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PBM for healing of dental root fractures

By Martin Kaplan DMD, Stoughton, Ma., USA

Therapeutic lasers are known to be able to heal perforations between the pulpal tissue and the tooth cavity (1-5). It is obvious that odontoblasts and pre-odontoblasts can be stimulated to produce secondary/tertiary dentin and seal the perforation, maintaining the vitality of the pulp. Less known, if at all, is that PBM also can heal the interface between the two separate parts in root fractures. The following case will illustrate the procedure and the history.

A 9 year 11 month old male reported to the office 24 hours after treatment in a Boston Area Dental School emergency dental department. Medical History was non-contributory. His dental injury was due to blunt force trauma of a baseball. There was no concussion nor any signs or symptoms of any neurologic injury He presented in the clinic 24 hours post dental splint treatment performed by a post-graduate student dentist. Dental x-ray was taken to evaluate the obvious uneven repositioning and the dislodged orthodontic wire splint.

  Situation when appearing in the clinic on day 2.

The tooth was properly repositioned under anesthesia and re-splinted with “Ribbond”.

On day 2 post trauma, 4 J were applied to the crown and 2 J over the apex of the fractured tooth and 2 + 2 J over the neighboring incisor. This was repeated weekly.

After two years, the tooth was still free from symptoms and vital. Judging from this single case experience, PBM is a promising tool, not only for perforations into the pulpal chamber but also for root fractures in young patients.

 

References:

  1. Paschoud Y et al. Effet du soft-laser sur la néofromation d´un pont dentinaire après coiffage pulpaire direct de dents humaines à l’ hydroxyde de calcium. Rev Mens Suisse Odont-Stomatol. 1988; 98 (4): 345-356.
  2. Ferreira ANS, Silveira LB, Genovese WJ et al. Effect of GaAlAs laser on reactional dentinogesis induction in human teeth. Photomed Laser Surg. 2006; (3): 358-365.
  3. Arany P R, Cho A, Hunt T D, Sidhu G, Shin K, Hahm E, Huang G X, Weaver J, Chen A C, Padwa B L, Hamblin M R, Barcellos-Hoff M H, Kulkarni A B, J Mooney D. Photoactivation of Endogenous Latent Transforming Growth Factor-beta1 Directs Dental Stem Cell Differentiation for Regeneration. Sci Transl Med. 2014; 28 6 (238): 238-69.
  4. Iraj Yazdanfar, Norbert Gutknecht & Rene Franzen. Effects of diode laser on direct pulp capping treatment. Lasers Med Sci. 2015 May;30(4):1237-43.
  5. Bidar M, Moushekhian S, Gharechahi M, Talati A, Ahrari F, Bojarpour M. The Effect of Low Level Laser Therapy on Direct Pulp Capping in Dogs. J Lasers Med Sci. 2016 Summer;7(3):177-183.
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