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HOT TOPIC: Regenerating Hope for the Hopeless Pulp

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Date: 08-07-2020 09:06:28 am

For an endodontist, bringing a tooth back from the dead is the ultimate victory. And nowhere is this victory more important than in the case of pediatric patients. Currently, the frequent treatment for managing permanent teeth with immature apices that show swelling or infection is extraction. But at this stage, the teeth are really just maturing. When you extract a permanent immature tooth, not only does it lend itself to malocclusion or alter how the teeth function, but it can be a cosmetic concern that leads to self-doubt. This is especially damaging in today’s selfie and social media culture.
The primary goal in my endodontic practice is to favor saving natural teeth. I began exploring regenerative endodontic procedures (REPs) as part of research for my endodontic residency over 10 years ago. Since then, the protocol has been central to my treatment approach. 

Case in Point
In a groundbreaking 2004 case report,* 2 researchers used a protocol for revascularization or REP to treat an immature permanent premolar that was necrotic and pre­sented with a localized draining abscess. What’s so amaz­ing about this case is that not only did the abscessed gums in the surrounding bone and tissue heal, but dentin in the root itself became thicker and the root reached full matura­tion—allowing structural formations to increase in size and minimizing the risk of fracture. So, basically, these research­ers took a hopeless tooth that most clinicians would have extracted and reinstated its form and function—essentially bringing it back to life!

Eliminating Extractions
REPs are reproducible in most clinical settings; however, the literature does highlight nuances of technique—more specifically, the disinfectant protocol implemented to elimi­nate microbes, create a sterile environment, and promote stem cell survival and activity. The goal is to create a fertile environment for stem cells of the apical papilla (SCAP) to repopulate into the root canal, and then promote a scaffold that allows the regenerative process to continue.
There are a couple ways that you can start exploring how to implement REPs in your practice—whether you’re a general practitioner or a specialist:
1 Visit the AAE website. If you visit the American Association of Endodontists website at aae.org, you’ll find a database of cases and treatment protocols that you can access to help you negotiate and manage a case from start to finish.
2 Talk to your colleagues. Any endodontist or pediatric dentist within your community is a great resource. The pediatric profession has really taken to this procedure and adapted it into their discipline, so there’s a host of pediatric dentists to choose from who are well versed in managing these types of cases.

This technique is not new to dentistry, but it is starting to gain more traction as clinicians in residencies and private practice recognize the long-term value of saving a natural tooth. Although REPs are technique-sensitive and require multiple visits—not to mention, in this case, parent com­pliance—any time that we can save a natural tooth, it’s in the best interest of all parties involved.

Dr. Johnson hosts the Endo Voices podcast, sponsored by the AAE. Scan the QR code to tune in to everything endo.

*Banchs, Trope. J Endodontics. 2004 Apr;30(4):196-200.






 
Article 31 of 39

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

2D vs 3D Imaging in Endodontics: CBCT Application in Modern Endodontic Treatment

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

Educational Objectives

After completing this course, the reader should be able to:

1. Discuss the American Association of Endodontists and American Academy of Oral and Maxillofacial Radiology joint position statement on the use of CBCT in endodontics.

2. Explain how to use CBCT 3D imaging to evaluate unusual or complex anatomy of root canal systems, calci­ ed canals, and periapical pathosis.

3. Describe how to assess sinusitis of endodontic origin using CBCT imaging.

4. List other documented advantages of the routine use of CBCT in endodontics.

5. Discuss the impact of 3D imaging in decision-making in endodontics.


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Abstract

The use of cone beam computed tomography (CBCT) in endodontics has expanded in recent years. 3D imaging adequately supports the interpretation of dental anatomy and surrounding areas during root canal therapy. To assist decision making in endodontic cases, experts recommend small field-of-view (FOV), high-resolution CBCT imaging for diagnostic and treatment planning as well as for intraoperative procedures and managing cases post-treatment. This article presents some examples of everyday clinical cases to illustrate how CBCT images can help diagnose, treat, and solve endodontic problems.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 113 of 126

