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FRIDAY - September 6, 2024

09:00 – 09:15              Introduction and Overview

Hal Duncan, Matthias Widbiller

In the tradition of previous Autumn Meetings, the style of this meeting will be different from our conventional biennial event, with focus on one theme, albeit examined from the perspective of research and practice. In order to build on the intimate nature of previous events, the meeting features only one plenary hall hosting a series of events on both Friday 6th and Saturday 7th September. Although the focus of the meeting will revolve around recommendations and evidenced based practice in endodontics, the purpose will be to simplify message and discuss where we are now in endodontic practice as well as evidence we need to improve.

Part 1: Instrumentation

Clinical Aspects

09:15 – 09:45              Clinical advantages of heat treated nickel-titanium instruments

Gianluca Gambarini (Rome, Italy)

The lecture will describe the advantages of heat treatments and their positive influence on mechanical properties of the NiTi rotary files. Besides describing the mechanical properties it will also show the clinical impact on such properties on operative performance, providing also some hints on how to optimize the clinical performance by using proper motion and handling and will also show how to increase safety by using specific clinical approaches.

09:45 – 10:15              Root canal instrumentation - Clinical aspects

Sebastian Bürklein (Münster, Germany)

Does a clinical algorithm exist for choosing the most appropriate instrument and/or instrumentation technique during root canal treatment? The clinical aspects of root canal preparation are complex. The clinician is confronted with many factors that have an influence on individual treatment planning and implementation. Which procedure guarantees a successful endodontic treatment? Based on patient and treatment considerations as well as the practitioner's own skills, efficiency, simplicity and safety in the use of suitable instruments are paramount when deciding on the choice of the instrument/system in terms of flexibility, rigidity, cutting and cleaning efficiency, fed-in effect and others - in short, performance during root canal preparation. Nonetheless, these parameters are of secondary importance for the patients, as they are unable to assess these factors themselves. The comfort, the duration of the treatment, any post-interventional complaints, long-term tooth preservation, quality of life and, above all, the costs take priority here. There is a lack of randomised controlled trials taking into consideration the quality of evidence and patients' values, preferences and financial resources. The presentation is an attempt to interpret both clinical and patient-related aspects and to make practical clinical suggestions that take into account both the limitations of existing studies and common sense.

10:15 – 10:30               Discussion

10:30 – 11:00               Coffee Break

Research Aspects

11:00 – 12:00              Research background and gaps in knowledge on root canal instrumentation

Ana Arias (Madrid, Spain), Gianluca Plotino (Rome, Italy)

In this lecture the speakers analyse critical aspects of instruments and techniques for root canal preparation and emphasize the pivotal role of effective root canal instrumentation for successful endodontic outcomes. The presentation gives a comprehensive overview of the historical evolution of root canal procedures, highlighting the key milestones in instrumentation methodologies. The audience gains insights into the evolution of root canal instrumentation, with an exploration of cutting-edge technologies enhancing precision and efficiency in root canal shaping. Various contemporary techniques and instruments are discussed, shedding light on their advantages and limitations. A significant portion of the lecture is dedicated to a thorough analysis of the current state of research trends in root canal instrumentation. The speakers identify existing gaps in knowledge and research, addressing the need for further exploration and innovation. Topics such as the impact of instrumentation on treatment success rates, challenges associated with anatomical variations and the influence of instrumentation on post-operative outcomes are examined. The speakers encourage the audience to critically engage with these existing gaps in understanding and drive advancements in root canal instrumentation, emphasizing the need for targeted research initiatives and clinical trials to bridge these gaps.In conclusion, this lecture serves as a comprehensive overview of the research background and current gaps in knowledge in root canal instrumentation. It not only provides a historical context and current research trends, but also challenges the audience to contribute to the evolving landscape of endodontics through rigorous research and collaborative efforts.

