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Interview: “Bioactive endodontics is the future”

Dr. James Bahcall and colleagues are exploring the possibilities of cryotherapy in endodontic dentistry. (Photograph: Dr. James Bahcall)
Monique Mehler, Dental Tribune International

Monique Mehler, Dental Tribune International

Mon. 8. July 2019

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In the medical field, cryotherapy is used in an effort to relieve pain and swelling after soft-tissue management or surgery. Currently, researchers in the U.S. are exploring the possibilities and limitations of vital pulp cryotherapy in clinical trials. Dr. James Bahcall, who plays an important role in these investigations, is a clinical professor at the University of Illinois at Chicago. He spoke to Dental Tribune International about the studies.

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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College of General Dentistry publishes new edition of Standards in Dentistry

The updated edition of Standards in Dentistry reaffirms the College of General Dentistry’s commitment to supporting dental professionals with clear, evidence-based guidance. (Image: Evgenii/Shutterstock)
Dental Tribune International

Dental Tribune International

Mon. 20. October 2025

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LONDON, England: The UK College of General Dentistry has released the third edition of Standards in Dentistry, a comprehensive and freely accessible online manual that consolidates current standards and guidelines for primary care dentistry. Serving as a practical reference for both individual and practice-wide quality assessment, the compendium outlines basic and aspirational standards across 17 key areas of dental practice.

Focusing on practitioner processes rather than treatment outcomes, the manual adopts the college’s established notation system for grading recommendations as aspirational, basic or conditional. Fifteen of these areas—including consultation, diagnosis and endodontics—have been comprehensively updated from the second edition to reflect recent evidence and contemporary developments. In addition, two new sets of standards have been introduced, covering aesthetic and digital dentistry.

Standards in Dentistry also summarises more than 100 standards, guidelines and advisory publications issued by the college and over 50 other national and international organisations. It signposts readers to further relevant resources, professional bodies and legislation.

Moreover, summaries of 18 clinical and non-clinical topics from the second edition have been revised, including sections on clinical governance and emergency dental care. Four summaries have also been newly added, addressing antimicrobial prescribing and stewardship; environmental sustainability; equality, diversity and inclusion; and mental health and well-being.

The first edition of Standards in Dentistry was published by the former Faculty of General Dental Practice (FGDP) in 2006, combining the functions of two earlier FGDP publications: Self-Assessment Manual and Standards and Guidelines for Structure and Process in Dental Practice. The second edition followed in 2018. Since inheriting the FGDP’s portfolio of guidance and standards publications in 2021, the college has made them widely available to the profession. The new edition represents the college’s first comprehensive update of a flagship FGDP work and is the first standards document to feature its new branding since the recent grant of a coat of arms.

Celebrating the publication of the latest edition, Dr Roshni Karia, president of the College of General Dentistry, said in a press release: “The provision of guidance and standards by dental professionals, for dental professionals, is central to the mission of the college, and Standards in Dentistry is an indispensable reference guide offering a comprehensive pool of information for all those working in general dental practice and primary dental care.”

She continued: “Generations of oral healthcare professionals across the world have been supported by this and other publications of the former FGDP in their journey to provide effective clinical care and better outcomes for their patients, and the college will continue to provide this assistance for future generations. On behalf of the college, I would like to thank all the authors for their hard work, and the many college members and external consultees who gave their time to provide feedback and suggestions.”

Members, subscribers and new users can view the full document free of charge here after logging in or registering.

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