Principle and antimicrobial efficacy of laser-activated irrigation: A narrative review.

In the last two decades, the activation of root canal irrigants with pulsed lasers as an adjunct in root canal treatment has become increasingly popular. This narrative review explains the physical basics and the working mechanism of laser-activated irrigation (LAI), explores the parameters influencing LAI efficacy, considers historical evolutions in the field and summarizes laboratory and clinical evidence with emphasis on the antimicrobial action of LAI. Cavitation is the driving force behind LAI, with growing and imploding vapour bubbles around the laser tip causing various secondary phenomena in the irrigant, leading to intense liquid dynamics throughout the underlying root canal.

A 22-year follow-up cross-sectional study on periapical health in relation to the quality of root canal treatment in a Belgian population.

Aim: To investigate the prevalence of apical periodontitis (AP) and the technical standard of root canal treatment in a Belgian population, assess the association of different variables with periapical status, and compare the results to a similar study conducted 22 years previously.

Methodology: In this cross-sectional study, 614 panoramic radiographs of first-time adult attendees at the Dental School of the University Hospital of Ghent were examined. Recorded patient-level parameters included gender, age, number of teeth, number of root filled teeth, presence of any AP lesion, and number of implants.

Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A systematic review and meta-analysis.

Objectives: Different materials have been used for capping the pulp after exposure during caries removal in permanent teeth. The purpose of this study was to collate and analyze all pertinent evidence from randomized controlled trials (RCTs) on different materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth.

Materials And Methods: Trials comparing two or more capping agents used for direct pulp capping (DPC) or pulpotomy were considered eligible.

Protocols for cleaning the incisor access cavity contaminated with epoxy resin sealer.

This study compared different methods for cleaning the sealer-contaminated access cavity of upper incisors. After standard endodontic access, the canals of 50 extracted maxillary incisors were chemomechanically prepared and obturated with gutta-percha and epoxy resin sealer. Teeth were randomly assigned to one of five different pulp chamber cleaning protocols (n = 10): air/water spray, ethanol-saturated cotton pellet (CP), ethanol-saturated microbrush reaching the root filling (MB), MB + air polishing (PROPHYflex; KaVo), or MB + etching with 37% phosphoric acid.

Explaining the working mechanism of laser-activated irrigation and its action on microbial biofilms: A high-speed imaging study.

Aim: Laser-activated irrigation (LAI) using pulsed erbium lasers has been studied with regard to canal cleaning, but its working mechanism remains poorly understood. This study sought to unravel the method of action of LAI and to assess its effect on bacterial biofilms in a root canal model, by means of high-speed imaging.

Methodology: A root canal model consisting of dentine and glass walls was used.

Model system parameters influence the sodium hypochlorite susceptibility of endodontic biofilms.

Aim: To evaluate in a laboratory setting the influence of several model system parameters on the sodium hypochlorite (NaOCl) susceptibility of endodontic biofilms. Based on these findings, a relevant in vitro endodontic biofilm model is proposed.

Methodology: In vitro biofilms were cultured, varying the following experimental model parameters: biofilm composition (monospecies Enterococcus faecalis and a multispecies biofilm including E.

Efficacy of different irrigation technique in simulated curved root canals.

The aim of this study was to assess the influence of the canal curvature on the efficacy of sonically, ultrasonically, and laser-activated irrigation in removing a biofilm-mimicking hydrogel (BMH) from simulated canal irregularities. Transparent resin blocks containing a curved root canal (40° or 60°) were used as test models. A 4-mm groove at 1 mm from the apex was filled with BMH.

The Decisive Role of Laser Doppler Flowmetry for Pulp Preservation in Discolored Traumatized Teeth.

: It has been stated that blood pigments within discolored teeth may interfere with Laser Doppler Flowmetry (LDF) measurements. The aim of this study was to assess pulp vitality with LDF in a cohort of discolored traumatized teeth referred for endodontic treatment or where the referring dentist had doubts regarding maintained tooth vitality. Discoloration of teeth is a common sequel of dental trauma.

Adjunctive Steps for the Removal of Hard Tissue Debris from the Anatomic Complexities of the Mesial Root Canal System of Mandibular Molars: A Micro-Computed Tomographic Study.