12:00 – 12:15              Discussion

12:15 – 13:30              Lunch

Part 2: Irrigation

Clinical Aspects

13:30 – 14:00               Irrigation: Lessons learned from the S3 guideline process

Maarten Meire (Ghent, Brussels)

One of the outcomes of the ESE S3 guideline process is the suggestion not to use adjunct therapy in addition to traditionally (syringe-needle-based) delivered irrigants for the treatment of apical periodontitis. This recommendation suggests that all techniques, methods, devices, as well as all well-intended efforts aiming to improve root canal cleaning, need to be kicked. What should we do with this recommendation as clinicians aiming for excellence, best possible treatment outcomes and patient satisfaction? This talk will address some critical points on how to interpret this guideline recommendation and how to deal with it as a clinician delivering endodontic care.

14:00 – 14:30              Clinically realistic irrigation. Am I doing well?

Hagay Shemesh (Amsterdam, Netherlands)

Numerous clinical factors may be linked to the efficacy of irrigation in root canal treatments, including irrigating material, concentrations, insertion method, activation, anatomy and diagnosis. Despite ongoing research, a consensus on the recommended protocol has yet to be established, and previous suggestions face continual scrutiny. Above all, new technology is being introduced which does not always benefit the clinical outcomes yet required additional high costs.  This presentation centers on the latest evidence regarding the impact of factors associated with irrigation on treatment outcomes.

14:30 – 14:45              Discussion

14:45 – 15:15              Coffee Break

Research Aspects

15:15 – 15:45              A critical analysis of research on irrigants and irrigation techniques: Mind the gap!

Christos Boutsiouki (Thessaloniki, Greece) 

​Irrigation is an essential part of root canal treatment and a popular topic in the endodontic literature. A vast amount of research has been concentrated on the evaluation and fine-tuning of various irrigants and irrigation techniques. The development of the recent S3-level Clinical Practice Guidelines of the European Society of Endodontology motivated a comprehensive search and analysis of the available clinical evidence on a number of fundamental topics concerning root canal irrigation. However, surprisingly little evidence was retrieved to answer even the most basic PICOTS questions, leading to very general and frequently open recommendations. The lack of randomized clinical trials reporting primary outcomes of interest along with an overreliance on non-validated surrogate outcomes and unrealistic laboratory models have been identified as key components of this problem. The aims of this lecture are to explain the gaps in knowledge on root canal irrigation, to elaborate on the reasons why the ESE working group was unable to give more specific recommendations and to discuss future directions in research so that the guidelines can be further developed in the next update.

15:45 – 16:15              Transgressing from basic science to translational research models for improving biofilm 


Xenos Petridis (Athens, Greece)  

Background: Apical periodontitis (AP) is considered a biofilm-induced disease. Treatment of AP relies on biofilm disinfection. The finite capacity of endodontic instruments to eliminate biofilms from the intricate root canal system has established irrigation as the principal determinant of disinfection. From an inferential point of view, enhancing the irrigation efficacy should lead to improved control of the root canal biofilm infection, which, in turn, should be reflected on increased treatment success. Within this context, the level of disinfection achieved by irrigation is considered as a valid surrogate endpoint predicting treatment success. Despite the intuitive positive association between improvement of surrogate endpoints and increased treatment outcome success, clinical investigations have failed to corroborate it. In clinical endodontic research, it is inherently difficult to standardize and isolate parameters of interest and mechanistically explore the action of irrigants. These constraints prompt researchers to develop translational laboratory models to increase generalizability to the clinical setting. In endodontic irrigation research, converting fragmented knowledge derived from basic research into translational laboratory models is a demanding task. It requires appreciation of disease etiology and root canal configuration, creative engineering, laborious optimization steps, and multimodal assessment tools. These research facets are construed as development of appropriate biofilm models, realistic root canal models, and selection of a broad range of evaluation tools for appreciating the antibiofilm capacity of irrigants. Aim: to present methodological aspects of research on endodontic irrigation-driven biofilm disinfection and challenges that need to be considered for the effective transition from basic to translational research.

