Endo Tribune Middle East & Africa Edition No. 1, 2021

Endo Tribune Middle East & Africa Edition No. 1, 2021

Innovative endodontics using SWEEPS technology: Tips and tricks

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Innovative endodontics using SWEEPS technology: Tips and tricks
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www.dental-tribune.me

Published in Dubai

January-February 2021 | No. 1, Vol. 11

Innovative endodontics
using SWEEPS technology: Tips and tricks
By Drs Giovanni Olivi, Linhlan Nguyen, Matteo Olivi & Jason Pang, Italy
& Australia
Conventional endodontic treatment
is based on different phases, resulting in the elimination of acute or
chronic inflammation of the pulp
and periapical area (Table 1).1–3
The different phases of the therapy
are:
•
initial cleansing of the endodontic space,
•
shaping the root canals to a
size sufficient for delivery of irrigants,
•
final cleansing and 3D disinfection of the endodontic space,
and
•
3D sealing of the endodontic
space and restoration of the
post-endodontic space and the
crown to conclude the therapy.
The cleansing and shaping phases
include two different types of cleansing: a chemical cleansing, carried

out by different irrigating solutions,
and a mechanical cleansing, carried out by endodontic instruments
that shape the root canals. However,
many studies have demonstrated
the incomplete action of the tested
instrumentation, which left 35% or
more of the canal surface area unchanged.4–6 Accordingly, it is the efficient irrigation of the endodontic
space that determines the success
of the therapy. During the shaping
phase, hand irrigation is performed
using a syringe with an end- or side-

vented needle, alternating with instrumentation using files of different
sizes. Besides reducing the bacterial
load, irrigants act as a lubricant during filing prior to the final activated
irrigation protocol. The purpose of
this article is to present an innovative rationale for endodontic therapy using the newest cutting-edge laser technology SWEEPS (shock wave
enhanced emission photoacoustic
streaming).

Not previously treated

Previously treated

Asymptomatic irreversible pulpitis
Symptomatic irreversible pulpitis
Asymptomatic apical periodontitis

Asymptomatic apical periodontitis

Symptomatic apical periodontitis

Table 1: Diagnostic classification of endodontic pathology.1–3

Irrigating solutions
in endodontics
In endodontics, different irrigating
solutions are used to kill microorganisms, dissolve the organic components (pulp remnants and collagen), and chelate and remove the
inorganic components (calcification
and debris).7 The smear layer is composed of both organic and inorganic
components. However, there is no irrigating solution that has all the ideal
characteristics.7 An effective irrigation approach is based on a specific
alternating sequence of use of different irrigating solutions, before, during and at the end of the therapy. After creation of an access cavity, root
canal therapy is started by cleaning
the pulp chamber and canals using
an irrigant with antibacterial and
pulp-dissolving action.
Sodium hypochlorite
Sodium hypochlorite (NaOCl, 1–6%)
is the main irrigant used in endodontics owing to its high bactericidal

activity and pulp tissue dissolution
action.7 Higher NaOCl concentrations achieve faster bacterial load
reduction; however, the more concentrated the solution of NaOCl, the
thicker it is, resulting in reduced wetting ability. NaOCl is still recognised
today as the gold standard solution
in endodontics because of its use
from the initial to final phases of
the therapy.7 NaOCl has significant
biological toxicity risk for periapical
tissue when pushed under pressure
through the root canal orifice.8 The
outcome is significantly worse for
higher concentrations.
EDTA
Irrigation with chelating solutions
such as ethylenediaminetetraacetic
acid (EDTA, 15–17%) is often utilised
during root canal therapy. When alternated with NaOCl, such as in cases
of calcified canals and at the end of

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Dental Tribune Middle East & Africa Edition | 1/2021

