Interdisciplinary management of the legacy of complex trauma in children and adolescents
Paediatric Dentists are in a privileged position of treating young patients who are in a period of growth and development. Interdisciplinary and multidisciplinary team efforts for the treatment of young children and adolescents with developmental defects and who are unfortunate to suffer severe dento-alveolar trauma, will ensure good long term outcomes for the patients. The management of much dental trauma in a growing child patient requires interdisciplinary management, such as intrusion injuries that may require orthodontic extrusion. Also, there are implications for the orthodontic movement of teeth that have been traumatised in the past as many of these will remain prone to external root resorption during orthodontic movement. In particular teeth that become ankylosed after trauma pose a serious management issues for clinicians with a very severe long term implications for the child. What are the management options for such teeth? What should clinicians do for teeth that are ankylosed and are getting infra-occluded? Infra-occluding teeth can have disastrous consequences for the patient in the long term due to lack of alveolar bone growth in that region. Bone management requires complex treatment planning but is crucial for a good prognosis for the child in the long term. The speaker will present the methods for conserving bone in region of ankylosis, and the role of the interdisciplinary team working between orthodontists and Paediatric dentists to secure the best outcome for the child into adulthood. We have developed a true interdisciplinary approach for the management of anterior teeth with poor prognosis as a result of dental trauma. This involves bone management at the affected site followed by autotransplantation. Since the inception of this programme we have placed over 250 transplants using the multidisciplinary team comprising of both paediatric dentistry and orthodontic expertise.
This talk will aim to map out the journey of a young child which starts at the time the child suffers severe trauma to anterior teeth through to adulthood where lost anterior teeth are replaced biologically to give this patient a good and sustainable, long term outcome.
- to understand the impact of previous trauma
- to understand the role of orthodontics in the treatment of traumatised teeth
- the role of orthodontics in treatment of traumatized teeth of poor prognosis -the role interdisciplinary care in dental Traumatology
- management of bone when loss of tooth is inevitable
- rationale and outcomes for tooth transplantation in children
PROF. MONTY DUGGAL
Monty obtained his dental degree and MDS in Paediatric Dentistry from India. He then immigrated to the United Kingdom and obtained his FDSRCS from the Royal College of Surgeons of England and his PhD from University of Leeds. He was appointed Professor and Chair of Child Dental Health at Leeds Dental Institute in 1999 where he oversaw a large postgraduate programme in Paediatric Dentistry which has international acclaim. In January 2017 he was appointed as Professor and Head of Paediatric Dentistry in Faculty of Dentistry, National University of Singapore. Prof Duggal has served in various senior positions, and was President of the European Academy of Paediatric Dentistry from 2014-2016 and has been on the board of EAPD for last 10 years. Professor Duggal has published over 150 research papers in international journals and is author of “Restorative Techniques in Paediatric Dentistry, which has been published in 7 languages and has sold over 16,000 copies worldwide. He is also a co-author of a textbook on Dental Traumatology and has Co-Edited “Paediatric Dentistry” by Oxford, now in its 5th edition, and more recently “Paediatric Dentistry at a Glance”, published by Blackwell Willey. He has administered research grants totaling over seven million pounds and is an internationally recognised researcher and clinician with main research interest is Cariology and Translation Research in Clinical Paediatric Dentistry, including dental traumatology. Apart from Paediatric Dentistry his main interest is playing and watching cricket and any time spare from work and family is devoted to this important activity
Session Chair: Christof Pertl
Herpesviruses as putative pathogens in endodontic diseases
In 2003 herpesviruses were proposed as putative pathogens in endodontic diseases. Their involvement in the development of apical periodontitis may be a direct consequence of viral infection, or an indirect repercussion of virally induced impairment of local host defense that will in turn favor bacterial overgrowth. It is assumed that the interactions between herpesviruses and bacteria, at the site of periapical inflammation, are responsible for the expression of various clinical characteristics of endodontic diseases.
Epstein-Barr virus and Human cytomegalovirus are the most frequently detected viruses in apical periodontitis and periodontal abscess samples, and their occurrence has been related to symptomatic and large-sized periapical lesions in previously conducted studies. In addition, Varicella-zoster virus has been also recognized as a potential causative agent of apical periodontitis and root cervical resorption with unspecific clinical manifestations. Although several hypotheses of herpesviral involvement in the pathogenesis of apical periodontitis have been proposed, some controversies are still present. Also, underlying molecular mechanisms and pathways need to be better understood.
This lecture aims to present the current knowledge on herpesviral infections in endodontic diseases in terms of their impact on clinical, radiographic and histopathological findings. In addition, methodological issues related to differences in the detection rates of herpesviruses in previously conducted studies, will be discussed.
This lecture overviews the roles of herpesviruses in pathogenesis of endodontic diseases. Therefore, participants should be able to critically assess the significance of herpesviral infection in the pathogenesis of endodontic diseases and discuss about potential clinical implications, methodological issues, and further perspectives in research and treatment of potentially infected patients.
