BY Ken Koch, DMD
We are excited to renew our monthly column for Dental Economics. More importantly, we are thrilled at the prospect of reconnecting with you, our readers, in this renewed forum. There will be a few changes, all of which promise to be exciting.
The first change is that in addition to Real World Endo, we are launching Real World Dentistry™. This column will involve multiple aspects of dentistry, with a particular emphasis on how endodontics interfaces with all of them. Also in the very near future we will bring you Real World Perio, with real world clinicians.
Our philosophy will remain the same in all cases - to bring you technology and techniques that will help you accomplish your goals more efficiently. We remain dedicated to you, the readers of Dental Economics, and we will continue to bring you new ideas and procedures that are reproducible and predictable. We will always be mindful of the ultimate beneficiary - your patient.
Secondly, this monthly column will feature various authors. It is very exciting to showcase new people and to have them share their knowledge on various aspects of endodontics, and dentistry in general. In addition to being informative, we hope that this will be stimulating and refreshing.
The third change is that we will produce articles that will give you information on topics you want to hear about. In other words, some columns will be specifically dedicated to topics that you actually vote for, not just ones we select. We want to make this column as interactive and dynamic as possible.
We'd like to begin this first column with a topic that is relevant to all dentists - how to predictably accomplish a direct pulp capping procedure in one visit. We all face this dilemma at some point in our careers. It may be in the midst of multiple crown preparations, it may be following deep caries excavation in a young patient, or it may be when a patient simply walks through your front door with pain. Whatever the cause, bioceramic technology is the answer.
We introduced bioceramics a few years ago, and the results have been simply phenomenal. The most important thing is the properties associated with bioceramics and their ease of use. Some of their properties are a high pH of 12.8 (which is strongly antibacterial), being hydrophilic and not hydrophobic, not shrinking upon setting, generating hydroxyapatite during the setting reaction, and osseoconductivity. Also, due to their incredibly small particle size (2 microns), they can be delivered either by a syringe or placed as a putty.
For direct pulp caps, we recommend the following technique
Bioceramic putty (Brasseler USA). Isolate the tooth under a rubber dam and disinfect the exposure site with a cotton ball and NaOCl. Check to make sure that you have good hemostasis, as sometimes direct exposures can bleed quite easily. After confirmation of the isolation and hemostasis, you can begin the procedure. Even though the syringeable putty works well, I prefer using the bioceramic putty for direct pulp caps. Therefore, take a small amount of the EndoSequence Root Repair Material putty from the jar, knead it into a hot dog shape, position it on the end of a plastic instrument, and place the putty over the exposure area. Then cover the bioceramic repair material with a compomer or (preferably) a glass ionomer cement. What is so fabulous about using a glass ionomer is that the ceramic particles in the glass ionomer bond to the ceramic particles in the bioceramic putty. So in essence, you are producing a bonded direct pulp cap, which is very cool! Following the placement of this material, proceed with the final restoration, including etching if required. Single visit direct pulp capping is now here.
In this introductory column we discussed a new technique for direct pulp capping that will allow all practitioners to better serve their patients. In particular, we hope this makes the treatment of young patients easier and more predictable. The key is the preservation of the natural dentition. Additionally, we had the opportunity to introduce you to Real World Dentistry. We will continue to give you "the facts, nothing but the facts," but we will deliver this message through various authors and new topics as selected by you, our readers. Please send your requests to [email protected].
It's good to be back with DE. We look forward to hearing from you, and we are excited to present Real World Dentistry: "Global by Design - Inclusive by Nature."
Ken Koch received both his DMD and Certificate in Endodontics from the University of Pennsylvania School of Dental Medicine. He is the founder and past director of the new program in Postdoctoral Endodontics at the Harvard School of Dental Medicine. Dr. Koch is a cofounder of Real World Endo. Contact him at [email protected].
