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ESE Pre-congress Symposium: Revitalization. Led by Kerstin Galler

Afternoon course 14.00-17.30 hrs Led by: Kerstin Galler

Presenters: Stephane Simon (Paris, France), Ralf Schlichting (Passau, Germany), Matthias Widbiller (Regensburg, Germany), Josette Camilleri (Birmingham, UK)

This interactive pre-congress workshop will discuss different aspects of the clinical procedure of revitalization. The key aims are to

• Provide the procedural details of the clinical protocol

• Discuss outcome, be aware of pitfalls

• Understand biological, physiological and pathological reactions

• Improve knowledge of biomaterials used in the context of revitalization

COST: 130 + VAT Euros (ESE Registered Postgraduate students 90 + VAT Euros)

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14:00
rightRevitalization Symposium Introduction

Abstract

Revitalization is meanwhile an established treatment alternative to MTA-apexification in immature teeth with pulp necrosis. As evidence from in vitro and in vivo studies, from case reports, case series and clinical studies is accumulating, we are able to better understand tissue responses and prognosis of teeth treated with revitalization. This symposium will provide a current assessment of revitalization procedures, including indication, treatment protocol, prognosis and expected tissue responses.

Aims

After this symposium, endodontists should know the procedure, be able to decide whether it is indicated, perform it and know potential outcomes.

Objectives

- To provide the procedural details of the clinical protocol - To discuss outcome, be aware of pitfalls - To make attendants understand biological, physiological and pathological reactions - To improve attendants' knowledge of biomaterials used in the context of revitalization

rightKerstin Galler
 Kerstin Galler

Kerstin Galler obtained her degree in dentistry from the Ludwig-Maximilians-University in Munich in 2000. She worked in Private Practice until 2002 and then joined the Department of Conservative Dentistry and Periodontology at the University of Regensburg, Germany. She received post-doctoral training at the University of Texas Health Science Center in Houston from 2004 to 2006, and earned her Ph.D. in Biomedical Engineering from Rice University in Houston in 2009. Dr. Galler is currently Associate Professor and leader of the section of Endodontology and Dental Traumatology at the University of Regensburg. Her time is divided between clinical work with focus on endodontology and restorative dentistry, teaching as senior lecturer and clinical instructor, and research. Her research group works on tunable hydrogel scaffolds and dental stem cells for dental pulp tissue engineering and regenerative endodontics, on dentin matrix proteins and on biofilm-associated reactions of the pulp tissue. Dr. Galler was President of the Pulp Biology and Regeneration Group of IADR in 2013/14, and led the committee for the ESE Position Statement on Revitalization. She has published numerous articles in the field of pulp biology and dental pulp tissue engineering, received several awards for her scientific work and has lectured extensively nationally and internationally in clinical as well as scientific meetings.

14:15
rightRevitalizaton - Indication, Treatment and Outcome

Abstract

Initially developed as an alternative to apexification for the treatment of immature teeth, the initial objective of revitalization was to regenerate the dentine pulp complex inside an empty and infected root canal. The several clinical reports and in vivo studies tend to highlight that if the clinical goals are achieved, the biological ones are not. Biological tissue has definitely grown inside the root canal, but is very different from pulp tissue. Nevertheless, some clinical reports highlight a true dentine-pulp complex regeneration, even though they remain quite rare. One explanation of the difference of biological outcome could be found in the case selection. Regenerative procedures were initially presented for the treatment of immature teeth only. Recently some investigators proposed to extend the indication to mature teeth. Only few papers highlight such a clinical approach, but biologically, this extension of indication make sense. By considering the Regenerative procedures from the bench to the chair, it is easier to understand why case selection and clinical protocol car interfere on the final clinical outcome.

Aims

The aim of this lecture is to explain how biology understandings will help the clinician to better select his/her clinical cases for Regenerative procedures.

