Laser Use In Endodontics

9/2011 By: Il Dentist Amoderno

"The complexity of the root canal system is well known. Numerous lateral canals of various dimensions and with multiple morphologies branch off from the principal canals."

"The goal of endodontic treatment is to obtain an effective cleaning and decontamination of the smear layer, including bacteria and all its products, in the rootcanal system. According to Moritz1 there are three main factors that hinder the achievement of a sterile environment: the anatomical root confi guration; the particular quality of the bacterial colonization; bacteria resistant to the oral solutions used."

Download here the complete article: Il Dentist Amoderno, 9/2011 (.pdf)

Disinfection of Root Canals with Photon-initiated Photoacoustic Streaming

7/2011 By: Journal of Endodontics, JOE

"Introduction: This study set out to compare the efficacy of laser-activated and ultrasonically activated root canal disinfection with conventional irrigation, specifically its ability to remove bacterial film formed on root canal walls."

"Methods: Seventy human premolars were shaped to an apical size #20, taper .07, sterilized, and contaminated in situ with oral bacteria for 1 week and incubated for 2 more weeks. Irrigation was done with 6% NaOCl (group 1), NaOCl ultrasonically activated with blunt inserts (group 2), or a pulsed erbium: YAG laser at nona-blative settings (group 3) for a total of 60 seconds each. Positive and negative controls were also included. Aerobic bacterial sampling was performed, and the inci-dence of positive samples after 24 and 48 hours as well as bacterial counts (colony-forming units) were deter-mined. Fixed and demineralized sections 1 mm and 4 mm off the apex were Brown-Brenn stained and assessed for remaining intracanal bacteria/biofilm and dentinal tubule penetration."

Download here the complete article: Journal of Endodontics, JOE 7/2011 (.pdf)

Laser in endodontics(Part II)

2/2011 By: Roots International Magazine of Endodontology

"After explaining the basic physics of the laser and its effects on both bacteria and dentinal surfaces, the second part of this article series will analyse some of the most important research in the international literature today and the new guidelines for the use of laser as a source of activation of chemical irrigants."

"The preparation of the access cavity can be performed directly with Erbium lasers, which can ablate enamel and dentine. In this case, the use of a short tip is recommended (from 4 to 6mm), with diameters between 600 and 800µm, made of quartz to allow the use of higher energy and power. The importance of this technique should not be underestimated. Owing to its affinity to tissues richest in water (pulp and carious tissue), the laser allows for a minimally invasive access (because it is selective) into the pulp chamber and, at the same time, allows for the decontamination and removal of bacterial debris and pulp tissue. Access to the canal orifices can be accomplished effectively after the number of bacteria has been minimised, thereby avoiding the transposition of bacteria, toxins and debris in the apical direction during the procedure. Chen et al. demonstrated that bacteria are killed during cavity preparation up to a depth of 300 to 400 µm below the radiated surface.20 Moreover, Erbium lasers are useful in the removal of pulp stones and in the search for calcified canals."

Download here the complete article: Roots International Magazine of Endodontology 2/2011 (.pdf)

Laser in endodontics(Part I)

1/2011 By: Roots International Magazine of Endodontology

"The main goals of endodontic treatment are the effective cleaning of the root-canal system. Traditional endodontic techniques use mechanical instruments, as well as ultrasound and chemical irrigation to shape, clean and completely decontaminate the endodontic system."

"The complexity of the root-canal system is well known. Numerous lateral canals, of various dimensions and with multiple morphologies, branch off from the principal canals. A recent study found complex anatomical structures in 75% of the teeth analysed. The study also found residual infected pulp after the completion of chemo-mechanical preparation, both in the lateral canals and in the apical structures of vital and necrotic teeth associated with peri-radicular inflammation.1"

Download here the complete article: Roots International Magazine of Endodontology 1/2011 (.pdf)

PIPS technology an effective new tool

2/2011 By: Allegato n.1 di Dental Tribune Italian Edition

At the National Congress of the Sie-November, the technique PIPS (new endodontic technique that, with the Er: YAG laser completion of manual or conventional mechanical systems, can effectively cleanse, detoxify and remove the biofilm of the channel) was received with great interest, as a true innovation presented in many subsequent reports. We talk to the two parties directly concerned, the professors John Olivi and Enrico DiVito.

