Saturday 13th January 2024

Venue: The View at The Royal College of Surgeons of England

About The Event

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Time & Location

13th  January 2024, 09:30 am (Registration from 09.00 am)

Venue: The View at the Royal College of Surgeons of England,  38-43 Lincoln's Inn Fields, London, WC2A 3PE

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Speaker Profile

Paul Lambrechts Prof. Dr. Dent., PhD

Professor Emeritus, Department of Oral Health Research, K.U.Leuven

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Paul Lambrechts Prof. Dr. Dent. is born in 1955. He followed Latin-Greek studies at the ‘St. Jan Bergmanscollege’ of Diest, Belgium. He graduated as a dentist (DDS) in 1978 at the Catholic University of Leuven (K.U.Leuven), Belgium and obtained his PhD at the same university in 1983 based on a thesis investigating dental composites: "Basic properties of dental composites and their impact on clinical performance". Today, he is Professor Emeritus at the Department of Oral Health Research (K.U.Leuven) and is still involved in the teaching for postgraduate students in endodontology. He was Program Director of the dental Bachelor/Master and Master-after-Master programs at K.U.Leuven for 27 years. He teached cariology, oral aspects of nutrition and endodontics. His research focussed on endodontics. More specifically on the development of a concept of minimal-invasive endodontics, using 3D X-ray Micro-CT scanning, Cone beam CT and Environmental SEM, towards new root-canal preparation and filling techniques. The pathology of external cervical resorption is one of his favourite study topics. A randomized clinical trial on pulp revascularisation is ongoing. In addition, specific interest goes also to laboratory and clinical research on dental composites, actually focussing on 3D-laser-profiling of clinical wear phenomena and biotribocorrosion. Together with Prof. B. Van Meerbeek, he became in 2003 co-holder of the Toshio Nakao Chair for Adhesive Dentistry. He is (co-)promoter of several doctoral dissertations, and (co-) author of numerous publications (346) together with the Leuven BIOMAT Research Cluster (Hirsch-index of 75). He gives scientific and post-academic courses all over the world.

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Learning Content

Adventure to discover the anatomic, radiologic and histological complexity of external cervical resorption / External cervical root resorption. Treatment and outcome.

External cervical resorption (ECR) is an extremely complex periodontal and endodontic pathology. Diagnosis and differential diagnosis with internal resorption or root caries is confusing and the periapical radiographs have several detection limitations. Since the introduction of high-resolution Cone Beam CT (CBCT) the prevalence seems to increase but this is due to improved detection power. Also, the etiological multifactorial triggers are becoming more evident. Most common causes are non-vital walking bleach technique, collateral damage induced by orthodontic treatment, cementum damage induced by extraction of neighbouring teeth, cementum abfraction caused by parafunction like bruxing or nail biting, cementum lesions related to eruption collision, chronic irritation caused by cracks or invagination grooves, periodontal pathology and surgery, trauma and even viral infections. Hypoxia in the ligament is a crucial factor.

ECR-affected teeth often keep their vitality for a long time even in the advanced stages of the Heithersay classification. The morphological changes during ECR are numerous at the cementum/enamel/dentin/pulp/bone boundaries and the radiographic visualisation is complex. The Heithersay classification needs further improvement in graphical detail because resorption and granulation tissue invasion are only parts of the story. Substitution by osteodentin and reparative processes are as important as well. Also, the portal(s) of entry and portal(s) of exit for ECR need to be specified.

Treatment options are variable depending on the resorption stage and the understanding of the pathology by the practitioner and his ability to approach the lesion in a minimal invasive microscopic way. The pathology outcome and the treatment success are related to the ability to circumscribe the lesion and seal the defect. The aim of treatment is to retain affected teeth in a healthy and functional state. The objectives of treatment are elimination of the resorptive tissue, sealing of the resultant defect and portal(s) of entry and prevention of recurrence. Options include: 1) External repair of the resorptive defect ± endodontic treatment; 2) Internal repair and root canal treatment; 3) Intentional replantation; 4) Periodic review; 5) Extraction.

Further research is required to assess the impact of the size and stage of the lesion (resorptive versus reparative), and the management options on the outcome of treatment, as well as prognostic factors which may impact on the survival rate of affected teeth. External Cervical Resorption lesions that are accessible and therefore amenable to conservative treatment have a good prognosis. However, patients should be advised of the limited evidence on treatment outcomes.

 

Iatrogenic damage to the endodontium.

Sometimes the biggest threat to the endodontium comes from the practitioner. Several dental treatment procedures can lead to iatrogenic trauma of the endodontium. All disciplines can be guilty. Poor diagnosis and a lack of respect for biological vital structures are often at the basis of endodontium damage.

Restorative interventions can challenge the endodontium by weakening the tooth structure. Cracks can be induced by invasive restorative or endodontic treatment. Uncontrolled caries excavation may lead to pulp irritation and necrosis.

Endodontic mishaps can occur, such as: instrument fracture, instrument inhalation or ingestion, plastination of the apical vascular structure with sealer, coronal or root perforation during access preparation, zipping, ledges, straightening, penetration of irrigants or sealer in the canalis mandibularis with vascular or nerve damage. NaOCl accident can happen with eye irritation, sinus mucosa reaction, emphysema of the soft tissue. Dental tissues can suffer from temperature impacts induced by thermoplastic obturation techniques, ultrasonics, sensitivity testing.

Sinus pathology can be induced by implants, orthognathic screws, extrusion of irrigants and overextension of root canal filling materials inside the sinus,

Orthodontics can induce vascular strangling and ischaemic necrosis, apical root resorption, cementum resorption and external cervical resorption.

Orthognathic surgery can cause vascular damage or root damage due to incorrect placement of orthognathic screws.

Incorrect implant placement can inflict apical damage or root damage of the neighbouring tooth.

A more biologic awareness by the dentist can prevent most of the endodontium threats.

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Aims and Objectives

The aims and learning points of these lectures are:

• To unravel the morphological alterations and to increase the understanding of the intriguing biological processes that lead to hard tissue resorption, granulation tissue invasion and formation of osteodentin substitute material.

• The participant will be guided to use the diagnostic power of CBCT to link image acquisition to the morphological and histological changes, so that the outcome of the minimal invasive treatment will be significantly enhanced by better CBCT diagnosis.

• The participant will end up with an increased understanding when to treat and how to treat. He will understand the impact of a controlled watchful waiting approach or therapeutic approach.

• The participant will obtain confidence in the decision making how to determine treatment strategies

• To increase the biologic awareness of the dentist to prevent most of the threats to the endodontium.

• Through a clinical scala of iatrogenic mishaps the whole spectrum of potential trauma to the endodontium is given. A mixture of confronting cases should hold a mirror towards the profession without accusing the dental practitioner.

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Outline of the day