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Saturday 14th Hall 3

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9:00 to 12:30 Symposium: Endodontics and systemic health
Led by Thomas Kvist and Luc van der Sluis
9:00
rightSymposium overview: Endodontics and systemic health

Abstract

In 2014, the ESE organized a Research Meeting on “The relationship between endodontic infections and their treatment with systemic diseases’’. A report from the meeting was published in the International Endodontic Journal (IEJ 2015:48,913-5). An overall outcome from the meeting was that the evidence of a relation between endodontic infection and systemic disease was low. The report included some suggestions for further action.

Finally, the report (ESE-statement from 2015) should be revised, if necessary, in the light of possible any relevant new evidence on these topics.

Objectives

The presentations and discussions of this symposium are focusing on the following issues;

• Has evidence on these topics evolved since 2014?

• To what extent the suggestions for further actions have been implemented?

• How is the progression of two ESE funded projects on these topics?

• Is there a need for new initiatives or networks?

9:00
rightIntroduction: Endodontics and systemic health

Abstract

In 2014, the ESE organized a Research Meeting on “The relationship between endodontic infections and their treatment with systemic diseases’’. A report from the meeting was published in the International Endodontic Journal (IEJ 2015:48,913-5). An overall outcome from the meeting was that the evidence of a relation between endodontic infection and systemic disease was low. The report included some suggestions for further action.

Finally, the report (ESE-statement from 2015) should be revised, if necessary, in the light of possible any relevant new evidence on these topics.

Objectives

The presentations and discussions of this symposium are focusing on the following issues;

• Has evidence on these topics evolved since 2014?

• To what extent the suggestions for further actions have been implemented?

• How is the progression of two ESE funded projects on these topics?

• Is there a need for new initiatives or networks?

rightLuc van der Sluis
 Luc van der Sluis

Luc graduated in 1985 at the Academic Centre Dentistry Amsterdam (ACTA), the Netherlands, where he successfully completed the postgraduate endodontic program in 1993 under the guidance of prof. dr. P.R. Wesselink. He received his PhD degree in 2007 with the supervisors prof. dr. P.R. Wesselink and dr. M-K. Wu. Since 1993 Luc workes in a practice limited to Endodontics and held a position in research and teaching until 2010 at the Department of Cariology, Endodontology and Pedodontology at ACTA. From 2010 until 2012, Luc worked as professor at the University of Toulouse (France). Actually Luc is head of the Center for Dentistry and Oral Health at the University Medical Center of Groningen in the Netherlands and is Principal Investigator at the Kolff Institute (University of Groningen). Furthermore, he is (co)author of book chapters in international text books. Luc is frequently invited as invited lecturer on international conferences. The current focus of his research is the prevention of apical periodontitis, disinfection of the carious lesion and root canal system, which he systematically investigates with specialists in biofilm research, fluid dynamics and (sono) chemistry.

9:15
rightThe oral – general health connection. Association or causation? Scientific and ethical challenges.

Abstract

There is an oral exceptionalism in medicine: the mouth is singled out as being different. The mouth is treated in special places and needs attention by a particular profession. In most other fields you have specialists for specific organs or body parts, but for the mouth, you have a separate profession. There may be historical and practical reasons for this. However, it poses some challenges in viewing the human being as a unified organism and a whole person. How does the mouth connect to the rest of the body? This is the key question of this presentation. The presentation will draw on conceptual analysis with basis in standard approaches in philosophy of science and ethics. In particular, it will refer to theories of causality and uncertainty.

Aims

The aim of the presentation is to highlight and discuss some scientific and ethical challenges with reconnecting the mouth to the rest of the human body.

Objectives

The aim will be achieved by addressing three specific questions: 1. Are there causal connections between oral health and other health problems? 2. How should we handle the uncertainty with respect to such connections? 3. What are the ethical challenges with handling such connections?

rightBjørn Hofmann
 Bjørn Hofmann

Bjørn Hofmann is full professor at The Norwegian University of Science and Technology at Gjøvik and an adjunct professor at the Center for Medical Ethics at the University of Oslo. Hofmann’s research and teaching covers five main areas: 1. Philosophy of medicine, 2. (Bio)medical ethics, 3. Ethics in health technology assessment, 4. Philosophy of health sciences and technology, and 5. Research ethics and Research Integrity.

