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ePaper created 2016-07-29, 16:53:04 | version 1.38.0
| industry 20 laser 2 2016 Laser-activated irrigation with PIPS® The power of better irrigation Why endodontics? Bacterial infections of the root canal system are one of the main causes of apical periodontitis.1 The infectionusuallyentersthroughthedentinaltubules. Carious lesions, leaky fillings, leaky dental implants, hairlines, traumas, or erosion may be the cause of canalsysteminfections.2 Fortheprimaryandforthe secondaryinfectionaswell,anintra-radicularmixed bacterial flora was proven.3 The median bacterial count for the primary infection was 4.6 x 107 colony forming units (CFU) per apex.4 For persistent infec- tions, 5.4 x 104 CFU per apex were determined.5 Bac- teria may enter very deeply into the dentinal tubules andramificationsoftherootcanalsystem.6 Colonies ofE.faecalis,forexample,canbefoundupto500 µm away from the main canal (Fig. 1).7 The bacteria within the infected canal system appear either in plankton form, i.e. swimming in tissue fluid8 , or rela- tively “organised” in the so-called “biofilm”. This is a conglomerate of various bacterial species, which or- ganisethemselvesinanextra-polysaccharidematrix that adheres tightly to the canal walls and the den- tinaltubules(Fig.2).9 Thealmostsymbioticinterrela- tionsamongthebacteriawithinthebiofilmresultsin a much higher resistance of the individual bacterial species against antimicrobial agents.10 In advanced stages of apical periodontitis, you can therefore always refer to an infectious disease triggered by biofilm.11 With regard to the preferably complete removal of bacteria from the canal system and the dentinal tubules, the increased resistance of the bacteria embedded in biofilm, together with the extremely strong adhesion due to the extra-poly saccharide matrix, is one of the essential problems in endodontic treatment. In summary, bacteria are the main cause of apical periodontitis.12 The purpose of any endodontic therapy must therefore be the extensive eradication of microorganisms, infected tissue residues, and infected dental hard tissue from the canal system and dentinal tubules.13 Antimicrobial treatment concept To meet this requirement as best as possible, it is necessarytocomplywithastrictantimicrobialtreat- ment concept. This includes the imperative applica- tion of a dental dam, the removal of potentially in- fected dental restorations and scrupulously exact caries excavation as well as the preparation of a dentin-adhesive tight pre-endodontic buildup. The preparation of the correct access cavity facilitates all Fig. 1: Bacterial infection of dentinal tubules. Source: Prof. V. Kaitsas. Fig. 2: Biofilm. Source: Prof. V. Kaitsas. Fig. 1 Fig. 2 Author: Dr Ralf Schlichting, Germany 22016