Root Canal Instrumentation Errors
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- Includes Credits
CE Hours: 0.5
Description: Being a rather delicate and complicated procedure root canal treatment automatically is associated with a certain risk of intraoperative mishaps, among these wrong diagnosis, perforation, ledging, loss of working length or overextension of preparation and obturation, instrument fracture, loss of working length, overpreparation, apical extrusion of microorganisms or materials, irrigation mishaps, and some more. As some of these mishaps may be associated with pain or finally even treatment failure and frequently will disrupt the patients` confidence into the performance of the endodontist good knowledge of origin, nature, and consequences of such mishaps is of utmost importance for daily practice.
Irrigation mishaps are among the most frequently reported mishaps during root canal treatment and may show a wide range of symptoms and sequelae and sometimes may be difficult to manage timely and sufficiently.
Etiology, prevention, symptomatology, and management of irrigation mishaps, will be discussed in this lecture.
Learning Objectives:
- Recognize the importance of mishaps during root canal treatment for success and failure
- Explain the nature, prevention and management of irrigation mishaps
- Discuss the nature, prevention and management of instrument fractures
Michael Hulsmann, Prof. Dr.
Professor. Dr. Michael Hülsmann, DDS, PHD 1980: Graduation in Dentistry from the University of Göttingen, Germany. 1982-2021 Senior Lecturer, Department of Operative Dentistry, University of Göttingen, Germany 1988: Doctoral degree 1998: PhD degree (Dr. med. dent. habil.). 2004: Promotion to Professor 2009 - 2013 Head of Dept. of Operative Dentistry, University of Göttingen 1993: Hans Genet Award from the European Society of Endodontology and the Netherlands Society of Endodontology. Since 2021: Working in a Private Practice and Guestprofessorship at the University of Zurich (Switzerland) Member of the German Society of Endodontology and Dental Traumatology (DGET), European Society of Endodontology (ESE) and the American Association of Endodontics (AAE). Chief Editor of the German journal Endodontie, and Associate Editor of the International Endodontic Journal., Co-editor of the textbook Problems in Endodontics: Prevention, Identification and Management (2nd ed. in 2019) More than 300 publications and more than 700 lectures and hands-on-courses.
- Includes Credits
CE Hours: 2.0
Description: The occurrence of tooth/root fracture is a well-recognized cause of tooth loss after endodontic treatment. It has been attributed to tooth structure removal associated with traditional endodontic cavity and canal instrumentation concepts. This understanding has given rise to novel Contracted Endodontic Cavity (CEC) designs that highlight directed dentin conservation while discarding traditional principles of outline and convenience form, and to minimal canal instrumentation/shaping, both in line with the contemporary concept of minimally invasive dentistry. It has been argued that tooth structure preservation directed access and instrumentation may increase fracture resistance of teeth potentially resulting in extended long-term survival; however, it has also been argued that it may compromise canal disinfection potentially resulting in impaired periapical healing.
This lecture will describe the clinical applications of CEC and minimal canal instrumentation/shaping and review contemporary research into their possible impacts in specific tooth types. The potential benefits and risks associated with tooth structure preservation directed access and instrumentation will be debated in the context of minimally invasive endodontics, and options for clinicians to consider.
Learning Objectives:
- Describe how various contracted endodontic cavity designs differ from traditional designs
- Discuss the contemporary research on the various impacts of contracted endodontic cavity designs and minimal canal instrumentation/shaping
- Debate the benefits and risks of contracted endodontic cavities and minimal canal instrumentation/shaping, and the clinical options for clinicians
Shimon Friedman, D.M.D.
Dr. Shimon Friedman is Professor Emeritus, former Head of Endodontics and Founding Director of the M.Sc. Endodontics Program at the Faculty of Dentistry, University of Toronto, Canada. He received the D.M.D. degree (1975) and endodontics certificate (1983) from the Hebrew University in Jerusalem, Israel. He is board-certified in endodontics in Israel and had served as Chairman of the Israel Endodontic Society from 1985 to 1988. With over 250 peer-reviewed articles, textbook chapters and research abstracts, and over 330 international lectures, Dr. Friedman has acquired extensive experience in endodontic practice, research and education. He is the recipient of several awards, culminating in the AAE’s 2008 Louis I. Grossman Award, as well as the AAE's 2018 I.B. Bender Lifetime Educator Award, for outstanding contributions to endodontic science and education. Though now retired, Dr. Friedman continues following the research and lecturing extensively on endodontic treatment outcomes, management of post-treatment endodontic infection, and impacts of contracted endodontic cavity designs on nonsurgical treatment efficacy and biomechanical responses of teeth.
Speaker Disclosure
In accordance with this policy, I declare I have a 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, as indicated: Sonendo Inc.: Ownership Interest (stocks, stock options, patent or other intellectual property or other ownership interest excluding diversified mutual funds) (Ongoing), Scientific Advisory Board member (Ongoing)
- Includes Credits
CE: 1.25
Description: Instrument separation is very frustrating. Instrument retrieval is even more frustrating and considered more challenging than any other procedure in endodontics because there was no predictable protocol for instrument retrieval. But the recent literature suggested that separated instruments that are visible under a dental operating microscope (DOM) can be predictably removed with ultrasonic tips alone using a single standardized retrieval protocol that minimizes potential variables. Visualization and accessibility to the separated instrument play a major role in successful instrument retrieval.
However, when it comes to the removal of non-visible separated instruments, an instrument retrieval procedure would be completely unpredictable from a lack of visualization. Hence, in the lecture how to manage non-visible separated instruments will be discussed and the best technique will be suggested to make it as predictable as possible to remove those beyond the curve under the DOM. In addition, the standard protocol in combination with CBCT for instrument retrieval will also be shown and discussed.
At the conclusion of this presentation, participants will be able to:
- • Make a predictable treatment plan for non-visible separated instruments
- • Demonstrate minimally invasive and predictable way to prepare the canal for removal of non-visible separated instruments
- • Perform the best technique to remove non-visible separated instruments
Yoshi Terauchi, D.D.S., Ph.D.
Dr. Terauchi is an adjunct professor at Department of Endodontics Faculty of Dentistry Bahçeşehir University İstanbul, Turkey, an adjunct clinical assistant professor of Endodontics at Boston University Henry M. Goldman School of Dental Medicine, and a part-time lecturer at Tokyo Medical & Dental University while maintaining a private practice limited to endodontics in Tokyo, Japan since 1998.
He earned his DDS in 1993 and completed his residency at Tokyo Medical & Dental University in 1995, where he also received his PhD from the Department of Endodontics. He has published several articles in peer-reviewed journals nationally and internationally. He also authored in several chapters in textbooks including the 11th and the 12th edition of “Pathways of the Pulp”, “Endodontics: the 6th edition of Principles and Practice”, and “Retreatments Solution for Periapical Disease of Endodontic Origin”. He has lectured nationally and internationally both onsite and online a number of times a year.
Speaker Disclosure
In accordance with this policy, I declare I have a 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, as indicated: Financial/Material Support: Woodpeck and Zumax.
- Includes Credits
CE Hours: 1.0
Description: Inferior Alveolar Nerve injury is a relatively uncommon occurrence but nonetheless is a serious side effect of endodontic treatment of mandibular posterior teeth. It can result in permanently altered sensation which can have serious and detrimental effects on the patient’s quality of life. It is largely avoidable with correct preoperative assessment and judicious treatment protocols.
Endodontic treatment-related inferior alveolar and mental nerve injuries are most commonly (but not exclusively) reported in relation to mandibular second molars and premolars. An understandable desire to retain these teeth coupled with complex restorative histories, increasingly presents practitioners with challenging endodontic cases which may involve greater risk of nerve damage. We look forward to proposing a new tiered grading system based upon radiographic and clinical factors to aid risk assessment and thus decision-making regarding suitability for treatment, further investigation or early appropriate referral to specialist endodontists.