Introduction: This in vitro study sought to compare the efficacy of a sonic irrigant activation device with ultrasonic activation and needle irrigation in removing hard tissue debris (HTD) from anatomic complexities of the root canal system.

Methods: Twenty-seven mesial roots of extracted human mandibular molars with 2 canals connected by an isthmus were selected based on micro-computed tomography scans (12-μm voxel size). The mesial canals were mechanically prepared to ProTaper Next X3 (Dentsply Maillefer, Ballaigues, Switzerland) and anatomically distributed into 3 groups (n = 9) according to the final irrigation protocol: sonically activated irrigation (SAI) using the EDDY system (VDW GbmH, Munich, Germany) for 3 × 20 seconds, ultrasonically activated irrigation (UAI) using a size 20 Irrisafe tip (Satelec Acteon, Mérignac, France) for 3 × 20 seconds, and conventional irrigation using a 30-G needle adapted to a syringe.

The efficacy of ultrasonic and PIPS (photon-induced acoustic streaming) irrigation to remove artificially placed dentine debris plugs out of an artificial and natural root model.

The aim was to validate an artificial resin 'root canal wall groove model' (RCWGM) mimicking the situation of natural roots with a groove of identical dimensions on debris removal out of these grooves, and to evaluate Erbium 'laser-activated irrigation' (LAI) with two conical tips at PIPS (photon-induced photoacoustic streaming) settings, with different activation times and different root canal positions on debris removal out of the grooves. A split RCWGM was used (resin blocks and roots of maxillary canines) with a canal size 40/0.06.

Comparison of apical irrigant solution extrusion among conventional and laser-activated endodontic irrigation.

The aim of this study was to determine the amount of extruded endodontic irrigant among needle-syringe irrigation (NSI) and laser-activated irrigation (LAI) regimens. Twenty extracted maxillary central incisors were prepared utilizing GT professional rotary files (size 40, taper 0.06).

Impact of Different Irrigant Agitation Methods on Bacterial Elimination from Infected Root Canals.

Activation techniques are essential for root canal disinfection but may result in incomplete removal of bacteria. The aim of our study was to assess the antibacterial action of sonically, ultrasonically and laser-activated irrigation and 5.25% sodium hypochlorite (NaOCl) on in an infected tooth.

How standard deviation contributes to the validity of a LDF signal: a cohort study of 8 years of dental trauma.

The aim of this cohort study was to document the potential of laser Doppler flowmetry (LDF) for diagnosing tooth vitality in traumatized teeth in a population of 88 referred patients with dental trauma over a period of 8 years (2011-2018). The main reason to refer was tooth discoloration (26%), and the main trauma cause was a traffic injury (35%). Taking into account that referral for LDF is best given within the week after trauma, 66% of referrals were overdue.

In vitro evaluation of experimental light activated gels for tooth bleaching.

Dental bleaching is an important part of aesthetic dentistry. Various strategies have been created to enhance the bleaching efficacy. As one such strategy, light-activated nanoparticles that enable localized generation of reactive oxygen species have been developed.

Debris Removal from the Mesial Root Canal System of Mandibular Molars with Laser-activated Irrigation.

Introduction: The purpose of this study was to compare in vitro the canal and isthmus debridement of manual-dynamic, passive ultrasonic, and laser-activated irrigation with an Er:YAG laser in mesial roots of human mandibular molars.

Methods: Fifty extracted mandibular molars with an isthmus were embedded in resin and sectioned axially 4 mm from the apex. The teeth were reassembled with guide pins and bolts, and the mesial canals were instrumented up to a ProTaper F2 rotary file (Dentsply Maillefer, Ballaigues, Switzerland).

Diurnal variations and pulpal status: is there a need for FFT besides LDF?

The aim of this article was to investigate the use of laser Doppler flowmetry (LDF) combined with a fast Fourier transformation (FFT). LDF data in relation to three different scenarios were evaluated: (a) LDF records of a right central upper incisor of one patient were used for FFT analysis. These records were obtained by means of 30 pre-manufactured splints, handled by dentists without any experience in LDF recording.

Influence of a calcium hydroxide-based intracanal dressing on the quality of the root canal filling assessed by capillary flow porometry.

