Endo Tribune Middle East & Africa No. 1, 2017
Tooth notation: Upper right first permanent molar / Laser Enhanced Endodontic Treatment
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DTMEA_No.1. Vol.7_ET.indd
www.dental-tribune.me
PUBLISHED IN DUBAI
January-February 2017 | No. 1, Vol. 7
ENDO TRIBUNE
Tooth notation:
Upper right first permanent molar
The World’s Endodontic Newspaper Middle East & Africa Edition
By Prof. James Prichard, UK
Patient Symptoms
Severe pain (Visual Analogue Scale
9 out of 10). Poorly localized on the
right hand-side. Always starting on
the upper right hand side of the face.
Pain radiates in to the ear and the
cheek on the right hand-side. Pain
is spontaneous and not responding
well to over the counter analgesics
(ibuprofen 400mg qds). Pain has
been gradually getting worse over
the last 48 hours. The patient was
experiencing sleep disturbance and
the pain came on in waves. Extreme
sensitivity to cold stimulus, not so
painful with hot.
Examination
Upper right first and second molars
are restored with amalgam.
No pocketing or mobility and no
tenderness to percussion. No tender-
ness in the buccal or palatal sulcus.
Sensibility testing with EndoFrost:
UR7 +ve, UR6 ++ and triggered the
patients’ toothache.
Preparation) ultrasonic tip (Acteon
UK ) and 3 canals were immediately
identified with a DG16 endodontic
probe.
Pre-operative radiograph
Before canal shaping was performed
the coronal 2/3rds was explored with
a size 10 K-flex file. Shaping was performed as follows:
Upper right first molar has a pin retained restoration, 25% bone loss mesially and distally, no obvious caries,
a possible furcal radiolucency but no
obvious peri-apical radiolucency at
the root apices.
The pulp chamber is reduced in size
and the canals are not obviously visible. The mesial root exhibits severe
curvature in excess of 30 (Schneider
1971-Figure 1 [b]) towards the distal
aspect. The sinus outline appears to
be low and in close approximation to
the roots.
Diagnosis
Acute irreversible symptomatic pulpitis from the upper right first molar.
Fig. 1a
Fig. 1b
Treatment Options
and sealed with Oraseal (Optident)
caulking agent.
Root canal treatment or extraction.
The patient opted for root canal
treatment.
Treatment
Anaesthesia was achieved with 1x
2.2 ml Lignospan (2% Lidocaine,
1:80,000 adrenaline) via buccal and
palatal infiltration and isolation
achieved with non latex dam (3M)
Access was performed with a short
tungsten carbide bur and the pulp
chamber de-roofed with a safe ended
tapered tungsten carbide bur (FKG).
There was a pulp stone present in
the chamber over the palatal root canal (Figures 2 [a] and [b]) which was
removed with a CAP 1 (Canal Access
“ScoutRace” (FKG Dentaire) sizes
10/.02; 15/.02 and 20/.02 (Figure
3) were used in an NSK Endomate
(NSK) running at 1000 rpm to estimated working length using 3%
Sodium Hypochlorite-NaOCl (FKG)
as the lubricant and irrigant. The irrigant was delivered with a 27G side
vented Monoject needle attached to
a 3ml syringe.
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[2] =>
DTMEA_No.1. Vol.7_ET.indd
A2
ENDO TRIBUNE
Dental Tribune Middle East & Africa Edition | 1/2017
◊Page A1
Fig. 2a
Fig. 2b
Fig. 4
Fig. 3
Fig. 5
Fig. 8
The canal lengths were determined
electronically with an Apex NRG
apex locator (Medic NRG) using a
size 10 k-flex file (Dentsply-Maillefer)
and shaped with BioRace (FKG Dentaire) BRO, BR1, BR2, BR3 and BR4 sequentially to length irrigating with
3ml 3% NaOCl between each file.
After shaping, the root canals were
cleaned with the Irrisafe Passive Ultrasonic Irrigating tip (Acteon UK) for
3 cycles of 20 seconds per canal replenishing the irrigant between each
cycle (Figure 4). Following which a
soak was performed with 17 % EDTA
(FKG) for 60 seconds delivered as
before, and the final flush was made
with 3% NaOCl.
