Interview: “Bioactive endodontics is the future”

Search Dental Tribune

Interview: “Bioactive endodontics is the future”

E-Newsletter

The latest news in dentistry free of charge.

  • This field is for validation purposes and should be left unchanged.
Dr. James Bahcall and colleagues are exploring the possibilities of cryotherapy in endodontic dentistry. (Photograph: Dr. James Bahcall)
Monique Mehler, Dental Tribune International

By Monique Mehler, Dental Tribune International

Mon. 8. July 2019

save

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.

Leave a Reply

Your email address will not be published. Required fields are marked *

New Zealand increases dental grant after 25 years

E-Newsletter

The latest news in dentistry free of charge.

  • This field is for validation purposes and should be left unchanged.
Oral health inequality in New Zealand has been exacerbated by decades of inaction and insufficient funding by consecutive governments. (Image: AsiaTravel/Shutterstock)

WELLINGTON, New Zealand: Oral healthcare campaigners in New Zealand are celebrating an increase in the special needs dental grant and a broadening of the criteria that patients need to meet in order to receive it. The grant had not been increased since the 1990s, despite substantial rises in the cost of living and around 40% of the population not being able to afford a visit to the dentist.

The Ministry of Social Development dental grant more than tripled on 1 December—from NZ$300 to NZ$1,000 (€181 to €605)—and can now be used for immediate and essential dental treatment such as dental restorations and the treatment of gingival infections. Previously, the grant had only been available to patients who were in pain and required emergency treatment, as reported by state broadcaster Radio New Zealand.

The increase followed a mid-November report that highlighted stinging inequalities in the accessibility of dental care in New Zealand. According to the Tooth Be Told report, in 2020, 40% of New Zealand adults and half of the Māori and Pasifika population were unable to afford dental treatment. In the same year, New Zealand had the highest unmet need for adult dental care among 11 comparable countries, and around 250,000 adults had teeth extracted owing to dental caries.

According to the New Zealand Dental Association (NZDA), which has long campaigned for greater equality in oral care, the increase constitutes a first step towards improving access to dental treatment for low-income adults. “The NZ$300 limit had not increased for a quarter of a century. The association is pleased that our advocacy for increasing access to dental care for low-income families has succeeded,” NZDA President Dr Erin Collins said in a statement.

Patients do not need to pay back the NZ$1,000 grant, and it can be used to fund a number of dental procedures over a 12-month period. Last year, around 40,000 New Zealand beneficiaries received advanced benefit payments for emergency dental care, and the Ministry of Social Development said that the changes to the grant would enable up to 50,000 adults to meet their dental costs without having to take on debt.

Leave a Reply

Your email address will not be published. Required fields are marked *

advertisement
advertisement