Nishad SG et al. Laser in Endodontics.

Review Article
LASER IN ENDODONTICS
Sumita Giri Nishad1, Muhammad Nishad Thyath2, Meha Sharma2, Iram Zaidi2

Departments of 1Conservative Dentistry and Endodontics, 2Pedodontics and Preventive Dentistry, Shree
Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India

ABSTRACT:
With the rapid development of laser technology, new lasers with a wide range of characteristics are now
available and being used in various fields of dentistry. Clinical studies clearly show advantages of laser
treatments over currently-used conventional methods and techniques. The most important advantages are
improved disinfection efficacy, more effective root canal cleaning, reduction of permeability, reduction of
micro-leakage, and elimination of the need to use toxic solvents. The main aim of this review article is to
give an update on lasers in endodontics.
Key words: Laser, endodontics, pulp, disinfection.

Corresponding Author: Dr. Sumita Giri Nishad, Department of Conservative Dentistry and Endodontics,
Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, India. E mail: sumitagirinishad
@gmail.com
This article may be cited as: Nishad SG, Thyath MN, Sharma M, Zaidi I. Laser in Endodontics. J Adv Med
Dent Scie Res 2015;3(2):137-141.

I
NTRODUCTION
The word “LASER” is widely used in of common irrigants to penetrate into the lateral
dentistry. It stands for Light amplification by canals and the apical ramifications. Hence, there is
stimulated emission of radiation. With the need for new materials, tech- niques and technologies
rapid development of laser technology, new that can improve the clean- ing and decontamination
lasers with a wide range of characteristics are of these anatomical areas.3
now available and being used in various fields of Dental lasers are named from chemical elements,
dentistry. Studies continue to be conducted in order molecules, or compounds that compose the core, or
to make maximum use of properties of the existing active medium, that is stimulated. This active
lasers in the field of endodontics.1 medium can be a combination of gas, solid crystal
rod, or a solid-state electronic device. Gas-active
LASER IN ENDODONTICS medium lasers are argon and carbon dioxide. Solid
The use of lasers in endodontics has been studied semiconductors are made with metals such as
since the early 1970s, and lasers have been more gallium, aluminum, and arsenide. Solid rods of
widely used since the 1990s. A successful endodontic garnet crystal are generally made from yttrium and
therapy is when there is complete and effective aluminum, to which are added elements chromium,
cleaning of root canal.1 Tradi- tional endodontic neodymium, holmium, or erbium.4
techniques use mechanical instru-ments, as well as Different lasers considered for endodontic
ultrasound and chemical irrigation to shape, clean applications are the near infrared laser—diode (810,
and completely decontaminate the endodontic 940, 980 and 1,064 nm) and Nd:YAG(1,064 nm)—
system. There is limitation of endodontic therapy and the medium infrared lasers—Erbium,Chromium:
such as lateral canals with various morphologies and YSGG (Er,Cr:YSGG; 2,780 nm) and Erbium:YAG
dimensions.2 (2,940 nm).5
The usefulness of the debridement, cleaning and
refining of the intra-radicular space is limited, Near infrared lasers such as Nd:YAG (from 803 nm
because of anatomical complexity and the difficulty to 1,340 nm) were the first to be used for root

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Nishad SG et al. Laser in Endodontics.

