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ePaper created 2018-03-06, 08:52:14 | version 1.38.0
| industry report Fig. 6 Fig. 7 Fig. 6: Accessory anatomy evident in the apical that has been filled with sealer accessible due to use of the LiteTouch Er:YAG laser. (© Dr David Guex, Lyon, France) Fig. 7: Accessory apical anatomy filled with sealer due to use of the LiteTouch™ Er:YAG laser. (© Prof. Georgi Tomov, Plovdiv, Bulgaria) debris and pulpal tissue to yield a cleaner chamber aiding it identification of the canal orifices (soft tis- sue mode). Once the canal orifices are identified, hand files are utilised to establish a glide path to the apical working length in each canal. Canals are then enlarged to the desired ISO canal size with either hand or rotary files (Fig. 5a). Laser-assisted canal irrigation requires ca- nal preparation to an apical preparation ISO 25/30 at a minimum. A canal taper of .04 or .06 for the final in- strumentation is recommended. Sodium hypochlorite (NaOCl) is utilised within the chamber and canals during instrumentation both as a pulpal tissue dissolvent and to lubricate the files within the canal, decreasing the potential of file separation that can occur when instru- menting a dry canal (Fig. 5b). Photo-activation of the irrigant within the canal sys- tem is performed using the Er:YAG laser with a 0.4/17 or 0.6/17 mm tip which assists in removal of the debris created by the files. Between each rotary file, the cham- ber is filled with NaOCl and the tip of the laser is placed into the chamber and the solution activated with the laser at 40 mJ at 10 Hz with an average power of only 0.5 W for 20 seconds (Fig. 5c). The chamber is suc- tioned and fresh NaOCl is placed into the tooth and the next file is used for instrumentation. It is unnecessary to place the lasers tip into the canals themselves, as activation of the solution within the chamber transmits down the irrigant into the canals to the apical aspect of the roots. Laser activation may also be performed with 26 roots 1 2018 17 % EDTA solution alternated with NaOCl. The benefit of EDTA solution is its chelation effect opening canal anatomy so that the next round of NaOCl can reach more pulpal tissue not accessible to the files in fins, as well as accessory and lateral canals. Following final instrumentation of the canals with rotary files, the chamber is filled with NaOCl and the Er:YAG tip is placed into the chamber again and ac- tivated for a minimum of 60 seconds. This allows the photo-activated irrigant to clear debris and remaining pulpal tissue from the complete canal system. The irri- gation solution is suctioned from the chamber and fresh irrigant placed and photo-activation repeated until no visible debris (cloudiness) is noted in the chamber fluid. This indicated that all accessible debris has been re- moved from the canal system. Any remaining solution is suctioned from the tooth and the canals are dried with paper points. Obturation is then accomplished using the practitioners preferred method and materials allow- ing obturation of anatomy inaccessible by instrumenta- tion with files (Figs. 6 & 7). Conclusion The key to endodontic success is two pronged, clean- ing the system and sealing it. Although, rotary files have improved the efficiency of instrumentation they are un- able to reach any more of the anatomy that handfiles are able to reach. Cleaning of the canal system is keyed to irrigation of the canal system to improve debris re- moval in anatomy that the files are unable to contact. When anatomy is not fully cleaned, sealer is unable to fill this leaving bacteria to inhabit those areas which may lead to endodontic failure over time. Laser enhanced activation of endodontic irrigants cleans more anatomy adjacent to the main canals so that a more complete obturation of the canal system can occur. An added benefit is that the laser has an antibacterial effect, kill- ing bacteria within the canal anatomy as well as distant to where the irrigation solution may reach essentially sterilising the entire tooth to the periodontal ligament. Editorial note: A list of references is available from the publisher. contact Dr Gregori M. Kurtzman Implant Cosmetic Dental Center 3801 International Drive 102 Silver Spring, MD 20906, USA Tel.: +1 301 5983500 dr_kurtzman@maryland-implants.com www.maryland-implants.com