B³ Framework™ — A Biologically Anchored Approach to Endodontic Disinfection
Overview
The B³ Framework™ is a conceptual clinical–academic model designed to reframe how
endodontic disinfection success is defined, evaluated, and communicated.
Rather than relying solely on canal-centric surrogate endpoints
(e.g., irrigant volume, taper size, or isolated imaging metrics),
the framework emphasizes biologically anchored decision-making aligned with
real-world clinical constraints.
B³ stands for Biology, Burden, and Boundaries—three interdependent domains that guide
rational disinfection strategies in contemporary endodontic practice.
The Three Pillars
1. Biology
Focuses on the biological objective of treatment rather than procedural checklists.
Microbial ecology and biofilm behavior
Host–microbe interaction
Tissue response and healing potential
Biological plausibility of disinfection protocols
Key question:
Is the intervention biologically sufficient for disease control in this case?
2. Burden
Recognizes the disease and treatment burden unique to each clinical scenario.
Microbial load and anatomical complexity
Pre-operative pathology and symptoms
Procedural intensity versus clinical payoff
Risk of overtreatment or diminishing returns
Key question:
What level of disinfection is proportionate to the actual disease burden?
3. Boundaries
Accounts for real-world constraints that influence outcomes.
Clinical time and workflow limitations
Patient tolerance and systemic factors
Operator experience and clinical setting
Resource availability
Key question:
What is achievable, ethical, and effective within these boundaries?
Why the B³ Framework™ Matters
The B³ Framework™ shifts the conversation from “How much was done?” to
“What was biologically necessary and sufficient?”
It provides a shared language for clinicians, educators, and researchers to:
Interpret disinfection outcomes more meaningfully
Avoid protocol escalation without biological justification
Align academic evidence with chairside reality
Intended Use
The B³ Framework™ is intended for:
Clinical education and postgraduate training
Academic discussion and scholarly commentary
Conceptual guidance in treatment planning and outcome interpretation
It does not prescribe a fixed protocol or replace clinical judgment.