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Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 1: Tooth #12—the radiograph showed a large periapical lesion. The asymptomatic tooth was prepared with an ISO 25/.06 TF Adaptive file (Kerr Dental).
Fig. 2: Tooth #12—root canal filling was performed with mineral trioxide aggregate (ENDOSEAL MTA, Maruchi). Note the sealing of the apical ramification, possible because of the
effective cleansing and decontamination of the apical terminus. There was almost complete healing after 12 months.
Fig. 3: Tooth #33— the patient showed a buccal sinus tract that radiographically corresponded to the area between tooth #32 and tooth #33. The CBCT and radiograph showed a
large periradicular lesion, especially on the distal side. Preparation was performed with a 20/.07v ProTaper Gold (F1; Dentsply Sirona).
Fig. 4: Tooth #33—root canal obturation was performed with a sealer and carrier-based gutta-percha (AH Plus and Thermafil, Dentsply Sirona). The radiographic control six months
post-op showed that several lateral canals had been filled and the healing process was in progress.

at 50°C, which left a higher quantity
of debris and the smear layer widely
distributed.14 Other studies have
reported that NaOCl at a concentration of 1 % heated to 60°C was significantly more effective than 5.25% at
20°C. The advantage of using lower
concentrations of NaOCl, heated to
higher temperatures, could be related to a twofold effect: the same
effectiveness and less systemic toxicity than that of non-heated, highconcentration NaOCl.15

Agitation techniques

Fig. 5: Proper isolation for SWEEPS is important. A liquid dam was interlocked beneath
the dam clamp. Traditional access cavity preparation of the maxillary first molar was
performed using a cylindrical or round diamond bur under magnification (4.5–6.0 x).

the treatment, EDTA cleans the canal
walls of debris and the smear layer
produced during instrumentation,
just before the final decontamination. EDTA is slightly irritating but
not toxic to periapical tissue.
Chlorhexidine
Chlorhexidine (2%) has good antibacterial properties, but it is not
able to dissolve pulp tissue. This suggests its use only in an additional
final decontamination step because
of its unique substantivity property, which could allow persistent
residual antimicrobial action. It is
important to prevent interaction
between NaOCl and chlorhexidine,
by rinsing the canals with distilled
water in between solutions to avoid
the formation of precipitates that
may discolour the tooth and that
may contain potentially mutagenic
compounds.9,10 Its inability to dissolve organic tissue also explains
the absence of toxicity to periapical
tissue.11,12
Other solutions
Other chemical solutions have been
investigated and used in endodontics. Among these, hydrogen peroxide, iodine, citric acid, ozone (gas)
and ozonated water are available,
but none of them have demonstrated superior properties and results
to the previously cited NaOCl and

Chemomechanical systems
XP-endo Finisher

EDTA solutions. EDTA plus Cetavlon and a mixture of doxycycline,
citric acid and a detergent are new
solutions that combine different
components, surface-active agents
and antibiotics which can be very effective and have broader action. The
experimental use of nanoparticles is
also very promising.

Irrigant activation techniques
The initial irrigation phase and the
irrigation during shaping are performed using a syringe with an
end- or side-vented needle that can
only negotiate the canal up to the
middle third. Therefore, it must be
considered that the efficacy of hand
irrigation is quite limited; thus, supplementary, active and dynamic irrigation (Table 2) is proposed at the
end of the treatment to ensure the
cleaning of the dentinal walls and
the deep decontamination of the endodontic system.13 Among the various activation methods, we can find
systems that heat the irrigating solutions or that activate the solutions by
agitation, with positive or negative
apical pressure.

However, the effect of agitation on
tissue dissolution was proved greater than that of temperature and with
continuous agitation resulted in the
fastest tissue dissolution.16 Comparing the efficacy of various agitation
systems, De Gregorio et al. found a
limited penetration of the irrigant
into lateral canals using an apical
negative pressure irrigation system,
whereas passive ultrasonic irrigation
demonstrated significantly more
penetration of irrigant into lateral
canals.17 Nevertheless, it could be
reasonable to combine the two techniques, using heated NaOCl and agitating it with the preferred method.

