The aim of this demonstration is to review critical procedural steps in endodontic retreatment. Non-surgical retreatment under microscope from the pre-endodontic build up and isolation to post endodontic restoration will be demonstrated. Materials and techniques will be introduced that help the clinician conduct the treatment in a streamline fashion optimizing success from restorative and root canal treatment point of view. The key to successful retreatment is adequate disinfection. To allow for irrigation and medication to be effect against the persistent intracanal infection, the previously filled gutta percha and sealer have to be efficiently removed. Ensuring correct working length and adequate disinfection of the apical third of the root canal is critical to a successful outcome. After biomechanical instrumentation, sealer based obturation technique with bioceramic sealer and gutta percha will be demonstrated to reseal the canal.

This demonstration masterclass will highlight the importance of the correct positioning of the operating microscope, patient, and clinician to achieve a comfortable, ergonomic, and efficient approach to endodontic microsurgery.
A complete surgical procedure will be performed on an extracted tooth mounted in a mannequin head model, replicating real-life clinical conditions. The procedure will be carried out under the operating microscope and will include the use of a piezoelectric device to create an osseous window, microsurgical instruments, and a pre-mixed, fast-setting bioceramic material for root-end filling.
The microsurgical armamentarium will be discussed in detail, allowing participants to understand the purpose and clinical relevance of each instrument throughout the procedure. Particular emphasis will be placed on ergonomics, surgical access, instrument selection, and the key steps required to perform endodontic microsurgery safely, predictably, and efficiently.

Complex endodontic microsurgery often requires advanced techniques to achieve predictable access, healing, and treatment outcomes. This lecture will explore the use of piezoelectric surgery to create and safely reposition a bone window, particularly in challenging anatomical situations such as mandibular molars with thick cortical bone.
The presentation will focus on the clinical application of platelet-rich fibrin (PRF), including the preparation of PRF plugs and membranes, as well as the use of autogenous bone from the surgical window combined with PRF-derived serum to create “sticky bone” for guided tissue regeneration.
The second part of the lecture will address treatment planning and case selection for intentional replantation. Surgical techniques and clinical decision-making will be discussed in detail, illustrated by a series of clinical cases with long-term follow-up.
Participants will gain practical insights into the management of challenging endodontic surgical cases and the integration of microsurgical and biologically driven regenerative techniques to optimize clinical outcomes.

When managing deep carious lesions approaching the pulp chamber, clinicians often face the dilemma of whether to preserve or remove the pulp tissue. Traditionally, teeth diagnosed with irreversible pulpitis have been treated with root canal therapy. However, emerging evidence is challenging this conventional paradigm, opening new possibilities for vital pulp therapy, even in cases previously considered unsuitable for conservative management.
In this first part, the tissue response to caries progression will be examined in detail, from initial lesions to deep caries approaching the pulpal space. New insights into early non-cavitated white spot lesions will be presented. The controversial issue of caries excavation depth will also be addressed, with a critical analysis of the evidence supporting selective versus non-selective caries removal.
Finally, the histopathological distinction between reversible and irreversible pulpal inflammation will be explored, with particular emphasis on the complex relationship between clinical and histological diagnoses. This evidence-based approach will provide a foundation for understanding how contemporary concepts of pulp biology can inform clinical decision-making in the management of deep carious lesions.

The aim of this presentation is to explore the range of retreatment options available to preserve the natural dentition. Modern clinical practice requires dentists to remain familiar with advances in materials, instruments, and treatment techniques in order to help patients select the most appropriate long-term treatment option for maintaining oral health and function.
Advances in dental materials and surgical techniques have made endodontic microsurgery increasingly predictable. Nevertheless, there are specific clinical situations in which surgical endodontic treatment cannot replace conventional non-surgical retreatment. Successful management requires a thorough understanding of the causes of treatment failure, the prognosis associated with each treatment approach, and the technologies and materials available to achieve the best possible outcome.
This presentation will review the relevant scientific literature evaluating the prognosis of conventional and microsurgical endodontic retreatment. By integrating current evidence with clinical considerations, it will provide a framework for informed decision-making when managing challenging and refractory endodontic cases, with the ultimate goal of preserving the natural tooth whenever possible.

The presentation will begin with an overview of modern endodontic microsurgery as developed and taught at Penn Endo, highlighting key areas of clinical importance through video demonstrations. Topics will include instruments, materials, biological principles, and, most importantly, clinical success rates.
The second part will introduce the newly developed “Bone Window Technique.” Endodontic microsurgery in teeth with large periapical lesions and an intact cortical plate may require the removal of additional bone, potentially resulting in delayed healing. In such cases, the Bone Window Technique provides excellent access and visualization of the surgical field while preserving the cortical plate.
Cone-beam computed tomography (CBCT) plays an essential role in preoperative assessment, case selection, and precise planning of the bone window. The technique will be presented as a reliable and minimally invasive approach that should be considered the preferred method when a large periapical lesion is associated with an intact buccal cortical plate.
This 2027 update will provide clinicians with practical insights into the latest developments in endodontic microsurgery, combining biological principles, advanced technology, and refined surgical techniques to improve clinical outcomes.

In this second part, clinical strategies for preserving pulp vitality in teeth diagnosed with reversible pulpitis will be presented. Based on extensive histopathological and histobacteriological research, a novel approach will be introduced, centered on intraoperative decision-making guided by the magnified visual assessment of the exposed pulp tissue.
Under favorable conditions, the exposed pulp can be sealed using biocompatible and potentially bioactive materials, promoting healing and long-term pulp preservation. The histological features of pulp healing will be described, together with an analysis of the factors associated with failure following direct pulp capping.
Finally, the current literature on the clinical outcomes of direct pulp capping will be critically reviewed, including long-term clinical evidence demonstrating high success rates. The presentation will highlight how a biologically based, evidence-driven approach can expand the possibilities for maintaining pulp vitality in deeply carious teeth.

In this third part, the possibility of preserving partial pulp vitality in teeth diagnosed with irreversible pulpitis will be explored. A clinical approach based on the progressive removal of diseased pulp tissue, followed by visual assessment under magnification, will be presented.
This technique enables clinicians to assess the extent and location of the infection front and selectively remove only necrotic and infected tissue while preserving the remaining healthy pulp. The resulting pulp wound is then covered with bioceramic materials to promote healing and maintain the vitality of the remaining tissue.
A series of clinical videos will illustrate a range of clinical scenarios and operative techniques, providing practical insight into the application of this approach. Finally, the current literature will be critically reviewed, including a comparison of the biological properties of traditional calcium hydroxide and contemporary bioceramic materials.
The presentation will examine how advances in pulp biology, magnification, and biomaterials are redefining the boundaries of vital pulp therapy in teeth previously considered candidates for conventional root canal treatment.