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د حاتم البيطار Dr hatem el bitar mob 01005684344

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د حاتم البيطار Dr hatem el bitar mob 01005684344

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د حاتم البيطار Dr hatem el bitar mob 01005684344

  1. 1. dr hatem bitar mob{01005684344}‫الرحيم‬ ‫الرحمن‬ ‫ال‬ ‫بسم‬researchOn role of laserin periapical lesion‫البيطار‬ ‫حاتم‬ ‫د‬‫الطلب‬ ‫تحت‬ ‫طبي‬ ‫محاضر‬Dr Hatem El BitarEGYPTIAN FELLOWSHIPLecturer in British board AcademyLecturer in Egyptian CenterLecturer in Emide CenterMob: 01005684344
  2. 2. dr hatem bitar mob{01005684344}ABSTRACT-The problem in cases of healing resistantperiapical lesions is to eradicate the contaminationat the periapical area,so it need-Paraendodontic surgery (apisectomy)consists of the mechanical removal ofharmful agents to promote healing and periapical health-Need for complete removal of microbial contamination was done bycutting the apical one third with retrograde fillingsWhich also not sucessful,that is make laser is the best choice fortreatment of these cases
  3. 3. dr hatem bitar mob{01005684344}Introductionperiapical infection results from microorganizmescolonizing the apex of the teethTreatment1Endodontic therapy isthe first step to treat periapical lesions.)However, in some cases periapical lesions persist ,even after propertreatment(Tronstad et al. reported the presence of periapical bacterialbiofilm on resistant periapical lesionsLin et al. suggested that successful treatmentis only possible with total removal of the irritating agents
  4. 4. dr hatem bitar mob{01005684344}introduction2Periapical surgery is indicated for cases with no sign ofhealing after retreatment.3apical curettage can be used to removeinfected tissue around the apex.)However, the removal of infected cementum andsurrounding tissue is not easy(,which may explain the persistence of a small numberof lesions that do not heal even after apical surgery.
  5. 5. dr hatem bitar mob{01005684344}is surgical technique used to treat periapicalspathologies, when it is practically impossibleto be treated with conventional endodontictreatmentapisectomy.
  6. 6. dr hatem bitar mob{01005684344}Fig1 shows xrays for periapical lesion
  7. 7. dr hatem bitar mob{01005684344}apisectomythe aim: remove infection or other pathologyfrom around the end of the root of a tooth.causes: It is usually carried out when a normalroot filling has failed or is impractical
  8. 8. dr hatem bitar mob{01005684344}procedurescarried out under a local anaesthetic and is usuallypainlessmaking flap &reflection of gingiva to expose theunderlying boneremoval of bone with surgical bur under coolingwater,salinecutting in the infected apex (removal of apical onethird with) retrograde fillingflap is repositioned and suturedevery step will be disscused in details
  9. 9. dr hatem bitar mob{01005684344}proceduresFIG.2,3 SHOWING PROCEDURES OF APISESCTOMYFIG.2FIG.3
  10. 10. dr hatem bitar mob{01005684344}the flapdef: used to expose area of operationincrease accessibility to the fieldtypes of flap designa-surgical technique,using scalpelhave many design acc to no. of incision linesuch as mucogingival,semilunarb-by using co2 laser.
  11. 11. dr hatem bitar mob{01005684344}A-surgical flapfig 4 showing flap design,muco gingival flap
  12. 12. dr hatem bitar mob{01005684344}complication of surgical flapbleeding from surgical incision in the gumThere is usually some post operative painpost operative swelling in the first few daysfollowing surgerybut healing is usually complete within a week
  13. 13. dr hatem bitar mob{01005684344}b-by using co2 laserCO2 laser is 1st laser for soft tissue surgeryWhyLaser surgery has benefits such as1Non-contact surgery2No or less bleedinig3Improved visibility of surgical site4No or less pain during and after surgery5Reduced surgical time6Minimal discomfort7Killing bacteria on laser site8Faster healing9No or less dressing10Reduced healing time
  14. 14. dr hatem bitar mob{01005684344}Retograde fillingdef: a suitable root-end filling material is inserted.usedto seal the root-end cavities andprevent leakage of microorganisms and theirby-productsideal requirments1should be non-toxic2non-carcinogenic3biocompatible with the tissue fluids and4dimensionally stable5The presence of moisture should not affect its sealingability6should be easy to use7radio-opaque to be recognized on the radiograph
  15. 15. dr hatem bitar mob{01005684344}retrograde fillingstypes of retrograde filling1Metals such as: gold-foil,silver poststitanium screws,tin posts,amalgam2sealers such as: ZnOE,SuperEBA,cavit,zinc-polycarboxylateglassIonomer,mta,calcium phosphatecement
