Endodontic Update: 2007 AAE Annual Session (and then some) Scott E. Shuler, DMD,MS Biological Topics пѓ� Auto пЃ¬ пЃ¬ 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. пѓ� вЂњTissue engineeringвЂќвЂ”guided regeneration of pulp-like tissue from cellular precursors (stem cells) Regenerative Endodontics пѓ� Growth of new cells in culture from pulp precursors пѓ� вЂњEmdogainвЂќ (enamel matrix protein formulation) showed potential for pulp regeneration пѓ� Discussion of relative costs and concerns Clinical Topics пѓ� Novel пЃ¬ пЃ¬ 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 пЃ¬ пЃ¬ Flap design considerations, microsurgery Grafting and matrix placement пѓ� Management of Endodontic flare-ups Product Buzz пѓ� Instrumentation пЃ¬ пЃ¬ вЂњAll the rageвЂќ at previous meetings Axxess Product Buzz пѓ� Irrigation: пЃ¬ пЃ¬ MTAD (Biopure) New irrigant introduced by Torabinejad in 2005 WhatвЂ™s in it? Product Buzz Benefits: пЃ¬ пЃ¬ пЃ¬ Antimicrobial (<NaOCl) Removes smear layer Somewhat dissolves tissue (<NaOCl) Drawbacks: пЃ¬ пЃ¬ Cost: Roughly $4 per canal Benefit is questionable over traditional irrigation (Kho, Baumgardner J Endod 2006) Product Buzz пѓ� Hydraulic пЃ¬ вЂњPositive pressure irrigation works only to the orifice of the needle in a closed system.вЂќ пЃ¬ пЃ¬ Irrigation (ANPвЂ”Endovac) Chow, J Endod, 1993 Schoeffel (USC)вЂ”Endovac (ANP) вЂў вЂњSewer pumpвЂќ vs. вЂњfire hoseвЂќ Concern--expression of irrigant beyond apex. Bonded Resin Obturation пѓ� What пЃ¬ пЃ¬ is it? Attempt to apply dentin adhesive technology to root canal obturation Products: Resilon, Epiphany, EndoRez пѓ� Claimed пЃ¬ пЃ¬ пЃ¬ benefits: вЂњMonoblockвЂќ: less coronal leakage Superior apical seal Resistance to root fracture Bonded Resin Obturation пѓ� вЂњMonoblockвЂќ questioned by Baumgartner пѓ� Zurich study: seal similar to gutta percha and AH26, but deteriorated over time пѓ� UT-SA: no fracture resistance пѓ� Superior to вЂњsingle coneвЂќ techniques of Thermafil, Soft-core HD, etc, but so is everything else! Dental Implants пѓ� Change in Meeting Sponsorship пѓ� вЂњFeelвЂќ (2005 versus 2007) Dental Implants пѓ� Papers пЃ¬ пЃ¬ presented: вЂњReal CostвЂќ comparison (Case Western) вЂњSuccessвЂќ comparison (USC, Case) вЂў Sample bias/ Exclusion factors вЂў Criteria (вЂњsuccessвЂќ vs. вЂњsurvivalвЂќ) вЂў Adjusted endo survival rates: пЃ¬ пЃ¬ пЃ¬ пЃ¬ USC 96.8% Case Western 94.4% Delta Dental 96.9% Taiwan 93-96% Dental Implants пѓ� Summary: пЃ¬ пЃ¬ 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 пЃ¬ пЃ¬ 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?