Previous Meetings of The Langham Endodontic Study Group
Dr Richard Kahan and Dr Dermot Canavan
Friday 13th January 2012
Morning Session: Dr Richard Kahan, BDS MSc (Lond) LDS RCS (Eng)
CBCT in Specialist Endodontic Practice - 4 years and still in love!
Subjects covered included
- The justification for use of CBCT in clinical endodontic practice
- The physics of cone beam computerised tomography
- How to read an endodontic CBCT scan
- Artifacts and limitations
- Radiation and CBCT scans
- The practicalities of owning a CBCT scanner
Mini CV
- 1984 - Qualified from the Royal London Hospital.
- 1993 - gained a Masters Degree in Endodontics with Distinction at the Eastman Dental Institute.
- 1999 - Specialist Endodontic Private Practice, Harley Street.
- 1999 - 2008 - Clinical part-time lecturer in Endodontology, Eastman Dental Institute
- 2008 - 2011 - Senior Clinical part-time Lecturer in Endodontology, Eastman Dental Institute
- 2003 - 2010 - Director of Endodontic Courses at Eastman CPD. Founded the Eastman Certificate in Endodontics. UCL University course accreditation - 2005 Lectured internationally, written research papers and academic referee for a number of dental journals
- 2005 Created EndoBiz - Endodontic Clinical software. Currently internet version 3.3
Afternoon Session: Dr Dermot Canavan, B.Dent.Sc., MGDS, MS (UCLA)
New Perspectives on the diagnosis of Persistent Orofacial Pain
The accurate diagnosis of persistent Orofacial Pain conditions remains a clinical challenge for general dentists and dental specialists. Advances in radiological techniques have enhanced our ability to detect tissue injury and infection. In addition, an improved understanding of acute and chronic pain mechanisms allows us to interpret the patient's history and clinical presentation in a more meaningful and accurate way.
Aims and Objectives
This presentation reviewed the diagnostic process for persistent orofacial pain in terms of maximising information gathered from the pain history, clinical examination and imaging studies. Recent advances in our understanding of orofacial pain mechanisms were discussed in relation to the diagnostic process. A series of clinical cases were presented to illustrate important diagnostic considerations.
Brief CV
Dr Dermot Canavan graduated in 1980 from Trinity College Dublin. He completed his residency training in Orofacial pain management at the University of California in Los Angeles 1984. Since that time he has maintained a private practice in Dublin and lectures in orofacial pain management at Dublin Dental School and Hospital. He also has a private clinic in London on a part time basis. Dr Canavan is a former president of the Irish Pain Society and is currently deputy editor of the Journal of the Irish Dental Association. He has contributed to several textbooks with chapters on oral and facial pain and he has lectured internationally to a variety of dental and medical organisations on the management of facial pain.
Prof Thomas von Arx
Saturday 10th September 2011
Vice Chairman and Associate Professor Department of Oral Surgery and Stomatology School of Dental Medicine University of Bern.
Subjects covered included
- a.. Oral Worlds
- b.. Anatomy for Endodontists
- c.. Apical Surgery
- d.. Patient Evaluation
- e.. Evaluation of Failures
- f.. Incision and Flap Design
- g.. Root End Management
- h.. Outcome Predictors
- i.. Regenerative Evaluations
Prof Geoffrey Heithersay
14 May 2011
Clinical Professor Geoffrey S Heithersay AO. DDS(Adel), DDSc(Adel), FDSRCSEd, FRACDS.
Geoffrey Heithersay is a half time Clinical Professor in the School of Dentistry of The University of Adelaide, having joined the Faculty in 1962 following 4 years postgraduate study in the UK and Sweden.
He began teaching endodontics that year as a part time member of the Faculty of Dentistry, a role he has continued to the present contributing to both the three year graduate programme as well as an undergraduate course in dental traumatology.
Primarily a clinician he practised as a specialist endodontist until 2002.
