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ePaper created 2017-10-26, 15:28:59 | version 1.38.0
industry | Laser parameters used during the procedure. Fig. 2: Cavity preparation. Fig. 3: Deeper parts with the risk of pulp exposure. Fig. 4: Laser application to exposed pulp. Fig. 5: Preparation to the composite restoration. laser 3 2017 17 Fig. 2 Fig. 3 Fig. 4 Fig. 5 provide better isolation with the use of the rub- berdam before the next stage of the procedure, cleaning the remaining part of the cavity, the con- servative restoration with indirect or direct pulp capping if its condition allows for such a procedure, or entering “classical” endodontic treatment, if the tooth will not prognose pulp viability preserving. Cleaning with laser In an articaine with epinephrine infiltration an- aesthesia, by means of ultrasonic scaler, the tem- porary filling was partially removed in order to ob- tain the space required for the conversion the cavity into Class I. Cleaning was continued with the use of Er:YAG laser (LightWalker, Fotona), using the contact contra-angle handpiece H14 with cylindrical optical fibre with a diameter of 1.3 mm. The laser parameters used during the procedure are presented on Figure 2 (cavity preparation) and Figure 5 (surface prepara- tion for reconstruction). The fibre tip of the contact contra-angle hand- piece was carried out at some distance from the sur- face of the tooth (circa 1 mm). The wall of the cavity was restored with the composite and the self-etch- ing system. After the conversion into Class I cavity and performing the occlusal adjustment, the rub- berdam was applied and, from the tooth prepared in such a way, all temporary filling was removed (us- ing the scaler again) revealing the pulp exposure of 1 to 1.5 mm2 area in the buccal part of the cavity bottom (Fig. 6). Delicate effusion of the colourless and odourless fluid stopped after two to three min- utes, confirming the theory about hyperaemia as response to the calcium hydroxide application. Treatment of hyperaemia In the first stage of the treatment, the exposure area was skipped, focusing on the remaining frag- ments of the cavity, continuing to clean it with la- ser on the previously mentioned parameters (Fig. 2). In order to minimise the laser's impact on the pulp, the deepest parts of the cavity were prepared using the parameters modified to the values presented in Figure 3. Once the dentine surface was cleaned, the inner surface of the filling (unevenness between dental dressing and metal matrix after condensa- tion) was smoothed with the diamond turbine drill. After preparation of the whole cavity, a piece of the temporary filling previously pressed into the chamber was removed by means of endodontic hand tools (Figs. 6 & 7). The pulp behaviour during the entire visit (correct pink colour of the visible fragment of the pulp, small serous effusion without anaerobic infection after the temporary filling re- moval, small pulp bleeding after removal of the for- eign body from the chamber, and spontaneous ter- mination of effusion and bleeding) resulted in, after the patient gave his consent to the treatment plan, an attempt to biological treatment. Er:YAG laser was applied on the exposed pulp (parameters shown in Figure 4) with the tip hold in 5 mm distance from the pulp in order to “defocus” the beam (to reduce the intensity of radiation). Then,