CE Hours: 0.75

Description: Numerous studies indicate the clinical success of regenerative endodontic procedures (REPs), as evidenced by symptom resolution, apical closure, canal wall thickening and lengthening, and restored reaction to vitality tests. However, the true nature of the regenerated human tissue after REPs remains unclear. Animal studies, employing various experimental protocols, have reported the greatest prevalence formation of cementum-like tissue, followed by bone-like tissue, and, to a lesser extent, dentin-like tissue. The question arises: does this conclusion also hold true for patients undergoing REPs? Ethical considerations preclude the conduct of cohort studies or randomized controlled trials in humans to evaluate histological outcomes of REPs. Nonetheless, a limited subset of investigations has delved into the histological outcomes after REPs, offering insights into the regenerative processes involved.Our case-report-based systematic review, encompassing studies from PubMed, Embase, and Web of Science, yielded 17 articles reporting on 22 teeth (mature and immature) from a total of 389 studies published between 2001 and 2023. The findings indicate a predominant presence of fibrous connective tissue, along with cementum-like, and bone-like tissues, whereas true dentinal regeneration is notably rare. Histological outcomes may vary based on factors such as the preoperative condition of the tooth, disinfection protocols, and procedural techniques. Furthermore, through a series of REPs cases from the presenter, we we’re going to discuss potential predictive factors influencing outcomes, including the status of the apical papilla, residual pulp tissue, patient age, and others.

Learning Objectives:  

• List the histological findings after REPs in animal study and human case reports.
• Discuss potential predictive factors influencing REPs outcomes.
• Perform REPs more confidently on selected cases.

CE Hours: 1.25

Description: Vital pulp therapy (VPT) plays a crucial role in managing mature permanent teeth with pulp exposure or inflammation, offering a less invasive alternative to root canal treatment. The decision on when and how to perform VPT depends on the degree of pulp involvement, the tooth's vitality, and clinical symptoms. Key VPT options include direct pulp capping, partial pulpotomy, and full pulpotomy, each with specific indications based on the extent of pulpal inflammation. Recent advancements in biomaterials, mineral trioxide aggregate and other bioceramic materials, have improved treatment outcomes by promoting pulp healing and reducing the risk of failure. Hence, these treatment modalities are emerging as promising treatments for maintaining tooth vitality. Proper case selection, strict asepsis, using biocompatible materials and good coronal seal are mandatory for success. This presentation reviews the current VPT options, emphasizing the importance of diagnosis, material selection, and individualized treatment planning to achieve optimal long-term outcomes in younger and adult patients.

Learning Objectives:  

• Describe the indications for vital pulp therapy (VPT) in treating mature permanent teeth in young patients and adults.
• Assess the role of infection control and a final restoration in successful vital pulp therapy procedures. 
• Examine the long-term outcomes and success rates of various vital pulp therapy procedures.

CE Hours: 1.0

Description: Severe traumatic dental injuries in growing patients often lead to a range of complications, including pulp necrosis, ankylosis, infra-occlusion, complex restorability issues, tooth loss and subsequent bone loss. These issues can severely impact the patient’s quality of life, since the most affected teeth are the maxillary central incisors in the aesthetic area. Given that young patients have limited options for tooth replacement, preserving both the architecture and amount of bone in the affected area is crucial. Effective bone preservation ensures that when the time comes for future prosthetic solutions, such as implants, they can be implemented with minimal additional procedures. By employing effective bone preservation techniques, both immediate and long-term results can be improved, making future tooth replacement easier and less costly. This presentation will cover a series of clinical cases  that demonstrate how these strategies can significantly impact aesthetic and functional outcomes for young patients.

Learning Objectives:  

• Identify the range of complications that can arise from severe traumatic dental injuries in young patients.
• Explain bone preservation techniques and how they can potentially maintain both the architecture and quantity of bone in these patients assisting in future replacement procedures.
• Describe practical skills in applying effective bone preservation strategies in clinical practice to ensure optimal outcomes for future prosthetic interventions.

