Modern endodontics taught and practiced by Penn Endo
Prof. Dr. Syngcuk Kim
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Penn Endo is a nickname of a group who graduated, educated and trained at University of Pennsylvania Dental School, Department of Endodontics. The Group was formed since 1992 when the Modern Endodontic defined as Endodontics (Endo) practiced with Microscope and perform Microsurgery was introduced to Endo field. Penn Endo consists of elite practitioners and leaders in the field over 22 different countries including Germany.
Basic purpose of Modern Endo is Saving Teeth on one’s mouth!!
To accomplish this objective Penn Endo is approaching it with Microscopic way.
Root Canal Therapy (RCT) was popularized in Germany some 100 years ago. My teachers in USA were trained in Dresden, Germany around 1930. In 1992 we introduced the use of microscope in Postgraduate training at Penn Endo. Advantages of the using microscope are obvious; See Better Do Better!!. Finding canals are fundamental first step in RCT. With the use of Microscope 4 canal molar is a routine procedure after using microscope!! Prior to the microscope 3 canal molar was routine and norm. Canals were there but we could not find them all. Microscope has made dentists to do better and more accurate job and elevated success rate over 90%. Instruments which cleaned the canal have also gone thru many stages of changes. Now 3D filing system such as XP shaper and XP finisher showed the years. But our multi-year investigation clearly supports Bioceramic sealer as the one and ONLY sealer should be used as it has all the required elements to be an ideal sealer; bactericidal, hermatic seal by expansion at setting, flow and radiopaque. Thus we called current advanced RCT treatment “Sealer Based Endo!!”
Endodontic microsurgery is fundamentally different from the old apical surgery in terms of instruments, materials, biological principles and, most importantly, the success rate. In this presentation I will illustrate 8 basic steps in microsurgery, so that the participants will have a clear understanding of the surgical procedures. These 8 steps are: esthetic flap management, effective hemostasis, a small osteotomy, skillful management of the mental nerve and the sinus, identification of complex root canal anatomy visible on the resected root surface, precise root-end preparation with ultrasonic tips and root-end filling with Bioceramic putty and flap closure with microsutures.
Modern endodontic practice must provide both nonsurgical and surgical treatment options. It has been our observation that there are too many nonsurgical retreatments of cases that should have been treated micro-surgically more endodontists will consider this option when faced with retreatment. The followings are indications for microsurgery on tooth which has no mobility and perio pockets.
- Good endodontic but failed
- Broken files or/and perforation
- Apical transportation cases
- Failed endo with thick large post
- Pocket leading the apex but good endo.
- Calcified canals
Clinical Dilemma: Saving Teeth or Extract and Implant
Modern clinical practice requires dentists to be familiar with new development in materials, instruments and procedures to guide their patients to the right path to enjoy esthetics and function of dentition through their lives. Two fundamental clinical dilemma facing dentists today is “save the teeth thru endodontics or extract them and replace with implants”. Correct answer is not easy. All depends on which angle you are looking at, from implant or endodontics. Regardless, there has to be a common agreement between dentists what is right thing to do. In this context many dentists are not aware of tremendous advancement in Endodontics but well informed on Implants advancements in the past decades. A false impression that Implants would solve all dental problems is prevalent in public due to social media!! In this lecture I will present what to save with advanced endodontic techniques what to extract and replace with implants. It is utmost important for dentists to be educated the pros- and cons- of the both fields and such that they can guide their patients to the right path. This is ultimate responsibility of being a dentist.