Endodontic Applications

Nd:YAG, Erbium Lasers and diodes have been studied extensively as an adjunct to endodontic treatment. Many of these studies have shown improved smear layer removal and disinfection in the apical third of the tooth. There is the concern of negative thermal effects within the confined space of the root canal.

A phenomenon known as Laser Assisted Irrigation (LAI) has been discovered. The extremely high peak power and affinity for water of the Er:YAG laser creates an interesting phenomenon when tips are place in irrigant solutions. When tips are submerged in solution each pulse sends a powerful wave of acoustic energy throughout the solution. The laser is used at a setting that creates very little thermal effect. The resultant shock wave propagates throughout the complete three-dimensional root canal system, even the tiniest accessory canals. Scanning electron microscope and microbiological studies have shown extremely thorough cleansing and disinfection of the total root canal complex.^18,19 The Laser Assisted Irrigation technique allows the dentist to instrument less aggressively and still achieves a thoroughly clean root canal system. It also goes by the acronyms PIPS (Photon Induce Photoacoustic Streaming).

A modified LAI technique called SWEEPS (Shock Wave Enhanced Emission Photoacoustic Streaming) has been recently developed. This technique uses a second variably timed pulse to enhance the shockwave of PIPS by about 30 percent.

Figure 43. Endodontics.

Figure 43. Endodontics.

Tooth 5 instrumented to a size 25 hand file and treated with Laser Assisted Irrigation (PIPS -Photon Induced Photoacoustic Streaming)using sodium hypochlorite, sterile water and EDTA. EndoRez cement (Ultradent Products) was used with a single gutta percha cone per canal. There are multiple lateral canals filled with cement both mid root and apically.

Figure 44. Photon Induced Photoacoustic Streaming (PIPS).

Figure 44. Photon Induced Photoacoustic Streaming (PIPS).

Photo courtesy of Dr. Enrico DiVito.

This molar was treated with PIPS only with no mechanical instrumentation and then sealed with EndoRez to demonstrate the effectiveness of the procedure. Multiple lateral canals were cleaned and sealed effectively.

Figure 45. Laser treated canal.

Figure 45. Laser treated canal.

Photo courtesy of Dr. Enrico DiVito.

Normal instrumentation and irrigation leaves significant smear layer on the left. The Laser Assisted Irrigation treated dentin on the right is free of smear layer.

Figure 46. Treated Lateral Canal.

Figure 46. Treated Lateral Canal.

Photo courtesy of Dr. Enrico DiVito.

A lateral canal in a laser treated tooth is free of debris.

PIPS is being performed on the mesiobuccal 1 canal and debris can be seen rising up from the mesiobuccal 2 canal on this upper molar. When the resin cement is injected into the mesiobuccal one canal it can be seen coming up the mesiobuccal 2 canal via anastomoses that have been thoroughly cleaned by PIPS. This phenomenon is commonly observed in various teeth by PIPS practicing dentists. (Er:YAG laser with special PIPS tip).

Source: Dr. Mark Colonna.