Management of iatrogenic errors by non-surgical and surgical retreatment
This presentation will systematically discuss treatment of iatrogenic perforations, removal of instrument fragments and other foreign objects from the root canal system. It will review both non-surgical as well as surgical treatment option using an evidence-based approach for decision-making in regard to materials and outcomes. In addition, it will be discussed how to successfully prevent instrument separations, or other iatrogenic errors that may occur throughout the instrumentation of complex root canal systems.
This lecture will provide the participant with key information to treatment plan and manage the most common iatrogenic errors.
- Discuss current materials and techniques for perforation repair.
- Review reasons for instrument separation, prevention and removal techniques.
- Evaluate differences in outcome and management strategies for non-surgical versus surgical retreatment.
Dr. Setzer graduated from the Dental School of the Friedrich- Alexander-University Erlangen-Nuremberg, Germany, in 1995, where he also received his doctoral degree in 1998. He pursued his endodontic specialty training at the University of Pennsylvania after working for nine years in a multi-specialist private practice as associate and partner. Dr. Setzer graduated from the endodontic program of the University of Pennsylvania in 2006, receiving the Louis I Grossman Postdoctoral Student Award in Endodontics. He earned a Master of Science in Oral Biology and a DMD degree in 2008 and 2010, respectively, and is a Diplomate of the American Board of Endodontics. Dr. Setzer serves as the Clinic Director and Pre-Doctoral Program Director at the Department of Endodontics of the University of Pennsylvania. He lectures nationally and internationally, and has authored over 80 peer-reviewed articles, abstracts and book chapters. He serves as the Associate/Section Editor for Quintessence International and Current Oral Health Reports and, amongst other journals, on the scientific advisory board of Journal of Endodontics, International Endodontic Journal and Journal of the American Dental Association.
Non-surgical retreatment of teeth with persisting apical periodontitis following apicoectomy
Root resection frequently is performed in cases of failed non-surgical endodontic therapy. The mean success rates from published studies for endodontic surgery are as high as 58.9% without and 79.6% with pre-surgical retreatment of the root canal filling. Systematic reviews reported a success rate for apical surgery of 77.8% 2-4 years postoperatively and of 71.8% after 4-6 years. Using microsurgical techniques even up to 94%have been reported. These data indicates that in a number of cases of failure of apical surgery further treatment is necessary.
The problems encountered with non-surgical retreatment include proper analysis of the reason for the persistence of the apical pathology, case selection, determination and measurement of endodontic working length, removal of retrograde fillings, disinfection and re-obturation. Few clinical studies and a limited number of published case reports indicate that the success rate of non-surgical orthograde retreatment of previously apicected teeth with persisting apical periodontitis will be between 60 and 70%, making this type of treatment a treatment option in selected cases.
Based on the current literature and on clinical cases non-surgical orthograde retreatment will be presented as a possible treatment option with limited success rates.
- to describe a strategy for non-surgical orthograde retreatment of previously apicected teeth with persisting apical periodontitis;
- to review the literature concerning case selection, techniques, problems and prognosis associated with such cases;
- and to present different clinical cases.
Chief-Editor of the German journal „Endodontie“,
Associate Editor of the „International Endodontic Journal“
Member of the European Society of Endodontology (ESE) and the American Association of Endodontists (AAE)
Author of “Problems in Endodontics: Prevention, Identification, Management”
Session chair: Mario Castro
Retrograde root canal treatment
Orthograde endodontic treatment of necrotic teeth with apical periodontitis may be complicated by limited access to the root canals due to restorations and root canal calcifications. To achieve entrance for root canal treatment in such cases the access preparation may jeopardize retention of the crown and cause prosthodontic failure. Leaving the crown intact and perform retrograde root canal treatment might be an alternative approach. The potential to promote healing with retrograde endodontic treatment and the technical feasibility to clean, shape and fill the canal has been evaluated in a prospective study.
Within the limitations of this study, retrograde root canal treatment is a reliable alternative to treat necrotic teeth with apical periodontitis on single- and two-rooted teeth with limited access to the root canals in the upper jaw.