Awards include an Officer of the Order of Australia for endodontic education and the Louis Grossman award of the American Association of Endodontists for research. In 2009 he received three awards for excellence in teaching; the Faculty of Health Sciences Executive Dean's award, The Stephen Cole the Elder award and The University of Adelaide's Vice Chancellor's award.
Subjects Covered
Biological and pathological challenges encountered in a long and continuing endodontic journey.
Where it all began - Sweden 1960-61
- Early use of calcium hydroxide in endodontic therapy
- Attempts to create a biologically deposited apical seal by partial pulpectomy (subtotal pulp amputation)- Hilding Nyborg, Nygaard Ostby
- The basis of endodontic microbiology - Ake Moller, Where it has continued - Adelaide. 1962 - present.
Topics presented:
- Tooth resorption - diagnosis and management - with particular emphasis on invasive cervical resorption.
- Splinting of traumatised teeth
- Healing patterns following root fractures
- Bleaching of root filled and heavily calcified teeth
- Some challenging periradicular pathoses
- Herpes Zoster and endodontic implications
- Dentinal dysplasia types 1 and 2- endodontic implications.
- Longevity of endodontically treated teeth- the implant debate.
Dr Paula Ng and Prof Kishor Gulabivala
29 January 2011
Dr Frances Andreasen and Dr Asgeir Sigurdsson
11 September 2010
Prof Ken Hargreaves
8th May 2010
An Update on Pain Control and Regenerative Endodontics
Dr Anders Molander
16th January 2010
Summary of Anders Molander
Dr Molander began his presentation by reminding us of the swedish tradition of microbiological sampling. He mentioned that, although as students, Swedish dentists were trained in microbiological sampling techniques, it was rarely carried out once they qualified!
Success rates for retreatments were looked at, the microbiological flora of the root canal in failed cases, showed a high increase in enterococci and in particular, Enterococcus faecalis. We were reminded that calcium hydroxide was not effective as an inter-appointment dressing against E.faecalis and Candida albucans.
Retreatment protocols should be modified to suit the type of retreatment to be performed. Iodine potassium iodide was recommended as irrigant in cases were E.faecalis was suspected.
Dr Molander then looked at the Scandinavian expirience of teaching postgraduate dentists nickle titanium rotary techniques. Uptake was good amongst practitioners if practical and theory were both taught. Also general practioner "ambassadors" could increase the uptake of new techniques.
No studies show a clear increased success rate of single visit treatments over multiple visits. There were many advantages in performing treatment in a single visit but it was felt that time available was the most critical factor.
Emergency endodontic treatment was the final subject covered. It was shown that a simple pulpotomy can relieve pain in 75% of cases by the evening after their appointment, 90% of patients being pain free one day after.
Dr Kevin Lewis / Prof Tara Renton
21st November 2009
Dr Kevin Lewis - Dento-Legal issues in Endodontics
The UK has one of the highest levels of dental litigation in the world. (Double that of the USA). Newly qualified dentists (within the first ten years of qualifying) carrying out endodontic procedures, were the group most likely to be sued.
There followed a review of the law of Tort and of negligence. Dr Lewis explored the role of the endodontic specialist and his duty of care to the patient. He reminded us that specialists are still dentists and therefore have an obligation to fully examine their patients to assess their general oral health. Consent was covered in detail.
The need for a comprehensive risk/benefit assessment was stressed and the importance of putting this before the patient in a clear and unambiguous way. Dr Lewis said that many legal cases arose because of poor communication between the dentist and the patient in obtaining consent to treatment. The need for accurate, honest record keeping was stressed.
Tara Renton - Iatrogenic neuropathy of the Trigeminal Nerve
Professor Renton felt that many chronic pain states were neuropathic in origin and illustrated the debilitating effects of neuropathic pain on patients. Regarding lingual nerve injury following wisdom tooth extraction, Professor Renton mentioned that approximately 80% of lingual parasthesias cases, can resolve without intervention, over the passage of time. With Inferior Alveolar Nerve injuries, intervention often has to be made and there is only a short period of time before permanent nerve damage occurs.
