Endodontic Congress

Dr. Mile Churlinov

Guided Tooth Autotransplantation

Tooth loss usually occurs after periodontal pathology, vertical root fractures, carious destruction and trauma. Autotransplantation of teeth is a technique that includes surgical creation of an artificial socket or utilising freshly extracted tooth socket and reposition an autogenous erupted or unerupted tooth to reestablish the primary role of dentition in terms of function, speech and aesthetics (1,2)

While preserving donor tooth “PDL” seems to be the key factor for success (4,5) some researchers found that immature teeth have a better prognosis in autotransplantation as they could promote revascularization easily than mature teeth (3), several case report studies have also reported high- success rates for autotransplantation of mature teeth (6–8) and 98.0% and 90.5% at 1 and 5 years, according to systematic reviews (6). Previous researchers found out that having a printed donor tooth (3D replica) prior extraction could optimise the total time of the procedure and most importantly it would decrease the donor tooth extraoral time (9). With digital planning and the CBCT, freshly extracted sockets are not a limitation anymore if the whole procedure is planned well and the procedure performed fast (12). Anssari Moin et al. described a method of computer- assisted template-guided autotransplantation with custom 3D designed/ printed surgical tooling (13) and few years later Abella et al. went even further with a custom designed osteotome and a fully exposed buccal wall of the donor tooth (14).
In this presentation the author will demonstrate how to plan and perform autotransplantation in different clinical situations by the use of modern technology and still be supported by the literature.

Accidental tooth loss is more frequent in younger persons than adults. Treatment of a missing tooth/teeth with an implant in adults is an excellent and predictable method of choice, but contraindicated in growing individuals as it does not provide further growth of the alveolar ridge vertically as natural dentition tends to. Follow-up studies of cases with missing incisors in growing patients have shown that in long-term perspective, prosthetic rehabilitation was the least desired treatment option compared to orthodontic space closure and autotransplantation.
Performing a successful implant procedure in a compromised recipient socket with a significant bone loss and/ or sinus lift in adults is a very challenging task even for the most experienced clinicians. Having an available fresh socket or bone height/ width makes the procedure fast and predictable. On the other hand if there is a soft and hard tissue deficiency, autotransplantation could be advantageous to implants mainly because of the “PDL ” osteoinductive potential and optimal biologic interactions with soft tissue.

1. H. Apfel.: Autoplasty of enucleated prefunctional third molars. Journal of oral surgery, vol. 8, no. 4, 1950, pp. 289-296.
2. B. Bjercke.: Autotransplantation in premolars. Trans. Int. Conf. Oral Surg., vol. 2, no. 2, 1967, pp. 380-382. PubMed
3. Andreasen, J. O., Reinholdt, J., Riis, I., Dybdahl, R., Soder, P .O. & Otteskog, P.: Periodontal and pulpal healing of monkey incisors preserved in tissue culture before replantation. Int. J. Oral Surg, 1978: 7: 104-
112.
4. Andreasen, J. O .: The effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. Int. J. Oral Surg, 1981: 10: 43-53.
5. Andreasen, J. O. & Kristerson, L.: The effect of limited drying or removal of the periodontal ligament upon periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol. Scand. 1981: 39: 1-13.
6. Bae JH, Choi YH, Cho BH, Kim YK, Kim SG.: Autotransplantation of teeth with complete root formation: a case series. J Endod. 2010;36 (8):1422-1426.
7. Sugai T, Yoshizawa M, Kobayashi T, et al.: Clinical study on prognostic factors for autotransplantation of teeth with complete root formation. Int J Oral Maxillofac Surg. 2010;39(12):1193-1203.
8. Yu HJ, Jia P, Lv Z, Qiu LX.: Autotransplantation of third molars with completely formed roots into surgically created sockets and fresh extraction sockets: a 10-year comparative study. Int J Oral Maxillofac Surg.
2017;46(4):531-538.
9. Lee SJ, Jung IY, Lee CY, Choi SY, Kum KY.: Clinical application of computer-aided rapid prototyping for tooth transplantation. Dent Traumatol. 2001;17(3):114-119.
10. Chung WC, Tu YK, Lin YH, Lu HK.: Outcomes of autotransplanted teeth with complete root formation: a systematic review and meta- analysis. J Clin Periodontol. 2014;41(4):412-423.
11. Bauss O, Engelke W, Fenske C, Schilke R, Schwestka-Polly R. Autotransplantation of immature third molars into edentulous and atrophied jaw sections. Int J Oral Maxillofac Surg. 2004 Sep;33(6):558-63. doi: 10.1016/j.ijom.2003.10.008. PMID: 15308255.
12. Tsukiboshi, M.: Autotransplantation of teeth: requirements for predictable success. Dental Traumatology, 2002:18, 157– 180.
13. Anssari Moin, D., Verweij, J.P., Waars, H., van Merkesteyn, R. & Wismeijer, D.: Accuracy of computed- assisted tem-plate guided autotransplantation of teeth with custom three- dimensional designed/printed surgical tooling: a cadaveric study. Journal of Oral and Maxillofacial Surgery, 2017: 75, e1–e7.
14. Abella Sans F, Ribas March F, Zubizarreta-Macho Á, Boschini L, Roig Cayón M, Durán-Sindreu Terol F.: Guided autotransplant of a first premolar to replace a maxillary ankylosed incisor using a custom-designed
osteotome. J Am Dent Assoc. 2022 Mar;153(3):265-272. doi: 10.1016/j.adaj.2021.08.010. Epub 2021 Dec 18. PMID: 34930574.

