An Alternative To Root Canal Treatment? Introducing: Biodentine.

The Root Canal Treatment has earned its status in pop culture as a form of punishment. While mostly overstated, it is true that the procedure may sometimes lead to varying levels of discomfort. It involves the removal of the nerve inside your teeth, followed by the placement of a rubbery material, known as Gutta Percha, to create a hermetic seal that prevents infections down the road.

Biodentine by Septodont

In order to save teeth, root canal treatment is often necessary especially when the nervous tissue is found to be severely infected or even dead. However, root canal treatment has historically been recommended even if a tooth has deep decay or has mild symptoms.

In such situations, an alternative material may be used: Biodentine. A relatively new kid on the block, Biodentine is a nerve coverage material that is referred to as a bioactive dentin substitute. As that phrase suggests, it is used to replace dentin that is often lost through dental decay or affected by trauma. It is placed as a material to cover the exposed dental nerve (direct pulp cap following a partial/full pulpotomy, for you dental nerds!), thus avoiding the need for root canal treatment.

Let's take a look at a couple of my experiences with Biodentine.

This patient presented with a deep decay on her upper left first molar (middle tooth, photo #1). The x-ray shown above shows that the decay extends to the nerve of the tooth. In situations such as this, root canal treatment would often be the traditional treatment of choice.

However, the patient was offered the option of Biodentine treatment. The decay indeed extended into the nerve, and the cavity was then filled with Biodentine, which was then left alone for 3 months (photo #2).

At the 3 month mark, the tooth was tested to be functioning well. The patient was also pain free. A stronger tooth coloured filling was then placed over the Biodentine as seen in photo #3 to enhance the integrity of the tooth. Root canal treatment successfully avoided! The patient returned a year later for a regular checkup with the tooth still functioning as it should.

Here's another case:

This patient had very deep decay on both his upper left second premolar and first molar (photo #1). Again, root canal treatments would often be the traditional recommended treatment for such extensive decay. Instead, both teeth were filled up with Biodentine (photo #2).

Both were tested to be fine three months later! Root canal treatment successfully avoided. A crown was even placed on the second premolar due to the extensive loss of tooth structure due to decay (photo #3).

Here's a photographic journey of an entire Biodentine treatment:

This is a severely decayed upper right first molar. With the decay removed, the nerve exposure can be seen (the red spot of blood in photo #2). Photo #3 shows the Biodentine placed prior to cleanup.

3 months later, after determining that the tooth was alright, the outermost layer of Biodentine was removed (photo #4). The tooth was then filled with a regular tooth coloured filling (photo #5).

Biodentine has offered a paradigm shift in the practice of endodontics in dentistry. With this material, root canal treatment can be avoided in many situations, thus offering patients a viable alternative. With studies showing success rates of Biodentine treatment ranging from 80% and above, it is no wonder that this wonder material is making such an impact on the treatment planning for dental disease.

Additionally, the cost of Biodentine treatment is markedly lower than that of root canal treatment. Crowns are also often indicated following root canal treatment, adding another significant layer of cost.

The downside of Biodentine treatment is the lower success rate of treatment (80% onwards) compared to root canal treatment (90% onwards). A failed of Biodentine treatment often means that root canal treatment will have to be done anyway in order to save the tooth, costing the patient additional treatment time and money.

When combined with painless dental injections, the treatment of deep decay with Biodentine can be a painless process.