The aim of this presentation is to evaluate the options that the endodontic retreatment spectrum provides for retaining natural dentition. Modern clinical practice requires dentists to be familiar with new developments in materials, instruments, and procedures to assist their patients in electing the most beneficial long-term treatment option in terms of maintaining health and function. Endodontic Surgery has evolved tremendously in the last decade into a microsurgical procedure. Due to advancements in dental materials and surgical techniques, surgical micro-endodontics now offers more predictable outcomes. However, there are specific cases for which surgical endodontics is not a replacement for conventional retreatment. Successful treatment requires a thorough understanding of the causes of failure, the prognosis for each approach, and the technologies and materials that enable the best possible outcome. This presentation will review the relevant literature, evaluating the prognosis of microsurgical and conventional retreatment, which will inform the decision-making process.
At the conclusion, the participants should be able to:
- Understand the biological and technical reasons for failure of initial root canal therapy.
- Discuss the advantages and disadvantages of conventional and surgical retreatment.
- Identify the studies that help in evaluating the prognosis of the microsurgery and conventional retreatment

Use of Piezotome for endodontic microsurgery has become quite popular, especially creating a bone “window” or “lid” to gain better access to areas like mandibular molars with thick cortical bone. It can be technique sensitive to replace those windows securely, allowing for the bone to revascularize and maintain the osteotomy space. This lecture will discuss drawing the patient’s blood and centrifuging out platelet-rich fibrin plugs and membranes as well as crushing the bone “window” and mixing it with the serum created from forming the PRF membrane to make “sticky bone”, which is sandwiched in between the PRF plugs and covered by the PRF membrane.

With billions of dollars being spent by implant companies to market their products and promote high-priced cases, one would think that saving natural teeth was in the past. The opposite is true and the pendulum has been swinging towards preserving the natural dentition. This presentation will discuss the history of implants and how teeth were being randomly removed just because of potential failure in order to be replaced by implants. Then the reality of peri-implantitis occurred along with literature in periodontal journals supporting saving one's natural teeth, even if the endodontic treatment was not working. The evolution of endodontic microsurgery will be discussed, explaining all the modern techniques with literature proving over 90% success rate. Endodontic surgery is a viable alternative for preserving teeth

When treating deep carious lesions near the pulp, clinicians often face the challenge of deciding whether to preserve or remove pulp tissue. Traditionally, irreversible pulpitis has been managed with root canal treatment; however, recent evidence supports the potential of vital pulp therapy even in such cases.
This lecture presents clinical strategies for maintaining pulp vitality in teeth diagnosed with reversible or irreversible pulpitis. Based on histopathological and histobacteriological insights, a novel intraoperative approach is introduced, using magnified visual assessment to guide selective removal of infected tissue. The remaining healthy pulp is sealed with biocompatible, bioactive materials to support healing and long-term function.

Minimally invasive endodontics has become the trending topic in root canal treatment. It encompasses clinical procedures that focus on removing less tooth structure during endodontic cavity preparation and root canal instrumentation/obturation while minimizing tooth structural alterations to facilitate post-treatment periapical healing and retention of the treated tooth.  This lecture explores the latest evidence behind minimally invasive techniques—both conventional and emerging non-surgical approaches—to answer the central question: Are we truly maximizing success with minimally invasive endodontics?

Learn to:

• differentiate among the various terminologies used to define minimally invasive techniques in endodontics, from access to obturation
• evaluate the advantages and limitations of these techniques based on current scientific evidence
• identify future trends that promote the long-term retention of teeth in function

The latter part of the presentation will focus on treatment planning and case selection for Intentional Replantation, explaining the techniques in detail and showing several clinical cases with follow-ups.

There are several difficult situations that require precise surgical intervention to solve. This lecture will focus on the most current techniques and use of instruments like the piezotome to successfully treat endodontic failures that may have otherwise led to extraction. The use of a piezotome to create a "bone window" to allow for easier and more precise access to difficult to reach areas while still maintaining the patient's bone as well as new circular piezo tips that allow for even more bone preservation and conservative root end treatment will be shown with several clinical cases. Other trouble shooting techniques will be discussed such as access to palatal roots with the piezotome and protection of the mental nerve.

The primary objective of root canal treatment is the removal of vital, necrotic, or infected pulp tissue from the root canal system, thereby promoting periapical healing. Equally important is the prevention of bacterial recolonization within the treated canal, achieved through a hermetic root canal filling and a well-sealed coronal restoration. This presentation explores the biological mechanisms underlying the restoration of a healthy periodontal ligament and the regeneration of periapical bone, detailing the expected morphological outcomes following successful endodontic therapy. Conversely, it examines the biological and non-biological factors that may hinder adequate healing of the periradicular tissues, with particular focus on the morphology, location, and clinical significance of residual infection.