Endodontic Update:Endodontic Update: 2007 AAE Annual Session2007 AAE Annual Session

(and then some)(and then some)

Scott E. Shuler, DMD,MSScott E. Shuler, DMD,MS

Biological TopicsBiological Topics

Auto and ReplantationAuto and Replantation Bioadhesives (Tissue-Tak), TGF-Beta, BMT Bioadhesives (Tissue-Tak), TGF-Beta, BMT

to promote ligament attachmentto promote ligament attachment Propolis extract to prevent resorptionPropolis extract to prevent resorption

Regenerative EndodonticsRegenerative Endodontics

Def: Biologically based procedures Def: Biologically based procedures designed to replace damaged structures.designed to replace damaged structures.

““Tissue engineering”—guided Tissue engineering”—guided regeneration of pulp-like tissue from regeneration of pulp-like tissue from cellular precursors (stem cells) cellular precursors (stem cells)

Regenerative EndodonticsRegenerative Endodontics

Growth of new cells in culture from pulp Growth of new cells in culture from pulp precursors precursors

““Emdogain” (enamel matrix protein Emdogain” (enamel matrix protein formulation) showed potential for pulp formulation) showed potential for pulp regenerationregeneration

Discussion of relative costs and concerns Discussion of relative costs and concerns

Clinical TopicsClinical Topics

Novel uses for MTANovel uses for MTA As primary obturation material in short As primary obturation material in short

roots,primary teethroots,primary teeth As capping material in IP with immature As capping material in IP with immature

apicesapices

Clinical TopicsClinical Topics

Bone preservation and regeneration Bone preservation and regeneration during endodontic surgeryduring endodontic surgery Flap design considerations, microsurgeryFlap design considerations, microsurgery Grafting and matrix placementGrafting and matrix placement

Management of Endodontic flare-upsManagement of Endodontic flare-ups

Product BuzzProduct Buzz

InstrumentationInstrumentation ““All the rage” at previous meetingsAll the rage” at previous meetings AxxessAxxess

Product BuzzProduct Buzz

Irrigation: MTAD (Biopure)Irrigation: MTAD (Biopure) New irrigant introduced by Torabinejad in New irrigant introduced by Torabinejad in

20052005 What’s in it? What’s in it?

Product BuzzProduct Buzz

Benefits:Benefits: Antimicrobial (<NaOCl)Antimicrobial (<NaOCl) Removes smear layerRemoves smear layer Somewhat dissolves tissue (<NaOCl) Somewhat dissolves tissue (<NaOCl)

Drawbacks:Drawbacks: Cost: Roughly $4 per canalCost: Roughly $4 per canal Benefit is questionable over traditional Benefit is questionable over traditional

irrigation (Kho, Baumgardner J Endod 2006)irrigation (Kho, Baumgardner J Endod 2006)

Product BuzzProduct Buzz

Hydraulic Irrigation (ANP—Endovac)Hydraulic Irrigation (ANP—Endovac) ““Positive pressure irrigation works only to the Positive pressure irrigation works only to the

orifice of the needle in a closed system.”orifice of the needle in a closed system.” Chow, J Endod, 1993Chow, J Endod, 1993

Schoeffel (USC)—Endovac (ANP)Schoeffel (USC)—Endovac (ANP)• ““Sewer pump” vs. “fire hose”Sewer pump” vs. “fire hose”

Concern--expression of irrigant beyond apex.Concern--expression of irrigant beyond apex.

Bonded Resin ObturationBonded Resin Obturation

What is it?What is it? Attempt to apply dentin adhesive technology Attempt to apply dentin adhesive technology

to root canal obturationto root canal obturation Products: Resilon, Epiphany, EndoRezProducts: Resilon, Epiphany, EndoRez

Claimed benefits:Claimed benefits: ““Monoblock”: less coronal leakageMonoblock”: less coronal leakage Superior apical sealSuperior apical seal Resistance to root fractureResistance to root fracture

Bonded Resin ObturationBonded Resin Obturation

““Monoblock” questioned by BaumgartnerMonoblock” questioned by Baumgartner Zurich study: seal similar to gutta percha Zurich study: seal similar to gutta percha

and AH26, but deteriorated over time and AH26, but deteriorated over time UT-SA: no fracture resistanceUT-SA: no fracture resistance Superior to “single cone” techniques of Superior to “single cone” techniques of

Thermafil, Soft-core HD, etc, but so is Thermafil, Soft-core HD, etc, but so is everything else!everything else!

Dental ImplantsDental Implants

Change in Meeting SponsorshipChange in Meeting Sponsorship ““Feel” (2005 versus 2007)Feel” (2005 versus 2007)

Dental ImplantsDental Implants

Papers presented:Papers presented: ““Real Cost” comparison (Case Western)Real Cost” comparison (Case Western) ““Success” comparison (USC, Case)Success” comparison (USC, Case)

• Sample bias/ Exclusion factorsSample bias/ Exclusion factors• Criteria (“success” vs. “survival”)Criteria (“success” vs. “survival”)• Adjusted endo survival rates:Adjusted endo survival rates:

USC 96.8%USC 96.8% Case Western 94.4%Case Western 94.4% Delta Dental 96.9%Delta Dental 96.9% Taiwan 93-96%Taiwan 93-96%

Dental ImplantsDental Implants

Summary:Summary: Implants are highly successful, but so is Implants are highly successful, but so is

uncompromised endodontic therapy, and at uncompromised endodontic therapy, and at considerably less costconsiderably less cost

Better visualization, diagnosis, Better visualization, diagnosis, instrumentation, obturation, and management instrumentation, obturation, and management of restorative and periodontal aspects can of restorative and periodontal aspects can eliminate many causes of failureeliminate many causes of failure

Dental ImplantsDental Implants

Case selection is the key to predictability, so Case selection is the key to predictability, so future research should focus on determining future research should focus on determining compromising factorscompromising factors

Implants should be considered before Implants should be considered before alternative treatments in cases with alternative treatments in cases with predictably poor prognosespredictably poor prognoses

Endodontic Update 2007Endodontic Update 2007

Thank You!!Thank You!!

Questions?Questions?