Within this presentation, the various host defense mechanisms activated by the pulp when enamel and dentin are lost during the carious attack are illustrated. Activation of these pathways results in tertiary dentinogenesis. When the pulp is exposed, 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, and treatments aimed at inducing regenerative processes have been recommended. The presenter 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.

In the presence of a deep caries lesion approximating the pulp chamber, clinicians are often in doubt about preservation or removal of the pulp tissue. Until recently, teeth diagnosed with irreversible pulpitis were root canal treated. In this lecture, the clinical strategies aimed at preserving pulp vitality in teeth with the diagnosis of both reversible and irreversible pulpitis will be discussed. Based on extensive histopathologic and histobacteriologic observations, a new approach is presented, consisting of an intraoperative evaluation-based decision-making. Through the visual observation of the exposed pulp under magnification, it is possible to estimate the localisation of the advancing front of infection, in order to selectively remove the diseased/infected tissue, and protect the uninfected pulp wound with biocompatible and potentially bioactive materials.

In the dynamic field of endodontics, the rise of Cone Beam Computed Tomography (CBCT) represents a pivotal shift in our approach to dental diagnostics. This lecture explores the transformative impact of high-resolution, limited field-of-view CBCT, offering endodontists a superior level of detail in assessing tooth structure, root morphology, and both odontogenic and osseous pathologies. It also illustrates the cutting-edge advancements in 3D imaging technology and their practical applications within our specialty. Additionally, the course will illuminate the role of task-specific enhancement filters, providing insights into their optimal use in various clinical scenarios. Participants will emerge from this presentation equipped with the knowledge to harness the full potential of CBCT imaging, thereby elevating the standard of endodontic care.

The clinical use of lasers in Endodontics had a rebirth in the late 1990s when new delivery systems, including thin and flexible fibers and endodontic tips, were developed. Today, lasers are used in various endodontic procedures including vital pulp therapy, cleaning and disinfecting the root canal system, gingivectomy, ablation of ICR granulation tissue, flap incision, osteotomy, root resection and conditioning/disinfection of the resected apex surface. The mid-infrared Erbium lasers (Er,Cr:YSGG, Er:YAG), whose wavelengths are highly absorbed in water and hydroxyapatite, appear to have the most value in Endodontic treatment. This presentation will review the available evidence on the use of Erbium lasers regarding cleaning and disinfection of the root canal system in routine endodontic treatment. Clinical cases will also be shown.

Plenary discussion directed by Dr. Domenico Ricucci

Several follow-up studies today demonstrate an excellent outcome of primary endodontic treatment in over 90% of cases with or without periapical lesions. However, these outcome results are demonstrated to be smaller when cross-sectional studies are taken into consideration, suggesting that a greater number of endodontic treated teeth in the general population are associated with disease (Post-Treatment endodontic disease – PTED). PTED will be predictably controlled leading to periapical healing only if the etiological factors (intra and/or extra-radicular infection) are eliminated or substantially reduced. To achieve this goal, two major therapies are considered: non-surgical retreatment and/or endodontic microsurgical retreatment. The clinical decision making of choosing one or another form of treatment will be depending on several biological and clinical factors that involve the patient's decision and expectations, the tooth involved (e.g. obstacles, posts, broken files, coronal leakages, non-restorable teeth, intra/extra radicular infection etc…) and the operator's clinical skills. The purpose of this presentation is to give an overview of the biological and clinical/technical factors associated with teeth with PTED and how to solve the clinical challenges during endodontic non-surgical retreatment to achieve a successful outcome.

This presentation summarizes and details the various challenges that the most apical root canal creates for effective treatment of apical periodontitis. The focus will be on canal anatomy and dimensions, role of instrumentation, conventional irrigation hydrodynamics, smear layer, antimicrobial action, biofilm detachment and/or killing, additional energy sources to aid irrigation, and the role of root filling with sealer. Finally, the risks for technical and biological complications as well as occurrence of extracanal (root surface) biofilms will be discussed.

Endodontic lesions may result in significant bone destruction. Large lesions of endodontic origin usually respond positively to conventional endodontic treatment performed according to high technical standards, with bone regeneration. However, when healing does not occur as expected, a surgical approach must be taken into consideration. In this presentation, a new approach to the management of large endodontic lesions will be discussed, based on a careful use of the CBCT technology, new resorbable membranes, bone grafting materials, piezo-surgery and the so-called "bone window technique". The potential to regenerate the original structures, particularly in the presence of endo-perio lesions, will be highlighted.

In the presence of teeth with severe loss of crown structure and pulp degenerative changes, root canal treatment is to be regarded as just one part of an interdisciplinary treatment. A thorough clinical and radiographic examination should be performed, jointly with the prosthodontist/clinician who will take care of the restoration, and a precise treatment plan should be established before the treatment is initiated. Direct/indirect restoration; cusp coverage; type of build-up; post/no post, are relevant aspect to be meticulously planned and discussed with the patient. This presentation will address these aspects, as well as the most suitable procedures to achieve an ideal and stable adhesion, and an even distribution of occlusal stresses. Participants will be offered a range of solutions to handle different level of tooth structure loss, and execute restorations that prevent crown-apical leakage and mechanical failures.

Plenary discussion directed by Dr. Domenico Ricucci