Laser-activated irrigation using
SWEEPS

Heating
Scanning electron microscope studies on intra-canal heating of NaOCl
at 180°C have proved this method
to be more effective for cleaning the
canal walls than extra-canal heating

The physical concepts behind laseractivated irrigation and SWEEPS
technology have already been explained in a previous issue of this
magazine (roots-international magazine of endodontics 4/2019).18 One of
the great advantages of SWEEPS over
all of the other activation techniques
is its profound effectiveness. Unlike
all the other techniques, SWEEPS action is not limited to the vicinity of
the tip, as is the case with ultrasonic
irrigation, but it is also effective at
distant regions of the root canal system.19,20 For this reason, SWEEPS only
requires positioning of the tip in the
access cavity to stream the irrigant
into all of the endodontic space at
the same time. This is different to
other techniques, which require needle or tip/ file or probe insertion up
to the apical third of each canal or
so for irrigation after the root canals
have been prepared. Thus, SWEEPS

Positive pressure systems

Negative pressure systems

Hand dynamic
Sonic
Multi-sonic

XP-endo Finisher

Ultrasonic
Laser-activated irrigation
(PIPS* and SWEEPS**)
* PIPS = photon-induced photoacoustic streaming. ** SWEEPS = shock wave enhanced emission photoacoustic streaming.
Table 2: Irrigant agitation techniques.

can be used from the initial phase
up to the final phase of the therapy,
permitting a progressive decrease
in the bacterial load before any le is
used. The efficacy and effectiveness
of SWEEPS rely on both chemical
activation of the endodontic solutions by agitation,21,22 improving
the ability of irrigants to kill bacteria
and to dissolve tissue, and mechanical flushing action to clean the root
canal wall.23,24
Researchers have found the SWEEPS
dual modality to be more effective
than the single-pulse modality SSP
(super-short pulse; PIPS, photoninduced photoacoustic tic streaming).25–28 Using the SWEEPS dual-pulse
modality, the sudden expansion of
the second bubble, generated by the
second laser pulse, exerts additional
pressure on the first bubble, leading to its violent collapse, during
which shock waves are emitted also
in very small canals. Furthermore,
shock waves are emitted from the
collapsing secondary cavitation bubbles that form naturally throughout
the entire length of the canal during
laser-activated irrigation.25–29 The
secondary cavitation bubbles are in
close proximity to the canal walls
during their collapse, generating
shear stress and vortical flows that
are able to remove debris, the smear
layer and biofilm from the root canal
surface, as well as from undetected
and uninstrumented anatomical areas, such as isthmuses, lateral canals,
loops and ramifications, thereby increasing the cleaning and decontamination mechanism even further
(Figs. 1–4). The enhanced pressure
generation along the root canal consequently also increases the depth of
penetration of irrigants into dentinal
tubules.25–28

Clinical protocols
Proper patient draping with a waterproof bib to protect clothing is highly recommended. Local anaesthesia
is performed in all cases (asymptomatic and symptomatic) to avoid
any unpleasant sensation of internal
pressure during the treatment. A
dental dam is then applied, and a liquid dam is interlocked beneath the
clamp to ensure complete isolation
(Fig. 5). In case of occlusal or proximal
decay or a defective filling, complete
removal of the carious tissue and
filling must be performed, followed
by composite reconstruction of the
entire tooth crown; this preliminary
step is mandatory to minimise leakage and reinfection. Furthermore,
good marginal sealing prevents any
irrigant extrusion during laser-activated irrigation.
Access cavity preparation
At this point, the access cavity is
opened using a small carbide, or
cylindrical or round diamond bur
under magnification (4.5–6.0x).