Obturation was performed with TotalFill BC Sealer (FKG Dentaire) and
size 35/.04 TotalFill BC Points, gutta
percha cones impregnated with bioceramic. The cones were sized to
fit each individual canal with good
tug back in canals still wet with 3%
sodium hypochlorite. The canals
were dried with 35/.04 paper points
(FKG), the cones coated with TotalFill BC Sealer (Figure 5) and seated
into the canals, withdrawn half way
and reseated. The coronal portion of
the cones were then removed with a
heated instrument and packed gently into the canal orifices (Figure 6
and Figure 7), and the access cavity
cleaned by washing with a 3-in-1 triple syringe.
An amalgam Nayyar core was placed,
the dam removed and the occlusion
checked. A final radiograph was
taken (Figure 8) showing a well-condensed root canal filling in all 3 canals extending to length with a welladapted coronal restoration.
Discussion
The diagnosis of acute symptomatic
irreversible pulpitis can sometimes
be difficult, however by repeating
the patients’ sensitivity to cold it
soon became apparent which tooth
was causing the trouble. The best
way to treat a pulpitis is to remove
the inflamed tissue as quickly as possible; antibiotics have no place, as
there isn’t an infection.
The narrowness of the canals and the
severe curvature on the mesial root
can make instrumentation challenging. Sclerosis of canals takes place as
a result of deposition of secondary
dentine and progressive deposition
of calcified masses that originate in
the root pulp (Bernick & Nedelman
1975), and true pulp stones are made
of dentine and lined by odontoblasts
(Johnson & Bevelander 1956).
Pulp stones are common, ranging
from 4% of first molars Chandler et
al. 2003 to 78% of primary molars
Fig. 6 (Buccals)
Fig. 7 (Palatal)
Arys et al. 1993, and vary in size from
50 μm in diameter to several millimetres when they may occlude the
entire pulp chamber (Sayegh & Reed
1968). Therefore if the pulp stone
is not removed, the natural canal
anatomy may be obscured making
shaping and disinfection difficult or
impossible.
(Zhang et al. 2009a,b) and adhesion
to dentine (Nagas et al. 2012). It is supplied in premixed, injectable form
and sets in the presence of natural
canal moisture (Loushine et al. 2011).
When sealer is placed on the cone
and initially seated the canal walls
are coated, withdrawing it and reseating it then allows more sealer
to be placed and dispersed within
the complex canal ramifications. It
is imperative that the cones fit well
with tug back or are customized
to improve apical control (van Zyl
2005) and that hydraulic pumping is
not employed. With this technique,
the GP cone acts as a carrier and the
sealer is employed to fill the entire
canal space, thus providing the desired three-dimensional seal (Schilder 1967).
Shaping canals is essential to endodontic success (Schilder 1974), but
nickel titanium files are prone to cyclic fatigue fracture and torsional tip
fracture (Bergmans et al. 2001). Glide
path creation is essential when shaping with rotary Nickel-Titanium instruments to prevent these fractures
(Patiño et al. 2005) and mechanical
glide path preparation with ScoutRace files has been shown to be superior to stainless steel hand files in
maintaining the canal shape (Ajuz et
al. 2013).
As always, shaping is only part of
the process of canal debridement
(Byström & Sundqvist 1981), shaping and irrigating with 0.5% NaOCl
significantly reduced bacterial load
compared to shaping and irrigating
with saline (Byström & Sundqvist
1983) and irrigation with NaOCl and
EDTA has been demonstrated to create cleaner canal walls (Baumgartner
& Mader 1987). Additionally, the use
of ultrasonic irrigant activation removes more debris from canals than
syringe irrigation alone. (Burleson et
al. 2007).
Root canal preparation to a size 35
allows better irrigant flow and exchange (Boutsioukis et al. 2010),
creates space for the ultrasonic tip
to vibrate thereby reducing contact dampening (Ahmad et al. 1992)
which in turn improves the acoustic
micro-streaming (Ahmad et al. 1987)
and increases the reduction in bacterial load (Bhuva et al. 2010; Carver et
al. 2007).