10:00
rightDo root fillings and apical periodontitis increase the risk of a first myocardial infarction?

Abstract

The evidence of a possible association between cardiovascular disease and inflammatory processes of endodontic origin is poor and only a few scientific studies of good quality are available. The association between marginal periodontitis and cardiovascular disease rests on a more solid scientific basis. For example, a recent Swedish case-control study (Parokrank) of 805 patients diagnosed with their first myocardial infarction found an increased risk (OR 1.28) for a first myocardial infarction in individuals with marginal periodontitis.

Objectives

Using the available panoramic radiographs from (Parokrank), the following variables of primary interest were recorded for each of the 805 myocardial infarct patients and their age, gender and geographical area matched controls.

1. The number of remaining teeth.

2. The number of root filled teeth.

3. The number of teeth with periapical bone destruction.

The main findings of the analyses from this ESE supported research project will be presented.

rightThomas Kvist
 Thomas Kvist

Associate professor Thomas Kvist, DDS, PhD

Thomas Kvist has practiced general dentistry in Sweden and in Sorrento, Italy. He completed specialization in endodontics in 1993 and received his PhD in 2001 at the Department of Endodontology, University of Gothenburg, Sweden where he is presently head and holding a position as associate professor. For several years, he was director of the postgraduate program and head of the Specialist Clinic for Endodontics at Public Dental Service in Gothenburg. He has published articles in peer-reviewed journals on decision-making and clinical outcome in endodontics. He also authored several textbook chapters and edited a textbook on apical periodontitis in root- filled teeth. Thomas Kvist participated in the project group for the report Methods of Diagnosis and Treatment in Endodontics published in 2010 by the Swedish Council on Health Technology Assessment (SBU). He is a member of the editorial board of the International Endodontic Journal and Acta Odontologica Scandinavica. Thomas Kvist is also a participant in the Endodontic Research Collaboration in Scandinavia (EndoReco).

10:15
rightEndodontic infections, inflammation, and coronary artery disease.

Abstract

Coronary artery disease is mainly caused by atherosclerosis, which is a slowly progressive, multifactorial disease described as a disorder of lipid metabolism and a chronic inflammatory disease. Endodontic lesions are among the dysbiosis-driven infections putatively contributing to systemic inflammatory burden and atherogenesis. One of the most studied virulence factor of gram-negative bacteria, which potentially originates from the oral microbiota, is lipopolysaccharide. It is a potent activator of both innate and adaptive immunity and considered as a proatherogenic molecule. The hypothesis is that endodontic infections give rise to proinflammatory mediators, bacteremia/endotoxemia, and proatherogenic immune responses.

The aim is to investigate, i) how endodontic infections associate with the local and systemic biomarkers of inflammation, tissue destruction, and immune response, ii) whether endodontic infections associate with cardiovascular outcomes including death.

Considering the high prevalence of endodontic lesions and the putative proatherogenic inflammatory burden that they cause, the relevance of dental care to public health is extensive. Investigating the role of endodontic infections in coronary artery disease is important both for mapping the individual cardiovascular risk factors and in planning of the treatments. The results may lead to improvements in the treatment modalities of endodontic infections in the aging population.

rightPirkko Pussinen
 Pirkko Pussinen

Pirkko Pussinen graduated from the University of Helsinki, Finland, as a biochemist (MSc) in 1993 and defended her PhD thesis on high density lipoprotein (HDL) metabolism in 1997. After the post-doctoral work in Institute of Medical Biochemistry, the Karl Franzen’s University in Graz, Austria, she started her research at the Department of Oral and Maxillofacial Diseases, University of Helsinki.

She is an Adjunct professor of Medical biochemistry in University of Helsinki and an adjunct professor of Translational dentistry in University of Turku. She works as Principal investigator in the Faculty of Medicine, University of Helsinki, and her research group has been investigating the association of chronic oral infections/inflammation and cardiometabolic disorders since 2002. The research is translational with the focus on oral microbiota, bacterial virulence factors and immunological responses.

