American Association of Endodontists

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American Association of Endodontists

• General Information
• Membership
• Certification
• Major Research and Technology Changes
• Trends in Education
• Changes in Scope of Practice

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American Association of Endodontists

• Impact of Bisphosphonates
• Improve Magnification and New Materials
• Referral Patterns
• Principle Health Services
• Changes over the past 10 Years
• Practice Settings

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General Information
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General Information

• The AAE Foundation
• Funded 2.6 million in research
• grants
• 1.2 million in endodontic
• educator fellowships
• 11 new endodontic educators
• Annual national workshop

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General Information

• Results of Foundation Support
• New dental material uses
• More information on supplemental intraosseous
  anesthesia
• Growing understanding of microflora

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General Information

• Results of Foundation Support
• Improved clinical trials
• Improved systematic reviews
• Increased knowledge regarding dental pulp

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General Information

• The Live Learning Center
• Access online endodontic education materials
• Obtain CE credits
• View previous and upcoming AAE meetings

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General Information

• International Association for Dental Research
• 2009 Symposium on pulp biology and regeneration
• 2010 Symposium on Tissue Injury and Pulp
  Regeneration

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Membership
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Membership

• From 2000-2009
• Active Membership increased by more than 15
• Auxiliary Membership increased by more than 500
• Total Membership increased by 35
• The AAE currently has over 7000 members

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Membership Categories

• Active
• Associate
• Auxiliary
• Educator
• Honorary

• International
• Life
• Predoctoral
• Student
• Retired
• Student

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New Membership Categories

• Predoctoral Student
• Educator
• International

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All Membership Categories
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Gender Trends Among Membership
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Membership Projections

• 1-2 growth annually
• Members transitioning into Life and Retired
  membership
• Increase in number of International members

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AAE Surveys

• 2003-2009 results indicated
• 80 of people who receive root canal treatment by
  a specialist would return to one
• 94 of general dentist have positive perceptions
  of endodontists
• 9 out of 10 general dentists partner with
  endodontists

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Membership Surveys

• 2009 results indicated
• 83 of endodontists provided charitable care to
  underserved populations. 
• The average specialist performs 10 or more
  charitable procedures per year.

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Certification
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Certification
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American Board of Endodontics Recent Changes

• 4-year identity requirement eliminated
• Resident/graduate students allowed to sit for
  written exam in last year of program
• Track II allows clinicians to submit case
  portfolio before taking written exam
• Extension of eligibility
• Multi-site testing centers

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Preliminary Application Submitted 2006 or After
Step Maximum Time
Part I 3 years
Part II 6 years
Final Application 1 year
Part III 2 years
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Track One for Board Certification

• Written Examination Part I
• Case History Portfolio Part II
• Oral Examination Part III

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Track Two for Board Certification

• Case History Portfolio Part I
• Written Examination Part II
• Oral Examination Part III

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Active Diplomates
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Endodontic Board Certification Data
CDELs Annual Reports of ADA-Recognized Dental
Specialty Certifying Boards, 2000-2008
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Future Changes in Board Certification

• Online Submission of case
• portfolios
• Distance technology to
• conduct oral exams

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Recertification

• Candidates who applied for certification after
  January 1, 1997 must recertify every 10 years
• Complete 25 Continuing Education Credits
• Begin 3 years before expiration date

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Significance of Board Certification

• Board Certified Endodontists demonstrate a high
  level of accomplishment and commitment to art and
  science of current clinical practice.

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Major Research and Technology Changes
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Major Research Changes

• Dental materials
• Pain management
• Endodontic microbiology
• Clinical research
• Regenerative endodontics revascularization
• Dental trauma
• Endodontic diagnosis

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Dental Materials

• Mineral trioxide aggregate (MTA) uses
• Root end fillings
• Perforation repairs
• Apical plugs for open apices
• Vital pulp protection
• Dental bonding agents

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Pain Management

• Future Developments
• Liposomal-encapsulated anesthetic agents
• Terminal receptor-potential vanilloid agonists
  and antagonists
• Mediators of pupal and periapical pathosis

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Endodontic Microbiology

• Biomechanical debridement protocols
• Bacterial-host interaction
• Infected root canal spaces
• Diverse organism populations

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Clinical Research

• Research methods
• Randomized clinical trials
• Systematic reviews of
• clinical outcomes
• Evidence-based protocols

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Regenerative Endodontics and Revascularization

• Research
• Pulpal regeneration
• Reprogramming stem cells
• Significance
• Better treatment of childrens teeth

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Regeneration/Revascularization

• Pre-op
• Trauma
• Cold
• Sinus tract
• Treatment
• Irrigation
• 5.25 NaOCl
• Medication
• Ciprofloxacin
• Metronidazole
• Minocycline
• 3 weeks later
• Irrigate with 5.25 NaOCl and then H2O
• Initiate bleeding
• Seal MTA/Composite

Law, in Petrino Northwest Dent 8633, 2007
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Dental Trauma

• Affects 30 of population
• Research Benefits
• Pulp Preservation
• Avulsed teeth
• Pulp necrosis treatment
• Root fracture management
• Intrusive luxations
• www.dentaltraumaguide.org