Bioceramics (tricalcium silicates)
have many uses in endodontics,
taking advantage of their ability
to form an apatite layer (bioactivity) and penetrate dentine tubules.
Mineral Trioxide Aggregate (the first
bioceramic) is currently employed
for several endodontic techniques
including root-end filling, direct
pulp capping, repair of perforations
and providing an apical seal in teeth
with open apices (Parirokh & Torabinejad 2010). The literature reports
several favourable properties of recently developed bioceramic sealers
as root canal filling materials including good sealing ability (Zhang et al.
2009a,b), biocompatibility (Zhang
et al. 2010,), antibacterial activity
Conclusions
Pulp stones are a common occurrence and act as a barrier to successful endodontic treatment Mechanical glide path preparation with
ScoutRace files allows predictable
canal preparation.
Single cone obturation is possible
with this sealer.
- Further information on these techniques, instruments and materials is
available on www.fkg.ch
References
Ahmad M, Pitt Ford TR, Crum LA
(1987). Ultrasonic debridement of
root canals: acoustic streaming and
its possible role. Journal of Endodontics 14, 486-93.
Ahmad M, Roy RA, Kamarudin AG
Observations of acoustic streaming
fields around an oscillating ultrasonic file. Endododontic Dental Traumatology 1992 8, 189-94
Ajuz NC1, Armada L, Gonçalves LS,
Debelian G, Siqueira JF Jr Glide path
preparation in S-shaped canals with
rotary pathfinding nickel-titanium
instruments.
Journal of Endodontics. 2013
Apr;39(4):534-7.
doi:
10.1016/j.
joen.2012.12.025. Epub 2013 Feb 12.
Arys A, Philippart C, Dourov N Microradiography and light microscopy
of mineralization in the pulp of undemineralized human primary molars. 1993 Journal of Oral Pathology
and Medicine 22, 49–53.
Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of four root canal irrigation regimens. Journal of Enododontics 1987
Apr;13(4):147-57.
Bergmans L, Van Cleynenbreugel J,
Wevers M, Lambrechts P. Mechanical
root canal preparation with NiTi rotary instruments: rationale, performance and safety. Status report for
the American Journal of Dentistry.
American Journal of Dentistry. 2001
Oct; 14(5):324-33.
Bernick S, Nedelman C Effect of aging
on the human pulp. Journal of Endodontics 1975 (1), 88–94.
Bhuva B, Patel S, Wilson R, Niazi S,
Beighton D, Mannocci F (2010). The
effectiveness of passive ultrasonic
irrigation on intraradicular Entrococcus faecalis biofilms in extracted
single rooted human teeth. International Endodontic Journal 43, 241250.
Boutsioukis C, Gogos C, Verhaagen B,
Versluis M, kastrinakis E, van der Sluis L (2010). The effect of apical size on
irrigant flow in root canals evaluated
using an unsteady Computational
Fluid Dynamics Model. International
Endodontic Journal, 43, 874-881.
Burleson A, Nusstein J, Reader A, Beck
M (2007). The in-vivo evaluation of
hand/rotary/ultrasound instrumentation in necrotic, human mandibular molars. Journal of Endodontics.
33, 782-7 Byström A, Sundqvist G
(1981). Bacteriological evaluation of
the efficacy of mechanical root canal
instrumentation in endodontic therapy. Scandinavian Journal of Dental
Research 89, 321-8.
Byström A, Sundqvist G (1983). Bacteriologic evaluation of the effect of 0.5
percent sodium hypochlorite in endodontic therapy. Oral Surgery Oral
Medicine Oral Pathology 55(3):307-12
Carver K, Nusstein J, Reader A, Beck M
(2007). In-vivo antibacterial efficacy
of ultrasound after hand and rotary
instrumentation in human mandibular molars. Journal of Endodontics.
33, 1038-43
Chandler NP, Pitt Ford TR, Monteith
BD Coronal pulp size in molars: a
study of bitewing radiographs. International Endodontic Journal 200336,
757–63. Johnson PL, Bevelander G
Histogenesis and histo- chemistry of
pulpal calcification. Journal of Dental
Research 1956 35, 714–22.
