Protrusive Dental Podcast

Teaser:
They become agitated, and they want to blame the dentist. And without a conversation, without a dialogue, they’re clueless, and all of a sudden, they just think you did something wrong. You are a human, and you are the doctor. Speak to yourself. Let the words flow out so that you can explain all the different possibilities in a way that the patient feels heard, understood, but also nurtured, and at the same time you realize this is biology. We are not in control.

Jaz’s Introduction:
In a world where we want to do everything to preserve pulp vitality, is it ever appropriate to carry out elective endodontics? Another terminology that our guest today, Dr. Brett Gilbert shared with me is preemptive endodontics.

For example, you have a tooth with dubious pulpal prognosis. And you know that by prepping it for a crown or by removing the caries, this tooth may need root canal treatment. Is it okay to just go ahead and do the root canal so it doesn’t bite you in the behind in the future? You see, I was always taught to do everything possible to preserve pulp vitality.

So I started my career being very much against it. And yes, I burnt my fingers a few times. So we’ll ask our guest today, who’s a specialist endodontist, and you know what, Protruserati, you’re going to absolutely love him. He’s so direct, he’s so quick, he’s so punchy with his answers. And whilst this episode is just half an hour, it’s part of a two part special.

So this half an hour we focus on elective or pre emptive endo. We talk about things like biodentine and bioceramic sealers. And this is worth 0.5 CE credits or half an hour’s worth of enhanced CPD. The subject code for this one, because we are a PACE approved provider, is 070 endodontics. And in the part two of this episode, we’re going to discuss irrigation.

Is sodium hypochlorite still the best thing around? How can we improve the efficacy of our irrigation? How can we get all those bugs? Because endo is all about getting rid of the bug. So that’d be in part two. So don’t miss that one next week.

Dental Pearl
Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. Every PDP episode, I give you a Protrusive Dental Pearl. And this one comes straight from the protrusive community. As you know, we have our platform, it’s called Protrusive Guidance. It’s been going strong for about seven months now. There’s over 2000 dentists on our community now that have been approved.

So there’s hundreds of people who want to join, but we manually approve each one because A, we want there to be only dental professionals in our group. You want this to be a safe space and I want the nicest and geekiest dentists in the world. So if you identify yourself as that, please join us because today’s pearl comes straight from the community.

We have a very busy chat section of our community, and someone was asking about the management of pericoronitis. And then came Dr. Pav Khaira, who’s like the implant guru, but he dropped such a powerful pearl that I really want to share this with you all. He says that you can use a bit of Alvogyl. You know that stuff we use for dry sockets, we put inside the dry socket?

He suggests putting just a tiny bit of that under the operculum. So where that inflamed tissue is, just tuck it under. Obviously you’ve got to do this after you’ve irrigated, you got rid of the debris, you’ve disinfected the tissues, and now you leave a bit of Alvogyl. And this stuff gives immediate relief to patients.

Now, this was so good that community member Dr. Nikhil Misra said that he’s used this technique for three patients this week with immediate relief. And he’s very grateful that that tip was shared. So thank you to everyone on Protrusive community. Thank you Pav for sharing such a powerful little tip. It’s something we virtually all have in our clinics.

And now we have another use for it. So once again, if you missed it, Alvogyl for pericoronitis. Now, totally unrelated, let’s get back to endodontics and let’s join our wonderful guest, Dr. Brett Gilbert. You’re going to absolutely love him. I’ll catch you in the outro.

Main Episode:
Dr. Brett Gilbert from the U. S. So, so good to have you on the podcast. You were recommended to me by Dr. Tom Levine, who’s a member of the community, and he did some CE with you, which I love to hear about. And the more I research and look into you, the more amazed I am. So I’m super, super excited in a geeky way to chat endo with you today. Specifically irrigation, but there’s so many communities, so many, so many questions the community has actually asked, and I can’t wait to dig in.

But for anyone who hasn’t heard about you before, tell us about yourself. I see you’ve got your lovely little box there on the cusp podcast and you do so much in education, but tell us about you, Brett.

[Brett]
Yes. So thanks so much. Jaz excited to be here. And I do think Tom, he was at my AGD presentation and within, after the first break, he came up, he goes, do you know, Jaz? And I said, I’ve heard of him. I’ve seen his podcast. He said, well, you guys have to meet. Cause there’s so many just synergies between your energy and your message. So very grateful to be here.

