Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-06-21, 10:00:36 | version 1.38.0
laser-assisted treatment case report | Fig. 2 Fig. 3 interactions that could in turn present a contraindi- cation in the case of patients with symptoms of car- diac disease. In the case of multimorbid patients who are frequently prescribed anticoagulants, the danger of secondary haemorrhage can be minimised. In ad- dition, in these cases, a bloodless surgical field can be created ad hoc, so that moisture-sensitive restorative measures (adhesive dentistry) can be carried out. In general, for multi-morbid patients it is important that restorative procedures can be carried out in a short time and that the use of anaesthetics should be re- duced to a minimum. Excision wounds should heal in a short time period. A dry environment is advantageous, in particular when a dental rubber dam cannot be used. 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, a bloodless, clean, and dry adhesive sur- face must be guaranteed before application of restor- 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 anterior tooth area. Fig. 4 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- tion in the anterior tooth regions of the upper jaw were noticeable at the initial examination. In addition, sub- gingival probing showed defects in dental hard tissues at 11 and 21. For tooth 11, a fistula and an apical radio- 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. The probing depths of the teeth 11 and 21 were 4–5 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 (1.8 ml UDS), the subgingival carious defects in teeth 11 and 21 were visualised in a gingi- vectomy (Fig. 3). For both teeth, approximately 4 mm of soft tissue had to be removed to expose the af- Fig. 5 Fig. 2: Preoperative situs. Fig. 3: OP-situs after laser surgery (gingivectomy). Fig. 4: Situation after adhesive composite restauration following laser surgery. Fig. 5: Postoperative recall after seven days. roots 2 2017 27