Regenerative Endodontics
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Includes Credits
CE Hours: 1.0
Description: Management of immature necrotic permanent teeth is complicated for many reasons. The treatment options vary depending on the etiology of pulpal and periradicular disease. In addition, the behavior of the patient may hinder the endodontist’s ability to provide ideal treatment. Finally, reimbursement rates and lack of coverage for certain services may not allow for treatment of the immature permanent tooth to become part of a financially sustainable endodontic practice. The purpose of this webinar is to highlight some of these challenges and offer practical solutions to allow for treatment of the pediatric patient to become a more viable option for your practice.
Learning Objectives:
- Explain how the etiology of pulpal and periradicular disease influences the outcomes of treatment in the young patient.
- Apply non-pharmacologic behavior guidance techniques during the treatment of pediatric patients to improve the experience for all.
- Identify strategies to improve the financially feasibility of treating pediatric patients.
Zameera Fida, D.M.D
Zameera Fida is a dual trained, dual board-certified endodontist and pediatric dentist. Her clinical interest focuses on the endodontic treatment needs of the young patient. Dr. Fida built an endodontic clinic for pediatric patients within the Department of Dentistry at Boston Children’s Hospital. Through these services, she was providing comprehensive endodontic care for the young patient. She recently transitioned to the Tufts University School of Dental Medicine where she is Chair of the Department of Endodontics and Program Director for the Advanced Graduate Program in Endodontics. In this new role, Dr. Fida aims to train endodontists and general dentists to feel more comfortable in management of the endodontic needs of the immature permanent tooth.
Disclosure(s): No financial relationships to disclose
- Explain how the etiology of pulpal and periradicular disease influences the outcomes of treatment in the young patient.
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Includes Credits
CE Hours: 0
Description: This presentation will clarify the concept of regenerative endodontics and review its progress. There are two categories of clinical approaches to regain vitalization 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). This approach has shown the regeneration of pulp- and dentin-like tissues in the canal space from animal and human clinical trial studies, suggesting potential practice of true “regenerative endodontics” in the future. On the other hand, 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 the tissues developed in CF-RETs are fibrous connective tissue, some resembling periodontal ligament, not pulp-like, and the mineral tissue as cementum-like or bone, not dentin-like. One outcome regarding revitalization treatment is canal space obliteration by calcification which accounts for a high percentage of such cases.
- Describe the definitions of CB-RET and CF-RET.
- Describe the progress of CB-RET.
- Describe the progress of CF-RET.
George T-J. Huang, D.D.S., M.S.D., D.Sc
Dr. Huang is a board certified endodontist, currently Professor and Director for Stem Cells and Regenerative Therapies, Department of Bioscience Research at UTHSC, College of Dentistry. He is the former Chair/Herbert Schilder Professor in Endodontics, at Boston University, also a former Chair in Endodontics at Columbia University. Dr. Huang has published ~180 research articles, abstracts, review articles, including papers in Stem Cells, Stem Cells and Development, Stem Cell Research and Therapy, Stem Cell Reviews and Reports, Tissue Engineering, Regenerative Medicine, Infection and Immunity, Human Gene Therapy, Journal of Dental Research, Journal of Endodontics, etc; and 19 book chapters in books such as Ingle’s Endodontics, Cohen’s Pathways of the Pulp, Endodontic Microbiology, Principles of Regenerative Medicine, Tissue Engineering and Regenerative Dentistry, Tissue-Specific Stem Cell Niche, Material-Tissue Interfacial Phenomena, etc; and co-edited with Dr. Irma Thesleff and wrote chapters for the text book “Stem cells, craniofacial development and regeneration”, in 2013, published by Wiley-Blackwell. His research has been funded by various sources including NIH and AAE Foundation. His current research interest is in the area of stem cells and regenerative medicine.
Disclosure(s): No financial relationships to disclose
George T.-J. Huang, DDS, MSD, DSc
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.
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Includes Credits
CE Hours: 0
Description: Regenerative endodontic treatment of immature teeth is now advocated as first treatment choice for immature teeth with pulp necrosis. Traditionally, calcium hydroxide apexification and more recently MTA apical barrier techniques are alternative approaches. A disadvantage of these approaches is no further root development and a belief that calcium hydroxide may weaken teeth. The veracity of that claim will be examined. Clinical outcomes regarding resolution of signs and symptoms of infection are similar for all approaches. Immature teeth with pulp necrosis treated with REPs generally show further root maturation although the results are variable. Furthermore, patient-based criteria such as tooth discoloration, indications for changing the treatment option, and number of treatment appointments are all important parameters for discussion before electing the appropriate treatment plan for the management of immature teeth with pulp necrosis. Recommendations for which treatment approach are dependent on aesthetic requirements and stage of root development.
- Describe the parameters of success in the treatment of immature teeth
- Evaluate patient and clinician based outcome measures.
- Evaluate the efficacy of three treatment approaches for immature permanent teeth with pulp necrosis
Bill Kahler, DClinDent., Ph.D.
Bill is a full-time Endodontist and an honorary Clinical Professor at the University of Sydney. He has a DClinDent in Endodontics from the University of Adelaide and a PhD from the University of Sydney. He is a Board member and Treasurer of the International Association of Dental Traumatology. Bill has published 80 papers in international dental, material science and engineering journals. Bill is a contributing author for 6 book chapters on renarrative endodontics, endodontic outcomes, vital pulp therapy, and dental trauma, including the iconic North American and European texts, “Pathways of the Pulp” and the “Textbook and Color Atlas of Traumatic Injuries to the Teeth”.