Aleksandar Jakovljevic (born 1986) graduated in 2010 as a DDS from the University of Sarajevo, Bosnia and Herzegovina. He earned his PhD in basic and clinical dental sciences related to herpesviral infection in apical periodontitis from the University of Belgrade, Serbia, in 2017. From 2017 he is teaching assistant at the Department of Pathophysiology, Cathedra of Dental Pathology, School of Dental Medicine, University of Belgrade, Serbia.
He has published numerous articles in peer reviewed international journals in the field of etiopathogenesis of apical periodontitis and Herpesviruses. He also acts as a reviewer for a number of international journals (including International Endodontic Journal, Archives of Oral Biology, Acta Odontologica Scandinavica, Journal of Applied Oral Science, Journal of Virology, etc.) and as external reviewer for the French Institute for Dental Research (IFRO). He has received several awards for his scientific work, including the Best young investigator at the 20th Congress of the Balkan Stomatological Society in 2015, at the 4th Congress of the Austrian Society for Endodontology in 2016, and the 11th edition of Paul Calas Prize of the French Society of Endodontics in 2018. In 2015 he received the prestigious award of the European Endodontic Society – Young Investigators Research Grant for the project entitled: “Oxidative stress biomarkers and bone resorption regulators in apical periodontitis - correlation with Epstein-Barr virus infection”. In 2018, his paper entitled: “The Role of Varicella Zoster Virus in the Development of Periapical Pathoses and Root Resorption: A Systematic Review” has been selected by the American Association of Endodontists Continuing Education Committee for inclusion on Endo On Demand CE program.
Persistent orofacial pain and endodontics: pre-op and post-op considerations
This presentation will outline and discuss the causes of persistent orofacial pain that can masquerade as odontogenic pain pre-operatively and those that present post-operatively complicating endodontic decision-making in the healing phase. The following conditions will be specifically addressed: Temporomandibular disorders that refer pain to the dentition; Trigeminal Neuralgia presenting with concomitant continuous pain; “phantom" neuropathic tooth pain. Diagnostic strategies will be outlined alongside management options.
To outline and discuss the causes of persistent orofacial pain that can masquerade as odontogenic pain pre-operatively and those that present post-operatively complicating endodontic decision-making in the healing phase
1) Identify the referral propensity and patterns of Temporomandibular Disorders to the dentition;
2) Outline the differing presentations of Trigeminal Neuralgia in respect of the dentition;
3) To be able to effectively screen for, and then increase the index of suspicion of 'phantom' tooth pain following endodontics
Justin is a Professor of Orofacial Pain and Deputy Dean of Clinical Medicine at Newcastle University and an Honorary Consultant Oral Surgeon at Newcastle-Upon-Tyne’s Hospitals’ NHS Foundation Trust in the UK.
Justin was appointed Clinical Fellow/Hon SpR in Oral Surgery at Newcastle University in 2003. He obtained his PhD, “Ideologies and outcomes in Temporomandibular Disorders (TMD)”, from Newcastle University in 2008. He subsequently completed his Oral Surgery specialist training and also became the first person in the UK to pass the American Board of Orofacial Pain. He held a prestigious NIHR Clinician Scientist award from 2012-2017, which funded his research into the care pathways in chronic orofacial pain and was promoted to a personal chair in 2017. In his clinical practice he has established and leads a multidisciplinary orofacial pain clinic that receives tertiary-level referrals from both dental and medical specialities in the North of England.
In addition to holding a prestigious NIHR award he has previously received the outstanding post-doctoral award from the Behavioural, Epidemiology, and Health Services Research group of the International Association of Dental Research (IADR), for his research into TMDs. His teaching was also acknowledged through the Vice-chancellor’s award for excellence in teaching and learning and he also received the IADR Education Research Faculty award in 2010.
His primary research interests are in orofacial pain both at the first and second translational research gaps. He has wide experience in a variety of methodologies involved in health services research. He is also keenly interested in helping develop the next generation of clinical academics and as such is involved nationally with NIHR as the Acting Associate Dean for Dental Integrated Academic Training and locally as Director of Newcastle University’s Faculty of Medical Sciences’ fellowship support programme for clinicians applying for externally funded research fellowships.
Poster Presentations / Trade Exhibition
14: 30 to 18:00 Symposium: External cervical tooth resorption.
Led by Shanon Patel. This exciting symposium aims to deliver the latest knowledge and clinical research on External Cervical Resorption and will be delivered by a knowledgeable team of European clinical academics from KCL, UK and KU Leuven, Belgium.
Aetiology and potential predisposing factors
Unlike other oral diseases such as caries and periodontitis, there is limited evidence on the aetiology of External Cervical Resorption (ECR). The literature is replete with possible predisposing factors; trauma and orthodontic treatment being the most commonly cited. However, more spurious causes have also been hypothesised such as bisphosphonates and even poor oral hygiene. However, there with no good evidence of a ‘cause and effect’ for any of these proposed factors. ECR may simply be an idiopathic in nature.
To date, there have been no in vivo aetiological models. Emerging research using molecular methods is now being carried out at King’s College London with the aim of identifying different upregulated markers which may be present within ECR which ultimately may ultimately give a true insight in the of different aetiological factors.