10:30
COFFEE BREAK
11:00
rightThe influence of apical periodontitis on the concentration of inflammatory mediators in peripheral blood plasma

Abstract

In dentistry, we wish to know more about the impact of apical periodontitis on general health. This talk will start with results from a recent systematic review of the literature. Then, a current ongoing clinical study that follows patients with apical periodontitis before and until three months after treatment will be discussed. In this study it was chosen to investigate the impact of apical periodontitis on health rather than medical conditions such as cardiovascular disease, renal disease, diabetes etc. But how can general health be defined? Background information about low-grade inflammation is given and why we must know about low-grade inflammation in endodontology.

Aims

To give an overview of recent literature about apical periodontitis and inflammatory mediators in peripheral blood. To propose new study designs to investigate relationships between apical periodontitis and health.

Objectives

By explaining the design and choices that were made for a current clinical study about the relationship between apical periodontitis and general health. Also, suggestions are given on how to perform such a study plus on how to present data in a more uniform way so that data of smaller-scale studies can be used for meta-analyses.

rightSuzette van der Waal
 Suzette van der Waal

Suzette van der Waal, DDS, PhD, graduated in 1991 and finished the post-graduate program in endodontology in 2009 (both at ACTA; Academic Centre Dentistry Amsterdam). In 2015, she defended her PhD thesis ‘A new strategy in root canal therapy; there’s a lot going on in endodontic disinfection’ about novel and current endodontic disinfection methods (University of Amsterdam). Currently, she works in a private practice limited to endodontics. She also holds a position as assistant professor at ACTA, departments Endodontology and Preventive Dentistry. She teaches undergraduate dental students and post-graduate students program endodontology and is involved in several clinical studies as principal, coordinating or executive investigator. One of which is ‘The influence of apical periodontitis on the concentration of inflammatory mediators in peripheral blood plasma and the metagenomic profiling of endodontic infections.’ She is chair of the scientific committee of the Nederlandse Vereniging voor Endodontology, the Dutch endodontic society.

11:20
rightHow healing of Apical Periodontitis is influenced by the health of the patients and their genetic background

Abstract

It is widely-known that a correct endodontic treatment should take care of endodontic infection and promote healing of apical periodontitis (AP). The general health of the patient, the medications taken, and host predisposing factors, like genetics, have been seldom considered when discussing the treatment and prognosis of AP, and they have proved to be almost as important as the quality of root canal treatment. The population of patients requiring endodontic treatment is changing: patients often suffer from a variety of pathologies and/or are under new categories of medications (like immune- modulators). All these conditions influence both the clinical manifestations and the response to treatment of AP, and it is important that are brought to the attention of the clinician to enable him/her to alter the treatment and evaluate its expectations accordingly. Furthermore, the new studies available provide information on the interaction of the status of the patient and the outcome of endodontic treatment, and this newly investigated field brings an opening to a future pharmacologic approach to persistent AP.

Aims

The aim of this lecture is to discuss the impact of factors from the host and of biologic modifiers on the progression and response to treatment of apical periodontitis (AP), exploring how persistent AP may be influenced positively or negatively by the use of medications.

Objectives

In the light of the classic and latest literature available and based on recent research, the following items will be addressed:

1. which is the impact of the status of the immune system of the patient on progression, healing and timing of healing of AP.

2. Which are the interferences of immune-modulatory drugs and of drugs acting on bone metabolism on the development and treatment of AP.

3. which are the dedicated protocols for the management of AP in medically compromised patients.

4. which could be a future opening to a pharmacological aid for the treatment of persistent AP.

rightElisabetta Cotti
 Elisabetta Cotti

Elisabetta Cotti, DDS, MS, received her DDS from the University of Cagliari – Italy and the specialty and MS in Endodontics from the University of Loma Linda- California. Since 2000, she is Professor of Restorative Dentistry and Endodontics, and the Chairman of the Department of Conservative Dentistry and Endodontics at the School of Dentistry, University of Cagliari- Italy. She is currently the Director of the Post Graduate programme (Master) in Clinical Endodontics at the University of Cagliari. She teaches in the Advanced Education Programs in Endodontics at the University of Bologna and she is lecturer in the Department of Endodontics at Loma Linda University, USA. She is active member of the AAE, of the Italian Association of Endodontics (SIE) where she has served as executive member for ten years, of the European Association (ESE) where she has served as Country Delegate for seven years. She is the Past President of the Italian Society of Dental Traumatology (SIDT). She also works in private practice limited to Endodontics. She is author of several papers in the field of Endodontics and has a specific interest in apical periodontitis, immature teeth, complex case management, imaging techniques and interactions between apical periodontitis and systemic conditions.

