Actualización en técnicas anestésicas en odontopediatría

El control del dolor es una parte importante del odontólogo y particularmente del odontopediatra. La aplicación de la anestesia local asegura la obtención de una buena analgesia, siendo el procedimiento que genera un mayor estado de ansiedad en niños y adultos. Para erradicar el miedo a la inyección en los niños, se emplean tácticas psicológicas y agentes anestésicos tópicos previos a la inyección. El propósito de este artículo es el de resumir las técnicas de anestesia tópica y local que se encuentran actualmente a disposición del odontólogo para su utilización en pacientes pediátricos

La prevención de la alveolitis seca

La alveolitis seca representa una de las complicaciones más frecuentes de la extracción dentaria. La incidencia de esta patología varía del1% al4%, aunque en casuísticas en las que sólo se incluye la exéresis del tercer molar mandibular los porcentajes ascienden a l20-30%. De acuerdo con la etiopatogenia de la al veo litis seca podemos considerar como válidas las siguientes medidas de prevención: 1) Disminución de los factores de riesgo; 2) asepsia pre-y post-quirúrgica; 3) conducta operatoria meticulosa; 4)material de relleno alveolar; 5) uso de antibióticos; 6) uso de otras sustancias (antifibrinolíticas); y 7) métodos físicos (Soft-Láser). En nuestra experiencia, que incluye un gran número de exéresis en los terceros molares, el constante cumplimiento de los puntos 1, 2 y 3 y algunas veces de los 4 y 5, nos ha permitido constatar una incidencia muy baja de alveolitis seca (aproximadamente 1 %)

Aerosols generation using Er,Cr:YSGG laser compared to rotary instruments in conservative dentistry: a preliminary study

Background: In restorative dentistry, the use of high-speed air turbine, which generates aerosols, can be associated with the transmission of airborne diseases. New laser technologies could be useful in reducing the amount of aerosols, but there is a lack of scientific research on this topic. Material and Methods: This is a descriptive study to analyze the amount of aerosols produced after class I cavity preparation using high-speed air turbine (group 1) and Er,Cr:YSGG laser with two different parameters (groups 2 and 3). Fluorescein dye was incorporated into the coolant reservoir in order to visualize the production of aerosols during each procedure. Tooth preparation was performed in a typodont with human lower molar tooth under rubber dam isolation. The procedure was carried out in a transparent plastic box to avoid aerosols dispersion. Sixteen grade I cellulose filter discs were distributed along the surfaces of the box. The area contaminated with aerosols in the filters was measured using ultraviolet illumination. Results: In group 1, the contaminated surface area covered with fluorescein dye reached 77.3% (1349 cm2) of the total; in group 2 (laser with 80% water) we observed 7.3% (128 cm2) and in group 3 (laser with 40% water) it was 3.8% (68 cm2). The reduction in water parameter from 80% to 40% coincided with 48% reduction of the contaminated area on the filter discs. Focusing on the surfaces of the box, we noted that the mean contamination on the left side was more than on the right side in all three experimental groups. In group 1 using air turbine, we measured a mean of 102.6[ 7.5 SD]cm2 on the left side, compared to 70.6[ 32.3 SD]cm2 on the right side. In laser groups 2 and 3, a mean of 12.8[ 14.9 SD]cm2 and 6.8 [ 5.7SD]cm2, respectively, was described on the left surface versus 0 cm2 of surface contamination on the right surface. Conclusions: The contaminated area during the procedure of class I cavity preparation, is reduced by 70% using Er,- Cr:YSGG laser compared to high-speed turbine. A slightly higher contamination was observed between laser groups with 80% versus 40% water. The use of Er,Cr:YSGG laser in restorative dentistry can be a valid treatment alternative to reduce aerosols production compared to conventional high-speed rotary instruments

Photodynamic Therapy in Endodontics: A Helpful Tool to Combat Antibiotic Resistance? A Literature Review