  16. 16. dr hatem bitar mob{01005684344}Why laser is used to eradical contamination inperiapical lesionsno material has been found that fulfillsall or most of the propertiesfor ideal retrograde filling materialalso, the removal of infectedcementum and surroundingtissue is not easywhich may explain falirue of many cases &number of lesions that do notheal even after apical surgeryso we use laser to eradicate microbial florawith no recurrence
  17. 17. dr hatem bitar mob{01005684344}Why laser is usedLASERis very special type of Light( lightAmplification byStimulated Emission of Radiation)characterized byCoherent,monochromic,highpower,unidirectional,collimated.Lasers are composed of three main elements:the optical amplifier,pump and opticalresonator
  18. 18. dr hatem bitar mob{01005684344}Fig.4 shows types of laser machineTypes of laser1solid laser such as ruby laser,er:yag,nd:yag2gas laser such as argon laser ,co2 laser3liquid laser such as dye laser4semiconductor such as diode lasers
  19. 19. dr hatem bitar mob{01005684344}The purpose of this study wasto assess the results of Er:YAGlaser irradiation on the apical rootthirdof newly extracted teethto eliminate microbial contaminationon root apex surface
  20. 20. dr hatem bitar mob{01005684344}Material and Methods-Erbium yttrium aluminum garnet (Er:YAG)laser of 2.94 µm wavelength is stronglyabsorbed by water-human teeth with periapical lesions extractedand soaked in saline and stored in a sterileflask until use.
  21. 21. dr hatem bitar mob{01005684344}Technique of workThe teeth were fixed, submerged ina flask with waterand irradiated with the laserEr:YAG laser device of 2.94 µmwavelength was used in this studyusing an experimentalchisel-shaped contact tip of 0.256 mm²Continue<<
  22. 22. dr hatem bitar mob{01005684344}Er:YAG laser device of 2.94µm wavelength was used inthis study. The specimenswere irradiated with-3.5 W peak power-3 times-on the apical 3 mm of the root- at an agle of 60°-during approximately 3 s
  23. 23. dr hatem bitar mob{01005684344}The lased specimens weredehydrated in 99.5% ethanolcritical-point driedsuppter-coated with gold using anion coaterand examined under scanningelectron microscopyat 25 kV.
  24. 24. dr hatem bitar mob{01005684344}Resultsbased on a morphologicalanalysisof SEM micrographsEr:YAG laser irradiated areaat high magnification (3000X)shows vaporization ofmicrobiological apical biofilm
  25. 25. dr hatem bitar mob{01005684344}At the same magnification(3000X)the non-lased area with biofilmfirmly attached to root apexsurfaceshow the presence of cocci androdson the root surface in thisbiofilm layer
  26. 26. dr hatem bitar mob{01005684344}Fig.5 shows sem micrographs of apical one thirdof study specimens
  27. 27. dr hatem bitar mob{01005684344}DiscussionThe treatment of apisectomy failuresis very difficult because periapicallesions usually do not respond wellto mechanical, chemo-pharmacologicalTherefore laser irradiation has been presentedas a promising method for providingmorphological changes ondentin and cementum surfacesas well as for biofilm removal.
  28. 28. dr hatem bitar mob{01005684344}The Er:YAG laser has beenrecently introduced to dentistryand has potential for differentclinical applicationswith excellent results Studieshave shown that dentalhard substances can be removedby pulsed Er:YAG laserirradiationconclusions
  29. 29. dr hatem bitar mob{01005684344}entionYAG laser has attracted attthe ER:due to1 its capacity for ablating hard tissue2 extremely small thermal effects3 The 2.94 µm wavelength is highlyabsorbed by water4 causes little damage on hard tissues5 HAS minimal or no pain6 induces little temperature rise leading tosafe clinical use
  30. 30. dr hatem bitar mob{01005684344}Role of laser in biostumlationlow powered lasers are believed to increase theproduction of collagen which provides healing fornon-healing tissues and to stimulate the production ofenzymes which remove or reduce the byproducts oftissue inflammation and thereby reduce swellingleading to the alleviation of pain and swelling
  31. 31. dr hatem bitar mob{01005684344}Role of laser in biostumlationtypes of lasers used for biostimulationHeNe at 635nmdiodes at between 820to904nmtechnique & parameterare used either in CW or pulsed modes atbetween15 to 60 mW levels.They are usuallyapplied for a few minutes at each treatment, andare repeated on a daily or weekly basis until relief fromthe symptoms is achieved
  32. 32. dr hatem bitar mob{01005684344}Thank you

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