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

A Restorative-Driven Approach to Endodontic Treatment—Maintaining Tooth Structure for Better Long-Term Prognosis

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

After completing this webinar, participants will be able to:
-Comprehend the concept and need for ferrule as a way to maintain the restored tooth long-term under function
-Recognize how maintaining tooth structure, especially in the cervical region, affects the long-term stability of the tooth
-Determine when and how to restore endodontically treated teeth
-Gain an understanding of conservative endodontic treatment to preserve tooth structure and how it affects the long-term prognosis of a tooth

Abstract

Conserving unaffected tooth structure when performing endodontics, especially in the cervical region of the tooth where loading is concentrated under function, will affect the survivability of that tooth over time. This is why endodontic treatment needs to begin with a determination of how the tooth will be restored. Then, high-quality endodontic treatment can be geared toward preserving important tooth structure in a way that does not compromise the results of restorative treatment. This webinar will examine the benefits of providing endodontic treatment with a restorative focus as a way to improve long-term survival and function of the teeth.

Supported through an unrestricted educational grant from SS White

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 106 of 126

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Current Shifts in Endodontic Technologies:Irrigation Devices and Solutions

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

After completing this webinar, participants will:
»      Discuss the anatomical complexities of root canal systems and the historical limitations of our clinical techniques to fully cleanse these convoluted spaces.
»      Describe the mechanism of action and clinical usage of the latest endodontic irrigation technologies: irrigation needle tips, ultrasonic activated irrigation and apical negative pressure irrigation.
»      Evaluate the literature-based evidence for the clinical efficacy of each irrigation method.
»      Discuss how each doctor can assess which irrigation technique and technology is most practical for their own practice setting.

Supported through an unrestricted educational grant from Vista

Abstract

This webinar will take you on a journey to discover the intricate complexity of root canal system anatomy and how to best approach cleaning it with irrigation. We will cover why the classic method of needle irrigation is not the ideal method of delivery in current day practice. The latest advances in irrigation solutions and the device technologies that best deliver them will be discussed. Evidence basis will support the usage, mechanism of action and clinical implementation of ultrasonic activated irrigation and apical negative pressure irrigation methods. A discussion on how to decide which technology is practical for your practice will complete our presentation.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 92 of 126

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

A Guide to Sutures

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

After completing this article, the reader should be able to:

  1. Gain a fundamental understanding of tissue repair and the role of suturing.
  2. Recognize the various types of suture materials and needles.
  3. Learn fundamental suture techniques and ergonomics.
  4. Determine alternative suture techniques and their indications.

Abstract

“Suturing” is a fundamental skill in dentistry but can be a very daunting and confusing topic for many dental providers. Gut suture or polytetra°uoroethylene (PTFE)? Square knot or surgeon’s knot? Simple interrupted or mattress suture? The abundance of available techniques, materials, and clinical applications can be overwhelming. Fortunately, the vast majority of clinical scenarios can be addressed by understanding the basic technique and fundamental concepts. This guide will review wound healing, suture types and materials, and basic and advanced techniques to equip the dental provider with a foundation in wound closure and management.

COMMERCIAL SUPPORTER: This course has been made possible through an unrestricted educational grant from Karl Schumacher.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 78 of 126

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Vital Pulp Therapy in Permanent Teeth

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

Educational Objectives

Upon completing this article, the participant should be able to:
 
  1. Define the latest endodontic diagnostic terminologies
  2. Describe the ideal cases for vital pulp therapy
  3. Compare the different vital pulp therapy materials, methods, and outcomes
  4. Discuss several recommendations when performing vital pulp therapy.