So I’m a full time clinical endodontist. I’m board certified. I’ve been in practice for 21 years. I have a ton of passion for the profession, but as I’ve gotten a bit older into my career and dealt with burnout and the mental distresses and the burdens of the stress of being a dentist, I’ve also become super passionate and a student of personal growth and development and just sort of that ability to manage our stress.

And so I really try to balance them both out because I really feel it’s really important to have the opportunity as a dentist to study the X’s and O’s to understand technique, rationale, the way that we approach dental treatment in whole, but before we do that, we really have to make sure we’re also focusing on the human being inside the scrubs.

And that’s another area of passion that I have. And so I know you share that and I’m really grateful to be here and to meet your audience and to talk it up a little bit and let’s get into some endo.

[Jaz]
Absolutely. What I’d love to start with is your journey from the perspective of did you spend much time as a GP before you niched into endo or for you was it like you’re always you’re calling since after dental school?

[Brett]
Yeah, interestingly enough, so I’m a son of a dentist, general dentist and my whole life I was going to be a general dentist and practice with my dad and then after one year of dental school, I started to feel a little out of sorts. I just felt like pulled in so many directions with all the different disciplines of dentistry.

And that’s when the discussion of specializing came up. And my dad sent me to all of his different friends, offices, ortho, oral surgery, perio, and then endo. And I got there and this gentleman, he just was incredible. His name was Barry Jurist. He was doing rotary at this time. He had microscopes. He was showing me videos of his surgeries.

And I was just struck. And from that moment on, I was full go for endo. I picked up my studies. I really focused down and I was lucky enough to be accepted right out of dental school into my endo residency at the University of Maryland.

[Jaz]
Great. It’s nice to learn about someone’s background and story. Now I’ve got a million questions and also it’s just great about your background in or your passion in self development growth, the human perspective.

And I’m sure wherever we can weave that in. We should, but I’m going to start with a few questions from the community. So community, which Tom is part of is called Protrusive Guidance. I’d love for you to join on there and help us out with our endo woes and queries. There’s always a radiograph being popped up saying, oh, what’d you think of this?

So you’d be great for that. But the first question I’m going to start with, amazing. I’ll make sure I’ll get you hooked up. The first question I’m going to start with is about what I emailed you about. I called it Elective Endodontics. And you introduced me to the term, Pre-Emptive Endodontics, which I’d never heard of before and I really like it.

And so from the background, the context of this question is I have always been taught never expose the pulp. Like whatever you do, avoid the endo. And actually an endodontist’s first response responsibility is to protect the pulp and avoid the endo, which is great. And then taking that on board, I had these scenarios where the caries were so deep, the tooth was still vital.

And my diagnosis. was still reversible pulpitis at that stage. It wasn’t irreversible pulpitis. So I thought, okay, maybe there’s a chance that by placing a restoration on here, I can avoid the endo. And then a few times it happened where a few days later, the patient’s in agony and you think, Oh man, I wish I just did the endo.

So I know in other countries, it’s more popular. It’s more accepted in other countries whereby anytime they’re doing any sort of indirect work, they’re thinking, ah, let me go ahead and kill the pulp off so it’s not going to be an issue in the future, which I think is at the other extreme and perhaps irresponsible, I would say. Where do you lie in terms of, is there a time and a place for pre-emptive endo or elective endo? And how do you assess that kind of situation?

[Brett]
Yeah, by all means there is. And I think what’s important to remember is that all of these decisions aren’t done just by the clinician, right? It’s a collaborative decision based upon a very specific conversation with the patient. And so the decay issue is different because the more I study restorative, schools of thought, some are comfortable leaving some decay, as part of the underlying parts of a restoration and others are not.

But ultimately, I think we have to look at the history of symptoms first and foremost, because if you have a patient that you were describing with reversible pulpitis, that you feel very confident is reversible. We do have to recognize that there’s probably about a 50 50 chance that it either calms down underneath the restoration or it doesn’t.

