The etiology and goals of endodontic treatment have long been understood and quite well agreed on. However, for the past century, progress in endodontics has been incremental. Several "non-revolutionary" improvements in diagnostic methods, materials, instruments and equipment have contributed to continuous yet small improvements in the treatment, mostly measured by both doctor and patient satisfaction. Cross-sectional epidemiological studies in different countries done 20 -30 years ago and again recently, however, do not indicate major improvements in treatment outcome. This presentation gives short analytical summary of the past and then looks to the future, painting a more promising view of the new era in endodontics that actually has just begun already… be prepared to be surprised!
To understand why and how we are where we are presently in endodontic treatment, and how a new era has already started.
The objectives are
1) to have a bird's perspective to the present status of endodontic treatment and understand the shortcomings
2) to have a positively critical/analytical view of the shape-clean-fill triad
3) to understand the philosophy and practice of new approaches to the next level endodontic treatment
Dr. Markus Haapasalo (DDS, PhD, Fellow of RCDC (endodontics)) received his dental degree from the Faculty of Dentistry of the University of Helsinki, Finland in 1978. From 1995 to 2004 he was a Professor of Endodontics in Oslo, Norway and from 2004 professor and chair of the Division of Endodontics at UBC, Vancouver, Canada. He is the former head of the Department of Oral Biological and Medical Sciences at UBC.
Dr. Haapasalo has authored or co-authored over 220 scientific peer reviewed articles (Thomson Reuters ‘all databases’; H-index 51, >8000 citations) and written chapters in several international endodontic textbooks. He has supervised over 30 PhD and MSc theses. Research funding is mostly from patent royalties and industry agreements & donations. He is Editorial Board member of “Journal of Dental Research” and "International Endodontic Journal", and editor of "Visual Endodontics 2012" and “Visual Endodontics for iPad” multimedia. He is also a former editor-in-chief of "Endodontic Topics", and a former associate editor of "Journal of Endodontics". Dr. Haapasalo is a reviewer for many peer review journals in medical and dental sciences. In endodontics, his areas of special interest include biofilms, irrigation, persistent infections, resorptions and instrumentation. His research laboratory has continuously 3-6 visiting scientists from all over the world. Dr. Haapasalo is the inventor of root canal irrigant QMiX (world wide patent), which is commercially sold in North America.
Dr. Haapasalo has received several teaching awards including the Louis I. Grossman International Award by the French Endodontic Society in 2007 and Canadian “Teacher of the Year 2014 in Dentistry" Bisco award. he was recently awarded the American Association of Endodontist Louis I Grossman award for “Cumulative publication of significant research studies that have made an extraordinary contribution to endodontology (2019)” Dr. Haapasalo actively lectures about endodontics world-wide.
Session chair: Marco Georgi
The future - the relationship between Endodontics and Restorative Dentistry
Endodontic Therapy allows the maintenance of natural teeth for aesthetic and cosmetic benefit of patients. The relationship between endodontics at routine, enhanced and complex levels and restorative dentistry needs to be good. Higher expectation of our ageing populations will mean more focus on re-cycling of restorations and root fillings. The oral health needs and wellbeing of European population is changing rapidly with a general overall reduction in prevalence and complexity of dental disease. There has been a significant change in restorative concepts over the last 20 years that allow more conservative approaches to be used to restore teeth. Such changes include the ‘Dahl concept’ and better understanding of the aetiology and prevention of tooth wear. Advancements in Dental materials and 3D digitisation will affect the knowledge and skills needed for those responsible for primary and secondary endodontic therapy of compromised teeth in the future. Many younger dentists will have done less conventional indirect restorations themselves but will need to be able to manage teeth and dentitions restored with such restorations when caries, pulpal or periapical pathology dictates. Although the shift to additive adhesive restorative procedures is generally positive the implications for patients in the UK, and other countries committed to the Minamata Convention phase down, are unclear as the profession moves away from significant use of dental amalgam. The ageing baby boomer generation will create significant challenges for us in the future as the number of dentate patients living with old age and dementia will grow significantly with heavily restored teeth. With less time now devoted to formalised education and practical skills-training are we prepared for the future challenge of endodontic and restorative re-cycling and re-restorability? Are we able to train and encourage our young dentists to deliver high quality endodontic treatment across the various complexity bands?