Local anaesthetics can also cause nerve damage. High concentration local anaesthetics such as Articaine(4%) should be handled with care when giving a direct Inferior Alveolar Nerve blocks. Professor Renton said that Articaine can be used as a buccal and lingual infiltration injection, for the extraction of mandibular molars, without the need for a direct IDB injection. Repeated IDB injections might also lead to nerve damage due to direct trauma of the nerve.
With regard to endodontic treatment, direct trauma to the IAN by instruments or obturation material and/or chemical injuries can occur. Rapid treatment is essential to avoid permanent damage to the IAN. Chemical injuries to the IAN are usually impossible to resolve.
Dr David Spratt/ Professor Paul Dummer
16th May 2009
David gave us an excellent, illuminating and to coin his phrase 'cool' update on modern microbiological sampling and culture techniques. He certainly took us at our word when we asked for an esoteric presentation.
The afternoon format was a change from the normal didactic style with a group discussion on the subject of endodontic microbiology hosted by Paul Drummer.
It was interesting to learn the group's views on some controversial subjects. It is a format that hopefully can be repeated in the future.
Jeff Okesen
24th January 2009
Professor Okeson addressed the society with a comprehensive and thought-provoking presentation on the causes and treatment of oro-facial pain.
It was a circumspect view that will make us all think differently, particularly about non-odontogenic pains.
His delivery skills were excellent and the content was a well researched summary of current neuroscience theory and treatment practice.
Eric Whaites
20 September 2008
Eric addressed the group on the subject of "Justification, Optimisation and Limitation" in dental radiography.
The presentation comprised partially of the mandatory IR(ME)R CPD course but also included an update in radiological techniques and diagnosis. As always, Eric gave a lively, thought-provoking and entertaining talk.
Dr.Domenico Ricucci
10 May 2008
Dr Ricucci addressed the society with a tour de force of biological responses to endodontic procedures: his skill and experience in histology was manifest.
The audience had a circumspect presentation on diagnostic aspects in the literature backed up with some first-class slides.
Prof. Paul Abbott
12 Jan 2008
Professor Paul Abbott gave an eloquent presentation on current controversies in endodontics including aspects of nomenclature, diagnosis and biological approaches to treatment.
His methodical, restorative-based approach provoked great discussion. We were priveleged to have an academic with such a broad research base present to the group.
Dr.Shimon Friedman
Shimon gave us an excellent presentation which centered mainly on one of his favourite subjects: outcome.
The talk was challenging and very erudite. He gave us all food for thought and I am sure we will all look at these papers differently in the future. He also talked in depth about treatment planning and decision making.
All in all, a very well presented and informative day.
Elio Berutti, Professor of Endodontics School of Dentistry
The speaker of the Langham endodontic study group in May 2007 was Professor Elio Berutti from Turin University, Italy.
The audience enjoyed a full day of excellent presentation about dealing with endodontic problems. Professor Berutti demonstrated some novel approaches to treatment of difficult endo/restorative cases.
Throughout the meeting, there was a lively and dynamic pace to the discussion (both in English and Italian)
Dr Ian Needleman & Prof Richard Palmer
In a departure from normal practice, there were two home grown speakers at the meeting. In the morning Dr Ian Needleman gave an excellent and insightful résumé of current periodontology. He discussed the literature as it related to the currently held concept of periodontal disease progression, the success of non-surgical and surgical treatment and the outcome of treatment and survival of the treated dentition compared with the survival of single tooth implants. Encouragingly, the outcome appears to be very similar!
In the afternoon, Professor Richard Palmer kept the audience on its toes with an equally excellent discussion on treatment planning and case selection for implant placement or alternative restorative solutions. With his great knowledge and experience of the theory and practice of implant placement and restoration, he discussed in detail both the obvious advantages and the several and various complications and potential failures that have become apparent over the past few years.
