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Lasers in endodontics: A review
Article in International Endodontic Journal · June 2000
Impact Factor: 2.97 · DOI: 10.1046/j.1365-2591.2000.00280.x · Source: PubMed





3 authors, including:
Yuichi Kimura

Petra Wilder-Smith

Ohu University

University of California, Irvine




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Available from: Petra Wilder-Smith
Retrieved on: 26 May 2016

Irvine. Japan. This article reviews the role of lasers in endodontics since the early 1970s. and ultraviolet regions with all the waves in phase capable of mobilizing immense heat and power when focused at close range. acceptance of this technology by clinicians has remained limited. clinicians began using other Page 173 Monday. Showa University School of Dentistry. 1995). and dental research. Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971. International Endodontic Journal. Japan (fax: +81 3 3787 1229. April 17. International Endodontic in dentistry and in endodontics in particular. Stern & Sognnaes (1964) and Goldman et al. laser therapy use. attempts were made to seal the apical foramen using the Nd:YAG laser (Weichman et al. carbon Correspondence: Dr Yuichi Kimura. infrared. The purpose of this paper is to summarize laser applications in endodontics. Pick 1993. root canal treatment. accepted 12 April 1999 dioxide (CO2). Matsumoto K. Lasers in endodontics: a review. and 2Beckman Laser Institute and Medical Clinic. California. much interest is developing in this promising field. 33. showa-u. 2–1-1 Kitasenzoku. Although more information regarding this laser’s interaction with dentine was obtained. A laser is a device which transforms light of various frequencies into a chromatic radiation in the visible. with growing interest in this topic in the last 5 years. 2000 11:08 AM REVIEW Blackwell Science. Indeed. Wilder-Smith2 & K. Wilder-Smith P. 33. © 2000 Blackwell Science Ltd root canal walls and periodontal tissues are also reviewed. 2000. a variety of papers on potential applications for lasers in endodontics have been published. With the potential availability of many new laser wavelengths and modes. Department of Endodontics. Many papers have been published on endodontic applications and much information has been gathered. After initial experiments with the ruby laser. 1972). researchers have investigated laser applications in dentistry. P. the use of the laser in endodontics was not feasible at that time. Since then. e-mail: yukimura@senzoku. The effects of laser on Introduction Since the ruby laser was developed by Maiman (1960). sterilization of root canals. to acid demineralization. Tokyo 145–8515. many papers on laser applications in dentistry have been published (Midda & Renton-Harper 1991. 173–185. 2000 173 . (1964) were the first to investigate the potential uses of the ruby laser in dentistry. they did find a reduction in permeability. Ohta-ku. dentinal hypersensitivity. such as argon (Ar). Subsequently. neodymium: yttrium-aluminum-garnet (Nd:YAG). Nevertheless. of enamel after laser irradiation. The essential question is whether a laser can provide equal or improved treatment over conventional care. Received 14 January 1999. root canal shaping and obturation and apicectomy. Ltd Lasers in endodontics: a review Y. Showa University School of Dentistry. University of California. Although their goal was not achieved. perhaps partly due to the fact that this technology blurs the border between technical. laser diagnosis. Matsumoto1 1 Department of Endodontics. biological. The purpose of this paper was to summarize laser applications in endodontics. sufficient relevant and interesting data were obtained to encourage further study. 173–185. summarizes many research reports from the last decade. USA Abstract Kimura Y. and erbium (Er):YAG lasers. Wigdor et al. They began their laser studies on hard dental tissues by investigating the possible use of a ruby laser to reduce subsurface demineralization. 1993. and surmises what the future may hold for lasers in endodontics. including their use in pulp diagnosis. pulp capping and pulpotomy. Keywords: dentine. The first laser use in endodontics was reported by Weichman & Johnson (1971) who attempted to seal the apical foramen in vitro by means of a high power-infrared (CO2) laser. Secondary issues include treatment duration and cost/benefit ratio.

