King Abdulaziz UniversityFaculty of Dentistry
Conservative Dental Science DeptEndodontic Division
Course Portfolio Course Name: Clinical Endodontics
Course Number: CDS 522 Academic Year: 2007/2008
Prepared byCourse Director
Dr. Laila Bahammam
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Course Portfolio
Contents: Page
Preface--------------------------------------------- 3
Title page------------------------------------------
Course Syllabus---------------------------------- 4
Course related material------------------------ 37
Examples of the extent of student learning ------- 37
Instructor reflection of the course----------- 38
☼Preface
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In accordance to self evaluation for the last two years and with advances in the field of endodontics, we have integrated six new practices into the teaching methodology of this course as follows:-
1- Modular system for distribution of related lectures among the stuff
2 – Module Exams at the end of each module lectures
3 - Rotary Ni-Ti systems incorporated into the course schedule
4 – Electronic working length determination using EAL`s in the clinical sessions
5 – Students start to use of Rotary Ni-Ti system for cleaning and shaping of root canal system
5 – E- sheet marking for evaluation of the student
6 – E-teaching on tutorials by incorporating e-discussion board
Each item is detailed in this document as ordered.
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Course Syllabus
Course Name: Clinical EndodonticsCourse Number: CDS 522Academic Year: 2007/2008
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Course syllabus:
Contents:
Instructor information
Course information
Course objectives
Learning resources
Course requirements and grading
Detailed course schedule
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Instructor information
Course Director: Dr Laila Ahmed BahammamAssistant professorOffice location: Building # 10 ext. # 23211Office hours: Wednesday (8-12 am) & Wednesday (1-5 pm) E-mail address: [email protected]
Faculty members:
Prof: Madiha Mahmoud GomaaCourse director for 4th yearOffice location: Building # 10 ext. # 23254Office hours: Monday (8-12 am) & Monday (1-5 pm)E-mail address: [email protected]
Prof.: Sawsan Taha AbuzeidOffice location: Building # 10 ext. # 23291Office hours: Monday (8-12 am) & (1-5 pm)E-mail address: [email protected]
Prof: Omar FaheemOffice location: Building # 12 ext. # 21010Office hours: Tuesday (1-5pm) & Wednesday (1-5 pm)E-mail address: [email protected]
Prof: Ragab Eid SaifOffice location: Building # 12 ext. # 21010Office hours: Tuesday (1-5pm) & Wednesday (1-5 pm)E-mail address: [email protected]
Dr. Khaled BaltoAssociate professor Office location: Building # 12 ext. # 21011Office hours: Wednesday (8-12 am) and (1-5 pm)E-mail address: [email protected]
Dr. Lubna ShafieCourse director for 4th yearOffice location: Building # 10 ext. # 23254Office hours: Monday (8-12 am) & Monday (1-5 pm)E-mail address: [email protected] Office hours: Wednesday (8-12 am) & Wednesday (1-5 pm) E-mail address: [email protected]
Course information
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Course name: clinical endodontics
Course number: CDS522
Course meeting times: one hour lecture followed by three hours clinical session weekly.
Course meeting places: student lectures will be held at the 5th year lecture room building #10 for female students and building #14 for male students.
Clinical sessions : 3 hours / week will be taken at building # 10 for female students and building # 12 for male students.
Course website
COURSE DESCRIPTION
This course is the first clinical endodontic course, which the students take after didactic and preclinical training in endodontics. The scope of the course includes preparing the students to be able to understand, recognize, diagnose and successfully treat pulpally involved or potentially pulpally involved teeth. Important fundamentals are stressed with emphasis on the correlation between basic clinical and biological principles. The course includes:
a. Classroom lecture series, which correlate between clinical and biological principles of endodontics.
b. Clinical exercises to perform endodontic treatment for:
1. Three (3) single canaled anterior teeth (bicuspids or incisors)2. Two (2) premolars teeth (at least one bicanaled premolar)3. One (1) upper or lower molar.
c. Along the course, the lecture time will precede the clinical session.
COURSE OBJECTIVES
Based on the content of the lecture series, required test and the recommended reading material, this course is expected to:
1. Prepare the student to demonstrate a mastery of performing the basic and the fundamental procedures in the field of endodontics, regardless of his future professional plans or areas of clinical interest.
2. Prepare the student who can evaluate his own clinical competency and know the extent of his diagnosis and operative capabilities therefore, he will not be hesitant in seeking the counsel of specialist or a colleague.
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3. Prepare the student who must demonstrate the mastery of recognizing the different levels of sophistication and complexity of endodontic cases that his patients present.
4. Prepare the student who must demonstrate the ability to state the theoretical and biological principles of every endodontic clinical procedure.
5. Prepare the student who must demonstrate a mastery of the dental materials and instruments used in endodontics.
6. Prepare the student who must demonstrate a mastery of tooth morphology.
Learning Resources :
1 - Text books:
1 – Main reference Reference # 1. Cohen S., Hargreaves K , Pathways of the pulp. Ed.9, Mosby, Inc., 2006
2 – Supplementary references -:
Reference #1. Ingle J., Bakland L: Endodontics. Ed.5 BC Decker Inc., 2002
References # 2. Walton R., Torabinejad M: Principles and Practice of Endodontics . Ed.3 W.B. Saunders Company, 2002
The above mentioned text books are available at the students' library .
