Predictable and minimally invasive removal of separated instruments

Yoshitsugu Terauchi, DDS, PhD<Education and Work experience>
DDS from Nihon University School of Dentistry
PhD from Tokyo Medical & Dental University
private practice limited to endodontics in Tokyo from 1998
<Current Positions>adjunct professor at Department of Endodontics Faculty of Dentistry
Bahcesehir University Istanbul
adjunct clinical assistant professor of Endodontics at Boston University
Henry M. Goldman School of Dental Medicine
part-time lecturer at Tokyo Medical & Dental University<Memberships>
American Association of Endodontists
The European Society of Endodontology
Japan Endodontic AssociationJapan Association of Microscopic DentistryAbstract:
Retrieval of separated instruments from the root canal system can be challenging and often
frustrating. When a NiTi instrument fractures, it usually occurs at the apical one-third of the root
canal, or beyond a curve in the canal. Consequently, the separated instrument often prevents theclinician from successfully preparing the entire root canal system, thereby resulting incompromising the treatment outcome. Although the reported success rate of instrument retrieval
using ultrasonics is high, the nonstandardized protocol is still unpredictable in terms of removaltime. Additionally, a major disadvantage of the traditional mechanical methods for instrument
retrieval is the excessive removal of sound dentin during retrieval attempts, which may lead toiatrogenic accidents such as perforation and/or ledge formation. A recent study has shown thatinstrument retrieval is highly predictable if the standardized protocol is followed. In thispresentation, the treatment planning based on CBCT imaging and the predictable and minimallyinvasive instrument retrieval protocol will be demonstrated and discussed.
At the conclusion, participants should be able to:
1. Describe the accurate diagnosis and treatment plan for safe instrument retrieval.
2. Make a predictable and minimally invasive preparation for instrument retrieval.
3. Recognize the most predictable and minimally invasive removal procedures of separatedinstruments.

Tunneled coronally advanced flap for root coverage and interdental tissue reconstruction
Dr. Po-Jan Kuo, DDS, MS, PhD＜Education & work experience＞
2020 Diplomate-The Taiwan Academy of Aesthetic Dentistry (TAAD)2018 Degree- Doctor of Philosophy in Medical Sciences
Graduate Institute of Medical Sciences
National Defense Medical Center
Taipei, Taiwan
2014 Diplomate-The Taiwan Board of Periodontology (TAP)
2012 Degree- Master of Science in Periodontology
Certificate in Periodontics & Master of Dental Science
National Defense Medical Center
Taipei, Taiwan
2009 Degree- Doctor of Dental Surgery
Kaohsiung Medical University, School of Dentistry
Kaohsiung, Taiwan＜Current positions＞
Assistant professor, School of Dentistry, National Defense Medical Center, Taipei, Taiwan
Director in private practice, Taipei, Taiwan＜Memberships＞
The Taiwan Academy of Periodontology (TAP): Diplomate; Member
The Chinese Academy of Implant & Esthetic Dentistry (CAIED): Diplomate; Member
The Taiwan Academy of Aesthetic Dentistry (TAAD): Diplomate; Member
The Japanese Society of Aesthetic Dentistry (JSAD): Certified Dentist
The American Academy of Periodontology (AAP): International Member
The International Team for Implantology (ITI): International Member
Abstract
Gingival recession is defined as the apical shift of the gingival margin to the cemento-enamel
junction, associated with attachment loss and exposure of the root surface to the oral environment.
This condition may cause several problems, including esthetic concerns, dental hypersensitivity,
root caries, non-carious cervical lesions, and difficulties achieving optimal plaque control. It may
progress over time without management. Clinically, the most frequently selected techniques for rootcoverage were coronally advanced flap (CAF) and the tunnel technique (TUN). However, bothmethods have advantages and disadvantages, and clinicians are often faced with the choice ofperforming only one during root coverage procedures.
In addition, maximum precision is required in performing mucogingival surgery to satisfy
particular esthetic demands; a surgical microscope that enhances complete visualization of theoperative field may represent a valuable tool for root coverage. This presentation highlights thetunneled coronally advanced flap (TCAF) under the dental microscope for root coverage and papillaaugmentation. This newly introduced technique combined the benefits of both the CAF and theTUN. The CAF provides better access for flap advanced, and the TUN maintains more blood
supply and nutrition without papilla incision. Based on various benefits of TCAF, more stable rootcoverage could be expected even in the recession defects with interdental attachment loss.
Moreover, the clinical cases will be demonstrated and discussed to familiarize with this technique'sclinical application and possibilities to improve clinical outcomes.

