This demonstration masterclass will focus on the essential clinical steps of Vital Pulp Therapy (VPT). Participants will learn how to perform direct pulp capping, partial pulpotomy, and full pulpotomy using specially designed tooth models. Emphasis will be placed on critical success factors, including complete caries removal and strict aseptic technique. Materials and methods that streamline the procedure and enhance clinical outcomes will be introduced and demonstrated. A step-by-step workflow will be illustrated, with particular attention to the proper placement of bioceramic materials on the pulp wound and the subsequent base layers. Attendees will gain a clear understanding of how to choose the most appropriate VPT approach for different clinical scenarios. The course will also provide guidance on patient communication and management, as well as considerations for prognosis.

This demonstration masterclass will highlight the importance of the correct positioning of the operating microscope, patient, and clinician to achieve a comfortable, ergonomic, and efficient approach to endodontic microsurgery.
A complete surgical procedure will be performed on an extracted tooth mounted in a mannequin head model, replicating real-life clinical conditions. The procedure will be carried out under the operating microscope and will include the use of a piezoelectric device to create an osseous window, microsurgical instruments, and a pre-mixed, fast-setting bioceramic material for root-end filling.
The microsurgical armamentarium will be discussed in detail, allowing participants to understand the purpose and clinical relevance of each instrument throughout the procedure. Particular emphasis will be placed on ergonomics, surgical access, instrument selection, and the key steps required to perform endodontic microsurgery safely, predictably, and efficiently.

Complex endodontic microsurgery often requires advanced techniques to achieve predictable access, healing, and treatment outcomes. This lecture will explore the use of piezoelectric surgery to create and safely reposition a bone window, particularly in challenging anatomical situations such as mandibular molars with thick cortical bone.
The presentation will focus on the clinical application of platelet-rich fibrin (PRF), including the preparation of PRF plugs and membranes, as well as the use of autogenous bone from the surgical window combined with PRF-derived serum to create “sticky bone” for guided tissue regeneration.
The second part of the lecture will address treatment planning and case selection for intentional replantation. Surgical techniques and clinical decision-making will be discussed in detail, illustrated by a series of clinical cases with long-term follow-up.
Participants will gain practical insights into the management of challenging endodontic surgical cases and the integration of microsurgical and biologically driven regenerative techniques to optimize clinical outcomes.

When managing deep carious lesions approaching the pulp chamber, clinicians often face the dilemma of whether to preserve or remove the pulp tissue. Traditionally, teeth diagnosed with irreversible pulpitis have been treated with root canal therapy. However, emerging evidence is challenging this conventional paradigm, opening new possibilities for vital pulp therapy, even in cases previously considered unsuitable for conservative management.
In this first part, the tissue response to caries progression will be examined in detail, from initial lesions to deep caries approaching the pulpal space. New insights into early non-cavitated white spot lesions will be presented. The controversial issue of caries excavation depth will also be addressed, with a critical analysis of the evidence supporting selective versus non-selective caries removal.
Finally, the histopathological distinction between reversible and irreversible pulpal inflammation will be explored, with particular emphasis on the complex relationship between clinical and histological diagnoses. This evidence-based approach will provide a foundation for understanding how contemporary concepts of pulp biology can inform clinical decision-making in the management of deep carious lesions.

Successful endodontic treatment depends not only on effective disinfection and obturation of the root canal system, but also on its protection from the oral environment. Rubber dam isolation provides aseptic conditions during treatment; however, the endodontist must also establish a durable seal capable of maintaining this isolation long after the procedure has been completed.
Adhesive restorative procedures are therefore integral to contemporary endodontic care. Pre-endodontic restoration may be required to eliminate coronal leakage, facilitate predictable rubber dam placement, create an irrigant reservoir and provide stable reference points for treatment. Sealing freshly prepared dentine before further endodontic procedures can protect the adhesive substrate from contamination and simplify the subsequent restorative protocol. Following root canal treatment, immediate adhesive core reconstruction should seal the endodontic access, stabilise the residual tooth structure and provide a reliable foundation for the definitive restoration.

