Dr. Bahcall, in collaboration with other researchers, you have published an article titled “Introduction to vital pulp cryotherapy” in which the use of cold therapy in endodontics is explored. What is the history behind the use of  cryotherapy in vital pulp therapy?
There has been a paradigm shift in vital pulp therapy over the last three to five years. We have gained a better understanding of pulp biology from caries involvement, and there have been new developments in bioceramic materials. We have also come to view vital pulp therapy as a permanent rather than temporary dental treatment. All of this allowed us to develop vital pulp cryotherapy. Although we did not invent cryotherapy, we were the first to bring it into endodontics for vital pulp treatment. Medicine has demonstrated since the early 1960s that cryotherapy can reduce nerve pain response, inflammation and hemorrhaging, and can help reduce a patient’s need for postoperative pain medications.

Vital pulp cryotherapy is performed when a carious lesion is removed from a tooth and there is direct or indirect exposure of the dental pulp. The cryotherapy portion of treatment involves placing sterile ice on the exposed pulp. The application of ice lowers the temperature of the tooth’s blood and nerve supply, and this has been shown clinically to reduce inflammation and post-treatment tooth pain. It is important to note that, after performing the cryotherapy procedure, 17% EDTA irrigation is applied, a bioceramic material is then placed over the directly or indirectly exposed pulp, and the tooth is restored with a permanent restorative material, such as composite or amalgam.

How is this different from classic root canal therapy?
Vital pulp cryotherapy involves treating a carious tooth while maintaining the tooth’s pulpal tissue as opposed to root canal therapy that involves removal of the entire dental pulp and replacing it with gutta-percha and sealer.

What are the benefits of vital pulp cryotherapy, and what are its limitations?
The benefits of vital pulp cryotherapy are its ability to eliminate pulpal inflammation and a patient’s tooth pain without the complete removal of the dental pulp. By maintaining the dental pulp, we are able to maintain the tooth’s strength by not having to remove root dentin, the pulp–dentin complex and the pulp’s immune defense mechanisms. Another benefit of vital pulp cryotherapy is the treatment time for the patient. Once the patient is properly anesthetized and the caries is removed, the actual time to complete the vital pulp cryotherapy portion is 10–15 minutes. In comparison, root canal therapy can take 1–2 hours. Vital pulp therapy procedures are completed in one patient treatment visit.

The limitation of vital pulp cryotherapy is that this procedure can only be performed on vital teeth that can be permanently restored with composite or amalgam immediately after the procedure. It cannot be performed with necrotic or partially necrotic pulps. A clinician cannot prepare a vital pulp cryotherapy treated tooth for a crown. The reason for this is that, once the vital pulp cryotherapy is completed, you do not want to do any further dental treatment to this tooth because you risk the possibility of restimulating the pulpal inflammation.

In your article, you conclude that further clinical studies are needed in order to establish the long-term prognosis of a pulp after vital pulp cryotherapy. What are your expectations?
As with any new dental procedure, clinical cases and studies need to be published in peer-reviewed dental literature. Vital pulp cryotherapy is no different. We have published case reports and have been conducting clinical research on vital pulp cryotherapy. Our study has found that patients have less postoperative pain immediately after treatment and maintain normal pulp vitality at six months and at one year after treatment. This is as far as our clinical study has patient recalls at this point. Our expectations are, firstly, to demonstrate that this is a valid procedure for vital pulp treatment beyond one year. Secondly, we hope to encourage our dental colleagues to publish vital pulp cryotherapy case reports and clinical research in the dental literature.

How do you think vital pulp cryotherapy will advance endodontics?
We feel that vital pulp cryotherapy will help to broaden the type of pulpal treatment that we can provide to our patients. It also will be an important treatment component in bioactive endodontic therapy. Bioactive endodontics is the future. By definition, “bioactive” means having a biological effect. Bioactive endodontics in conventional endodontic treatment includes vital pulp cryotherapy and regenerative endodontics. It involves the use of bioactive materials and the patient’s own blood to help heal, as in the case of vital pulp cryotherapy, and to replace the gutta-percha and sealer in classic root canal therapy.

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The first webinar, “Prosthetic dentistry in the digital era: How technology changed our workflows”, will take place on 25 February at 7 p.m. CET and will be presented by Prof. Stefan Vandeweghe, head of the Department of Reconstructive Dentistry at Ghent University in Belgium. A leading authority in reconstructive and digital dentistry and the author of more than 60 international publications, Prof. Vandeweghe will explore how artificial intelligence and cloud-based platforms are transforming traditional prosthetic dentistry workflows. The webinar will demonstrate the application of digital technologies across a wide range of scenarios—including tooth-supported restorations, advanced aesthetic cases and full-arch implant rehabilitation. The webinar will be presented in English and be available with German captions and voice-over.

The second webinar, “Managing implant restoration complications: A practical guide for clinicians”, will take place on 12 March at 5 p.m. CET. Dr Varisha Parikh, a prosthodontist in private practice in Los Angeles in the US and a clinical instructor in the advanced prosthodontics residency programme at the University of California, Los Angeles, will present the webinar. She will teach participants how to identify common implant restoration complications, determine their underlying causes and apply a systematic approach to timely and accurate assessment and diagnosis.

The Dentsply Sirona Academy’s implant dentistry curriculum supports a structured continuing education pathway built around complete clinical workflows for common case types, delivering an interactive learning experience tailored to clinicians’ experience levels and individual learning preferences. Developed in collaboration with international key opinion leaders and world-renowned clinicians, the series consists of 16 courses, starting from foundational learning, progressing to procedure-based courses—covering the full implant workflow for various cases—and reaching mastery level—addressing advanced materials and techniques.

The course series covers a broad spectrum of implant treatments—from single-tooth cases to advanced and complex implant procedures—guiding participants through every stage of implant therapy. The goal is to help clinicians stay current with evolving materials, technologies and techniques by equipping them with the knowledge, skills and inspiration to apply them in practice, supporting clinical, technical and practice excellence.

To learn more about Dentsply Sirona’s range of implant dentistry courses, please visit the website.

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