Objective: The objective of this study is to evaluate the influence of a calcium hydroxide intracanal dressing (CH) on the short- and long-term sealing ability of the root canal filling using capillary flow porometry (CFP).

Materials And Methods: To verify the repeatability of the method, five obturated specimens were submitted to CFP. Measurements were repeated three times and compared with the non-parametric Friedman test.

Laser Doppler flowmetry: reproducibility, reliability, and diurnal blood flow variations.

The aim of this investigation was (1) to evaluate the reliability of laser Doppler flowmetry (LDF) taking into consideration the use of a silicone splint and the inclination of the probe towards the buccal surface of a human tooth and (2) to determine whether diurnal variations of pulpal blood flow can be registered by means of LDF. Forty-one splints were made by one and the same principal investigator for the registration of pulpal blood flow in vivo in a maxillary right central incisor. Thirty dentists, without experience in LDF recording, were then asked to drill a right-angled shaft in a pre-manufactured splint with a referral point at 2 mm from the enamel-cement border central on the buccal surface of the right central upper incisor.

Influence of lasing parameters on the cleaning efficacy of laser-activated irrigation with pulsed erbium lasers.

Laser-activated irrigation (LAI) using erbium lasers is an irrigant agitation technique with great potential for improved cleaning of the root canal system, as shown in many in vitro studies. However, lasing parameters for LAI vary considerably and their influence remains unclear. Therefore, this study sought to investigate the influence of pulse energy, pulse frequency, pulse length, irradiation time and fibre tip shape, position and diameter on the cleaning efficacy of LAI.

Three-dimensional finite element analysis of anterior two-unit cantilever resin-bonded fixed dental prostheses.

The aim of this study was to evaluate the influence of different framework materials on biomechanical behaviour of anterior two-unit cantilever resin-bonded fixed dental prostheses (RBFDPs). A three-dimensional finite element model of a two-unit cantilever RBFDP replacing a maxillary lateral incisor was created. Five framework materials were evaluated: direct fibre-reinforced composite (FRC-Z250), indirect fibre-reinforced composite (FRC-ES), gold alloy (M), glass ceramic (GC), and zirconia (ZI).

Laser teeth bleaching: evaluation of eventual side effects on enamel and the pulp and the efficiency in vitro and in vivo.

Light and heat increase the reactivity of hydrogen peroxide. There is no evidence that light activation (power bleaching with high-intensity light) results in a more effective bleaching with a longer lasting effect with high concentrated hydrogen peroxide bleaching gels. Laser light differs from conventional light as it requires a laser-target interaction.

Insight in the chemistry of laser-activated dental bleaching.

The use of optical radiation for the activation of bleaching products has not yet been completely elucidated. Laser light is suggested to enhance the oxidizing effect of hydrogen peroxide. Different methods of enhancing hydrogen peroxide based bleaching are possible.

In Vivo Intracanal Temperature Evolution during Endodontic Treatment after the Injection of Room Temperature or Preheated Sodium Hypochlorite.

Introduction: Heating a sodium hypochlorite solution improves its effectiveness. The aim of this study was to measure the in vivo temperature changes of sodium hypochlorite solutions that were initially preheated to 66°C or at room temperature inside root canals during routine irrigation.

Methods: Thirty-five root canals were prepared to ISO size 40 with 4% taper.

Treatment of dentinal hypersensitivity by means of Nd:YAP Laser: a preliminary in vitro study.

Objective: The aim of this study is to evaluate the effectiveness of Nd:YAP laser to seal dentinal tubules at different parameters.

Material And Methods: 24 caries-free human wisdom impacted molars were used. The crowns were sectioned transversally in order to totally expose the dentin.

Visualization of removal of trapped air from the apical region in simulated root canals by laser-activated irrigation using an Er,Cr:YSGG laser.

The aim of this visualization study was to obtain a better understanding of the mechanism by which trapped air is removed from the apical region of simulated root canals by activation of an irrigant using an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser during endodontic procedures. A high-speed imaging system with high temporal and spatial resolution was used to visualize laser-induced shock waves in a resin block model with a curved root canal (inner diameter at the apex 0.08 mm, taper 4 %, crown height 10 mm, overall length 40 mm) and a glass cylinder model with a straight root canal (inner diameter 1 mm, crown height 10 mm, overall length 40 mm).