3 – Electronic Resources
URL:www,endoarabia.net "developed and maintained by the division members"
Course Requirements and Grading :
The primary objective of the division of Endodontics is to contribute to the total college efforts in preparing the students to become excellent clinical practitioners. In order to carry out this goal, clinical (5th year) Endodontic students will be evaluated by his/her performance on: Student evaluation: Student performance in the course will be evaluated as follow:
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Continuous Assessment Final Examination
1. 2 module Exams2. 2 module Exams3. Midyear Exam4. Clinical Requirements
Marks1010 2040
1. Written Exam2. Oral Exam3. Practical Exam.
Marks802020
T O T A L80
T O T A L120
Clinic Grading Cards The endodontic sheet form will only be utilized to record the student’s activity in clinic. The student should make appropriate diagnosis, entries for tooth, working length determination, cleaning and shaping of root canal (s) using step back instrumentation technique, root canal obturation technique using lateral gutta-percha obturation technique. All procedure grades will be recorded on the “Endodontic Clinical Evaluation Card”. The evaluation letter (‘A*, A , B*, B, C*, C- ,D*,D and E which is unacceptable) will be marked by the faculty staff. Evaluation form for every student is available with instructor every clinical session. The endodontic sheet for the clinical finished cases of student will be collected by the instructor, submitted to course director and kept in the Endodontic office.
2 module exams: Written first quiz will performed at the end of each lectures module, covering all the teaching materials up to this time. The question will be in form of MCQ, definitions or complete.
Midyear Exam:Written midyear exam will performed at the end of the first term, covering all the teaching materials up to this time. The question will be in form of MCQ, definitions or complete, and assay. 2 module exams: Written second quiz will performed at the end of each lectures module of the second term covering all the teaching materials up to this time. The question will be in form of MCQ, definitions or complete.
Final Exam:o Final (Written) Exam
The Final Exam will cover all materials in the course. Test questions on the first quiz, Midyear, second quiz and Final examination will come from information found in the Lecture Outlines, Supplemental Reading
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List, Lecture Presentations, and any other handouts provided during the progression of the course.
o Data show Exam After the written exam, the students will be examined orally in the covering
material during course. The exam will be performed in form of station, managing problem or other material discussed in the previous course using slide data show to keep the standardization of evaluation between student (males and females).
Evaluation of final The final course grade will be determined by sum of the numerical grades of clinical requirement, first quiz, midyear exam, second quiz and Final Examinations.
Grading Scale:
85 to 100 = A 65 to 74 = C 75 to 84 = B 64 to 60 = D Below 60 = F
Grading policy : Attendance:
Attendance is mandatory for all lectures and clinical sessions. Exceeding the
maximum permissible absences might lead to your deprivement from attending the
final exams. Unexcused absences from written exams will result in marks being
deducted from your final grade.
Deadline for requirements completion: The deadline for completing the clinical requirements is the last day of the course
as published by the Office of the Associate Dean for Education. Failure to complete the class assignments by the specified deadlines will result in reduction in the clinical requirement's marks relative to the number of the deficient requirement, which will undoubtedly affects the final overall student score.
Expectations from the students Behavior of a dental student reflects on a student’s qualification and potential to become a competent dentist. Attitudes and behaviors inconsistent with the above mentioned definition will be unaccepted. As the King Abdulaziz University certifies that the student is competent to undertake a career as a dentist. It also certifies that in addition to the competency in dental knowledge and skills, the graduate possesses those personal traits essential to the profession of dentistry. Professionalism encompasses altruism, accountability, compassion, duty, excellence and respect for others.
Student responsibilities to the course : The student should be able to :
1. Review all the technical phases of root canal treatment starting from access preparation to canal system obturation.
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2. Demonstrate competence in the use of root canal instruments both in preparation and in obturation of the single and multirooted teeth.
3. Demonstrate how to prevent and solve errors and mishaps that occurred during various phases of treatment.
4. Show competency in treatment of single, double and multirooted teeth5. Evaluate the cleaned and shaped root canal in accordance with the standard
criteria of evaluation 6. Evaluate the radiograph after canal obturation in accordance with the written
crite
Lecture Schedule for the First Half of the Academic Year 2007-2008
LectureLecture TitleDATEProf. R. SaifIntroduction, Clinical requirements, Lecture ScheduleM 8/9/2007
F 11/9/2007Prof. S. AbouzaidDr. L.Bahammam
Diagnosis ( 2 hours lecture )M 15/9/2007
F 18/9/2007Prof. S. Abouzaid
All faculty staff
Case selection and treatment planning (one hour lecture).
+Demo for pulp testing procedure ( one hour practical )
M 22/9/2007
F 25/9/2007
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Dr. K. BaltoPreparation for treatment – Rubber Dam, Endodontic Radiography – magnification in Endodontics (2 hours lecture)
M 29/9/2007
F 2/10/2007Eid Vacation األربعاء يوم بنهاية المبارك عيدالفطر إجازة الموافق 21/9/1428بداية م3/10/2007هـ
Prof. R. Saif
All faculty staff
Review (Step by Step) RCT procedures (1 hours lecture).
practical (3 hours)
M 20/10/2007
F 23/10/2007
Prof. R. SaifDr. L. Bahammam
Role of Endodontics after dental traumatic injuriesM 27/10/2007F 30/10/2007
Prof. R. Saif Dr. L. bahammam
Role of Endodontics after dental traumatic injuriesM 3/11/2007F 6/11/2007
Prof. R. Saif Dr. L. bahammam
Role of Endodontic after dental traumatic injuriesM 10/11/2007F 13/11/2007
Dr. K. BaltoRotary Ni-Ti SystemsM 17/11/2007F 20/11/2007
Dr. K. BaltoRotary Ni-Ti SystemsM 24/11/2007F 27/11/2007
Prof. S. AbouzaidRotary Ni-Ti Systems M 1/12/2007F 4/12/2007
Faculty staffPracticalM 8/12/2007F 11/12/2007
Faculty staffPracticalM 29/12/2007F 1/1/2008
Faculty staffPracticalM 5/1/2008F 8/1/2008
Faculty staff Mid year ExamM 12/1/2008F 15/1/2008
Lecture Schedule for the First Half of the Academic Year 2007-2008
LectureLecture TitleDATEProf. S. AbouzaidOro-facial painM
F Prof. S. AbouzaidEmergency treatment of endodontic painM
F Dr. K. BaltoEndodontic surgery M
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F Dr. K. BaltoEndodontic surgery M
F
Dr. K. BaltoEndodontic surgery M
F Prof. M.GomaaEvaluation of Success and Failure:M
F Prof. M.GomaaNonsurgical surgical Endodontic RetreatmentM
F Prof. M.GomaaNonsurgical surgical Endodontic RetreatmentM
F Faculty staffpracticalM
F Faculty staffpracticalM
F Faculty staffpracticalM
F Prof. R. SaifEndodontic and Periodontic interrelationshipsM
F Prof. R. SaifDr. L. Bahammam
Restoration of endodontically treated teethM F
Faculty staffPracticalM F
Final ExamM F
Detailed course contents
Lectures' learning objectives and outlines
Module 1
Introduction, clinical requirements, and lecture schedule
Learning objectives: Each student should understand how to prepare and manage the patient inside
the clinic.