Dr. Agnieszka Pacyk

7 Deadly Signs of Local Dental Anesthesia During Endodontic Treatment

The prevention of pain during endodontic treatment is of paramount importance to all patients. Nowadays, more than ever the patients expect safe, efficient and one-visit treatment. The rules of painless and safe injection will be presented during this lecture. One of the most challenging clinical situation is the pulpitis and important to know the best strategies to do effective local anesthesia. Moreover this lecture will provide the best ways how to select and use local anesthetics and instruments to protect patients and dental teams from complications.

Dr. Nuno Pinto

The Evolution of Reciprocating Files

It was undoubtedly a step forward in the evolution of cleaning and shaping, the appearance of the single reciprocating file opened new horizons in terms of concepts. I am an unconditional supporter of the reciprocal because I consider it safer and easier, it can be used by both experts and beginners and I see in essence a great advantage, a single file and single use.
The evolution of this system would always involve managing to create less invasive files without ever destroying the essence of the reciprocal. We all know that a reciprocating file will always have to follow certain requirements in order to maintain quality and reliability and that was the great difficulty in creating this new file, we managed to add all the reliability of a reciprocating but where the concern for anatomy is always present. The introduction of Flatside and the low taper give this file an excellent advantage over the competition. Flash is the new reciprocal file developed by Bondent and a step forward in the cleaning and shaping procedure.

Dr. Byron Tsivos

How Innovations and Technological Strategies Improve the Long-Term Prognosis in Endodontics

Prior to 1990s, there was only conventional endodontic treatment, end those were performed with stainless-steel hand files for root canal preparation and cold lateral gutta-percha compaction for obturation.  Visualisation during treatment was not easy, as magnification (ie, dental loupes), were hardly ever used. And radiographs (in two dimensions)  were the only guide for the clinician to determine working length and how the treatment was being done.
Since then, the field of endodontics has embraced technological advancements and changes to better perform the root canal therapy. Today’s innovations in instrumentation (new files systems, ultrasonics devices, etc.) in obturation, in visualisation (the of magnification) and surgical operating techniques have enabled endondontologists to provide better long-term prognosis for their patients’ treatment. Future trends in endodontics  will include regeneration techniques and the use of 3-D printing
This lecture is about all those innovative and technological strategies in current endodontic treatment.

Dr. Michał Ganowicz

Biological Treatment of Teeth – Almost All Indications of Bioactive Cements

When preparing a deep cavity, do you wonder how deep you can drill? How much demineralized dentin can you safely remove? Do you have concerns that you will expose the pulp and must perform root canal treatment? Or maybe you want to increase the effectiveness of your root canal treatment? Do you want to see if complications such as canal perforation are treatable?

If so, I invite you to my lecture, where I will talk about the surprising properties of bioactive cements in the treatment of caries, dental pulp, and periapical tissues. You will see how to use Bioroot RCS and Biodentine in daily practice. You will learn which of these materials to choose in a specific situation. I will show you simple procedures for the treatment of deep caries, single-visit root canal treatment as well as treatment of perforation and wide physiological foramen in the root canals.

Dr. Ruth Perez Alfayate

Complex Diagnosis in Endodontics

An accurate diagnosis is fundamental for the determination of an appropriate treatment plan. To emphasize, the majority of cases can be resolved in a simplified way, in others its characteristics can cover the diagnosis needing more invasive complementary tests to understand the etiology. In fact, the use of diagnostic tests can actually present a high level of doubt. Therefore, when faced with cases of complex diagnosis it is important to implement scientific knowledge and common sense unified with the capacity to interpret results of the complementary tests, decide the prognosis and to do an appropriate selection of the case within the first phase towards a successful treatment.

Dr. Giovanni Olivi

Innovative Endodontics Using Shock Wave Enhanced Emission Photo-Acoustic Streaming

There has been a volcanic eruption of technologies in Endodontics over the past 20 years. The development of NiTi shaping files, the debut of biocompatible materials, the advent of CBCT for improved diagnostics. These minimally invasive technologies promote the maximum preservation of tooth structure, but according to an old aphorism enunciated by Herbert Schilder, for the success of endodontic therapy, “what is removed” is more important than “what is introduced” into the canal system. In this view, laser activated irrigation, and more specifically SWEEPS technology represents a breakthrough method for 3D cleaning and disinfection of the root canal system. Photoacoustic technology is used to activate the commonly used irrigants in endodontics (NaOCl and EDTA) and does not replace any conventional  instrumentation.
The SSP technology (single super short pulse) first and the SWEEPS one (dual ultra short pulse) today are validated by a wide body of published and non-published experiments and data. High-speed videos at 100.000 frames are shown to explein the innovative dual pulse laser emission in endodontic envirement. Scanning Electron Microscopy and CT imaging were used to evaluate the tissue dissolution, the debridement, smear layer, and endodontic filling material removal from the endodontic space. Bacteriological studies as well as Confocal analysis were performed to assess the decontaminating effect of these techniques. The lecture will present an overview of the scientific concepts behind the clinical application and a series of clinical cases will be discussed.

Learning Objectives:
– to understand the relevance of endodontic irrigation in Endodontics;
– to understand the limitations of the use of conventional systems for  endodontic irrigation;
– to understand the difference among sonic, ultrasonic, multisonic and laser activated irrigation;
– to understand the main advantages of SWEEPS technology for root canal irrigation;
– to understand the different role and timing of NaOCl and EDTA during different steps of root canal therapy;
– to learn the tips and tricks for efficently and safely use the laser in Endodontics.