IEJ280. 1987. and no reports on pulp injury by this method have been made. 2000 11:08 AM Laser applications for endodontics Kimura et al. 1994). This method was adopted to monitor blood flow in intact teeth in animals (Edwall et al. 1996) and 780– 820 nm (Vongsavan & Matthews 1993. Odor et al. Olgart et al. 1972). 1994). 1986. e. WilderSmith 1988a. renal cortex and skin (Morikawa et al.8 nm. Odor et al. LDF techniques are united in their validity for pulp vitality testing as they reflect vascular rather than nervous responsiveness (Tronstad 1992). 2000 Figure 1 Identification of different types of dental lasers. Zang et al. This light was detected and processed to produce a signal that was a function of the red cell flux (volume of cells illuminated × mean cell velocity). Hartmann et al. which. April 17. and that the 633 nm wavelength showed good specificity.g. the value being expressed as a percentage of full scale deflection (percentage FSD) at a given gain. 1991. These results were confirmed by Sasano (1998). Nonlaser light (peak output at 576 nm) has also been used for the detection of pulpal perfusion (Diaz-Arnold et al. 33. This original technique utilized a light beam from a helium–neon (He-Ne) laser emitting at 632. Zang et al. (1996b) reported that the 810 nm wavelength showed good sensitivity. (1997) considered it to be limited in its usefulness for human pulp vitality testing. Due to some of the inherent problems associated with this technology. Sasano et al. Figure 1 shows the identification of different types of dental Page 174 Monday. 174 International Endodontic Journal. (1996) demonstrated greatly improved results using forward scattering detection. Ingolfsson et al. 1989a). In general. 1992. Gazelius et al. 1988. 1996a). Diagnosis of blood flow in the dental pulp Laser Doppler flowmetry (LDF) was developed to assess blood flow in microvascular systems. but poor specificity. Riva et al. 173–185. Lasers He–Ne (633 nm) GaAlAs (810–830 nm) a Table 1 Laser characteristics used in LDFa Penetration ability (enamel and dentine at the thickness of 3 mm) Specificity Sensitivity 2. 1996. 1988. infrared light (780–810 nm) has a greater ability to penetrate enamel and dentine than shorter wavelength red light (632. underwent a frequency shift according to the Doppler principle. in the retina. It has not been established that laser Doppler flow meters provide a reliable indication of changes in red cell flux of pulp tissue under physiological conditions © 2000 Blackwell Science Ltd .11% good poor 3. gut mesentery. Other wavelengths of semiconductor laser have also been used: 780 nm (Watson et al. 1971. as opposed to conventional backward scattering detection. The lasers used for LDF are usually at a low-power level of 1 or 2 mW. 1987) and in man (Gazelius et al. 1996. A fraction of the light back-scattered from the illuminated area was frequency shifted in this way.8 nm) (Vongsavan & Matthews 1993). 1996b). but poor sensitivity. This information can be used as a measure of blood flow. The other use of laser for diagnostics related to endodontics was the application of an excimer laser system emitting at 308 nm for residual tissue detection within the canals (Pini et al. Odor et al. when scattered by moving red cells. Table 1 shows the laser characteristics used in LDF. Watanabe 1993.91% poor good Referred by Watanabe et al.