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Main points:1. Learn the student how to collect the patient's personal data , taking the chief
complain ( CC ) and history of CC2. Learn the student how to record these data in endodontic chart3. Learn the student how to perform extra-oral and intra-oral examination4. Learn the students how to use different sensitivity ( sensibility ) tests :
a. Cold testb. Hot testc. EPTd. Anesthetic teste. Cavity test
5. Learn the students how to perform mechanical testsa. Palpation testb. Percussion testc. Mobility test
6. Learn the students how to interpret the radiographs7. Learn the student the criteria for selection of suitable endodontic cases8. Each student should understand the indications and contraindications of
endodontic treatment9. Practical demonstration for all previous pulpal and periodontal tests
References:1. Cohen S. Diagnostic procedures. In Cohen S, Burns RC, Pathways of the pulp.
8th ed. St Louis: CV Mosby, 2002: Chapter (1), P.3-30.
Module 1Endodontic diagnostic procedures
Learning objectives: Each student should understand how to properly analyze the information
obtained from medical and dental histories, clinical examinations and diagnostic tests in order to make an accurate endodontic diagnosis .
Main points:At the conclusion of the lesson, each student should be able to:
1 - Understand the basic diagnostic procedures available for making an accurate endodontic diagnosis.
2 - Understand the importance and methods of obtaining complete medical and dental histories.
3 - Understand the procedures required for conducting a proper oral examination.4 - Understand how to correlate other dental problems of the patient as they relate to
the success or failure of the endodontically treated tooth.5 - Understand the differential diagnosis of pulpal versus periodontal pain6 - Understand the differential diagnosis of pulpal versus periodontal pathosis
Outline of Lecture:Diagnostic procedures in EndodonticsSteps of diagnostic process Subjective finding
the chief complaint, medical and dental histories, history of the present condition
o Inception:
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o Intensityo Qualityo Location: o Provoking factors: o Durationo Spontaneityo Attenuating factors:o Frequency and course
Type of pain according to the origin & site of pain-coming fromo Primary pain:o Heterotopic pain
Differential diagnosis of pulpal and periodontal pain Objective examination
Visual Examination Periodontal evaluation
o Percussion testo Palpation testo Mobility test
Pulpal evaluationo Sensitivity tests
Thermal stimulio Cold Tests:o Heat tests
Electric pulp testing Limitations of sensitivity tests
– False negative response– False positive response.
o Vitality test– Laser Doppler flowmetry – Pulse Oximetry
o Cavity Testo Transillumination Testo Biting Testo Wedging & Stainingo Radiographic examination– Gutta-Percha tracing
Differential diagnosis of pulpal and periradicular pathosiso Clinical featureo Radiographic feature
ReferencesCohen S. Diagnostic procedures. In Cohen S, Burns RC, Pathways of the pulp .
8th ed. St Louis: CV Mosby, 2002: Chapter (1), P.3-30.Module 1
Case selection and treatment plan
Learning objectives: Each student should understand how to properly analyze and evaluate the collected data obtained during clinical examinations and diagnostic tests. In addition,
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each student should understand how to evaluate the restorability of the affected tooth in order to decide the appropriate treatment plan
Main points: At the conclusion of the lesson, each student should be able to:
1. Understand how to correlate other dental problems of the patient as they relate to the success or failure of the endodontically treated tooth.
2. understand how to manage the medical compromise patients during endodontic treatment
3. Understand how to establish dental evaluate and restorability of the affected teeth
4. Understand how to establish the proper endodontic treatment plan5.
Outline of Lecture:Process of case selection & treatment planning.Evaluation of the patient:
Physically evaluation Management of medically compromised patients.
o Cardiovascular patiento Rheumatic fevero Artificial valve or with heart murmmuro Pace makero Hypertensiono Coronary artery bypass:o Dialysis patients.o Hemophilic patient.o Diabetic patiento Steroid Therapyo Cancers Patiento Allergicso Pregnancyo Kidney Disordero Infectious Diseaseso Hepatitis.o tuberculosis.o AIDs (human immuno deficiency virus HIV)o Organ Transplantso Orthopedic Implants
Evaluation of the tootho Morphological and anatomical consideration. o Pathological conditiono Previous treatment.o Location of the tooth.o Restorability.o Periodontal status.o Accessibility:o Availability:o Strategic value of the tooth.
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Psychological Evaluationo Motivation.o Difficult Patient.
Economic evaluation
Types of Endodontic treatment Emergency treatment. Single appointment root canal therapy.
o Guidelines for One appointment Root Canal Therapy o Indication contraindication advantages and disadvantages of single
appointment root canal therapy Multiple appointment root canal therapy.
References:1. Rosenberg P: Case selection and treatment planning. In Cohen S, Burns RC,
Pathways of the pulp. 8th ed. St Louis: CV Mosby, 2002: Chapter (4), P.91-102.
2.Module 2
Magnification devices in endodontics: the era of micro-endodonticsLecture outline for the students of the 5th year 2007
By: Khaled A. Balto; Associate Professor
Learning objectives:1. describe the operative advantages of using magnification devices in
endodontics2. enumerate and elaborate on the elements that constitute magnification devices3. describe the requirements for ideal surgical loups for each students
Lecture outline:
1. The era of micro-endodontics:a. The growing need for predictability and consistencyb. If a task can be seen better, it will be done better.
