Periapical Diagnoses

Periapical Diagnoses

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  • Includes Credits

    CE Hours: 0.75

    Description: Apical periodontitis (AP) manifests with variable clinical and radiographic presentations that may be attributed to differences in microbial and host factors. While the microbial segment of AP has been extensively studied, the host factors involved in AP predisposition have only recently begun to be elucidated. Understanding host and microbial biomarker/molecular signatures in AP is critical for advancing knowledge and for the development of improved preventive and/or precision-based therapies. In this seminar, the clinical presentations of AP as well as host and microbial factors will be reviewed. New perspectives on future diagnostic and treatment approaches for AP will also be discussed.

    Learning Objectives:  

    • Explain how individual host response affects predisposition to pulpal and periapical pathosis
    • Explain the results of contemporary microbial analysis of endodontic infections, and how this may guide antimicrobial approaches
    • Describe how information gleaned from microbial and genetic analysis can inform future precision based treatment approaches

    Ariadne Letra, D.D.S., M.S., P.h.D.

    Dr. Ariadne Letra is a tenured professor of Oral and Craniofacial Sciences and Endodontics, and a member of the Center for Craniofacial and Dental Genetics at the University of Pittsburgh School of Dental Medicine.  

    Dr. Letra’s research focuses on gene discovery and functional genomic characterization approaches to understand the etiology of complex craniofacial and oral traits and conditions such as cleft lip/palate, tooth agenesis, and apical periodontitis. Another aspect of Dr. Letra’s work focuses on identifying host factors contributing to the interconnectedness between oral and systemic health and disease. 

    Dr. Letra has been the principal investigator for several NIH and AAE foundation grants and has served in various NIH study sections. Her residents have also been recipients of numerous AAE Resident Research grant awards and placed among the top ten winners of the AAE/Dentsply Resident Research Presentation Awards for the last ten years.

    Dr. Letra’s work has been recognized through prestigious awards including the 2020 Journal of Endodontics Best Paper in Clinical Research Award. Her work was also featured on the cover of the Journal of Endodontics, Journal of Dental Research, and Orthodontics and Craniofacial Research Journal.  Dr. Letra is a recipient of the distinguished 2018 AADR/SCADA Burton C. Borgelt Faculty 160 peer-reviewed articles, 5 book chapters, and numerous abstracts and publications in the media. She is an associate editor of the Journal of Endodontics, and a member of the editorial board of numerous medical and dental journals including the Journal of Dental Research, Journal of Dental Research Clinical and Translational Research, American Journal of Human Genetics, among others.

    Dr. Letra is currently Chair of the AAE Research and Scientific Affairs Committee.

    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.

    Ashraf F. Fouad, D.D.S., M.S.

    Dr. Fouad obtained his DDS, Certificate of Endodontics and MS at the University of Iowa. 

    He served on the faculty and in various administrative roles at University of Connecticut, the University of Maryland, and the University of North Carolina at Chapel Hill. He is currently Professor and Chair, Department of Endodontics, Director, Advanced Endodontics Program, and Interim Director, Health Information and Business Systems (HIBS) at the University of Alabama at Birmingham.

    Dr. Fouad has published over 110 peer-reviewed manuscripts, 25 textbook chapters, and 145 abstracts. He edited and co-authored the textbooks: Endodontic Microbiology (now in its second edition), as well as the fifth and sixth editions of Endodontics: Principles and Practice. He is a Diplomate and Past President of the American Board of Endodontics, and an Associate Editor of the Journal of Endodontics, Dental Traumatology and Frontiers of Dental Medicine – Endodontics. He received the Distinguished Scientist Award from the Pulp Biology and Regeneration Group of the International Association of Dental Research in 2017, and the AAE President’s Award in 2022.

    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

  • Includes Credits

    CE Hours: 1.5

    Description: Join us for a review of common and significant conditions that may present as a conventional endodontic lesion, with tips on early recognition and what to do following diagnosis.

    Learning Objectives:  

    • List common and significant conditions that can mimic conventional endodontic lesions
    • Identify the helpful clinical and imaging features that may suggest a non-conventional endodontic lesion
    • Explain the importance of tissue biopsy for diagnosis and next steps with common and significant imposters of endodontic lesions

    Laurence Gaalaas, D.D.S., M.S.

    Dr. Gaalaas received his dental degree from the University of Minnesota and completed specialty training and a Master of Science degree in oral and maxillofacial radiology from the University of North Carolina at Chapel Hill. As a researcher and inventor, his expertise includes clinical applications of cone beam computed tomography, caries detection and diagnosis, and development of novel imaging techniques specific to dentistry such as low dose 3D intraoral radiography and dental MRI. He is a Diplomate of the American Board of Oral and Maxillofacial Radiology, a member of the American Academy of Oral and Maxillofacial Radiology, and has ongoing teaching responsibilities plus an active radiology practice through the University of Minnesota and RAYUS Radiology.

    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.

    John R.. Kalmar, D.M.D., Ph.D.

