Prof. Herbert Schilder left us and I was asked to give the sad announcement when I was a speaker at a congress in Switzerland. After a few days an editorial appeared in the Journal of Endodontics in memory of him, where among other things it was read that Schilder had taught all over the world and had never been to teach in a single continent: Antarctica!
And it is true. This little man, thin and skinny but with an exceptionally strong personality, has changed the way of practicing the Endodontic specialization all over the inhabited world. He was the first to introduce the term “predictability”, demonstrating that remote results are always predictable and repeatable, if we stick to the “discipline” he taught. And so thanks to him we learned to make correct diagnoses, correct root canal preparations and to perform the three-dimensional obturation of the root canal system with a technique that is still unsurpassed today. Of course, things have changed dramatically since I returned from my stay at Boston University over 40 years ago and started applying and passing on his teachings. Just think of apex locators, nickel titanium instruments, magnifying media, biocompatible materials to end up with digital radiography and Cone Beam Computed Tomography. The question that arises today could be: are his teachings of 40 years ago still valid in the light of everything we have and know today? Are the 5 mechanical principles of shaping still valid? What about the 5 biological goals of shaping? Is it still important to be able to block the lateral canals? Can we expect the healing of large cystic lesions after orthograde therapy alone? During the conference these and other topics will be examined and we will discuss together whether or not Prof. Schilder was a farsighted person, a pioneer, a character faithful to the characteristics that distinguish all those born in the sign of Virgo. And even Schilder was of the Virgin!

The necrotic tooth with “Open apex” is a condition which represents a treatment challenge in endodontics. It is a    clinical situation which may be the consequence of:  1) trauma which has caused the interruption of the development of the pulpal-dentinal complex in  immature teeth;  2) trauma which leaves the teeth in an immature stage, but is  discovered in the adult age; 3)  complex anatomies such as “dens in dente” 4) Resorptive defects that create irregularly opened apices.  Current treatment options and techniques include traditional apexification, MTA apexification, and the latest trends that are represented by the so-called regenerative/reparative procedures.

The different options will be discussed in the background of clinical experience and literature.

Learning Objectives

1. At conclusion participants should be able to consider “classic apexification” as a good and predictable treatment standard and the best up to date  protocols to use it
2. At conclusion participants should be able to recognize the use of “MTA/bioactive cements pre-formed apical barrier” as an alternative treatment  which is becoming more predictable after  15 years of  clinical experience, and  the best protocols on how to use it
3. At conclusion participants should be able to apply open apex treatment to resorbed teeth
4. At conclusion participants should be able mix the available techniques to apply them to unusual clinical situations
5. At conclusion participants should be able to consider the possibility to attempt “ regenerative procedures”  in  immature teeth

Lesions are the result of the evolution of an Apical Periodontitis and are due to a bacterial proliferation. But when a large periapical lesion is diagnosed on the X-ray, most of the time, the first idea is to ask how to remove it and then who will be able to do it surgically: the practitioner, the oral surgeon or possibly the endodontist.

In fact, faced with this situation, the first step is a precise diagnosis to determine the origin of the lesion and ensure that it is a lesion of endodontic origin, in order to avoid treating endodontically vital teeth or performing unnecessary surgery.

Different tests will be necessary (vitality tests, CBCT, and clinical examination) and the analysis of the results and their comparison with the patient’s perception will allow us to make this diagnosis and to determine our therapeutic choice between an endodontic or surgical treatment or both.

Throughout this presentation, our experiment, as a clinician, will allow the participants through many clinical cases, to learn to diagnose and treat large periapical lesions.

Composite materials are mixtures of organic resins and inorganic filler particles, interconnected by an interfacial bonding agent. Composite materials can also be defined as a combination of two or more chemically different materials with a clear boundary between the components, which is characterised by properties better than those of its individual components. The key component is a mixture of different monomers that convert to a cross-linked polymer matrix during the process of polymerisation. In addition to monomers, other components are necessary to attain the desired properties of the composite material, namely fillers, an interfacial bonding agent, and polymerisation initiators. All the components of composites have been changed, developed and improved to get the composites we have today. As composite materials have found applications in all branches of contemporary dental medicine, daily work in modern dental practice is unthinkable without this material group. Composite materials are used for many indications, ranging from reconstructions of carious defects, traumas, morphological and aesthetic abnormalities, discolourations in permanent and deciduous dentition, as cavity coatings, pit and fissure sealants, inlays, onlays, overlays, crowns, luting materials for indirect restorations and intracanal posts, for making core build-ups, splints, adhesive bonding of orthodontic braces, etc.

This is the reason why we have to have an optimal contemporary material to fulfill all the expectations of the dentist and the patient.

It would be ideal to have a material with good esthetic, physical, mechanical and biological properties with optimal handling properties and bioactive potential.