Loushine BA, Bryan TE, Looney SW
et al. (2011) Setting properties and cytotoxicity evaluation of a premixed
bioceramic root canal sealer. Journal
of Endodontics 37, 673–7.
Nagas E, Uyanik MO, Eymirli A. et al.
(2012) Dentine moisture conditions
affect the adhesion of root canal sealers. Journal of Endodontics 38, 240–4.
Parirokh M, Torabinejad M Mineral
trioxide aggregate: a comprehensive
literature review – Part III: clinical
applications, drawbacks, and mechanism of action. Journal of Endodontics 2010 36, 400–13.
Sayegh FS, Reed AJ Calcification in
the dental pulp. Oral Surgery, Oral
Medicine, Oral Pathology 1968 25,
873–82.
Schilder H (1967). Filling root canals
in three dimensions. Journal of Endodontics 32, 281-90.
Schilder H Cleaning and Shapinng
the Root Canal Dental Clinical of
North America 1974 Vol 18 No.2
Schnieder S A comparison of canal preparations in straight and
curved root canals 1971 Aug Vol 32
(2), 271–275 van Zyl SP, Gulabivala
K, Ng YL. Effect of customization of
master gutta-percha cone on apical
control of root filling using different
techniques: an ex vivo study. International endodontic Journal 2005
Sep;38(9):658-66.
Zhang H, Shen Y, Ruse ND, Haapasalo
M Antibacterial activity of endodontic sealers by modified direct contact
test against Enterococcus faecalis.
Journal of Endodontics 2009a 35,
1051–5.
Zhang W, Li Z, Peng B Assessment of a
new root canal sealer’s apical sealing
ability. Oral Surgery Oral Medicine
Oral Pathology Oral Radiology & Endodontology 2009b 107, 79–82.
Zhang W, Li Z, Peng B Ex vivo cytotoxicity of a new calcium silicatebased canal filling material. 2010
International Endodontic Journal 43,
769–74.
FKG Dentaire SA
Alexandre MULHAUSER
Middle East, Africa and India Director
a.mulhauser@fkg.ch
M +971 52 765 8888
Skype ID mulhauser.alexandre
Prof. James Prichard, UK
BDS(ULond);MSc(ULond);LDSRCS(Eng;MF
GDP(UK);FIADFE(USA); FHEA(UK); FBARD
(UK)
Visiting Professor and Programme Leader,
MClinDent in Endodontology at BPP University working with the City of London
Dental School.
Professor Prichard is a renowned teacher
in Endodontics, delivering hands on
courses, lectures and seminars throughout the UK and overseas. He has held the
posts of Associate Clinical Teacher, Clinical
Teaching Fellow and Clinical Supervisor in
Endodontics on the Masters Programme
at The University of Warwick prior to joining BPP University in London as Visiting
Professor and Programme leader for the
MClinDent in Endodontology. He has
supervised postgraduate students in Endodontics including several dissertations
and theses. He has published in the scientific journals including the International
Endodontic Journal, The British Dental
Journal and Endodontic Practice. He has
lectured at conferences including the British Dental Association annual meeting
and the British Academy of Restorative
Dentistry. He is a Key Opinion Leader for
several endodontic companies and has
demonstrated the latest advances in
endodontic technology for Schottlander
and FKG Dentaire at the Dental Showcases and Dentistry Show in the UK since
2004. He gained his Masters Degree
(MSc) in Restorative Dental Practice with
distinction for his dissertation which he
completed at The Eastman Dental Institute in London. He is a Fellow of the International Academy of Dental Facial Esthetics in New York, a Fellow of the Higher
Education Academy and a Fellow of the
Biritish Academy of Restorative Dentistry.
[3] =>
DTMEA_No.1. Vol.7_ET.indd
Dental Tribune Middle East & Africa Edition | 1/2017
A3
ENDO TRIBUNE
Laser Enhanced Endodontic Treatment
By Dr Gregori M. Kurtzman, USA
Endodontic success is predicated on
the ability to debride 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.
(Figure 1) As practitioners, we are able
to clean the main canals with files,
either hand or rotary. But can not
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, obturation material can not fill
areas still occupied by pulpal tissue.
