Clinical preconditions and treatment modality: effects on pulp surgery outcome.

Lasers in Surgery and Medicine 22:25–29 (1998) Clinical Preconditions and Treatment Modality: Effects on Pulp Surgery Outcome Jennifer Dang, BS , Petra Wilder-Smith, DR George M. Peavy, DVM MED DEN ,* and Beckman Laser Institute and Medical Clinic, University of California, Irvine, California 92612 Background: The purpose of this research was to evaluate the factors affecting the outcome of localized laser pulp surgery in the canine model. Study Design/Materials and Methods: Pulpal exposures 2 mm and 5 mm in diameter were prepared in eight healthy teeth in each of five dogs. The total of 40 teeth were left open to infection from the oral cavity for 3 hours or 72 hours; 2–3 mm of surface pulpal tissue were then removed using a fresh diamond bur or a CO 2 laser emitting @ 9.3 mm, at 3.5 W average power in the Su- perpulse mode. Teeth were monitored clinically and radio- graphically by one blinded, pre-standardized clinician for 3 months. Results: Chi-square test and Fisher’s Exact test (2-tail) results associated laser treatment with significantly better clinical and radiographic outcome (P < 0.001). Using regression analysis, du- ration of pulpal exposure to contamination by the oral environ- ment was identified as primary determinant for treatment out- come within the laser-treated and control groups (P = 0.0018). Conclusion: Clinical preconditions significantly affect the out- come of pulp surgery treatments. Lasers Surg. Med. 22:25–29, 1998. © 1998 Wiley-Liss, Inc. Key words: calcium hydroxide; CO 2 laser; laser treatment; pulpotomy INTRODUCTION Conventional pulp treatments used in ma- ture adult teeth include pulp capping or root canal therapy. Whether the pulp capping is indirect or direct, the outcome of the treatment is often un- predictable, with reported success rates ranging- from 44–97% [1]. The success rate for full root canal treatment has been reported to be 78–90% [2,3], depending on factors such as the pathologies treated, tooth anatomy, and follow-up duration. In immature permanent teeth, the choice for end- odontic treatment is pulpotomy with subsequent dressing of calcium hydroxide. However, this may ultimately result in internal tooth resorption [4]. In primary teeth, pulpotomy procedures are still widely used in conjunction with formocresol, de- spite concerns over its irritancy [5], toxicity, and mutagenicity [6–8]. Clinicians and patients alike would prefer to © 1998 Wiley-Liss, Inc. avoid unpredictable pulp capping or pulpotomy procedures as well as tooth devitalization and root canal therapy. However, we do not possess an ad- equate clinical capability for performing localized pulp surgery (e.g., pulpotomy) and wound dress- ing to allow predictable pulpal healing and long- term survival. The preconditions for localized pulp surgery include atraumatic removal of compromised Contract grant sponsor: DOE; Contract grant number: DE903-91ER 61227; Contract grant sponsor: ONR; Contract grant number: N00014-90-0-0029; Contract grant sponsor: NIH; Contract grant number: RR01192. *Correspondence to: Dr. Petra Wilder-Smith, Director, Den- tal Program, Beckman Laser Institute and Medical Clinic, 1002 Health Science Road East, Irvine, CA 92612. E-mail: pwsmith@bli.uci.edu Accepted 15 August 1997