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Endodontic Update: 2007 AAE Annual Session (and then some)

Endodontic Update: 2007 AAE Annual Session (and then some). Scott E. Shuler, DMD,MS. Biological Topics. Auto and Replantation Bioadhesives (Tissue-Tak), TGF-Beta, BMT to promote ligament attachment Propolis extract to prevent resorption. Regenerative Endodontics.

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Endodontic Update: 2007 AAE Annual Session (and then some)

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  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 • 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 capping material in IP with immature apices

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

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

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

  9. Product Buzz Benefits: • Antimicrobial (<NaOCl) • Removes smear layer • Somewhat dissolves tissue (<NaOCl) Drawbacks: • Cost: Roughly $4 per canal • 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.” • Chow, J Endod, 1993 • Schoeffel (USC)—Endovac (ANP) • “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 • Products: Resilon, Epiphany, EndoRez • Claimed benefits: • “Monoblock”: less coronal leakage • Superior apical seal • 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) • “Success” comparison (USC, Case) • Sample bias/ Exclusion factors • Criteria (“success” vs. “survival”) • Adjusted endo survival rates: • USC 96.8% • Case Western 94.4% • Delta Dental 96.9% • Taiwan 93-96%

  15. Dental Implants • Summary: • 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

  16. Dental Implants • 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

  17. Endodontic Update 2007 Thank You!! Questions?

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