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The primary goals of endodontic treatment are to provide patients with the best possible long-term outcomes regarding function, comfort, and esthetics. Accurate diagnosis and proper treatment planning are essential for achieving these goals. Like other procedures, initial root canal treatment is not always successful and alternative procedures should be explored. The purposes of this lecture are (1) to discuss the appropriate means to obtain an accurate endodontic diagnosis, including the specifics of the examination process, and a discussion of definitive care to be delivered based on the findings and their interpretation and (2) to discuss factors influencing outcomes and compare the outcomes of initial non-surgical root canal treatment with those of non-surgical retreatment, surgical retreatment, and alternative treatments, such as replantation, transplantation and single tooth implants.

One of the main functions of the dental pulp is formation of dentin. When the pulp undergoes pathologic changes before complete root development, normal root growth is disrupted. If the pulp is reversibly inflamed due to caries or exposure, the treatment of choice is to maintain pulp vitality by pulp capping or pulpotomy. When the pulp dies, root canal treatment is indicated. Teeth with necrotic and infected pulps are routinely treated with endodontic procedures with a high rate of long-term success. The consequence of pulpal necrosis in immature teeth, however, is the cessation of root development, making endodontic treatment with conventional techniques and materials difficult or impossible . Treatment options for these teeth include: apexification, regenerative endodontics or a new tooth. Apexification procedures that involve the production of an induced or artificial apical stop can allow for condensation of obturation materials. However apexification procedures do not promote continuation of root development, nor do they increase fracture resistance of the root walls. An ideal treatment for a necrotic immature tooth is the regeneration of pulp tissue into a canal and promotion of the a normal root development. There is a growing body of evidence to suggest that revascularization of the pulp space, along with continued growth of the root, may in fact be possible after pulpal necrosis and apical pathosis in teeth with immature apices. In this lecture the presenter will discuss the pros and cons of pulp regeneration and the alternative treatments for teeth with pulp necrosis and open apexes.

Bacterial contamination of pulp tissue results in the development of pulpal and periradicular diseases. Removal of irritants from the infected root canals is one of the major goals of endodontic therapy. This task is accomplished by mechanical and chemical means. Mechanically, canals are cleaned with hand and rotary instruments. Chemically they are cleaned with irrigants and intracanal medications. To clean canals properly, they need to be shaped adequately. There are several methods for cleaning and shaping. Recently NiTi rotary files have been suggested for cleaning and shaping of root canals. The advantages and disadvantages of these techniques will be discussed.

Endodontic emergencies are induced as a result of pulpal and/or periapical inflammation and are associated with pain and/or swelling. Microbial, mechanical and chemical irritation of pulp or periapical tissues result in release of numerous potent biological substances. A basic knowledge of physiopathologic and psychological factors associated with endodontic emergencies is essential for every dentist. Diagnosis, treatment and factors involved in endodontic emergencies prior, during, and after root canal therapy based on in vitro and clinical investigations will be discussed. In addition, the effect of various medications on postoperative pain following cleaning and shaping as well as obturation will be revealed.

Root canal therapy, like other disciplines of dentistry, sometimes is associated with unwanted and unforeseen circumstances; these are collectively called procedural accidents. The mishaps can occur during diagnosis, access preparation, cleaning and shaping, obturation and post preparation. Knowledge of etiologic factors involved in procedural accidents is essential for their prevention. Methods of recognition, treatment and their effects on success and failure of endodontics are discussed. The levels of evidence for clinical efficacy of various techniques to correct these accidents are discussed during this presentation.

The primary function of the hard tissues surrounding root canal space is to protect the pulp and periodontium from external irritants. When these natural barriers are compromised the host is equipped with defensive mechanisms to protect itself. Existing materials do not possess “ideal” characteristics to seal the pathways of communication between the external surfaces of the teeth and the root canal system.
Repair materials used to protect or reestablish the integrity of the vital tissues within and outside of the teeth should not only seal the pathways of communication between the external surfaces of the tooth and the pulp and periapical tissues, they should be also biocompatible. Mineral trioxide aggregate (MTA) was introduced as a repair material over thirty years ago. Numerous in vitro and in vivo investigations have shown MTA’s effectiveness as a repair material for pulp capping, pulpotomy, apical plug, pulp regeneration, root perforation, root end filling and root canal filling. Degree of success of MTA for these procedures is discussed based on present levels of evidence.
Because of its ideal characteristics, it is also recommended as a root canal sealer. Despite its advantages, original MTA has a long setting time. This disadvantage is rectified by development of a fast set MTA. Preliminary data regarding fast set MTA and MTA sealer will be presented.

When routine endodontic procedures fail, endodontic surgery is an alternative to extraction and placement of a crown, a bridge or an implant. The main cause for root canal failure is the presence of bacteria within the root canal system. Studies have shown a significant percentage of failed root canals heal following re-treatment. The presenter in this lecture will discuss when to retreat and when to perform surgical endodontics. Various types of endodontic surgeries including and their indications for calcified canals, irretrievable filling materials, symptomatic cases, procedural accidents requiring surgery, presence of non removable post, unusual canal anatomy, horizontal apical fracture, and exploratory surgery will be discussed. Outcome of endodontic surgery is discussed based on systematic literature reviews and compared to non surgical retreatment and single tooth implants.

