Marvelous pictures Ron and really cool case.

I have had very very little success with this kind of treatment. Almost every carious exposure despite my attempts to maintain the pulp have ended in endo or a very calcified canal.

Hansen a while back provided some research on his technique and it had great success. I havent been able to duplicate things.

I like the final composite, very nicely done and thanks for posting the pics and NOPE I wont call you a dummy for no preop, it happens to me all the time!

Grin

Good stuff………

Glenn

Great question Ron…….the two cases that come to mind , I did the endos 2-3 months after the restorations were placed. One was a buccal and one a MO that come to mind.

I have two others that have had prolonged pulpal sensitivity that I am watching now and both are leaning towards the endo after the prolonged sensitivity to cold.

I have had two others where the sensitivity lessened. One was a 8 year old and the central ( traumatic fracture) discolored and vitality testing showed no pulp.

The other traumatic lateral calcified in on the pulp when the patient came back 2 years later because mom noticed the tooth getting darker and not matching the restoration……..pulp had calcified in which I thought was strange.

It just hasnt worked for me except on accidental exposures not chasing caries.

I would LOVE to hear what others are finding……in fact this is one area of using the laser that has disappointed me.

It may be something I am doing or it may be the pulp just cant respond despite our best efforts.

Who knows……..Mark? Bob? Ron?

What say ye

I know placing calcium hydroxide isn’t fashionable now but I continue to do so on exposures. I usually place the Calcium hydroxide and then ketac silver. I then etch and bond.
Thought this was interesting-

Biocompatibility of a resin-modified glass-ionomer cement applied as pulp capping in human teeth.
do Nascimento AB, Fontana UF, Teixeira HM, Costa CA.

Faculdade de Odonologia de Araraquara/UNESP, Departamento de Fisiologia e Patologia, Sao Paulo, Brazil.

PURPOSE: to evaluate the human pulp response following pulp capping with calcium hydroxide (CH, Group 1), and the resin-modified glass-ionomer Vitrebond (VIT, Group 2). MATERIALS AND METHODS: Intact teeth with no cavity preparation were used as control Group (ICG, Group 3). Buccal Class V cavities were prepared in 34 sound human premolars. After exposing the pulps, the pulp capping materials were applied and the cavities were filled using Clearfil Liner Bond 2 bonding agent and Z100 resin-based composite. The teeth were extracted after 5, 30, and from 120 to 300 days, fixed in 10% buffered formalin solution, and prepared according to routine histological techniques. 6-microm sections were stained with hematoxylin and eosin, Masson’s trichrome, or Brown & Brenn technique for bacterial observation. RESULTS: At 5 days, CH caused a large zone of coagulation necrosis. The mononuclear inflammatory reaction underneath the necrotic zone was slight to moderate. VIT caused a moderate to intense inflammatory pulp response with a large necrotic zone. A number of congested venules associated with plasma extravasation and neutrophilic infiltration was observed. Over time, only CH allowed pulp repair and complete dentin bridging around the pulp exposure site. VIT components displaced into the pulp tissue triggered a persistent inflammatory reaction which appeared to be associated with a lack of dentin bridge formation. After 30 days a few histological sections showed a number of bacteria on the lateral dentin walls. In these samples the pulp response was similar to those samples with no microleakage. VIT was more irritating to pulp tissue than CH, which allowed pulp repair associated with dentin bridge formation. These results suggested that VIT is not an appropriate dental material to be used in direct pulp capping for mechanically exposed human pulps.

PMID: 11763899 [PubMed – indexed for MEDLINE] [/quote]

Bob Gregg is the expert on LLLT ( Low level laser therapy) and biostimulation.

I am not a big guru in this area. I doubt it would improve the pulpitis much but I could be wrong.

Glenn

Hi David,

Thanks, Glenn, but I don’t know how much of an LLLT expert I am compared to someone like Paul F. Bradley, BDS, MD, FDS, FR (no kidding).

To some degree, yes. It sould help with any symptoms and inflammation. And I don’t think it can hurt anything.

I think this may be a little too open for a full recovery, but that depends on things like the age of the patient, whether there is root apexification, etc.

Give it a try and let us know!

Bob

Yes. Yes, I do.

Bob

David–Just funnin’ while I remembered where I put those references…..

Here’s a great one for everyone to start with:

1.  Dr. Paul Bradley’s video from the 1999 ALD meeting in Palm Springs, “Current Status of LILT”.  #039

Very informative, very well presented and entertaining.

Contact Joyco MultiMedia and ask for Bob or Joy (tell ’em I sent ya’) at P: 303-421-0093;  Fax 303-403-9112

2.  Low Level Laser Therapy by Tuner and Hode available from Dr. Larry Lytle of Lasers, Inc. 605-342-5669.  Good book.  Larry is also a great sourch of information.

3.  The Science of Low Power Laser Therapy
by Russian researcher Tina Karu available at Amazon.com for &#3699.95 (used to be around &#36250).

<a href="http://www.amazon.com/exec/obidos/tg/detail/-/9056991086/qid=1045621118/sr=1-1/ref=sr_1_1/104-0480242-5763108?v=glance&s=books

” target=”_blank”>http://www.amazon.com/exec&#8230;.ooks

Karu’s book is by far the most scientific and also the most dry…….

Larry Lytle is usually at the ALD meetings and is always very fun to talk to.  Ask him about “proud tissue”.

Bob