SP-22 - Management of Complex Cases, a Daily Clinical Challenge

Many natural teeth with disease of the pulp and periradicular tissues are saved through endodontic treatment and/or nonsurgical retreatment.The complex anatomy of root canal system is the conditioning factor for the cleaning and shaping technique. In addition, the re-negotiation of the altered anatomy due to procedural errors remain a great challenge for our clinical practices. Topics will include retreatment, management of open apices, and perforations; and locating, shaping, cleaning and filling of difficult or missed canal anatomy, such as calcified, ledged, blocked and severely curved canals. Clinical and imaging evaluation are mandatory to carry out a correct diagnosis and establish a prognosis. CBCT images impact finally in the evaluation of the internal anatomy, number of canals, and the periradicular adjacent tissues. In addition, the application of technologies such as operative microscope, loupes, ultrasonic tips, new file alloys, and other approaches, will be discussed to describe predictable and safer protocols to manage complex clinical cases. The lecture will be supported by literature and own complex clinical cases to show and explain how to manage them.