Understand the change in Oral health needs of our population and the likely shift in restorative and endodontic skills required.
Identify the important oral and dental diseases of the future population Discuss how recent concept and changes in restorative dentistry should positively impact on endodontic treatment needs of restored dentitions.
Discuss the Restorative / Endodontic interface and re-cycling with focus on tooth restorability for both conventional and adhesive restorations
Outline the unintended consequences for countries (like the UK) who are moving away rapidly from use of dental amalgam - in line with Minamata agreement; where they have previously routinely relied upon this material to restore vital and endodontically-treated posterior teeth for patients with a high susceptibility to dental disease.
Understand the specific challenges for dentists of Generation X (1965 – 1976), Generation Y (1977 – 1997) and Generation Z (after 1998) to acquire complex restorative / endodontic skills for the future
Highlight the implication to the younger clinicians who live in fear of litigation, and complaints to the dental regulator, and the long-term effect this will have on the dental profession.
Peter Briggs BDS (Hons), MSc, MRD, FDS RCS(Eng)
Senior Lecturer / Consultant in Restorative Dentistry at Bart’s and Royal London Dental Institute and Queen Mary’s University London. Specialist Practitioner, Hodsoll House Dental Practice, Kent, England
Peter qualified in 1983 from King’s College Hospital School of Medicine and Dentistry. He then underwent higher specialist training and was awarded a Winston Churchill Travel Scholarship in 1994. He was appointed an NHS Consultant in 1995 at St. George’s and King’s College Hospitals. He worked within Multi-Disciplinary Teams and was Clinical Director in South West London for many years helping to build a vibrant and well respected clinical and training Unit. After 20 years Peter moved to QMUL & Bart’s Healthcare Trusts as part time Senior Lecturer / Consultant. He was President of British Society of Prosthodontics (BSSPD) in 2014/15. In 2004 he established a part time, specialist restorative referral practice at Hodsoll House, in Farningham, Kent.
Peter has authored, or co-authored, over 70 peer-reviewed publications with recent emphasis on education and training of clinical dentistry. His main focus has been on clinical outcome. He has spoken at UK and European Conferences and looks forward to supporting the 2019 ESE conference in Austria.
In 2018 Peter was appointed by Health Education England (HEE) as the Regional Postgraduate Dental Dean for London and Kent, Surrey and Sussex (LKSS). He currently leads the Workforce Intelligence work stream of the Advancing Dental Care, a national project overseen by Health Education England, with the goal of future-proofing the composition, training and educational needs of the future workforce.
In 2019 Peter has been closely involved with the NHS commission and validation of Tier 2 complexity practitioners in Endodontics within London.
In his spare time his main interests are walking and exploring the UK, and Europe, with his wife Karen.
The future - the prevalence of pulp and periapical diseases
Endodontology deals with the causes, diagnosis, prevention, and treatment of diseases of the dental pulp and their sequelae. We know that the prevalence of apical periodontitis in populations is high, and that the proportion of successful root canal treatments is low, compared to what is obtained in controlled clinical settings. Further, we know that the risk of apical periodontitis is higher in root filled teeth if the root filling is assessed inadequate. On the other hand, it has been documented that root filled teeth most often are retained for many years, with or without evidence of periapical disease.
This pattern has not changed much during the last decade or more, even though there has been an enormous development in treatment-related instruments and optical aids. Additionally the diagnostic methods provide more and more detailed, and perhaps more precise, information.
The question remain: Will the improvement of instruments and materials improve the endodontic status in the general population? Will new diagnostic methods affect our diagnostic thinking and eventually lead to other treatments for the patient?
During the recent years, there has been a trend towards less invasive endodontic treatments to maintain pulp vitality. How will that influence the endodontic status?
The population is ageing and the proportion of elderly individuals will increase. How will this affect our treatment and treatment choices, and the prevalence of apical periodontitis in the population?
To discuss endodontic status in the population, and relate it to present and future improvements and challenges.
This lecture will discuss implementation of new diagnostic tools, changes in treatment strategies and the use of more patient-based outcomes and the possible effect on dental and general health in a population with a higher proportion of elderly individuals.