decontamination delivers laser energy through an B. Thermal testing

optical fibre.5 To check the vitality of the pulp, Pulsed Nd:YAG
laser has been used and it is better tolerated than hot
The medium infrared lasers, such as the Erbium
gutta percha. 6
(2,780 nm and 2,940 nm) laser family, with flexible,
fine tips have also been used. LASER & DENTIN HYPERSENSITIVITY
2
The far infrared laser CO (10,600 nm) was the The mechanism of laser for treatment of dentin
first to be used in endodontics for decontamination hypersensitivity is not well explained, However
and apical dentine melting in retrograde surgery. It is Pashley suggests that it may occur through
no longer used in this field with the exception of vital coagulation and protein precipitation of plasma in
pulp therapy (pulpotomy and pulp coagulation). dentinal fluid or by alteration of nerve fiber activity. 8
Laser therapy has been recommended by Kimura et
LASER- TISSUE INTERACTION6 al. to treat dentin hypersensitivity with effectiveness
Four type of interaction occur at tissue level. between 5.2% and 100%, depending on the type of
1. Absorption is the phenomenon of the energy laser and parameters used. According to authors,
incident on tissue with affinity being absorbed lasers are more effective than other treatments,
and thereby exerting its biological effects. although effect diminishes in severe dentin
2. Reflection is the phenomenon of a beam of laser hypersensitivity. Mckarthy et al indicates that the
light hitting a target and being reflected for lack reduction in dentin hypersensitivity could be the
of affinity. result of alteration of root dentin surface, physically
3. Diffusion is the phenomenon of the incident light occluding the dentinal tubules.9
penetrating to a depth in a non-uniform manner LASERS & PULP CAPPING
with respect to the point of interaction, creating The role of LASER in direct and indirect pulp
biological effects at a distance from the surface. capping has proved to be useful in endodontics.
4. Transmission is the phenomenon of the laser Temperature increases during treatment is minimal,
beam being able to pass through tissue without and may even sometime decrease while working with
affinity and having no effect water spray cooling. During application of laser
APPLICATION OF LASER dentinal tubules may remain open allowing hybrid
layer formation. No smear layer is produced. Another
Laser in analgesia feature is very superficial thermal effect, therefore
The pulsed â Nd:YAG laser is widely used as a the necrotic zone is likely to be small. Examples are
analgesia in endodontics. Its wavelengths interfere Er:YAG or Er,Cr:YSGG lasers which have
with the sodium pump mechanism, change cell bactericidal properties.10
membrane permeability, alter temporarily the
endings of sensory neurons, and block LASERS IN ROOT CANAL TREATMENT 10
depolarization of C and A fibers of the nerves. 7 The various uses of laser in root canal treatments
are as follow
Pulp vitality and laser 1. Access cavity preparation and root canal orifice
A. Laser doppler flowmetry enlargement.
This is one of the important application of LASER in 2. Root canal wall preparation.
endodontics. It is a noninvasive method of assessing 3. Sweeping of Root canal and irrigation.
and accurately measuring the rate of blood flow in 4. Removal of pulp remnants and debris at the
the pulp which is a highly vascular tissue and cardiac apical foramen.
blood flow in the supplying artery is transmitted 5. Sterilization or disinfection of infected canals.
through pulsations. 1 These pulsations are apparent on 6. Obturation with gutta percha or resin.
the laser doppler monitor of vital teeth and absent in 7. Removal of temporary cavity sealing materials,
the nonvital teeth. This method uses Helium Neon root canal sealing materials, and fractured
and diode lasers at a lower power of 1 or 2 mW. 7 instruments in root canals.
Er,Cr:YSGG (2780nm) and Er:YAG (2940nm) can
be used for access cavity preparation, root canal
shaping and cleaning. Lasers such as Er:YSGG

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Nishad SG et al. Laser in Endodontics.

(2780nm), Er:YAG(2940nm) and Nd:YAG(1064 well absorbed by the water content of the dentinal
nm) are use3d for root canal wall preperation. 11 The walls and consequently have a superficial ablative
length of the root canal, obtained through the X-ray, and decontaminating effect on the root canal surface.
is transferred to the fiberoptical wave guide to ensure With vertical condensation method, obturation of
that the flexible 200µm fiber reaches the apex. The canals can be done with Lasers. Anic and Matsumoto
laser is activated only after the fiber reaches the apex attempted to investigate whether it is possible to
and the fiber is guided in an apical to coronal perform the root canal filling using sectioned gutta-
direction with rotary movements and in contact with percha segments and a pulsed Nd:YAG laser. With
the root canal wall. the lasers, Removal of temporary cavity sealing
When the laser fiber is unable to be inserted into the materials, root canal sealing materials, and fractured
canals, reamers and files are to be used, followed by instruments in root canals became possible.15 In fine
lasers. Smear layer is completely removed and and strongly curved canals, however, there were
dentinal tubuli are for the most part closed if pulsed many cases in which laser tips perforated the canal
Nd:YAG laser is applied at 15 Hz / 1.5 W settings. wall.
Sweeping of Root canal and irrigation are done in
Straight, slightly curved and wide canals with lasers. LASER TREATMENT OF PERIAPICAL
Along with lasers, 5.25% Sodium hypochlorite or LESIONS OF SINUS TRACT
14% EDTA must be used along laser irradiation.12 Laser therapy is recommended for cases for which
Nd:YAG are widely used for Removal of pulp apicoectomy or periapical curettage cannot be
remnants and debris at the apical foramen. removal performed, or for which standard endodontic
of pulp remnants, control of hemorrhage, and treatment cannot be performed, because of deep post
stimulation of cells surrounding the root apex as well in the root canal. This treatment can be performed to
as debridement on the surface. accelerate wound healing in combination with
Sterilization or disinfection of infected canals are endodontic or surgical treatment. Pulsed Nd:YAG
done with Pulsed Nd:YAG, argon, semiconductor and CO 2 lasers are recommended for these
diode, CO, Er:YAG lasers. Because of laser energy treatments. 16 This treatment generally is performed
and wavelength characteristic, they are useful in three or four times during one visit. When using the
killing microorganism. In Photoactivated CO laser, the exit of drainage 2 must be ablated as
disinfection, tolonium dye is applied to the infected deeply as possible at 1 or 2 W and under air cooling
area and light is transmitted into the root canals at the or local anesthesia. The aforementioned laser
tip of a small flexible optical fiber that is attached to treatments are performed once or twice a week until
a disposable hand piece. Laser emits 100mW and the sinus tract disappears. For the pulsed Nd:YAG
does not generate sufficient 8 heat to harm the laser, 2 W and 20pps are the recommended
adjacent tissues.12,13 parameters and the fiber tip must be inserted into the
In endodontics, lasers use the photo-thermal and tract and drawn slowly from the root apex to the exit
photomechanical effects resulting from the through the sinus tract.17
interaction of different wavelengths and different
parameters on the target tissues. These are dentine, LASER IN PERIAPICAL CURETTAGE,
the smear layer, debris, residual pulp and bacteria in APICOECTOMY AND RETROGRADE
all their various aggregate forms. Using different CAVITY PREPARATION
outputs, all the wavelengths destroy the cell wall due Because of relatively bloodless and post surgical
to their photo-thermal effect. Because of the course, coagulation, minimal cutting, sterile surgical
structural characteristics of the different cell walls, area, swelling and scarring, vaporization and minimal
gram-negative bacteria are more easily destroyed or no suturing and much less or no post surgical pain,
with less energy and radiation than gram-positive lasers proved to be effective. 18 Permeability of
bacteria.14 The near infrared lasers are not absorbed dentin exposed by apicoectomy is one of the causes
by hard dentinal tissues and have no ablative effect of endodontic surgery failure because microleakage
on dentinal surfaces. The thermal effect of the and bacterial contamination trigger inflammation.
radiation penetrates up to 1mm into the dentinal The use of lasers resulted in smoother surfaces and
walls, allowing for a decontaminating effect on more homogenous dentin fusion and
deeper dentine layers. The medium infrared lasers are

