Introduction: A Philosophy at a Crossroads
Biological dentistry should be based on the principle of treating the patient while integrating their oral, systemic, and immune health. Despite the profession’s paucities and confusing protocols, an increasing number of patients are seeking our services in this new field of dentistry to obtain safe, sustainable, and minimally invasive dental care.
We are often asked whether compromised teeth should be extracted and replaced with dental implants, given no other options?
The emerging debates on the management of compromised teeth should be carefully discussed. What are the staged biological treatments in endodontic and periodontal regeneration? Or how should we approach the complex endodontic-periodontal tissue-interface destruction caused by biofilm?
Dental implants have revolutionised restorative dentistry and full mouth rehabilitation in many dental practices. Although in well-selected patient cases it can result in excellent clinical outcomes, in specific compromised cases, it is not always an ideal solution, as there is a risk that their immunological adaptation could compromise the outcomes we expect in holistic dental tooth rehabilitation. The aim of the holistic approaches is to preserve, minimise, and eliminate the root causes of oral infection at the earliest possible.
The Biological Rationale for Tooth Preservation
The advantages of natural teeth
The consistent natural bone stimulation, preservation of the periodontal ligament, and maintenance of proprioceptive feedback, aligned with tooth conservation, will be permanently compromised or lost, even when utilising the most advanced implant systems and designs. Therefore, we should preserve natural teeth to maintain the neuro-muscular adaptability responsible for jaw joint balance, occlusal harmony, and natural bone stimulation. Most histological studies support the biological principles underlying the consistent natural stimulation of the alveolar bone in the presence of the periodontal ligament.
The biological trauma following tooth extraction disrupts the natural stimulation of the alveolar bone via the periodontal ligament.
Section 1: The Staged Biological Endodontic Approach introduced by Dr Nico Kamosi
In biological dentistry, endodontics is not a single event but a staged, biologically complex protocol comprised of:
1. Disinfection Phase
After meticulous mechanical and conventional chemical debridement procedures, we introduce ozonated saline and activated ozone gas into the infected root canals. Nico kamosi implements adjunctive laser-assisted disinfection at 640nm using a triple laser to eliminate endodontic bacteria, biofilms, and residual toxins deep within dentinal tubules.
2. Monitoring & Stabilisation
A bioactive and bioinert antibacterial non-setting paste is inserted into the root canals, and the tooth is temporarily sealed.
The patient’s periodontal and peri-apical tissue healing is then monitored and assessed both clinically and radiographically.
We should assess and follow the trends in the emergence and maintenance of inflammation markers, signs & symptoms, and periodontal and periapical healing before embarking on treatment completion.
3. Final Root Canal Therapy
After satisfactory Status Health Quo confirmation, we can perform root obturation using biomimetic, bioactive, and bioinert pastes as these biomaterials could successfully integrate within dentin, while encouraging periapical healing with minimal long-term leakage as a result.
The staged and carefully monitored disinfection procedure may reduce the biological infection burden to give the previously considered questionable a chance, not a guarantee, for a more predictable long-term clinical survival, but not necessarily a sub-clinical success at all times!
Section 2: Periodontal Treatment as a Cornerstone of Biological Dentistry
The health status supporting Periodontal tissues is the foundation of the tooth and a requirement for tooth preservation.
A plethora of evidence from decades of clinical research, as well as integrative medicine and biological dentistry, all support the adverse effect of untreated periodontal disease as a biological burden on systemic health.
Periodontal Therapy as the First-Line of the initial care plan
- Initial periodontal treatment includes meticulous mechanical debridement followed by laser-assisted periodontal disinfection (LAPD). Degranulation of the infected/non-infected/disinfected tissue is a perquisite procedure during the cause-related non-surgical and surgical root debridement.
- Biological adjuncts such as ozone therapy, growth factor implementation, host-modulation strategies e.g., photo-bio-modulation (PBM) are designed for enhance healing.
- The ultimate therapeutic goal is not merely periodontal pocket reduction by eliminating microbial reservoirs that cause systemic inflammation, but also the reattachment of periodontal fibres and tissue regeneration.
The Systemic health burden caused by Periodontal Disease
The endotoxins released from periodontal bacteria constantly enter the bloodstream, triggering the release of systemic inflammatory cytokines. Therefore, periodontal pathogens persistently stimulate inflammatory and maintenance responses, especially in immunocompromised patients with autoimmune, cardiovascular, and diabetic diseases, or chronic inflammatory syndromes.
Periodontitis has been strongly associated with atherosclerosis, endocarditis, and cardiovascular events. Therefore, implementation of sophisticated cause-related staged periodontal care in these patients could reduce the systemic bacterial load and preserve the chewing function. Care should be taken that an aggressive, poorly planned surgical extraction may further destabilise the immune balance!
Section 3: The Case Selection for Dental Implants
When Implants Are Indicated?
Please read more in Dental Implants
Section 4: Biological Dentistry as Minimalist Medicine
The primary goal of biological dentistry is to reiterate physiological Homeostasis and reduce the systemic burden, not function!
- Atraumatic Restorative Treatment (ART) and Minimal intervention: — not simply replacing damaged teeth with implants.
- Eliminate the root cause of the disease by: Treatment of the oral and dental diseases and efficient elimination of the sources of infection, implementing integrative advanced endodontics and periodontal intervention and maintenance
- Respect systemic immune balance: Unnecessary surgery in an overwhelmed, fragile immune system should be avoided.
Section 5: Evidence-Based Insights
- Endodontics: A good number of studies show that staged root canal treatment utilising bioactive/ceramic sealers may have a success rate comparable to that of implant-supported prosthetics.
- Periodontology: Periodontal treatment can successfully reduce systemic inflammatory markers, silent inflammation and adverse systemic health issues, e.g., diabetes, cardiovascular disease and many others.
- Implantology: Although Dental implants may have excellent long-term success rates (92–96%) in healthy individuals, they are less predictable in high-risk individuals or compromised sites.
Dr. Nico Kamosi
Dr. Nico Kamosi
Specialist Periodontist, Implantologist, Prosthodontist, Holistic and Biological Dentist
TDL. DDS. (Swe.), MSc.Perio.(Eng.),
MClinDent.Perio.(Eng.), MSc.Imp.Dent.(Eng.),
Dip.Aesth.Med. (Eng.), MClinDent.Prosth.(Eng.),
Cert., Dip.DHSLM.(RCS.Eng.), Cert.Orth.(Eng.), Cert.Law (Eng.), AIAOMT
Accredited member of IAOMT, SMART Certified
Member of AACD, EFP, AAP, ESCI, IAOMT