CE Hours: 0.75

Description: Pulp Necrosis in young patients may lead to interruption of the normal root development. Regenerative Endodontic Procedures (REP) have been shown to be a promising treatment strategy for the repair or regeneration of the damaged tissues in order to achieve complete development or closure of the apical root third. Most published reports using REPs have focused on patients aged 8-16 years and mainly with open apex teeth. In the recent years, REPs have been also suggested for the treatment of adult patients in different clinical scenarios. During this presentation, different situations where REP have been performed in adult patients will be introduceD treatment of teeth with fully developed roots, apical root resorptions, teeth with previous surgical and non-surgical retreatment or autotransplanted teeth. Some of these cases have been followed for up to 15 years after treatment.

Learning Objectives:  

• List the different clinical scenarios where regenerative endodontic procedures can be performed in adult patients.
• Describe the potential benefits and limitations of regenerative endodontic procedures in adult patients, as compared to conventional endodontic procedures.
• Discuss the short and long-term outcomes of regenerative endodontic procedures in adult patients.

CE Hours: 1.0

Description: Regenerative Endodontics and Vital Pulp Treatments has emerged as attractive biologically based procedures aiming at preservation of pulp vitality and ultimately tooth survival. The assessment of whether such treatments achieve their goals is often described as a clinical endpoint outcome of success or failure. However, consensus on what is considered success or failure of these emerging treatments is lacking. This talk will provide an overview of an international consensus process for establishing a standardized, agreed set of outcomes for VPT and revitalization procedures, highlighting what outcomes are considered critically important for patients and clinicians, how these outcomes are measured and the optimal time for their measurement. The importance of this core outcome set for evidence based clinical decision making and optimal patient care will be emphasized.

Learning Objectives:  

• Describe the concept of core outcomes and how a core outcome set  is developed.
• Incorporate patients focused outcomes in the process of informed consent and treatment decision making.
• Apply an evidence based approach on how and when outcomes are measured.

CE Hours: 1.5

Description: Teeth with mature apexes, necrotic pulps, and periapical lesions are routinely treated with conventional endodontic procedures with a high and long-term survival rate. Traumatic injuries associated with severance of the blood supply result in pulpal ischemia and often a secondary infection with bacteria. The consequence of pulpal necrosis in teeth with immature apexes, however, is the cessation of root development, making endodontic treatment with conventional techniques and materials difficult and sometimes impossible. Currently, treatment options for these teeth include MTA apexification, regenerative endodontics or a new tooth. MTA Apexification induces an artificial apical stop that allows for condensation of obturation materials. However, this procedure does not promote continuation of root development, nor does it increase fracture resistance of the root walls. An ideal treatment for a tooth with necrotic pulp and immature apex is the regeneration of pulp tissue into a root canal and promotion of a normal root development. The advantages of regenerative endodontic procedures (REPs) lie in the potential for reinforcement of dentinal walls by deposition of hard tissue and the potential for the development of an apical morphology more appropriate for conventional endodontic therapy if future treatment becomes necessary. The American Association of Endodontists has developed Clinical Considerations for REPs, which outlines detailed information regarding the steps involved in REPs. However, there are challenges, and mishaps that can occur during pre- treatment, mid treatment or following treatment. The presenter will discuss how to prevent and manage these challenges and Mishaps.

Learning Objectives:  

• Describe treatment options for teeth with open apexes.
• Describe challenges and mishaps during regenerative endodontics.
• Describe prevention and treatment of the challenges and mishaps.

CE Hours: 1.5

Description: Team endodontic microsurgery has different procedural goals to non-surgical treatment. Although the aim of achieving a favourable patient centred outcome is the same – to preserve a tooth without any functional impairment, where the parameters are those valued by the patient – the entire mindset with a microsurgical approach requires a refocused treatment strategy for the team. Because extended treatment time and associated factors (an open surgical wound, prolonged bleeding) are critical in affecting healing outcomes and morbidity, the microsurgical team needs to be even more efficient than the non-surgical team in order to provide the same level of care. This means two chairside assistants are needed, each with different roles. The operatory setup also requires some changes to ensure both assistants are able to perform at the highest level of teamwork and efficiency. The instruments and materials are also different, but similarly to non-surgical treatment, are arranged in the sequence of use to ensure time is not wasted and the procedure occurs in a logical order.

