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laser - international magazine of laser dentistry No. 2, 2017

case report | Fig. 9: The child has been completely asymptomatic and tooth showed normal signs of physiological resorption. 2 to 5 years old. Since E. faecalis is very resistant to antimicrobials, this makes the endodontic treatment of primary teeth a bit more challenging.4 P. gingivalis has been found to affect about 27 per cent of primary teeth.6,7 P. nigrescens, P. intermedia and P. endo- dontalis also contribute to the infectious process of the pulp.3 Other bacteria that are found to contribute as well are Fusobacterium nucleatum.8 Bacterial associations such as Porphyromonas/Prevotella spe- cies and P. gingivalis/Enterococcus species had been found in primary teeth as per few studies done on the microbiology of the deciduous teeth with periapical abscess and fistula.9 Spirochaetes such as Treponema denticola are also profound.7 Enterococcus faecalis, P. gingivalis and F. nucleatum were found in extensive numbers especially in the fistula related to primary teeth.3 It is the complex nature of the primary root canal microbiology that renders the conventional treatment supported only with antimicrobial not 100 per cent successful. Complex microbiology that demands laser There are predominantly two factors that complicate the success of primary teeth root canals: 1. Anatomical root configuration 2. Complex resident bacterial flora10 The presence of lateral canals and a predominant number of canal openings in the apical delta is a specific anatomical variation of baby teeth. Blind end- ing canals called Diverticles pass through the root dentin.10 Additionally, dentinal tubules run through the entire dentine in complex manner and store the bacteria at the depth of up to 1,000 µm.11,12 At this depth, the microbes are able to sustain against the body’s own defences and conventional pulpectomy procedures.11,12 The conventional irrigants used in pulpectomy can penetrate to the depth of about 100 µm.13 Lasers of different wavelengths have been used in the root canals and have shown the depth of penetration between 500 µm to less than 1,000 µm.10 Laser light Kurz & bündig Fig. 9 causes permanent destruction of the microbial cell membrane and thereby stops their further growth.10 Conclusion Primary tooth endodontics has gained utmost importance in the past few decades, where parents come seeking root canal treatments for the chron- ically affected primary teeth. Those who are not aware of the same are educated about the impor- tance of baby teeth at the first appointment. Parents feel more assured when a successful alternative to extraction is given. Even if teeth are in grossly decayed shapes, laser-assisted endodontics proves successful in the lasting success of the treatment until the tooth exfoliates on its own._ contact Author details Dr Imneet Madan Specialist Pediatric Dentist MSc Lasers Dentistry (Germany) MDS Pediatric Dentistry MBA (Hospital Management) Children’s Dental Center, Dubai Villa 1020 Al Wasl Road, Umm Suqeim 1 Dubai, United Arab Emirates Tel.: +971 506823462 imneet.madan@yahoo.com www.drmichaels.com Das Milchzahngebiss setzt die Grundlage für die bleibenden Zähne. Daher sollte bei einer Behandlung die Bewah- rung der Milchzähne im Vordergrund stehen, solange, bis diese von alleine ausfallen. Die beste Behandlungsstrategie ist Prävention. Sollte es doch einmal zu einem vorzeitigen Verfall und einer chronischen Infektion kommen, die bis in den periapikalen Bereich vordringt, kann eine Lasertherapie effektiv sein und zur Rettung des Zahns beitragen. Im Fallbericht schildert die Autorin den erfolgreichen Einsatz des Lasers bei der Behandlung einer Fistel im oberen Frontzahn einer vier Jahre alten Patientin. Die laserunterstützte, endodontische Behandlung führte zum Erfolg und trug dazu dabei, den Oberkieferfrontzahn im Milchzahngebiss bis zum Zahnwechsel im Alter von sechs bis sieben Jahren zu bewahren. Das Kind kommt zu regelmäßigen Kontrollterminen in die Praxis und zeigt seit zwei Jahren keine klinischen oder radiologischen Anzeichen einer erneuten Infektion. Literature laser 2 2017 09

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