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.

Tags:

Lead author Dr Bushra Ahmad, assistant professor of periodontics at Tufts University School of Dental Medicine in Boston, told Dental Tribune International: “Our team was interested in investigating whether omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), could influence inflammatory pathways in both the oral cavity and the systemic circulation.”

She continued: “Although omega-3 fatty acids are recognised for their anti-inflammatory properties, their effects on oral inflammatory markers in humans have not been well established. This made the topic particularly relevant, as it may help us better understand whether a systemic nutritional intervention could complement established approaches to managing oral inflammation.”

The study involved 240 patients with stable coronary artery disease and who were undergoing statin therapy. For 30 months, patients received either a high-dose prescription formulation of EPA and DHA or no omega-3 supplementation. For the oral analysis, gingival crevicular fluid was collected from both maxillary quadrants. The researchers then compared the oral inflammatory markers in the fluid and systemic inflammatory markers in the blood between the test and control groups.

The analysis found that the omega-3 group had significantly lower levels of one oral inflammatory marker in the left quadrant. These patients also had a significantly lower neutrophil-to-lymphocyte ratio, a marker of systemic inflammation that has been associated with cardiovascular outcomes. “The findings suggest that omega-3 fatty acids may have a potential role as an adjunct to established mechanical plaque control measures by helping reduce oral and systemic inflammation,” Dr Ahmad explained.

“Interestingly, the reduction in the oral inflammatory marker was observed on the left side but not the right. We proposed that toothbrushing behaviour and handedness might have contributed to this difference, as right-handed individuals may remove plaque more effectively from the left side,” Dr Ahmad commented. She added that, since handedness was not recorded in the study, this explanation should be considered exploratory and requires further investigation.

The study forms part of broader collaborative research exploring the relationship between periodontal and systemic health. Through several ongoing projects, the researchers are examining how periodontitis and oral inflammation may be linked to cardiovascular disease, cognitive function and systemic inflammation. “Our goal is to contribute to a more integrated understanding of oral health as an important component of overall health,” Dr Ahmad said.

Other nutritional approaches to modulating oral inflammation are also being explored. Dental Tribune International has recently reported on a fasting-mimicking diet investigated as an adjunct to non-surgical periodontal therapy and on an association between a plant-rich Mediterranean diet and lower periodontal disease severity and inflammatory marker levels.

Dr Ahmad cautioned that the findings of the present study should not be generalised to other patient populations or to other omega-3 supplements. Further research is needed to help determine whether the findings translate into long-term periodontal and cardiovascular benefits and whether similar effects are observed in broader patient populations.

The study, titled “Omega-3 fatty acids and oral and systemic inflammation: A secondary analysis of a randomized trial in patients with coronary artery disease”, was published in the August 2026 issue of the Journal of the American Dental Association.

Topics:

Tags: