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Endo tips    Better Endo    Endo abstracts    Endo discussions

Laser & Endodontics
The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy John A Khademy

From: Fred Barnett
To: ROOTS
Sent: Sunday, December 24, 2006 9:27 AM
Subject: Re: [roots] Laser and Endodontics

Has it been shown that it can render the canal system as clean as 
with NaOCl (which we know has limitations) or bacteria-free as with 
Ca(OH)2 (which we know has limitations)?

However, these are the standards to which a laser must be judged....
or why spend thousands of dollars?

I do think lasers will be a most valuable adjunct when several issues 
are demonstrated to be true.  Perhaps PAD will do
the trick, but the laser tested by Columbia University apparently 
was no more effective than conventional methods.

J Am Dent Assoc. 2006 Jan;137(1):67-70.   L
Comment in: J Am Dent Assoc. 2006 Jun;137(6):722, 724; author reply 724, 726.
Inability of laser and rotary instrumentation to eliminate root canal infection.

Jha D, Guerrero A, Ngo T, Helfer A, Hasselgren G.
Division of Endodontics, School of Dental and Oral Surgery, 
Columbia University, 630 West 168th St., P.O. Box, 20
(PH7E-117), New York, NY 10032, USA. dm762@Columbia.edu

BACKGROUND: The authors evaluated the antibacterial effectiveness of laser 
instrumentation and rotary instrumentation of anterior, single-rooted teeth 
infected with Enterococcus faecalis. METHODS: The authors divided 35 infected 
samples into five groups: Group A: inoculation, laser, 17 percent 
ethylene-diamine-tetra-acetate (EDTA), 2.5 percent sodium hypochlorite (NaOCl) 
(n=10); Group B: inoculation, laser, 17 percent EDTA, sterile saline (n = 10); 
Group C: inoculation, rotary, 17 percent EDTA, 2.5 percent NaOCl (n=10); 
Group D: inoculation, no instrumentation (positive control) (n=5); 
Group E: no inoculation, no instrumentation (negative control) (n=5). 
They sampled and incubated dentin shavings from each canal for bacterial growth. 

RESULTS: In Group A, eight tubes were positive for bacterial growth. In
Group B, 10 tubes were positive for bacterial growth. In Group C, six tube were 
positive for bacterial growth. In Group D, all of the tubes were positive for 
bacterial growth. In Group E, no tubes showed bacterial growth. The Fisher exact
test showed no significant differences among groups A, E and C. 

CONCLUSION: Neither the laser nor the rotary instrumentation was able to eliminate
endodontic infection. CLINICAL IMPLICATIONS: Although lasers have been presented
as high-tech tools for disinfecting root canals, the laser was ineffective 
in this study.

On 12/24/06, Thomas Shimko  wrote:
His EndoLase tip was shown in the article by my mentors Prof. Stabholtz,Prof. Moshonov 
& my collegue Dr. Sachar-Helft on Roots few days ago.- Thomas

Adam Stabholz has been working on side firing for years - Russ

Both lasers and Mechanical instrumentation is flawed in reference to bacteria.

Unquestionably, a new model system needs to be developed...but I don't think PAD in 
and of itself will do it.

Reason?  You have to FORCE the stuff your gonna use to wipe out bacteria and clean 
the areas not traditionally addressed by these modalities.- Joseph Dovgan

Joey, I thought you had a new irrigation system in the works.  Do you????
Guy W. Moorman, Jr. DDS

Guy, I do have something in the works...but it's NOT just a single irrigation 
solution or mechanical mechanism.

We do have a bleach irrigant with surface modifiers that decreases surface angle.  
In addition, we can speed up the process by adding energy.  Finally we can move 
the irrigant around using electricity.  We've also got CHX that has
ionic surface modifiers with the ability to drive this stuff into the tooth as well...