2. Magnification achieved by:a. Microscopesb. Loupes
3. Historical account on the use of magnifications in medicine and dentistry:a. Otollgistsb. Ophthalmologistsc. Neuro surgeonsd. Endodontists
4. Advantages of the use of MDs in endodontics:a. Visualization of the surgical fieldb. Evaluation of surgical techniquesc. Use of fewer radiographs
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d. Less occupation stress
5. Elements affecting the choice of magnification devices:a. resolutionb. field depthc. field widthd. weight e. working anglef. magnifying power
6. Resolution Vs. magnification7. classification of loupes based on lenses design: class I, II, III and IV8. The triad of microscope uses in endodontics9. Elements of magnification power in microscopic endodontics10. Operational utilization of magnification powers in micro-endodontics11. The ideal magnification device for you !!
Module 2
Problems encountered during root canal working length estimation
Learning objectives:1. describe the difficulties encountered during root canal treatment
radiography and the strategies used to overcome them2. describe the reasons for long and short electronic readings and the methods
to overcome them.3. enumerate the factors that control the quality of endodontic radiographs .
Lecture outline:
1. Importance of radiographic images in endodontic treatmenta. Information for diagnosisb. Information for treatment phasesc. Evaluation of success and failures
2. Requirements for Ideal radiographic image in endodonticsa. Tooth should be at the middle of the x-ray filmb. 2-3 mm of bone must be visible at the end of the apexc. Parallel technique=film is parallel to the long access of the tooth +
central beam at right angel
3. What are the difficultiesa. The need for paralleletyb. Rubber dam in situec. Cone placementd. Superimpositione. We do not know where the canal exitf. Mal-development!!!
4. The search for parallelisma. Film placement
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b. Cone placement
5. Film holding devise and their utilization during operative endodonticsa. Endo rayb. Xcp holders
6. Over coming the obstacles of the rubber dam during endodontic film taking7. Troubleshooting with an Apex Locator
a. Short readingb. No readingc. Long reading
8. Operational utilization of Electronic Apex Locators9. Problems encountered with films processing
a. Temperature of the solutionsb. Freshness of the solutionsc. Light exposured. Over-developinge. Under-fixing
Module 2
Rubber dam isolation in endodontic therapyLearning objectives:
1. learn techniques for single tooth isolation during root canal preparation2. learn the techniques for isolation of badly destructed teeth during root
canal treatment
Lecture outline:
1. When, Why and how2. Winged Vs. Wingless clamps3. Isolation technique for endodontic treatment
a. Wingless clampsb. Winged clamps
4. THE SPLIT-DAM TECHNIQUEa. Indicationsb. Technique
5 .Techniques of isolation of badly destructed teeth
Module 3 Role of Endodontic after Dental Traumatic Injuries
Learning objectives: Each student should identify the World Health Organization’s Application
of International Classification of dental traumatic injuries. Also he should understand
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the definition, clinical and radiographic appearance, general management ( including emergency and definitive treatment ) of each type of dental trauma ,
Main points: At the conclusion of the lesson, each student should be able to:
1. Understand why it is important to record the complete history of a traumatic injury.
2. Understand the diagnostic procedures of dental trauma to detect the problem of affected tooth and surrounding structures.
3. Know the importance of determination of pulp status stage of root development that affecting the treatment plan
4. Know and identify the definition, clinical and radiographic features, , emergency and definitive treatment of different uncomplicated and complicated coronal fractures.
5. Know and identify the definition, clinical and radiographic features, emergency and definitive treatment of uncomplicated and complicated coronal/ root fractures.
6. Understand the treatment objective of complicated coronal fracture of tooth with immature root canal is maintain vitality of root canal ( in vital tooth) to allow apexogensis process, or induce apical closure by apexification technique ( in nonvital tooth)
7. Know and identify the definition, methods used to diagnosis, clinical and radiographic features, emergency and definitive treatment of root fractures at different levels.
8. Know the different healing pattern of root fracture 9. Know and identify the definition, clinical and radiographic features,
emergency and definitive treatment of different types of luxative injuries (including concussion, subluxation, lateral luxation, extrusion, intrusion).
10. Understand the treatment objective of luxative tooth is reposition as soon as possible then to stabilize anatomically correct position and achieve optimize healing of the periodontal ligament and neurovascular supply, while maintaining esthetic and functional integrity
11. Know the definition, clinical and radiographic features, emergency and definitive treatment of avulsed tooth.
12. Know the important of fasting reposition of avulsed tooth as soon as possible in its anatomically correct position to optimize healing of the periodontal ligament and neurovascular supply, while maintaining esthetic and functional integrity.
13. Know the factors affecting the prognosis of replantation of avulsed tooth.14. Know the different typed of storage media for avulsed tooth15. Know the requirements of an acceptable splint (types & time of splinting)16. Know the endodontic treatment needed for an avulsed tooth based on:
Extra-oral period Stage of root formation
17. Know the three types of periodontal healing observed by Andreasen following replantation of an avulsed tooth.
18. . Explain the role of calcium hydroxide in the replantation of an avulsed tooth.19. Understand the sequelae of dental trauma on neurovascular structure and
periodontal attachment
Outline of Lecture: Diagnosis of traumatized tooth;
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History of dental trauma Classification of dental traumatic injuries (WHO) Enamel infraction :
o Definition o Diagnosiso Emergency treatmento Definitive treatment
Complete Enamel fracture o Definition o Diagnosiso Emergency treatmento Definitive treatment
Enamel–dentin fracture (Uncomplicated crown fracture o Definition o Diagnosiso Emergency treatmento Definitive treatment
Complicated crown fracture o Definition o Diagnosiso Factors affecting treatment plano Emergency treatmento Definitive treatment
Vital pulp therapy : Management of vital immature traumatized tooth
o Pulp cappingo Partial pulpotomyo Cervical pulpotomyo Definition of apexogenesis
Management of nonvital immature traumatized tootho Apexification technique
Crown root fracture (uncomplicated and complicated )o Definition o Diagnosiso Emergency treatmento Definitive treatment
Root fracture o Definition o Typeso Diagnosiso Emergency treatmento Definitive treatmento Time and type of splintingo Sequale of root fractureo Healing pattern of root fracture
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Luxation injuries o Definition of different types:
o Concussion. o Subluxation o Lateral luxationo Extrusive luxation o Intrusive luxation
o Diagnosiso Emergency treatmento Definitive treatment
Avulsion (exarticulation). o Definition o Diagnosiso Storage mediao Factors affecting treatment plano Emergency treatmento Splintingo Definitive treatmen-The effect of trauma on neurovascular structure
Pulpal responses to traumatic injuries Pulpal necrosis, pulp canal obliteration Internal root resorption
The effect on the periodontal attachment 1. surface resorption2. Inflammatory resorption 3. Dento-alveolar ankylosis and replacement resorption,
References:1. Trope M, Chivian N, Sigurdsson A, Vann WF: Traumatic injuries. In Cohen S,
Burns RC, Pathways of the pulp. 8th ed. St Louis: CV Mosby, 2002: Chapter (16), P: 603-645.
Module4
Emergencies in Endodontics
Learning objectives: After attending and reading this lecture, the student will be able to:
1. Define endodontic emergencies.
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2. Identify causes of endodontic emergencies as they occur before treatment (pretreatment), between appointments (interappointments), or after obturation (post obturation), as well as emergencies resulting from traumatic injuries.
3. Differentiate between what constitutes a true emergency as opposed to urgency.
4. Understand and describe the emotional status of the emergency patient and explain how this complicates diagnosis and treatment.
5. Describe and outline a system of subjective and objective examinations and radiographic findings to identify the source of pain (pulpal or periradicular):
a. Determine the source of pain. b. Establish a pulpal and periradicular diagnosis. c. Identify the etiologic factor of the pathosis. d. Design an emergency (short term) treatment plan.
6. Describe how to manage pretreatment emergencies. 7. Describe how to gain a profound anesthesia 8. Describe the emergency steps for treatment of painful irreversible pulpitis. 9. Outline the emergency steps involved in the treatment of necrotic pulp with
acute apical periodontitis. 10. Describe the treatment of acute apical abscess. 11. Outline the indications and procedure for incision and drainage. 12. List the factors that relates to greater frequency of interappointment flare- ups
and how to minimize their occurrence. 13. Describe treatment of acute apical periodontitis secondary to treatment. 14. List the causes of postendodontic emergency conditions. 15. Describe the emergency treatment required according to each condition. 16. Classify dental traumatic injuries that need emergency intervention. 17. Describe the emergency treatment plan required according to each type. 18. Detail the pharmacologic supportive therapy (analgesics, antibiotics, and anti-
inflammatory agents) used in emergency situations. Outline of Lecture:Endodontic emergencies:
Definitions .Differentiation of Emergency and Urgency
Emergency categories :I. Pretreatment emergencies .II. Interappointment emergencies.Postobturation emergencies.
Psychological and emotional management of the emergency patient. - System of diagnosis:
Medical and dental histories .Subjective examination.Objective examination .Periodontal examination .Radiographic examination .Diagnostic outcome.
I. Pretreatment emergencies: 1. Acute Pulpitis. 2. Acute Pulpitis with Acute Apical Periodontitis.3. Pulp Necrosis with periapical pathosis.
1. Acute Pulpitis: Clue for diagnosis Emergency treatment plan
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2. Acute Pulpitis with Acute Apical Periodontitis: Clue for diagnosis Emergency treatment plan
-The problem of inadequate pain control during endodontic emergencies -Anesthetic considerations for pulpally and or periapically affected teeth: . -Local anesthetic techniques:
Local infiltration. Regional nerve block. Supplementary injections:
Intraligamental Intraseptal Intrapulpal Intraosseous
3. Pulp Necrosis with periapical pathosis: a. Acute apical periodontitis with no swelling:
Clue for diagnosis Emergency treatment aim
b. Acute apical abscess with localized swelling. Clue for diagnosis Emergency treatment aim
c. Acute apical abscess with diffuse, extensive swelling: Clue for diagnosis Emergency treatment aim
-Incision and drainage: Basic incision and drainage tray setup Steps for incision and drainage
II. Inter Appointment Emergencies "Flare-up": Definitions Inter appointment emergency conditions:
- Incomplete removal of pulp tissue. - Apical periodontitis secondary to treatment. - Recrudescence of a chronic apical periodontitis.
- Incomplete removal of pulp tissue: Possible causes. Management.
