JICDRO is a UGC approved journal (Journal no. 63927)

   Table of Contents      
CASE REPORT
Year : 2012  |  Volume : 4  |  Issue : 1  |  Page : 25-28

Laser induced biostimulation: A possible healing prospect in endo-perio lesion


1 Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
2 Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India

Date of Web Publication23-Apr-2014

Correspondence Address:
Mithra N Hegde
Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.131395

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   Abstract 

The health of the tooth is governed by both endodontic tissue and periodontal apparatus. "Endo-perio lesion" is the term used to describe the lesions in which inflammatory products involves both pulpal and periodontal tissues in varying degrees. The disease of endodontium may lead to the involvement of the periodontium and vice versa. Endo-perio lesions are the clinical conditions that are often difficult to diagnose and persistent if not treated appropriately. Lasers have been used successfully in endodontic as well as periodontal procedures. With endodontic treatment alone, only part of the lesion will heal to the level of the secondary periodontal lesion. Overall prognosis depends upon the severity of periodontal damage and the efficacy of the periodontal treatment. Laser can be considered as an efficacious tool and an adjunct to conventional periodontal therapy both for its decontaminating and biostimulating effects.

Keywords: Biostimulation, endo-perio lesion, healing, lasers


How to cite this article:
Hegde MN, Hegde N, Dahiya R. Laser induced biostimulation: A possible healing prospect in endo-perio lesion. J Int Clin Dent Res Organ 2012;4:25-8

How to cite this URL:
Hegde MN, Hegde N, Dahiya R. Laser induced biostimulation: A possible healing prospect in endo-perio lesion. J Int Clin Dent Res Organ [serial online] 2012 [cited 2019 Jun 16];4:25-8. Available from: http://www.jicdro.org/text.asp?2012/4/1/25/131395


   Introduction Top

"Endo-perio lesion" are the lesions in which inflammatory products involves both pulpal and periodontal tissues in varying degrees. The relationship between endodontic and periodontal diseases was first described by Simring and Goldberg. [1] There are anatomic and non-physiological pathways of communication between the pulp and the periodontium. [2] The most conventional classification of endodontic-periodontal lesion was given by Simon et al. in 1972. [3] Lasers have been used successfully in endodontic as well as periodontal procedures. [4]

It is essential to treat the periodontal defect simultaneously with an adequate endodontic therapy to improve the functional ability of the tooth and to prevent its re-occurrence. [5]


   Case Report Top


We describe a case of a 40-year-old male patient who reported to the dental specialty clinic with the chief complaint of discomfort and pus discharge from his mandibular left lateral incisor, which he had experienced since last few months.

On intraoral examination, loss of stippling and draining sinus was observed in the attached gingiva with respect to 32. Periodontal probing depths were measured using a William's graduated periodontal probe with increased probing depth suggesting localized periodontitis. Electric pulp test and cold test were performed to check for tooth vitality with a negative response, which confirmed that the tooth was non-vital. On radiographic examination, peri-apical radiograph showed radiolucency involving the periapical area with radiolucency extending to the lateral surface of the root [Figure 1]. A diagnosis of endodontic-periodontal lesion was established and classified according to Grossman's classification 1988 [6] as a primary endodontic lesion with secondary periodontal involvement in relation to 32. Treatment planning was done taking into consideration that the tooth was non-vital along with concurrent periodontal lesion.
Figure 1: Pre-operative radiograph

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Subgingival scaling was performed. Access cavity was prepared in relation to 32 using endo access bur (Dentsply Tulsa Dental specialties; Tulsa, Oklahoma). Cleaning and shaping of the canals was done by crown-down approach using ProTaper - Universal rotary files (Dentsply Maillefer, Ballaigues, Switzerland) with 5.25% of sodium hypochlorite irrigation. Canal disinfection was done using laser with 200 μm optical fiber (Kavo Gentleray 980 Diode Laser). The canal was dressed with calcium hydroxide (UltraCal XS; Ultradent, South Jordan, UT, USA) as intracanal medicament and access cavities were sealed with intermediate restorative material cement.

New attachment procedure was performed on the same appointment using a 980 nm Diode laser with optical fiber thickness 300 μm. The laser was aligned exactly parallel to the root and the entire interior of pocket was brushed with the distal end of optical fiber at 1-1.5 W power, which completed debridement of the pocket, hemostasis was achieved and created a soft clot and a closed system. The tissue was compressed against the root surface for about 1-2 min to close the pocket and stabilize the fibrin clot. No graft was placed. Occlusion was checked. Post-operative instructions were given to the patient with proper plaque control and 0.12% of chlorhexidine mouthwash for rinsing twice a day.