Use CAD-CAM composite to restore heavily damaged tooth structure with the aid of dental
microscope

Dr.Hung YingKai

1.Graduated from National Yang-Ming university(2000~2006)

2. Intern training in Taipei Veteran General Hospital(2006)
3.Service at Jiepin dental clinic(2008~2013) in Taipei County,Taiwan.
4.Service at Elegance dental clinic(2014~2016) in Taipei City,Taiwan.
5.Owner of Hung's dental studio(2017~) in Taichung City,Taiwan.
Using indirect CAD-CAM composite to restore heavily damaged toothstructure is a good choice.Because this material has very excellent physicalproperty when chewing and function, It's very easy to handle by dentist anddental technician.The most important thing is that it can be easily repaired in
the pt's mouth.
With the aid of dental microscope,we can precisely control the range of caries
invasion and avoid the non-necessary endo and perio problems.Also we canpreserve as much tooth structure as possible. Have nice marginal sealing ofrestoration material,good contact area and emergency profile,create aharmony relationship between restoration and periodontal tissue and make it
be easily cleaned by the patient and the hygienist.
Simple,precise,and effective are three main principles for me to use indirect
cad-cam composite and dental microscope to treat my patient.

)

The Development of a Telesurgical Support System Using 3D Digital Microscope

Junya Okawara DDS, Ph.D.

Office: ALICE DENTAL CLINIC
Address: 2-30-4 Higashi Tsukuba Ibaraki Japan, 305-0046
E-mail: alicedentaloffice@yahoo.co.jp＜Education & work experience＞
1988-1994: Nihon University of dentistry at Matsudo.
1994: DDS degree.
1994-1998: Graduate School of Nihon University.
1998: Ph.D degree.
1999-2004: Dr. Masana Suzuki’s dental clinic.
2004-: Private Practice in General Dentistry, Alice Dental Clinic.
2005-: Instructor of Nihon University of dentistry<Membership>
Specialist of Japan Association Microscopic Dentistry(JAMD)
Board Member of Academy of Japan Clinical Dentistry(SJCD Tokyo)
Member of Academy of Microscope Enhanced Dentistry(AMED)"CTUSBDU1FSJPEPOUBM NJDSPTVSHFSZ XBT TVDDFTTGVM VOEFS UIF TVQQPSU PG SFNPUF EFOUBMTQFDJBMJTULNBXBZ0VSQSPQPTBMGPSSFBMUFMFTVSHJDBMTVQQPSUTZTUFNCBTFE
PO DPNNVOJDBUJPO UFDIOPMPHZ XJMM UBLF UIF DPODFQU PG UFMFUFBDIJOH B TUFQGVSUIFS CZ FOBCMJOH B EFOUBM TQFDJBMJTU UP HVJEF UIF EFOUJTU XJUIPVU CFJOHQIZTJDBMMZ QSFTFOU BOE JO SFBM UJNF *OFYQFSJFODFE EFOUJTUT XJMM CF BCMF UPQSPWJEFNJDSPEFOUJTUSZQSPDFEVSFTUIBUMFWFSBHFUIFFYQFSJFODF LOPXMFEHFBOE
TLJMMTPGEFOUBMTQFDJBMJTUT JGUIJTTZTUFNCFDPNFTXJEFTQSFBE"MTPUIJTTZTUFN
DBO CF BQQMJFE UP BMM NJDSPEFOUJTUSZ QSPDFEVSFT %FWFMPQNFOU PG UIFTF SFNPUF
TVSHFSZ TZTUFNT XJMM SFWPMVUJPOJ[F UIF NJDSP EFOUJTUSZ EVF UP JUT NVMUJQMF
CFOFpUT
8F XJMM JOUSPEVDF UIF DBTFT PG QFSJPEPOUBM NJDSPTVSHFSZ  MFBSO B OFX UFMF
TVSHJDBMTVQQPSUTZTUFNGPSEFOUJTUSZJOUIJTTFTTJPODentistry with Show and Vision

Yoshifumi Kaneko DDS
Office: FUJI DENTAL CLINIC
Address: 2-5-13 Oda Kawasaki-ku Kawasaki-city Kanagawa Japan, 210-0846
E-mail: fujishika.sdhe6fgd@gmail.com<Education & Work experience>
2007-2013: Kanagawa Dental College 2013: DDS degree.
2013: Asano Dental Clinic
2014-: Yagasaki Dental Clinic
2017-: Fuji Dental Clinic<Membership>
Japan Association Microscopic Dentistry (JAMD): Certified Dentist

Microscopes have improved many dental treatments. Generally,
microscopes are used often for root canal treatment, and highmagnification and illumination help improve treatment accuracy.