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Abstract

With our increased understanding of pulpal biology and the advances in material biocompatibility, the potential to transform the fate of a compromised dental pulp from a condemned tissue to that of hope and recovery has never been more promising. In this article, several aspects of vital pulp therapy (VPT) in permanent teeth from diagnosis and indications to treatment outcomes will be discussed in detail.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 75 of 126

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

ENDODONTICS Access and Glidepath

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

At the conclusion of this course, participants will be able to:

1. Understand the trend to be more minimally invasive in access preparation.
2. Comprehend why preservation of critical dentin is important.
3. Identify new instruments and tools allowed for this trend.
4. Learn to recognize cases to tackle and cases to refer, and where challenges may be.
5. Explain why securing a smooth glide-path is critical for rotary instrumentation and important for the cleaning and shaping to follow.

Abstract

Access cavity preparation and glide path are the critical first steps in root canal treatment. There have been many changes from traditional access preparation to current access trends, due to improvements in available instruments, dental operating microscopes, and cone-beam computed tomography (CBCT). The access preparations have been trending toward being more minimally invasive and to conserve dentin. However, this puts more strain on the instruments and may make subsequent cleaning, shaping, and obturation more difficult. Securing the glide path is a very delicate procedure and must be performed with mindfulness and patience. The proper sequence of instruments should be followed, as well as the care is taken to irrigate between instruments.

COMMERCIAL SUPPORTER: This course has been made possible through an unrestricted educational grant from KaVo Kerr.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 69 of 126

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $19.00

Management of Severely Curved Root Canals

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dentists from novice to advanced

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Educational Objectives

  • 3D perceptions that lead to stress less endodontics.
  • Scientific and practical choice of rotary files.
  • Safe and efficient protocols of instrumentation for severely curved root canals.

Abstract

Management of Severely Curved Root Canals – a real challenge for every endodontist.

Ignoring and incompetence to manage complex cases, can lead to instrumentation errors – ledges, zipping, blockages, perforations or instrument fracture, that may compromise the outcome of treatment.

The rational approach is the key to success. From planning to performing, every step of treatment must be argued and well determined. Knowing the anatomy and to be able to read the preop radiological investigations, move us to phase of instrumentation, where our knowledge and ability to select the right technique, instruments, and sequence of files, make us have an absolute control and predictability on extreme difficulty clinical cases.

COMMERCIAL SUPPORTER: This educational activity is made possible through an unrestricted educational grant from SS White. 

ADA Credits: 2 | AGD Credits: 2 | Cost: $19.00

Course 44 of 126

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Modern Endodontics: Rethinking Access and Instrumentation

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Target Audience: Dental Assistants, Dental Students, Dentists

Duration: 1:23:24

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Synopsis

We will be examining legacy concepts such as access design, instrumentation, restoration of endodontically treated teeth, and how modern technologies such as small-diameter heat-treated rotary files, microscopes, and CBCTs are allowing us to completely change the way we perform endodontics at the highest level with strategic dentin preservation in mind.

Get CE Credit for this course here: http://www.dentallearning.net/modern-endodontics-rethinking-access-and-instrumentation

COMMERCIAL SUPPORTER: This course has been made possible through an unrestricted educational grant from SS White.

Videos 39 of 42

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Endodontic Breakthroughs: NiTi Shaping Protocol Ensuring Endodontic Predictability

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Target Audience: Dental Assistants, Dental Students, Dentists

Duration: 56:10

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Synopsis

This webinar will address breakthrough shaping and irrigation concepts and detail the skills necessary for acquiring the expertise and confidence to perform the highest quality endodontics. The participants of this presentation will become familiar with the use of the “apex last” approach to canal shaping with nickel-titanium instrumentation using the TFA™ (Twisted File) Adaptive System, using Adaptive Motion Technology. Learn how Adaptive Motion technology provides the advantages of rotary and reciprocation but minimizes the disadvantages of both. The continuous feedback loop from file to motor allows the movement of the file to self adjust to the intracanal torsional stresses providing effective and most importantly safe root canal shaping.


Get CE credit for this course here: http://dentallearning.net/endodontic-breakthroughs-niti-shaping-protocol-ensuring-endodontic-predictability

COMMERCIAL SUPPORTER: This course has been made possible through an unrestricted educational grant from Kerr.

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Ensuring Endodontic Predictability 

Videos 36 of 42