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The purpose of this study was to compare the effects of scaling and Nd:YAG laser treatments with that of scaling alone on cementum and levels of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis, and Treponema denticola. Study samples consisted of 14 patients, age 30 to 75 years, 8 females and 6 males, with a total of 150 periodontally involved sites with probing depth > or = 5 mm. Group A consisted of 100 pockets that were subdivided into 4 equal groups that were treated with conventional scaling and pulsed Nd:YAG laser using an optic fiber of 300 microns and 4 different power levels as follows: Group 1: P = 0.8 W, f = 10 Hz, E = 100 mJ/pulse; Group 2: P = 1.0 W, f = 1.0 Hz, E = 100 mJ/pulse; Group 3: P = 1.2 W, f = 12 Hz, E = 100 mJ/purse; and Group 4: P = 1.5 W, f = 15 Hz, E = 100 mJ/pulse. The time of each treatment was 60 sec per pocket in all 4 groups. Group B consisted of 50 pockets that were treated by conventional scaling alone and served as a control group. Microbiological samples from group A were collected before scaling; after scaling = before laser, just after laser, 2 weeks later, 6 weeks later, and 10 weeks later. Microbiological samples from group B were collected before scaling, after scaling, 6 weeks later, and 10 weeks later. Microbiological analysis of all samples was done by the Institute Für Angewandte Immunologie (IAI) method. The effects of laser on root surfaces were assessed by SEM examination and the sample consisted of 13 teeth from 5 different patients. Four sets of 3 teeth each were treated with Nd:YAG laser using 0.8, 1.0, 1.2, and 1.5 W, respectively. One tooth was just scaled and not treated with laser to serve as a control. Microbiological analysis of Group A samples indicated posttreatment reduction in levels of all 4 bacterial types tested compared to pretreatment levels and Group B controls. SEM examination of the specimens treated with Nd:YAG laser at different levels exhibited different features of root surface alterations.

This clinical review confirms the very positive prognosis for endodontic therapy, conditional to strict compliance with imperatives. Endodontics failures are transient and can be remedied. The authors define the attitude to be adopted and the measures to be taken in accordance with the type of difficulty encountered.

Recovery after an endodontic treatment can only be assessed clinically, on the basis of symptomatological and radiographic data, for lack of histo-clinical correlations. An anatomicopathological examination of damaged tissues pinpoints the anatomical obstacles and tissular modifications apt to undermine the success of root canal work. The aim of endodontic treatment is to maintain or reinstate an environment conducive to healing through the use of a non-traumatic endodontic technique, followed by functional rehabilitation of the dental organ in its periodontia structures.

When large restorations are necessary, self screw-cutting dentinal pits are very useful auxiliaries. The main risks encountered during their utilization are: --perforation through periodontium--pulpal wound--dentinal cracks--weakness of mechanical properties of restorative material--corrosion--breakdown of the drill--pulpal warning up--unesthetical front restorations. The way to prevent those difficulties are: --precise clinical and radiological examinations--insertion point--direction--number--composition--choice of pits.