Background: Antibiotic resistance has become a growing global problem where overprescription is a contributing factor for its development. In the endodontics field, complementary treatments, such as antimicrobial photodynamic therapy (aPDT), have been described to eliminate residual bacteria from the root canal space and reduce complications. The aim of this review is to describe the literature evidence up to now regarding the advantages, efficiency, and clinical outcomes of this therapy in endodontics as a possible tool to combat antibiotic resistance. Methods: A review of the literature from 2010 to 2021 was carried out using the PubMed and Web of Science databases. Two steps were taken: First, articles were compiled through the terms and MeSH terms "Photochesdmotherapy" and "endodontics." Then, a second search was conducted using "photodynamic therapy" and "antibiotic resistance" or "drug resistance, microbial." Results: A total of 51 articles were included for evaluation: 27 laboratory studies, 14 reviews, and 10 clinical studies. Laboratory studies show that aPDT achieves significant bacterial elimination, even against antibiotic-resistant species, and is also effective in biofilm disruption. Clinical studies suggest that aPDT can be considered a promising technique to reduce bacterial complications, and reviews about the issue confirm its advantages. Conclusion: The benefits of aPDT in reducing complications due to its antibacterial effects means a possible decrease in systemic antibiotic prescription in endodontics. In addition, it could be an alternative to local intracanal antibiotic therapy, avoiding the appearance of possible antibiotic resistance, as no bacterial resistance with aPDT has been described to date

Parameters Used With Diode Lasers (808-980 nm) in Dentin Hypersensitivity Management: A Systematic Review

Introduction: The present study aimed to describe parameters used with 808- to 980-nm wavelength diode lasers for managing dentin hypersensitivity and analyze their results.Methods: The inclusion criteria were based on randomized controlled clinical trials using diode lasers at an 808-980 nm wavelength range in patients with dentine hypersensitivity with a minimum of 1-month follow-up. An electronic search for articles on Medline, PubMed, and Cochrane databases was performed. The risk of bias was assessed with the Cochrane collaboration tool.Results: Our electronic search resulted in 130 papers, of which 11 articles met the inclusion criteria. A majority of the studies assessed dentine hypersensitivity using the Visual Analogue Scale, which ranged between 2.3 and 8.8 before treatment and significantly reduced to a mean value of 0.45-3.7 after diode laser application. The power settings ranged between 1.5 mW and 3 W with an emission mode of continuous wave, except for 2 authors who used chopped mode. The energy density varied from 2.5 to 128 J/cm2, and the exposure time was between 10 and 120 seconds. The authors applied a minimum of 1 to 4 treatment sessions with a 2-day to 1-week interval between them. Most of the studies mentioned the tooth surface as the treatment site but without describing the specific irradiation points.Conclusion: Despite the heterogeneity of the analyzed variables, a statistically significant improvement in all laser groups as described. However, they cannot be compared homogenously. Doi:10.34172/jlms.2022.03

Atomic force microscopy visualization of injuries in Enterococcus faecalis surface caused by Er,Cr:YSGG and diode lasers

Aim: To visualize by atomic force microscopy the alterations induced on Enterococcus. faecalis surface after treatment with 2 types of laser: Erbium chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser and Diode laser. Material and methods: Bacterial suspensions from overnight cultures of E. faecalis were irradiated during 30 seconds with the laser-lights at 1 W and 2 W of power, leaving one untreated sample as control. Surface alterations on treated E. faecalis were visualized by atomic force microscopy (AFM) and its surface roughness determined. Results: AFM imaging showed that at high potency of laser both cell morphology and surface roughness resulted altered, and that several cell lysis signs were easily visualized. Surface roughness clearly increase after the treatment with Er,Cr:YSGG at 2W of power, while the other treatments gave similar values of surface roughness. The effect of lasers on bacterial surfaces visualized by AFM revealed drastic alterations. Conclusions: AFM is a good tool to evaluate surface injuries after laser treatment; and could constitute a measure of antimicrobial effect that can complete data obtained by determination of microbial viability

Post-endodontic pain evaluation after different intracanal laser assisted disinfection techniques. A Systematic Review

Post-endodontic pain (PEP) management is an important factor to be considered in endodontic treatment. Several risk factors have been described that can attribute to its appearance. Laser-assisted disinfection has been described by many authors for its a

Photobiomodulation therapy and endodontic treatment of teeth with apical periodontitis using 940-nm diode laser. Report of two cases.