Objectives

The objectives are to review the literature on the indication and outcome of Revitalisation, and use the basic science (mainly biology) to make the link with the clinical consideration. From the bench to the chair is the best way to improve our clinical treatment. We will also discussed when and why regenerative procedure could be proposed as an alternative of apexification, and when it should not.

rightStéphane Simon
 Stéphane Simon

Stéphane SIMON has been qualified as Doctor in Dental Surgery in 1994 at the University of Reims. He completed in 2009 his PhD in Pulp Biology in the frame of a co-supervised Thesis between the University of Paris 7 and the University of Birmingham. To date he is full time academic teacher/researcher and his clinical practice is limited to Endodontics. He has been graduated as a Professor in restorative dentistry and endodontics. He is the director of the European Postgraduate Endodontic Program at Paris Diderot University (3 years full time program). His time is 50% devoted to the clinical practice and 50% to Basic Science/clinical research about Tissue engineering and dental Pulp healing. He works as a Researcher in Paris and as Associate Researcher in Birmingham. Today, his main interest is about Tissue engineering, cell and molecular Biology of pulp tissue (Basic science and clinical practice), and is highly involved into development of new techniques and concepts for graduate and postgraduate teaching (E learning, flipped classroom, MOOCs, etc.)

15:00
rightRevitalization and Disinfection

Abstract

Revitalization and Disinfection

The eradication of bacteria and biofilm from the root canal space is crucial for conventional root canal treatment, but also for revitalization procedures. Due to thin dentinal walls in immature teeth, mechanical debridement and removal of infected dentin is not recommended in order to not weaken the canal walls further. Therefore, chemical debridement and the activation of irrigation solutions plays a major role in disinfection in the context of revitalization. In this seminar, modern concepts for chemical debridement and activation of disinfecting agents in revitalization procedures will be introduced, and advantages and disadvantages of different activation methods will be discussed.

rightRalf Schlichting
 Ralf Schlichting

Dr. med. dent.Ralf Schlichting

Graduation from University of Regensburg in 1998

Specialisation in Endodontics in 2005

Practice limited to endodontics

Specialist of Endodontology of the German Society of Endodontology and Traumatology (DGET)

Specialist Member of the American Association of Endodontists (AAE)

Certified Member European Society of Endodontology (ESE)

Board Member of the German Society of Endodontology and Traumatology (DGET)

National and International lecturer in Endodontics

Author of many articles related to Endodontics

15:30
COFFEE BREAK
16:00
rightRevitalization and Tissue Responses
Biological and Biomechanical Aspects

Abstract

Over the last decade, research has increasingly focused on the development of biology-based treatment concepts such as revitalization, which aims for the regeneration of the pulp-dentine complex. The clinical outcomes of revitalization procedures have been reportedly successful with root maturation by dentine wall thickening and lengthening. However, due to the presence of ectopic tissue like dental cementum and a lack of cells with a distinct odontoblast phenotype, the generated tissue has consequently been described as reparative tissue instead of regenerated pulp. Clinical aspects and treatment modalities that determine revitalization outcome are various. Essential for a success is certainly a thorough disinfection of the root canals. Microbial infection of revitalized teeth can turn an asymptomatic situation back and even a contamination with bacterial remnants or endotoxins modulates the differentiation and mineralization. Dentin itself provides a multitude of bioactive molecules, which are exposed on the root canal surface and influence important processes like cell migration or differentiation as well as neurogenesis. Simultaneously, local stem cell sources and the bioactive environment in root canals needs to be preserved as both are affected by irrigation solutions and intracanalar medicaments. Besides the biological advances, the type of tissue formed in the root canal also determines the biomechanical resistance of revitalized teeth. The capacity of newly deposited dentin to bear and share loads outperforms ectopic tissues like cementum. Thus, formation of reparative tissue can cause biomechanical issues that need to be overcome by innovative tissue engineering approaches, which facilitate a reproducible regeneration of the pulp-dentin-complex.

