AN ELECTRONMICROSCOPIC STUDY ON THE HEALING PROCESS OF THE REMAINING PULPAL TISSUES AFTER PULPOTOMY BY Nd-YAG LASER

Nd-YAG레이저에 의한 치수 절단후 잔존 치수 조직의 치유과정에 관한 전자현미경적 연구

The purpose of this study was to investigate a fragment of possibility of pulpotomy with the Nd-YAG laser by the observation of pulpal healing process and the fine structural changes of the fibroblasts of the remaining pulpal tissues. Class V cavities on !55 teeth from 4 adult dogs were prepared and the pulp chambers were opened with a sterilized round bur. In the control group(19 teeth), the exposed coronal pulps were excised by a sharp excarvator. After bleeding was controlled with the sterilized cotton pellets, calcium hydroxide powder was applied on the remaining pulpal tissues and the cavities were sealed with Z.O.E. In the experimental group 1 : the pulpotomy with laser-calcium hydroxide powder application group(l9 teeth), the exposed coronal pulps were excised by Nd-YAG laser(10 watts power, 2 psi water, 20 psi air) for 2 or 3 seconds and calcium hydroxide powder was applied on the remaining pulpal tissues and the cavities were sealed with Z.O.E. In the experimental group 2 : the pulpotomy with laser-no calcium hydroxide powder application group(17 teeth), after amputating the coronal pulps with Nd-YAG laser as the experimental group 1, the remaining pulpal tissues were covered with stenilized aluminum foil and the cavities were filled with Z.O.E. The animals were sacrificed at the intervals of 1, 2, 3 and 4 weeks. All the teeth were rouutinely processed and the remaining pulpal tissues were observed by the light microscope and electron microscope. The results were as follows : 1. In light microscopic findings, there was no significant difference of the inflammatory response in the remaining pulpal tissues between the control group and the experimental groups. In both of the experimental group 1 : pulpotomy with laser-calcium hydroxide powder application group and the control group, the dentin bridges were observed after 2 weeks and the structure of the dentin bridge was almost same. In the experimental group 2 : pulpotomy with laser-no calcium hydroxide powder application group, the fibrous layers instead of dentin bridge were observed on the superficial portion of the remaining pulpal tissues after 2 weeks and they were consisted with densely crowded active fibroblasts. 2. In the electronmicroscopic findings, the active fibroblasts in the experimental groups were more frequently observed than in the control group at 1 week. But active fibroblasts were found with same frequency after 2 weeks in all of the control group and the experimental groups. 3. General distortions of the cell such as loss of the cell membrane, vaculoization of the cell etc. were observed at the suberficial layer of the remaining pulpal tissues and the carbonization was found in the dentinal wall in 1 week of the experimental groups. 4. In the experimental group 2 : pulpotomy with laser-no calcium hydroxide powder application group, the activity and the density of the fibroblasts in the fibrous layer were more than those in the deep portion of the remaining pulpal tissues after 2 weeks. 5. In the control group, bacteria such as cocci and bacilli were observed frequently, but in the experimntal groups, they could not be observed.