Traditional access cavity preparation, following the laws of centrality and concentricity, is advisable
(Fig. 5).30 Several studies have demonstrated the lack of usefulness of
ultra-conservative “ninja” access cavity preparation in terms of fracture
strength and preservation of the
original canal anatomy during shaping compared with traditional access
cavity preparation, particularly at
the apical level. Furthermore, standardised access cavity preparation is
advisable when the X-SWEEPS modality is chosen for laser-activated
irrigation. Future publications will
explain this topic in depth in order
to establish the correct laser settings
to be used with standardised access
cavity preparation volumes. Whatever the pathology is, the concept is
to minimise the root canal shaping,
optimising the cleansing and decontamination of the endodontic space
by exploiting the chemomechanical flushing of SWEEPS. The main
difference between asymptomatic
and symptomatic pulpitis and apical
periodontitis therapy is in the longer
or shorter initial NaOCl SWEEPS-activated irrigation phase. Retreatment
also involves a few differences in
the energy applied during the initial
phase when filling material has to be
removed.
Asymptomatic and symptomatic
irreversible pulpitis
In the case of irreversible pulpitis,
the pulp is irreversibly inflamed,
with or without acute symptoms.
The patient’s age and preoperative
radiograph give information on a
possible immature apex; this condition contra-indicates a full-power
SWEEPS irrigation and suggests a
more careful intervention and lowering of the energy used (more to
follow). Once the pulp chamber has
been opened, excessive bleeding
may be present, indicating the presence of inflamed pulp tissue inside
the chamber and root canals. In this
case, one-visit therapy is advisable.
The treatment starts with NaOCl irrigation by syringe (3–5 ml) and simultaneous activation by Er:YAG laser
(2,940 nm; LightWalker AT, Fotona),
using the dual-pulse (25 µs duration)
Auto-SWEEPS modality for 30–40
seconds. The resting time after irrigation can be extended to 1–2 minutes
to allow more NaOCl pulp dissolution. A at- or radial-ended SWEEPS
tip (400 μ) is used. The pulp tissue
may show different grades (levels) of
inflammation, up to initial necrotic
degeneration. It is important to consider at this stage whether the pulp
tissue itself is preventing any extrusion of the irrigant so that full-power
Auto-SWEEPS activation (20 mJ at
15 Hz and 0.6 W) can be performed
up to almost complete pulp dissolution, which is indicated by a progressive decrease in bleeding. According
to the tooth type and condition, this
initial phase can be repeated for two
to three cycles for single-rooted teeth
and up to three or four cycles for premolars and molars.
The initial irrigation phase also decreases the bacterial load. The access
cavity can now be observed under
magnification (6–10x) in order to
locate all canal orifices. If the orifices
are not all visible, the use of ultrasonic tips can easily discover orifices
hidden under calcification in the
pulp chamber. These are usually located at the angles, at the floor–wall
junction and at the terminus of the
root developmental fusion lines.
Then pre-flaring of the orifices and
enlarging of the coronal thirds of the
canals allow easy and direct access
to the canals. Subsequently, a direct
glide path to the apical third is established by hand or dedicated rotary

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◊Page A2
instruments, up to 3–4 mm from the
apex. This manual or rotary instrument step produces debris and dentine chips that must be removed by
AutoSWEEPS NaOCl irrigation, again
for 30–40 seconds, followed by 30
seconds of resting time. At this point,
use of a small stainless-steel hand le
(ISO 06 to 10) is recommended with
a cream containing urea peroxide
or EDTA to lubricate and avoid tissue plugging when sliding the le to
the anatomical opening to scout the
canal and determine the anatomical
length (Fig. 6). It must be emphasised
that by now most of the pulp tissue
will have already been dissolved by
NaOCl and the possibility of dislodging pulp remnants or debris inside
unreachable anatomical areas is very
difficult if the previous phases have
been correctly followed. Also, the
bacterial load is highly decreased so
that apical transportation of bacteria
is minimal or absent. Use of an electronic apex locator and radiographic
confirmation provide verification of
the anatomical length of the tooth.
Different approaches to the apical
constriction can be used: working
to the anatomical length or 1 mm
shorter, in order to prevent possible
over-instrumentation of the apex
with enlarging of the apical opening.
This is one reason for possible extrusion at the end of treatment (Fig. 7).
At this point, the canals can be minimally prepared. Because SWEEPS
technology does not require the tip
to be placed in the canal, it is not necessary to prepare the canals to a large
size. This results in a more conservative and biomimetic result: 20/.06
and 25/.06 are sufficient to warrant
a hermetic apical obturation. These
two or three mechanical preparation
steps are always alternated with Auto-SWEEPS NaOCl irrigation and recapitulation with the smaller first instrument (ISO 06 or 08) used at the
apical anatomical constriction to ensure apical patency and remove any
possible dentinal plugs produced
during instrumentation (Fig. 8).
Asymptomatic and symptomatic
apical periodontitis
Chronic pathology can last for years
without symptoms and without
temperature hypersensitivity, and
diagnosis can be done occasionally
during check-ups with radiographic
control. It ranges from minimal lamina dura dilatation to larger periapical
radiolucent lesions. If symptomatic,
the tooth presents with a painful
dull ache, intermittent pain, gingivae
that can be sore to the touch, up to
excruciating pain in cases of are-ups,
possible buccal swelling and a possible visible buccal sinus tract, and the
tooth is tender to percussion. More
frequently, such a tooth has undergone previous dental treatments,
such as a full-crown or deep restoration with or without recurrent caries,
and may have untreated deep decay
(cavity) extending to the pulp chamber. In this case, carious removal and
cavity filling reconstruction are preliminarily performed as previously
mentioned.
When creating the access cavity, the
chamber and the canals are usually
empty, with no pulp tissue. Sometimes, especially in molars, the pulp
condition can differ from one canal
to another. Some may present with
minimal bleeding. In case of swelling and a periapical abscess, pus may
ow out of the tooth from the opening into the canal orices. Treatment
starts with two to three cycles of
saline irrigation (3–5 ml by syringe)
and simultaneous activation by
Er:YAG laser (2,940 nm; LightWalker
AT), using the dual-pulse (25 µs duration) Auto-SWEEPS modality for
30–40 seconds, at 20 mJ and 15 Hz.
This preliminary irrigation with saline, besides its initial cleansing and

