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2007 AAE Annual Session

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Endodontic Update:
2007 AAE Annual Session
(and then some)
Scott E. Shuler, DMD,MS
Biological Topics
пѓ� Auto
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and Replantation
Bioadhesives (Tissue-Tak), TGF-Beta, BMT to
promote ligament attachment
Propolis extract to prevent resorption
Regenerative Endodontics
пѓ� Def:
Biologically based procedures
designed to replace damaged structures.
� “Tissue engineering”—guided regeneration
of pulp-like tissue from cellular precursors
(stem cells)
Regenerative Endodontics
пѓ� Growth
of new cells in culture from pulp
precursors
� “Emdogain” (enamel matrix protein
formulation) showed potential for pulp
regeneration
пѓ� Discussion of relative costs and concerns
Clinical Topics
пѓ� Novel
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uses for MTA
As primary obturation material in short
roots,primary teeth
As capping material in IP with immature
apices
Clinical Topics
пѓ� Bone
preservation and regeneration
during endodontic surgery
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Flap design considerations, microsurgery
Grafting and matrix placement
пѓ� Management
of Endodontic flare-ups
Product Buzz
пѓ� Instrumentation
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“All the rage” at previous meetings
Axxess
Product Buzz
пѓ� Irrigation:
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MTAD (Biopure)
New irrigant introduced by Torabinejad in
2005
What’s in it?
Product Buzz
Benefits:
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Antimicrobial (<NaOCl)
Removes smear layer
Somewhat dissolves tissue (<NaOCl)
Drawbacks:
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Cost: Roughly $4 per canal
Benefit is questionable over traditional
irrigation (Kho, Baumgardner J Endod 2006)
Product Buzz
пѓ� Hydraulic
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“Positive pressure irrigation works only to the
orifice of the needle in a closed system.”
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Irrigation (ANP—Endovac)
Chow, J Endod, 1993
Schoeffel (USC)—Endovac (ANP)
• “Sewer pump” vs. “fire hose”
Concern--expression of irrigant beyond apex.
Bonded Resin Obturation
пѓ� What
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is it?
Attempt to apply dentin adhesive technology
to root canal obturation
Products: Resilon, Epiphany, EndoRez
пѓ� Claimed
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benefits:
“Monoblock”: less coronal leakage
Superior apical seal
Resistance to root fracture
Bonded Resin Obturation
� “Monoblock”
questioned by Baumgartner
пѓ� Zurich study: seal similar to gutta percha
and AH26, but deteriorated over time
пѓ� UT-SA: no fracture resistance
� Superior to “single cone” techniques of
Thermafil, Soft-core HD, etc, but so is
everything else!
Dental Implants
пѓ� Change
in Meeting Sponsorship
� “Feel” (2005 versus 2007)
Dental Implants
пѓ� Papers
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presented:
“Real Cost” comparison (Case Western)
“Success” comparison (USC, Case)
• Sample bias/ Exclusion factors
• Criteria (“success” vs. “survival”)
• Adjusted endo survival rates:
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USC 96.8%
Case Western 94.4%
Delta Dental 96.9%
Taiwan 93-96%
Dental Implants
пѓ� Summary:
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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
Dental Implants
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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
Endodontic Update 2007
Thank You!!
Questions?
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