LASERS IN ENDODONTICS

CONTENTS
 Introduction

 History Of Lasers In Endodontics

 Advantages and Disadvantages of Lasers

 Applications In Endodontics
• Pulpal diagnosis
• Pulp capping
• Pulpotomy
• Access cavity preparation
• Root canal preparation
• Root Canal Sterilisation and disinfection
• Bleaching
• Endodontic Surgery

 Conclusion
 INTRODUCTION

A device that emits light through a process of optical amplification based

on the stimulated emission of electromagnetic radiation
 IN ENDODONTICS

1971 1986 1998

• WEICHMAN AND • ZAKIRASEN ET AL • MAZEKI ET AL
JOHNSON
Root canal
Introduced Sterilization of shaping with
LASERS in Root Canals Er:YAG laser
Endodontics
NOTE:
 When working on tissue, laser should always be used either
with the focal point positioned at tissue surface or above
the tissue surface.
 laser should never be positioned with the focal spot deep or
within tissue as this can lead to deep thermal damage and
tissue effects.
 ADVANTAGES
 Reduced need for anesthesia

 Greater comfort during and after surgery.

 Haemostasis and reduced risk of blood borne pathogens

 High patient acceptance

 Reduced stress and fatigue for the practitioner and staff.

 Produce less collateral thermal damage than with an electrocautery.

 LIMITATIONS

 All lasers require specialized training and attention to safety precautions.

 Slower than traditional methods.

 No single laser can perform all desired dental applications

LASER WAVE LENGTHS USED IN DENTISTRY
APPLICATIONS
 Clinical applications of lasers in Operative Dentistry/
Endodontics

The use of lasers in dentistry Alleviating dental hypersensitivity

and in endodontics in
particular , acceptance of this  Pulp diagnosis
technology by clinicians has
remained limited , perhaps  Modification of dentin structure
partly due to the fact that this
technology blurs the border
between the technical ,
 Pulp capping and pulpotomy
biological and dental
research.  Cleaning and shaping of the root canal system

 Endodontic surgery
OPERATIVE DENTISTRY ENDODONTICS

Pulpal diagnosis

Diagnosis of dental caries Pulp capping

Pulpotomy
Dentinal hypersensitivity
Access cavity preparation
Deep caries management
Root canal preparation
Remineralisation
Root Canal Sterilisation and disinfection

Bleaching

Endodontic Surgery
PULPAL DIAGNOSIS
 DIFFERENTIAL DIAGNOSIS –
NORMAL PULP, ACUTE PULPITIS, CHRONIC PULPITIS

 Laser used - Nd:YAG at 2W, 20 pulses per sec (pps) at distance of 10mm from tooth
surface

 NORMAL PULP: mild transient pain within 20 -30 sec; disappears in a couple of seconds
after laser stimulation is stopped

 ACUTE PULPITIS : pain induced immediately and continues more than 30sec

 CHRONIC PULPITIS : no pain or pain started after one min application and continues
more than 30sec
 PULP DIAGNOSIS

LASER DOPPLER FLOWMETRY:

• LDF was developed to assess blood flow in micro vascular systems.

• Eg: in retina , gut mesentry , renal cortex & cortex.

• He-Ne laser - 632.8 nm , which when scattered by moving red cells , under went a
frequency shift according to the Doppler principle.
Original technique utilized a light beam from a He-Ne
laser emitting at 632.8 nm , which when scattered by
moving red cells , under went a frequency shift according to
the Doppler principle.

A fraction of light back scattered that is Doppler shifted is

detected and processed to produce a signal that was a
function of the red cell flux.(volume of cells illuminated x
mean cell velocity)

This information can be used as a measure of blood flow ,

the value being expressed as a percentage of full scale
deflection. ( % FSD )
 ADVANTAGES :
• It reflects vascular rather than nervous responsiveness
• Recent trauma or following orthognathic surgery

LIMITATIONS :
• Difficult to obtain laser reflection from certain teeth.

• Differences in sensor output and inadequate calibration by the manufacturer may

dictate the use of multiple probes for accurate assessment.

• Values may vary i.e sometimes may not be reliable indicator due to problems
• changes in red cell flux in gingival tissue
• changes in ambient light intensity
• movement artifacts.
 PULP CAPPING

As defined by AAE – ” A procedure in which a dental material is placed over an exposed

or nearly exposed to encourage the formation of irritation dentin at the site of injury.”

