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ePaper created 2017-09-12, 09:26:18 | version 1.38.0
| industry report lasers in endodontics volume suddenly increases 800 to 1,000 times. This causes the formation of very small bubbles, micro- bubbles, which collapse again just fractions of sec- onds later. The thermal effect, which is obligatorily presupposed when a fluid acting as medium, is lim- ited to a micrometer-thin layer on the root canal surface. Therefore, the exposure of tooth substance to excessive thermal effects that has been observed and feared with other laser applications is excluded. I have been working with the Morita AdvErL Evo (Fig. 1) in my practice since 2015. This laser also is based on the principle of Laser-activated irrigation (LAI) and uses the formation of microbubbles to activate the irrigants, even if the term PIPS is not used for reasons of patent law. In the course of time, the Morita AdvErL Evo has become an obligatory part of our treatment proto- col, especially for the following procedures: 1. Cleaning the access cavity, representation of the root canal entrances. 2. Opening root canals, obtaining patency. 3. Removal of blockages. 4. Cleaning the root canals, removing the smear layer. 5. Removing calcium-hydroxide, removing any for- eign bodies. Although the manufacturer offers a large selec- tion of laser tips, two different tips have proven particularly well suited for endodontic treatments and are used as part of my workflow (Fig. 2) in every endodontic treatment. The P400FL tip (Fig. 3) is designed for cleaning the trepanation cavity. Fur- thermore, in view of its diameter of 0.4 mm, length of 13 mm and curved attachment, it allows instru- mentation of the coronal and, if necessary, middle sections of the root canal. The R300T tip (Fig. 4), which has a diameter of 0.3 mm and a length of 16 mm, can be used for accessing deeper areas of the root canal after preparation has been completed. Clinical workflow of LAI within the scope of endodontic treatments Below I would like to describe in detail a clinical workflow: 1. Cleaning the access cavity, representation of the root canal entrances After the initial dental trepanation, the P400FL tip with 25 pps and 70 mJ is used. Dentine splinters, which are pressed into the innumerable cracks and pores during the preparation of the access cavity and cannot be removed by conventional irrigation methods, can be removed in this way. After just a few Fig. 2 Fig. 3 Fig. 4 The Morita laser AdvErL Evo At the annual conference of the German Society for Endodontology and Traumatology (DGET) in Hamburg in 2014, David Jaramillo spoke about the so-called PIPS method using an Er:YAG laser.5 It displayed outstanding results regarding the clean- ing of root canals and dentinal tubules. This type of laser application, which uses an Erbium:YAG laser with an effective wavelength of 2,940 nm, is no longer based on a direct thermal effect. Instead, en- dodontic irrigants are activated by small gas bubbles that form at the tip of the laser due to heat. As they move away from the tip, they cool down and col- lapse quickly. In this way, up to 50 bubbles per sec- ond are formed in quick sequence, forming a chain of bubbles that streams through the irrigant, press- ing it into the branches of the root canal system and the dentinal tubules. Up until now, this had not been possible in an adequate manner, irrespective of whether activation was initiated with the help of sound, ultrasound or the SAF system. The micro-explosions are the key element of this new treatment method. Micro-explosions occur when the laser energy is absorbed by water and the Fig. 2: Clinical workflow of LAI within the scope of endodontic procedures. Fig. 3: The P400FL tip primarily is used for cleaning the endodontic access cavity as well as the upper and middle sections of the canal. Fig. 4: The R300 T tip can also be used deeper in the root canal and is helpful when cleaning the middle and apical sections of the canal. 42 roots 3 2017