Make a date in your diary for the upcoming BES Regional Meeting. We are hosting a great mix of keynote speakers, table clinics, conference dinner, trade exhibition and endless opportunities for networking. We will be at the beautiful Principal Hotel in Manchester - we hope to see you there. Registration Registration will take place on Friday 22nd November between 09.00 and 10.00 hrs in the Whitworth Suite. Table clinics There will be four Table Clinics but there is no need to pre-book a place as delegates will have the opportunity to attend each one throughout the morning. Conference dinner This will be held on Friday 22nd November in the Ballroom at the hotel. There will be a Drinks Reception from 19.30 pm and the dinner will commence at 20.00 pm. After dinner entertainment will include
British Endodontic Society
Speaker: Prof Paul Lambrechts
Title: ‘Innovative approach to unravel external cervical resorption’.
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.
ECR-teeth often keep their vitality for a long time even in the progressed stages of the Heithersay classification. 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 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 is only one part 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.
Aim. (The one over-riding purpose of the lecture).
The aim of the ECR lecture is 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 diagnostic power of CBCT is used to link the image acquisition to the morphological and histological changes and to prepare the practitioner to a controlled watchful waiting approach or therapeutic approach.
Objective. (The objective should describe how the aim is achieved).
There are several research tools that help to unravel the ECR pathology and to bring their information together in a 3D understanding of the ECR dynamics.
The synergistic use of clinical surgical microscopy, digital radiography, Cone Beam CT, Micro-CT, Nano-CT, scanning electron microscopy, hard tissue & soft tissue histology and immunohistochemistry helps to visualize the numerous morphological and histological changes in ECR lesions.
The resorption of cementum, enamel and dentin occurs in a dynamic way. Bacterial penetration in dentin tubules and tooth tissue interfaces is becoming evident and can be considered as a maintaining factor in ECR.
The pericanalar root resorption resistant sheet (PRRS), visible as a radiopaque line on digital radiography, is not only composed of a predentin layer, but is thicker than estimated. It includes primary dentin, reactionary dentin and reparative osteodentin.
The formation of intracanalar and intrapulpal reaction calcifications indicate a chronic pulp irritation and is co-responsible for the radiographic cloudy appearance.
The formation of vascularised osteodentin as a substitute for the resorbed enamel, cementum, dentin and PRRS tissue is extremely complex and only histology linked to Nano-CT clarifies the real nature of the dynamic ECR process.
Also the bone turnover of the osteodentin can be proven and is a regular process occurring in hard tissue biology.
Key learning points
• Cone beam CT is essential in the diagnosis of ECR
• Histological and histochemical imaging of the granulation tissue highlights the resorption process.
• SEM-analysis provides a better insight in activity of clastic cells and osteodentin formation.
• The root canal is surrounded by a pericanalar resorption resistant sheet (PRRS).
• Osseoid tissue formation and osseodentin apposition in a coral like manner makes the pathology even more complex.
• The outcome of the minimal invasive treatment is significantly enhanced by better diagnosis.
• Increase understanding when to treat and how to treat.
• Obtaining confidence in the decision making how to determine treatment strategies for ECR.
Prof. Paul Lambrechts is extremely focussed on minimal invasive restorative dentistry using advanced diagnosis and treatment protocols. He’s a strong protagonist of microscopic dentistry during all restorative procedures, endodontics and even animal dentistry. Micro, bio and techno in resto and endo are his idealistic goals in clinical dentistry, research and teaching.
PAUL LAMBRECHTS, Prof. Dr. Dent. is born in 1955. He followed Latin-Greek studies at the ‘St. Jan Bergmanscollege’ of Diest. 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 Full Professor and Chair of the Department of Conservative Dentistry (K.U.Leuven), and also serves the dental school as Program Director of the dental Bachelor/Master and Master-after-Master programs at K.U.Leuven. He teaches cariology, oral aspects of nutrition and endodontics. During two tenth of his week time, he teaches pre-clinical and clinical conservative dentistry; 4/10 is spent to own clinical activity in the University Hospital, primarily in microscopic endodontics, but also in aesthetic restorative dentistry; for the remaining 4/10, he conducts research in endodontics, more specifically focussing on the development of a concept of minimal-invasive endodontic research, using 3D X-ray Micro-CT scanning, Cone beam CT and Environmental SEM, towards new root-canal preparation and filling techniques. The photodynamic laser-activated disinfection (PAD) techniques are one of the new research challenges of his group, while 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 (225) together with the Leuven BIOMAT Research Cluster. He gives scientific and post-academic courses all over the world.