Taking the endodontic procedure to the next level

A conversation with Dr. Benedict Bachstein sharing insights on his clinical experience using Odne™Fill for minimally invasive, light-cured obturation

What motivated you to become an endodontist?

Mainly it is the level of patient contact and care, of being able to spend time with a patient and focus on one patient at a time. I also enjoy the attention to detail that the role requires and working under a microscope. There is also the satisfaction of saving teeth by providing care at the limit of what is currently possible and being on the forefront of new technologies and materials.

You have a close relationship with Jefferson Einstein Philadelphia Hospital. Can you tell us more about that?

I originally moved to Philadelphia because it is the birthplace of endodontics. I chose Einstein for my specialty training and am now faculty there. Einstein has a very strong clinical program and the chairman, Dr. Frederic Barnett and I share the same values and uncompromising commitment to excellence, so it made sense for me to continue as faculty there. Dr. Barnett and Dr. Stephen Niemczyk (also faculty) have been excellent mentors to me, and I now get to pass that on by being mentor to the next generation of endodontists.

You were one of the first clinicians to use Odne™Fill in your practice. Can you tell us about your experience with it?

Odne™Fill is a material that is completely different from any of the materials I’ve used before and therefore offers us a different way to operate in the root canal system, which has the potential to be a huge advancement for our field.

If I were to try to describe it to someone who has never used it, I would say it reminded me of applying a calcium hydroxide paste, where you can literally inject the material. However, Odne™Fill is even more flowable than a paste, with a consistency just slightly thicker than water. Technique-wise, it makes me think of the progression from cold lateral obturation from years back, to the warm vertical back-filling techniques. Again, even these don’t really describe Odne™Fill as it does not require any force or compression at all; it very gently flows into the root canal morphology due to its water-like consistency.

What is really exciting, beyond the tremendous benefit of the gentle back-fill technique, is that Odne™Fill seems to fill the root canal system further than what we are currently capable of. When I look at the post-op CBCT images, I see that the material seems to really cover and flow into spaces that we previously might not have been able to fill to the same extent.

Retreatment with this material is incredibly simple and easy. Of the patients for whom we have used Odne™Fill, we have not needed to retreat, but we have completed simulated cases where we intentionally retreated to test the material. Since Odne™Fill is a hydrogel, it has a pulp-like consistency in its cured state, so we don’t even need to change our instruments; we can go back with the same instrument even after it has cured and easily remove the material and retreat it. This is much different than even BC sealer which is not as easy to suction back out.

I am also working with residents at Einstein for them to learn and evaluate the technique. Part of this was learning that instead of picking up a heat source, they use the Odne™Cure micro-laser curing light to cure the material, and prior to curing, they take an X-ray to evaluate the obturation quality. We started with extracted teeth and then moved to patient cases. It was amazing to see how quickly they were able to successfully treat live cases and get great results.

What are some challenges you’ve faced with this new approach?

As with every new product, it is a new workflow to get accustomed to, not just for the endodontist, but for the assistants and the clinical team, so it took some time to adjust even though, ultimately, it simplifies the process.

We are used to materials that auto-cure, and with Odne™Fill there is a curing step that needs to be incorporated. The curing happens in two parts — first, at the apical third and then, at the pulp chamber. But once we understood the process and how to use it, it became very natural.

I also find that the contrast of the material during application takes getting used to. It is light blue, turning transparent once cured, but we are used to the bright orange of gutta percha.

Given its water-like consistency, I have found the microscope to be very helpful for greater control in applying the material.

Would you recommend Odne™Fill to other endodontists?

In general, if there’s a new product, there are several questions that I always ask to determine if it is worth adopting. Does it improve the treatment outcome, and does it have the potential to improve the standard of care? Does it make our current treatment more efficient? Meaning, does it make the treatment easier for the patient and make it faster and easier for us to achieve the same level of care?

Odne™Fill does make treatment and re-treatment more efficient and is less technique-sensitive compared to other obturation methods. This means less chair time for patients. And simplicity is one of the most appealing aspects for me.

Any treatment that preserves tooth structure, while ensuring adequate disinfection of the root canal system, leads to improved tooth resistance, lower prevalence of fractures, and improved outcomes. The Odne™System (which includes Odne™Clean, the company’s root canal debridement technology), is a tremendous improvement to current minimally invasive root canal technology and potentially, to outcomes. The Odne™System uses 190µm tips, which are smaller than what is currently available, such that the minimal preparation needed is ISO 20.04. This is a huge advantage for minimally invasive approaches. The main reason we traditionally instrumented the root canal to size 35 is to make sure that it would accommodate the needed tools to irrigate and clean. Odne™Clean recently received FDA clearance and joined the family of new minimally invasive root canal debridement devices, and Odne™Fill provides an obturation solution for the resulting minimally instrumented canals.

Another interesting consideration is regarding the preservation of tooth structure. Up until now, we have been shaping the canal to fit the cone — this principle will become obsolete, as Odne™Fill can flow into any kind of geometry.

One of my values is to always look to further improve the care I provide. For this, it is important for me to always stay abreast of science and education as innovation drives all progress. Odne’s science-based approach aligns with this value. The Odne team truly looked at the science first before they even considered putting this in a clinician’s hand. They took time to look at the foundations of this material — the biocompatibility, the properties, and what could be achieved with this new material. It was a very thorough pre-clinical process, unlike other companies we’ve encountered that try to make claims about something being the next greatest material when it hasn’t gone through a thorough evaluation process. The researcher line-up at AAE 2024 for Odne was impressive, and clinical studies are ongoing with renowned researchers.

In summary, I’d say that any product that has the potential of either improving the quality of care or making treatment more efficient and easier for both the patient and clinician are products that I would use in my practice, would recommend to colleagues, and importantly, would further the development of our profession. I think Odne™ products have the potential to do exactly that.