Tooth decay is the most widespread dental disease. It is the most common cause of pulpitis (pulp inflammation). Cavities are characterized by demineralizing and destructive processes in the hard dental tissues (enamel and dentin). The carious lesion can affect all dental surfaces – occlusal (chewing), interproximal (between the teeth), lingual (toward the tongue and palate), buccal (toward the cheek), cervical, and root surfaces.

Chronic caries develops slowly and often without symptoms. When the carious lesion has reached the deepest layers of dentin and affected the nerve of the tooth, the treatment becomes more complicated. Depending on various factors assessed by the dental practitioner, either biological treatment or routine endodontic (root canal) treatment is undertaken.

Depending on the indications, our team at Noradent decides which of the two treatment options to pursue. Before caries removal, the patient is inquired about current and past symptoms related to the respective tooth. Deep caries may be associated with lingering pain (pain that remains after removal of the causative agent), pain upon exposure to different types of mechanical or thermal irritants, etc.

What is the biological treatment?

Biological treatment is an attempt to preserve the vitality (life) of the tooth. Our team at Noradent refers to it as an attempt or possibility, as we cannot guarantee 100% success. After taking a medical history, conducting a clinical examination, and performing an X-ray, the patient is informed about the potential option of biological treatment. The dentist assesses whether to proceed with this type of treatment after cleaning the cavity and evaluating the size of the ulcer, if present. The ulcer represents an open communication between the dentin and the pulp (nerves) of the tooth, which occurs during the removal of the infected tissue.

Types of biological treatment:

  • Indirect pulp capping (covering)
  • Direct pulp capping (covering)

When there is a remaining layer of healthy dentin, approximately 0.5 mm thick, and the pulp is visible through it, an indirect biological solution is employed. When a communication between the pulp and dentin (ulcer) is detected during decay removal, a direct pulp capping method is used. In both types of treatment, a bioactive material is placed to build a barrier between the two layers of the tooth and maintain its vitality in the long term. Commonly used materials include MTA, Biodentin, and Calcium hydroxide, etc. All of them have antibacterial properties, stimulate dentin mineralization, and induce the formation of a “dentin bridge.”

When is biological treatment of a tooth performed – indications?

  • Good oral health (caries resistance)
  • Maintaining good oral hygiene
  • Young patients
  • Motivated patients
  • Ulcer size up to 0.5 mm
  • Ability to control bleeding from the ulcer, etc.

Stages of treatment:

In a clinically indicated case for biological treatment, isolation with a rubber dam is used. It involves the placement of a dental dam to keep the operative field clean and prevent saliva from entering. After cleaning the cavity, the enamel and dentin tissues are treated with solutions, and a bioactive material is placed on the ulcer (direct covering) or its projection (indirect covering). To ensure precise and high-quality work, specialists at Noradent use magnification microscopes.

At our dental clinic, Noradent, we believe in the success of biological treatment when performed with proper indications, accurate methods, and regular monitoring.

Dental Studio Noradent - City Center, Sofia, Bulgaria

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