Please activate JavaScript!
Please install Adobe Flash Player, click here for download

Endo Tribune Middle East & Africa Edition No. 6, 2017

A2 ◊Page A1 ENDO TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2017 Figs. 1a–e: X-rays of the upper jaw.—Subgingival carious lesions at 11 and 21. Fig. 2: Preoperative situs. Fig. 3: OP-situs after laser surgery (gingivectomy). Fig. 4: Situation after adhesive composite restauration following laser surgery. Fig. 5: Postoperative recall after seven days. Fig. 6: Follow-up inspection after 14 days. Figs. 7a–c: X-rays documentation of the endodontic treatment of 11. restorative material. Here, laser as- sisted procedures provide a funda- mental advantage in comparison to classical surgical procedures. Ad- equate haemostasis after soft tissue excision with the scalpel, scalers and cuvettes is often not achievable by styptics. This case study presents a treat- ment protocol for restorative and endodontic treatment of patients with extensive subgingival carious lesions in the anterior tooth area. Case report A 72 year old patient visited the Dental School of the University of Bonn to obtain a dental consul- tation regarding prosthodontic aspects. The medical history was unremarkable. The patient did not suffer pain. Among other things, insufficient composite restoration in the ante- rior tooth regions of the upper jaw were noticeable at the initial ex- amination. In addition, subgingival probing showed defects in dental hard tissues at 11 and 21. For tooth 11, a fistula and an apical radiolucency were found in the vestibular mar- ginal area in the X-ray image (Figs. 1a–e). Teeth 12 and 21 reacted posi- tively to a sensitivity test, in con- trast to tooth 11. The probing depths of the teeth 11 and 21 were 4–5 mm. The treatment plan was explained thoroughly to the patient. In the first session, tooth 11 was trepana- ted as part of an emergency pro- cedure. After exposure of the root canal, it was rinsed with sodium hy- pochlorite and calcium hydroxide was applied. Ahead of this emer- gency endodontic procedure, the carious lesions on 11 and 21 were excavated incompletely and treat- ed temporarily with glass ionomer cement. The patient came for further treat- ment five days later. The fistula on 11 had closed, clinical symptoms were no longer present (Fig. 2). Af- ter an infiltration anaesthesia (1.8 ml UDS), the subgingival carious defects in teeth 11 and 21 were visu- alised in a gingivectomy (Fig. 3). For both teeth, approximately 4 mm of soft tissue had to be removed to expose the affected area. The gin- givectomy was carried out using a 445 nm diode laser (Sirona K-Laser blu, Sirona) with a power output of 1.5 W in cw mode and an application tip with a diameter of 320 µm. This device is a pre-serial model equiva- lent to SIROLaser Blue (Sirona). The resection was carried out in six minutes. The surgical procedure was per- formed with no pain. After finishing the gingival exci- sion, the surgical field was blood- less and dry (Fig. 3), so that the tem- porary fillings at 11 and 21 could be removed and the caries completely excavated under visual control. The defects were treated with adhe- sive restorations with a composite material in a multi-layer technique (Herculite®; A3,5). Figure 4 shows the situation after the restora- tion had been completed, includ- ing finishing and polishing of the aesthetically complex restoration. After laser treatment, haemostatic measures were no longer neces- sary for all subsequent treatment steps. In the post operative recall after seven days (Fig. 5), the patient reported that here was no post op- erative pain. After the procedure, the patient did not find it necessary to use the analgetics that had been made available. After 14 days (Fig. 6), the excision wounds had healed to a very great extent. There was still slight redness in the marginal area. No swelling occurred in the entire post opera- tive phase. At this time, endodontic treatment was also performed for the devitalised tooth 11. After prepa- ration and sealing of the root canal, the trepanation cavity was closed using a composite material (Figs. 7a–c). Three months after the op- erative procedure, the endodontic treatment of tooth 11 resulted in no further clinical symptoms. In the treated area, the probing depth was 1.5 mm. No bleeding was found dur- ing probing. No further recession of the gingival margin was found Fig. 8: Postoperative recall after three months.—Healthy gums and aesthetic restauration of the carious lesions at 11 and 21. after the primary healing, approxi- mately two weeks after treatment or at the follow-up inspection after three months. Gingival colour and surface texture (gingival stippling) corresponded to a healthy appear- ance (Fig. 8). To ensure long-term good oral hygiene and to prevent approximal gingival recession at 11/21 in a further step a frenecto- my (laser-assisted) should be per- formed. Discussion The presented treatment protocol for laser assisted gingivectomy ena- bled the badly destroyed teeth 11 and 21 to be restored in an aestheti- cally satisfactory manner. Due to the safe procedure and the drying of the surgical field after laser assisted excision, adhesive fillings were placed in the same session and exhibited no discol- oration in the marginal zone, even after three months. This indicates a good bonding between the restora- tive material and the dentin. There was only little discomfort for the 72-year-old patient which derived from this complex therapy. After an emergency treatment, definitive rehabilitation, including adhesive restorations and endodontics, was carried out in two sessions. The patient did not report any dis- comfort related to the laser treat- ment. The patient’s aesthetic ap- pearance in the anterior teeth of the upper jaw was restored with moderate means. This treatment procedure improves the patient’s compliance, because it allows the patient to partake in a systematic care and treatment concept, which enables the continuation of addi- tional necessary treatment meas- ures. Editorial note: A list of references is available from the publisher. This article was first published in laser magazine 4/2016. Prof. Matthias Frentzen Welschnonnenstraße 17 53111 Bonn, Germany Tel.: +49 228 287-22470 frentzen@uni-bonn.de

Pages Overview