I’m delighted to present the program of The Dental World Endodontic Congress, the top event in 2020. Focusing this year not only on the clinical aspect of our profession, but also on the scientific part. 4 days, 14 lecturers from all over the world, 7 hands-on and workshop courses and 2 days long continuous postgraduate education are scheduled. Researchers, high level clinicians and professors from different universities will share their knowledge and result in the field endodontics. Young and talented under and postgraduate students can prove and demonstrate their results in the poster section. I recommend this event for endodontists, postgraduate endodontic residents and for those who are interested in learning the highest level of endodontics.

Journey to the apex of the root

My first root canal treatments were carried out around 1998, being an undergraduate student. One of them is still followed up. What happened to the others? I have no clue.

My graduation was 20 years ago. I was brave, puppy, self-confident and enthusiastic. Created nice white lines, visualized on x-ray. Sometimes, they were obturated with puffs and lateral canals. I felt to know everything about dentistry and endodontics. I was successful.

I loved endo.

Then later on, failures arised. Flare ups, fractures, lot of files were broken, perforations and ledges were created. I had many unsatisfied patients. I felt knowing nothing about endodontics.

I hated it.

In the last two decades approx. 9.000 – 10.000 teeth were root canal treated in my chair. That means 25.000- 30.000 root canals. Lot of gadgets were bought, the latest super-trouper file systems and also an operating microscope were purchased. I have listened to more than 2000 lectures and online courses.

What has changed? Almost nothing. Still I got the feeling to know nothing about endodontics. Much ado about nothing? We will discuss this during my presentation.

Objectives:
1. Identify the common reasons for extraction of endodontically treated teeth.
2. Understand the language behind endodontic outcomes and decision making.
3. Introduction into dentin conservation and endodontic access design.

Objectives:
1. Restoring the endodontic access from a conservative approach.
2. Identifying challenging restorative situations.
3. Managing these difficult situations predictably.

In addition to the clinical examination, the evaluation of diagnostic imaging is the most important component of preoperative diagnostics in dentistry. This lecture describes the influence of cone beam
computed tomography on decision making in treatment planning, particularly in endodontic treatment.

Aim:
The aim of this lecture is to provide the audience with a basic understanding of how cone beam computed tomography imaging may influence treatment planning by providing substantial additional informations over two dimensional imaging modalities.

Objectives:
An overview of the current literature is presented and in selected cases the different diagnostic abilities of two- and three-dimensional modalities are portrayed.

The aim of endodontic therapy is the reduction of bacteria by chemo/mechanical procedures as bacteria persisting within the root canal system is a major cause for the failure of endodontic treatment. One of the factors that may affect our mechanical preparations is the complexity of root canal anatomy however new technologies have recently been introduced and appear to improve the efficacy of this very important aspect of root canal disinfection. Positive Pressure Irrigation, Sonic and Ultrasonic Irrigation has been the most widely techniques used in the irrigation of the root canal system. Laser Assisted Irrigation (LAI) and Multisonic Ultracleaning technologies improve root canal disinfection greatly but also allow for “minimally invasive endodontics” leading to the use of fewer instruments, conserving more tooth structure and the reduction of treatment duration. This presentation will illustrate the efficacy of these technologies compared to positive pressure, sonic and ultrasonic irrigation by means of SEM, confocal microscopy and histological consecutive sections. Attendees will see the effects of debridement, disinfection and dentin sparing results objectively measured.

Learning Objectives:
1. Describe the role of bacteria in endodontic disease
2. Describe the characteristics of positive pressure, sonic, ultrasonic, LAI and Multisonic Ultra-cleaning technology.
3. Describe and identify the efficacy of the new technologies of root canal and dentin disinfection.