16:15 – 16:30              Discussion

16:30 – 17:00              Round Up and Group Discussion

SATURDAY - September 7, 2024

09:00 – 09:15              Introduction and Overview

Hal Duncan, Matthias Widbiller

Part 3: Obturation

Clinical Aspects

09:15 – 09:45               Endo-Resto obturation in single visit appointment

 Maciej Zarow (Krakow, Poland)

The success of an endodontic treatment excessively depends on obturation as well as chemomechanical shaping. A total root canal obturation is a major objective in endodontic treatment. Composing a both apically and coronally, three dimensional sealing  is crucial in order to ensure maximum preservation of root canals from microorganisms and inhibit their penetration to periradicular tissues. Although apical percolation has always been considered a factor in the failure of endodontic treatment, over the last 20 years there has been a significant focus on the contamination of the root canal system via the coronal route of an inadequate restoration. Obturation is a barrier to the elimination of bacterial irritants and must be supplemented as soon as possible by coronal restoration. This will optimize the outcome of the endodontic treatment. Should it be performed in single appointment today? What are the Endo-Resto protocols aiming to single appointment? How to finish obturation without risk of contamination?

09:45 – 10:15              Is root canal filling with bioceramics fillers really predictable?

Stéphane Simon (Paris, France) 

Root canal treatment is a succession of interlocking steps. Successful completion of each stage determines the prognosis of the treatment. Root canal obturation is the final stage of the treatment and "freezes" things in time. Over and above the technical objectives to be achieved, it is the filling of the three-dimensional space and maintenance of the disinfected state that will enable the tooth to be returned to a favourable biological context for bone regeneration in the case of apical pathology, or to be maintained in good health. Over the past fifteen years, Bioceramic materials have become increasingly popular as a new filling material. Their dimensional stability, biochemical adhesion to tooth structures and potentially interesting biological properties make these materials a possible technical alternative to three-dimensional gutta percha obturation. Drawing on 12 years' experience with this technique, I will present our latest multicentric randomized clinical trial, including 13 operators and 160 patients with a 24-month follow-up, which will enable us to discuss the relevance of this still highly controversial obturation technique. (Financially supported by Septodont Company)

10:15 – 10:30              Discussion

10:30 – 11:00              Coffee Break

Research Aspects

11:00 – 11:30              Obturation: Reality vs Instagram

Josette Camilleri (Birmingham, UK)

Root canal obturation techniques have changed from mostly gutta-percha based to sealer-based. The use of hydraulic cement sealers provides huge opportunities to have a simplified and effective obturation. The main shortcoming is that the materials interact with the clinical environment thus require a bespoke irrigation and obturation protocol. Currently there seems to be no correlation between the obturation technique and the outcome of apical periodontitis. This may be due to the heterogeneity of the cases in the clinical research undertaken. This lecture will overview the materials and techniques and look into how enhanced knowledge of the materials can improve the clinical outcomes.

11:30 – 12:00              Obturation - Should we know more?

Leo Tjäderhane (Helsinki, Finland)

Obturation of the root canals is - along with diagnostics, cleaning and shaping, and restorative work - one of the cornerstones of success in endodontics. Gutta-percha has been used in root canal obturation since late 1800’s, and there’s been a tremendous development both in materials (especially sealers) and obturation techniques. Still, the most recent clinical practice guidelines are not able to present any strong, evidence-based recommendations regarding the optimal obturation technique or gold standard sealer. There are several reasons behind this. Some relate to the methodological problems in in vitro sealibility studies; clinical studies are troubled with numerous confounding factors; and finally, vast number of tested sealers, techniques and their combinations make comprehensive conclusions difficult. In this presentation, we will discuss the various aspects why, despite huge efforts in research, definitive recommendations in root canal obturation are difficult to obtain.

