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ePaper created 2018-03-06, 08:52:14 | version 1.38.0
research | How can lasers help? Pulpotomy procedure with erbium laser Since laser is not commonly available at all practices, there could be a possibility that there had been no real discussion on the use of lasers in the treatment. Another possibility of having a good experience with lasers can change the perception of the child who is in for the first time. When the carious decay is found deep and in close proximity to pulp, exposure of the pulp canals can hap- pen while removing this decay. In such situations, ex- posed pulp needs to be treated by removing the affected coronal pulp contents. This procedure is referred to as Pulpotomy. When laser is introduced to the parents, they are in- formed about details on the functioning of laser and its benefits. While explaining euphemisms to the child, the laser is shown as “Popping Light”. There is a significant number of children who go awe-inspired to come back and get there teeth fixed. The whole mindset of the child changes when they are told that treatments do not involve any needles approach. “No Anaesthesia” Procedures that can be done without anaesthesia are: – Restorations: Decays involving occlusal, labial, palatal, buccal or proximal surfaces of the teeth. Deep caries are excavated with pre-adjusted rapid prep settings: MX7, 5 W, 20 Hz, air 80, water 50; and then com- fort prep settings: MX7, 3.75 W, 25 Hz, air 60, water 30 are used as we approach deep into the dentinal caries. As soon as there is pin point pulp exposure, few drops of Lignospan are dropped inside the coronal pulp chamber. This step is followed by opening partial access into the coronal pulp chamber. As we go further deep into the cor- onal chamber, more anaesthetic intrapulpal infilteration is used followed by complete laser access opening. After removing the coronal pulp contents, the chamber is irrigated and dried followed by diode laser sterilisation and coronal pulp filling with zinc oxide eugenol. The tooth is then filled with base Fuji IX and final restoration is done with composite or stainless steel crown. – Deep restorations on teeth with decays close to the Pulpectomy procedure with erbium laser pulp. – Pulpotomies in primary teeth. – Pulpectomies in primary teeth. – Pulpectomies in primary teeth with abscess, fistula or swellings. Teeth that have chronic profound caries, active signs and symptoms, and radiographical signs of pulp involve- ment, are indicated for Pulpectomy. Pulpectomy involves the removal of both coronal and radicular pulp contents. The term “No Anaesthesia” is a misnomer as the pro- cedure is accomplished with few drops of anaesthesia in between, especially when endodontics is involved. The “No Anaesthesia” approach for enamel dentine resto- rations are the erbium laser Prep mode for restorative dentistry: MX7, 3.25 W, 25 Hz, air, water. There are two commercial settings that can be followed for the most ac- ceptable cavity preparation: – Rapid Prep: MX7, 5 W, 20 Hz, air 80, water 50. This setting is usually used for enamel caries removal as water content is lesser. Since there is less water in the enamel, higher power is needed for appropriate ab- sorption of laser. – Comfort Prep: MX7, 3.75 W, 25 Hz, air 60, water 30. This setting is usually advised when we have reached the level of the dentine as the water content in the den- tine is higher in comparison to enamel. Once complete excavation of the decay has been at- tempted with laser, gentle hand excavation, low speed excavation is attempted. This step should be followed with Bond prep: MX7, 3.25 W, 50 Hz, air 60, water 30. Following this step, the tooth is isolated and restored with composite (Figs. 1 & 2). When the tooth is indicated for pulpectomy or root ca- nal procedure, deep caries are excavated with pre-ad- justed rapid prep settings: MX7, 5 W, 20 Hz, air 80, water 50; and then comfort prep settings: MX7, 3.75 W, 25 Hz, air 60, water 30 are used as we approach deep into the dentinal caries. As soon as there is pin point pulp expo- sure, few drops of Lignospan are dropped inside the cor- onal pulp chamber. This step is followed by opening par- tial access into the coronal pulp chamber. As we go further deep into the coronal chamber, more anaesthetic intrapulpal infilteration is used followed by complete laser access opening. Once access has been done with laser, coronal pulp contents are removed. Be- fore gaining access into radicular pulp chamber, few more drops of anaesthesia are dropped in. Complete extirpation of radicular pulp contents is done with rotary instruments. Continuous copious irrigation is done with saline and chlorhexidine. Canal measurement is done, and as a final step before obturation, both the erbium and diode laser are used for sterilisation. Final step is zinc oxide eugenol obturation, Fuji IX base filling and composite restoration. roots 1 2018 09