Success is dependant on disinfection
and debridement 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
difficult to achieve with traditional
methods using even sodium hypochlorite (NaOCL) solutions. (Figure
2) Studies have demonstrated that
addition of an Er:YAG laser to activate the irrigation solution greatly
enhances not only the efficiency of
the irrigation solutions advocated
(NaOCL and EDTA) but also improves
disinfection of the canal system,
clearing accessory so that it may be
sealed during obturation. (Figure 3, 4)
Irrigation the key
to Endodontic success
Although, instrumentation with files
is important to enlarging 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 can
not 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 contains 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
Figure 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.
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
Laser enhanced irrigation
Laser energy has been documented
to enhance the known effects of
NaOCL irrigation through both heating the solution within the canal
system and its distant antibacterial
effects. But not all laser wavelengths
have demonstrated to be equal in effectiveness. The best effects are when
NaOCL is combined with an Er:YAG
laser as compared to NaOCL alone or
when utilized with other type lasers.3
Antibacterial effects were reported
to be the best with this combination of irrigant and laser.4 The higher
wavelength of the Er:YAG compared
to the Nd:YAG or diode was more
effective in smear layer removal,
hence better at bacterial elimination
within the canal system.5 Utilization
of a EDTA as an irrigant alternated
with NaOCL provides the best debridement of the canal system with
enhancement with a Er:YAG laser, as
these two solutions have a synergistic effect complimenting each others
effects in the canal anatomy.6
Additionally, the Er:YAG laser (LiteTouch™, distributed in USA by AMD
LASERS, Indianapolis, IN) creates
hydrodynamic pressure following
cavitation bubble expansion and
collapse when the irrigation solution
is activated in the chamber.7-9 Placement of the laser tip does not require
entry into the canals to achieve the
desired effects and activation of the
irrigation solution in the chamber
is sufficient to affect the entire canal
Figure 5: LiteTouch™ Induced Photomechanical Irrigation protocol (LT-IPI™): Establishment of glide path with hand files (A), Canal and chamber filled with NaOCL (B) and
Placement of the LiteTouch™ tip into the irrigant in the chamber and activation of the
Er:YAG laser. (Illustrations: courtesy of Dr Parvan Voynov, Plodiv, Bulgaria)
Figure 2: SEM showing bacteria and pulpal debris in the apical 1/3 that was not
removed fully using standard irrigation
protocol. (Courtesy Prof. Georgi Tomov,
Plodiv, Bulgaria)
Figure 3: SEM showing complete removal
of bacteria and pulpal tissue in the apical
1/3 after irrigation using the LT-IPI™ protocol. (Courtesy Prof. Georgi Tomov, Plodiv,
Bulgaria)
Figure 4: SEM cross-section showing
complete removal of bacteria and pulpal
tissue in the apical 1/3 after irrigation using the LT-IPI™ protocol leaving dentin tubules open. (Courtesy Prof. Georgi Tomov,
Plodiv, Bulgaria)
system. The LiteTouch™ Er: YAG laser
energy is set at a sub-ablative power
level which allows its use without
structural changes to the hard tissue
within the tooth. This eliminates the
risks of ledging and perforation of
the pulpal floor allowing safe usage
within the tooth.
Once the canal orifices are identified,
hand files are utilized 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.
(Figure 5A) Laser-assisted canal irrigation requires canal preparation to
an apical preparation ISO 25/30 at a
minimum. A canal taper of 0.04 or
0.06 for the final instrumentation
is recommended. Sodium hypochlorite (NaOCL) is utilized 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 instrumenting a dry canal.
(Figure 5B)
accessible by instrumentation with
files. (Figure 6, 7)
When the Er:YAG laser is activated a
heat pulse is generated by the laser
radiation delivered via a sapphire tip
into an absorbing liquid (irrigant).