11:45
rightApical periodontitis and diabetes – an update
Association does not always imply causation

Abstract

Apical periodontitis (AP) and root canal treatment (RCT), the elective treatment for teeth with AP that must be preserved, are both very prevalent. The possible connection between AP and RCT and systemic health is an exciting aspect faced nowadays by the scientific community. In the last years, endodontic medicine has developed and numerous epidemiological studies have analysed the relationship between AP and RCT and some prevalent systemic status such as diabetes mellitus, smoking habits and cardiovascular disease. The results of these studies suggest the association between endodontic variables, i.e. AP and RCT, and diabetes. Furthermore, several data suggest a relationship between diabetes and RCT outcome. This lecture reviews the scientific evidence regarding the connection between periapical and endodontic states and diabetes analyzing the systematic reviews and meta-analyses carried out on this topic. Two meta-analyses concluded that the outcome of RCT is significantly worse in diabetic patients compared to healthy control subjects. Root-filled teeth (RFT) of diabetic patients showed radiolucent periapical lesions more frequently and were also extracted more frequently than RFT of healthy controls. Difference between causation and association is highlighted.

Aims

To analyze the scientific evidence regarding the connection between endodontic variables and diabetes, differentiating between association and causation.

Objectives

To analyze the published systematic reviews and meta-analysis carried out on the association between endodontics and diabetes, and to assess the fulfillment of the causation criteria of Bradford Hill.

rightJuan José Segura-Egea
 Juan José Segura-Egea

Prof. Dr. Juan J. Segura-Egea (MD, PhD, DDS) born in Jaen (Andalucía, Spain) in 1959. He got the degree in Medicine in 1982 from the University of Sevilla, Spain. He received his PhD degree in 1991 from Dpt. of Biochemistry and Molecular Biology, University of Sevilla, Spain. He got the degree in Dentistry at the same University in 1995. He is currently Chairman and Professor of Endodontics, as well as Director of the Master in Endodontics, at the University of Sevilla, Dental School, (Sevilla, Spain). Prof. Segura-Egea started his research activity in 1991. Since then he has authored more than 100 papers in international peer reviewed journals (H index = 23) and 175 papers in other scientific journals. He is investigating on endodontic medicine, antibiotics in endodontic infections and pulpal and periapical inflammatory responses. He is editor of Endodoncia, the official journal of the Spanish Endodontic Society (AEDE), is Associated Editor of the Journal of Clinical and Experimental Dentistry, is member of the editorial board of the International Endodontic Journal, and is reviewer in several journals included in JCR. Prof. Segura-Egea is an Active Member of the Spanish Endodontic Society and Certified Member of the European Society of Endodontology (ESE).

12:00
Discussion
12:30
LUNCH
13:30
Poster Presentations / Trade Exhibition
14:30
14:30 to 16:00 Symposium: Digital endodontics.
Led by Gianluca Gambarini
14:30
right3D models for teaching and research in Endodontics

Abstract

The highly variable and complex internal anatomy of the human teeth poses a challenge regarding the standardization of levels of difficulty for teaching, as well for sample selection for research. Currently, digital technologies can be used for the virtual rendering and rapid prototyping of three-dimensional dental models, as well as virtual and augmented realities can be applied to the learning environment and development of competencies. These resources have the potential to improve many aspects of teaching and research in our field.

Aims

The aim of this presentation will be to discuss how digital technologies could be used to improve teaching or research in Endodontics.