Learning Objectives:  

• Describe how to provide apical microsurgery in a fast, efficient and predictable way.
• Describe how to ergonomically design a surgical operatory.
• Describe basic patient positioning.

CE Hours: 1.0

Description: The pediatric endodontic patient poses a challenge both in patient management and the status of root development. Often treatment decisions are affected by the ability to manage the behavior of the child. Knowing the various modalities available will be reviewed so that optimum treatment is sought. Dr. Usman has a philosophy of proactive treatment versus "waiting and watching" which will minimize untoward sequelae such as infection and discoloration of the tooth as well as facilitate an optimum and conservative, long-term restorative solution. Starting with a thorough understanding of diagnosis and the role of frequent recall, she will demonstrate the management of various patients who have undergone trauma or have gross caries which threaten the premature loss of the permanent tooth. A review of diagnosis and the various spectrum of pupal therapeutic techniques from apexogenesis to indirect pulp capping, modified apexification, and regenerative treatments. The clinical uses of various materials such as MTA, Endosequence bioceramics, Biodentine calcium silicate cement and collagen containing materials which have been demonstrated to have applications, will be compared. Using her own personal cases Dr. Usman will highlight her process of establishing a treatment plan taking into consideration the psychosocial factors, diagnosis and short term and long term prognoses. Some interdisciplinary time-sensitive treatments will be discussed such as decoronation and autotransplantation which involve other specialists such as orthodontics and oral-maxillofacial surgery and periodontics.

Learning Objectives:  

• List various treatment options available to manage the complex pediatric endodontic patient.
• List the materials needed to perform the intended treatment on the complex pediatric patient.
• Create a treatment plan based on the patient's psychosocial factors, diagnosis and desired treatment outcome.

CE Hours: 1.25

Description: The European Society of Endodontology has developed contemporary recommendations for the management of patients presenting with pulpal and apical disease. For this the so-called S3 process was adopted (1) a core outcome set was defined, (2) systematic reviews (SRs) were commissioned and (3) a consensus conference was held. This robust process is new to endodontics but was adopted earlier in medicine and in periodontology. Of note, the core outcome set described ‘tooth survival’ as the most critical outcome, while other critical outcomes were ‘pain, tenderness, swelling, need for medication’, ‘presence of sinus tract’, ‘satisfactory soft tissue healing’, ‘radiographic evidence of reduction of apical lesion size'. In total 14 SRs were published that addressed PICOT questions directly related to the defined outcomes. The concluding consensus conference resulted in a comprehensive guideline document. This presentation will inform in detail about the process and resulting material relevant for the practice of endodontics.

Learning Objectives:  

• Describe the process involved in creating the S3 guidelines.
• List clinical procedures that are effective and evidence-based for core outcomes desired in endodontics.
• Conduct an assessment of the alignment of their clinical practices with the ESE S3 recommendations.

CE Hours: 1.25

Description: The discovery of dental stem cells (DSCs) in the 2000s has led to the emergence of regenerative endodontics and promoted recent endeavor on vital pulp therapy. The knowledge on dental stem cells particularly dental pulp stem cells (DPSCs) and stem cells of apical papilla (SCAP) has helped the establishment of two categories of clinical approaches to regain the vitality of pulp. One is stem-cell based therapy that involves implanting exogenously processed stem cells into the root canal space, termed cell-based regenerative endodontic therapy (CB-RET). The other is the known revitalization or also termed revascularization, that does not involve the delivery of exogenously processed stem cells into the canals therefore is termed cell-free regenerative endodontic therapy (CF-RET). The various animal and human clinical studies have shown that both CB-RET or CF-RET increase root thickness and/or allow further root development, as well as eliminating endodontic pathosis with high clinical success rates.

Learning Objectives:  

• List the types of oral stem cells that have been studied.
• Provide an overview of cell-based and cell-free therapy for regenerative endodontics.
• Relate the importance of dental pulp stem cells and stem cells of apical papilla to vital pulp therapy.