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ePaper created 2017-06-15, 09:14:00 | version 1.38.0
| case report Dual-wavelength laser application Dental-fistula in a primary anterior tooth Author: Dr Imneet Madan, UAE Primary teeth play a vital role in setting the healthy pathway towards permanent dentition. The treatment modalities for primary teeth should therefore be in best favour of preserving these teeth until they exfoliate naturally. Chronic dental caries in primary teeth are the most common cause of premature extractions. The best mode of man- agement is to prevent the onset, nevertheless, when the decay does occur and reach the stage where there is chronic infection leading to periapical areas, laser therapy can be used effectively to save the tooth. The current case report emphasises on the suc- cessful effect of laser in the treatment of fistula in primary upper anterior tooth in a four-year-old fe- male. Laser- assisted endodontic treatment resulted in success and this helped to retain the anterior primary tooth until the permanent tooth will even- tually replace it at the age of six to seven years. The child is under periodic follow-up and has had no clinical or radiographic signs of reinfection since the last two years. Introduction Primary teeth functions extend far beyond enhancing the smile of the child. They act as the natural space maintainers that can be the best guide in the eruption of permanent teeth in accu- rate alignment. Primary teeth contribute to the de- velopment of jaws, maintain the speech of the child and avoid the development of any parafunctional habits such as tongue thrusting.1 Considering these vital functions of the primary teeth, it is important that under any given condi- tions, it should be prioritised to save them and avoid premature extraction. One of the most common reasons for the primary teeth to undergo extraction is chronic untreated dental caries. Chronic dental carious lesions lead to necrosed pulpal changes and treatment for this is very complex in primary teeth.2 Both anatomical and physiological nature of pri- mary teeth does not allow complete elimination of root canal infection. There has been no reported endodontic concept for the treatment of primary teeth so far.3 The microbiology of endodontic infections is complicated. Enterococcus faecalis has been re- ported in high prevalence in primary root canal in- fections.4 However, lasers, by virtue of their deeper permeability help in sterilising the affected and in- fected canals leading to better success rates with compromised teeth. Case report A four-year-old female child reported to the den- tal clinic after referral from their general practi- tioner. The child came in with her mom in January, 2015 after a traumatic fall on the upper front teeth a few weeks back. No antibiotics were taken. The upper front tooth had been mobile ever since the fall. The mom took the child to her dentist and they were then referred to consult for an opinion other than extraction. On intraoral examination Tooth number 61 presented with grade II mobility and a periapical fistula. An intraoral periapical X-ray showed widening of the periodontal ligament in the periapical area. There were no signs of tenderness to percussion, although the child was in discomfort due to infection and swelling in the gum (Fig. 1). Discussion prior to the treatment Based on radiographic and clinical examination, two options of the treatment were given as follows: 06 laser 2 2017