Using a Laser for Class I Cavity Prep in a Pediatric Patient
A healthy 7-year-old boy was brought to my office for a second opinion. The father, who is a dental hygienist, had (under proper supervision) placed a sealant on his son’s tooth No. 19 (Figures 1 and 2). On taking a radiograph of this tooth at the patient’s 6-month recall, the dentist and hygienist (the patient’s father) noticed a gray area on the x-ray of tooth No. 19. The patient did not complain of any pain on percussion, nor of any heat or cold sensitivity.
After placing an Isolite Systems mouthprop to control moisture, a Class I cavity preparation was performed using the Er,Cr:YSGG 2790 nm WaterLase MD from Biolase (Figure 3). This preparation was performed without local anesthetic because of the analgesia provided by the laser technology. After removal of the carious lesion (Figure 4), an indirect pulp cap was placed using TheraCal LC (BISCO) (Figure 5). TheraCal LC is a light-curable pulp-capping material composed of resin and calcium silicate. The FDA has approved TheraCal as an “apatite stimulating liner with the ability to induce apatite crystal formation...” It also has a sustaining release of calcium and hydroxide ions. The TheraCal LC indirect pulp cap is shown (Figure 6) after placement of the restoration. The restoration was placed using a one-step primer/bonding agent. First, BeautiBond (Shofu) was applied to the cavity preparations. After 10 seconds, the preparation was air-dried and light-cured. Next, Beautifil Flow Plus, a flowable Giomer (Shofu), was applied as a liner for the restoration and light-cured. Then, Beautifil II, a nano-hybrid, fluoride-releasing composite (Shofu), was placed and light-cured to fill the preparation. The restoration was then finished and polished (Figure 7).
The FDA approved the erbium laser for marketing in the United States in 1997. It offers an alternative to the high-speed drill, eliminating fear and patient discomfort for both adults and children. The laser is revolutionizing dental care—just as it has in many other areas of our lives. With the erbium laser, the dentist can provide new methods of dental treatment that can often be performed without local anesthesia.
The indirect pulp cap was successful in preventing a pulp exposure, and the patient had no further discomfort with this deep carious lesion. After the restoration was placed, the patient did not complain of any pain.