Clinical Endodontics Professional Training

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Module 4

Management of Endodontic Failure

Programme outline: Rational behind non-surgical endodontic retreatment. Disassembly of commonly used obturation materials. Removal of obturation materials. Disinfection during retreatment. The 3-dimensional anatomy of root canal systems and its relation to root canal treatment failure. Outcome studies on non-surgical root canal treatment. Management of broken endodontic instruments. Calcium silicate cements and their application during non-surgical retreatment. Microsurgical Endodontics. Local anesthesia for surgery, flap design, osteotomy preparation, root-end resection and retrograde preparation with microsurgical instruments, precision root-end filling with calcium silicate cements and putty, and suturing techniques.

Hands-on training: Re-treatment of common endodontic obturation materials. Removal of gutta-percha fillings. Removal of carrier-based materials. Removal of fiber posts. Broken instrument removal and bypassing. Pulp floor perforation repair. Internal resorption defect management. Apical plug placement. Hands-on training using 3D printed special tooth models, sheep cadaveric specimens and microscopes.


DAY 1

Title: Non-surgical Retreatment

Aims

To understand the rationale behind non-surgical retreatment approaches and the aitiology of initial root canal treatment failure. To present an evidence-based framework for the safe and effective disassembly of non-obturation and obturation materials.

Objectives

Students will be able to remove guttapercha obturations from root canals, remove Carrier based obturations from the root canals, remove paste obturations and remove fiber posts. Students will have the opportunity to use most of the current technology used during retreatment procedures.

Agenda

08:30 – 11:00
Rational behind non-surgical endodontic retreatment
Dr. Chaniotis Antonis
11:00 – 11:30
Coffee Break    

11:30 – 13:00
Disassembly of non-obturation materials | Removal of obturation materials | Disinfection during retreatment
Dr. Chaniotis Antonis  
13:00 – 14:00
Lunch        

14:00 – 15:30
Microscope powered hands-on | Removal of gutta-percha fillings | Removal of carrier-based materials | Removal of fiber posts
Dr. Chaniotis Antonis
15:30 – 16:00
Coffee Break  

16:00 – 18:00
Video demonstration of cast post removal Discussion
Dr. Chaniotis Antonis


DAY 2

Title: Non-surgical Retreatment 

Aims

To understand the factors related to the long-term outcome of non-surgical endodontic retreatment and to develop a rational diagnostic and decision-making framework. To appreciate the importance of magnification and illumination for the management of complicated non-surgical retreatment cases.

Objectives

Students will be able to bypass and remove broken endodontic files and understand all the preventive measures to avoid complications during endodontic instrumentation. The students will be able to repair a pulp floor perforation, to obturate an internal resorption defect and perform apical plugs with biocompatible materials.

Agenda

08:30 – 11:00
The 3-dimensional anatomy of root canal systems and its relation to root canal treatment failure | Outcome studies on non-surgical root canal treatment
Dr. Chaniotis Antonis
11:00 – 11:30
Coffee Break      

11:30 – 13:00
Prevention and management of broken endodontic instruments | Calcium silicate cements and their application during non-surgical retreatment
Dr. Chaniotis Antonis
13:00 – 14:00
Lunch        

14:00 – 15:30
Microscope powered hands-on | Broken instrument removal and bypassing
Dr. Chaniotis Antonis
15:30 – 16:00
Coffee Break

16:00 – 18:00
 Pulp floor perforation repair | Internal resorption defect management | Apical plug placement | Discussion
Dr. Chaniotis Antonis


DAY 3

Title: Surgical Retreatment

Aims

To understand the rationale behind microsurgical retreatment approaches and acquire basic surgical knowledge.

Objectives

By the end of the course delegates will understand:

  • Outcomes of endodontic microsurgery vs traditional apicectomy
  • The science behind effective local anesthesia in endodontic microsurgery
  • The use of a dental operating microscope in endodontic microsurgery
  • Flap design and tissue handling to improve post-surgical healing
  • How to effectively prepare an osteotomy
  • Correct methods of ultrasonic root-end preparation and how to identify anatomical markers
  • Which equipment is appropriate for use in microsurgical techniques
  • Performed root end resection and retrograde preparation of the root canal space

Agenda

09:00 – 11:00
Rational behind micro-surgical endodontic retreatment
Indications-Contraindications for microsurgery
Pre-surgical evaluation
Armamentarium for microsurgery
Prof. James Prichard
11:00 – 11:30
Coffee Break  

11:30 – 13:00

Effective Anesthesia and hemostasis staging
Soft tissue management (Flap designs, retraction, suturing)
Prof. James Prichard
13:00 – 14:00
Lunch        

14:00 – 15:30
Hard tissue management (Osteotomy and root resection)
Retro preparation
Retro-filling Materials and Techniques
Wound healing-surgical Sequel-complications
Outcomes of Microsurgery    
Prof. James Prichard
15:30 – 17:30
Microscope powered hands-on
Flap Design
Root resection
Prof. James Prichard
17:30 - 18:00
Discussion and Q&A
 Prof. James Prichard


DAY 4

Title: Surgical Retreatment

Aims

To understand the importance of magnification in endodontic microsurgery and acquire basic microsurgical skills

Objectives

By the end of the course delegates will have:

  • Been calibrated to a dental operating microscope
  • Have identified cases where surgical intervention is appropriate
  • Performed microsurgical suturing
  • Retropreparation and retro-filling techniues
  • Wound healing-surgical sequelae-Complications
  • Outcomes of microsurgery
  • Effective suturing and postoperative care including analgesia
  • Developed a post-operative care strategy to minimize complications and improve healing


Agenda

09:00 – 10:45
Microscope powered hands-on
Retro preparation And Retro-filling techniques
 Prof. James Prichard  
10:45 – 11:15
Coffee Break  

11:15 – 13:00
Suturing Techniques Hands On
Prof. James Prichard
13:00 – 14:00
Lunch        

14:00 – 16:00
Risk factors in Endodontics
Prof. James Prichard
16:00 – 16:30
Coffee Break    

16:30 – 17:30
Clinical Cases Discussion in Groups
Prof. James Prichard
17:30 - 18:00
Discussion and Q&A
Prof. James Prichard
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