One of the major objectives of root canal treatment is complete cleaning and disinfection of the root canal system. Presence of bacteria, complexity of the root canal system and the smear layer hamper achievement of this task. Many methods have been proposed to achieve these goals, none of which are totally effective or have received universal acceptance. A mixture of a tetracycline, an acid, and a detergent (MTAD) has recently been suggested as a final irrigant to remove the smear layer and disinfect the root canal system. The properties of this solution will be compared to those of currently used intra-canal irrigants and medications.

Advances in endosseous implants have had a significant effect on treatment planning in dentistry. The purpose of this presentation is to discuss factors involved in decision-making regarding selection of root canal treatment or dental implants. Indications and contraindications as well as the criteria used to determine the outcomes of root canal treatment and dental implants will be reviewed. In addition, success rates and the factors affecting the success of each treatment modality will be discussed. Current data indicates similar levels of clinical functionality over time for both treatments. Retention or removal of teeth should be based on thorough knowledge related to risk factors affecting the long-term prognosis of both root canal treatment and dental implants.

Traumatic injuries associated with severance of the blood supply result in pulpal ischemia and often a secondary infection with bacteria. Teeth with necrotic and infected pulps are routinely treated with endodontic procedures with a high rate of long-term success. The consequence of pulpal necrosis in immature teeth, however, is the cessation of root development, making endodontic treatment with conventional techniques and materials difficult or impossible . Treatment options for these teeth include: apexification, regenerative endodontics or a new tooth. Apexification procedures that involve the production of an induced or artificial apical stop can allow for condensation of obturation materials. However apexification procedures do not promote continuation of root development, nor do they increase fracture resistance of the root walls. An ideal treatment for a necrotic immature tooth would be the regeneration of pulp tissue into a canal and promotion of the a normal root development. The advantages of regenerative endodontics lie in the potential for reinforcement of dentinal walls by deposition of hard tissue and the potential for the development of an apical morphology more appropriate for conventional endodontic therapy if future treatment becomes necessary. There is a growing body of evidence to suggest that revascularization of the pulp space, along with continued growth of the root, may in fact be possible after pulpal necrosis and apical pathosis in teeth with immature apices. In this lecture the presenter will discuss the pros and cons of pulp regeneration and the alternative treatments for teeth with pulp necrosis and open apexes.

Vital pulp therapy and pulp regeneration are within the scope of endodontic practice. The pulp is normally protected by dentin and its surrounding enamel and cementum. Once these protective layers are lost, the pulp is at the risk of infection and consequently activation of various host defense mechanisms. The dental pulp and its surrounding dentin have several defense mechanisms. Activation of these pathways results in reactionary or reparative tertiary dentinogenesis. When the pulp is reversibly inflamed, the treatment of choice is maintaining its vitality by indirect or direct pulp capping procedures as well as partial or complete pulp chamber pulpotomies. When the pulp dies before complete root development, normal root growth is disrupted. A treatment option is regenerative endodontics. There is a growing body of evidence to suggest that revascularization of the pulp space in these teeth will result in continued growth of the root and elimination of periapical pathosis. However, experimental studies have shown that the tissues formed after use of vital pulp therapy and regenerative endodontic procedures do not entirely recapitulate the lost native dentin-pulp tissue. Various materials and techniques have been used for vital pulp therapy, apexification and regenerative endodontics to save natural dentition. In this lecture the presenters will discuss the pros and cons of vital pulp therapy procedures and regenerative endodontics, as well as current and the emerging materials, clinical protocols and next-generation strategies to promote regenerative processes and improve the outcomes of these treatments for teeth with mature and immature apexes in endodontic practice.

The main objectives of root canal treatment are complete cleaning, shaping, and obturation of canals and placement of a final restoration to prevent recontamination of the root canal system. Adherence to proper protocols when performing these procedures significantly improves the prognosis. The high survival rates of dental implants have created a paradigm shift in treatment planning. The first treatment option after failure of root canal treatment is not extraction of the tooth and replacing with a single implant. The purpose of this lecture is to discuss indications, contraindications and review outcomes of single implant, non-surgical retreatment, endodontic surgery, replantation, and transplantation following failure of initial non -surgical root canal treatment and describe reasons for extraction of teeth after root canal treatment.

Predicting the future is very difficult. Identification of strengths, weaknesses, opportunities and threats are the key elements for determination of current status. In this lecture the presenter will discuss strengths and weaknesses of endodontics, threats against endodontics, and opportunities for endodontics. In addition he will address areas for improvement in: biology of pulp and periradicular tissues , vital pulp therapy, diagnosis and treatment planning, proper access cavity preparations , proper cleaning and shaping, providing biological obturation, adequate restoration, managing procedural accidents, performing non- surgical retreatment, performing surgical re-treatment, improving endodontic outcomes and understanding the biology and operation of single implants.