Fig. 6: After the cavity access has been prepared, laser-activated irrigation of NaOCl using
SWEEPS is performed in the access cavity. Then lubricant gel containing urea peroxide is
placed on the le (or in the cavity) to lubricate and avoid tissue plugging when sliding the
le to the apical constriction. (Courtesy of Dr Giovanni Olivi)

antibacterial action,33 helps to test
the patency of the apical constriction
to the pressure applied. Frequently,
chronic periapical inflammation can
lead to an enlargement of the apical
constriction so that irrigant extrusion can occur, especially in cases of
apical contraction larger than ISO
40–50. Then NaOCl irrigation is activated by Auto-SWEEPS, using a low
energy, 10 mJ, at 15 Hz for 30 seconds
to start the decontamination and
lubrication of the canals prior to using the ISO 10 hand le to explore the
canal and verify patency and anatomical length. Once apical patency
and working length are established,
new NaOCl irrigation activated by
Auto-SWEEPS is performed. The possibility of decreasing the energy output from 20 mJ to 15 or 10 mJ allows
reduction of the streaming pressure
to the apex. However, the dual-pulse
Auto-SWEEPS modality promoted an
almost constant flow rate for different pulse energies of between 10 mJ
and 20 mJ, compared with the singlepulse modality SSP, indicating superior safety of Auto-SWEEPS regardless
of the pulse energy.29
Furthermore, the pressure efficacy is
higher for a smaller fibre tip diameter
(400 vs 600 µ), and radial-ended fibre
tips are slightly less effective for generating pressure in comparison with
cylindrical tips.28 To simplify, in case
of a larger apical size, it is suggested to
use the Auto-SWEEPS modality with a
larger size tip (600 µ), preferably with
the radial-ended tip (X-Pulse). This
management of energy and tip choice
allow beginner users to work carefully
in case of altered apical anatomies.
When the apical opening is more
than ISO 40–50, a simple operation
that permits control of any unwanted
irrigant extrusion is the use of a particularly smooth needle le of different
calibres (from ISO 40 to ISO 100). The
apical end closes the apical opening of
the canal while laterally all the irrigant
flows throughout the canal.

Fig. 7: In order to prevent possible over-instrumentation of the apex with enlarging of
the apical opening, the authors suggest working to 1 mm shorter than the anatomical
length.

Final irrigation protocol
At the end of the preparation and
before the final irrigation protocol,
the root canal system has already
been cleansed and disinfected by
the SWEEPS protocol used from the
beginning of the therapy. Further
research is required to confirm the
reported efficacy and effectiveness
of SWEEPS’s cleansing ability and
pressure generation regarding decontamination. Several researchers
have reported the superior decontamination results of the SSP modality using PIPS.34–36 Therefore, this

ÿPage A4

Fig. 8: Recapitulation with the smaller first instrument (ISO 06 or 08) is performed to the
apical anatomical constriction (working length + 1 mm) to ensure apical patency and remove any possible dentinal plugs produced during instrumentation. The last millimetre
is just cleansed and disinfected by SWEEPS. (Courtesy of Dr Giovanni Olivi)