1995 D.D.S. (Aarhus University, Denmark)
2001 Ph. D. From (Aarhus University, Denmark)
2003-2007 Holder of a post doc. scholarship from the Danish Agency for Science, Technology and Innovation
1995-1996 Dentist, private practice
1997-2001 Ph. D. student (Aarhus University, Denmark
2000-2007 Dentist part-time, private practice (owner)
2003-2007 Research associate (Aarhus University, Denmark)
2007- Associate professor (Aarhus University, Denmark)
2012-2018 Professor (University of Oslo, Norway)
2018- Private endodontic practice
Lise-Lotte Kirkevang has published papers in both national and international journals. She serves as scientific editor for the Danish Dental Journal, and endodontic textbooks. She has given both pre- and postgraduate lectures, and she has served as member of several national and international committees with the focus to improved endodontology in general, as well as endodontic teaching, in particular. She has received prizes for both teaching and research in the field of endodontology.
Poster Presentations / Trade Exhibition
Session chair: Karl Schwaninger
The future - the impact of CBCT imaging on endodontic treatment planning
For several years, intra-oral images (i.e. periapical images) have been state-of-the-art for diagnosing and establishing the treatment plan for periapical lesions. As these are two-dimensional images, some areas might not be possible to evaluate clearly, due to overlapping of anatomical structures or areas where dense cortical bone masks small areas of mineral loss in the cancellous bone. In the present, imaging guidelines focusing into the use CBCT imaging to overcome problems such as the superimposition of anatomical structures. Implementing CBCT may beneﬁt the ﬁeld of endodontics as an additional diagnostic method to be used in cases when the clinical examination, patient symptoms, and traditional two-dimensional imaging techniques do not give clear answer. Currently, we accept that even though CBCT generally shows a higher sensitivity for detecting small periapical lesions compared to periapical images, while the clinical documentation of the diagnostic accuracy of CBCT is yet to be disclosed. In the future, we need to concentrate on what the dentist, the patient, and the society gain from implementing CBCT in the decision-making and therapeutic process in relation to the endodontic treatment planning. In other words, we need to clarify how the use of CBCT will affect endodontic treatment choice and (eventually) its outcome. Current information does not show to what extent the use of CBCT is beneﬁcial to the patient (or even to the dentist). Further, no studies have evaluated whether the use of CBCT will affect the prognosis of the treatment (e.g. healing of a periapical lesion). At last, there is a lack of information regarding the socio-economic effects and the effect of an increased radiation burden to the population of systematic use of CBCT as a supplement during endodontic treatment planning.
The main objective of the lecture will be to discuss the probable next steps regarding the use of CBCT imaging on endodontic treatment planning.
Associate Professor, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark. Holds a PhD in Periodontology, from Sao Paulo State University (Brazil), and a PhD in Dentomaxillofacial Radiology from Aarhus University (Denmark).
The future - endodontic microbiology
The evolution of endodontic microbiology is a response to clinical needs. This can take the form of an increased demand to translate results from research and technical innovations garnered from laboratory investigations to improve anti-infective therapies. With the inclusion of biofilm biology in endodontics, research in endodontic microbiology is slowly abandoning the dogma of the pure culture technique. Moreover, molecular biology techniques have improved our knowledge of endodontic infections and promise to revolutionize the diagnosis of endodontic disease. This lecture offers a framework of what's to come in the field of endodontic microbiology, based mostly on the evolutionary pace of microbiologic studies witnessed over the past years.
The main goal of this lecture is to provide an overview of the current status of endodontic microbiology research and whats next to come,
List the applications of innovative methods used in microbiology to improve clinical outcome.
Define the importance of improving the translation of basic science studies to meet clinical needs.
Define the place that basic research in endodontic microbiology has in the context of endodontic pathobiology.
