8/7/2019 julysupplement01
1/1
AAE and AAPD Symposium Overview: Emerging Sciencein Pulp
TherapyNew Insights Into Dilemmas andControversies
Evidence-based best practices are yet to be established for
themanagement of caries-associated pulpal disease in young
perma-nent and primary teeth. Controversies still remain among
practi-
tioners, including pediatric dentists and endodontists, as to
which treat-ment modalities are most predictable in the
contemporary practice ofpulp therapy. Manyclinicians still remain
divided as to whether indirectpulp capping is a viable procedure in
primary and young permanentteeth, or whether formocresol remains
the medicament of choice forpulpotomies in primary teeth. To begin
the process of establishing
evi-dence-basedbestpracticesinpulpaltherapyaswellashighlightsomeofthe
future directions in pulp therapy including pulp regeneration
withstem cells and root canal revascularization, the American
Academy ofPediatric Dentistry (AAPD) and the American Association
of Endodon-
tists (AAE) jointly sponsored Emerging Science in Pulp Therapy:
NewInsights into Dilemmas and Controversies.The symposium washeld
onNovember 23, 2007, in Chicago, Illinois.
The convening of this pulp therapy symposium was heralded as
amajor event in that it was a first time conjoint symposium
sponsored bythese 2 national specialty organizations. The genesis
of the idea for jointsponsorship wasthe need to examine the
sharedprocedures performedby the 2 specialties. With specialty
organizations routinely producingevidence-based practice guidelines
that provide the foundation fortreatments performed, it is critical
that when 2 specialties perform thesame or similar treatments,
their guidelines areparallel in language andin content. Without
these guidelines, confusion and uncertainty willresult in clinical
practice when a rational treatment plan is required tomanage a
specific pathologic entity such as caries.
Pediatric dentistry and endodontics share in the important
treat-ment decisions associated with pulpal therapy for the
cariously involvedyoung permanent tooth. In addition, endodontists
are consultants toand involved in pulp therapy treatment decisions
for the cariously in-volved primary tooth. With the eventual
expectation that the 2 organi-zationscould cometogether and produce
practice guidelines that sharecommon goals and language for
caries-associated pulp therapy for pri-mary and young permanent
teeth, the decision was made to bring to-gether a panel of
world-renown experts from both specialties to presentthe current
best evidence as a first step in developing the
anticipatedguidelines.
Individuals identified to be on the planning committee from
theAAE were DrsGeraldN. Glickman, Alan Gluskin, and Bradford
Johnson.
From the AAPD, Drs Suzi Seale, Elizabeth Barr, and James Coll
wereselected. These individuals met and identified the following
areas asappropriate forfocus: the nature of the cariouslesionof
dentin;indirectpulp therapy, including stepwise excavation for both
young permanentteeth and primary teeth; primary tooth pulpotomy
agents with specialemphasis on formocresol and the controversy
surrounding its use; andrevascularization of young permanent teeth
and pulpal regeneration byusing stem cells. To that end, a cadre of
9 experts was identified andinvited to present evidence for
assigned topics. The articles resultingfrom their presentations
appear in this publication.
During the conference Professor Lars Bjrndal discussed the
car-ies process and its effect on the pulp. He applied this
information to thedilemma of the deep carious lesion and indirect
pulp capping, withspecial emphasis on the coronalseal. Dr JoeCamp
focused on diagnos-tic dilemmas in vital pulp therapy for young
immature teeth. Dr MartinJ. Trope spoke on how new trends are
changing our understanding ofthe regenerative potential of the
dental pulp, whereas Dr David Wither-spoon spoke on new directions
and treatment perspectives involvingpulpal revascularization for
permanent teeth. Dr Anna Fukspresented acompilation of the evidence
for different pulpotomy agents in treatingthe vital cariously
involved primary tooth. Dr Jim Coll provided infor-mation about
indirect pulpcapping for primary teeth as an alternative
topulpotomy. Drs Alan Milnes and P. J. Waterhouse presented
opposingviews about the controversy over formocresol as a pulpotomy
agent forhuman teeth. Finally, Dr Ken Hargreaves provided evidence
for thefuture of pulpal regeneration for the young permanent
tooth.
Because 2 specialty groups were represented, the planning
com-mitteesoughttodetermine,throughabriefpretestcompletedbeforethefirst
speaker, the baseline opinions of the audience about the
varioustopics to be presented. After the last speaker, a more
lengthy set ofquestions about the same topics were presented to the
audience fortheir opinions by using an audience response system.
Attendees re-sponses were identified by specialty, and the results
of the comparisonsof the presymposium and postsymposium opinions
within specialty andacross specialties are also presented in this
publication.
We believe this symposium represented an important landmark
inbringing together different disciplines with potentially
different opin-
ions to reach an evidence-based consensus about common
treatmentdilemmas. Because practice guidelines increasinglydrive
our treatmentdecisions, it is important that we are in agreement
about their content,ultimately for the care and benefit of our
patients.
Gerald N. Glickman, DDS, MSVice-President, American Association
of Endodontists
and
Professor and Chairman, Department of Endodontics
Baylor College of Dentistry
Texas A&M University Health Science Center
Dallas, Texas
N. Sue Seale, DDS, MSDRegents Professor and Chairman, Department
of Pediatric Dentistry
Baylor College of DentistryTexas A&M University Health
Science Center
Dallas, Texas
Conflict of Interest: Gerald N. Glickman, DDS, MS, reports no
financialinterests or potential conflicts of interest. N. Sue
Seale, DDS, MSD, reports nofinancial interests or potential
conflicts of interest.
Copyright 2008 American Academy of Pediatric Dentistry and
AmericanAssociation of Endodontists.
This article is being published concurrently in Pediatric
Dentistry, May/June2008; Volume 30, Issue 3. The articles are
identical. Either citation can be usedwhen citing this
article.doi:10.1016/j.joen.2008.02.036
Pulp Symposium
JOE Volume 34, Number 7S, July 2008 AAE and AAPD Symposium
Overview S1
