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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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Osstem Implant announces offerings for visitors and dealers at IDS

Osstem Implant presented the latest implant technologies at IDS 2023. (All images: Osstem Implamt)

Tue. 18. February 2025

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SEOUL, South Korea: Osstem Implant has announced plans to conduct strategic consultations with dealers, manufacturers and distributors looking to expand their product lines or distribution networks through the company at the upcoming International Dental Show (IDS). During the five-day event, Osstem Implant will showcase its full portfolio—including Hiossen Implants, Toplan, Osstem Orthodontics and Implacil—offering dentists and dealers a wider range of product options.

The K3 dental unit chair will be on display at IDS 2025.

The K3 dental unit chair will be on display at IDS 2025.

Visitors to Osstem Implant’s booth will have the opportunity to explore the company’s latest innovations, including:

  • the TS SOI (Super Osseointegration) implants featuring the patented fourth-generation surface technology,
  • advanced implant kits designed to simplify clinical procedures, and
  • cutting-edge medical equipment that enhances dental implant treatment.

A special highlight will be Osstem’s K3 unit chair and the T2 CBCT system, which delivers enhanced image quality for improved diagnostics in complex cases.

The Osstem Implant IDS stand will also feature a photo booth where visitors can take commemorative photos with company mascot Leoger and enter the draw to win prizes.

Osstem Implant has positioned itself as a strong business partner for manufacturers and suppliers looking to enter the South Korean market or expand their global distribution networks. The company states that it holds nearly 50% of the South Korean dental market and has a domestic sales force of 630 professionals. With 37 subsidiaries in 32 countries and a global sales team numbering nearly 2,000 members, Osstem Implant is currently active in over 100 countries.

To support its partners, Osstem Implant regularly hosts dealer seminars, both online and in person, providing comprehensive product training to enhance sales performance. Additionally, the company invites dealers to its annual Osstem World Meeting, where they can learn about Osstem’s long-term vision and discover its latest advancements.

The Osstem World Meeting, held in Seoul on 27 and 28 April 2024, attracted 1,500 dental professionals from 56 countries.

The Osstem World Meeting, held in Seoul on 27 and 28 April 2024, attracted 1,500 dental professionals from 56 countries.

Dlegates had the opportunity to attend numerous hands-on workshops at the 2024 Osstem World Meeting.

Dlegates had the opportunity to attend numerous hands-on workshops at the 2024 Osstem World Meeting.

The K3 unit chair surpassed 58,000 cumulative sales in 2024. It features high-performance handpieces and scalers from leading brands such as KaVo, NSK, EMS and Bien-Air. Offered at a competitive price, the K3 has helped boost partner sales and gained a 70% market share in South Korea.

Between 2021 and 2023, Osstem Implant produced an average of around 8,000 unit chairs annually, 90% of which were the K3 model. Of all K3 units manufactured in South Korea, 78% have been exported to other dental markets. The company has also built strategic partnerships with Dentsply Sirona, Geistlich, Ivoclar, Zeiss, GC and Carestream.

In 2022, 3Shape CEO Jakob Just-Bomholt visited Osstem Implant’s headquarters in South Korea to congratulate the company on the Osstem Meeting. This highlighted the partnership between the companies, which began in 2018 with a domestic sales contract and expanded into a global agreement in 2020. This collaboration enabled Osstem to distribute 3Shape’s TRIOS intra-oral scanner and CAD software, culminating in the launch of TRIOS 5 in South Korea in November 2022. “I think we share the same passion for innovation and for our customers. We also want to move forward in the market, as do those at Osstem Implant,” Just-Bomholt said in his congratulatory address at the time.

During IDS 2025, visitors will find Osstem Implant at Booth J078/K079 in Hall 4.2. More information is available at www.osstem.eu.

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