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ePaper created 2017-10-26, 15:28:59 | version 1.38.0
| industry Laser-assisted direct pulp capping Author: Pawel Roszkiewicz, Poland The essence of conservative dentistry is conser- vative, that is, economical tissue management— for both hard tissues and the protection of the endodontium’s vitality. Deep cavities accompanied by pulp exposure are, indeed, a huge challenge for the pulp to preserve its vitality, but also for the den- tist and treatment performed to increase, not de- crease, the chance to save vital pulp for many years. In case of very deep cavities, it is oftentimes in- dicated to perform an endodontic treatment. How- ever, one should remember that the possibilities of contemporary endodontics do not limit to com- plete cleaning of the root canals system and its tight 3-D filling, but offers other, less radical methods of treatment. Endodontic treatment does not have to be equal with “killing” the tooth. If the image of the pulp seen in the microscope is correct, direct pulp capping performed in aseptic conditions allows to preserve the tooth's vitality. If small serous effusion, small bleeding accom- panying possible mechanical injury during clean- ing stop by itself thanks to cleaning the chamber with a piece of cotton wool soaked with NaCl, chlor- hexidine, or laser-assisted pulp protection, there are good prognosis for biological treatment. If no pulpitis occurs (the application of a rubberdam and Class II to Class I cavities conversion are necessary), when the pulp capping with MTA or Biodentine is performed, the size of pulp exposure (in a reasonable Fig. 1: RTG image before the treatment. Fig. 1 16 laser 3 2017 scope resulting from mechanical aspects) seems to have a secondary meaning. Dried pulp, being a con- firmation of its aseptic death, pus leak (at least part of the pulp inflamed), heavy bleeding difficult to stop (strong hyperaemia of the pulp, usually due to the inflammation) are the situations when different treatment protocols need to be used. Case report A 35-year-old patient was referred to our clinic because of a deep cavity Class II (MO) in tooth 16. Because of the cavity complexity and a desire to avoid its complication—the pulp exposure, partially cleaned cavity bottom was covered by non-harden- ing (UltraCal XS) and self-hardening (Ultra-Blend) calcium hydroxide. Then, the cavity was filled with a temporary filling. The patient did not report any pain, and the sensitivity to stimuli was similar to other molars in the maxilla. Clinical findings In order to assess the extent of the tooth core damage and its chances for biological treatment, a RTG photo of tooth 16 has been taken (Fig. 1). On the photo we can see the radiological shadow indi- cating the presence of fillings on the occlusal sur- face. The radiological shadow in the medial part of the chamber projection, not having its counter- part in this tooth's fillings, requires intraprocedural differentiation by pumping calcium hydroxide or dental dressing into the chamber. In the chamber projection we can additionally ob- serve thickened tooth structure, which suggests the presence of denticles. Brightness in the area of roots requires the differentiation between irreversible pulpitis and congestion of the pulp as a response to the calcium hydroxide use. Treatment plan The reasonable treatment plan included: resto- ration of the medial wall of the cavity in order to