ASEAN Endodontic Forum 2018

Usage of Rotary Instruments (technique and indications) - Rotary files – ProTaper Gold

NiTi files have brought a revolution to endodontic therapy. The use of those files is though not without some risks. NiTi files have been reported to have higher incidence of separation in the canals compared to hand steel files and due to their efficiency, they can quickly deform the canals. The lecture will discuss how these risks can be minimized with proper use of the file system with emphasis on the new post production heat treated ProTaper Gold system. In addition the lecture will explore in details the engineering behind the rotary NiTi files and how new and novel engineering approaches have reduced the separation risks, and yet improved the efficiency the ProTaper Gold files. How best using those will be presented and then practiced as well when they are the best files to clean and shape the canals.

Objectives:

• To know about the key design elements for most NiTi file systems
• To have a good understanding on how and when to use files like PT Gold
• To be able assess the quality of their cleaning and shaping of a root canal

Gutta Core

Through the years dentist have struggled with being able to obturate root canals that have been instrumented, cleaned and shaped. Over 25 years ago an obturating system, called ThermaFil was introduced to aid the clinician in being able to consistently obturate instrumented canals. That system consisted of a metal carrier that was covered with gutta percha and the procedure entailed flame heating the gutta percha and then place it in the canals to length. As good as that system was, heat control, flow characteristics and the ability to remove the carrier in case of less than desirable outcome was not always ideal. Since the first introduction there has been significantly engineering improvements cumulating in the latest product, named GuttaCore, which does have a cross-linked gutta percha core rather than metal or plastic as its predecessors had. The quick heating ovens makes this approach quick and simple and the gutta percha core makes it easier and quicker to create post space as well as remove.

This lecture will review the history of this technique and where it is today, including how hydraulic force sends warm gutta-percha flowing equally in 3 dimensions, creates predictable and consistent 3D fill that follows curves, finds accessory canals and flows into isthmuses. And how best to place GuttaCore, quickly, safely and efficiently.

Objectives:

• To know about the key design elements of GuttaCore
• To have a good understanding on how and when to use GuttaCore
• To know how to best place a post space as well as how to remove the filling in case of need for a retreatment

Congress: Problem Solving Endodontics

In this lecture the most common reasons for failures of endodontic therapy will be discussed in some details. Emphasis will be placed on what the dentist could or should do to prevent failures of this nature by reviewing issues regarding diagnosis, access, root anatomy, instrumentation (including the proper selection and use of NiTi rotary/reciprocating instruments) and obturation techniques. Multiple cases will be discussed in details and solutions found with the help of audience.

Objectives:

• At conclusion, the participants should know the most common reasons for endodontic failure
• At conclusion, the participants should know what they could do to reduce the risk of endodontic failures
• At conclusion, the participants should know about some treatment options for a failing endodontic therapy

One of the iatrogenic accidents in endodontic treatment is an instrument fracture within the root canal system. The majority of instruments fractured in root canals are reported to be NiTi. The literature shows the majority of NiTi instruments fracture, unfortunately, in the apical one-third or beyond a curve in the canal because of the superelastic property. An instrument fracture is very frustrating and instrument retrieval is considered to be even more challenging in endodontics than any other part of endodontic procedure. In addition, the instrument fracture immediately hinders the clinician from performing further treatment, and thus the outcome of the treatment will be compromised. Although the success rates of instrument retrieval with ultrasonics are in the range of 80 to 90 %, ultrasonic retrieval has never been 100 % successful and it is deemed to be unpredictable in terms of time and dentin sacrifice. Ultrasonic removal attempts especially from the apical one third of a curved canal often result in a significant amount of dentin sacrifice. On top of that, aggressive use of ultrasonics could lead to perforation and secondary fracture especially around a curve because there is no standardized technique for successful instrument retrieval. Therefore, In the lecture the standardized technique is suggested to retrieve a broken file to both maximize the success and minimize dentin sacrifice without causing iatrogenic events as it has been developed using a novel instrument retrieval kit. The recent literature has shown that the instrument retrieval with this technique was predictable and was significantly more successful and more conservative in dentin sacrifice than that with ultrasonics. The unique procedures in combination with CBCT for instrument retrieval will also be shown and discussed using contemporary concepts.

Objectives:

• To describe how an endodontic instrument fractures
• To make a treatment plan for broken instrument removal
• To understand the concept of broken file removal
• To prepare the canal for broken instrument removal
• To remove a broken instrument from the canal

Endodontic surgery has been considered the last resort for treatment of persistent periapical diseases. With the development of new instruments and techniques, it is now possible to perform endodontic procedure from the surgical approach with predictable outcomes in healing. The presentation will focus on the latest techniques, instruments and materials in modern endodontic surgery along with clinical cases. Surgical principles, clinical applications and indications will be reviewed. Lastly, the presentation will compare traditional with modern methods and discuss how modern microsurgery has become a viable option that should be offered to our patients.

Outline:

1. Introduction
2. Purpose
3. Indications and Contraindications
4. Traditional vs. Microsurgical Methods
5. Success Rate
6. Clinical Cases
7. Post-operative Instructions

Periapical lesions of Endodontic origin are sequelae to endodontic infections as the host defense response to microbial challenge from the root canal system. Radiographically, they are presented as periapical radiolucencies of various sizes and shapes. Histologically, it is viewed as a dynamic encounter between host defenses with microbial factors resulting in local inflammation, resorption of hard tissues, and ultimately destruction of the periapical tissues. Their treatment modalities will depend on the understanding of their disease process and the architectural components of the lesions. This is paramount important to enable clinicians to treat these lesions effectively.

Learning objectives:

1. Various clinical cases will be utilised to elaborate the clinical diagnosis and management of periapical lesions of Endodontic origin.
2. Evidence based approach to treat periapical lesions of Endodontic origin: Non surgical orthograde root canal therapy and/ or apical surgery.
3. The used of various types of irrigants and intra-canal medications to treat periapical lesions of Endodontic origins.

A wide array of biomaterials are used in endodontics, each with differing compositions, roles and properties. There is no perfect irrigant, medicament or obturation material so clinicians must determine which biomaterials, or combination of biomaterials, will produce the best outcomes for their patients. The presentation will focus on the popular materials in endodontics and assess the supporting evidence and ideal protocols.