Fig. 9

Fig. 11

Fig. 10

Fig. 12

Fig. 13

Calcified canals
Sometimes canal restrictions and
calcifications, due to tertiary dentine
formation, may be found, hindering
the negotiation of the canal (Figs. 9
& 10). In case of a multirooted tooth,
another canal may be accessible and
the usual protocol can be applied up
to completion of root canal filling
(Figs. 11–13). In a separate session, the
calcified canal is irrigated by EDTA
solution, activated and forced by fullpower Auto-SWEEPS, at 40 mJ and
15 Hz (Figs. 14 & 15). The single-pulse
USP mode (25 µs) can also be more effective for pressure generation. Note
that, if the canal is obstructed by
calcification while the other canals
have already been prepared with
files, this procedure at higher energy
is very safe. EDTA in this case is used
to chelate and soften the dentine, but
sometimes the use of a thin, rigid ultrasonic tip is necessary to remove
the calcification in the coronal third.
Stainless-steel hand files with EDTA
gel can be used to help bypass the
blockage in the middle and apical
thirds.

Fig. 14

Fig. 15

Fig. 9: The symptomatic maxillary second premolar showed a periapical lesion on radiographic examination. The preparation of the
buccal and palatal canals was performed with a 25/.08v ProTaper Gold (F2) to 4 mm short of the radiographic apex. A size 10 hand
instrument was used up to 2 mm short of the apex. Fig. 10: The calcified canals hindered the negotiation of the apical constriction.
Full-power Auto-SWEEPS (40 mJ, 15 Hz) activation of 15 % EDTA solution was able to force through the blockage to cleanse and disinfect the last 2 mm of the confluent curved canals. Obturation was performed with Thermal and AH Plus sealer. Fig. 11: A symptomatic
maxillary first molar with large mesioocclusal decay and a large periapical lesion. Fig. 12: Root canal preparation was performed with
a 25/.06 ProTaper Next X2 (Dentsply Sirona) in the buccal canals and 40/.06 X4 in the palatal canal, which demonstrated pre- existing
apical resorption. Obturation was performed with EndoSequence BC Sealer (Brasseler) and gutta-percha. The first and second mesiobuccal canals merged into one unique larger canal in the apical third. Fig. 13: The three-month post-op radiographic examination
showed that healing was progressing rapidly. Fig. 14: Radiograph showing deep distal caries with a large periapical lesion on symptomatic tooth #47. The mandibular molar presented with a typical C-shaped canal, and it was prepared with an ISO 25/.06 TF Adaptive
le. Fig. 15: Auto-SWEEPS (20 mJ, 15 Hz) activation of 4 % NaOCl and 15 % EDTA solution was able to dissolve the tissue and debris from
the complex radicular anatomy, allowing a sealer (EndoREZ, Ultradent) to ll the full endodontic space (ve-month post-op radiograph).

[4] =>

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◊Page A3

Fig. 16: SWEEPS final irrigation protocol: at the end of therapy, the final irrigation protocol entails two cycles of 17 % EDTA activated by Auto-SWEEPS for 30 seconds each and 30
seconds of resting time, followed by rinsing with distilled water activated by SWEEPS for
30 seconds, then three cycles of 5 % NaOCl activated by USP/SSP for 30 seconds each and
a resting time of at least 30 seconds. A final distilled water rinse completes the protocol.

evidence-based protocol is used for
the final NaOCl disinfection (Fig. 16).
Continue using the tip size and

shape (at- or radialended) chosen:
– Two cycles of 30-second EDTA
(15–17%) irrigation by syringe is per-

formed, delivered in the access cavity and activated by Auto-SWEEPS at
20 mJ and 15 Hz. In case of an open
apex, the energy can be reduced to
15 or 10 mJ. Each cycle is followed by
30 seconds of resting time, to allow
the solution to react on the dentinal
walls. At this point, gutta-percha
points can be tested after calibrating
length and apical size. Apical friction
and retention should be checked and
adjustments made if necessary. This
simple operation contributes, with
its hand dynamic action, to irrigation efficacy.
– One cycle of 30-second irrigation
with distilled water (or water directly from the 0/1 laser spray) is performed to rinse the canals before the
final decontamination.
– Three cycles of 30-second NaOCl
(5% minimum) irrigation using a syringe is performed, delivered in the
access cavity and activated by SSP at
20 mJ and 15 Hz. The resting time af-