And sometimes that’s a conversation to be had. Sometimes I’ll explain to a patient, listen, we may be able to send you back and have the crown cemented and you’ll be just fine. I don’t know. It’s possible we send you back and you’ll have symptoms as you mentioned a week, a day, a year later, and endo may need to be done through the restoration.

So what I need you to understand is, are you comfortable moving forward with the understanding we may have to go through the restoration later? And if not, then understand that there is the option of pre-emptive endo now, meaning we can do the root canal now so that the foundation underneath your restoration is sound.

It’s not going to cause problems later. It’s surprising. You can never go into these conversations with an expectation of how they will answer. That’s what I’ve learned. So it’s about giving them the A to the Z. Explaining the situation if they opt to not do endo at that time. It’s fine I do recommend having an extra little consent line that the potential for endodontic treatment after the restoration is place was discussed.

Patient defers and will prefer to wait and see what happens. Have them sign it. It’s amazing how helpful that piece of paper becomes later when the patient’s upset and they realize that now their brand new crown has to have a small access opening, but I also do tell patients, listen, it’s pretty non intrusive for us to be able to go in and do endo through a crown.

So it’s not like the end of the world, but it’s important for you to understand the situation now where that starts to become more clinician centered as far as the decision is to your point. There was a lot of decay. You’re very close to the pulp. In fact, you might even see it. Our studies would show that really anywhere from about 1. 8 millimeters away from the pulp, there are already destructive changes happening into the pulpal cells. So you have to then take into account, this doesn’t seem very good.

[Jaz]
Is that a radiographic, Dr. Gilbert, is that a radiographic measurement?

[Brett]
It’s really more probably just eyeball to be honest, because you’re probably looking at some huge change in the dentine that would indicate where you are. Domenico Ricucci out of Italy has done a lot of work with this, as far as when it’s appropriate to leave the pulp and when the appropriate to take it out, but ultimately in the global scale of dentistry, I think ultimately it comes down to your gut instinct as the clinician with a really good conversation with the patient and allowing them to be a part of the decision making process.

[Jaz]
In your week to week endodontics, or month to month, I mean, how often does this pop up with the kind of work you do? Is this something that you’re doing on a weekly, monthly basis, or not so much?

[Brett]
Yeah, I mean, I think ultimately it depends on what kind of restoration you’re placing to, right? If it’s a direct composite, if it’s a standard restoration that does not involve cementation, I think we’re often much more patient before we institute endodontics, because, of course, once endodontics is completed on a molar, then typically some type of cuspal coverage is recommended afterwards.

So that’s a lot of dentistry. That’s a tremendous amount of expense for the patient. So really it comes down to more of the cemented type of restoration where this conversation really takes hold. And so, if you’re just doing fillings, et cetera, et cetera, then ultimately a veneer even.

Then really the conversation can lean more toward, let’s see what happens. But once it’s full coverage or cuspal coverage, it’s cemented, you know you have to go through it. Then that’s where this conversation of pre-emptive treatment becomes more profound.

[Jaz]
Well, I’m going to share my screen now for those who are listening on Apple and Spotify. They won’t get to see this, but I’ll describe it literally today on the community, I posted this like hot, cold, like a poll, and I said, how do you feel about elective or pre-emptive endodontics? Example, deep carries and will need indirect, RCT it pre-emptively or no, I’m not comfortable with this. I wouldn’t do this.

It’s like a hot and cold. And as you can see, the audience is generally veering more towards cold, not freezing, but towards cold. And there’s a few in the middle like me. And then there’s a few to the right of me, a bit warm. No, one’s hot in it, which is good. We don’t want as a community to be trigger happy doing these endos.

We still value and respect the importance of preserving pulp vitality. But then from the chat here, Brett, what came here is a great discussion whereby colleagues, what they’re doing, and essentially here’s the question, what colleagues are doing in those scenarios is yes, it may benefit from cuspal coverage because a lot of these are huge MOD amalgams, recurrent caries.

So they’re going to need cuspal coverage. But what our clinicians are opting to do is remove the caries, remove the old restoration, clean everything up, and then just put a well bonded composite and tell the patient, look, It needs something more definitive than this, but let’s see how it goes for a year. What is your thought on this kind of approach?