    John Kalmar is a Professor of Oral and Maxillofacial Pathology at The Ohio State University. Dr. Kalmar received his BS from the University of Illinois, his dental degree from Southern Illinois University, residency training in hospital dentistry (UNC-Chapel Hill) and oral pathology (Emory University) and a Ph.D. in Experimental Pathology from Emory in 1989. He served as Director of Clinical Operations in the Emory School of Postgraduate Dentistry until 1992, when he joined the Department of Pathology at the University of Rochester, Rochester, NY. In 1999, he moved to Ohio State, where he currently serves as Program Director in Oral Pathology and president of the Ohio State Dental Faculty Practice. Dr. Kalmar is a Past-President of the American Academy of Oral and Maxillofacial Pathology, a diplomate and past Director of the American Board of Oral and Maxillofacial Pathology and serves on the Editorial Board of Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology (OOOO). Dr. Kalmar has published over 80 manuscripts and book chapters and has served as a Consultant for the ADA Council of Scientific Affairs. He teaches both pre-and post-doctoral students and enjoys providing continuing education to a variety of professional audiences.

  • Includes Credits

    CE Hours: 0.75

    Description: Apical periodontitis (AP) is the inflammatory response to the endodontic infection advancing within the root canal, and is normally resolved with a correct instrumentation, disinfection and obturation of the endodontic system.

    Nevertheless, according to recent reports, the incidence of persistent AP (PAP) in treated teeth is increasing. The most important clinical factors related to persistent AP, have to do with residual infection in uninstrumented volumes of the root canals. In recent years, it has become evident that also systemic conditions affecting the patients, on one hand, and individual genetic predisposition to sustain a stronger immune-inflammatory response, on the other hand, may influence the development and presentation of AP and its healing response to endodontic treatment. 

    Taking into account the patient's health may help predicting the outcome of endodontic treatment, future protocols may enhance healing by complementing treatment of AP with medications.

    Learning Objectives:  

    • Explain the increased prevalence of AP and of persistent AP in the western world
    • Describe impact of some autoimmune diseases, and of the individual immune system on the development, presentation and healing of apical periodontitis
    • Evaluate the impact of immune-modulatory drugs and of of other medications on healing of apical periodontitis

    Elisabetta Cotti, D.D.S., M.S.

    Elisabetta Cotti, DDS, MS, received her DDS from the University of Cagliari – Italy and the specialty and MS in Endodontics from the University of Loma Linda- California. She is Full Professor of Conservative Dentistry and Endodontics, and the Chairman of the Department of Conservative Dentistry and Endodontics at the School of Dentistry, University of Cagliari- Italy. She is currently the Director of the Post Graduate programme (Master) in Clinical Endodontics at the University of Cagliari. She teaches in the Advanced Education Programs in Endodontics at the University of Bologna and she is lecturer in the Department of Endodontics at Loma Linda University, USA. She is the Treasuree for IFEA, active member of the AAE, of the Italian Association of Endodontics (SIE), Italian Academy of Endodontics (AIE), of the European Association (ESE). She is the Past President of the Italian Society of Dental Traumatology (SIDT). She practices limited to Endodontics, She is author of several articles and chapters in the field of Endodontics with has a specific interest in apical periodontit

  • Product not yet rated Includes Credits

    CE Hours: 1.0

    Description: The immunesystemis an extremely complex biological network that plays a crucial role in the hemostasis of periapical tissue, pathogenesis of apical periodontitis (AP), and periapical tissue healing. The successful elimination of microbial infections remains a significant challenge, mostly because of the ever-growing development of antimicrobial-resistant pathogens. The bacterial endurance in the root canal system contributes to features ranging from altered posttreatment healing to exacerbation of chronic periradicular immune response, which compromises the outcome of endodontic treatment. A highly effective strategy for combating infectious diseases and the associated inflammation-mediated tissue damage is to modulate the host immune response in conjunction with antimicrobial therapy. There are several medications currently used in endodontic treatment; however, they suffer various levels of microbial resistance and do not deliver all the required characteristics to simultaneously address both intracanal bacteria and periapical inflammation. The interaction of antimicrobial agents with the immune system can impact its function, leading to immune-suppressive or immune-stimulatory effects. The group of nonconventional antimicrobial medications, such as antimicrobial peptides, propolis, and nanomaterials, are agents that provide strong antimicrobial effectiveness and concomitant immunomodulatory and/or reparative effect without any host tissue damages. In this review, we provide an overview of local immune modulation in AP and a comprehensive review of the immunomodulatory effect of antimicrobial intracanal medications applied in endodontics with specific emphasis on the antimicrobial nanomaterial-based approaches that provide immunomodulatory potential for successful clinical deployment in endodontics. (J Endod 2022;48:430–456.)

    • List the characteristic functions of the innate versus adaptive immune systems.
    • Describe the immune response implicated in periapical tissue inflammation/healing.
    • Differentiate between immunomodulation and immunosuppression.  
    • Discuss the potentials of topical medication for immunomodulation in apical periodontitis.


