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ePaper created 2017-01-04, 09:21:41 | version 1.38.0
| industry 22 laser 4 2016 Er:YAG caries treatment according to minimally invasive therapy Authors: Kinga Grzech-Les ´niak & Swietłana Kozaczuk, Poland Main MiCD principles are based on the following five rules: 1. “The-sooner-the-better”—Early diagnosis of ill- ness or the cavity allows minimising the need of invasive treatment in the future. 2. Smile Design Wheel—the procedure taking into accountthepsychological,health,functional,and aesthetic situation of the patient. 3. “Do-no-harm”—One should choose therapeutic methods which saves healthy tissues of teeth to a maximum extent. 4. “Evidence-based approach”—The choice of mate- rials and instruments should be based on the re- sults of scientific research. 5. “Keep-in-touch”—more attention should be paid to regular check-ups and examining the patients carefully,explainingtothemwhythisissoimport- ant. Tooth decay is one of the most prevalent infec- tious diseases, and continuous progress of knowl- edge, development of new techniques of treatment in the early stages cause that physicians face new challenges and opportunities. Currently, the patient also expects from the clini- cian an interdisciplinary, innovative and minimally invasive approach. Over the years, a significant changeoftheapproachofsurgicaltreatmentforso- called biological treatments has been made. Biolog- icaltreatmentpresupposestheeliminationofbacte- rial infection (by the use of ozone or laser, for example) and impermeability of fillings, relying on theadhesionpropertiesoftherestorativematerials. This concept is also based on the selective removing of the decayed tissues without unnecessary prepa- ration of healthy tissues surrounding the defect. Thus, the concept of minimally invasive therapy and early diagnosis correlate with the innovative idea of treatment involving laser techniques. In conservative dentistry, in order to prepare de- cayed hard dental tissue and replace dental fillings, high-energy Er:YAG laser is used.2 Er:YAG elimi- nates many harmful experiences of the patient (vi- bration, overheating of the tissues during prepara- tion, unpleasant sound)3 , introducing him/her to a new dimension of treatment. No pressure occurs, as unpleasant experiences of the patient are fully eliminated, and thus, the patient is motivated to further cooperation. Moreover, pain sensation is limited. In the case of Er:YAG laser, there is very short pulse duration and nerve endings are often not stimulated. In many clinical trials, limited use of anesthetics was reported and full acceptance of this therapy methodbythepatientswasdemonstrated.Thetech- nique of laser preparation of the cavity allows per- formingtheprocedurepainlessly,orwithamildpain sensation (NRS—Numerical Rating Scale < 3) for profound tooth decay in 59.8 %, and medium tooth decay—at 94.8 %.5 Theuseoflasertechnologyinrestorativedentistry refers to the action scheme described below. Er:YAG laserradiationat2,940 nmispreferablyabsorbedby waterandhydroxyapatite.Thisprocessofanon-ther- mal nature is based on “evaporating” the tissue by short light pulses of high energy (photoablation). The key role is played by the water molecules incor- porated in the crystalline structure of the miner- alised tooth tissue. Water, activated by the supplied energy, is converted into steam, and the pressure within the mineral structure of teeth increases rap- 42016