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ePaper created 2017-11-24, 11:00:53 | version 1.38.0
| case report vital pulp therapy Diode-laser assisted vital pulp therapy Authors: Dr Maziar Mir, Prof. Dr Norbert Gutknecht, Dr Masoud Mojahedi, Dr Jan Tunér & Dr Masoud Shabani, Germany, Iran, Sweden Introduction The preservation of pulp vitality is one of the most challenging approaches in endodontics. In Vital Pulp Therapy (VPT), after pulp exposure due to extensive dental caries, tooth injuries and iatrogenic events, the intact portion and uninflamed dental pulp is preserved with a suitable dressing at the exposure area. The dressing materials are biocompatible or bio- active.1–3 At the moment, different methods for VPT are used, including: (1) direct pulp capping, (2) indi- rect pulp capping, (3) partial pulpotomy and (4) full pulpotomy. Pulp dressing in these methods is per- formed using mineral trioxide aggregate (MTA), cal- cium-enriched material (CEM), calcium hydroxide and biodentin.4–6 Bleeding control and pain reduction are the most common complications in partial or full pul- potomy.7 Lasers have several benefits in endodontic treatment, for example: (1) pulp diagnosis, (2) dental hypersensitivity reduction, (3) pulp capping, (4) pul- potomy, (5) disinfection of root canals, (6) root canal shaping, (7) root canal obturation, (8) apicectomy and (9) root canal photodynamic therapy.8 Dental lasers are either Class 3B (< 500 mW) or Class 4 (< 500 to 5,000 mW). The former lasers are used for biostimula- tion (Low Level Laser Therapy—LLLT), whereas the lat- ter are used for evaporisation, coagulation, cutting, etc. Most lasers in both groups are based on diodes, but the 500+ mW lasers are often called “diode lasers”. Although particularly used for such proce- dures, they can also be set at their lowest output and be used as biostimulators in a defocused mode. In the current case, a Class 4 laser in defocused mode was used for biostimulatory purposes in a case of VPT.8–9 Case report An 18-year-old female patient with complaints due to a right permanent molar tooth with deep caries was referred for treatment. Medical history The patient’s medical history showed neither sys- temic medical problems nor any allergic reaction, pharmaceuticals or history of past surgical proce- dures. Thus, the patient did not need to be referred for medical consultation. Dental history Oral and maxillofacial examination of the patient revealed no TMJ or myofascial disturbances, no functional or parafunctional habits, Class I occlu- sion, but a relatively poor oral hygiene. Clinical findings Intermittent pain during the last 24 hours, binding of explorer at the occlusal surface was obvious, ther- mal and cold vitality pulp tests were positive. Fig. 1: Immediately after pulpotomy with high-speed handpiece and good coagulation with diode laser and then LLLT treatment. Fig. 2: After CEM cement placement. Fig. 3: Immediately after interim restorative treatment (IRT) with Glass Ionomer cement (GC Fuji IX). Fig. 1 Fig. 2 Fig. 3 14 roots 4 2017