Dental News - Interview: “Bioactive endodontics is the future”

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

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.

Tags:

Bioactive Cryotherapy Endodontics Future Interview Is Pulp The Vital

To post a reply please login or register

Interview: “Digital dentistry is the future”

The use of digital technologies in dentistry is on the rise, a fact that Dr Andreas Kurbad is well aware of. Kurbad, who has been running his own dental ...

Interview: “The future is certainly looking bright”

This year, Planmeca is celebrating 50 years of contributions to modern dental practice. Many of our readers will know Heikki Kyöstilä, chairman and CEO ...

The ProTaper technique: Shaping the future of endodontics

There are enormous differences in opinion regarding the best methods for shaping root canals. A review of the literature reveals virtually no agreement on a...

Dynamic navigation—The future of minimally invasive endodontics

Dynamic real-time surgical navigation digital imaging, diagnostics and impressions, and the use of computer-aided design/computer-aided manufacture ...

Digital ecosystem: The future is not in five years, the future is now

At a time when venerable institutions in numerous countries, such as the UK’s National Health Service, are already setting up their own digital ecosystems...

Interview: Irrigation in endodontics—New standards in the dental office

A main goal of endodontic treatment is to effectively irrigate the canal and thus prevent reinfection of the peri-apical tissue. Recently, a range of new ...

Interview: Dentists will be recognised as oral physicians in the future

Specialised in periodontology and oral implantology, Dr Rajiv Saini is an avid lecturer in both fields. He is Editor-in-Chief of the International Journal ...

Interview: “The Planmeca Compact i5 is a future-proof, ecological and safe investment”

As one of the world’s largest dental equipment manufacturers, Finnish company Planmeca is committed to providing products that can be enjoyed by dental ...

Digital dentistry is not the future; it is the present

BASEL, Switzerland: It is clear from the growing number of clinicians already using digital technologies that offering simple, safe and more pleasant ...

Interview: "The future of dentistry will be digital"

As the operator of his own dental practice in the German town of Laer and a member of the Digital Dental Academy in Berlin, Dr Hendrik Zellerhoff is clearly...

Education

Live webinar
Wed. 11 November 2026
7:00 am EST (New York)

Mastering the Mobile Tissue: Advanced Intraoral Scanning Protocols for the Edentulous Arch

Dr. Guo Wei Chong

1CE

Live webinar
Wed. 11 November 2026
11:00 am EST (New York)

Direkte Füllungstherapie: Effiziente Ästhetik mit Komposits

Dr. Monika Reichenbach

1CE

Live webinar
Wed. 11 November 2026
12:00 pm EST (New York)

Dincolo de scanare: Stăpânirea fluxului de lucru digital cu iTero

Assoc. Prof. Dan Pătroi DDS, PhD

Live webinar
Wed. 11 November 2026
2:00 pm EST (New York)

Evoluzione degli approcci mini-invasivi nella gestione della carie in età evolutiva: evidenze scientifiche e applicazioni cliniche

Prof. Milena Cadenaro, Dr. Valentina Luppieri PhD

1.5CE

Live webinar
Wed. 11 November 2026
5:00 pm EST (New York)

Tips clínicos para restauraciones ocluso proximales

Dr. Fioreella Isamar

Live webinar
Thu. 12 November 2026
2:00 pm EST (New York)

Fiber-reinforced posts in restoring endodontically treated teeth: An update

Prof. Hani Ounsi DDS PhD FICD

1CE

Live webinar
Thu. 12 November 2026
2:30 pm EST (New York)

Mastering Modern Periodontal Therapy: Soft Tissue Grafting, Cosmetic Periodontics & Ultrasonic Instrumentation

Dr. Crystal Marruganti, Cat Edney

1CE

Latest Unread Articles

Melatonin may improve bone healing around immediate dental implants

ALEXANDRIA, Egypt: Melatonin is being studied as a local adjunct to immediate implant placement for its potential to influence both bone formation and ...

save

IDL Dental Technologies to showcase implant solutions at GNYDM 2026

NEW YORK, US: IDL Dental Technologies, an Israeli manufacturer of dental implant systems and associated prosthetic products, will showcase its product ...

save

Qatar reports first digitally planned subperiosteal implant procedure

DOHA, Qatar: Hamad Medical Corporation (HMC), Qatar’s principal public healthcare provider, has reported performing the country’s first subperiosteal ...

save

Qatar reports first digitally planned subperiosteal implant procedure

Advances in digital imaging and CAD/CAM have renewed interest in subperiosteal implant treatments, a development reflected in an international expert consensus study published in the International Journal of Implant Dentistry in October. (Image: sona/Adobe Stock)

Dental Tribune International

Mon. 9. November 2026

save

DOHA, Qatar: Hamad Medical Corporation (HMC), Qatar’s principal public healthcare provider, has reported performing the country’s first subperiosteal implant procedure using 3D imaging, virtual surgical planning and patient-specific components. The case illustrates the potential of digitally designed subperiosteal implants as an alternative treatment approach for selected patients with insufficient bone volume.

HMC announced in a press release that the procedure was performed at its Surgical Specialty Center by a team led by Dr Khalid Abdel-Galil, senior consultant and chair of the oral and cranio-maxillofacial surgery department. The patient, a woman in her 60s, had lost all her mandibular teeth and presented with severe jawbone atrophy.

Before surgery, the team used 3D imaging to create a digital model of the patient’s jaw and 3D-printed models to plan the operation. This enabled the surgical approach to be simulated and customised components to be designed according to the patient’s anatomy.

HMC reported that medical-grade titanium was used for the implanted component and that the patient was fitted with a provisional prosthesis. A definitive prosthesis is planned once her condition has stabilised.

The service was introduced through a collaboration between HMC’s dentistry department at Al Wakra Hospital and the oral and cranio-maxillofacial surgery department. HMC said that the new service would be available to eligible patients after prosthodontic assessment and multidisciplinary treatment planning.

Expert consensus supports selective clinical use

Although subperiosteal implants have a long clinical history, advances in digital imaging and CAD/CAM, particularly 3D printing, have renewed interest in contemporary patient-specific designs. An international expert consensus study, published in the International Journal of Implant Dentistry in October, sought to establish guidance for their use in clinical practice.

Through two rounds of questionnaires in which international specialists assessed proposed clinical recommendations, the researchers established consensus on 40 statements covering patient selection, surgical workflows, prosthetic treatment, complications and follow-up. The panel supported considering patient-specific subperiosteal implants for carefully selected patients with severe maxillary or mandibular atrophy, particularly when endosseous implants are not feasible, would require extensive bone augmentation or have previously failed. The experts also emphasised the need to integrate the intended prosthesis into digital implant treatment planning and to provide structured long-term monitoring.

Uncertainty remains regarding clinical outcomes and complications. The researchers noted that the available evidence is predominantly observational and that comparative studies and long-term follow-up data are limited. The consensus results support considering contemporary subperiosteal implants for complex cases.