- Evaluate the relationship of the Inferior alveolar canal and the apical portion of teeth using 2D and 3D radiographic modalities
- Use the new tiered grading system to evaluate the risk of nerve injury associated with endodontic treatment
- Plan appropriate endodontic treatment methodologies to manage moderate and high risk cases
Allen F. Gaon, BDS MSc (Endo) MFDS RCPS (Glasg) MDTFEd MFDS RCSEd MFGDP(UK)
Dr Allen Gaon is a Specialist Endodontist in clinical practice in the UK. Allen is a UK and International educator and presenter of Postgraduate Endodontics programmes. Allen is currenrtly undetaking research for a PhD at the University of Warwick, United Kingdom. Previously, Course Director for Post Graduate Masters Programme in Endodontics, University of Warwick, United Kingdom.
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.
Paul G. Cruci, BDS MSc Endo MSc Imp Dent FDSRCSEd MFDSRCSEd MFDSRCPS Glasg MDTFEd MGDSRCSEng DPDS Brist MFGDP(UK) LDSRCS Eng
Former Associate Professor, University of Warwick Medical School, Coventry, UK, teaching on the MSc Endodontics course. Examiner for the Royal College of Surgeons of Edinburgh, for the Membership in Endodontics, which is the exit qualification from U.K. specialist training. I also examine for the Membership in Advanced General Dental Surgery at the same College.
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: The clinical practice of endodontics has dramatically changed over the last two decades, to a large extent driven by technological advances in canal shaping. This session will examine the evidence-based that practitioners may use in selecting products and strategies needed when performing root canal preparation. The vast majority of publications describe in vitro data, looking into shaping quality, physical properties and debridement effects of various systems. Other studies highlight actual and possible negative outcomes such as instrument fracture and the development of dentinal microcracks. In contrast, only limited information is available to demonstrate clinical outcomes as related to canal shaping. Open questions are overall preparation sizes and the connection to antimicrobial efficacy and long-term retention. In summary, this session will present researchers and clinicians with a comprehensive review of present technology and perhaps an outlook towards future developments in this area.
- List in detail design features and testing results of current canal preparation instruments and techniques.
- Describe the evidence for possible and actual negative outcomes in root canal shaping.
- Differentiate and critically evaluate evidence for clinical selection of canal shaping modalities.
Ove A. Peters, DMD, MS, PhD
Dr. Ove A. Peters is the discipline lead and a professor of endodontics at the University of Queensland School of Dentistry. Previously he held faculty positions in Heidelberg, Germany and Zurich, Switzerland, as well as at the University of California and the University of the Pacific, both in San Francisco, CA, USA. He received his postgraduate education in endodontics at the University of Zurich and at UCSF and is certified as a Diplomate of the American Board of Endodontics. He was the founding director of the postgraduate endodontic program at the Arthur A. Dugoni School of Dentistry in San Francisco, a professor with tenure and the Chair of the Department of Endodontics at that school. Dr. Peters has wide-ranging research expertise and has published more than 175 manuscripts related to endodontic technology and biology. He has authored two books, contributed to several leading textbooks and is an associate editor for the International Endodontic Journal, an academic editor for PLOS One and serves on the review panels of multiple other journals. Dr. Peters has received, among other awards, the Hans Genet Award of the European Society of Endodontology and more recently the Louis I. Grossman Award of the American Association of Endodontists. He is a member of OKU as well as a Fellow of the International and American Colleges of Dentistry.
Speaker Disclosure
In accordance with this policy, I declare I have a 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, as indicated: Grant/Research Support (Ongoing), Honorarium (Ongoing), Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Ongoing
Ove A. Peters, DMD MS PhD
In accordance with this policy, I declare I have a 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, as indicated: Dentsply Maillefer (Self) : Consultant (Status: Ongoing), Grant/Research Support (Status: Ongoing), Honorarium (Status: Ongoing), Other Financial or Material
- Includes Credits
CE Hours: 1.5
Description: Literature shows more than 90 % of NiTi instruments fracture in the apical third or beyond the curve. Fractured instruments in those areas might be not only frustrating but challenging for those without enough experience in successful removal. Besides the challenge, instrument fracture immediately hinders the clinician from performing further treatment, and thus the outcome of the treatment will be compromised. The majority of clinicians would not want to make an attempt to retrieve the broken file in consideration of possibilities of having procedural accidents during the retrieval attempts mainly because instrument retrieval is considered unpredictable. The disadvantages of traditional instrument removal techniques are excessive removal of dentin, which may result in perforation or ledge formation. If the whole procedure for instrument retrieval can be standardized and simply made predictable, it will become no longer issues for every clinician. Therefore, in the lecture it will be described how to make the instrument retrieval procedure easy and predictable so that every single clinician involved in the mishap can also enjoy retrieving those fractured instruments.