To present results from a prospective study evaluating retrograde root canal treatment as an alternative approach to orthograde root canal treatment in teeth with necrotic pulps and apical periodontitis.
To share experiences from performing retrograde root canal treatment by a surgical procedure as a primary endodontic treatment.
Dr Peter Jonasson received his dental degree from the University of Gothenburg, Sweden in 1998. Where he also completed his PhD doctoral Degree in 2004 and the three-year postgraduate program in Endodontics in 2006. At present, he is senior lecturer at the Department of Endodontology, Institute of Odontology at The Sahlgrenska Academy University of Gothenburg and is responsible for the post-graduate endodontic program. He has for several years been giving endodontic hands-on courses nationally. He has been part of the board and secretary in the Swedish National Endodontic Society. He has authored and co-authored international and national articles, including book chapters in the ﬁeld of endodontics. In clinical endodontics his areas of special interest include endodontic techniques for minimal invasive treatments and relationship between endodontic infections and general health, where he is involved in endodontic research and is co-supervisor for two PhD projects.
How to restore broken down root filled teeth
Endodontic therapy is not complete until a final coronal restoration has been performed. A number of research papers have demonstrated that success rates fall dramatically the longer the delay between the completion of the obturation and the final rebuilding of the crown. Research also tells us that endodontic success is contingent with the quality of the coronal restoration.
Many changes take place after root canal treatment, and it is sometimes hard for the clinician to deal with heavily compromised teeth.
The ultimate restoration has to return the tooth to function, protect the underlying tooth structure and have proper aesthetics.
The lecture will focus on the diagnosis and decision making in the restoration of endodontically treated teeth, it will offer an overview on the different available solutions for the restoration, and it will discuss a workflow both for direct and indirect restorative procedures.
Present the guidelines for the restoration of severely damaged teeth
The lecture will provide the audience with an overview of the limits and possibilities when restoring a severely damaged tooth
Prof Simone Grandini
Prof Simone Grandini
Born on 22nd February 1970 in Florence, Italy and graduated in 1994 from the Dental School of Florence University. In 1995 he obtained a postgraduate certificate in Periodontology at the University of Genoa, Italy and in 1996 he obtained a postgraduate certificate in Restorative dentistry at the University of Florence, Italy. He was clinical instructor of Restorative Dentistry at the University of Florence (1997-1999) In 1999 he started working as visiting professor at the University of Siena, Italy. In 2002 he obtained a Master of Science in Dental Materials and Clinical applications, and in 2004 he completed his PhD studies at Siena University with the thesis “Basic and clinical aspects of selection and application of fiber posts”. Since 2005 he has been Head of Department and is Chair of Endodontics and Restorative Dentistry in Siena University. Since 2010 he has been the Dean of the School of Dental Hygienists. Over the last 20 years he has given more than 700 lectures on Endodontics and Restorative dentistry in Europe, America, Asia, Africa and Oceania. He has published more than 300 papers in national and international journals, and is a reviewer for many peer reviewed journals. Board Member of SIDOC (Italian Society of Conservative Dentistry), active member of IAED (Italian Adademy of Esthetic Dentistry), academic member of SIE (Italian Society of Endodontics), IADR.
Member of Style Italiano, Style Italiano Endodontics, founder of Style Italiano Research.
Poster Presentations / Trade Exhibition
Session Chair: Marco Versiani
Endodontic disinfection in a world of surrogates
Endodontic disinfection is certainly the crucial phase of the treatment and besides its fate and role in the outcome it is the single technical step that lacks a clear and meaningful measurement tool. Because of this limitation, endodontic disinfection is solely estimated by various technical landmarks - such as working length, quality and size of preparation, radiographic quality of obturation, quality of irrigation, chemical solution used etc... Although related, none of these technical parameters provide a direct measure of disinfection level, and therefore could be regarded as disinfection surrogates. Unfortunately, root canal disinfection is nearly 100% estimated on the basis of surrogates. Moreover, several of those surrogates are constantly not proven to be directly correlated to apical healing.
