1. Endodontic Update: 2007 AAE Annual Session (and then some) Scott E. Shuler, DMD,MS

2. Biological Topics  Auto and Replantation Bioadhesives (Tissue-Tak), TGF-Beta, BMT to promote ligament attachment Bioadhesives (Tissue-Tak), TGF-Beta, BMT to promote ligament attachment Propolis extract to prevent resorption Propolis extract to prevent resorption

3. Regenerative Endodontics  Def: Biologically based procedures designed to replace damaged structures.  “Tissue engineering”—guided regeneration of pulp-like tissue from cellular precursors (stem cells)

4. Regenerative Endodontics  Growth of new cells in culture from pulp precursors  “Emdogain” (enamel matrix protein formulation) showed potential for pulp regeneration  Discussion of relative costs and concerns

5. Clinical Topics  Novel uses for MTA As primary obturation material in short roots,primary teeth As primary obturation material in short roots,primary teeth As capping material in IP with immature apices As capping material in IP with immature apices

6. Clinical Topics  Bone preservation and regeneration during endodontic surgery Flap design considerations, microsurgery Flap design considerations, microsurgery Grafting and matrix placement Grafting and matrix placement  Management of Endodontic flare-ups

7. Product Buzz  Instrumentation “All the rage” at previous meetings “All the rage” at previous meetings Axxess Axxess

8. Product Buzz  Irrigation: MTAD (Biopure) New irrigant introduced by Torabinejad in 2005 New irrigant introduced by Torabinejad in 2005 What’s in it? What’s in it?

9. Product Buzz Benefits: Antimicrobial (<NaOCl) Antimicrobial (<NaOCl) Removes smear layer Removes smear layer Somewhat dissolves tissue (<NaOCl) Somewhat dissolves tissue (<NaOCl)Drawbacks: Cost: Roughly $4 per canal Cost: Roughly $4 per canal Benefit is questionable over traditional irrigation (Kho, Baumgardner J Endod 2006) Benefit is questionable over traditional irrigation (Kho, Baumgardner J Endod 2006)

10. Product Buzz  Hydraulic Irrigation (ANP—Endovac) “Positive pressure irrigation works only to the orifice of the needle in a closed system.” “Positive pressure irrigation works only to the orifice of the needle in a closed system.” Chow, J Endod, 1993 Chow, J Endod, 1993 Schoeffel (USC)—Endovac (ANP) Schoeffel (USC)—Endovac (ANP) “Sewer pump” vs. “fire hose”“Sewer pump” vs. “fire hose” Concern--expression of irrigant beyond apex.

11. Bonded Resin Obturation  What is it? Attempt to apply dentin adhesive technology to root canal obturation Attempt to apply dentin adhesive technology to root canal obturation Products: Resilon, Epiphany, EndoRez Products: Resilon, Epiphany, EndoRez  Claimed benefits: “Monoblock”: less coronal leakage “Monoblock”: less coronal leakage Superior apical seal Superior apical seal Resistance to root fracture Resistance to root fracture

12. Bonded Resin Obturation  “Monoblock” questioned by Baumgartner  Zurich study: seal similar to gutta percha and AH26, but deteriorated over time  UT-SA: no fracture resistance  Superior to “single cone” techniques of Thermafil, Soft-core HD, etc, but so is everything else!

13. Dental Implants  Change in Meeting Sponsorship  “Feel” (2005 versus 2007)

14. Dental Implants  Papers presented: “Real Cost” comparison (Case Western) “Real Cost” comparison (Case Western) “Success” comparison (USC, Case) “Success” comparison (USC, Case) Sample bias/ Exclusion factorsSample bias/ Exclusion factors Criteria (“success” vs. “survival”)Criteria (“success” vs. “survival”) Adjusted endo survival rates:Adjusted endo survival rates: USC 96.8% USC 96.8% Case Western 94.4% Case Western 94.4% Delta Dental 96.9% Delta Dental 96.9% Taiwan 93-96% Taiwan 93-96%

15. Dental Implants  Summary: Implants are highly successful, but so is uncompromised endodontic therapy, and at considerably less cost Implants are highly successful, but so is uncompromised endodontic therapy, and at considerably less cost Better visualization, diagnosis, instrumentation, obturation, and management of restorative and periodontal aspects can eliminate many causes of failure Better visualization, diagnosis, instrumentation, obturation, and management of restorative and periodontal aspects can eliminate many causes of failure

16. Dental Implants Case selection is the key to predictability, so future research should focus on determining compromising factors Case selection is the key to predictability, so future research should focus on determining compromising factors Implants should be considered before alternative treatments in cases with predictably poor prognoses Implants should be considered before alternative treatments in cases with predictably poor prognoses

17. Endodontic Update 2007 Thank You!! Questions?