Journal of Conservative Dentistry
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Year : 2013  |  Volume : 16  |  Issue : 3  |  Page : 277-279
Author's reply

Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India

Click here for correspondence address and email

Date of Submission17-Dec-2012
Date of Decision10-Mar-2013
Date of Acceptance15-Mar-2013
Date of Web Publication4-May-2013

How to cite this article:
Shah N, Logani A. Author's reply. J Conserv Dent 2013;16:277-9

How to cite this URL:
Shah N, Logani A. Author's reply. J Conserv Dent [serial online] 2013 [cited 2019 Oct 14];16:277-9. Available from:

It is not true that 'biological seal' has not been demonstrated. Complete healing of periapical lesion and normal bone pattern at the root apex indirectly means that some mineralized tissue is formed in close proximity to apical foramen as well. The direct evidence is provided by pre and post treatment Cone Beam Computed Tomography (CBCT) evaluation, where increased mineral density of bone and cementum is documented with numerical values, which is beyond any doubt.

It is surprising that after reading the entire manuscript and series of X-rays taken longitudinally, showing excellent healing, Dr. Ram Kumar thinks that it was achieved, even without aiming to achieve complete disinfection!

It is known that periapical lesion will heal if the canals are thoroughly disinfected. To enhance complete disinfection, a modified cleaning technique is described which Dr. Ram Kumar has failed to understand correctly. First "apical clearing" is done within the apical constriction (i.e., within the lumen of the canal) with file sizes 2-4 larger than the master apical file (MAF). If the initial apical file (IAF) size was #15, the conventional preparation recommends widening three sizes larger than the IAF, which is till size #30. Further enlarging to file sizes 2-4 would be #40 or #45, which equals 400-450 μ. This is in conformity to the recommended widening to 300-500 μ. In convention preparation, "apical foramen widening" is not recommended at all; in fact, it is stressed that original apical foramen size should be maintained; as widening would increase the area of the foramen, which is difficult to seal and would lead to microleakage. [1] Only a small patency file #10 is recommended, which is also debated. Therefore, "apical foramen widening" is a new concept and was performed as an additional step combined with "apical clearing", so that cemental part of the canal was also debrided, which enhances the canal disinfection.

Regarding comment on [Figure 1], first and foremost, the procedure is not "revascularization", which is usually done in an immature tooth to fill the canal space with blood clot. The case was treated by the novel technique of "SealBio", in which bleeding is induced only at the periapical area without any attempt to fill the lumen of the canal in mature teeth.

Secondly, between the initial and 6-months follow-up radiograph, the tooth position is more or less the same; the minor difference could be due to angulation of tube placement. As can be appreciated in the initial radiograph, there was bone resorption (demineralization) on the mesial aspect of tooth #47. It is well-known that there is always a mesially directed force, acting at contact areas, which maintains the proximal contacts between the teeth. Since bone was demineralized and softened, it is possible that the second molar had shifted mesially and the space between it and the impacted tooth has increased. The level of calcium sulfate cement in the mesial canal at 6 months and at 3 years follow-up X-ray makes it obvious that the same tooth has shifted mesially. (Our observations and explanation was also discussed with two oral radiologists, who were in agreement with our observations). The serial X-rays taken over a 3-years long period, clearly shows progressive healing. It is surprising that the entire focus is on the adjacent impacted tooth and the main area of interest, i.e., the periapical and periodontal bone healing is completely missed!

We would like to mention here that we had submitted X-rays of six cases to the Editor for publication. However, the Editor has published the X-rays of only two cases. You may request to see those X-rays from the Editor, which would further strengthen the efficacy of this novel technique.

It is not surprising to read the last paragraph of the letter to understand that Dr. Ram Kumar has not read the article with an open mind and a positive attitude towards a new and exciting concept of "SealBio", combining a modified cleaning and shaping protocol with "regeneration" concept. The increased bone density on X-rays and numerical values on CBCT, both at the centre of periapical defect and at the apical end of the root adequately document deposition of mineralized tissue. It was only for an academic interest that animal experiment was mentioned, to know exactly which type of tissue is deposited.

The question of doing animal experiment before doing in humans is totally uncalled for. All the procedures in this technique are well-established procedures in conventional endodontic treatment; therefore, there was no harm expected. In fact, this technique uses all these established procedures in a systematic and logical sequence, which has led us to innovate a new technique of endodontic treatment which is much simpler and cost-effective. Besides, the clinical study on novel technique of "SealBio" was conducted after obtaining Institutional Ethical clearance, registration with Clinical Trial Registry of India and after obtaining informed consent of the patients. Each and every step performed in this novel technique has a rationale and scientific basis.

We would like to add here that this paper was presented at the General Assembly of International Association for Dental Research (IADR) in 2010 held at San Diego, USA and later at Pan-European Region meeting of IADR, where abstracts go through strict peer review process, before getting accepted. It is also presented at other international and national meetings, where it was very well-appreciated.

Comments/observations on a scientific manuscript are welcome for initiating debate and discussions and for improving the standard and quality of research and publication in future, provided it is done with an open mind. As scientists and clinicians, it is imperative to keep the eyes and mind open to newer ideas and concepts and not criticize something for the sake of criticizing and without proper understanding.

   References Top

1.West JD, Roane JB, Goerig AC. Cleaning and shaping of the root-canal system. In: Cohen S, Burns IC, editors. Pathways of the Pulp. 6 th ed. 1994. p. 183.  Back to cited text no. 1

Correspondence Address:
Naseem Shah
Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-0707.111336

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