    Hebatullah Hussein, BDS, MDS,

    Anil Kishen, B.D.S., M.D.S., Ph.D.

    Dr. Anil Kishen BDS, MDS, Ph.D., received his clinical specialty training in Endodontics & Conservative Dentistry from the Madras Dental College, India. His Ph.D. is in the field of biomedical engineering from the Nanyang Technological University in Singapore. After his stint as assistant/associate professor at the National University of Singapore, he moved to the University of Toronto, where he is currently a full-professor in endodontics, graduate coordinator, raduate Education, and a principal investigator at the Dental Research Institute, University of Toronto. He currently serves as an associate editor for the Journal of Endodontics, BMC Microbiology and Clinical Oral Investigations, in addition to serving as an editorial board member for several international journals.

    Dr. Kishen is a recipient of many awards and honors including the AAE Foundation-Denstply Research Excellence Award (2013), the Journal of Endodontics Publication Awards (2015, 2016, 2020), and the prestigious Louis I. Grossman Award (2020) from the AAE, which recognizes an author for cumulative publication of significant research studies that have made an extraordinary contribution to endodontology.

    Dr. Kishen has published over 20 book chapters, and has edited three interdisciplinary textbooks. He has published over 150 peer-reviewed journal publications, and is a co-inventor in several patents/invention disclosures. 

  • Includes Credits

    CE Hours: 1.0

    Description: The pathological extension of periapical infection into the maxillary sinuses is often overlooked in clinical medical and dental practice, with its sequelae often misdiagnosed as rhinogenic sinusitis. This lecture explains and illustrates the similarities, distinguishing differences, and frequent inter-relationship between endodontic disease and paranasal sinus infections. The associated clinical and radiographic findings of maxillary sinusitis of endodontic origin (MSEO) are explained using many real-world clinical case examples with an update on the current literature. Emphasis is placed on the importance of CBCT imaging, magnification, proper terminology, and clinical expertise for rendering both non-surgical and surgical endodontic treatment when indicated. The goal is to help practitioners distinguish rhinosinusitis from odontogenic sinusitis, and specifically MSEO, in an effort to improve the health of patients through accurate diagnosis, appropriate treatment, and improved communication between endodontists and ENT specialists.

    Learning Objectives: 

    • Describe the clinical symptoms and radiograph similarities and differences between rhinogenic sinusitis and the various forms of odontogenic sinusitis.
    • Describe the progression and pathogenic effects of apical periodontitis on the sinus tissues and the associated clinical and radiographic findings of maxillary sinusitis of endodontic origin (MSEO) using current terminology.
    • Describe the importance of proper endodontic management for successful treatment of MSEO, recognizing the complexity of maxillary posterior canal morphology and the unique non-surgical and surgical challenges present with maxillary posterior teeth proximate to the maxillary sinus.

    Roderick W. Tataryn, DDS, MS

    Dr. Rod Tataryn received his DDS degree in 1989 and Master of Science degree in Endodontics in 1994 from Loma Linda University. He has been in private practice endodontics in Spokane, Washington for 28 years and maintains a faculty position at Loma Linda University School of Dentistry. Dr. Tataryn has served on the Clinical Practice Committee for the American Association of Endodontists, has authored clinical and scientific articles on endodontics, including recent multidisciplinary consensus statements on the diagnosis and management of odontogenic sinusitis. Dr. Tataryn is also a contributing author for several endodontic textbooks including the Sixth and Seventh Editions of "Ingle’s Endodontics", and Torabinejad and Rubinstein's "The Art and Science of Contemporary Surgical Endodontics".

    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.

  • Includes Credits

    CE Hours: 1.0

    Description: After a review of the classic concepts of endodontic-periodontal lesions and their diagnosis, the presentation will introduce a large variety of conditions that may involve these concepts in their treatment by the endodontist. Procedures including guided bone regeneration, intentional replantation, external cervical resorption, and others will be discussed with supporting literature to stress these relationships.

    Learning Objectives: 

    • Discuss the need for careful patient assessment in diagnosing endo-perio lesions
    • Explain the classical presentation of Endo-Perio Lesions as described by Simon and Harrington
    • Discuss a variety of endodontic therapies that require an understanding of endo-perio concepts

    Kenneth J. Frick, D.D.S., M.S.

    Dr. Frick began his academic career at UMKC in 2013 after 25 years of private practice. He is currently the Director of the Advanced Education Program in Endodontics at the University of Missouri-Kansas City. He is a Diplomate of the American Board of Endodontics, President of the College of Diplomates of the ABE, Chair of the AAE Membership Services Committee, and holds dental licensure in Arizona, Kansas, and Missouri. He graduated from the University of Missouri, Kansas City, School of Dentistry, in 1986, and then completed three years in the USAF as a Dental Officer, with one year as an AEGD resident. In 1997 he earned a Certificate in Endodontics and Master of Science Degree from Marquette University. From 1997 to 2012 he practiced as an endodontist in Scottsdale, AZ. His research interests are in clinical teaching methodologies and biomaterials.

    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.