[Brett]
I mean, it’s very conservative and that’s great. We always love conservative treatment. You’re going to be in the same situation a year from now, though, when you go to do a more significant prep and place and cement the crown, we often find that the actual, it’s like the last little straw that breaks the bow is the cementation.

And what it does to the pulp through the dental tubules. So I think it’s always again about this conversation and about consent and about what’s your gut instinct for the patient because the patient says, I’m so busy. I travel a lot. The last thing I want is to all of a sudden start having tooth pain.

It sounds to me like you’re saying that’s possible. So I would prefer just moving forward with the root canal now. And then another patient says, well, my insurance is running out. I don’t have a lot of out of pocket resources. I think I’ll take my chances. And so you have to look at the actual patient’s lifestyle and their thought process, because I do believe in these instances, you are justified to recommend the treatment.

You’re not demanding it. You’re not saying it’s dogma. But you’re having a conversation so the patient understands because what happens if you don’t is you do your work, you’re doing it in best faith, patient winds up in pain and they become very angry. They become agitated and they want to blame the dentist and without a conversation, without a dialogue, they’re clueless and all of a sudden they just think you did something wrong. So whether you wind up pre-emptively treating or not having the conversation, I believe is paramount for building the relationship and ultimately managing the patient winding up in pain later.

[Jaz]
Thank you. And one thing I struggle with in informative years and a lesson I pass on a lot on the podcast, especially for our younger colleagues, Brett, and I think you’d be great to give a perspective with your interests on the human side is when colleagues are communicating this to their patient, I feel as though sometimes our colleagues, our friends, end up owning the problem.

They’re thinking like it’s their tooth, right? And I think it’s really important for our mental health, our anxiety, that we’re just there to help to guide the patient, to do what’s best for them and dissociate themselves from the problem. Because if you start stomaching the problem with yourself, and you start being a bit too vested in it, then that can have bad health effects on us. What do you think about owning the patient’s problem when it comes to the ultimate decision?

[Brett]
I mean, this is the one of the biggest stressors we carry as dentists. We are very empathic people. We want to help people. We also have been trained in an era of we are expected to be perfect, whether it’s been imposed on us in our dental school training or self imposed.

And so when something doesn’t work out the way you had hoped, and now someone else is suffering, it’s very, very challenging to separate The human being, the tender soul inside of you and the dentist. And that’s where the identity as a human first is so important. And that only comes with addressing it, feeding that human inside of you so that you can have some separation.

I, as a young clinician took everything personally. I went to bed thinking about it. Terrified of what might happen or what had happened, and then I make it a little sleep. And the second I wake up, it’s right there. So the advice is this. It’s important to understand that when you are a dentist, there’s a full spectrum of reactions that an individual patient might have to our treatment.

Now, are our treatments ever going to be perfect? Let me just say from my own pursuit of it every single day. Nothing’s perfect. So what we should be striving for is excellence, not perfection. And within the frame of excellence, you have to be aware that there are different reactions. And what’s important is to understand how to have these conversations, just like the pre-emptive conversation.

And what I suggest, especially to the younger dentists who haven’t quite been through as many situations, talk to yourself in the mirror. You are the patient and you are the doctor. You are human and you are the doctor. Speak to yourself. Let the words flow out so that you can explain all the different possibilities in a way that the patient feels heard, understood, but also nurtured.

And that at the same time you realize this is biology. We are not in control. And so you do your very best. And Jaz, if every dentist that hears this within your community can recognize all that’s expected of you, not to be perfect, not for everything to be 10 out of 10, all that we can ask is that every day that you show up, you have the intention of doing your very, very best.

That’s it. And if you do that, then when a patient does have a problem, you can look back and say, yes, Mrs. Smith, I have to say, the treatment that we did looks good, but I understand you’re suffering. Let me explain why. And ultimately, let me give you sort of a view of what might come down the road.

I don’t know that you’ll need potentially this tooth to be extracted, but I want to put it out there to you that ultimately, if that were to happen, I just want you to know that there will be a game plan to replace the tooth. But in the meantime, for now, let’s focus on just getting the symptoms to settle down.

I’ll have you back for frequent followups. So, you know, I’m here for you, right? I like to say that to patients, just so you know, I’m here for you. I will be here if you need me. That’s all patients need. Sometimes the pain isn’t as much physical as mental and emotional and financial, right? They’ve gone through all of this time, energy, they miss work, they spent all this money and now the tooth hurts when they bite on it.