- Apical periodontitis secondary to treatment: Probable causes: "separate or in conjunction" Microbial factors influencing the development of painful flare-up How can microorganisms cause flare-up? Mechanical injuries Chemical injuries Type of pain Emergency treatment
-Recrudescence of a chronic apical periodontitis. Emergency treatment Preventive measures to infectious flare ups
III. Post-obturation emergencies Causes Emergency treatment
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Emergency treatment for traumatized teeth. Classification Key points for diagnosis Emergency treatment
References:1. Weine F S : Endodontic Therapy, Ed 6, Mosby, Inc, 2004, Chapter 3, P 72.2. Cohen S & burn R: Pathways of the pulp Ed 8, Mosby, Inc, 2002, Chapter 2,
P 31
Module 4Endodontic and Periodontic Interrelationships
Tackling the vicious circle: Endo Perio Lesions
Learning objectives :1. Delineate the anatomic pathways of communication between
the dental pulp and periodontal ligament.2. Describe the effects of pulpal disease and endodontic
procedures on the periodontium.3. Describe the effects of periodontal disease and procedures on
the pulp.4. Identify which clinical diagnostic tests and finding are
important in the differential diagnosis of periodontal- endodontic problem.5. Understand treatment requirement and sequencing according
to diagnostic findings.6. Recognize when treatment has been successful or has failed
and develop alternative treatment plan7. Identify which complex cases should be considered for
referralOutline of Lecture:
1. Intercommunication between pulpal and periodontal tissues:a. Embryonic originb. Influence of pulpal pathologic conditions on the periodontal tissuesc. Influence of periodontal inflammation on the pulp
2. Definitions:a. Vital pulpb. Healthy pulpc. Pulp and periodontal lesionsd. Pulpal lesionse. Periodontal lesionsf. Combined lesions
3. Pathways of intercommunication between pulp and periodontal tissues:a. Apical foramenb. Lateral canalsc. Exposed dentinal tubulesd. Palato-gingival groovese. Vascular systemsf. Neural pathwaysg. Common vascular lymphatic drainage
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h. Root fracture4. Natural history of endodontic infections5. Theoretic pathways of osseous lesions:
a. Primary endodontic lesionsb. Primary endodontic lesions with secondary periodontal involvementc. Primary periodontal lesionsd. Primary periodontal lesions with secondary endodontic involvement e. True combined lesionsf. Concomitant pulpal and periodontal lesions
6. Differential diagnosisa. Tactic’s of assessmentb. Parameters:
i. Clinicalii. Radiographic
iii. Histopathology7. Clinical cases
References: 1- Wang HL, Glickman GN: Endodontic and periodontal interrelationship. In Cohen S, Burns RC, Pathways of the pulp. 8th ed. St Louis: CV Mosby, 2002: Chapter (17), P: 651-664.
Module 5 Endodontic Surgery
Learning objectives:At the conclusion of the lesson, each student should be able:
1. Understand the potential false and true indications , and contraindications of endodontic surgery
2. Understand the importance of starting with conventional endodontic treatment before deciding the endodontic surgical approach.
3. Know the definition, objectives and indications of different periapical surgical procedures.
a. Incision and drainage b. Trephinationc. Apical curretaged. Apicoectomy. e. Retrofilling (retroseal)
4. Know the indications and contraindications of different flap design5. Understand how to locate the apex of the affected root6. Understand how control the bleeding during surgical procedures to improve
the vision7. Understand how to perform the apical end preparation.8. Understand the advantages of using ultrasonic system during retro-
preparation.9. know the properties of different retrofilling materials to be able to choice the
suitable one10. Know the postoperative instructions and care to improve the prognosis of the
case11. Understand the importance of using endodontic microscope12. Understand the characters and clinical significance of isthmus13. Identify the differences between, the indications and contraindications of
corrective surgery including (hemisection, bicuspdization and root
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amputations) to preserve the endodontic- periodontal involved multirooted teeth
14. Understand the indications and contraindications of intentional reimplantation15. Understands the indications and contraindications of endodontic endosseous
implant
Outline of Lecture:
Endodontic SurgeryDefinition
• Traditional Endo-surgery• Microsurgery
Indication of endodontic surgery• False indication• True indication• Indication of microsurgery
Contraindication of Endodontic SurgeryObjectives of endodontic surgeryprocedures of periapical surgery
1- Incision & drainage2- Cortical osteotomy (Trephination).3- Periradicular curettage.4- Apical resection .5- Retrofilling (Retroseal).
Incision & drainage:• Definition.• Objectives• Indications
Cortical osteotomy• Definition.• Objectives of cortical trephination• Indications
Periradicular curettage• Definition.• Objectives • Indications
Apical resection • Definition.• Objectives • Indication
Retrofilling• Definition.• Objectives • Indication
Steps of apical surgery• Flap design.• Localization of the apex.
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• Hemostasis• Root-end preparation.• Root end resection• Indication• Root beveling• Objectives of root beveling• Indication of root end resection • Drawbacks• Root-end cavity preparation • Ultrasonic systems• Retroseal.• Properties of ideal retrofilling material • Types of retrofilling materials• Advantages and disadvantages
• Postoperative care and instruction• Suture removal and evaluation
Microsurgery• Magnification• Instruments • Endodontic Microscope• Ultrasonic • Micro contra • Micro mirror• Illumination• Advantages of microsurgical approach • Classification of endodontic microsurgical case• Isthmus characteristics
Corrective Surgery1- Root resection (root amputation).2- Tooth hemisection.3- Bicuspdization.4- Intentional replantation.5- Endodontic endosseous implant.
• Definition• Indication and contraindication• Factors affecting prognosis of intentional reimplantation
References:Kim S: Endodontic Microsurgery. In Cohen S, Burns RC, Pathways of the pulp. 8th ed. St Louis: CV Mosby, 2002: Chapter (19), P: 683-725.