In addition, using microscopes for purposes other than root canaltreatment, it is possible to obtain beneficial effects for many points,
not just improve treatment accuracy. For example, improvement oftreatment posture and sharing information from the video recording.
Among them, I will talk about taking records especially. Recordings
can be effectively used in the following ways: improvement ofsatisfaction by patient explanation, prevention of misunderstanding,staff education, self-improvement, etc. If you are a microdentist,
recording is a process that you do on a daily basis, but to make theprocess more effective, I will present important points and application
methods.

Periodontal surgery in the microscope:faster or slower?
̶̶better healing, less pain̶-Dr.Chen Dong,DDS,PhD,Prof

The use of microscope in periodontal treatments is not widely popularized.
The main reason is that the periodontal clinicians don’t regard it as a fasterway(the periodontal clinicians cannot use the microscope skillfully). However,
it is the use of the microscope that allows us to achieve more precision, more
comfortable experience and less pain.
Microsurgery is described as a modification and refinement of existing
surgical techniques which is in order to improve visualization.
The theme of the talk is that as long as clinicians acquire more microsurgicalskills, precise operation ,complete debridement and tension-free sutures will
become easier to achieve.

Vital pulp therapy in irreversible pulpitis

Dr.Sun Yu D.D.S.
Endodontist
Graduated from West China Stomatology collage SiChuan University
Vice dean of Lanchie Dental Hospital
Permanent council member of Endodontic association of YunNan Province
Permanent council member of PMP stomatology association ofYunNan Province

Abstract
Dental injuries occur frequently in children between 8-15years, immature
permanent teeth with a wide-open apex and exposed pulp can lead to poor
prognosis. Young permanent teeth with necrotic pulp, periapcial diseases, orroot resorption remain a big challenge for endodontists. This report introducessome cases with permanent immature traumatized teeth, using regenerative
endodontic procedures under dental microscope,hope to provide someevidence for the long-term preservation for the traumatized young permanent
teeth.

“Rethinking Endodontic Cavity Preparation”
Dr. Dongkyun Lee DDS, MSD, PhD.
＜Education & work experience＞
DDS, (MSD, PhD) from Chosun University, Gwangju, South
Korea
Residency program at the Department of Conservative
Dentistry, Chosun University Dental Hospital
Dental Surgeon at the ROK Air Force
Fellowship at the Department of Conservative Dentistry,Chosun University Dental Hospital
Adjunct Professor at College of Dentistry, Chosun University＜Current positions＞
Chief Director in Mokpo Mir Dental Hospital
Instructor in Mir Dental Network Academy
Instructor in APEX Endodontic Study Group＜Memberships＞
The Korean Academy of Conservative Dentistry : Certified Dentist, Specialist
Korean Academy of Endodontics : Member
The Korean Academy of Microscope Dentistry : Member

The endodontic cavity preparation to access the root canal system is closely related to canalcleaning and shaping, and obturation for successful endodontic treatment. The purpose ofendodontic cavity preparation is to facilitate access from the margin of the access cavity to
the apical foramen during instrumentation, and to remove all caries, restorations, calcified
materials, pulp residues, necrotic materials, and visually checking the positions of all root
canal entrances.
If the roof of pulp chamber is removed, the entrance to the root canal can be seen visuallyand tactfully. In addition, a method of straight-line access from the outside of the endodontic
cavity to the root canal has been introduced. The endodontic files used in clinical practice
may require unobstructed instrumentation as much as possible until they reach the root
canal. Endodontic cavity preaparation performed to achieve this purpose can reduce thefracture strength of the tooth because the endodontic treatment process necessarily accompanies the loss of dentin. There are several options in the post endodontic restorations. Differences exist depending on the restoration method, there may be slight differences in thepart of dentin considered important. The removal of the pulpal wall reduces the mass ofdentin on the margins of the restorations. Therefore, it will be important to preserve thedentin during endodontic cavity preparation in order to use the endodontic treated teeth for along time.
It has been reported that the more dentin remain after root canal treatment, the higher thelong-term survival rate even without prosthodontic treatment. In recent years, various studies related to the endodontic cavity have been reported.
Even if the loss due to dental caries cannot be controlled, there is a possibility that the clinician can control the amount of dentin removal due to endodontic treatment. The form of endodontic cavity preparation established at the time of traditional endodontic treatment using
the naked eye and manual instruments is important in the endodontic treatment process. On
the other hand, with the development of a dental microscope and a nickel-titanium files, endodontic treatment with an improved aspect compared to the naked eye and existing instruments is possible. Therefore, I think that endodontic cavity preparation has some scope toconsider in dentin preservation. In this presentation, I would like to rethink endodontic cavity preparation from the review the considerations.