Disclosure(s): No financial relationships to disclose
Bill Kahler, DClinDent., Ph.D.
In accordance with this policy, I declare that I have NO past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith.
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Includes Credits
Bleaching of a Discolored Tooth with Retrieval of Remnants after Successful Regenerative Endodontics
CE Hours: 1.0 CE hour
This report presents the retrieval of remnants from a discolored mandibular right second premolar (tooth #29) of a 17-year-old female after a successful regenerative endodontic procedure (REP).
At the conclusion, participants should be able to:
- Describe the endodontic relevance of dens evaginatus
- List the disadvantages of the use of MTA in regenerative endodontic procedures (REP)
- Discuss alternative materials and procedures to enhance the outcomes of REP
Aovana Timmerman, BDSc, DCD
Dr Aovana Timmerman graduated with a Bachelor of Dental Science from the University of Melbourne in 2001. After completing her fellowship with the Royal Australasian College of Dental Surgeons (RACDS) in 2011, she continued with her specialist training in endodontics, obtaining a Doctorate of Clinical Dentistry in Endodontics, also from the University of Melbourne.
She is actively involved with endodontic education and is currently a lecturer for the Doctor of Dental Surgery Endodontic program at The University of Melbourne, clinical demonstrator for La Trobe University, mentor and examiner in the Membership (GDP) program for RACDS. In 2013, she was awarded the Australian and New Zealand Academy of Endodontics (ANZAE) JM Booth award to attend the IADT Trauma Congress in Istanbul.
As part of her specialist training, Aovana worked in emergency services at the Royal Dental Hospital Melbourne and provided endodontic treatment for patients of Plenty Valley Community Clinic and Melbourne Dental Clinic up to 2016. She has published papers in Journal of Endodontics and Australian Dental Journal. Aovana is fluent in Mandarin (Chinese).
Peter Parashos, MDSc, PhD
Professor Parashos graduated from the University of Melbourne in 1980. He earned his MDSc in Endodontics from the University of Melbourne in 1989 and maintained a full-time private endodontic practice until 2001. He received his PhD in 2004 from the University of Melbourne. His PhD thesis title is: “The Diffusion of Innovation in Dentistry: Factors Affecting the Adoption of Rotary Nickel-Titanium Endodontic Instruments”. Dr Parashos is a fellow of the Royal Australasian College of Dental Surgeons, the American College of Dentists and the International College of Dentists. He is currently inaugural Chair and Professor in Endodontics, Head of Restorative Dentistry, Head of Endodontics and Convener of Postgraduate Endodontics at the University of Melbourne. He also works in private Endodontic practices in Melbourne and Hobart, and is actively involved in CPD programmes. Dr Parashos lectures extensively and has published over 80 papers in peer reviewed journals nationally and internationally. He has supervised over 40 postgraduate and undergraduate student research projects. His contribution to endodontics has earned him Honorary Life Membership of the Australian Society of Endodontology (Victorian Branch) and the Distinguished Service Award from the Australian Society of Endodontology (Inc). He was awarded the inaugural Australian Dental Association (Inc) Award of Excellence for his scientific paper on the reprocessing of rotary NiTi instruments.
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Includes Credits
CE Hours: 1.0 CE hour
Description: The goal of regenerative endodontic treatment (RET) is to regenerate the pulpdentin complex in immature teeth with pulp necrosis. There is no consensus in using RET in previously treated teeth. This article reports on long-term outcomes of RET in previously
treated immature teeth.
At the conclusion, participants should be able to:
- Describe the antibacterial strategy adopted for regenerative endodontic treatment (RET) in immature teeth with failed root canal treatment
Describe the significance of CBCT imaging in diagnosis, treatment planning and assessment of outcomes in immature teeth undergone RET - Explain the advantages offered by RET for treatment of immature teeth with failed root canal treatment
Ali Nosrat, DDS, MS, MDS
Dr. Ali Nosrat is currently a part-time Clinical Assistant Professor at the School of Dentistry, University of Maryland in Baltimore. Dr. Nosrat received his specialty degree in Endodontics and Masters of Oral Biology in June 2015. He became a Diplomate of the American Board of Endodontics in June 2016. Dr. Nosrat maintains a full-time private practice limited to Endodontics in Northern Virginia.
Dr. Nosrat holds a Doctor of Dental Surgery (DDS, 2002) and Master of Science (MS) and a specialty degree in Endodontics from Tehran Dental School, Iran (2002). He received his Board Certification from Iranian Association of Endodontist in 2007.
Dr. Nosrat currently serves on the Research and Scientific Affairs Committee at the AAE. He is a member of the Scientific Advisory Board for the Journal of Endodontics and a scientific reviewer for International Endodontic Journal and Dental Traumatology. He has published more than 50 articles in the fields of pain, vital pulp therapy in immature teeth, regenerative endodontics, root canal anatomy, management of resorptions, and the impacts of COVID-19 pandemic on endodontic patients.Jerome J. Cymerman,DMD
Dr. Jerome J. Cymerman has been in private endodontic practice in Stony Brook, N.Y., since 1983. He received his D.M.D. degree from the University of Pennsylvania School of Dental Medicine. He is the program director of the advanced specialty education program in endodontics and the director of the division of endodontics at the Stony Brook School of Dental Medicine. He has lectured nationally and internationally and has had numerous publications in the "Journal of Endodontics." Dr. Cymerman is a Diplomate of the American Board of Endodontics.
The authors deny any conflicts of interest related to this study.
- Describe the antibacterial strategy adopted for regenerative endodontic treatment (RET) in immature teeth with failed root canal treatment