Luis Chavez de Paz
Luis obtained his dental degree in 1998 from the University of San Marcos in Lima, Peru. In 2000 he obtained a Master of Science degree in Odontology from the University of Gothenburg, and in 2005 he defended a doctoral thesis at the same institution. Luis doctoral thesis comprised clinical and experimental work that focused on bacteria that persisted during and after root canal treatment. For several years as a post doc and researcher at the Department of Oral Biology at Malmö University, Luis worked intensely on oral microbial biofilms, and the different aspects of the physiology of oral microbial communities and specific microbial stress responses. Luis has authored several publications with high citation ranks, textbook chapters and he is recurrently invited to lecture for endodontic societies and endodontic group studies where he covers microbial aspects of persisting root canal infections and microbial biofilms. In 2015 the book ‘The Root canal Biofilm’ was published, where Luis served as co-editor. Luis currently practices clinical endodontics in the Stockholm region.
Luis research interests cover the main areas of oral and endodontic microbiology, with particular focus on microbial biofilms. Within these areas, Luis’s research has centered on studying the physiology of endodontic bacteria and their molecular responses to stress. Luis has authored several publications in scientific journals including reviews and textbook chapters, all with high citation ranks. Luis serve as an advisor in scientific boards of the Journal of Endodontics and International Endodontic Journal.
Session Chair: Thilo Weeger
The future - access cavity design
Rational approach and future perspectives on access cavity designs
Recently the endodontic specialty experienced multiple technological advancements. These advancements enabled the application of minimal invasive dentistry concepts in clinical endodontics. The geometrically predesigned shapes of access cavity designs were the first to be affected by this minimalistic invasion. Traditional access cavity designs were questioned, regarded as legacy concepts and modified to fit current minimal invasive trends. The objective was always dentin conservation that might benefit the patients by increasing the longevity of the endodontically treated teeth. Although dentin conservation during access cavity designs seems logical, problems do exist and more research is needed to grow the evidence for minimal invasive intervention
To investigate the current trends in access cavity shapes, their benefits and drawbacks. The future of access cavities might be exciting
1. Develop a rational approach to minimal invasiveness in endodontics
2. Investigate the influence of different access cavities on root canal treatment procedures
3. Suggest solutions for clinical problems during access cavity preparation
4. Reflect on the future of access cavity designs
Chaniotis Antonis graduated from the University of Athens Dental School, Greece (1998). In 2003 he completed the three-year postgraduate program in Endodontics at the University of Athens Dental School.
Since 2003, he owns a limited to microscopic Endodontics private practice in Athens, Greece.
For the last ten years, he served as a clinical instructor affiliated with the undergraduate and postgraduate programs at the University of Athens, Athens Dental School, Endodontic department, Greece.
In 2012 he was awarded the title of Clinical fellow teacher at the University of Warwick, Warwick dentistry UK.
He lectures extensively nationally and internationally and he has published articles in local and international Journals.
He currently serves as an active member of the Hellenic Society of Endodontology (ESE full member society), a certified member of the European Society of Endodontology (ESE) and international member of American Association of Endodontists (AAE).
Invited speaker and sponsored lecturer for Coltène / Micro Mega
The future - working length estimation and control
how to make it easy
Endodontic treatments are currently based on changes in the shape and contents of what is known as the endodontic space: it is difficult to distinguish the point, or, better, the so-called passage plan between ‘‘in’’ and ‘’out’’. periodical radiographs, electronic apex locators and CBCT are currently the most popular methods to establish the distance between a coronal and an apical reference point: this distance at the end of the shaping procedure could decrease and become shorter due to the removal of the interferences in the root canal. For that reason shaping under continuous control of an apex locator will be described, giving attention to the pros and cons of this method.
The last part of the presentation will be focused on the other steps of the root canal treatment and the possibility to reconsider in the future the current gold standards.
Aim of this lecture is to give to the participant a clear vision of the current methods for establishing the working length and how to optimise this information
The participant will reinforce his knowledge about the working length issue, understanding the limits and benefits of the current techniques
- President and Active member of the Italian Association of Endodontists (SIE)
-Active member of the Italian Association of Dental Microscopy (AIOM).
-Treasurer and Certified member of the European Society of Endodontology (ESE) . Lecturer in more than 200 Presentations , Precongress Courses, and Workshop during many National and International Meeting.
- Author of scientific articles related to Endodontics published on National and International Dental journals and chapters of books related to Endodontics.
Private precticioner and Specialist in Endodontics in Rome, London and St albans