• Pulp capping is recommended when the exposure is very small, 1mm or

less ( Isermann et 1979, Cvek et al 1982)
• Traditionally used pulp capping agent is calcium hydroxide.
• Another recently introduced material is MTA.
• Success rates of pulp capping, whether direct or indirect, ranges from
44%- 97%
 INDIRECT PULP CAPPING:

Reduction in permeability of the

In cases of deep and hypersensitive
dentin- achieved by sealing
cavities
dentinal tubules

LASERS USED
• Nd: YAG – 2W & 20 PPS for less
than one sec with black ink
• CO2 laser – with silver No post operative pain
ammonium fluoride solution
 DIRECT PULP CAPPING:

Sterilization of treated
Bloodless field
wound

Paschoud and Holz(1988) Melcer: successful pulp

laser treatment causes direct restoration after direct
stimulation of dentin capping of inflamed pulps
formation with laser irradiation
PULPOTOMY & VITAL PULP
AMPUTATION
One of the most anticipated laser treatment in Endodontics

Lasers used –
• CO2 laser 1- 4 W
• Nd:YAG for 2sec Carbanized layer that is formed on
the surface must be removed with
• Ga-As laser 3% hydrogen peroxide and
5.25% of NaOCl

Shoji et al 1985 -first laser

pulpotomy using CO2 laser in
dogs
• No damage -radicular portions of
irradiated pulps
• Wound healing better than
controls.
Wildar- Smith et al 1997 and Dang et al 1998 :

• found CO2 laser pulpotomy to be very successful :

 teeth with large exposure sites, subjected to bacterial
contamination for several days

 Wound healing – one week

 Dentine bridge- 4 to 12 weeks
 Success rate – 50%
PULPECTOMY AND ROOT CANAL WALL
PREPARATION
• Various laser systems emit energy that can be delivered into

the root canal system by a thin optical fiber

• Can be used in straight and slightly curved canals

• Laser with air water spay

• Laser tips placed 1mm short of the apex

• Apical region is shaped with files and reamers

Potential bactericidal effect of
laser irradiation can be used Access cavity preparation
effectively for additional • Er:YAG – 8Hz, 2W
cleaning of root canal system
following biomechanical
instrumentation

Pulpectomy
• Nd:YAG for 2W at 20PPs for
one sec,
• Multiple application with 5
sec interval
 CLEANING AND SHAPING

 CO2 laser with Ag(NH3)2 F of 9.3 to 10.49μm- effectively seals dentinal

tubules
 Nd:YAG laser with black ink

 Argon lasers

 Er:YAG- most effective

 KTP – Potassium titanyl phosphate 532nm removes smear layer and debris
• Stabholz and Colleagues 2003 developed a new endodontic tip that can be
used with an Er:YAG laser system

• The beam of Er:YAG laser is delivered through a hollow tube to allow lateral
emission of the irradiation (side-firing)a
THIS NEW ENDODONTIC SIDE FIRING
SPIRAL TUBE (RC LASE) WAS
DESIGNED TO FIT THE SHAPE AND
VOLUME OF ROOT CANAL PREPARED
BY NI-TI ROTARY INSTRUMENTS.

• Emits radiation laterally to the walls of the

root canal through a spiral split
• The tip is sealed at its far end
 LIMITATIONS OF LASERS IN CLEANING AND SHAPING

• Laser energy from tip is directed along root canal

• Not necessarily laterally to the root canal wall.

• Thermal damage to the periapical tissues

 STERILIZATION OF INFECTED ROOT CANALS

Disinfection depends on
Effective tools for killing micro-
organisms by its bactericidal effect • Laser wavelength
• Laser energy

Lasers used
• Pulsed Nd:YAG laser 2W, 20PPS with silver ammonium fluoride solution for 5 sec – 80 to
90% sterilization
• Argon lasers
• Diode lasers- 810nm CO2 lasers
• Er:YAG laser
• Nd:YAP laser 1.34μm Xe-Cl lasers – 308 nm
 Various endodontic attachments for the
Er:Cr: YSGG laser handpiece

Er:Cr: YSGG endodontic

attachment in a root canal
 PHOTO-ACTIVATED DISINFECTION

Combination of photosensitizing
Less toxic and alternative to
dye and a laser of specific
chemical disinfection
wavelength

Destroys collagen, and carious

Kills high population of bacteria
dentin
 OBTURATION OF ROOT CANALS

Laser initiates photo

Obturation with AH –plus
polymerization by
and composite resin
activation of composite
activated by Argon lasers
resin

Argon laser, CO2 laser,

Nd:YAG- soften the Argon lasers – good apical
guttapercha – vertical seal
compaction
RETROGRADE CAVITY PREPARATION:
ER:YAG LASER – 8HZ & 2W

PREVENTION OF MICRO LEAKAGE

• Sealing of dentinal tubules

• Nd:YAG laser 1 or 2W under air water cooling in

combination with silver ammonium solution

• CO2 laser
 ENDODONTIC SURGERY
Miserendino 1985 suggested that the rationale for laser use in
Endodontic periapical surgery should include :

Improved haemostasis &

Potential sterilization of
concurrent visualization of
contaminated root apex
operative field

Potential reduction of
Reduction in post operative
permeability of root surface
pain
dentin

Reduced risk of surgical site

contamination by
eliminating the use of
aerosol producing air
turbine hand pieces for
apicosectomy
 APICECTOMY STERILIZATION OF ENDODONTIC Removal of calcified
INSTRUMENTS attached denticles

• Er:YAG laser – root

resection • Argon lasers
• Er,Cr:YSGG laser • CO2 lasers • Pulsed dye lasers
• Nd:YAG lasers -504nm
• CO2 laser
SUMMARY
 CONCLUSION

• Successful use of lasers in dentistry especially endodontics relies upon the

understanding of characteristics and their limitations.

• Lack of understanding often leads to the misuse and abuse of lasers, causing

detrimental results