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ePaper created 2017-10-26, 15:28:59 | version 1.38.0
| industry (Figs. 5 & 6). Any denticles will be detached from the soft tissue surrounding them and rinsed out, any soft- and hard-tissue will be removed from occult canal entrances, making them visible and penetrable. 2. Opening root canals, obtaining patency Using Morita’s AdvErL Evo will prove its worth particularly in very narrow canals, which involve a high risk of iatrogenic blockage. Morita’s AdvErL Evo will rinse out the canals. Whereas the P400FL tip (25 pps, 50 mJ) is used before the initial opening, the R300T tip (25 pps, 50 mJ) is used for 20 seconds re- spectively after the coronal preparation of root ca- nals. In this way, it will be significantly easier and foreseeable to open up root canals completely with thin manual instruments or mechanical glide-path instruments up to the foramen apicale within the meaning of the ‘patency’ concept. If the irrigation solution exhibits slightly red colouring, this indi- cates that there may be a patency. If there is stronger bleeding, even if it stops on its own just a short time after the laser instrument is used, the energy param- eter should be reduced from 50 to 30 mJ. In the same way, periapical sensations of pain, which may occur sporadically to a minor degree, can be considered a sign that patency has been achieved and the energy parameter should be reduced to 30 mJ. 3. Removal of blockages If there are any blockages, as can frequently be the case in revisions of the root canal filling, the P400FL and R300T tips are used at 25 pps and 70 mJ and, if necessary, with several irrigation cycles of 20 sec- onds respectively. 4. Cleaning the root canals, removing the smear layer Following the initial opening of the root canals and the use of mechanical nickel-titanium instru- ments to complete the root canal preparation, if necessary also intermittently during the prepara- tion, Morita’s AdvErL Evo laser is used to remove the smear layer analogous to conventional irrigation of the root canals with irrigation solutions, ultrasound or sound-activated irrigation. Figs. 5 & 6: The endodontic access cavity can be cleaned efficiently with Morita’s AdvErL Evo. Fig. 5 Fig. 6 22 laser 3 2017 Then the R300T tip with 25 pps and 50 mJ is used. The cloudiness of the irrigation solution after acti- vation and the removal by rinsing of suspended particles clearly demonstrates the efficiency of the measures taken. This is particularly impressive if the conventional irrigating methods mentioned above were applied for the recommended duration in the root canal and, nonetheless, the laser still removes a smear layer from the root canal when it is applied afterwards. The cloudiness of the irrigation solution is a good indication for determining the duration of irrigation, which can be ended when the irrigation solution that is transported out of the root canal seems to be clear. As a rule, this should be the case after about 15–20 seconds. In the event of bacterial infections, 3 % NaOCI is used for the LAI; in the case of vital extirpation, 17 % EDTA should be used. 5. Removing calcium hydroxide, removing any foreign bodies As helpful as calcium hydroxide may be when it is used as an agent for disinfecting bacterially infected root canals, it is also difficult to completely remove this pasty material from root canals. Within the scope of endodontic treatments, I insert calcium hydroxide in the root canals as a medicinal filling after the me- chanical preparation has been completed but before the root canal filling is inserted. It remains there for several days; in the case of large apical bright spots, it may stay 12 to 16 weeks so that we can verify by means of X-rays that reossification, a visible sign of healing, has started before we fill the root canal. Before filling the root canal (Figs. 7–9), the calcium hydroxide has to be removed from the root canals. To this end, the mechanical apical master file is used to proceed up to 1 mm before reaching the working length to be able to remove as much of the pasty cal- cium hydroxide as possible by using the instru- ment’s spiral-shaped teeth like a screw conveyor. This is followed by a sound-activated irrigation using an EDDY attachment (VDW). Each root canal is rinsed for one minute with EDTA irrigation solution and sound activation. Afterwards, an XP-endo shaper instrument (FKG Dentaire) is used up to 1 mm before reaching the working length; however, the instrument is used less for preparation than for cleaning the walls of the canals mechanically. It seems reasonable to expect that there would be no more calcium hydroxide after such a time- and ma- terial-intensive manner of proceeding. So, it is highly impressive when Morita’s AdvErL Evo laser trans- ports a surprisingly large quantity of remaining calcium hydroxide out of the root canals. It is equally impressive to see that irrigating with Morita’s AdvErL