9:00 to 12:30 Symposium: Micro- and nano-CT in endodontic research.
Led by Dag Ørstavik
Introduction Micro- and nano-CT in endodontic research
Three-dimensional imaging has greatly improved diagnostic and therapeutic approaches in medicine and dentistry. Particularly, hard-tissue analyses with various computer tomographic techniques have proven to be of special value in dentistry and endodontics. Micro-CT and now nano-CT are exciting tools that find ever-expanding applications in endodontic research. While the complex structures of enamel, dentine and tooth cementum have been studied by 2-D techniques for a long time, micro- and nano-CT technology, with resolutions down to 300-500 nanometer voxels, opens new vistas for illustrating and thereby understanding the details of the hard tissues.
The symposium aims to describe recent advances of applications of micro-CT, and to explore the emerging field of nano-CT investigations in endodontics, hosting experienced researchers in the field and showing exciting new data.
Dag Ørstavik is professor emeritus at the University of Oslo (UiO), where he was Head of the Department of Endodontics from 2004 to 2016. He graduated as a dentist from UiO in 1969, where he also took his PhD in Oral Microbiology in 1977 and completed the specialization program in endodontics in 1984. Dr. Ørstavik worked as scientist/senior scientist at the Nordic Institute of Dental Materials (NIOM) from 1978 to 2004, interrupted by 2 years as visiting professor at the Department of Endodontics at the University of North Carolina at Chapel Hill 1993-1995. He has maintained a part-time private practice with endodontics throughout his career. His research has focused on mechanisms of dental plaque formation; physical, chemical, biological and antimicrobial properties of endodontic filling materials; and clinical studies on factors influencing treatment outcome in endodontics.
Fundamental aspects of micro and nano-CT applied to biological tissues
Man has always sought to understand what cannot be seen by naked eyes, and this curiosity has been fulfilled over time by the improvement in technology, especially in the medical field such as optical microscopes, the discovery of x-rays as well as its applications, etc. All this is allowing for unveiling microstructures as never before.
Among these, one can highlight the advances in radiographic imaging, which started yet in the 18th century, and developed up to the possibility of the 3D computed tomography in the seventies, and that now can allow the non-destructively visualization of structures in the sub-micrometer resolution.
MicroCT is already widely used in studies of mineralized tissues, but when it comes to soft tissues it is often limited by low imaging contrast. Some limitations can be overcome to some extent by adjusting the working parameters of micro-CT equipment, while others need more detailed preparation of the samples.
We will present important principles on microCT, as well as the challenges and recent developments for overcoming some important issues in microCT
Understand the fundamental principles of microCT with its possibilities, limitations and some special issues on soft tissue enhancement
Liebert Parreiras Nogueira
Graduated in Physics by Rio de Janeiro State University, Brazil (2005). Master and PhD in Applied Nuclear Physics by the Federal University of Rio de Janeiro, Brazil (2011). I am a former Professor at the Rio de Janeiro State University (2012 - 2017). Nowadays I am a senior Engineer at the Oral Research Lab, at the Faculty of Dentistry, University of Oslo, UiO, Norway. Specialist in x-ray imaging, microCT and nanoCT.
Micro and nano-CT applied to dental research
X-ray imaging including tomography has developed rapidly over the last decade, and the technological advances and user friendliness have made the technique applicable to virtually all branches of the natural sciences and manufacturing industries. The unique advantages of X-ray imaging reside in the combination of high resolution, the penetrating ability of looking inside materials even through complex sample environments, and the relative ease with which the resulting images can be interpreted. Still, X-ray imaging keeps progressing and near-future breakthroughs will include ultrafast measurements, computer-assisted image interpretation (machine vision & learning) and lower-dose measurements. 3D images are easy to grasp, and CT is quite literally an eye-opener to internal processes in living and functional objects. Also for the general public and popular dissemination, CT images are easily digested and of invaluable importance when it comes to visualizing complex internal structures. Technically, a range of different contrast mechanisms can be employed (diffraction, scattering, and absorption) where the spatial resolution may reach a few nanometres, while temporal resolutions can be below one microsecond. Such developments are typically spearheaded at international large-scale facilities (synchrotrons and free-electron lasers), but also rapidly adapted to laboratory-based equipment. These fundamental aspects of nano-CT will be address for application to dental tissues.
Present recent developments in X-ray imaging including tomography for dental research
The lecturer will provide the audience with an overview of the recent technological advancement and limitation in X-ray imaging
Prof Håvard Jostein Haugen
Håvard J. Haugen is currently professor and leader of the Biomaterials group at The Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo. He received a Master in chemical engineering at the Imperial College of Science, Technology and Medicine in London, UK in 2001 and a doctoral engineering in biomaterials from the Technische Universität München in 2004. Previously Haugen has been working at the Central Institute for Medical Engineering in Munich (2001-2004), at Helmholtz Institute for Biomedical Engineering in Aachen (1999) and the Tissue Engineering Centre at Imperial College, London (2000-2001).
