Onsite Endodontic Symposium Celebrating the professional contributions of Dr. Leif K. Bakland

Onsite Endodontic Symposium Celebrating the professional contributions of Dr. Leif K. Bakland is organized by Loma Linda University School of Dentistry (LLUSD) and will be held on Nov 16, 2025 at Loma Linda University School of Dentistry, Centennial Complex, Loma Linda, California, United States of America.

Course Description:
This program will be a lecture.

Vital Pulp Therapy and Revascularization: Current and Emerging Perspectives

Vital pulp therapy and pulp revascularization are within the scope of endodontic practice. The pulp is normally protected by its surrounding hard tissues. Once these protective layers are damaged, the pulp is at the risk of infection and consequently activation of various host defense mechanisms. The dental pulp and its surrounding dentin have several defense mechanisms. Activation of these pathways results in reactionary or reparative tertiary dentinogenesis. When the pulp is reversibly inflamed, the treatment of choice is maintaining its vitality by indirect or direct pulp capping procedures as well as partial or complete pulp chamber pulpotomies. When the pulp dies before complete root development, normal root growth is disrupted. Treatment options for these teeth include: MTA apical plug, revascularization or a new tooth. In the MTA apical plug, an artificial apical stop is produced that allows for condensation of obturation materials. However, this procedure does not promote root development, nor does it increase fracture resistance of the root walls. An ideal treatment for a necrotic immature tooth would be the regeneration of pulp tissue into a canal and promotion of the normal root development. The advantages of this procedure lie in the potential for reinforcement of dentinal walls by deposition of hard tissue and the potential for the development of an apical morphology more appropriate for conventional endodontic therapy if future treatment becomes necessary. There is a growing body of evidence to suggest that revascularization of the pulp space in these teeth will result in continued growth of the root and elimination of periapical pathosis. However, experimental studies have shown that the tissues formed after use of revascularization do not entirely recapitulate the lost native dentin-pulp tissue. Various materials and techniques have been used for vital pulp therapy, apexification and revascularization to save natural dentition. In this lecture the presenters will discuss the pros and cons of vital pulp therapy procedures and apexification and revascularization, as well as current and the emerging materials and methods, and new strategies to promote regenerative processes and improve the outcomes of these treatments for teeth with mature and immature apexes.

The Endo-Antral Connection
The pathological extension of endodontic disease into the maxillary sinuses is a common disease process yet is often unrecognized in clinical medical and dental practice, with its sequelae often misdiagnosed as rhinogenic sinusitis.  This lecture explains and illustrates the etiology and symptoms of acute and chronic rhinosinusitis and its similarities, distinguishing differences, and frequent inter-relationship with pulpal etiology and symptoms.  The associated clinical and radiographic findings of maxillary sinusitis of endodontic origin (MSEO) are explained using many real-world clinical case examples.  Emphasis is placed on the importance of CBCT imaging, magnification, and clinical expertise for rendering both non-surgical and surgical endodontic treatment when indicated in the maxillary posterior dentition.  The goal is to help practitioners distinguish rhinosinusitis from MSEO, and improve the health of patients through accurate diagnosis, appropriate treatment, and improved communication between endodontists and ENT specialists.

Apical Periodontitis and the Host: What we know and what we need to know

• Apical periodontitis is an inflammatory reaction to the infection spreading from the root canal space of an infected tooth. If left untreated, apical periodontitis may degenerate into acute manifestations which may be dangerous for the life of the patient and represents an inflammatory burden which may be associated to the insurgence of systemic conditions like cardiovascular diseases and autoimmune diseases.
• On the other hand, systemic conditions, genetic and epigenetic factors from the host seem to influence the prevalence, development, clinical presentation and healing of this disease.  Further, innate and adaptive immunity may modulate the host response to the endodontic treatment of AP. Lastly, immunomodulatory and immunosuppressive medications seem to impact on AP in both a positive and negative way.
• This lecture will cover the more recent information on the role of AP in systemic conditions, and on the influence that  the host’s genetic makeup,  diseases  and medications may have on endodontic infection, with an opening for future treatment directions.
• Learner Outcomes

Vital Pulp Therapy and Revascularization: Current and Emerging Perspectives

• After attending this lecture, the participant should be able to:
• Enumerate treatment options following vital pulp exposure.
• Elaborate treatment options for teeth with necrotic pulp and open apexes.
• Discuss the challenges and mishaps during and after revascularization procedures.
• State the emerging materials and methods to promote regenerative processes in endodontics.

The Endo-Antral Connection

• At conclusion, participants should be able to:
• Describe the pathogenic effects and progression of periradicular inflammation on the sinus tissues and the associated clinical and radiographic findings of maxillary sinusitis of endodontic origin (MSEO).
• Recognize the distinguishing differences between rhinogenic sinusitis and odontogenic sinusitis and know when to render endodontic care and/or make an appropriate ENT referral.
• Recognize the indications for endodontic treatment and periapical surgery, and the unique anatomic challenges associated with maxillary posterior teeth proximate to the maxillary sinus.

Apical Periodontitis and the Host: What we know and what we need to know

• At conclusion, participants should be able to:
• Describe the impact of endodontic infection (AP) on the health status of the host
• Describe the diseases which are more often connected with a higher prevalence of AP.
• Describe the impact of some medications on apical periodontitis.