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ePaper created 2016-11-22, 09:52:12 | version 1.38.0
| case report use of Er,Cr:YSGG laser in endodontics 36 roots 4 2016 root canal system disinfection and to allow irriga- tion solutions to travel apically.22, 30–32 In addition, Er,Cr:YSGG laser irradiation has been shown to pro- duce clinically safe temperature increments along the root canal walls,32–35 together with absence of molecular dentine changes, signs of melting or car- bonisation.18, 34, 36 Previously, laser-assisted endodontic protocols consistedofusingplainfibres(withastraightforward emission beam profile). Generally, these fibres were placed in the main canal and withdrawn from apical to coronal in a rotating motion. However, such tech- nique is known to be sensitive and to produce incon- sistent results.18, 35, 37 Designed to overcome such limitations, radial fir- ing tips (RFT) present a beam expansion pattern— promoted by the tip geometry—that favours a ho- mogeneousenergydistributionalongtherootcanal wall. In contrast with plain fibres, RFT have been shown to produce consistently relevant in vitro re- sults. They are known to spread their energy in the direction of the dentinal tubules,22 to produce lower temperatureincrements,27 toincreasecavitationef- fects towards the root canal walls without harming periapical tissues,38 to be highly efficient in bacterial and biofilm reduction39, 40 and to allow irrigating solutionstotravelapicallybyovercomingtheairlock effect.41 Althoughsomeclinicalstudieshavedemonstrated the potential benefits and long-term outcomes after laser-assisted treatments,42, 43 there is no mention of any IRR case treated with a laser-assisted technique. The report of distinct clinical cases with long-term follow-ups may be an additional support for an evi- dence-based proof of concept. Case report A 31-year-old female patient presented for con- sultation, complaining of recurrent swelling and painfulepisodesrelatedtotooth11,whichhadbeen treated with antibiotic prescriptions over the past fewyears.Thepatient’smedicalhistorywasnotcon- tributory. The patient reported trauma to her upper teeth when she was 20 years old. After performing clinicalandradiographicexaminations,tooth11was diagnosed with pulp necrosis with internal root re- sorption and apical periodontitis. The tooth was slightly tender to percussion, periodontal probing depths were considered normal (< 3 mm), and there was no discoloration (Figs. 1 & 2). Approval for the study protocol (N_682/068) was obtained.Treatmentoptionswerediscussedandthe required consent obtained (Helsinki Declaration, re- visedinEdinburgh2000).Nofinancialincentivewas offered (i.e., patient was responsible for the usual root canal treatment fee). Under local anaesthesia (2 % lidocaine with 1:100,000 epinephrine, Scandonest, Saint Maur des Fossés, France) and rubber-dam isolation (Hy- genic Non-Latex Rubber Dam, Coltène/Whaledent, Germany), an access cavity was prepared with a high-speed carbide bur (SS White, Lakewood, NJ) and Zekrya Endo burs (DENTSPLY Maillefer, Ballai- gues, Switzerland). The working length (WL) was electronically established (Root Zx mini, Morita, USA)as1 mmshortofthebiologicalapexoftheroot and confirmed by radiography. No bleeding was noted from the root canal. Patency was confirmed with an ISO#20 K-file and root canal preparation wasperformedwiththeProtapersystem(DENTSPLY Maillefer,Ballaigues,Switzerland)uptoanF5(#50.05) Fig.1 Fig.2 Fig.3 Fig.1: Clinical picture demonstrating aesthetic initial appearance of tooth 11. Fig.2: Initial radiographic appearance of tooth 11 demonstrating an extensive apical radiolucency and internal root resorption. Fig.3: Immediate post-operative radiograph of tooth 11. 42016