Despite the technological developments in our discipline, so far, there is no convincing evidence to suggest that the overall prognosis of root canal treatment has increased over a period of 50 years. Consequently 25-50% of root filled teeth are associated with radiographic signs of pathology. Although rarely associated with clinical symptoms such teeth have been classified as “failures” and researchers have pointed out the high number of potential retreatment cases.
The increased understanding of the complexity and diversity of the biofilms that are present in necrotic root canals and many root filled teeth has challenged the view that root canal treatment is about getting root canals sterile. With new imaging technologies like CBCT it also stands clear that postoperative situations without symptoms and agreeable periradicular conditions, as can be assessed on an intraoral X-ray, may still prove to have signs of residual inflammation. At the same time, we face a renewed interest in a possible association between endodontic infections and general health. These observations put your finger on a crucial point. What should be regarded as sick and what needs to be treated and what does not need to be addressed?
However, endodontic retreatment is the distinctive feature of many specialist clinics in endodontics and retreatment methods and techniques are frequently presented at conferences, in journal papers and in textbooks. Available modern equipment has made both non-surgical and surgical retreatment methods more precise and the outcome more predictable. However, high-quality scientific evidence of the benefits of retreatment compared to conservative monitoring or radical extraction and tooth replacement is meagre.

Endodontics have seen many changes in the past few years, from diagnosis to final restoration, going through access, shaping, cleaning, and three-dimensional filling. Nickel-titanium instruments are evolving every day, ultrasonics were confirmed as an essential adjunct to improving the cleaning process, bioceramic filling materials established their supremacy as filling materials, the operating microscope opened new treatment horizons, and 3D radiography techniques allow for more accurate diagnosis and better treatment planning. But has our understanding of these technological advances, that of course also have limitations, matured enough to allow us to perform a paradigm shift in our day-to-day treatments? Are they enough to allow proper disinfection and cleaning to obtain healing? Is it possible nowadays to ride the wave of minimally invasive dentistry in endodontics without jeopardizing the quality of your treatments? These are the questions that this presentation will attempt to answer.

Kinematics of endodontic motors changed in the last years deeply. Mechanical nickel-titanium (NiTi) instruments were used only in continuous rotation until ten years ago. Then, the introduction of reciprocating movements as well as of reverse rotation controlled by torque allowed increasing the speed and safety of endodontic
shaping procedures. However, continuous rotation does not protect the NiTi instruments to the torsional fracture; reciprocation could transport or extrude debris apically, reverse rotation does not allow the apical advancement of the endodontic instrument.
Many studies investigated the kinematics in endodontics, however, different study designs applied and contrasting findings were reported. Therefore, a review of the pros and cons of the different kinematics related to endodontic procedures and instruments will be done critically following the findings of the most recent literature
available and their relation with the clinical experience.
Moreover, the new perspective in kinematics of endodontic instruments as the new fully automated, electric controlled, “Jeni” movement and its “self-driving mode” and “shaping guided irrigation” algorithm will be discussed..

Nowadays the clinician is faced with the difficult challenge of covering discoloration sometimes quite severe. Currently we can use extremely predictable techniques of dental bleaching, allowing sometimes to avoid the covering discolored elements, achieving excellent results in terms of aesthetics and durability. The choice of extremely versatile products, together with the use of appropriate techniques, facilitates the clinician in cases of discoloration of medium severity. In contrast, in more complex situations, which require changes in shape, color and position, it is possible to use high-performance ceramic materials, in order to perform high aesthetic rehabilitations, however using minimally invasive procedures. The choice of the ideal ceramic ingot and on how to communicate to the lab the real abutment color are the new challenges: the color matching, with innovative systems, is very crucial not only for the ingot choice but also in terms of cementation, especially in case of thin restorations.

The current orientation of modern endodontics is aiming at a concept of “minimally invasive” respecting the original anatomy of the dental structure. This approach should be maintained starting from the creation of the access cavity until the final step of endodontic restoration wherever reasonably possible. This philosophy should also be respected in the shaping step. In the past the elimination of excessive dental structure was necessary in order to reduce the risk of fracture of mechanized endodontic instruments during their use.
However, with the introduction of ever more performing alloys in terms of flexibility and resistance to cyclic fatigue, the concept of “minimally invasive” could be applied even in endodontic treatments and especially also in particularly difficult cases with extremely severe curvatures.

The aim of this update is to focus on how in particular the blue wire heat treated alloy applied to two different movements, rotating and reciprocating, has brought significant advantages for clinicians, and how to make the most of it in different clinical situations.