Module 6Evaluation of Success and Failure:
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Learning objectives:After attending this lecture, the student should be able to:- Define success- Recorganize signs of successful root canal treatment- Describe unsuccessful root canal treatment- Describe the most common modalities used to determine success or failure- Describe how to explain the prognosis to the patient- Evaluate and estimate prognosis before, during, and after treatment- Describe the importance of recall appointments
Lecture outline:- What is success?- Prognosis:
* Success rates* When to prognosticate* How to prognosticate
- Variability of treatment results- Factors influencing success and failure- When to evaluate- Methods of evaluation- Causes of endodontic failures, recognition, prevention, and retreatment
References:* Pathways of the Pulp "Cohen and Hargreaves" (2006)* Principles and Practics of Endodontics "Walton and Torabinjad" (2002)
Module 6
Nonsurgical Endodontic Retreatment (I):
Learning objectives:After attending this lecture, the student should be able to:- Recorganize signs of successful root canal treatment- Identify causes of persistent apical periodontitis- Describe differences from intial treatment- State rational and indications for nonsurgical retreatment- State rational and indications for surgical retreatment- Discuss considerations for case selection for nonsurgical retreatment- Discribe the basic armamentarium and techniques for nonsurgical retreatment- Outline methods of detecting hidden and missed canals- Describe how to regain access to the apical foramen- Describe methods and techniques for removal of gutta-percha
Lecture outline:- Etiology of persistent apical periodontitis- Diagnosis of postreatment disease- Treatment planning
* Nonsurgical versus surgical retreatment- Nonsurgical endodontic retreatment
* Coronal Access Cavity Preparation
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* Post RemovalPost Removal techniquesPotential complications of post removal
* Regaining Access to the Apical AreaMisses canalsCalcified canalsGutta-percha removal: Using rotary systems to remove gutta-percha (R-endo) Conventional method of gutta-percha removal (heat and solvents)
Managing solid core obturatorsPaste retreatmentSilver point removal
References:* Pathways of the Pulp "Cohen and Hargreaves" (2006)
Nonsurgical Endodontic Retreatment (II):
Learning objectives:After attending this lecture the student should be able to:- Recognize the causes of instrument separation and its prevention- Evaluate and estimate the prognosis of instrument separation- Be familiar with the different methods for management of separated instruments- Identify and define canal impediments- Outline techniques for management of canal impedinebts- List the causes of root perforations- Describe techniques of perforation repair
Lecture outline:* Removal of Separated Instruments
Causes of Instrument SeparationKey consideration in assessing separated instrumentPrognosisRemoval Techniques
* Management of Canal Impediments* Finishing the Retreatment
- Repair of perforations* Factors affecting the prognosis* Pro-Root MTA* Steps of perforation repair
- References:* Pathways of the Pulp "Cohen and Hargreaves" (2006)
Module 7Restoration of endodontically treated teeth
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Learning objectives: After attending this lecture the student should be able to:
1. State the effect of restorative procedures and materials on the pulp.2. Describe the effect of restorative procedure on the pulp. 3. Describe the effect of restorative materials on the pulp. 4. Identify the risk of possible post restorative endodontic complication. 5. List and describe the indications for pre-restorative "prophylactic"
endodontics. 6. Describe how to make a pre-restorative evaluation. 7. Discuss the effect of endodontics on the tooth. 8. Describe post endodontic treatment planning. 9. Identify guidelines for posts use. 10. Identify guidelines for post selection. 11. Recognize canal selection for post foundation. 12. Describe the different modalities of molars restoration after root amputation.
Outline of Lecture:I. Restorative dentistry and the vital pulp:
Effect of restorative procedures and materials on the pulp. Risk of post-restorative endodontic complications. Indications of pre-restorative endo-therapy "prophylactic endodontics" Pre-restorative evaluation:
A) Endodontic evaluation. B) Periodontal evaluation. C) Restorative evaluation. D) Esthetic evaluation.
II. Restorative dentistry and the pulpless tooth: Effect of endodontics on the tooth.
Changes in endodontically treated teeth. Treatment planning:
Important considerations in treatment planning. Basic components used in restoration of pulpless teeth:
Need for posts. Guidelines for posts use. Possible overuse of posts.
III. Restoration of teeth after root amputation
References:1. Wagnild GW, Mueller KI: Restoration of the endodontically treated tooth. In
Cohen S, Burns RC, Pathways of the pulp. 8th ed. St Louis: CV Mosby, 2002: Chapter (22), P: 765..
Module 7Bleaching Of Discolored Teeth
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Learning objectives: After attending theses lectures, the student should be able to:-
1- Identify the causes of teeth discolorations. 2- Describe and differentiate between enamel and dentin discolorations. 3- Describe the internal bleaching techniques. 4- Describe the external bleaching techniques.
Outline of Lecture:
- Causes of Discolorations. - Natural. - Iatrogenic.
- Endodontically related discolorations - Obturating materials. - Remnants of pulpal tissue. - Intracanal medications.
- Bleaching materials. - Hydrogen peroxide. - Sodium perborate.
- Internal bleaching techniques - Thermocatalytic technique. - Walking Bleach technique.
- Complications of bleaching. - External bleaching techniques.
References:1. Walton RE, Rotstein I: Bleaching of discolored teeth: Internal and external. In
Walton R, Torabinjad M: Principles and practical of endodontics. 3rd Ed. W.B: Saunders Company, 2002:Chapter (19), P: 331-345
2 - CLINICAL PROTOCOL
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1. The clinic timings will be 3 hours only. 2. The student should attempt to treat single canaled teeth first then move on
two or three canaled teeth. 3. If a single canaled tooth is not available, the student can initiate a two
canaled bicuspid or molar. 4. The molar tooth should be initiated when the student has at least performed
root canal therapy on two root canals. 5. If a two canaled bicuspids is not available the student can replace it with two
single canaled bicuspids or anterior teeth. 6. The cases selected for treatment should be of routine nature and the students
should discuss the case with instructors prior to initiating endodontic therapy.
7. It is the responsibility of the student to coordinate with the booking area regarding appointments for patients.
8. Case started with one instructor should be preferably completed under the supervision of same instructor.
9. The student start his/her treatment with taking chief complains, performing subjective and objective examination of the case.
10. The supervisor should discus and accepts the diagnosis of the case.11. Strict aseptic technique will be followed in clinic and use of rubber dam will
be mandatory. 12. It is important to have the endodontic therapy records properly filled out,
signed and evaluated by the instructors in the endodontic sheet. 13. The radiographs belonging to each case should be properly arranged on
mounts available at radiology. The radiographs and patient records should be handed over to instructors at the earliest opportunity. Each student must fulfill all endodontic steps of assigned teeth to the satisfaction of the instructor.
It is required that each student submits the finished endodontically treated teeth with the radiographs including five radiographs as follows: 1. Pre-operative radiograph2. Working length determination radiograph 3. Master apical file radiograph4. Intermediate radiograph (i.e.) a radiograph after cementation of the master
cone and two accessory cones.o Or radiograph of properly selected master cone
5. Post operative radiograph (i.e.) a radiograph after cutting the excess gutta percha, cleaning the access, removal of the clamp, the rubber dam and placement of temporary filling.
