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ePaper created 2016-11-22, 09:52:12 | version 1.38.0
use of Er,Cr:YSGG laser in endodontics case report | 37 roots 4 2016 instrument. Root canal irrigation was performed between each file with 3 ml of sterile saline solution (Monoject27G,Kendall-Covidien,USA).Nochemical irrigantsorinter-appointmentdressingswereused. For smear layer removal and root canal disinfec- tion, a previously reported laser-assisted protocol was adopted.42, 43 Following root canal preparation, the main canal was filled with distilled water and laser irradiation was performed with the 2,780 nm Er,Cr:YSGG laser (Waterlase MD; Biolase Technol- ogy,SanClement,CA)andradialfiringTip(RFT2En- dolase, Biolase Technology; calibration factor of 0.55)whichwas270 µmindiameter,withpanelset- tings of 0.75 W, 20 Hz (37,5 mJ), 140 µs pulse, 0 % waterand0 %air.Thetipwasplacedattheworking length and irradiation was performed, approxi- mately, at the speed of 2 mm/s until it reached the most coronal part of the canal. The irradiation pro- cedure was repeated four times: 2x with the canal filledwithdistilledwater(forsmearlayerandgran- ulation/pulp tissue removal) followed by 2x in dry conditions (to achieve deep dentine penetration and disinfection), with approximately 15 seconds between each irradiation. Afterward, a sterile cot- ton pellet was placed in the pulp chamber, and the access cavity was sealed with a reinforced zinc-ox- ideeugenolintermediaterestorativematerial(IRM, DENTSPLY). At the second appointment after seven days, the patient reported pain, tenderness to percussion and swelling upon questioning. Under local anaes- thesia and rubber dam isolation, the canal was re-accessed.Themaincanalwasfilledwithdistilled water and laser irradiation was performed using a 320 µm radial firing tip (RFT3 Endolase, Biolase Technology: calibration factor of 0.85), with panel settings of 1.25 W, 20 Hz (62.5 mJ), 140 µs pulse, 0 % water and 0 % air. The irradiation protocol was identicaltothefirstappointment. Afterirradiation, a final rinsing of sterile saline solution (3 ml) was performed, and the canal was dried with sterile pa- per points, checking for the absence of any suppu- ration or exudate. Filling was performed with a #50.05 auto-fit gutta-percha cone (DENTSPLY Maillefer, Ballaigues, Switzerland) using a down pack-backfill technique (Calamus, DENTSPLY Maillefer) and a resin-based endodontic sealer (Topseal,DENTSPLYMaillefer).Bothdownpackmo- tion and gutta-percha injection were performed with low pressure and extreme caution due to the root weakness. Radiographic images were taken immediately (Fig. 3) and after one (Fig. 4), two (Fig. 5) and three years (Figs. 6 & 7). Over this follow-up period, the tooth remained completely asymptomatic and periapical healing was noticed. Discussion Duetoitsinsidiouspathology,thefollowingclin- ical findings enabled the establishment of the diag- nosis of IRR:44 initial absence of bleeding from the rootcanalconfirminganecroticpulp,normalprob- ing depth (< 3 mm) and the complete resolution of apical radiolucency after endodontic treatment, followed by the cessation of the progression of re- sorption. Given that there is insufficient clinical data sup- portingthesuperiorityofanychemicalirrigationreg- imen and no guidelines for the management of low- occurrencepathologiessuchasIRR,casereportsmay beofspecialrelevancewhileadequatelyreportingnew disinfectiontechniquesandtheirclinicaloutcomes.3, 45 The present protocol adopted the use of an Er,Cr:YSGG laser and innocuous irrigants (e.g. saline solution as irrigation and distilled water for laser ac- tivation). The decision was primordially based on the assumption that IRR lesions may perforate external root surfaces without being detectable on conven- Fig.4:Twelve-month follow-up. Fig.5:Two-year follow-up. Fig.6:Three-year follow-up from the mesial direction. Fig.7:Three-year follow-up from the distal direction. Fig.4 Fig.5 Fig.7 Fig.6 42016