Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-06-15, 09:14:00 | version 1.38.0
| case report Fig. 5: X-ray of the primary upper anterior teeth after treatment. Fig. 6: X-ray, follow-up after four months. Fig. 7: X-ray, follow-up after nine months. Fig. 8: X-ray, follow-up after eighteen months. 08 laser 2 2017 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Informed consent Due to the nature of pathology, uncertain progno- sis for the treatment was suggested. The child’s mom understood that in case of failure of treatment, retreatment is not recommended. The tooth would be extracted in such a scenario. Cost estimates for both options were given. The mom chose the treatment plan with laser under conscious sedation. Written consents for the agreed treatment, nitrous oxide sedation and costs were taken. periapical area. Since the canals had no bleeding and were completely dry, zinc oxide eugenol obturation was done followed by GC Fuji IX base fill and the composite fill on the top (Figs. 2-5). After four months, the child presented with no clinical signs or symptoms. An intraoral periapical X-ray showed no abnormal changes (Fig. 6). The child was able to eat, chew and there had been no recur- rence of infection since the completion of treatment. Procedure As the child was seated in the chair, basic neuro-lin- guistic programming techniques were used to get her attention to follow the instructions of deep breathing. One of the introductory techniques is to ask the child to “imagine”. As she began to imagine her own cre- ations such as clouds, butterflies, flower garden, she was guided into deep breathing. Further continuation of stories and metaphors helped to place the mask. Nitrous oxide was slowly increased to 50 per cent and then finally settled at 55 per cent. During this eu- phoric state, the child chose to watch a movie on the overhead screen. She was allowed to relax in this state for five minutes before the procedure was started. After that, an erbium laser access from the palatal surface was done with following settings: Er,Cr:YSGG 2,780 nm, MX7 tip, 3.75 W, 25 Hz, 80 water, Air 60. Ro- tary instruments, TCM prep, were used to enlarge the canals until ISO #35. Intermittent irrigation with saline and chlorhexidine was done. The erbium laser was used for initial sterilisation of the canals with following settings: Er,Cr:YSGG 2,780 nm, RFT2, 1.25 W, 50 Hz, Air 34, Water 24. Paper points were then used to dry the canals. A diode laser 940 nm, 1.5 W, continuous wave, 2 mm/sec, 4–5 turns in circular mo- tion was used. An interim temporary filling was placed in order to allow the fistula to heal before the final obturation. After three days, the tooth was reintervened. The temporary fill was removed and the canals were re-ir- rigated with saline and chlorhexidine. Both erbium and diode laser were used to sterilise the radicular and The follow-up after nine and eighteen months shows no clinical or radiographic changes (Figs. 7 & 8). The child has been completely asymptomatic and the tooth showed normal signs of physiological resorption (Fig. 9). Discussion Primary teeth act as the natural blue print for the eruption of permanent teeth. They facilitate vital functions: – Act as a natural space maintainers for the teeth. – Support proper chewing and digestion of the food. – Help in normal development of speech. – Add to self-esteem and confidence of the child. Early loss of primary teeth can interrupt a proper development of the speech. It can also lead to tongue interposition and development of parafunctional oral habits. Keeping the above functions in mind, it is ideal not to decide to savage the primary tooth until it is time for the new permanent teeth to erupt. The microbiology of fistula The microbiology of fistula has been reported to be quite complex. Even though, the details of the same are scarce. The deep areas of periapical region and around do not provide oxygen to feed the bacteria; hence, it is mainly the anaerobic population that dwells here quite well. These bacteria can result in pain, swelling, tenderness and exudation of pus. A high prevalence of Enterococcus species and P. gingivalis has been observed in the necrotic pulp of