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ePaper created 2015-03-10, 11:16:47 | version 1.33.01
76 — issue 1/2015 Laser Dentistry Article prove a significant effect regarding intra- canaldisinfection.Furtheradjustmentsto the PAD protocols and comparative re- search models may be required before recommendationscanbemaderegarding clinical usage. Discussion and conclusion Therearegoodreasonstofocusthetreat- ment of non-vital contaminated teeth on the destruction of bacteria in the root canal. The possibility of a favorable treat- mentoutcomeissignificantlyhigherifthe canal is free from bacteria when it is ob- turated. If, on the other hand, bacteria persist at the time of root filling, there is a higher risk of treatment failure. There- fore, the prime objective of treatment is toachievecompleteeliminationofallbac- teria from the root-canal system.2, 31 Today,thepotentialantibacterialeffect oflaserirradiationassociatedwiththebio- stimulationactionandacceleratedhealing process is well known. Research has sup- ported the improvement of endodontic protocol. Laser therapy in endodontic treatmentoffersbenefitstoconventional treatment,suchasminimalapicalleakage, effective action against resistant micro- organisms and external apical biofilm, and an increase in periapical tissue repair. For thisreason,laserprocedureshavebeenin- corporatedintoconventionaltherapeutic concepts to improve endodontic therapy (Fig. 8). Clinical studies have proven the bene- fits of an endodontic laser protocol in apical periodontitis treatment. For en- dodontic treatment, the protocol entails standardtreatmentstrategiesforcleaning and shaping the root canal to a minimum of #35, irrigating solutions with antibac- terial properties and intra-canal laserirra- diation using controlled energy parame- ters. Ideal sealing of the root canal and adequate coronal restoration are needed for an optimal result. In practice, little additional time is re- quired for laser treatment. Irradiation is simple when flexible optical fibers of 200μmindiameterareused.Thefibrecan easily reach the apical third of the root canal, even in curved molars (Fig. 9). The releasedlaserenergyhasaneffectinden- tine layers and beyond the apex in the pe- riapical region. The laser’s effect extends to inaccessible areas, such as external biofilm at the root apex. The irradiation technique must adhere to the following basic principles. A humid root canal is required and rotary move- ments from the coronal portion to the apexshouldbecarriedout,aswellasscan- ning the root canal walls in contact mode (Figs. 10a–c). The power settings and ir- radiationmodedependonone’schoiceof a specific wavelength. Nd:YAG, diodes of different wave- lengths,Er:YAG,andlow-powerlaserscan be used for different procedures with ac- ceptable results. Lasertechnologyin den- tistryis a reality.The development of spe- cific deliverysystems andthe evolution of laserscombinedwithabetterunderstand- ingoflaser–tissueinteractionincreasethe opportunities and indications in the en- dodontic field. Fig. 8 Therapeutic plan. Fig. 9 Intra-canal laser irradiation, molar. Fig. 10 Intra-canal laser irradiation, technique. Editorial note: A complete list of references is available from the publisher. Fig.8 Fig.9 Fig.10