Both these first class presentations easily achieved their objectives of bringing the endodontic audience right up to date with two of our main complementary disciplines..
Professor Syngcuk Kim
Professor Kim addressed the group with a fascinating programme; this consisted of the practical and academic aspects of apical surgery, outcome in relation to apical surgery and implants, and finally some detail on what is taught on the postgraduate course in Pennsylvania. Professor Kim is without doubt, one of the world's leading clinicians in the field of endodontic surgery; it was very illuminating to see video footage of him at work. The group also picked up tips on the way to improve their practice of this area of dentistry. Professor Kim's literature review of the comparative success rates of endodontic treatment versus dental implantology appeared to confirm what most endodontist have believed for some time; that well-executed endodontic treatment is normally more predictable than exodontia and prosthetic replacement with titanium.
Dr David Figdor
In May 2006, we were honoured to have David Figdor travel from Melbourne, Australia, specifically to address The Study Group. Despite being in a different time zone, he gave what will probably be remembered as one of the best talks, both in presentation and content, that The Study Group has heard. David gave us an in depth review of the literature relating to endodontic microflora. This was made fascinating, not only because of his great depth of personal experience, both in sampling and culturing, but also because of the personal anecdotes relating to some of the great names in endodontic microbiology. David introduced some video footage of interviews with Goran Sundqvist (with whom he had worked during his PhD), and talked in-depth about other eminent microbiologists such as Ramachandran Nair and Lars Bystrom. The day was rounded-off by a series of video interviews with past and present postgraduate students at the university of Melboune.
John Whitworth
In Jan 2006, John Whitworth spoke to us about 'A view from a provincial teaching hospital'. During a highly entertaining and well presented day, he covered subjects related to his many different interests. These included running an endodontic department, the role of postgraduate and undergraduate educators, their interrelationships and the difficulties encountered in these roles. It was interesting to hear about the work involved in refereeing and maintaining the high standards of a journal such as the International Endodontic Journal. John also covered aspects of current research including, pulp capping and instrument design, and the importance of an eclectic education so that the outcome of this research can be fully implemented.
Dr Martin Trope
In Sep 2005 Martin Trope entertained, stimulated and stirred
much debate within the audience when presenting his own views
on the available endodontic literature. His views were presented
in a relaxed yet informative manner that challenged the audience
to question and confront his views. The day was very well received
and was one of the more lively meetings in the society had witnessed.
Professor Pierre Machtou
In May 2005 Pierre Machtou delighted a large audience of members
and guests with a superb presentation on controversies in endodontics,
nickel titanium instrumentation and retreatment techniques.
The presentation was concise and stimulating and had an excellent
audiovisual content that fueled discussion and interaction with
the audience. The only disappointing part of the day was when
the presentation had to end.
Dr David Brown
In Jan 2005 David Brown gave an excellent presentation, giving his personal opinion on a variety of clinical problems and the evidence that backs up the way that we approach these problems. The topics included success and failure in endodontics, the challenge of where to prepare root canals to, and finally the the emergence of implant therapy in the market place. The presentations were though provoking and created much debate and discussion.
Dr Markus Haapasalo
In Sep 2004 Dr Haapasalo presented a day that was very well recieved and included the topics of Dental Resoption, Disinfection of Root Canal Systems and a superb demonstration on how to produce superb digital presentations that are pleasing to the eye and help to deliver teaching material in a balanced fashion.
Dr Alan H. Gluskin
In May 2004, Dr Alan Gluskin , Professor and Chairperson, Department of Endodontics, University of the Pacific School of Dentistry in San Francisco was the guest speaker in a day titled "Endodontic Mishaps and Clinical Calamities" The day was one of the best received presentations since the Langham group was set up, as judged by the enthusiastic comments by all the audience. Alan delivered a captivating and varied day discussing hybridisation of NiTi systems, ultrasonic burns, the sequelae of overfill into neurovascular bundles, structural rehabilitation of weakened root systems and demonstrated some truly wonderful teaching aids for 3D anatomy and virtual dento-alveolar surgery.