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Endodontic Diagnosis

• 2008 Consensus Conference on Endodontic
  Terminology
• Expert attendees
• Recognition of research needed
• Standardized diagnostic terms

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Major Technology Advances

• Special Instruments
• New ultrasonic instruments
• Modalities and disinfecting solutions
• Operatory microscope
• Cone-beam volumetric tomography

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Impact of changes/advances

• Increased predictability
• Better outcomes
• Better pain management
• Improved dental injury understanding
• Enhanced treatment options

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Trends in Education
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Endodontic Programs and Enrollment
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Endodontic Program Directors
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Increasing Full Time Board Certified Faculty

• Initiatives
• AAE Foundation grants and awards
• Educator courses
• Networking opportunities
• Annual Session Educator Track

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Changes in Scope of Practice
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Changes in Scope of Practice

• Major conditions routinely treated
• Pulpal and Periapical Disease
• Caries
• Dental Trauma
• Periodontal Disease
• Extensive Restorations
• Tooth Fractures or Host Factors

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Changes in Scope of Practice

• Patients with multiple systemic diseases
  including diabetes experienced decreased
  retention of endodontically treated teeth and
  increased need for retreatment by endodontists.

Mindiola MJ, Mickel AK, Sami C, Jones JJ,
Lalumandier JA, Nelson SS. Endodontic treatment
in an American Indian population a 10-year
retrospective study. J Endod 2006 32 828-32.
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Changes in Scope of Practice

• 97 of endodontically treated teeth (nearly
  1.5 million teeth) were retained in the oral
  cavity eight years after initial treatment.

Salehrabi R, Rotstein I. Endodontic treatment
outcomes in a large patient population in the
USA an epidemiological study. J Endod 2004 30
846-50.
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Impact of Biosphosphonates
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Impact of Bisphosphonates

• Bisphosphonates, associated with
• osteonecrosis of the jaws (ONJ), has
  significant medical and dental implications.

Carter G, Goss AN, Doecke C. Bisphosphonates and
avascular necrosis of the jaw A possible
association. Med J Aust 2005 182 413-15.
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Impact of Bisphosphonates

• Pathogenesis of ONJ is related to
• the profound inhibition of oseoclast function
  brought on by the Bisphosphonates

Ruggiebo SL, Drew SJ. Osteonecrosis of the jaws
and bisphosphonate therapy. J Dent Res 2007 86
1013-1021
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Improved Magnification and New Materials
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Increased use of Magnification

• Endodontists use of the Microscope
• In 1999 Increased 52
• In 2007 Increased 90
• Required by CODA in Endodontic Residency Standards

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Implant Dentistry Endodontics

• 6.6 of Endodontists are placing implants

Creasy J, Mines P, Sweet M. Surgical Trends among
Endodontists The Results of a Web-based Survey,
DDS 35 30-34.
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Referral Patterns
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Referral Patterns

• 60 of patients have treatment performed by
  general dentist
• 19-24 of patients have treatment performed by
  endodontists
• 38 of patients receive knowledge of endodontics
  from their dentist

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Referral Patterns

• 2005-2007 surveys of general dentist
• 42 report doing all 8 of the root canal
  procedures in their office
• 22 refer most 20 or all 8 of the cases to
  specialist
• 94 consulted with an endodontist over the past
  12 months
• 68 believe referral to endodontists makes good
  business sense

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Referral Patterns
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Principle Health Services
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Principle Health Services

• Vital pulp therapy
• Indirect pulp cap
• Direct pulp cap Pulpotomy
• Nonsurgical endodontic treatment
• Expertise in pulp system anatomy
• Recognition of anomalies

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Principle Health Services

• Team work in dealing with complex restorations
• Management of patients with complicated medical
  histories
• Endodontic retreatment
• Surgical endodontic treatment root-end resection

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Principle Health Services

• Biopsy
• Root resection/amputations
• Perforation repair
• Intentional replantation
• Implant dentistry

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Principle Health Services

• Post removal
• Apexification/Apexogenesis
• Dental trauma management
• Intracoronal bleaching
• Restoration of endodontically treated teeth

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Principle Health Services

• Cracked tooth management
• Pulp regeneration
• Biocompatible regenerative materials
• Mineral trioxide aggregate
• Bioceramics

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Changes over the past 10 Years
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Changes over the past 10 years

• Pulpal regeneration
• Bioceramics
• Cone-beam computed tomography
• Operating microscope

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Practice Settings
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Practice Settings

• Trends and Changes
• Private Practice increased 2
• Solo Private Practice increased 12
• Private practitioners in a group practice
  decreased 10

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Practice Settings

• Trends and Changes
• Multidisciplinary practices increased 1
• Other practice settings increased 2

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Practice Settings

• 4,600 active practicing endodontists in U.S.
• 200 in federal dental health services
• 250 full-time educators
• 4,150 in private practices
• 800 part-time private practitioners

• Vacancies in dental school endodontic positions
  decreased 5
• 248 full-time endodontic educators
• 415 part-time educators compensated
• 347 part-time volunteers

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• The AAE Works for YOU!