Lasers are being used for soft tissue removal, caries removal, and treatment of root surface sensitivity. One concern for laser safety is that the heat produced at the irradiated root surface may diffuse to the pulp causing irreversible pulpal damage. To test this heat diffusion, copper-constantan thermocouples were inserted into the radicular pulp canals of extracted teeth. Simulating direct exposure which might occur during gingival excision, superficial caries removal, and modification of the dentin surface for treatment of root surface sensitivity, a 2 mm2 area of the external root surface was uniformly irradiated with a pulsed Nd:YAG laser using a 320 microns diameter fiber optic contact probe. Power was varied from 0.3 to 3.0 W with frequencies of 10 and 20 Hz. Temperature changes during cavity preparations using a high speed handpiece with air coolant were also recorded. Repeated measures ANOVA (P < or = 0.05) indicated that intrapulpal temperatures increased as a function of power, frequency, and time. Intrapulpal temperatures decreased as remaining dentin thickness (0.2 to 2.0 mm) increased for each laser parameter. Irradiation of dentin using a Nd:YAG pulsed laser, within the treatment times, powers, and frequencies with adequate remaining dentin thickness, as outlined in this paper, should not cause devitalizing intrapulpal temperature rises.
This analysis suggested that the interpositional vascularized augmentation neogenesis (IVAN) technique can be used effectively to simultaneously augment hard and soft tissue. This technique is effective when used in conjunction with the immediate or delayed placement of dental implants in the maxillary anterior segment. Furthermore, when using this technique, the specific membrane and FDBA source can be chosen by the practitioner to treat individual defects.
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