The aim of this presentation is to explore the range of retreatment options available to preserve the natural dentition. Modern clinical practice requires dentists to remain familiar with advances in materials, instruments, and treatment techniques in order to help patients select the most appropriate long-term treatment option for maintaining oral health and function.
Advances in dental materials and surgical techniques have made endodontic microsurgery increasingly predictable. Nevertheless, there are specific clinical situations in which surgical endodontic treatment cannot replace conventional non-surgical retreatment. Successful management requires a thorough understanding of the causes of treatment failure, the prognosis associated with each treatment approach, and the technologies and materials available to achieve the best possible outcome.
This presentation will review the relevant scientific literature evaluating the prognosis of conventional and microsurgical endodontic retreatment. By integrating current evidence with clinical considerations, it will provide a framework for informed decision-making when managing challenging and refractory endodontic cases, with the ultimate goal of preserving the natural tooth whenever possible.

The presentation will begin with an overview of modern endodontic microsurgery as developed and taught at Penn Endo, highlighting key areas of clinical importance through video demonstrations. Topics will include instruments, materials, biological principles, and, most importantly, clinical success rates.
The second part will introduce the newly developed “Bone Window Technique.” Endodontic microsurgery in teeth with large periapical lesions and an intact cortical plate may require the removal of additional bone, potentially resulting in delayed healing. In such cases, the Bone Window Technique provides excellent access and visualization of the surgical field while preserving the cortical plate.
Cone-beam computed tomography (CBCT) plays an essential role in preoperative assessment, case selection, and precise planning of the bone window. The technique will be presented as a reliable and minimally invasive approach that should be considered the preferred method when a large periapical lesion is associated with an intact buccal cortical plate.
This 2027 update will provide clinicians with practical insights into the latest developments in endodontic microsurgery, combining biological principles, advanced technology, and refined surgical techniques to improve clinical outcomes.

In this second part, clinical strategies for preserving pulp vitality in teeth diagnosed with reversible pulpitis will be presented. Based on extensive histopathological and histobacteriological research, a novel approach will be introduced, centered on intraoperative decision-making guided by the magnified visual assessment of the exposed pulp tissue.
Under favorable conditions, the exposed pulp can be sealed using biocompatible and potentially bioactive materials, promoting healing and long-term pulp preservation. The histological features of pulp healing will be described, together with an analysis of the factors associated with failure following direct pulp capping.
Finally, the current literature on the clinical outcomes of direct pulp capping will be critically reviewed, including long-term clinical evidence demonstrating high success rates. The presentation will highlight how a biologically based, evidence-driven approach can expand the possibilities for maintaining pulp vitality in deeply carious teeth.

The necrotic immature permanent tooth with an open apex remains one of the most challenging clinical situations in endodontics. The lack of apical constriction, thin dentinal walls, and variable root development can complicate disinfection, obturation, and long-term preservation of the tooth.
This clinical scenario may result from different conditions. Pulp necrosis following trauma or infection may interrupt development of the pulp–dentin complex in a young permanent tooth; alternatively, an immature tooth affected by trauma during childhood may remain untreated and only be diagnosed years later in an adult patient. Developmental anomalies and complex anatomies, including dens invaginatus and dens evaginatus, may present additional diagnostic and therapeutic challenges.
Several treatment strategies are currently available. These range from traditional calcium hydroxide apexification using the Frank technique to the creation of an artificial apical barrier with hydraulic calcium silicate cements and, more recently, regenerative endodontic procedures aimed at promoting further root development and repair of the periapical tissues.

This lecture will critically examine the indications, advantages, limitations, and expected outcomes of the different treatment approaches, integrating clinical experience with the current literature and the latest European guidelines. Particular emphasis will be placed on clinical decision-making: when to choose apexification, when to create an apical barrier, and when regenerative endodontic procedures may offer a meaningful biological advantage.