Well, that’s upsetting to them. So it’s important to meet them as a human where they are, but also separate yourself as a human, as someone that has done their best in every moment. And that’s all that was ever asked of us.

[Jaz]
This is absolutely communication gold. If anyone was multitasking when Brett was given this most wonderful monologue, you need to hit rewind, just go back the last couple of minutes and just listen to this again.

And just for a few days, just that was absolutely fantastic. I love that. The whole thing about rehearsing in the mirror, we don’t do that enough. And that connection that you make with the patient and yes, ultimately patients need to have that feeling that, okay, I’m in safe hands here. This guy will look after me and that can’t be emphasized enough just to reflect on what you said.

I had a guest Marco Maiolino from Italy on recently and we talked about how we’re always striving for perfection this gold standard but he very much resonates with what you said where if you show up and do our best every day and we call that the daily standard. So what he suggested was Instead of like one or two cases going 10 out of 10 and the rest going four or five out of 10 because you’re particularly putting too much energy.

And if you lift your daily standard to eight out of 10 consistently, we will better serve our patients and try and do that rather than chasing that 10. So I just want to remind everyone of that great reflection. And then going back to clinical on that point of pre-emptive endodontics, selective endodontics.

So once again, April from our community, she mentioned that actually she has been using biodentine with some good success. So previously when she’d be wondering about, ah, should I be having this conversation with the patient? How much are you using biodentine as part of your armamentarium to further reduce your risk or help this scenario? And based on the evidence base and your experience, is this a silver bullet?

[Brett]
So biodentine is an interesting material. It’s been around for a while. I haven’t used it as much as I think a lot of other dentists. And I don’t know if it’s a US thing or a global thing. But we do use the bioceramic materials in the same way, right?

Like a material that is non irritating to the pulpal tissue, that’s a nice insulator that can sort of rebuild where the natural dentine protection of the tooth structure has been removed, whether by biology or by bur, but these things are nice because in the past, all that we had to put close to a pulp was irritating, something with huge and all, etc.

And now what we have is examples of something like biodentine or any of the MTA products, the bio ceramic putties, where we actually can sort of kind of protect the pulpal tissue in a way that’s non irritating so that we could potentially extend the life of the pulp. And so I think that’s a very valid way to go.

Again, I think when you’re talking about fillings and things like that composites, that’s going to be a really important part of your armamentarium to maybe put something close to the pulp instead of something that was considered a base back in the day using something like this, that’s a little more biocompatible.

But ultimately, when it comes down to crowns and full coverage, cost full coverage, that’s where cementation comes into play and that’s where it becomes a little bit trickier. So I think bio dentine is a wonderful material. I think one of the reasons it’s not as in vogue is just because to my knowledge, still, it needs to be triturated.

And a lot of the bioceramics, you just basically just push a little bit out of a syringe already premixed, but I think you get a similar result. And so I think it’s a valid comment and definitely a material worth having in your office.

[Jaz]
Here’s a real world spit off from that question. We have an international audience here all around the world, and some countries, it’s just not something that they can afford in their clinic. And that’s the truth, right? So out of glass, iron and cement, composite, even amalgam if it was your tooth and it was a deep one and the dentists wanted to try their best to give It the shot for vitality. What should the dentist be using in what’s most likely going to be stocked in their cupboard already? What’s the kindest protocol to the pulp in terms of restorative material to place when you are close to the pulp?

[Brett]
That’s really interesting. I think it’s more of like how close are you and are you actually exposed. So if I have any type of exposure, I want to buy a ceramic cement against my pulp tissue 100 percent because the studies would show over volumes using MTA is the sort of essential baseline.

But since then, the bio ceramics as we learn, you know, bio ceramic putty, bio ceramic sealer. They’re all the same material. They’re just different consistencies based on particle size. But what we see is that the pulpal cells will actually grow against it without any zone of necrosis. So to be honest with you, once something like a bio ceramic is up against the pulp, you really need something of a resin to sort of hold it in place and seal it.

