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ePaper created 2017-01-04, 09:21:41 | version 1.38.0
07 4 2016 laser research | case of patients with symptoms of cardiac disease. In the case of multimorbid patients who are frequently prescribed anticoagulants, the danger of secondary haemorrhage can be minimised. In addition, in these cases,abloodlesssurgicalfieldcanbecreatedadhoc, so that moisture-sensitive restorative measures (ad- hesive dentistry) can be carried out. In general, for multi-morbid patients it is important thatrestorativeprocedurescanbecarriedoutinashort time and that the use of anaesthetics should be re- ducedtoaminimum.Excisionwoundsshouldhealina shorttimeperiod.Adryenvironmentisadvantageous, inparticularwhenadentalrubberdamcannotbeused. In case of extended subgingival loss of dental hard tissue, e.g. as a result of carious defects, it is always necessary to enable a visual inspection of the prepa- ration margin before the restoration can be placed. Furthermore,abloodless,clean,anddryadhesivesur- facemustbeguaranteedbeforeapplicationofrestor- ative material. Here, laser-assisted procedures pro- vide a fundamental advantage in comparison to classical surgical procedures. Adequate haemostasis after soft tissue excision with the scalpel, scalers and cuvettes is often not achievable by styptics. This case study presents a treatment protocol for restorative and endodontic treatment of patients with extensive subgingival carious lesions in the an- terior tooth area. Case report A 72-year-old patient visited the Dental School of the University of Bonn to obtain a dental consultation regarding prostodontic aspects. The medical history was unremarkable. The patient did not suffer pain. Among other things, insufficient composite restaura- tionintheanteriortoothregionsoftheupperjawwere noticeable at the initial examination. In addition, sub- gingivalprobingshoweddefectsindentalhardtissues at11and21.Fortooth11,afistulaandanapicalradio- lucency were found in the vestibular marginal area in the X-ray image (Figs. 1a–e). Teeth 12 and 21 reacted positively to a sensitivity test, in contrast to tooth 11. Theprobingdepthsoftheteeth11and21were4–5 mm. The treatment plan was explained thoroughly to the patient. In the first session, tooth 11 was trepan- ated as part of an emergency procedure. After expo- sure of the root canal, it was rinsed with NaOCl and calcium hydroxide was applied. Ahead of this emer- gency endodontic procedure, the carious lesions on 11 and 21 were excavated incompletely and treated temporarily with glass ionomer cement. The patient came for further treatment five days later. The fistula on 11 had closed, clinical symptoms were no longer present (Fig. 2). After an infiltration anaesthesia(1.8mlUDS),thesubgingivalcariousde- fects in teeth 11 and 21 were visualised in a gingivec- tomy (Fig. 3). For both teeth, approximately 4 mm of soft tissue had to be removed to expose the affected area. The gingivectomy was carried out using a 445 nm diode laser (Sirona K-Laser blu, Sirona, Bens heim, Germany) with a power output of 1.5 W in cw mode and an application tip with a diameter of 320 μm.Thisdeviceisapre-serialmodelequivalentto SIROLaserBlue(Sirona,Bensheim).Theresectionwas carriedoutinsixminutes.Thesurgicalprocedurewas performed with no pain. After finishing the gingival excision,thesurgicalfieldwasbloodlessanddry(Fig. 3),sothatthetemporaryfillingsat11and21couldbe removed and the caries completely excavated under visualcontrol.Thedefectsweretreatedwithadhesive Fig. 2: Pre-operative situs. Fig. 3: OP-situs after laser surgery (gingivectomy). Fig. 4: Situation after adhesive composite restauration following laser surgery. Fig. 5: Post-operative recall after 7 days. Fig. 2 Fig. 4 Fig. 3 Fig. 5 42016