Tuesday, June 11, 2013
Laser dentistry has come a long way since the mid 90s when hard tissue lasers were approved for use in the U.S. Minimally invasive laser dentistry and dental microscopes allow us to conserve tooth structure, make smaller surgical flaps, and in general, reduce the trauma to hard and soft tissues.
Fig. 1: A pre-treatment x-ray of tooth #3.
In a case that illustrates the effective combination of dental lasers and dental microscopes, the patient “B.B.” presented with discomfort in the upper right molar area. Clinical palpation and percussion along with radiographic evidence revealed a recurrent apical lesion on the mesial buccal root of tooth #3, the upper right first molar.
The tooth had undergone a previous endodontic treatment, and a fully functional crown was in place. After discussion of the options with the patient we decided on an apicoectomy procedure.
I chose to use the Fotona LightWalker class laser because of the Er:YAG laser’s more efficient cutting of hard and soft tissues due to its higher absorption in water, which is its chromofore.
Fig. 2: A flap is prepared to access the apex.
Fig. 3: The apex is exposed via the prepared flap.
For this case access was achieved solely with the laser while using a Global surgical microscope to improve visualization of the root apex. The apicoectomy was performed with the laser as well. With the aid of the magnification provided by the microscope I was able to accomplish this more conservatively. As a result of the procedure, an apical cyst and granulation tissue were removed and sent for biopsy.
Fig. 4: A bone graft is placed into the surgical site.
Fig. 5: A collagen membrane is placed at the surgical site.
Next a retrofil procedure was performed, then grafted with synthetic bone, covered with a collagen membrane and sutured. Afterwards, the surgical area was biostimulated to reduce any inflammation and start cellular healing. This was done using the Nd:YAG laser, which is a part of the LightWalker laser system.
Fig. 6: A post-operative x-ray of tooth #3.
One week following the procedure the sutures were removed and healing was uneventful. The biopsy came back consistent with a periapical cyst.
This case is a demonstration of the way dental lasers combined with surgical operating microscopes allow both general dentists and specialists to better treat cases of all types. Both of these products offer clinicians the ability to provide minimally invasive care, which should be a primary goal whenever it is possible.