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ePaper created 2017-06-15, 09:14:00 | version 1.38.0
industry | root canals can be achieved by laser- activated irrigation with NaOCl solu- tion due to the pulsation of laser output and the easy access to root canals by an optical fibre.22 The acous- tic streaming, caused by the collapse of laser-induced bubbles, was identi- fied as an effective mechanism for dentin debridement in the apical por- tion of root canals.21 The pressure pro- duced by the pulsation of laser beam in a narrow space like a root canal is a unique feature of laser devices. No study addresses the application of laser pulsation on canal filling so far. This report documents three cases of traditional endodontic treatment that were supplemented with the use of the Nd:YAP laser which resulted in the radiographic identification of sealer in apical ramifications. Material and methods Fig. 2a Fig. 2b Fig. 2c Fig. 2d Fig. 2e Three patients of this case report received root ca- nal treatment necessitated by carious exposure of the pulp or apical periodontitis. Endodontic treatment consisted of the following procedures: access open- ing, canal preparation by hand and rotary instru- ments, canal irrigation, and canal filling. The canals were enlarged conservatively providing adequate proximation of the optic fibre to the apical third of the root canal. Three-percentage NaOCl solution and EDTA paste (RC-Prep, Premier, USA) were used during instrumentation; saline was used between applica- tion of NaOCl and EDTA. Gutta-percha cones (Gutta Percha Points, Meta Biomed, Korea) and zinc-oxide eugenol-based sealer (ZOB Seal, Meta Biomed, Korea) were used for canal obturation. The exposure to the Nd:YAP laser (Lokki YAP, Lokki, France), using 220 µm optical fibre (Fig. 1) with 160 mJ/pulse and 30 Hz, was conducted during canal irrigation. The optical fibre was put into a root canal 2–3 mm short of working length as a starting point for pulsed radiation. Radiation of the laser was followed with upward movement of the optical fibre against the canal wall and stopped when the optic fibre was close to the orifice. Laser irradiation was repeated throughout all canals as mimicking circumferential filing until no debris was noted in the pulp chamber followed by drying of the canals with paper points. The 220 µm optical fibre with the mode of 180mJ/ pulse and 5 Hz was chosen for canal filling. After root canals were filled with sealer by using a lentulo spiral, a single pulse of laser beam was radiated at a position 2–3 mm short of working length at first, and then an- other two single pulses of laser beam were emitted in the middle of the root and at a location 2–3 mm below the orifice consecutively. Cold lateral condensation was accomplished with the placement of a master gutta-percha cone followed by accessory cones for complete obturation. Periapical X-ray films were taken to evaluate the quality of the root canal ob- turation. No medications were prescribed during treatment or postoperatively for patients. Case presentation Case 1 (Figs. 2a–e) A 45-year-old woman sought treatment for severe pain associated with a mandibular left canine. Clini- cally there was severe vertical mobility and cuspal interference existed when the patient moved her mandible in lateral excursion. Radiographic examina- tion revealed a radiolucent lesion extending along the mesial aspect of the root. Before beginning access opening, the canine was splinted to the mandibular left, lateral incisor and first premolar, and the occlu- sion was adjusted to eliminate lateral interference. Purulent exudate was drained not only from the periodontal pocket, but also from the canal orifice after the chamber was opened. An accessory canal mimicking a bifurcated apical canal was sealed. At the ten-month recall, bone density was increased around the root and no inflammatory signs were observed in the periodontal pocket. Case 2 (Figs. 3a & b) A 46-year-old woman with missing restorations on the mandibular right first and second premolars Fig. 2: Comparison of intraoral photos and periapical radiographs before treatment (a and c) and post treatment (b, d and e). a) Purulent exudate was drained from the mesiolabial periodontal sulcus. b) Intraoral photo: 10-month post treatment. Periodontal abscess subsided with gingival recession. c) Periapical radiograph before treatment. A significant radiolucency was observed around the root of mandibular left first premolar. d) Periapical radiograph immediately after treatment. e) Periapical radio- graph: 10-month post treatment. The increase in bone density was noted around the root of mandibular left first premolar even though excess of sealer was remained out of the root apex. laser 2 2017 27