b Kawakami et al.6 µm) 6 mW for 2–3 min 6 mW for 1–3 min 30 mW for 0. Laser energy at 1064 nm (Nd:YAG laser) is transmitted through dentine (Zennyu et al. 1993. most of the therapies have failed to satisfy one or more of these criteria. The mechanism causing a reduction in hypersensitivity is mostly unknown. Output powers used for this treatment ranged from 0. followed by others (Moritz et al. and because of other factors (Schuurs et al.9 58 100 100 98.5–3 min. Zhang et al. Dentinal hypersensitivity Dentinal hypersensitivity can arise through incorrect tooth brushing. Gomi et al. 1992 Matsumoto et al. 1993). Effectiveness rated up to 80%. Matsumoto et al. but it is thought that the mechanism for each laser is different. and a range of therapies have been devised to alleviate this condition (Midda 1992). indication of changes in red cell flux of gingival tissue or changes in ambient light intensity. 1985. It has been suggested that He–Ne laser irradiation may affect the electric activity (action potential) and not affect peripheral A∂ or C-fiber nociceptors (Rochkind et al. 1991. Effectiveness could be up to 90%.8 nm) GaAlAs (780 nm) GaAlAs (830 nm) Nd:YAG (1. gingival recession. 1996). To date. Grossman (1935) suggested a number of requirements for treatment of this condition. Several authors have investigated the He–Ne laser emitting at 632. 1985a. Table 2 lists the lasers used for the treatment of dentinal hypersensitivity. rapid in action. inappropriate diet. In the case of low-power lasers (He–Ne and GaAlAs lasers).6 83. 1991). documenting success rates of up to 90%. Gerschman et al. Parameters used for the treatment of dentinal hypersensitivity approximate 6 mW for 1–3 min.g. 173–185. 33. and pulpal analgesia (Whitters et al. Watanabe 1993).064 µm) was first investigated by Matsumoto et al. Lan & Liu 1996). mainly sealing of dentinal tubules is achieved. these still hold true today. indicating thermally mediated effects (Funato et al. Using the GaAlAs laser. Kawakami et al. relatively painless on application. Total energy output used ranged from 1. effective for a long period. 1985c Renton-Harper & Midda (1992) Moritz et al.5 s 10–100 mJ/p for 2 min 0. These investigations demonstrated effectiveness rates averaging 72%. 1987).064 µm) CO2 (10. 1985 Matsumoto et al. as well as reduction of permeability (Bonin et al. 1995).5–2. 1992. a small fraction of the laser’s energy is transmitted through enamel or dentine to reach the pulp tissue (Watanabe et al. GaAlAs laser radiation at 830 nm has a pain suppressive effect by blocking the depolarization of C-fiber afferents (Wakabayashi et al. e. Therapy should be nonirritant to the pulp. 1985a. Wilder-Smith 1988b). The sensation of pain is generally accepted to be associated with patent dentinal tubules not covered by smear layer terminating on the root surface.8 nm (Senda et al. It is claimed that 18% of all patients have some degree of sensitivity. Jarvis et Page 175 Monday. 1989. and movement artifacts.6 100 Senda et al. 1991).5 W for 5–30 s 1 W for 5–10 s 84 90 > 85 94. 1987.5–3 min 30 mW for 0.b. 1992). Parameters used for the treatment of dentinal hypersensitivity were 30 mW for 0. 1998a.5 to 3 W. 2000 175 . and a success rate of over 90% was reported. Gelskey et al. Jabbar 1993. then also by others (Renton-Harper & Midda 1992. Mezawa et al. GaAlAs laser emissions at 904 nm have an analgesic effect on the cat tongue although mechanisms remain unclear (Mezawa et al.8 to 25 J.IEJ280. and middle output power lasers (Nd:YAG and CO2 lasers). easily carried out. 1994) and 830 nm (Hamachi et al. Using the CO2 laser at moderate laser energies. 1988). but some authors report that lasers may now provide reliable and reproducible treatment. the most frequently applied wavelengths were 780 nm (Matsumoto © 2000 Blackwell Science Ltd et al.5–3 min 30 mW for 0. 1996 Zhang et al. 1998a due to problems such as artifacts. 1990). CO2 laser irradiation may cause dentinal International Endodontic Journal. 1992 Mezawa et al. Laser applications for endodontics Table 2 Laser list used for the treatment of dentinal hypersensitivity Lasers Parameters Effective rate (%) References He–Ne (632. (1996) reported the treatment of dentinal hypersensitivity using the CO2 laser. and consistently effective.5–3 min 30 mW for 5 min 10 W for 0. 1986 Matsumoto et al. 2000 11:08 AM Kimura et al. 1995). Moritz et al. 1998a). Stimulus transmission across dentine in hypersensitive teeth may be mediated by a hydrodynamic mechanism (Absi et al. (1985c). 1986. April 17. 1989 Hamachi et al. 1986. The lasers used for the treatment of the dentinal hypersensitivity are divided into two groups: low output power lasers [He-Ne and gallium/aluminum/arsenide (GaAlAs) lasers]. without staining effects. The Nd:YAG laser (wavelength of 1.