- Distinguish easy cases from difficult ones for instrument retrieval.
- Explain how to make loosening the fractured instrument in preparation more predictable.
- Describe how to make it predictable to remove the fractured instrument in removal attempts.
Yoshi Terauchi, D.D.S., Ph.D.
Dr. Terauchi is an adjunct professor at Department of Endodontics Faculty of Dentistry Bahçeşehir University İstanbul, Turkey, an adjunct clinical assistant professor of Endodontics at Boston University Henry M. Goldman School of Dental Medicine, and a part-time lecturer at Tokyo Medical & Dental University while maintaining a private practice limited to endodontics in Tokyo, Japan since 1998.
He earned his DDS in 1993 and completed his residency at Tokyo Medical & Dental University in 1995, where he also received his PhD from the Department of Endodontics. He has published several articles in peer-reviewed journals nationally and internationally. He also authored in several chapters in textbooks including the 11th and the 12th edition of “Pathways of the Pulp”, “Endodontics: the 6th edition of Principles and Practice”, and “Retreatments Solution for Periapical Disease of Endodontic Origin”. He has lectured nationally and internationally both onsite and online a number of times a year.
Speaker Disclosure
In accordance with this policy, I declare I have a 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, as indicated: Financial/Material Support: Woodpeck and Zumax.
Yoshitsugu Terauchi, D.D.S., PhD
In accordance with this policy, I declare I have a 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, as indicated: DELabs () : Other Financial or Material Support, Royal
- Includes Credits
CE: 0.75
Course Description:During root canal instrumentation, several incidents might jeopardize the outcome of endodontic therapy. In the past, several in vitro studies, have shown an association between root canal treatment procedures with the creation of dentinal defects. Theoretically these defects could propagate and develop in a VRF, which often times results in extraction of the affected tooth. Recently, different studies with more accurate methodologies, have questioned whether root canal instrumentation is related to the development of defects. Meanwhile, due to this called risk of fracture, there is a trend of less invasive preparation of the root canal. This trend emcompasses both endodontic access and root canal instrumentation. This presentation aims to discuss whether root canal instrumentation might lead to dentinal defects. What is the real impact of conservative root canal preparation in dentinal defects and consequently VRF? Are the procedures currently used for root canal disinfection sufficent for proper disinfection with such conservative instrumentation? This presentations aims to discuss with an unbiased and scientific approach the relationship between root canal instrumentation and dentinal defects.
At the conclusion, participants should be able to:- Discuss the methodological aspects that led to the conclusion that root canal preparation promotes dentinal defects.
- Describe the limitations of adjunct disinfection procedures.
- List the actual factors that are associated with Vertical Root Fracture.
Marcelo Coelho, D.D.S.,M.S.c, PhD
Dr Coelho graduate at the State University of Rio de Janeiro in 1991 and has a specialty degree in Endodontics at the State University of Campinas - Unicamp in 1996. He is a Master in Endodontics (2014) and has a PhD degree in Clinical Sciences (2017) both at the Faculdade de Odontologia São Leopoldo Mandic. He served as a Visiting Scholar at the University of North Carolina at Chapel Hill (2015-16). Dr. Coelho has published several papers and abstracts in peer-review journals. He colaborates as a reviewer for several Journals such as: International Endodontic Journal, Journal of Dental Education, Brazilian Dental Journal, Dental Traumatology and Australian Endodontic Journal. Dr. Coelho has lecture in the AAE meetings and in the ESE meeting among others. His research interests include dentinal defects and photodynamic therapy. In the last AAE meetings Dr. Coelho co-authored abstracts and clinical tables related to this topic.
Marcelo Coelho, D.D.S., Ph.D., M.Sc.
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.