Several retrospective studies have identified that maxillary incisor/canine teeth, as well as maxillary and mandibular molar teeth are the most commonly affected teeth. Why is ECR so prevalent amongst these teeth groups?
ECR are detected with increased diagnostic acuity thanks to CBCT, allowing a precise and early stage detection. Although the aetiology of ECR may not influence the subsequent clinical management, understanding the predisposing factors and potential aetiological causes will allow to provide an informed care to patients and minimising predisposing factors.
1. Appreciate the suggested aetiological causes of ECR
2. Recognise the potential predisposing factors contributing to ECR formation
3. Consider the effect of aetiological factors on clinical management
4. Understand the distribution of ECR
Dr Federico Foschi
Fede graduated with honours from the Alma Mater Studiorum, Bologna. He accomplished a PhD in Endodontic Microbiology at the Forsyth Institute in Boston, MA, leading to the IADR Pulp Biology award. He moved to the UK, as Lecturer in Endodontology at King's College London. He became Fellow of the Royal College of Surgeons of England after completing the five-year training in Restorative Dentistry at Guy’s Hospital, London. As registered Endodontist enjoys a part-time specialist practice. Consultant/Senior Lecturer and program director of the MSc in Endodontics of the The Faculty of Dentistry, Oral & Craniofacial Sciences at King's College London teaches both undergraduate and postgraduate students. He published 47 peer-reviewed papers and two book chapters. He is a Fellow of the Higher Education Academy.
Pathogenesis and histology of External Cervical Resorption
The pathology of ECR is challenging, since it is often asymptomatic and its clinical and radiographic presentation varies. Thus, in vivo Cone-beam CT, in vitro 3D imaging (Nano-CT) and histological analysis are essential to visualize and understand the characteristics and morphology of this condition. In addition, hard and soft tissue histology are essential to investigate the type of tissue and cells involved, as well as to match the morphology (based on 3D analysis) with the structure on the cellular level. Based on these findings different concepts will be presented, whereas the potential stimulus of this pathology will be discussed.
This work aims in analyzing and discussing the pathogenesis and histology of External Cervical Resorption (ECR) and proposes new concepts on the ‘why’ and ‘how’ ECR is triggered and evolves.
1. Morphology of ECR based on 3D imaging and histological techniques
2. Pattern of ECR based on histological analysis
3. Possible triggering factors for ECR evolution
Athina-Maria Mavridou graduated from the Dental School of the National Kapodistrian University of Athens in 2004. In 2008 she completed a 3 year postgraduate program in endodontics, at the University of Ghent in Belgium, investigating the influence of laser on root canal. From 2008 to 2010 she worked as an endodontist at the university clinic of Groningen in the Netherlands. Since 2010 she works as an endodontist at Endo Rotterdam in the Netherlands, while performing in parallel a PhD on the topic of external cervical resorption at BIOMAT research cluster of KU Leuven in Belgium.
Diagnosis and management of external cervical tooth resorption
External Cervical Resorption (ECR) is a relatively common phenomenon, which is often misdiagnosed. Its significance and also recent, novel research in this area has resulted in the European Society of Endodontology publishing a position statement on ECR. There is emerging evidence to suggest that there is no ‘classic’ clinical or radiographic presentation of ECR. The accuracy of diagnosis of ECR has improved significantly with the introduction of CBCT; for the first time the true nature of ECR can be truly appreciated. Novel ex-vivo and in-vivo research has resulted in a clinically relevant 3-dimensional classification being devised to allow better communication of ECR between colleagues. This improved 3-dimensional visualization of ECR means that the clinician appreciates the extent of ECR, and may therefore offer the most appropriate management. Treatment options include; external repair, internal repair, intentional replantation, periodic reviews or extraction.
To present the latest, clinically relevant and cutting-edge research on diagnosis and
management of ECR.
The delegate will have a clear understanding of:
• the various clinical presentations of ECR,
• the impact of CBCT on the radiographic presentation of ECR,
I divide my time between working in multi-disciplinary specialist practice in central London, and teaching future Specialist Endodontists in the Postgraduate Unit at King’s College London Dental Institute (KCL).
My PhD thesis assessed the use of CBCT in the management of Endodontic problems. I am actively involved in research and have (co-)supervised over 40 Masters and PhD students.
There is a direct synergy between my clinical practice, and the research that I carry out. My background as a clinical academic has resulted in me publishing clinically relevant, high impact papers. I have published over 75 papers in peer reviewed journals and 3 National and European guidelines in dental imaging. My expertise in Endodontology has resulted in giving over 50 presentations in international meetings spanning 5 continents.
I have co-authored 6 textbooks which have been translated into 4 different languages, ‘Principle of Endodontics’ is now in its third edition and is considered essential reading for undergraduates in the UK and the commonwealth, ‘Pitt Ford’s Problem Based Learning in Endodontics’ was the first PBL book published in Endodontics, and ‘CBCT in Endodontics’ is considered essential reading for Endodontists using CBCT, and has been translated into Mandarin, Japanese and Portuguese. Most recently ‘Endodontology at a Glance’ is the first authoritative revision guide in Endodontology.