Objectives

Present some of the different virtual models, 3D printed models, digital applications and medias that potentially can be applied for teaching or research in Endodontics

rightDr Lucila Piasecki
Dr Lucila Piasecki

Dr. Piasecki graduated in Dentistry from the State University of West Parana, Cascavel, Brazil (2003) and in the same institution completed the Specialization in Endodontics (2005). She obtained the Master's of Science degree (2011) and Doctorate (2014) focused in Endodontics at the Pontifical Catholic University PUCPR, Curitiba, Brazil. Dr. Piasecki joined the academic career in 2008 at the Paranaense University. Later she was also an invited professor in the Post-Graduation in Endodontics of the State University of West Parana, Cascavel, Brazil (2009-2016) and served as a part-time faculty of Endodontics at the Pontifical Catholic University PUCPR, Curitiba, Brazil (2013-2015). In 2015 she received a post-doctoral training at Sapienza University of Rome, Italy in the research lab of Dr. Gambarini. Currently, Dr. Piasecki is an Assistant Professor at the Division of Endodontics of the State University of New York at Buffalo, NY, USA. As a full-time faculty, she is teaching and mentoring research in Endodontics for predoctoral and graduate students. She is also a faculty of the graduate school of the University at Buffalo and Assistant Director of the Advanced Program in Endodontics. Dr. Piasecki also serves as the course director of the discipline "Introduction to Digital Dentistry" which has been recently implemented at UB Dental School. Dr. Piasecki is a member of the American Association of Endodontics and Brazilian Association of Dentists. She has published scientific articles in peer-reviewed journals, and is involved in laboratory and clinical research as well in the development of technologies in Endodontics.

14:50
rightEndodontic Guides and 3D Printing.

Abstract

Accessing the root canal system in some cases can be very difficult and time consuming. The use of CBCT is very useful or the treatment planing and for evaluation of the complexity of the dental anatomy. The use of virtual models and 3D guides allows a new approach minimizing the risk of procedural errors. 3D printed guides are used to locate the canal in a safe and easy way .

Aims

The aim of this presentation will be to review how new technology can reduce common iatrogenic problems during the cavity access in the treatment of complex endodontic cases.

Objectives

1. Discuss the future application of a combination of CbCt and a 3D printer in the treatment of calcified canal systems.
2. Utilize the new technology available (3D imaging, dental operating microscope, ultrasonics)to improve on the diagnosis and prognosis of cases with calcified canal systems.
3. Describe the steps required to produce a 3-D printed guide for targeted endodontic treatment.

rightDr P. Sebastian Ortolani Seltenerich
Dr P. Sebastian Ortolani Seltenerich

Dr. Sebastian Ortolani obtained his degree in dentistry from UEM  School of Dentistry in Madrid in 2001. Since 2008 he was a part-time staff member of the department of endodontic program at the University of Valencia, He obtained his PhD cum laude at the University of Valencia in 2014. He is currently holding the position as professor and head of the Division of Endodontology at the UCAM Catholic University of Murcia. He is member of the AEDE (Spanish Association of Endodontology) , Certifed Member of the ESE and AAE international member. Since 2002 he has had a private practice dedicated to endodontics in Alicante, Spain.

15:10
right3D assessment of canal complexities with new endodontic software
3d case assessment

Abstract

The lecture will address the impact of digital technologies, including low-dose CBCTs , softwares , 3d rendering and connected devices in the endodontic clinical practice.  Understanding anatomy in 3d dimensions ( 3d case assessment) to improve procedures and minimize risks is a great improvement for the quality and simplicity of treatments. The lecture will  describe the advantages of using CBCT softwares in diagnosis, treatment plan, and followups both for treatment and retreatment cases, also showing the possible advantages of new 3d guided devices in performing the above-mentioned endodontic procedures.

Aims

To describe how endodontic instrumentation can benefit from CBCT and related new technologies and softwares

Objectives

1. point out the advantages of understanding anatomy in 3d dimensions to improve shaping and access cavity design. 2. describe the advantages of 3d rendering also in diagnosis, treatment plan and followups 3. show the possible advantages of new technologies in the endodontic procedures

rightGianluca Gambarini
 Gianluca Gambarini

Full-time Professor; Head of Endodontic and Restorative, University of Rome, La Sapienza, Dental School; Director of Master of Endodontics in Sapienza. International lecturer and researcher, He is author of more than 480 scientific articles, He has lectured all over the world (more than 500 presentations) as a main speaker in the most important international congresses and many Universities worldwide. During his academic career he gained many awards and recognition, and was responsible of many scientific projects with national and international grants. He has focused his interests on endodontic materials and clinical endodontics. He is also actively cooperating as a consultant to develop new technologies, operative procedures and materials for root canal treatment. He has many patents concerning endodontic technologies. He is currently the Chairman of Clinical Practice Committee of ESE and memeber of the Executive Board. Honorary member of AIOM ( Italin accademy of operative microscopy) He still maintains a private practice limited to Endodontics in Rome, Italy.