So there’s been an advent of something called resin ionomer. One example is from Brasseler, USA. They have what’s called BC Liner. And what’s interesting about this material is that it bonds to both the dentine as well as the bioceramic material. So for instance, if we flip it around from a pulpal exposure and you think about like a perforation.

Same type of scenario, you would put the bioceramic putty down against the vital tissue, and then with this resin ionomer, you can basically just put a bandage over it, light cure it, and it’s bonded to dentin, it’s bonded to the bioceramic, and now that is essentially sealed. So whether it’s a healthy pulp that you’re trying to seal or perforation, this protocol to me is ideal in this day and age.

To your point, though, unfortunately, some of these materials are costly and therefore, some dentists may not have that. So in that situation, I think we have to still go with the old tried and true, which would be something like an I. R. M. Or using some type of base material. But ultimately, we used to talk about pulp exposure or indirect pulp capping, direct pulp capping as death of the pulp.

And with the advent of these bioceramic and bioactive materials, it’s just not so,. And a whole nother topic for your podcast would be vital pulp therapy, which really has come into vogue because we now have biomaterials that allow us to actually protect the pulp. And so if you have an immature tooth, you can do the same protocol over a pulp exposure, even like Cvek pulpotomy and actually allow for the natural Apexogenesis to occur because that pulp tissue will remain vital.

So there’s a lot of exciting things happening. We’ve learned that, there are parts of the world where even from an endodontic perspective, I still teach hand files and I still teach cold lateral condensation because that’s what they have. So it’s important as educators, I believe, to meet our doctors where they are. We can talk about the highest level of expensive materials and the lowest level. And fortunately, the beautiful part is you can still get a great result with either.

[Jaz]
Excellent. I mean, that’s very encouraging to hear. And I think you’ve given some good guidelines to consider. The final question I have is from Christos in the community before we talk more about irrigation, right?

So that’s gonna be the more like the part two. The final question is, because on the topic of bioceramics, he asked, is this the death of gutta-percha, GP, are we now doing these bio ceramic sealers in the canals or using the bio ceramics as an alternative to GP, which I know many endodontists have been doing for a while now.

So is there still a place for GP? And I think just to give you some background as a general dentist, I was recently advised by an endodontist that if a general dentist is doing an endo and you’re thinking, hmm, there’s something in doubt here, I don’t think I can get a perfect result due to a myriad of different reasons, then please use something like Tubli-Seal and GP because the re treatment will be easier.

If you, in that scenario, when you can’t get patency or you’re not 100 percent confident, if you use a bioceramic material to fill it, then that re treatment may become more difficult. So I want to learn from you in terms of how far have we come and how have we moved away from GP?

[Brett]
So a couple of things on this. So GP, what you have to look at it as, and the way I like to teach it is the gutta-percha is simply a vehicle and it’s a vehicle to essentially drive the sealer against the walls into lateral canals into dental tubules into apical rarifications and all kinds of apical deltas. We know that there is such a tremendous amount of anatomy within the root canal wall.

So you’re using a match cone system, ideally in modern systems where the gutta-percha and the final file that you finished with are the same dimensions, which means that what you’re depending on the gutta-percha to do is to fill the bulk of the center of the canal. While allowing this hydrodynamics, this condensation of hydraulics to push the sealer against the walls.

That’s the goal. Gutta-percha doesn’t seal to anything. So the reality is when bioceramics came into vogue, we started to see this concept of single cone, but the cone was tiny. So it was a bulk of bioceramic sealer and a tiny little central core of gutta-percha. And that’s where the whole retreatment argument began.

Because the reality is, you can’t remove cement from the inside of a canal. So we shifted our thinking and thought, well, we actually could probably get a very similar effect by using a normal size, a match cone gutta-percha to actually drive the sealer against the walls. But still retain the ability to retreat if necessary.

And so that’s essentially what most endodontists are doing. We do the single cone, we put the bioceramic material in the coronal third of the canal. And if you’ll see any of my videos, you can actually see as the gutta-percha comes in like that piston, you see it actually carry the sealer down. And then start to spread it out.

In fact, even getting some extrusion, which we don’t see as harmful at all. In fact, especially with a lesion where it’s more common to happen, it actually has osteogenic potential to actually help the body to form bone because it has hydroxyapatite. That forms on it within about 24 hours, and the body sees that hydroxyapatite as self.