Professor Paul Lambrechts
In Jan 2004, Professor Paul Lambrechts presented a well received programme on the subjects of micro-computer tomography, complexity of external root resorption and the cracked tooth syndrome and its implications. The programme was delivered in a light hearted but interesting manner and contained superb graphical illustrations that created many taking points during the day.
Dr Dag Orstavik
In Sep 2003, Dr Dag Orstavik presented his thoughts on the infected root canal system including the importance of endodontic diagnosis, rationale and efficacy of instrumentation and irrigation. He also discussed the current scientific knowledge relating to medicaments and how this might influence clinical practice. His presentation provoked lively debate and was extremely well recieved.
Professor Paul Wesselink
In May 2003, Paul Wesselink presented a programme on the biological and clinical implications of technical innovations. The talk was stimulating, often controversial but provoked much debate and interaction with the audience during the day.
Kishor Gulabivala
In Jan 2003, Kishor Gulabivala presented a programme centred around the nature of evidence for endodontics and concepts for practice that was extremely well received, and which gave an insight into his own concepts and the ways he felt endodontics should progress in its treatment methods.
Professor Jens Andreason
In Sep 2002, Professor Jens Andreason gave an enthusiastic and comprehensive presentation on the implications of current research on the management of trauma and its sequelae. He explained his most recent findings on the role of calcium hydroxide and brought the audience up to date on the latest research he is undertaking and the implications it may have on the treatment of traumatised teeth.
Arnaldo Castellucci
In May 2002, Arnaldo Castellucci presented a vast array of his clinical work on non-surgical retreatment from his many years in endodontic practice. He demonstrated how his techniques have changed as instrumentation techniques have improved. He gave an excellent video presentation showing some of his clinical techniques in practice.
Paul Dummer
In Jan 2001, Paul Dummer treated the Langham to an excellent presentation on Quality and Standards in Endodontics followed by some stunning 3D Microtomography graphics. He also discussed the role of NiTi in canal preparation and gave an interesting insite into his role with the International Endodontic Journal.
Claes Reit
In Sep 2001, Claes Reit gave an interesting perspective on retreatment and decision making in a relaxed and informative style.
Ramachandran Nair
In Mar 2001, Dr Nair presented his views on current theories in the development of periradicular pathology.
Mike Seare
In Feb 2001, Mike Seare gave a superb presentation on the use of digital imaging in endodontics.
Alan Holland
In Feb 2001, Alan Holland gave a thought provoking presentation on alternative approaches in endodontic treatments.
Nigel Foot
In Feb 2001, Nigel Foot gave a well constructed update on anaesthetic techniques.
Alan Gluskin
In Feb 2001, Alan Gluskin gave an interesting update on post and core systems from work recently done in the USA.
Bill Saunders
In Jan 2001, Bill Saunders gave an interesting presentation about his research and thoughts on endodontics in his own inimitable style to an appreciative audience.
Peter Velvart
In Sep 2000, the group were treated to an excellent presentation by Peter Velvart.
Dermot Canavan
In Jun 2000, Dermot Canavan gave a excellent presentation on his approach to pain diagnosis and management that was well received.
Tom Pitt Ford
In Jan 2000, Tom Pitt Ford gave an overview of his research and personal perspective on pulpal and periapical disease.
Ken Hargreaves
In Aug 1999, Ken Hargreaves gave a wonderful presentation covering the mechanisms of pain and pain management.
Kishor Gulabivala
In Jun 1999, Kishor Gulabivala give a superb presentation on new clinical and biological insights in endodontics.
James Guttman
In Mar 1999, James Guttman addressed the group on the subject of hard tissue healing.
Betrand Khayat
In Jan 1999, Betrand Khayat gave an action packed day on perio-endo lesions, Balanced Force and the operating microscope.
Jack Harrison
In Sep 1998, Jack Harrison gave a thought provoking presentation on surgical wound healing and modern concepts in surgical endodontics.
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