Management of Endodontic Failure

Programme outline: Rational behind non-surgical endodontic retreatment. Disassembly of commonly used obturation materials. Removal of obturation materials. Disinfection during retreatment. The 3-dimensional anatomy of root canal systems and its relation to root canal treatment failure. Outcome studies on non-surgical root canal treatment. Prevention and management of broken endodontic instruments. Calcium silicate cements and their application during non-surgical retreatment. Microsurgical Endodontics. Local anesthesia for surgery, flap design, osteotomy preparation, root end resection and retrograde preparation with microsurgical instruments, precision root end filling with calcium silicate cements and putty, suturing techniques.

Hands-on training: Re-treatment of common endodontic obturation materials. Removal of gutta-percha fillings. Removal of carrier-based materials. Removal of fiber posts. Broken instrument removal and bypassing. Pulp floor perforation repair. Internal resorption defect management. Apical plug placement. Hands-on training using sheep cadaveric specimens and microscopes.

DAY 1

Title: Non-surgical and surgical retreatment

Aims

To understand the rationale behind non-surgical retreatment approaches and the aitiology of initial root canal treatment failure. To present an evidence-based framework for the safe and effective disassembly of non-obturation and obturation materials.

Objectives

Students will be able to remove guttapercha obturations from root canals, remove Carrier based obturations from the root canals, remove paste obturations and remove fiber posts. Students will have the opportunity to use most of the current technology used during retreatment procedures.

Agenda

DAY 2

Title: Non-surgical and surgical retreatment

Aims

To understand the factors related to the long-term outcome of non-surgical endodontic retreatment and to develop a rational diagnostic and decision-making framework. To appreciate the importance of magnification and illumination for the management of complicated non-surgical retreatment cases.

Objectives

Students will be able to bypass and remove broken endodontic files and understand all the preventive measures to avoid complications during endodontic instrumentation. The students will be able to repair a pulp floor perforation, to obturate an internal resorption defect and to perform apical plugs with biocompatible materials.

Agenda

DAY 3

Title: Surgical retreatment

Aims

To understand the rationale behind microsurgical retreatment approaches and acquire basic surgical knowledge.

Objectives

By the end of the course delegates will understand:

• Outcomes of endodontic microsurgery vs traditional apicectomy
• The science behind effective local anesthesia in endodontic microsurgery
• The use of a dental operating microscope in endodontic microsurgery
• Flap design and tissue handling to improve post-surgical healing
• How to effectively prepare an osteotomy
• Correct methods of ultrasonic root-end preparation and how to identify anatomical markers
• Which equipment is appropriate for use in microsurgical techniques
• Effective suturing and postoperative care including analgesia

Agenda

DAY 4

Title: Surgical retreatment

Aims

To understand the importance of magnification in endodontic microsurgery and acquire basic microsurgical skills

Objectives

By the end of the course delegates will have:

• Been calibrated to a dental operating microscope
• Have identified cases where surgical intervention is appropriate
• Have raised a flap with microsurgical instruments
• Created an osteotomy and identified anatomical markers
• Performed root end resection and retrograde preparation of the root canal space
• Performed microsurgical suturing
• Developed a post-operative care strategy to minimize complications and improve healing
• Hard tissue management (osteotomy and root resection)
• Retropreparation and retro-filling
• Wound healing-surgical sequelae-Complications
• Outcomes of microsurgery

Agenda