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ePaper created 2017-09-12, 09:26:18 | version 1.38.0
lasers in endodontics industry report | small-diameter optical fibre can provide convenient access to root canals. Consequently, direct and indi- rect disinfection by laser possibly takes place while irradiating the inside of root canals. De Andrade AK et al.24 reported laser disinfection is an effective way to decrease bacterial colonies when the mean power of laser exposure was over 3 Watts. The energy of the Nd:YAP laser is powerful enough to eliminate microbes because the average output of the Nd:YAP laser is 10 Watts and the peak power may reach 2.6 kW. Only 0.00015 seconds of laser energy is emit- ted for every pulsed irradiation,25 so the fleeting mo- ment of emission minimises the risk of overheating surrounding tissues and has bactericidal effects by direct contact. Two possibilities may explain the indi- rect disinfection of laser. When the mode of 30 Hz is used in narrow space such as a root canal filled with irrigation solution, shock waves may occur repeatedly and be transmitted into dentinal tubules to kill bacte- ria. Pulsed irradiation causes vibrations in narrow spaces similar to ultrasonic devices.25 This laser energy caused by high frequency emission of the Nd:YAP laser help maintain the integrity of the root because it is not necessary to eliminate excessive con- taminated dentin of canal wall. Minimal enlargement is sufficient, if the space can allow 220 µm optical fi- bre to move passively through the canal. The laser en- ergy also causes temperature of the NaOCl solution to rise resulting in increased efficiency of dissolving or- ganic debris and disinfection in canals.26 This enhanced cleanliness gains space in apical ramifi- cations for sealer placement. In the clinical practice, the warm vertical conden- sation technique is widely used to obturate the canal, but keeping a gutta-percha cone warm enough to obtain favourable sealing in the ramifications may cause lasting discomfort because of thermal damage to periodontal tissues.27,28 On the other hand, the mechanism of sealer placement by the Nd:YAP laser is different from thermoplastic techniques. Sealer is placed in the canal with a lentulo spiral followed by application of the Nd:YAP laser to disperse the sealer into ramifications by the fleeting pressure of laser beam. Although the pressure causes slight discom- fort, the post-filled sensation is not overt and dissi- pates clinically within a few hours. In most cases, there was radiographic evidence of sealer being forced into lateral/accessory canals. Puffs of sealer from the periapical foramen are considered an evi- dence of tight seal.1 Zinc-oxide and eugenol-based sealer was chosen in this case report because working and setting time are conducive to completion of the entire obturation process before the sealer sets. The heat from laser irradiation induces fast setting and burning of epoxy resin-based sealer; these types of sealers are not recommended with this technique. Taking periapical films during obturation is recom- mended to confirm whether the sealer is placed into canal adequately. Another advantage of using the Nd:YAP laser is that the need for analgesics/antibiotics after treatment can be decreased. The Nd:YAP laser has a strong anti- bacterial effect and an excellent potential for promot- ing tissue healing induced without a more invasive procedure29,30; therefore, using the Nd:YAP laser may be more efficient in disinfection and obturation of the root canal system resulting in a higher success rate of non-surgical root canal treatment. Based upon per- sonal experience and observation for four years in laser application, Nd:YAP laser-assistant endodontic treatment is less technique sensitive and easy for general practitioners to acquire the skill and follow this method. Further histological analysis is needed to verify the significance of laser disinfection and sealer place- ment with the use of the Nd:YAP laser. These addi- tional investigations will hopefully add to the store of knowledge relative to canal disinfection and the benefits of adequate obturation of auxiliary canals. Conclusion Obturation of lateral canals and apical ramifica- tions were observed on postoperative radiographs. This indicates enhanced canal cleanliness and sealing of these small ramifications. The Nd:YAP laser can be utilised as adjuncts to disinfection, canal irrigation and canal filling to improve the quality of obturation in the canal system. The efficiency of Nd:YAP laser- assistant endodontic treatment could simplify the procedure of root canal treatment without purchas- ing additional equipment to provide an advanced level of treatment._ Editorial note: A list of references is available from the publisher. Acknowledgement: The authors are grateful to Eric Jacobs, a media specialist, from University of Detroit Mercy School of Dentistry for image edition. contact Dr John Palanci Clinical assistant professor Department of Oral Health and Integrated Care University of Detroit Mercy 2700 Martin Luther King Jr. Blvd. Detroit, MI 48208, USA Tel.: +1 313 4946863 palancjg@udmercy.edu roots 3 2017 39