Background: Diode laser (DL) can be used in endodontics both for its bactericidal effect inside the root canal system (RCS) and for photobiomodulation therapy (PBMT) to accelerate the repair of periradicular bone tissue. Clinical Cases: This work presents two cases of pulp necrosis/asymptomatic apical periodontitis (AAP) that were treated with 940-nm DL, administered both to disinfect the root canal and to apply PBMT to the periradicular tissues. The cases were analysed by Cone-Beam Computed Tomography (CBCT). Discussion: DL has become widely accepted due to its high antimicrobial effectiveness and its ability to accelerate the repair of large apical lesions by biostimulation. Nevertheless, differences of opinion persist within the scientific community due to the lack of standardized endodontic protocols. Conclusions: The application of 940-nm DL, both for disinfection of the RCS and for PBMT, is an effective treatment in non-vital teeth with large periapical lesions. In both cases reported, bone neoformation were found at the 6-month check-up

Er,Cr:YSGG Laser-Activation Enhances Antimicrobial and Antibiofilm Action of Low Concentrations of Sodium Hypochlorite in Root Canals

Abstract: The onset and persistence of endodontic infections due to residual biofilm after chemical disinfection promotes secondary bacterial infection. Alternative methods to disinfect operated root canals are a matter of great interest. The aim was to evaluate the antibacterial effectiveness of sodium hypochlorite (NaOCl) at low concentrations activated by the Er,Cr:YSGG laser-activated irrigation (LAI) against 10-day-old intracanal Enterococcus faecalis biofilm. Biofilms were formed inside the root canals and divided into 7 groups (n13): 0.5% NaOCl + Er,Cr:YSGG; Saline + Er,Cr:YSGG; 0.5% NaOCl + syringe irrigation(SI); 2.5% NaOCl + SI; 5% NaOCl + SI; positive and negative controls. Bacterial survivors were counted and specimens visualized under scanning electron and confocal laser scanning microscopy. Treatments with 0.5% NaOCl + Er,Cr:YSGG and 2.5% NaOCl + SI gave a significant reduction in the number of CFU/mm2. Moreover, scanning electron microscopy and confocal laser scanning microscopy imaging confirmed and reinforced bacteriological data. Thus, Er,Cr:YSGG LAI proved to be able to improve the intracanal distribution of 0.5% NaOCl after 60 s of activation, reaching the same level of effectiveness than 2.5% NaOCl. This is regarded as of clinical interest, since working with lower concentrations may contribute to reduce undesired effects

Thermal increment due to ErCr:YSGG and CO2 laser irradiation of different implant surfaces : a pilot study

Objective: An evaluation and comparison is made of the thermal increment at different implant surfaces during irradiation with CO2 and ErCr:YSGG lasers. Study design: Five threaded and impacted implants with four types of surfaces were inserted in an adult pig rib: two implants with a hydroxyapatite surface (HA)(impacted and threaded, respectively), a machined titanium surface implant (TI mach), a titanium plasma spray surface implant (TPS), and a sandblasted, acid-etched surface implant (SBAE). A 0.5-mm diameter bone defect was made in the implant apical zone, and a type-K thermocouple (Termopar)® was placed in contact with the implant. The implants were irradiated in the coronal zone of each implant with a CO2 (4 W continuous mode) and an ErCr:YSGG laser (1.5 W, pulsed mode) first without and then with refrigeration. The temperature variations at the implant apical surface were recorded. Results: An apical temperature increase was recorded in all cases during CO2 and ErCr:YSGG laser irradiation without refrigeration. However, when the ErCr:YSGG was used with a water spray, a decrease in temperature was observed in all implants. The acid-etched and sandblasted surfaces were those most affected by the thermal changes. Conclusions: The ErCr:YSGG laser with a water spray applied to the sealing cap or coronal zone of the implants does not generate thermal increments in the apical surface capable of adversely affecting osseointegration and the integrity of the peri-implant bone tissue