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Nishad SG et al. Laser in Endodontics.

recrystallization, which occluded tubules and 5. Shekhar Bhatia, Shivani Kohli. Lasers in root
decreased permeability. 19 canal sterlisation- A review. International journal
of scientific study. 2013, Vol1 (3): 107-111.
INDICATION AND CONTRAINDICATION OF 6. Nobert Gutknecht: Lasers in endodontics. Journal
LASERS IN ENDODONTICS 20,21 of laser and health academy 2008; Vol 4; 1-5.
7. Berutti E, Marini R, Angerreti A. Penetration
Indications- ability of different irrigants into dentinal tubules.
a. Teeth with lateral canal leading to periodontal
J Endod 1997; 23:725-727.
involment.
8. Pashley DH Potential treatment modalities for
b. Teeth with pulp necrosis and purulent pulpitis.
dentin hypersensitivity: in office products
c. Teeth with gangarenous changes.
clinical advances in restorative dentistry 2000;
d. Teeth with periapical lesions upto 5mm or more.
351-365.
e. Teeth that has been treated atleast 3 months with
9. McCarthy D Gillam DG, Parson DJ In vitro
no success.
effect of laser radition on dentin surfaces. J Dent
Contraindications- Res 1997: 76, special issue 233.
a. In advanced periodontitis cases. 10. Nair PN. Pathogenesis of apical periodontitis and
b. A deep crown and root fracture. the causes of endodontic failures. Crit Rev Oral
c. Obliterated root canals in endodontic treated Biol Med. 2004; 15: 348–381.
teeth. 11. Kathari A, Ujariya M. Lasers in endodontics- A
review. J Res Adv Dent 2014; 3:1:209-211.
LASER PROTECTION 12. Anic I, Matsumoto K: Comparison of the sealing
The operator should be well trained to use a laser ability of laser softened, laterally condensed and
device. The surgical environment must have a low temperature thermoplasticized gutta percha
warning sign and limited access. The operator, .J Endod .1995;21:464-469.
patient and the surgical team should wear protective 13. K Gorkhay et al: Effects of oral soft tissue
eyewear so that any reflected energy does no produced by a diode laser in vitro. Lasers in
damage. High volume suction must be used to Surgery and medicine 1999; 25:401-406.
evacuate the plume formed by tissue ablation, and 14. Sebeena Mathew, Deepa Natesan Thangara.
normal infection protocol should be followed. The Lasers In Endodontics . JIADS VOL 1 (1) Jan-
laser should be in good working condition.22,23 March, 2010, 31-37.
15. Lee B.S: Ultra structural changes of human
CONCLUSION dentin after irradiation by Nd:YAG laser. Lasers
Author concludes that with the advent of Lasers in Surg Med.2002; 30(3): 246-252.
dentistry, the complex procedures have become 16. Anic I, Matsumoto K: Dentinal heat transmission
easier and time saving. Thus the patient care has induced by a laser-softened gutta percha
improved. obturation technique .Journal of Endod. 1995;
21:470-474.
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