlorhexidine gel and foraminal enlargement techniques, aiming to assess whether these approaches enhance periapical healing outcomes and success rates compared to traditional NS-RCRT techniques reported in the literature.

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

• Evaluate the impact of foraminal enlargement on periapical healing outcomes in nonsurgical root canal retreatment (NS-RCRT). 
• Discuss the clinical implications of using 2% chlorhexidine gel as the primary irrigant in NS-RCRT. 
• Identify factors influencing the success rates of NS-RCRT based on the findings from the retrospective cohort study.

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.

CE Hours: 0.75

Description: Dealing with obliterated root canals presents a significant challenge in endodontic practice, often leading to treatment difficulties, stress and compromised outcomes. This presentation aims to equip endodontists with essential knowledge of four key principles required to effectively map dentine and localize obliterated root canals. By implementing these principles, endodontists can lower the risks associated with missed anatomy, feel confident when working in highly calcified teeth, and navigate the challenges associated with complex root canal anatomy in a predictable way.

Learning Objectives:  

• List 4 simple rules to locate canals in challenging endodontic cases.
• Describe the importance of dentinal color changes when locating canals.
• Minimize the occurrence of missed anatomy during treatments/retreatments.

CE Hours: 1.25

Description: The diagnosis and treatment of dental pain is fundamental to the practice of Endodontics. However, recent advances in neuroscience have illuminated how complex pain actually is, and that there can often be a disconnect between the experience of dental pain in a patient, and the presence of endodontic disease. Teeth are uniquely innervated, and cause severe pain and sensitization of the nervous system, even in the absence of pathology in the pulp. Sensitization can lead to a confusing presentation of symptoms and complicate determining the diagnosis. Furthermore, persistent pain can occur even after successful endodontic treatment, due to changes in the nervous system that have been triggered by the original injury to the pulp. Endodontic materials, including sealers can also cause inflammation and injury to nervous tissues, further complicating the clinical picture. Understanding the mechanisms by which these materials interact with the nervous system is crucial for successful treatment outcomes. In this presentation, we will discuss recent the effects of different classes of Endodontic sealers on sensory neurons, diagnostic dilemmas related to pain,  and bring a biologically based approach into your Endodontic practice.

Learning Objectives:  

• Recognize the process of sensitization in the nervous system and its impact on diagnosis and treatment of dental pain.
• Describe how changes in the nervous system produce persistent pain and this could contribute to ongoing symptoms after endodontic treatment.
• Explain how endodontic materials can cause injury to nervous tissues.

CE Hours: 1.5

Description: Traumatic dental injuries are potentially very complex and can lead to a number of different responses of the pulp and peri-radicular tissues. A thorough understanding of the various potential pulp responses is essential so appropriate management can be undertaken. Following many injuries, the pulp may survive – but this can only occur if the pulp is managed appropriately at the emergency visit which includes not removing the pulp in many cases! However, there are some specific injuries where pulp survival is predictably unlikely. If the pulp necroses and becomes infected, then there is the potential for external inflammatory resorption to develop if there has also been damage to the periodontal ligament and/or external root surface of the tooth. In such situations, a preventive approach can be used to prevent this resorption from developing. A key factor is to recognize which specific injuries make teeth susceptible to this type of resorption. Hence, understanding and knowing when and when not to commence root canal treatment after a traumatic dental injury is essential to ensure better outcomes and prognoses for traumatized teeth. This lecture will review the literature and provide guidelines for practitioners regarding when and when not commence root canal treatment.

Learning Objectives:  

• Discuss the various responses of the pulp following trauma to a tooth.
• Explain why some pulps survive and others do not survive after trauma to a tooth, and identify those teeth where pulp survival is unlikely.
• Discuss when and when not to commence root canal treatment following trauma to a tooth.

CE Hours: 0.75

Description: Not all superheroes wear capes! As endodontists our goal is to improve dental outcomes and ultimately save the tooth.  Sometimes, the challenge is real, especially when the tooth has been recommended for extraction, but the patient insist on keeping it. This presentation will explore methods for addressing complex cases with large lesions of endodontic origin in teeth that other providers believe "it will never heal".  These teeth can be successfully treated with standard endodontic techniques. We will review steps to not only avoid extraction, but also treat the tooth in a single visit and create full bone healing at the 1–2-year recall.

Learning Objectives:  

• Review steps to treat complex cases with large lesions of endodontic origin and guarded prognosis.
• Discuss the RCT process that creates "super healers" (complex cases recommended for extraction that have full bone healing in a short period of time).
• Assess the impact of technology on the outcomes of complex cases.