Each step should be evaluated and signed by supervisor in the endodontic sheet. All the radiographs and the signed sheet of the test case should be submitted to the
division at the end of the clinical session. Satisfactory completion of the clinical course is based on the following criteria:
1. Each student must follow accepted endodontic principles in treating the case from pre-operative examination selection of the case until filling of the root canal.
2. Each student is required to follow radiographic method in length determination.
3. Each student is required to follow the step-back technique in preparing the root canal system except in some cases step-down technique will be used.
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4. Each student is required to follow cold compaction technique to obturate of root canal system.
5. In addition, each student must demonstrate his/her knowledge of the principles of radiography as applied to endodontic therapy by obtaining adequate radiographs at various stages during the endodontic procedures.
Quick Guidelines for Treatment of an Endodontic Case
1. First appointment:
a. Review and update medical history – take medical history if not previously taken.
b. Question patient as to area of problem (chief complaint) and what type of symptoms patient is having. All has to be documented on the Endo therapy record.
c. Take preoperative film of suspected area if you don’t have a recent film. Review preoperative film for periapical changes, tooth morphology, pulpal morphology, caries or restorations impinging on pulp, etc.
d. Perform necessary diagnostic tests:
i. Sensitivity tests both electric pulp tester (EPT) and thermal “ICE” whenever are applicable to determine the condition of the pulp.
ii. Percussion and palpation to check the periapical.iii. Test cavity in case of full coverage.iv. Anesthesia test in case of diffuse pain.v. Fistulous tracking test in case of sinus tract opening.
If information is sufficient, arrive at a diagnosis as to which pulp is involved and what treatment is necessary .
e. If endodontic treatment is required, explain to the patient what you are going to do and why it is necessary.
f. Anesthetize the tooth. After you disinfect the tooth and the area.
g. Isolate involved tooth with rubber dam (only tooth being treated needs to be isolated). Check with your instructor in case rubber dam cannot be placed.
h. Prepare access opening and refine it so each canal be entered. Debride pulp chamber. Irrigate with sodium hypochlorite. Use other solution if rubber dam is leaking.
i. Determine the working length of the canal.
j. Instrument the canal to the working length at least to the size that removes most of the pulpal tissues. During instrumentation, irrigate frequently with
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hypochlorite if the canal is difficult to negotiate, discuss with your instructor. After instrumentation, irrigate and dry canal.
k. Place a cotton pellet in chamber and close access opening with cavit (cotton pellet should be blotted almost dry before placement). Consult with your instructor the best type of medication in your case if its indicated.
2. Second appointment:
a. Anesthetize the tooth b. Isolate the tooth with rubber dam c. Remove the temporary and the cotton pellet d. If the tooth is asymptomatic and no drainage present in the canal do the
following:
i. Complete instrumentation ii. Irrigate with NaOCliii. Dry canal with paper point iv. Fit the master cone and two accessory cones using cold compaction
technique and radiograph the tooth. v. Complete canal filling procedure vi. Remove excess filling material vii. Place permanent or temporary filling material viii. Remove the rubber dam, the clamp, put temporary filling and take
final radiograph
e. If the tooth is symptomatic and / or drainage is present in the canal(s), do the following:
i. Irrigate the canal ii. Re-debride the canal and complete instrumentation iii. Dry the canaliv. Place Ca(OH)2 , cotton pellet and temporary filling.
NOTE: These four steps may have to be done for several appointments until tooth is asymptomatic and no definite drainage is occurring into the canal(s), or Ca (OH)2 can be used in such cases.
3. Third appointment:
a. Anesthetize the tooth b. Isolate the tooth with rubber dam c. Remove the cavity and the cotton pellet d. If the tooth is asymptomatic and no drainage is present in the canal, fill it as
outlined in the second appointment step (d).
Always consult with your instructor before dismissing the patient.
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Assessment Guidelines Prior to taking the approval of competency examination:1. The student must attain of an at least 80% in attendance sheet of both lectures
and clinical session. 2. The student must fulfill of at least 60% of clinical requirements with
satisfactory evaluated score 3. If the student has no completed cases at the scheduled end of the fifth year,
he/she may receive failing grade
Marks of the clinical requirements
Tooth 3 Ant.× 5 Single RC PM Double RC PM Molar3 or 4 RC
Marks 15 5 8 12
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Course Related MaterialsContents
1- Examples of Clinical requirments
2- Sample of:
a- Module Exams
b- Mid-year Exam
c- Final Exam
Instructor Reflection
Instructor Reflection on the course:
The current course fulfills what the student need to know at this stage of
education. The course enables the student to acquire recognition skill to diagnose and
treat the pulpally and periradicularaly involved teeth with the least iatrogenic errors.
Strength Points:
1. It is fully applied course
2. Experienced teachers
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3. Adequate teaching facilities
4. The clinical explanation and demonstration is performed by professors and
lecturers of department even the clinical demonstration (highly qualified staff)
not by genior members (demonstrators). This will allow the student at the end
of course , be able to manage and treat every simple and complicated
endodontic involved cases either with single rooted or multirooted teeth with
satisfactory result
5. The student is allowed to treat sufficient number of clinical cases so that
he/she will get sufficient experience to manage the CC cases in the next year..
6. Every two year, the course subjects redistributed over the staff allow the
enhancement and development of the teaching
7. The student start to use the rotary systems for cleaning and shaping of the root
canal system of some clinical cases
8. The student start to use the portable X-ray machine which facilitate
radiography in the clinical sessions
Weak Points:
1. Insufficient number of demonstrators comparable with increasing the number
of the students every year.
2. Shortage of x-ray devices inside the clinical section lead to waste time during
clinical procedures
3. Lack of qualified radiographer technician lead to several remake of x-ray film
by student, increasing the waste time and the hazard of radiation
4. shortage of EAL`s in the clinical area
5. portable X-ray units are not enough compared with large number of students
Innovation and plan for future:
1. Each student successfully use the rotary root canal files for treatment of all
clinical cases
2. Each student learn to use the digital radiographs
3. Up to date course every year
4. e-teaching
5. E- sheet marking for evaluation of the studen
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