Since almost all technological advancements in the field are tested against common clinical and laboratorial surrogates, this may lead the profession towards technological investments that do not result in useful advancements for the outcome of the treatment. In this lecture, we explore this topic using a very though-provoking approach, addressing the current most important surrogates of Endodontic disinfection.
To uncover Endodontic disinfection under the perspective of surrogates
To revel the main technical limitation of Endodontic disinfection
To provide a meaningful understand of the role of surrogates in Endodontics
To underscore the main surrogates of Endodontic disinfection
To discuss alternatives to overcome this limitation - a call for action
Prof Erick Souza
Erick Souza received his DDS degree in 1999 from the Federal University of Maranhão (UFMA) - Brazil.
From 2002-2008 he completed his Master Science and PhD programs in Endodontics at the Araraquara Dental School - UNESP - Brazil.
From 2006-2007 he worked as a fellow researcher at the Academic Centre for Dentistry Amsterdam (ACTA), in the Netherlands.
Professor Erick Souza has been extensively working with teaching at both under-graduating and graduating levels, since 1999.
He has authored and co-authored more than 90 peer-reviewed papers in important international journals as a result of his active partnership with several outstanding endodontic research groups worldwide.
Dr. Souza also maintains a cutting-edge Dental Practice limited to Endodontics in São Luis-Brazil and has comprehensively lectured in some of the most important congresses and events in Brazil and abroad, exploring various Endodontic related topics.
Caries or pre-eruptive resorption? - a challenging differential diagnosis with clinical consequences
Pre-eruptive resorption is a rare clinical finding in erupting teeth of young individuals that maybe misinterpreted as a carious lesion. This may lead to unnecessary endodontic treatment. Pre-eruptive resorption develops in teeth before they break through the gingival tissue or replace their corresponding deciduous tooth. The pre-eruptive resorption tissue then becomes necrotic from loss of blood supply when the tooth erupts.
The differential diagnosis of pre-eruptive resorption is complex. To help this process, different clinical cases of pre-eruptive resorption, other external resorptions and deep carious lesions, will be reported together with their corresponding histological images. In addition reference will be made to invasive cervical resorptions in humans and external resorptions in the cat model. The emphasis is to explain the specific appearance of each different disease state with the clinical outcomes of their treatment, their prognosis and the possible alternative therapies.
To describe the clinical and histological appearances of pre-eruptive resorption and to differentiate them from other types of resorption (e.g. external) and from carious lesions.
By presenting detailed clinical cases of firstly, different stages of pre-eruptive resorption, secondly, external resorption and thirdly, carious lesions with their respective matched histological images their particular characteristics will be compared and contrasted.
Dr. med. dent.; eidg. dipl. Zahnarzt
Education History: 1964 - 1976 Basic Schools and Gymnasium in Berne, Switzerland
1976 Matura Type B
1977 - 1981 studies at the Dental School of the University of Bern, Switzerland
1981 Final Examination in General Dentistry
1985 Dr. med. dent., University of Bern, Departement of Operative Dentistry (Professor André Schroeder): "ENDOSONIC - a new endodontic cleaning and shaping method in a critical comparison to conventional procedures" (in german)
Professional History: 1981 - 1982 Associate in a private practice in Biel, Switzerland
1982 - 1986 Postgraduate Student and Clinical Tutor at the Departement of Operative Dentistry, University of Bern, Switzerland (Prof. André Schroeder, Prof. Peter Hotz)
1986- 1988 Senior Lecturer and Head Clinical Tutor at the Departement of Operative Dentistry, University of Bern, Switzerland (Prof. Peter Hotz)
Since 1989 Owner of a private endodontic practice in Bern and Senior Lecturer (Assistant Professor) in part time function at the Departement of Operative Dentistry, University of Bern, Switzerland (Prof. Peter Hotz, Prof. Adrian Lussi): clinical research in endodontics (vacuum obturation) and teaching staff members in endodontics
Since 1985 several publications, lectures and courses in endodontics.
Former Secretary and former President of the Swiss Society for Endodontology (SSE), Member AAE, Certified Member ESE, Specialist Member SSE and SSPRE.