And so it actually instigates healing. So to answer the question for the doctor, no gutta-percha is not going anywhere only because it’s that really nice inert material that can actually facilitate the movement of the sealer where we want it most into the apical rarefications into the lateral walls, et cetera.

But something exciting that’s come onto the market very recently is actually obturation with neither gutta-percha or sealer. And this is a hydro gel material. So a company out of Switzerland named Odne has developed what’s called OdneFill. And what it is, is it’s actually a liquid that you inject and then it has a laser that goes down and actually polymerizes it.

So what you get is an actual root canal filling that is neither gutta-percha and neither sealer. And so we’re seeing some paradigm shifts in thinking. The hydrogel is nice because as it sets, it pushes out just gently, almost like if you think of like oxygen mass being pushed against one’s face to make a seal.

Very similar concept, very easily retreatable. The key though, and again, it’s still in the early stages, but Jaz, think about it with sealer and gutta-percha. You do have some risk of extrusion, right? Whether it’s the sealer gets way out, whether it’s the gutter percha point. And with a material like this, it eliminates the extrusion because it’s basically an aqueous solution.

If it goes past the root, it’s simply absorbed and it can never be hardened because the laser doesn’t go beyond the apex. So just putting it out there to the community, there are some new developments, but right now, what’s nice about the bio ceramic sealer with the gutta-percha, is that there is, and it’s basically, it’s considered single cone, but it’s really called hydraulic condensation.

And the reason is, is you can put some pressure on that gutta-percha and find that the sealer actually can spread. So that’s where you’re seeing these lateral puffs on instagram and you’re seeing these anatomies just get filled with sealer because of the hydraulic nature of the bioceramic sealer, and that’s very exciting isn’t it?

[Jaz]
That’s only possible with the heated techniques, right? We can’t achieve that with lateral compaction. We are, if you don’t have the know how or the kit to do it in the hands of the cold lateral compaction, is bioceramic sealer still a good option for a general dentist to use?

[Brett]
Yeah, as long as you can sear off the top of the gutta-percha, you really are not putting like an apical penetration of heat. It’s really just, again, that piston of gutta-percha. And when you just condense it, it just puts a little more hydraulic force on the sealer. So yeah, it’s exciting time and just wanted to share that because I think it’s important to open the minds of what’s in research and development. And this is actually an approved material that’s available. And it’s a very new paradigm shift. Obviously, we don’t have a tremendous amount of evidence on any of it, but it’s exciting to think about de risking the endodontic procedure, especially for the GP.

[Jaz]
Well, the future of endo is certainly very exciting and that takes us very nicely to irrigation. Okay. So, I know you’re really hot on this. So the proper disinfecting protocols, let’s talk about where we are in 2024. Cause I was taught that sodium hypochlorite is the gold standard. So the first question is, is there anything better yet? Are we still relying on 3%, 5. 25%, wherever it is, sodium hypochlorite?

Jaz’s Outro:
There we have it, guys. Thank you so much for listening all the way to the end. How good was Brett? I told you you’d love him. His direct way of responding is absolutely fantastic. And hopefully now you have a more informed opinion about the relevance of pre emptive endodontics today. Is there a time and place?

Yes. There might be, but it’s all about that patient communication. If you’d like to claim 0.5 CE credits, cause you’ve done all the hard work of actually listening and hopefully we made it just that little bit fun. Head over to the Protrusive Guidance app. Now, if you’re downloading it on Android, you need to first make an account on the website, protrusive. app.

You can actually access it from your laptop, but then once you get your account, you can access it on iOS, Android. And about 99% of the episodes have quizzes. I’ve also got my masterclasses section for those who want to learn further. If you enjoyed this episode and you like what Brett’s doing, then firstly, give it a thumbs up and subscribe.

But don’t forget to join us for part two, where we talk about the latest innovations when it comes to irrigation. But even if you’re not using anything fancy, how can we improve how well your irrigation and disinfection protocols are working in your clinic? today, right now. So it’s another juicy one with Brett coming next week.

I will put Brett’s podcast and links to this episode as well, but the next one he talks more about all the wonderful things he’s doing to support the world of dentistry. Thank you again. I’ll catch you same time, same place next week. Bye for now.