I don't know how far we can drive this material into the dentinal tubles...
but it's very promisng at this point. But I don't have all the answers...and while 
the irrigants are already comming to market...they fancy irrigation stuff is at
least a year off from market - Joey D

We need something easier and more predictable.  I've started adding ethanol to 
the bleach per Pannkuk.  Hope that helps with surface tension.  Guy

Guy, Unquestionably, that's the goal...easier and more predictable.  Easier could 
be a simple substituition, say instead of bleach...the "Wiz bang Bleach".  
But I'll already predict the increased cleaning abilility will probalby be
limited.

There will be  step up by adding energy to the cleaning process...might be with 
a handpiece during the ultrasonic phase...or a handpiece during the rotary 
instrumentation phase....

Probably the ultimate extension of this will be a closed irrigating system that 
allows volumes of liquid to be done in a short 30 minute time period with multiple 
energies such as electrons and photons.

How all this will exactly plate out is only a guess at this point.  Fortunatley, 
we are alredy working to fund reseach into this - Joey D

None of this really matters until you find the canals and create some irrigant channels.
First case from today (sadly, hopelessly Fx'd): - John  A Khademy



Khademi, Your absolutely right..the Microscope is a key component.  
You gotta find the canals....Joey D

Bruce, This stuff works and I will bet my paycheck the data will verify that.  
Won't need 5 years to do it. Even without any electro/mech assist Chlor-Xtra is more 
reactive(just try some in a dish with a little pulp tissue/more stable/dissenfecting 
than standard bleach.  Its all about removing surface tension and then modifying the 
surface to allow greater contact with active/activated Chlorine Ions.- Gary

Gary, Gary, GAry, Keep in mind...you know it works in your heart...and it seems to 
work well in the lab...but that there is NO published research on it...at least not 
yet :::))))))

Ideally, a side by side comparison shou.ld be done with 5 year clinical outcomes...
and you can't shorten that time...it takes at least 5 years :::))) - Joey D

Joe, Was there ever a 5 year study on Bleach? MTAD?
We have to prove the following:
1.  Just as disinfecting as Hypo
2.  More digestive
3.  SUBSTANTIALLY greater depth of penetration
all the above can be done with results oriented research but without 5 year study.

Remember,  Chlor-Xtra is just a piece of the puzzle.
Our goal is to define an irrigation process, irrigants/time/delivery devices with 
our without electro assist.  Once we are locked and loaded then a 5 year study should 
and will be done to substantiate and validate the most effective
irrigation regiment - Gary

Gary,

There has been 5 year outcome studies with root canals using bleach...

As for MTAD...NO studies for 5 year outlook that I'm aware of.

Just because something is more digestive and has better penetration does NOT 
necessarily equate to higher success....there are tooooooo many variables.  
If someone decreases their instrumentation to a standarded #15 apical
(02) prep...will it be enough to actually get enough debrie out.  I think probably NOT.

Unquestionably the Chlor Xtra is just one piece of the puzzle...and the "ultimate" 
root canal washing and disinfecting machine is to come.  That could mean it's already 
been dreamed about :::))))

The "highest" standard will be 5 year randomized control outcome studies looking at 
traditional irrigation and treatment protocols vs the newer ones like with fancy
irrigants and delivery systems....  It will cost alot, probably at least 250K to have 
a multicenter, well controlled with IRB assistance study.  You are on the proper path..
once the variables are tamed and some knowledge developed...then it's time to lock & 
load and set the new standard for endodontics :::)))) - Joey D

Joe, I wont argue with you.  Your clinical sword is longer and sharper than mine.  
I am, but a humble product developer/manufacturer.
But.....
I am excited by what I see in the lab.
I am physiqued by the possibilities
I am convinced that the research will prove all the above.
I will share results along the way.

Thanks for your comments - Gary

Gary, It's not about my clinical sword (does it really matter who's is longer?).  
It's not about my optimisim.  It's about what research has been done.  What we can 
say with some certainty..or what has been proved.

I'm just a humble endodontist who wants answers...who thinks about things.  
Who wants my treatment to be succesful.

Hey...it's more then exciting...I think our mechanical model and our concepts 
on shaping and cleaning are about to be turned a little.  How much is this 
gonna twist things..who knows! - Joey D
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