Patient was recalled after 2 days. The absence of pain or signs of inflammation indicated that the root canal treatment could be completed. Obturation was done using Gutta-percha and AH Plus sealer (De Trey-Dentsply, Konstanz, Germany). Access cavity was restored using a high strength glass ionomer restoration [Figure 2].
Figure 2: Post-operative radiograph

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Patient was recalled for 1 month [Figure 3], 1 year [Figure 4] followed by yearly follow-up [Figure 5]. At 1 month recall, patient was asymptomatic with healed sinus tract. Periodontal probing showed pocket depth within physiological limits as measured by a Williams graduated periodontal probe. Peri-apical radiograph after 4 years follow-up revealed increased apical density indicating healing [Figure 6].
Figure 3: At 1-month recall

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Figure 4: At 1-year follow-up

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Figure 5: At 2 years follow-up

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Figure 6: At 4 years follow-up

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   Discussion Top


Endo-perio lesions are the clinical conditions that are often difficult to diagnose and persistent if not treated appropriately. The diagnosis must be based on a combination of the history obtained from the patient, the clinical examination findings, the radiographic observations and the results of all tests and investigations, in particular, pulp sensibility tests (both thermal and electric) and periodontal probing. [7],[8]

A correct diagnosis helps in formulating the correct treatment plan. The risk of impaired healing due to bacteria and its byproducts in the endo-perio lesions is reduced if adequate endodontic therapy is done followed by proper periodontal therapy. [9],[10] With endodontic treatment alone, only part of the lesion will heal to the level of the secondary periodontal lesion. Overall prognosis depends on the severity of periodontal damage and the efficacy of the periodontal treatment. Although scaling and root planning remain the initial treatment modalities in periodontal therapy, the use of a soft-tissue diode laser can be considered as an efficacious adjunct to conventional periodontal therapy. The role of laser radiation in disinfection of the root canal has been demonstrated by Shetty et al., [11] Saunders et al. [12] Yamazaki et al., [13] and Takeda et al. [14]

The use of a diode laser in soft-tissue procedures are advocated because it helps in bacterial decontamination, promotes reestablishment of connective tissue attachment and are less invasive nature, which reduces post-operative swelling. [15],[16]


   Conclusion Top


Based on the above study it can be concluded that endo-perio lesions always possess a challenge to the clinician for correct diagnosis and treatment planning. Although there may be difficulties in establishing a correct diagnosis, this is the most important phase of their management as this will determine the type and sequence of treatment required. Soft-tissue diode laser is more effective and less traumatic than conventional surgical methods. In this case, both endodontic and periodontal treatments were carried out in the same appointment resulting in shorter chair side time. This line of treatment with the biostimulating properties of lasers may hold better prospects of treating similar endodontic periodontal lesions more predictably in a shorter time.

 
   References Top

1.Simring M, Goldberg M. The pulpal pocket approach. Retrograde periodontitis. J Periodontol 1964;35:22-48.  Back to cited text no. 1
    
2.Zehnder M, Gold SI, Hasselgren G. Pathologic interactions in pulpal and periodontal tissues. J Clin Periodontol 2002;29:663-71.  Back to cited text no. 2
    
3.Simon JH, Glick DH, Frank AL. The relationship of endodontic-periodontic lesions. J Periodontol 1972;43:202-8.  Back to cited text no. 3
    
4.Kimura Y, Wilder-Smith P, Matsumoto K. Lasers in endodontics: A review. Int Endod J 2000;33:173-85.  Back to cited text no. 4
    
5.Solomon C, Chalfin H, Kellert M, Weseley P. The endodontic-periodontal lesion: A rational approach to treatment. J Am Dent Assoc 1995;126:473-9.  Back to cited text no. 5
    
6.Hegde MN. Text Book of Endodontics. 1 st edition, EMMESS Medical Publisher; 2009. Bangalore.  Back to cited text no. 6
    
7.Abbott PV, Salgado JC. Strategies for the endodontic management of concurrent endodontic and periodontal diseases. Aust Dent J 2009;54 Suppl 1:S70-85.  Back to cited text no. 7
    
8.Abbott P. Endodontic management of combined endodontic periodontal lesions. J N Z SocPeriodontol 1998; 83:15-28.  Back to cited text no. 8
    
9.Verma PK, Srivastava R, Gupta KK, Srivastava A. Combined endodontic-periodontal lesion: A clinical dilemma. JID 2011; 1(2):119-24.  Back to cited text no. 9
    
10.Chen SY, Wang HL, Glickman GN. The influence of endodontic treatment upon periodontal wound healing. J Clin Periodontol 1997;24:449-56.  Back to cited text no. 10
    
11.Shetty K, Hegde MN, Shetty S. Comparative evaluation of bacteriocidal effects on E. Faecalis using Diode laser irradiation, sodium hypochlorite, chlorhexidine irrigation - an in vitro study. Journal of OHDM (in press).  Back to cited text no. 11
    
12.Saunders WP, Whitters CJ, Strang R, Moseley H, Payne AP, McGadey J. The effect of an Nd-YAG pulsed laser on the cleaning of the root canal and the formation of a fused apical plug. Int Endod J 1995;28:213-20.  Back to cited text no. 12
    
13.Yamazaki R, Goya C, Yu DG, Kimura Y, Matsumoto K. Effects of erbium, chromium:YSGG laser irradiation on root canal walls: A scanning electron microscopic and thermographic study. J Endod 2001;27:9-12.  Back to cited text no. 13
    
14.Takeda FH, Harashima T, Kimura Y, Matsumoto K. Efficacy of Er:YAG laser irradiation in removing debris and smear layer on root canal walls. J Endod 1998;24:548-51.  Back to cited text no. 14
    
15.Kotlow LA. Lasers in pediatric dentistry. Dent Clin North Am 2004;48:889-922.  Back to cited text no. 15
    
16.Hegde MN, Hegde ND, Nagesh SC. Lasers in management of endo-perio lesion - A case report. AOSR 2011;1(4):215-18.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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