Bisco: Four Decades of Improving Restorative Dentistry
As BISCO celebrates its milestone 40th anniversary, we explore the key product innovations that have given the manufacturer a "sticking" reputation among clinicians everywhere
It should come as no surprise that, over the past several years, BISCO has accumulated 9 DPS Best Products—including its newest innovation, TheraBase, launched earlier this year. That’s because from 1981 to 2021, BISCO has dedicated time, resources, and talent to improving restorative dentistry. Products may not be quick to come to market, but when they do, clinicians can be sure that they will live up to and perhaps even exceed their product claims. And in today's constantly evolving landscape of dental restorative materials, that's not always a guarantee.
Inarguably, the key driver behind BISCO's DPS Best Products is a dedicated R&D team made up of highly capable chemists, engineers, and dentists. But it certainly didn't start out that way. While the man behind BISCO's science, research, and success, Dr. Byoung I. Suh, migrated to the U.S. from South Korea in 1964, bound for San Francisco State University on a graduate scholarship, it would take him nearly two decades to bring the company to fruition (See "A 40-Year Legacy Begins," at right).
When Dr. Suh did finally take the leap and open BISCO's doors in 1981, research and development went into overdrive. As a result, BISCO churned out unique products like BisFil-M, the industry's first reinforced nanofil composite; All-Bond 2, the first successful universal dental bonding system; and Duo-Link Universal, a dual-cured composite luting cement.
A Commitment to Solving Clinical Problems
Despite BISCO's initial success, any growing company is bound to have both peaks and valleys. According to Dr. Suh, one of the most challenging ventures for BISCO was developing TheraCal LC, the resin-modified calcium silicate liner that launched in 2011 and, over the past decade, has gained significant popularity among clinicians thanks to its protective qualities and pinpoint accurate delivery directly into the prep.
"TheraCal LC was actually developed in 2003, but it took many years to solve some of the stability/separation issues before we finally were able to launch it in 2011," Dr. Suh recalled.
In another challenging moment, BISCO struggled to launch a 2-part adhesive that would simplify bonding for clinicians, and after spending time and money on developing an unsuccessful dispenser, success was ultimately achieved via ALL-BOND UNIVERSAL, the first universal adhesive compatible with all direct and indirect restorations, as well as all light-, dual-, and self-cure materials.
Like TheraCal LC, ALL-BOND UNIVERSAL has been embraced by clinicians everywhere thanks to its simple, one-bottle application, reliable strength, and lack of postop sensitivity. Just ask several DPS evaluators who helped make the adhesive a DPS Best Product back in 2012 and are still using it today, including Dr. Mitchell Pasenkoff, who shared, "It is a good bonding agent and I love the versatility. One bottle has it all—etchant, primer, and bonding agent—and it can be used for different phases of curing from light- to self- to dual-cure.
A Closer Look at the TheraFamily
While BISCO may be most well-known for ALL-BOND UNIVERSAL and its breakthrough adhesive technology, the TheraFamily of calcium-releasing materials, designed to simultaneously elevate and simplify restorative procedures, has been steadily growing. TheraCal LC is now joined by 3 additional family members—each formulated with unique therapeutic benefits and easy syringe delivery.
TheraCal LC and TheraCal PTF
For example, the first member of the TheraFamily, TheraCal LC, was born out of BISCO’s desire to create a new liner and pulp-capping material that could retain the advantages of traditional calcium hydroxide and MTA materials while overcoming their obstacles, such as difficulty mixing and placing. By contrast, TheraCal LC comes in ready-to-use syringes with disposable dispensing tips for controlled and precise placement, even in deep cavity preparations.
Additionally, the light-cured, resin-modified calcium silicate material has a hydrophilic polymer matrix that facilitates significant calcium release.* Combined with an alkaline pH, it promotes healing and stimulates hydroxyapatite and secondary dentin bridge formation, leading to a protective seal.1–7“
I have been using TheraCal LC for the past 5 years with great results,” said Dr. David Martin. “Its formulation has saved many teeth that had either pinpoint exposures or were very deep—freeing these patients from more extensive treatment and preserving the dentition of many others.”Building on TheraCal LC’s success is TheraCal PT, a dual-cured, resin-modified calcium silicate material that is ideal when treating pulpotomies and during pulp-capping procedures. Like its predecessor, TheraCal PT features unique mixing tips that eliminate hand mixing—a feature that pediatric dentist Dr. Tim Fagan finds particularly helpful. “Decreasing treatment time is extremely important when treating children with short attention spans,” he noted, adding that he performs about 75 pulpotomies a month.
After attaching the mixing tip to a 4-gram dual-syringe and pressing the plunger, TheraCal PT is mixed and dispensed directly into the pulp chamber. “The material handles well and adapts to the pulpal floor with minimal manipulation,” shared Dr. Shohreh Sharif. “There is no mixing or dispensing from a bottle, and the material is not messy or sticky.”
TheraCem
Deemed a DPS Best Product by a team of clinicians in 2017, TheraCem offers calcium release like its fellow TheraFamily members. The self-adhesive resin cement is specifically formulated for easy automix dual-syringe delivery, as well as quick and easy removal.
“I like the ease of application with self-mixing tips,” said DPS evaluator Dr. Marybeth Shaffer, adding that she had no reports of post-cementation sensitivity. “The film thickness and handling properties provide good coverage with no inhibition of seating the restoration.”
