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ePaper created 2018-03-06, 08:52:14 | version 1.38.0
| industry report Laser-enhanced endodontic treatment Dr Gregori M. Kurtzman, USA Endodontic success is predicated on the ability to de- bride and clean the canal system. That canal system is a complex array of accessory and lateral canals, fins and other anatomical areas inaccessible to endodontic files (Fig. 1). As practitioners, we are able to clean the main canals with files, either hand or rotary. But they cannot mechanically remove pulpal tissue and debris from the canal anatomy present adjacent to the main canals. Treatment success requires elimination of the pulpal tissue and associated bacteria from this anatomy, so that it can be sealed during the obturation phase of treatment. As only one thing can occupy a space at a time, obtura- tion material cannot fill areas still occupied by pulpal tis- Fig. 1: Anatomy of the canal system demonstrating accessory canals, fins and lateral canals which are not accessible with endodontic files as shown in cleared teeth. 24 roots 1 2018 sue. Success is dependent on disinfection and debride- ment of the canal system so that it may be sealed during obturation. Irrigation has long been accepted as a key factor of treatment to achieve those goals. Yet, complete clearing of residual bacteria especially in the apical portion of the canal system has been diffi- cult to achieve with traditional methods using even so- dium hypochlorite (NaOCl) solutions (Fig. 2). Studies have demonstrated that the additional use of an Er:YAG laser to activate the irrigation solution greatly enhances not only the efficiency of the irrigation solutions advo- cated (NaOCl and EDTA) but also improves disinfection of the canal system, clearing accessory so that it may be sealed during obturation (Figs. 3 & 4). Irrigation the key to endodontic success Although, instrumentation with files is important to en- larging the canals and ready them to be obturated, debris consisting of pulpal tissue and associated bacteria is not effectively removed by files. Irrigation with an appropriate solution is required to remove that debris from the canal walls. NaOCl is still the accepted irrigant due to its tissue dissolving ability and antibacterial nature. Yet, it cannot effectively reach far beyond the main canals to remove the residual tissue. Tissue dissolution can be enhanced to more effectively remove pulpal tissue/bacteria and also reach further into the accessory anatomy to allow better sealing of the canal system improving treatment success. Smear layer within the canal system plays a factor in success in endodontic treatment. The smear layer con- tains bacteria which when left within the canal anatomy may lead to reoccurrence of infection endodontically. When compared to traditional irrigation methods, laser enhanced irrigation has demonstrated better intracanal smear layer removal.1 As Enterococcus faecalis has been routinely linked to endodontic failures, and is a common occupant of the oral cavity, elimination of this bacteria is critical to prevention of reinfection of the canal system. NaOCl as an irrigant has not shown to be effective in elimination of E. faecalis, yet when combined with laser enhanced irrigation with NaOCl this bacteria has been eliminated in the canal anatomy.2