From the article:

LT: "Did you expect, or the result of the report and the article published in November on Endo Tribune went above expectations?"

Dr DiVito: "We knew that the technique PIPS was something different, unique and revolutionary technique for Endodontics, and would create so much turmoil. What we did not know was that it was accepted so quickly."

Dr Olivi: "We were pleasantly surprised by the interest that many colleagues have shown Sie. Knowing the quality of endodontics Italian (but also the distrust of the laser), the success has given more weight to the scientific work of our group made in many years."

Download here the complete article: Dental Tribune Italian Edition (.pdf)

The Photoacoustic Efficacy of an Er:YAG Laser

Authors: Enrico DiVito, DDS; Mark P. Colonna, DDS; Giovanni Olivi, M.D.,D.D.S.

The aim of this in vitro study was to investigate, by scanning electron microscopy (SEM) analysis, the debriding ability of an Er:YAG laser system equipped with a new tapered and stripped tip of 400-micron diameter and auxiliary irrigating solutions after mechanical preparation. Fifty extracted human teeth were endodontically prepared with both hand and rotary instrumentation and conventional chemical irrigation (5.25% sodium hypochlorite). Following mechanical instrumentation with irrigation, different flushing protocols were used. Group A: 20 seconds Er:YAG laser irradiation in saline solution, wet canal; Group B: 20 seconds Er:YAG laser irradiation in 17% EDTA, wet canal; Group C: 40 seconds Er:YAG laser irradiation in 17% EDTA, wet canal. Laser settings were the same for all the groups: 20 mJ, 10 Hz, 0.2 W, 50-microsecond pulse duration, and water spray off; the tip was placed stationary superior to the coronal opening of the canal. Group D: 60 seconds of saline solution irrigation without laser activation was used as control group. SEM evaluation at the apical third showed that standardized instrumentation, followed by a final Er:YAG laser irradiation in EDTA-wetted canals, resulted in more debriding and cleaning of root canal surfaces in comparison with Er:YAG laser irradiation in saline solution or saline solution alone.

Download here the complete article: Divito Colonna Olivi from JLD 19(1) 2011 -5 (.pdf)

Lasers in Medical Science

Authors: Enrico DiVito, DDS;Ove A. Peters, DMD MS PhD;Giovanni Olivi, M.D.,D.D.S.

The aim of this study was to analyze, in vitro, the debriding ability of an Erbium:YAG (Er) laser system (2,940 nm) equipped with a newly designed radial and stripped tip of 400 micron diameter, using scanning electron microscopy (SEM) analysis. Eighty single-rooted extracted human teeth were endodontically prepared with rotary instrumentation and standardized chemical irrigation, using 5.25% sodium hypochlorite (NaOCl).

Download here the complete article: Lasers in Medical Science Manuscript Draft (.pdf)

Photo-acoustic endodontics using PIPS

Authors: G. Olivi, R. Crippa, E. DiVito,G. Iaria, V. Kaitsas

The goal of endodontic treatment is to obtain an effective cleaning and decontamination of the smear layer, including bacteria and all its products, in the root canal system. Clinically, traditional endodontic techniques use mechanical instruments as well as ultrasound and chemical irrigation in an attempt to shape, clean and completely decontaminate the endodontic system.

The effectiveness of debriding, cleaning and decontaminating of all the intra-radicular space is, however, limited given the anatomical complexity and the inability of common irrigants to penetrate into the lateral canals and the apical ramifications

Download here the complete article: Photo-acoustic endodontics using PIPS (.pdf)

Laser in Endodontics: a review and outlook

Allegato n.1 di Dental Tribune Italian Edition

The technology is laser-duced with the aim of improving the results obtained with traditional procedures, through the use of light, with different modes of action aims to:

- improve the decontamination of endodontic system

- increasing the ability of cleaning and removing debris and smear layer from root canals.

Download here the complete article: Endo Tribune Italian Edition (.pdf)

Inventors tout new endo laser tip

8/21/2009 By: Laird Harrison, Senior Editor

A new laser technique can clean root canals better than conventional instruments and more safely than other laser techniques, the inventors claimed at the recent World Congress of Minimally Invasive Dentistry (WCMID) in San Francisco.

