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ePaper created 2017-11-24, 11:00:53 | version 1.38.0
| case report pulp capping Laser-assisted direct pulp capping Author: Pawel Roszkiewicz, Poland The essence of conservative dentistry is conserva- tive, 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 dentist and treatment per- formed to increase, not decrease, the chance to save vital pulp for many years. In case of very deep cavities, it is oftentimes indi- cated to perform an endodontic treatment. However, one should remember that the possibilities of con- temporary endodontics do not limit to complete cleaning of the root canals system and its tight 3-D filling, but offers other, less radical methods of treat- ment. 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. Fig. 1: RTG image before the treatment. If small serous effusion, small bleeding accompa- nying possible mechanical injury during cleaning stop by itself thanks to cleaning the chamber with a Fig. 1 18 roots 4 2017 piece of cotton wool soaked with NaCl, chlor hexidine, or laser-assisted pulp protection, there are good prognosis for biological treatment. If no pulpitis oc- curs (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 scope re- sulting from mechanical aspects) seems to have a sec- ondary meaning. Dried pulp, being a confirmation of its aseptic death, pus leak (at least part of the pulp in- flamed), heavy bleeding difficult to stop (strong hy- peraemia of the pulp, usually due to the inflamma- tion) are the situations when different treatment protocols need to be used. Case report A 35-year-old patient was referred to our clinic be- cause of a deep cavity Class II (MO) in tooth 16. Because of the cavity complexity and a desire to avoid its com- plication—the pulp exposure, partially cleaned cavity bottom was covered by non-hardening (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 dam- age 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 indicating the presence of fillings on the occlusal surface. The radio- logical shadow in the medial part of the chamber pro- jection, not having its counterpart in this tooth's fill- ings, 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 pul-