Haugen has been granted more than 10 million Euros in various research grants the past five years from both the European Research Council and the Research Council of Norway. Haugen has about eighty publications, and has been awarded the British Petroleum Prize in 2000, University of Oslo Innovation Prize in 2008 and the German innovation award for 2009 (Innovationspreis 2009 der Deutschen BioRegionen). From 2012-2016 Haugen was the President of the Scandinavian Society for Biomaterials (www.scsb.eu).
The research group of Prof. Haugen bridges the gap between basic materials research and clinical treatment. UiO hub is highly interdisciplinary with extensive experience in dental biomaterials development, modification of biomaterials, soft tissue and hard tissue regeneration and integration of biomaterials into skin and related hard tissues, using methods from biomaterials, odontology, and biochemistry. His group currently has and operates advanced micro- and nanoscale X-ray imaging systems. Their nanoscale X-ray imaging system is one of only a few in Norway, covers a wide range of object sizes and spatial resolutions, and opens unique possibilities for 3D imaging
Morphometric tooth analysis by micro-CT
The comparative anatomy of contralateral premolars has not been previously studied using micro-CT technology . Micro–computed tomography investigations allows for detailed to assessment and comparison of the morphology of contralateral premolars in terms of linear measurements and anatomic/morphometric characteristics. Micro-CT technology along with metrology software can validate the use of contralateral premolars as samples in endodontic comparison studies.
Demonstrate the morphometric and anatomic similarity of contralateral premolars, thereby showing how they are ideal substrates for endodontic comparison studies.
1. Qualitatively and quantitatively describeand compare the similarity of the anatomy/morphology of contralateral premolars’ pulp cavity in terms of shape deviation analysis and simple morphometric geometric parameters
2. Assess and compare the morphology of contralateral premolars’ pulp cavity in terms of anatomic characteristics such as length, canal width, dentinal thicknesses, accessory canals, root canal configurations, isthmi, C-shapes, root canal orifices, and apical foramina.
3. Showing how micro-CT technology and metrology software can be used to validate the use of contralateral premolars in endodontic comparison studies by comparing their root canal systems before and after canal instrumentation with one instrumentation system.
Gaute Floer Johnsen
Gaute Floer Johnsen graduated from the University of Oslo Dental School in 2009. He completed his PhD and specialization in Endodontics at the University of Oslo in 2019.
He has practiced as a general dentist in the Norwegian Military Dental Service, National Public Dental Service, and maintained a private practice.
Since 2013 he has maintained a part-time private practice limited to Endodontics in Sørumsand, Norway. He has published articles in national and international Journals.
Applications of nano-CT in endodontic research"
Dr Pia Sunde
Pia Titterud Sunde is associate professor and has since 2016 been head of the Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo. She graduated as a dentist from the Faculty of Dentistry, University of Oslo in 1994, where she also took her PhD in Endodontic Microbiology in 2003 and specialization in Endodontics in 2012. She has more than 24 years of clinical experience and has for the past years been working part-time in private specialist practice with endodontics. Her research is focused on persistent endodontic infection (microbiologi), endodontic materials, micro-and nanoscale X-ray imaging of human teeth.
Poster Presentations / Trade Exhibition
14:30 to 18:00 Symposium: The impact of tooth anatomy on intracanal procedures.
Led by Ronald Ordinola Zapata
Managing the complex anatomy of single rooted teeth: mandibular premolars and dens invaginatus
Many endodontic failures are contributed to poor management of complex anatomy. No other group of teeth have more complex anatomy than Mandibular Premolars and Dens Invaginatus. With the help of 2D and 3D imaging,clinical photographs, Case Series with long term follow up, this presentation discusses complex anatomic variations in mandibular premolars and Dens Invaginatus teeth as well as the strategic clinical management directed at obtaining successful long term results.
Aim is to discuss how complex anatomy can influence clinical outcomes and highlight the anatomic variations and management strategies in mandibular premolar and Dens Invaginatus teeth.
Highlight the anatomic variations in Mandibular premolars.
Highlight the anatomic variations in Dens Invaginatus.
Discuss clinical management strategies for successful outcomes in this case type.
Dr. Sashi Nallapati did his B.D.S at Govt. Dental College & Hospital, India and his post graduate training in Endodontics at Nova Southeastern University (NSU), Davie, Fl, USA. He is in full time private practice limited to Endodontics in Kingston, Jamaica. He is a visiting faculty at NSU, Florida, USA and a part time lecturer at the University of the West Indies, Mona School of Dental Medicine, Kingston , Jamaica. He received the prestigious distinguished alumni achievement award from NSU in 2014.
He has authored articles in peer reviewed journals and contributed to text books in Endodontics. He was invited to speak in 17 countries to date.
He is an avid cyclist and likes to hike as well.
