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ePaper created 2017-11-24, 11:00:53 | version 1.38.0
pulp capping case report | Fig. 2 Fig. 3 Fig. 4 Fig. 5 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. pitis 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 pro- vide better isolation with the use of the rubberdam before the next stage of the procedure, cleaning the remaining part of the cavity, the conservative resto- ration with indirect or direct pulp capping if its con- dition allows for such a procedure, or entering “clas- sical” endodontic treatment, if the tooth will not prognose pulp viability preserving. The fibre tip of the contact contra-angle handpiece was carried out at some distance from the surface of the tooth (circa 1 mm). The wall of the cavity was re- stored with the composite and the self-etching system. After the conversion into Class I cavity and performing the occlusal adjustment, the rubberdam was applied and, from the tooth prepared in such a way, all tempo- rary filling was removed (using the scaler again) reveal- ing 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 minutes, confirming the theory about hyperae- mia as response to the calcium hydroxide application. Cleaning with laser Treatment of hyperaemia In an articaine with epinephrine infiltration anaes- thesia, by means of ultrasonic scaler, the temporary filling was partially removed in order to obtain 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 di- ameter of 1.3 mm. The laser parameters used during the procedure are presented on Figure 2 (cavity preparation) and Figure 5 (surface preparation for re- construction). In the first stage of the treatment, the exposure area was skipped, focusing on the remaining fragments of the cavity, continuing to clean it with laser on the pre- viously mentioned parameters (Fig. 2). In order to mi- nimise the laser's impact on the pulp, the deepest parts of the cavity were prepared using the parame- ters 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 condensation) was smoothed with the diamond turbine drill. roots 4 2017 19