A new tip they have developed for Lares Research's PowerLase sends acoustic waves into tiny, curved and otherwise inaccessible canals, said Enrico DiVito, D.D.S., and Mark Colonna, D.D.S. Using lasers can reduce the patient's discomfort and save tooth structure, so patients love them, they said.

"This is really where the future of dentistry is."— Enrico DiVito, D.D.S., director, Arizona Center for Laser Dentistry; "It's unbelievable stuff," said Dr. Colonna, a Whitefish, MT, general dentist. "This has changed our lives."

But Louis Rossman, D.M.D., immediate past president of the American Association of Endodontists, noted that "the research has not shown lasers to be over and above what we're doing today."

Drs. DiVito and Colonna reported successfully using their protocol -- photon-induced photoacoustic streaming (PIPS) -- in place of filing in some canals. In other canals, they used standard techniques, but by adding PIPS were able to limit their use of files to ISO size 20, which is what they recommended to the WCMID audience.

They also recommended that dentists wanting to use the system should invest in a microscope, and they demonstrated the technique using microscopes from Global Surgical.

The two used images made with scanning electron microscopy (SEM) to show that they were able to completely debride and decontaminate difficult-to-reach canals. And Dr. DiVito, director of the Arizona Center for Laser Dentistry, is doing histological and other studies that he hopes will show PIPS can also kill microorganisms.

PIPS vs. the Waterlase

Research on a competing laser system for endodontics, the Waterlase from Biolase Technology, has yielded mixed results. One study showed it could kill 99.7% of Enterococcus faecalis in extracted teeth lased in a laboratory (Journal of the American Dental Association, July 2007, Vol. 138:7, pp. 992-1002). And Biolase claims the laser can kill bacteria hidden 1,000 microns into root canal walls, where irrigation cannot reach them.

But other studies have found it no more successful at debriding (JADA, September 2006, Vol. 137:9, pp. 1261-1266) or disinfecting (JADA, January 2006, Vol. 137:1 pp. 67-70) than conventional methods.

Drs. DiVito and Colonna claim they've gotten around a potential problem with lasers in endodontics: the heat of the laser damaging dentin. Instead of ablating debris and burning microbes, PIPS works by creating waves inside fluid in the canals. They hope this technique will kill microorganisms.

Dr. Colonna compared it to the shockwaves of a depth charge destroying a submarine. "The concussion is rupturing the wall of the submarine and then it sinks," he said. In addition, acoustic waves move irrigant disinfectants into places they would not otherwise reach, according to the inventors.

The notion of creating acoustic waves in root canals isn't new. Biolase claims that the Waterlase debrides canals through hydrophotonics, a "powerful microagitation" created when water vapor is formed, creating bubbles that scrub the canals.

But to disinfect canals with Waterlase, the canals must be dry. In the JADA study that found the Waterlase could kill E. faecalis, researchers from Temple University and Biolase found that the laser killed the most bacteria when they dried all the fluid in the root canals. The laser was actually cooking the bacteria, not agitating them to death, they theorized.

The PIPS inventors said they are able to achieve more powerful shock waves with less energy by stripping the sheath from the shaft of the wand near the tip and using shorter pulse duration -- 50 microseconds (μs) versus 150 μs to 300 μs.

Techniques for the two systems differ as well. In the Waterlase method, after filing canals, operators introduce a series of different tips into the canal, starting at 1 mm from the apex, and gradually withdraw while firing. They make multiple passes with each tip.

Using the PIPS protocol, operators file up to ISO size 20, then use one tip that they insert only into the pulp chamber. This protocol eliminates any thermal effects at the apex, according to Dr. DiVito.

The two laser types also differ. The Waterlase is an erbium- and chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG), while the PIPS is used with a PowerLase erbium-doped yttrium aluminum garnet (Er:YAG).

Dr. Rossman, who is also a clinical professor at the University of Pennsylvania, questioned the use of any laser in endodontics. "It's a wonderful advertisement to patients, but it doesn't accomplish anything more than we are able to do with our standard instruments. Conventional hand instruments and the irrigation we use are enough to render the root canal sterile," he said. In addition, conventional root canal treatment is now relatively painless, he noted.

More research is on the way, according to Dr. DiVito. If successful, this approach would allow a more minimally invasive yet successfully efficient means of performing endodontics, he added.