Paediatric laser dentistry. Part 2: Hard tissue laser applications.

AIM: Erbium lasers can provide effective and minimally invasive caries removal in children. The bonding phase remains a critic step as well as the choice of material. Glass ionomers exhibits lower bonding properties in laser irradiated teeth compared to the conventional method or to composite and resin modified glass ionomer. Laser can also provide effective decontamination and coagulation effects in vital and non vital pulp therapy of primary teeth, improving and simplifying the cleaning and disinfecting steps.

Paediatric laser dentistry. Part 1: General introduction.

AIM: Knowledge of the physical characteristics of different laser lights and optical and thermal properties of oral tissues is very important to understand the interaction of dental lasers with biological tissues. Choosing the correct dental laser is crucial to match specific wavelengths with target chromophores of different tissues; this affinity makes laser irradiation selective and therefore minimally invasive. Various types of lasers are used in dentistry, offering a viable alternative to low and high-speed handpieces and surgical blades, and also minimising fear and discomfort of the patient. Lasers can provide innovative and minimally invasive therapies in different branches of dentistry including preventive and restorative dentistry, traumatic injury treatments and surgical procedures. Laser has also biostimulating and anti-inflammatory effects, as well as analgesic effect.

Paediatric laser dentistry. Part 4: Soft tissue laser applications.

AIM: Lasers can provide effective soft tissues applications in children. All the wavelengths produce incision and vaporisation of oral tissues, together with a high bactericidal effect. The haemosthatic effect varys according to the wavelength used, and the choice of a visibile, near, medium or far infrared laser allows a better interaction with specific targets, gingiva, mucosa, frenum, or oral pathology.

Intrusive luxation of primary upper incisors and sequelae on permanent successors: a clinical follow-up study.

AIM: The purpose of this report is to evaluate the epidemiological aspects of intrusion that occur against upper incisors in primary dentition, to determine the statistic correlation of developmental disturbances to permanent teeth in relation to age of children at the time of trauma. MATERIALS AND METHODS: A retrospective study was performed based on radiographic and clinical data of 34 intruded incisors in 30 patients aged between 12 and 60 months. Baseline data were collected in a questionnaire designed following the guidelines of the IADT-Italy. The descriptive statistical analysis between the different variables was performed with the Chi-squared test and the level of significance was set at 5%. The following parameters were considered: gender, age of patient at the time of injury, emergency treatment, clinical signs (vitality, mobility, spontaneous pain, colour change), presence of complications, degree of spontaneous re-eruption and possible developmental disorders to the following tooth. RESULTS: Intrusive luxation is not statistically related to gender. During the first 6-month follow-ups, 20 incisors belonging to 12 subjects aged between 12-24 months at the time of intrusion exhibited pulpal necrosis. The highest rate of total spontaneous re-eruption occurred in incisors intruded at 12-24 months. The likelihood of spontaneous re-eruption decreased with the child's age. A significant correlation between mobility at clinical follow-up and developmental disorders in permanent teeth was found, whereas a statistical correlation between age of patient at the time of trauma and sequelae was not pointed out, even if 17 primary incisors intruded at 12-24 months did not develop an arrest of root formation. CONCLUSION: The most traumatic intrusions in primary dentition occurs between 12 and 24 months of age, the most common cause being fall while walking. Intruded incisors with moderate mobility developed enamel hypoplasia and ectopic eruption. There was no significant correlation between age at the time of intrusion and type of subsequent developmental disturbances.

A long-term retrospective clinical study on MTA pulpotomies in immature permanent incisors with complicated crown fractures.

AIM: The study was undertaken to evaluate mineral trioxide aggregate (MTA) clinically and radiographically as a pulpotomy agent in immature permanent teeth whose pulps were exposed by a complicated crown fracture. MATERIALS AND METHODS: Thirty incisors with exposed pulps in twenty-nine patients were examined for this retrospective study. According to exclusion criteria, only twenty-seven teeth were selected. Each tooth was treated with partial pulpotomy and the wounded pulp was covered with mineral trioxide aggregate. The children were recalled for clinical and radiographic evaluation at 3 months, 6 months, at approximately 12 months and 36 months. RESULTS: Out of 27 cases, 22 were categorized as 'healed' and 1 as 'healing'. The remaining 4 ones highlighted persistent disease and needed further endodontic treatment. CONCLUSION: MTA partial pulpotomy is an effective treatment in maintaining pulpal vitality and allowing physiological root development (apexogenesis).