No etchant, primers, or adhesives are needed prior to applying TheraCem, which enhances predictability in preparations with subgingival margins and minimizes bleeding. It delivers a strong bond to zirconia and most substrates when luting crowns, bridges, inlays, onlays, and posts.
“We love the strong bond this material offers without having to etch and bond,” noted Jeffrey Peifer, DMD, adding that he was disappointed when a patient had postoperative sensitivity after crown seats. Now, he shared, patients rarely feel a “zing” from crown cementation, and there is generally no need for anesthesia. “We don’t have any issues anymore since switching to TheraCem," he said.
TheraBase
If it seems that BISCO has succeeded in creating a well-rounded therapeutic product line, think again. In creating TheraBase, the newest TheraFamily member, BISCO fine-tuned its proprietary hydrophilic resin matrix to allow a high degree of calcium release.“
The impetus for developing TheraBase was user demand from our TheraCal LC users,” said Dr. Rolando Nuñez, BISCO’s Manager of Clinical Research. “As a liner, TheraCal LC can’t be placed thicker than 1 mm. So, doctors would have to apply more to create a base, or cover it with a glass ionomer, for example. TheraBase fills this gap with its dual-curing capabilities.”
Featuring a familiar delivery technique, easy handling, high strength, and fracture resistance, TheraBase has a dual-curing ability that allows it to fully polymerize chemically, even in deep restorations. Once placed, it is highly radiopaque for simple x-ray identification and accurate diagnosis.
TheraBase becomes even more effective when used in tandem with other TheraFamily members. For example, when treating exposed pulp, TheraCal LC can be used for pulp capping and as a liner. TheraBase can then be placed in the sandwich technique, creating what Dr. Nuñez calls a “calcium explosion” for maximum pulp protection.
Where Efficiency Meets Support
Over the years, DPS evaluators have shared that, beyond product efficiencies, BISCO has provided another key benefit throughout its 40-year success: direct-to-dentist selling paired with an exceptional sales and customer service team. In our world of automation, it’s a rarity to have such a direct line to any business, let alone a major player in the dental materials market. Just ask Dr. Poojah Saroha, who has enjoyed using several of BISCO’s DPS Best Products over the years in her Woburn, MA, practice, including Z-Prime Plus to enhance the strength of her zirconia crowns prior to placing them with TheraCem.
“BISCO’s customer service is very good—they are prompt and helpful when it comes to product selection or answering any questions I may have. The products are reliable, and I get great results each time. I have saved so many teeth from needing root canals, and as a result, I have many happy patients,” shared Dr. Saroha, who also uses 2 key members of the TheraFamily, TheraCal LC and TheraCal PT.
Of course, Dr. Saroha is not alone in her perspective. “To me, BISCO sets themselves apart by having a readily accessible website that is user-friendly, and also the barrier to ordering is low,” shared Dr. Sean Sunyoto. “This means that I can take advantage of discounts and ordering by myself without going through another vendor.”
Exploring New Territory
From revolutionizing bonding to creating a fast-growing product line of therapeutic materials, BISCO proves that there are no boundaries when it comes to product development. A case in point is FluoroCal, which signals the manufacturer’s first product development outside of restorative dentistry.
The 5% sodium fluoride varnish, which releases both fluoride and calcium,** helps boost protection while penetrating and sealing dentin tubules to provide immediate sensitivity relief.
Like many of BISCO’s restorative solutions, FluoroCal is designed to deliver targeted and sustained release of fluoride and calcium over 24 hours,** while its spearmint flavor sweetened with xylitol improves patient compliance.
A Clue to BISCO's Future
Should we expect additional product developments and chemistry breakthroughs from BISCO, both inside and outside of restorative dentistry? The man who started it all 40 years ago, Dr. Suh, leaves us with an essential clue: “We have a great R&D team here at BISCO that I am confi dent will continue BISCO’s track record of developing new products in adhesive dentistry, bioactive materials, and self-adhesive materials that will enhance the future of restorative dentistry.”
References
- 1. Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. International Endodontic Journal. 2012 Jun;45(6):571–9.
- 2. ADA defi nitions for direct and indirect pulp capping at: HYPERLINK "https://www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter" www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter
- 3. Apatite-forming Ability of TheraCal Pulp-Capping Material, M.G. GANDOLFI, F. SIBONI, P. TADDEI, E. MODENA, and C. PRATI J Dent Res 90 (Spec Iss A):abstract number 2520, 2011 (www.dentalresearch.org)
- 4. Okabe T, Sakamoto M, Takeuchi H, Matsushima K (2006) Effects of pH on mineralization ability of human dental pulp cells. Journal of Endodontics 32, 198–201.
- 5. Sangwan P; Sangwan A; Duhan J; Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J. 2013; 46(1):3–19
- 6. Cantekin K. Bond strength of different restorative materials to light-curable mineral trioxide aggregate. J Clin Pediatr Dent. 2015 Winter;39(2):143–8.
- 7. Mechanical Properties of New Dental Pulp-Capping Materials Over Time. M. NIELSEN, R. VANDERWEELE, J. CASEY, and K. VANDEWALLE, USAF, JBSA-Lackland, TX, , J Dent Res 93(Spec Iss A): 495, 2014 (www.dentalresearch.org)
- * Bisco has, on file, the calcium release data for TheraCal LC
- **As tested in deionized water
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