" Enhanced vital pulp therapy protocol, what's the difference”
Prof. Minju Song D.D.S, MSD, PhD＜Education & work experience＞
DDS, MSD, PhD from Yonsei University, Seoul, Korea
Residency program at the Department of Conservative Dentistry, Yonsei
University Dental Hospital
Fellowship at Gangnam Severance Dental Hospital, Yonsei University
Clinical assistant professor at Gangnam Severance Dental Hospital,
Yonsei University
Visiting Assistant Project Scientist, Section of Restorative Dentistry,
Division of Constitutive & Regenerative Sciences, UCLA School ofDentistry＜Current positions＞
Assistant Professor in Department of Conservative Dentistry, Dankook University, Cheonan, Korea
Chair of Department of Conservative Dentistry, Dankook University Dental Hospital＜Memberships＞
The Korean Academy of Conservative Dentistry: Assistant Secretary
Korean Academy of Endodontics: Director of International Affair
The Korean Academy of Microscope Dentistry: Director of International Affair<Abstract>
The first pulp capping case using gold foil was reported in 1756. Entering the 20th century,Ca(OH)2 has been used as a gold standard as a pulp capping material, and pulp capping has becomea representative vital pulp therapy. However, long-term clinical studies showed unfavorable
outcomes such as tunnel defect of dentin bridge. As various limitations were reported, interest andrelated studies decreased.
Since the 2000s, however, studies related to pulp capping have increased again. There are a lot ofstudies reporting high success rates. They reported wider indications and reduced prognostic factors
compared to previously performed pulp capping. We can expect that this favorable change might bedue to the introduction of biocompatible materials such as mineral trioxide aggregates (MTA) andthe re-evaluation of the healing ability of exposed pulp tissue.
The principle of the pulp capping procedure did not change. However, the outcome of recently
performed pulp capping definitely has a good prognosis. According to the European endodontic
treatment society, the enhanced protocol (using of the microscope, disinfection irrigant, and CSC)
leads to a high level of success even after complete caries removal and pulp exposure. Today, I’dlike to review the process of enhanced protocol and share them with you. If you have a moreadvanced understanding of pulp capping than before and have confidence in the procedure, it will
be a good treatment option that you can fully consider before performing root canal treatment.

Keep Looking Don't Settle
̶Rethinking The Microscope̶Jun Mitsuhashi
Education & Work Experience
1989 DDS from Niigata Univ.
Mitsuhashi Dental Clinic in Niigata
1998 Araki Dental Clinic in Tokyo
2000 Private Practice”Dental Mitsuhashi” in Tokyo
Current Position
Visiting Professor of Nihon University
Director of Dental Mitsuhashi
Board member of JAMD
Memberships
Japan Association of Microscopic Dentistry
Japan Endodontic Association
Japan Society for Adhesive Dentistry
The spread of microscopy in dentistry has been spectacular over the past decade. In
particular, its widespread use in the Asian region is noteworthy from a global perspective. However, the number of microscopes sold is only a few percent of the total number of dental clinics, and the reality is that root canal treatment without the use of a microscope is still commonplace.
What about the medical field, which is the predecessor of microscopic treatment? For
the last century, we have not been able to perform any of these surgeries without theuse of a microscope, such as tympanoplasty, cataract surgery, and cerebral aneurysm
clipping.
! Why has dentistry lagged so far behind in terms of the widespread use of microscopy?! One of the reasons is that the microscopes used in dentistry are unique.
! ! In 1953, the world's first commercially available operating microscope, the OPMI 1,
was released by Zeiss, and it was equipped with a rotary magnification changer called aGalilean changer, coaxial illumination, and a suspension system. This was the foundation
on which the development of operating microscopes began.
In 1967, 14 years after the launch of the OPMI1, a revolutionary improvement in thehistory of operating microscopes was made with the appearance of the Motorized Microscope, a motorized version of the Stepless zoom system that enabled foot controlof magnification and focus to keep looking during treatment.
The motorized microscope gained overwhelming support in the surgical field, and became a standard feature of surgical microscopes from then on. The manual microscope
is now used for outpatient examinations, suture extractions, cleaning, and other medicalexaminations.

Currently, most dentists around the world use manual microscopes, and the appearances of motorized microscopes has not progressed. This is one of the reasons why
the use of microscopes in dentistry has not spread.
! In this lecture, the merits of using a motorized microscope in dentistry will be explained, and the future of microscopic dentistry will be discussed through demonstrations of the microscope in practice.