Use of photoactivated disinfection and platelet-rich fibrin in regenerative Endodontics

Abstract

Aim:Photoactivated disinfection has been used as an adjunct to conventional endodontic treatment. Its use in regenerative endodontics is not reported in literature. The aim of this case report was to describe a new proposal for pulp revascularization with disinfection of pulp canal space using a unique combination of a photosensitizer solution and low-power laser light.Materials and Methods:A 9-year-old boy came with the chief complaint of discolored upper central incisors (#8, #9). A diagnosis of pulp necrosis was made on the basis of clinical and radiographic findings. The canal was irrigated with 5.25% sodium hypochlorite solution and dried with paper points. Photodynamic therapy was used to disinfect the root canal and platelet-rich fibrin was used to revitalize the pulp. Three millimeters of gray mineral trioxide aggregate was placed directly over the platelet-rich plasma clot. Three days later, the tooth was double-sealed with permanent filling materials.Results:Clinical examination revealed no sensitivity to percussion or palpation tests. Radiograph revealed continued thickening of the dentinal walls, root lengthening, regression of the peri-apical lesion and apical closure. Both the roots showed complete apical closure at the 10-month follow-up. However, the teeth were not responsive to electric pulp test.Conclusion:This report of pulp revascularization shows that disinfection with photodynamic therapy combined with platelet-rich fibrin leads to satisfactory root development in necrotic immature teeth.

Uses of lasers in endodontics

“…Results showed that LASER group had a clinical success rate of 85.71%, and radiographic success rate of 71.42% formocresol group showed 90.47% success rate both clinically and radiographically. [5] …”

Photodynamic Therapy in Endodontics

“…In a case report, Johns et al 49 described a new protocol for pulp revascularization with canal disinfection using a combination of a low-power laser light and PS solution.…”

Revascularization and Treatment Methods

“…52 Lazer ışığı, ışığa duyarlı ajanı aktive ederek mikroorganizmaları öldüren tekli oksijen radikallerini ve serbest radikalleri açığa çıkarır ve bir takım kimyasal reaksiyonlar ile enerji aktarım şelalesi oluşturur. 53 Lee ve ark. 54 PDT'nin tekrarlayan kanal içi enfeksiyonlardan en sık izole edilen mikroorganizma olan Enterococcus faecalis'i öldürmede başarılı olduğunu rapor etmişlerdir.…”

“…Revaskülarizasyon tedavisinde PDT kullanımı ile ilgili ilk klinik çalışma Johns ve ark. 53 tarafından uygulanmıştır. Bu çalışmada 9 yaşındaki hastanın pulpa nekrozu görülen ve kök gelişimini tamamlamamış üst santral kesicilerine, PDT uygulayıp ve doku iskelesi olarak trombositten zengin fibrin kullanarak revaskülarizasyon tedavisi gerçekleştirmişlerdir.…”

“…Yapılan literatür değerlendirmesinde, sadece bir çalışmada fotodinamik dezenfeksiyon ile PRF'nin kombine kullanımının nekrotik immatur dişlerde tatmin edici kök gelişimine izin verdiği gösterilmiştir. 53 Ancak bu konuyla ilgili yeterince çalışma bulunmamaktadır.…”