12:00 – 12:20              Discussion

12:20 – 13:30              Lunch and Networking

Part 4: Regenerative Endodontics

Clinical Aspects

13:30 – 14:00              Regenerative endodontics: a clinical overview

Tugba Turk (Izmir, Turkey) 

In the contemporary landscape of dental science, the integration of cutting-edge technologies and evidence-based knowledge has given rise to innovative clinical principles aimed at mimicking nature. A crucial aspect of this evolution lies in endodontic practice, which is now urged to harmonize with principles encompassing biosustainability, biomimicry, and biominimalism. Regenerative endodontic therapy is a biologically driven procedure designed to replace damaged tissue, including dentin, root structures, as well as cells of the pulp-dentin complex. In the modern age of dentistry, preserving pulp vitality or revitalizing pulp tissue using biologically based approaches is of great importance, and regenerative therapies are at the core of pulp tissue management. The aim of the current lecture is to discuss advanced clinical revitalization procedures, featuring personal case reports and long-term follow-up. Significant clinical details, including the materials used and success criteria, will be thoroughly examined following the latest guidelines. Additionally, the advantages and limitations of extending the indications and scope of revitalization procedures will also be discussed.

14:00 – 14:30              Preserving and restoring pulp vitality: when, why and how to do it

Anibal Diogenes (San Antonio, USA) 

There has been considerable development in the understanding of the regenerative potential of dental structures in the last decade. Regenerative endodontics is currently considered a treatment option for certain cases. Despite its clinical and scientific value, factors related to the predictability of continued root development remain elusive. Several advancements have been proposed to overcome the current challenges with these procedures. This lecture focuses on discussing the current status of regenerative endodontics and the future directions to achieve the ultimate mission to preserve tissue homeostasis and tooth longevity.

14:30 – 14:45              Discussion

14:45 – 15:15              Coffee Break

Research Aspects

15:15 – 15:45              Beyond repair? Exploring the frontiers of endodontic tissue engineering

Matthias Widbiller (Regensburg, Germany)

Regenerative endodontic procedures, primarily using blood clot techniques, demonstrate biological repair without achieving complete regeneration of the original dental pulp. Recent advances in regenerative endodontics incorporate tissue engineering concepts to address apical periodontitis in both mature and immature permanent teeth. This advancement is encapsulated in Endodontic Tissue Engineering (ETE), where scaffolds or biomaterials, with or without cells, are introduced into the root canal to facilitate pulp tissue regeneration. Although ETE is a promising alternative to conventional procedures, the lack of comprehensive studies hinders the derivation of robust clinical recommendations. While an increasing number of clinical trials are evaluating the efficacy of ETE compared to existing procedures, there is still uncertainty as to whether ETE can go beyond mere repair to achieve true pulp regeneration.

15:45 – 16:15              Clarifiying the S3 recommendations for treatment of pulp necrosis without apical                                                              periodontitis in (im)mature permanent teeth by means of revitalization

Nastaran Meschi (Ghent, Belgium) 

Nearly one in five children worldwide have a history of dental trauma before the age of twelve. Generally, the immature permanent upper front teeth get injured, often resulting in pulpal inflammation or necrosis and arrested root development. Two treatment modalities have been described to treat immature permanent teeth with injured pulp, depending on the root development stage: apexification and the more novel revitalization procedures. Both treatments aim primarily in short-term periapical bone healing and in long-term preservation of teeth, which are attained in most of the clinical trials. However, the second main goal of revitalization (further root development) is not that easily reached clinically. Despite this, recent studies report the application of this novel treatment in mature permanent teeth, with promising results in terms of success and survival. But what is the certainty of the available evidence?  The recommendations of the ESE S3 guidelines in endodontology, published in 2023, were based on the best available evidence. One of the pillars of the current recommendations regarding revitalization procedures was the review published by Meschi et al. (2022): “Effectiveness of revitalization in treating apical periodontitis: a systematic review and meta-analysis”. This presentation will attempt to elucidate the reasoning of the current S3 guidelines for treatment of pulp necrosis w/o AP in (im)mature permanent teeth by means of revitalization procedures.

16:15 – 16:30          Discussion

16:30 – 17:00          Round Up and Group Discussion

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