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Dental Tribune Middle East & Africa Edition | 4/2016 endo tribune 3 PRINT DIGITAL EDUCATION EVENTS The DTI publishing group is composed of the world’s leading dental trade publishers that reach more than 650,000 dentists in more than 90 countries. VISIT US DURING PAVILION 8 FDI 2016 BOOTH C27-C36 activation of the irrigant includes a temperature rise in the irrigant in- creasing its effectiveness in debride- ment of dentinal walls and increase of chemical properties of the irri- gants. LiteTouch™InducedPhotome- chanicalIrrigation(LT-IPI™) Endodontic treatment is initiated with access to the pulp chamber, which may be performed by tra- ditional methods using burs or by ablation of the enamel and dentin with the LiteTouch™ Er:YAG laser. As the laser is ineffective in removal ofceramicsandmetals,suchasthose used in fixed prosthetics and also amalgam, carbides and diamonds are needed create access through these materials. Once dentin has been reached the laser may be uti- lized to unroof the pulp chamber (hard tissue mode). An additional benefit of the Er:YAG laser to ac- cess the pulp chamber is it provides decontamination and removal of bacterial debris and pulpal tissue to yield a cleaner chamber aiding it identification of the canal orifices (softtissuemode). Once the canal orifices are identified hand files are utilized to establish a glide path to the apical working length in each canal. Canals are then enlargedtothedesiredISOcanalsize with either hand or rotary files. (Fig- ure 4A) Laser-assisted canal irriga- tion requires canal preparation to an apical preparation ISO 25/30. Taper of 0.04 or 0.06 for the final instru- mentation is recommended. Sodi- um hypochlorite (NaOCL) is utilized within the chamber and canals dur- inginstrumentationbothasapulpal tissue dissolvent and to lubricate the files within the canal, decreasing the Figure 4: LiteTouch™ Induced Photomechanical Irrigation protocol (LT-IPI™): Establish- ment of glide path with hand files (A), Canal and chamber filled with NaOCL (B) and Placement of the LiteTouch™ tip into the irrigant in the chamber and activation of the Er:YAGlaser.(Illustrations:courtesyofDrParvanVoynov,Plodiv,Bulgaria) Figure 5: Accessory anatomy evident in the apical that has been filled with sealer accessible due to use of the LiteTouch™ Er:YAG laser. (Photo courtesy of Dr. David Guex,Lyon,France) Dr.Kurtzman He is in private general practice in Silver Spring, Maryland and a former Assistant Clinical Professor at University of Maryland and a former AAID Im- plant Maxi-Course. He is aslo assistant program director at Howard University College of Dentistry. He has lectured in- ternationally on the topics of Restora- tive dentistry, Endodontics and Implant surgery and prosthetics, removable and fixed prosthetics, Periodontics and has over460publishedarticles.Hehasearned Fellowship in the AGD, ACD, ICOI, Pierre Fauchard, ADI, Mastership in the AGD and ICOI and Diplomat status in the ICOI andAmericanDentalImplantAssociation (ADIA). ◊Page2 potential of file separation that can occur when instrumenting a dry ca- nal.(Figure4B) Photo-activationoftheirrigantwith- in the canal system using the Er:YAG laser with a 0.4/17 or 0.6/17mm tip assists in removal of the debris cre- atedbythefiles.Betweeneachrotary file,thechamberisfilledwithNaOCL and the tip of the laser is placed into the chamber and the solution acti- vated with the laser at 40mJ at 10Hz with an average power of only 0.5W for20seconds.(Figure4C)Thecham- ber is suctioned and fresh NaOCL is placed into the tooth and the next file is used for instrumentation. It is unnecessary to place the lasers tip intothecanal,asactivationoftheso- lution within the chamber transmits downtheirrigantinthecanalstothe apical aspect of the roots. Laser acti- vation may also be performed with 17% EDTA solution alternated with NaOCL. The benefit of EDTA solution is its chelation effect opening canal anatomy so that the next round of NaOCL can reach more pulpal tissue not accessible to the files in fins, as well as accessory and lateral canals. Following final instrumentation of the canals with rotary files, the chamberisfilledwithNaOCLandthe Er:YAG tip is placed into the cham- ber again and activated for a mini- mum of 60 seconds. This allows the photo-activated irrigant clear debris and remaining pulpal tissue from the complete canal system. The irri- gationsolutionissuctionedfromthe chamber and fresh irrigant placed and photo-activation repeated until novisibledebris(cloudiness)isnoted in the chamber fluid. Any remaining solution is suctioned from the tooth and the canals are dried with paper points. Obturation is then accomplished using the practitioners preferred method and materials allowing obturation ofanatomyinaccessiblebyinstrumentationwithfiles.(Figure5)