Lasers in dental traumatology and low level laser therapy (LLLT).

BACKGROUND: Dental trauma in children is a frequent and often complex clinical event in which laser-assisted therapy, particularly using erbium lasers, can offer new treatment possibilities, improving the outcomes and reducing the associated complications. REVIEW: In particular, it is worth considering that the use of laser-assisted therapies is associated with a marked reduction in the use of analgesics and anti-inflammatory medications compared with conventional procedures. Laser anaesthesia is another interesting and challenging area. CONCLUSION: Given the paucity of data on laser-assisted dental trauma therapy in the international literature and the absence of well-structured guidelines, this is an area ripe for scientific research.

Diode laser irradiation and fluoride uptake in human teeth.

AIM: To evaluate chemically the effects of diode laser on fluoride uptake before and after laser irradiation of enamel surfaces. METHODS: Crowns of 20 sound human teeth were halved and a 3 x 3 mm acid-resistant varnish uncovered window left for: A) no treatment; B) fluoride (Elmex gel); C) diode (fluoride + diode laser); D) diode (diode laser + fluoride). The dental surfaces were analysed using a fluoride ion-selective electrode, in order to evaluate the fluoride treatment in combination with a diode laser. Also, to investigate laser-induced compositional changes (contents in F(-)) in enamel before/after laser irradiation and topical fluoride application. RESULTS: The mean ± SD of fluoride uptake of teeth of group A was 1.55 ± 0.89 mg/l. Mean fluoride uptake increased sevenfold after fluoride gel treatment: 10.51 ± 3.38 mg/l for group B, up to 15 times after gel and laser treatment: 23.62 ± 3.58 mg/l for group C and was 22.7 ± 4.60 mg/l for group D (diode laser before fluoride application). The Kruskal Wallis test indicated a statistically significant effect of fluoride uptake for all three treatments (p<0.001). The Student-Newman-Keuls multiple comparison test indicated a statistically significant increase of fluoride uptake before and after all treatments, and also a statistically significant difference for laser treatment versus fluoride gel. However, there was no statistically significance difference between laser groups. CONCLUSIONS: There is an enhanced capability of lasers to increase fluoride uptake of enamel and providing protection to enamel surface from acid attack.

Lasers in dental traumatology.

AIM: Dental traumas are frequent in children. They can be complex events and sometimes real emergencies. Since very little attention is devoted to this topic in the international literature and there are no well-coded laser guidelines for these specific clinical events, our aim is to consider and present those situations in which laser-assisted therapy can offer new treatment possibilities. The authors' aim is to stimulate more extensive scientific research in this area, which might not only increase the use of these technologies, but also improve outcomes and reduce complications connected to dental trauma, particularly in children. Furthermore, laser-assisted therapies drastically reduce the need for analgesics and anti- inflammatory medications compared with conventional procedures. CONCLUSION: Using laser equipment to obtain anaesthesia is another challenge, while the use of low power setting for desensitising tissue and to obtain anaesthesia is also an open field.

Evidence-based dentistry on laser paediatric dentistry: review and outlook.

AIM: The goal of paediatric dentistry is to provide preventive education to parents and patients as well as interception and therapy of dental diseases in a minimally invasive way using a stress-free approach. Different laser wavelengths are used for different applications following these minimally invasive concepts: argon, KTP, diode, Nd:YAG, and CO2 lasers are used for soft tissue applications and the erbium family is used for both soft and hard tissue procedures. This paper offers a revision and a discussion of the international literature, showing also some clinical procedures. related to these scientific studies. Soft tissues laser applications in Pediatric Dentistry include application in oral surgery as well as in periodontics and orthodontics. Laser applications on hard tissues include caries prevention and detection and application for sealing of pits and fissures. Also application for cavity preparation, carious removal and pulp therapy are discussed.

[Dental trauma: coronal fractures of permanent incisors. A new technique of bonding fragments]. / Traumi dentali: fratture coronali degli incisivi permanenti. Nuova tecnica di incollaggio dei frammenti.

The coronal fractures of the upper incisors for traumatic injuries represent the 8% of the total dental trauma. The use of new dentinal adhesive have permitted to obtain new interesting development in dental traumatology and dental esthetic, like the possibility of the utilisation of the dental fragment, of the incisor broken for a trauma. The new dentinal adhesive is the Gluma (Bayer). The Authors describe the technique, the times, some particulars and step by step all the method to obtain good final results. Finally are presented all the advantages compared to the traditional methods with the composites materials.