15:30
rightDigital solutions for post-endodontic restorations
How CAD/CAM techniques will change your endodontic life

Abstract

The importance of the coronal seal have been already demonstrated by several studies and it should be considered a fundamental phase of the endodontic treatment itself. The reconstruction of endodontically treated teeth should be routinely accomplished by adhesive procedures, both in direct and in indirect ways; these procedures represent a challenge for the clinician. In these cases, most of the time, the residual tooth structure is very limited and a careful attention should be paid to the type of hard tissue available and to all the surrounding periodontal tissues. Many studies advocated a superior performance of complete vs. partial restorations, but many of these reports should be reviewed and no conclusive data are yet available. Inlay, onlay or overlays are the most recognized type of indirect partial reconstructions; they are made by different materials. Composite, glass and feldspatic ceramics are now available for modern CAD/CAM chairside devices and all of them are suitable to make indirect restoration; longitudinal studies report excellent outcome results and, the improvement of these techniques might encourage further types of reconstruction, particularly those named “endocrowns”. A comprehensive and fully documented overview on indirect partial extensive adhesive restorations, with or without intracanal adhesive endo-posts, will be illustrated and proposed as a reliable alternative to complete prosthetic crowns in all posterior teeth, to induce the clinicians to preserve sound tooth structure and to supply a better interface with all the periodontal tissues.

Aims

To emphasize the importance of the post-endodontic reconstruction To present a brief overview of the current status in CAD/CAM devices and technological support available for single tooth post-endodontic reconstruction To evaluate the materials available for these type of procedures To expose the integration between the digital workflow and endodontic treatment

Objectives

A short literature review will be accomplished to demonstrate the importance of the post endodontic reconstruction, some of the well known CAD/CAM devices and technologies available for single tooth post endodontic reconstruction will be illustrated, as well as a rapid evaluation of the materials available for indirect restorations will be presented. Case series and data from several different clinical trials will be presented to explain the integration between the digital workflow and the endodontic treatment and to illustrate the great clinical efficacy of these post-endodontic reconstructions

rightMassimo Gagliani
 Massimo Gagliani

Curriculum Vitae Born in Milan November 12th, 1958. He get the Degree in Medicine in 1983, Specialty in Dentistry in 1987, Specialty in Orthodontics in 1989. Active on Restorative Dentistry and Endodontics since 1990, he became Researcher at the University of Milan in 1992; in the same University was upgraded to Associate Professor in 2000. Actually he is the chief of the Restorative & Endodontics Dept. at the Dental School “Giorgio Vogel”, DDBS, University of Milan. He is an Active Member of the major international and national Society on Restorative & Endodontics such as: ESE, AAE, AIC, SIE, SIDOC. He is one of the five founders of the Digital Dental Academy (DDA). He published in all the major international journals several papers on Restorative & Endodontics topics. He, also, published chapters and was Editor in several books on Restorative and Endodontics topics. He is Member of the Editorial Board in some of the most respected italian journals and Scientific Coordinator for Editorial Group EDRA (active also in Poland and Spain) publisher of: Dental Cadmos (the oldest journal in Dentistry published in Italy) and of the website www.Odontoiatria33.it www.Dentistry33.com; formerly he was Editor in Chief of the Italian Journal of Endodontics (Giornale Italiano di Endodonzia).

Associate Professor, Dental School “Giorgio Vogel”, Dept of Dentistry, Biology and Surgery (DDBS), University of Milan, Via Beldiletto 1, 20142 Milan - Italy massimo.gagliani@unimi.it

15:50
Discussion
16:00
CONGRESS ENDS
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