Managing the complex anatomy of posterior teeth: surgical and non-surgical approaches
The surgical solution to a conventionally treated tooth that had become refractory to healing was once considered the next and final step prior to extraction, and that it was a singularly-occurring event. Considering contemporary techniques and technologies, are either of these statements true? Or should it be viewed as one extension of the current therapy, in addition to retreatment, in a process of revision and remodeling. When is it appropriate to consider a second intervention, either surgical or non-surgical, and what metrics are we using to determine this? Are they stand-alone procedures, or are outcomes enhanced with co-treatment options? What is the alternative if the conventional surgical options are exhausted? This presentation will examine the available literature for guidelines to these treatment decisions and, using multimedia, demonstrate various case scenarios and techniques.
At the end of the presentation, the participant should:
1. Appreciate the advantages of Virtual Surgery™ in pre-operative diagnosis and decision tree formulation
2. Identify the criteria established for choosing retreatment or re-surgery, and whether it can be in vivo or ex vivo
3. Describe the procedural steps required for each clinical revision of choice.
Dr Stephen Niemczyk
Dr. Niemczyk graduated from the University of Pennsylvania School of Dental Medicine, receiving his D.M.D. in 1982 and his postgraduate Endodontic certificate in 1984. Since 1995, Dr. Niemczyk has been the Director of Endodontic Microsurgery and Assistant Program Director for the Post Graduate program at Albert Einstein Medical Center in Philadelphia. He also serves as a surgical consultant to the Postgraduate Endodontic Program at the National Naval Medical Center in Bethesda, MD, and the U. S. Army Endodontic Residency Program in Fort Gordon, GA.
Dr. Niemczyk has lectured extensively in the U.S., Central America, Europe, the Middle East and Asia on topics ranging from Microsurgery and Intentional Replantation to advances in Non-Surgical Endodontics and Cone-Beam CT. He has authored numerous papers, chapters on Microsurgery in Dental Clinics of North America and use of CBCT in non-surgical Retreatment. He is a member of the Scientific Advisory Board for the Journal of Endodontics and the Journal of Oral and Maxillofacial Surgery, Medicine and Pathology. He is the founder of Endodontic Microsurgical Innovations, dedicated to the development of new treatment techniques and instrumentation. He is a Diplomate of the American Board of Endodontics, and maintains a full time practice limited to Endodontics in Drexel Hill, PA.
Root canal anatomy, The truth is in the details
The overall idea of this symposium is to give the audience the concept of multidisciplinary treatment and to “not miss the forest for the trees”. Most of dentists do not appreciate the nature of tooth variability because they are only considering a few parameters for the planning of a clinical procedure (the curvature, the apical diameter, the taper, the irrigant, or the medicament). However, the tooth, the periodontal condition, the restorative prognosis and the patient should be considered as a single entity.
To demonstrate the advantages of magnification, CBCT imaging and micro-computed tomography technology to describe relevant anatomical concepts.
- To use representative clinical cases that includes the use of the operative microscope, CBCT imaging and follow-ups to illustrate the treatment of complex anatomy.
- To analyze the root canal anatomy of mandibular molars and its relationship with endodontic failures.
- To describe the apical anatomy of the mesiobuccal root of maxillary molars and its relationship with non-surgical and surgical endodontic procedures.
- To revise the actual concept of danger zone in mandibular molars
Ronald Ordinola Zapata; Dr Marco Versiani
Dr. Ordinola-Zapata obtained his D.D.S. degree in 2001 from Inca Garcilaso de la Vega University in Lima-Peru. After practicing for 6 years as a general dentist, Dr. Ordinola-Zapata continued his career at the Endodontic Department of the Bauru School of Dentistry, University of Sao Paulo in Brazil where he obtained a Master and a Doctoral degree in Endodontics. Dr. Ordinola Zapata also completed a 2-year AEGD residency program at Larkin Community Hospital in Miami and his Endodontic residency program at the prestigious IB Bender Endodontic Division, Albert Einstein Medical Center in Philadelphia. Currently, he is assistant professor at the Endodontic Division, University of Minnesota, Minneapolis, USA. In his academic career Dr. Ordinola Zapata has published more than 70 scientific papers in peer-reviewed journals and lectured internationally in more than 10 countries. He serves as Associate Editor of the International Endodontic Journal (UK) and is a member of the scientific advisory board of the Journal of Endodontics (USA).
Dr. Versiani received his degree in Dentistry in 1992. Since 1994, he has been working part-time in the Brazilian Military Police Dental Department in which he reached the grade of Lieutenant Colonel. He is a certified specialist in Endodontics (1999), but also in Didactics (1998) and Bioethics (2003). In 2015, Dr. Versiani concluded his Master Degree and PhD studies, as well as 3 postdoctoral programs, at the University of Sao Paulo, in which he is currently a researcher fellow. He has authored books, several chapters and more than 80 peer-reviewed papers in endodontics, being an editorial board member of the International Endodontic Journal. More recently, he published the book 'Root Canal Anatomy in Permanent Dentition'. Dr. Versiani has lectured worldwide focusing on his main research interests that are the influence of root canal anatomy on endodontic procedures using non-invasive 3D X-ray micro-computed tomography, towards the improvement of both chemical and mechanical debridement of root canals.