ter each cycle can be easily extended
from 30 seconds up to 120 seconds,
if needed (acute infection). The energy can be reduced to 15 or 10 mJ in
order to prevent any risk of extrusion. If the apical size is larger than
ISO 40–50, a thin, smooth le of the
same apical master size is chosen to
occlude the apical terminus before
the disinfection cycles start.
– Before obturation, the canals must
be rinsed with distilled water agitated by laser and dried using sterile
paper points.
Root canal ﬁlling
The final obturation can be performed as usual. However, the use
of flowable sealer is recommended
to better fill the previously inaccessible endodontic areas, the cleansing
and decontamination of which were
made possible by SWEEPS. Additionally, the proven combination of carrier-based gutta-percha and warm

vertical condensation is recommended for complete 3D obturation.

Conclusion
Er:YAG laser, in vivo at very low energy, combined with the innovative
dual-pulse SWEEPS technology, allows further optimisation of the already effective SSP procedure (PIPS)
during root canal therapy in everyday practice. The ability to effectively
activate the irrigants directly at start
of the root canal therapy plays an
important role in the advantage of
laser-activated cleansing and decontamination over the conventional
chemomechanical
preparation.
SWEEPS promotes shock wave energy to clean and disinfect the root
canal system with fewer files than
needed during standard root canal
therapy. SWEEPS promotes fluid
streaming throughout the entire
root canal system, even in the microscopic areas that conventional treatments cannot reach. The chemomechanical flushing action of SWEEPS
produces superior cleansing and decontaminating action over conventional irrigation methods, reducing
the need for canal shaping and allowing new flowable sealer and gutta-percha to obturate the endodontic
space three-dimensionally. In this
way, the root canal preparation size
can be minimised, preserving more
dental structure without losing the
efficacious action of the irrigants.
Editorial note:
A list of references can be obtained
from the publisher.
This article was originally published
in roots-international magazine of
endodontics, Issue 3/2020.

About the authors
IAID Founder Members

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#trunatomy

Dr Giovanni Olivi
Dr Olivi graduated cum laude in Medicine and Surgery (MD) from the Università Cattolica del Sacro Cuore in Rome
in Italy and in Dentistry (DDS) from the
University of Rome Tor Vergata. He is a
contracted professor and scientific coordinator of the laser dentistry proficiency
course and Master of Science in Laser
Dentistry at the Università Cattolica del
Sacro Cuore in Rome. He is the President
of the International Academy of Innovative Dentistry and an active member of
the Italian Society of Endodontics.

5/16/19 7:49 AM

Dr Linhlan Nguyen
Dr Nguyen completed her BDS at the
University of Sydney in Australia in 1996,
a Master in Laser Dentistry at the Laser
and Health Academy in 2017 and is currently completing a Master of Science
in Laser Dentistry at the Università Cattolica del Sacro Cuore. She has been a
fellow of the International Congress of
Oral Implantologists since 2015 and the
International Academy for Dental-Facial
Aesthetics since 2016.
Dr Matteo Olivi
Dr Olivi graduated in Dental Medicine
from the Victor Babes University of
Medicine and Pharmacy in Timisoara
in Romania. He obtained the European
Master Degree in Oral Laser Applications
from La Sapienza University of Rome.
Dr Olivi is co- author of several peer-reviewed articles and books on laser dentistry topics and a member of the Italian
Society of Endodontics.
Dr Jason Pang
Dr Pang completed his BSc in Biomedical Science in 1994 at the University of
Technology Sydney in Australia, receiving a university medal. He completed his
BDS at the University of Sydney in 2002,
a Master in Laser Dentistry at the Laser
and Health Academy in 2017 and is currently completing a Master of Science
in Laser Dentistry at the Università Cattolica del Sacro Cuore. Dr Pang is chairman of the Australian study club of the
Academy of Laser Dentistry.

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[cover] => Endo Tribune Middle East & Africa Edition No. 1, 2021

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Innovative endodontics using SWEEPS technology: Tips and tricks
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Innovative endodontics using SWEEPS technology: Tips and tricks

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