Aims

To illustrate key determinants on the outcome of regenerative endodontic treatment and discuss the resulting clinical consequences.

rightDr Matthias Widbiller
Dr Matthias Widbiller

Dr. Matthias Widbiller received his degree in dentistry from the University of Regensburg in the year 2013. He immediately joined the Department of Conservative Dentistry and Periodontology at the University Hospital Regensburg as dentist and research fellow. Matthias Widbiller is university lecturer for conservative dentistry and directing a patient course in this subject.

Further, he is certified endodontist by DGZ/DGET/APW/DGZMK and clinically focused on dental traumatology, vital pulp therapy and endodontic regeneration. Since 2016, Dr. Widbiller is overseeing the Center of Dental Traumatology at the University Hospital Regensburg.

From 2017 to 2019, he received a post-doctoral training at the University of Texas Health Science Center at San Antonio (UTHSCSA) in the research lab of Dr. Kenneth M. Hargreaves and Dr. Anibal Diogenes. His areas of research include dental pulp tissue engineering, bioactive materials and bioactive proteins in dentin matrix. Dr. Widbiller has published numerous articles in the field of pulp biology and dental pulp tissue engineering, received several awards for his scientific work, has lectured extensively nationally and internationally in clinical as well as scientific meetings, and is part of the scientific advisory board of the Journal of Endodontics.

16:30
Revitalization and Biomaterials
rightDr Josette Camilleri
Dr Josette Camilleri

Josette Camilleri obtained her Bachelor in Dental Surgery and Master of Philosophy in Dental Surgery from the University of Malta. She completed her doctoral degree, supervised by the late Professor Tom Pitt Ford, at Guy’s Hospital, King’s College London.

She has worked at the Department of Civil and Structural Engineering, Faculty for the Built Environment, University of Malta and at the Department of Restorative Dentistry, Faculty of Dental Surgery, University of Malta. She is currently a senior academic at the School of Dentistry, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, United Kingdom. Her research interests include endodontic materials such as root-end filling materials and root canal sealers, with particular interest in mineral trioxide aggregate; Portland cement hydration and other cementitious materials used as biomaterials and also in the construction industry.

Josette has published over 100 papers in peer-reviewed international journals and her work is cited over 5000 times. She has been awarded the Louis Grossman Prize by the French Endodontic Society in 2018 and is the only female recipient of this prestigious award. She is the Editor of Mineral trioxide aggregate. From preparation to application published by Springer in 2014. She is a contributing author to the 7th edition of Harty’s Endodontics in Clinical Practice (Editor: BS Chong) and Glass ionomer cements in Dentistry (Editor: SK Sidhu). She is an associate editor for Scientific Reports and Endo, a reviewer of a number of international journals and an international lecturer.

17:10
Cases and Discussion
rightKerstin Galler
 Kerstin Galler

Kerstin Galler obtained her degree in dentistry from the Ludwig-Maximilians-University in Munich in 2000. She worked in Private Practice until 2002 and then joined the Department of Conservative Dentistry and Periodontology at the University of Regensburg, Germany. She received post-doctoral training at the University of Texas Health Science Center in Houston from 2004 to 2006, and earned her Ph.D. in Biomedical Engineering from Rice University in Houston in 2009. Dr. Galler is currently Associate Professor and leader of the section of Endodontology and Dental Traumatology at the University of Regensburg. Her time is divided between clinical work with focus on endodontology and restorative dentistry, teaching as senior lecturer and clinical instructor, and research. Her research group works on tunable hydrogel scaffolds and dental stem cells for dental pulp tissue engineering and regenerative endodontics, on dentin matrix proteins and on biofilm-associated reactions of the pulp tissue. Dr. Galler was President of the Pulp Biology and Regeneration Group of IADR in 2013/14, and led the committee for the ESE Position Statement on Revitalization. She has published numerous articles in the field of pulp biology and dental pulp tissue engineering, received several awards for her scientific work and has lectured extensively nationally and internationally in clinical as well as scientific meetings.

17:30
SESSION ENDS
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