This results in tensile stress with cavitation being induced in the liquid in
front of the sapphire tip at a distance
far below the optical penetration
depth of the laser radiation. Bubble
expansion and collapse cause the
surrounding fluid to flow at a speed
of up to 12 m/s traveling throughout
the canal system. This causes rapid
displacement of intra-canal fluid via
radial and longitudinal pressures
sufficient to drive irrigant into the
canal anatomy and clean the dentinal tubules significantly. This photomechanical activation of the irrigant
includes a temperature rise in the
irrigant increasing its effectiveness
in debridement of dentinal walls and
its tubules and increases the chemical properties of the irrigants.
LiteTouch™ Induced
Photomechanical Irrigation
(LT-IPI™)
Endodontic treatment is initiated
with access to the pulp chamber,
which may be performed by traditional methods using burs or by
ablation of the enamel and dentin
with the LiteTouch™ Er:YAG laser. As
the laser is ineffective in removal of
ceramics and metals, such as those
used in fixed prosthetics and also
amalgam, carbides and diamonds
are needed create access through
these materials. Once dentin has
been reached the laser may be utilized to unroof the pulp chamber
(hard tissue mode). An additional
benefit of the Er:YAG laser to access the pulp chamber is it provides
decontamination and removal of
bacterial debris and pulpal tissue
to yield a cleaner chamber aiding it
identification of the canal orifices
(soft tissue mode).
Figure 6: Accessory anatomy evident in the apical
that has been filled with
sealer accessible due to
use of the LiteTouch™
Er:YAG laser. (Photo courtesy of Dr. David Guex,
Lyon, France)
Photo-activation of the irrigant within the canal system is performed
using the Er:YAG laser with a 0.4/17
or 0.6/17mm tip which assists in removal of the debris created by the
files. Between each rotary file, the
chamber is filled with NaOCL and
the tip of the laser is placed into the
chamber and the solution activated
with the laser at 40mJ at 10Hz with
an average power of only 0.5W for 20
seconds. (Figure 5C) The chamber is
suctioned 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 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 activated 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 irrigation solution
Figure 7: Accessory apical anatomy filled with
sealer due to use of the
LiteTouch™ Er:YAG laser.
(Photo courtesy of Prof.
Georgi Tomov, Plodiv, Bulgaria)
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 removed 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 allowing obturation of anatomy in-
Conclusion
The key to Endodontic success is
two pronged, cleaning the system
and sealing it. Although, rotary files
have improved the efficiency of instrumentation they are unable 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 removal 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 the laser has an antibacterial effect, killing bacteria within the canal
anatomy as well as distant to where
the irrigation solution may reach essentially sterilizing the entire tooth
to the periodontal ligament.
References
1. Takeda FH, Harashima T, Kimura
Y, Matsumoto K.: A comparative
study of the removal of smear layer
by three endodontic irrigants and
two types of laser. Int Endod J. 1999
Jan;32(1):32-9.
2. Meire MA, Coenye T, Nelis HJ, De
Moor RJ.: Evaluation of Nd:YAG and
Er:YAG irradiation, antibacterial photodynamic therapy and sodium hypochlorite treatment on Enterococcus faecalis biofilms. Int Endod J. 2012
May;45(5):482-91. doi: 10.1111/j.13652591.2011.02000.x. Epub 2012 Jan 14.
3. Asnaashari M, Safavi N.: Disinfection of Contaminated Canals by Different Laser Wavelengths, while Performing Root Canal Therapy. J Lasers
Med Sci. 2013 Winter;4(1):8-16.
The full list of references is available
from the publisher.
Dr. Kurtzman is in private general practice in
Silver Spring, Maryland
and a former Assistant
Clinical Professor at University of Maryland and
a former AAID Implant
Maxi-Course. Assistant program director at
Howard University College of Dentistry. He
has lectured internationally on the topics
of Restorative dentistry, Endodontics and
Implant surgery and prosthetics, removable
and fixed prosthetics, Periodontics and has
over 510 published articles. He has earned
Fellowship in the AGD, AAIP, ACD, ICOI,
Pierre Fauchard, ADI, Mastership in the AGD
and ICOI and Diplomat status in the ICOI
and American Dental Implant Association
(ADIA). Dr. Kurtzman has been honored to
be included in the “Top Leaders in Continuing Education” by Dentistry Today annually
since 2006 and was featured on their June
2012 cover. He can be reached at
dr_kurtzman@maryland-implants.com
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