no laser damage was found in tissues underlying the laser-ablated tissues. (1995). 1996). The outcome of pulp capping procedure. In general. 1992). 1998a). The GaAlAs laser at a wavelength of 780 nm. Moreover. (1998) found CO2 laser pulpotomy to be very successful. Jukic et al. Pulpal effects of this type of laser irradiation have been investigated. Wilder-Smith et al. devitalization and root canal treatment are not advisable until full apex formation and closure have occurred. desiccation. Direct effects on the pulp were examined using Nd:YAG laser in rats (Ebihara et al. 2000 11:08 AM Laser applications for endodontics Kimura et al. (1997a) and Dang et al. and dentine bridge formation in the irradiated pulp was stimulated at 4 and 12 weeks after operation using the Nd:YAG laser (Ebihara 1989). 33. sufficient data were obtained to encourage further study. Pulp capping and pulpotomy In mature adult teeth. (1987) first described laser treatment of exposed pulp tissues using the CO2 laser in dogs to achieve haemostasis. no damage was reported after pulpal exposure to 3 W of power for 2 s in the continuous wave mode using monkeys and dogs (Melcer et al. no histologically measurable response was observed using a power of 50 mJ/pulse at 10 Hz for 30 s (total energy: 15 J) (White et al. Ebihara et al. even in teeth with large exposure sites. 176 International Endodontic Journal. 1985). (1997). April 17. Moritz et al. and a wide range of © 2000 Blackwell Science Ltd . Thus endodontic treatment of choice comprises pulpotomy and subsequent dressing with calcium hydroxide. In immature permanent teeth. 173–185. In both cases. After CO2 laser irradiation. has become a goal. Wilder-Smith et al. yielding temporary clinical relief of dentinal hypersensitivity (Fayad et al. conventional pulp treatment options include pulp capping or root canal treatment. 1992) used the Nd:YAG laser in rats and dogs. and Dang et al. Using the CO2 laser. whether direct or indirect. It is necessary to consider the severity of dentinal hypersensitivity before laser use. Other studies into the effects of CO2 laser irradiation on dentine were performed often using scanning electron microscopy (SEM) (Silberman et al. 1997). Although this smear layer may be beneficial. Pulpal extirpation and root canal treatment are performed if pulp capping procedures are not indicated. If a laser is used for the procedures. (1985) and subsequent reports from Figueiredo et al. 1997a. subjected to bacterial contamination for several days. 1989). 1995). dentine permeability was reduced (Pashley et al. (1998b) reported that the CO2 laser was a valuable aid in direct pulp capping in human patients. For these reasons. No detectable damage was observed in the radicular portions of irradiated pulps with the CO2 laser (Shoji et al. the pulp showed exudative inflammatory changes with hyperaemia and focal degeneration of the odontoblasts immediately after irradiation (Nakamura 1987). At an output power of 10 W for 0. Although the goal was not achieved. the efficacy of lasers is higher than other methods. Wound healing of the irradiated pulp seemed to be better than that of controls at 1 week. the treatment will be unsuccessful. Similar work using the Nd:YAG laser was performed in dogs (Ebihara 1989) and rats (Kato et al. it also may harbour bacteria and bacterial products (Fogel & Pashley 1990). (1998). Modification of root canal walls Endodontic instrumentation produces organic and mineral debris on the wall of the root canal. The sealing depth achieved by Nd:YAG laser irradiation on dentinal tubules measured less than 4 µm (Liu et al. 1988) and the CO2 laser in dogs (Wilder-Smith et al.3 s in the continuous wave mode (total energy density 31 J cm–2). 1994) and confocal laser scanning microscopy (Kimura et al. (1988. the treated wound surface would be sterilized. 1985). the removal by a laser of the smear layer and its replacement with an uncontaminated chemical sealant. 1996). Their results showed that lasers facilitated pulpal healing after irradiation at 2 W for 2 s. (1997a). 1998). or sealing by melting the dentine surface. For laser use in pulp capping and pulpotomy. Weichman & Johnson (1971) first applied a laser to the root canals by attempting to seal the apical foramen in vitro by means of a high-power CO2 laser. a bloodless field would be easier to achieve due to the ability of the laser to vaporize tissue and coagulate and seal small blood vessels. and an output power of 30 mW for 3 min caused no damage to pulp tissues in monkeys (Matsumoto et al. If the laser energy is too strong. it is less effective.IEJ280. 1985d). Dang et al. with the presence of secondary dentine and a regular odontoblast layer. an appropriate parameter must be Page 176 Monday. 2000 The first laser pulpotomy was performed using the CO2 laser in dogs by Shoji et al. The Ga-As semiconductor laser was used for this purpose in mice (Kurumada 1990) and the Ar laser in swines (Wilkerson et al. is unpredictable and success rates ranging from 44 to 97% have been reported. Melcer et al. but in severe cases. After exposure to the Nd:YAG laser. in that it provides an obstruction of tubules and decreases dentine permeability.

The Nd:yttrium alminum perovskite (YAP) laser emitting at 1340 nm (Blum & Abadie 1997. attempted to seal the entrance to the root canal at the apex of a tooth in vitro. 1993.IEJ280. Levy 1992. 1994. 1995b. 1986) and Nd:YAG lasers (Rooney et al. Arima & Matsumoto 1993. frequency-doubled Nd:YAG laser emitted at 532 nm on dentine (Arrastia-Jitosho et al. 1997b. 1995a.49 µm region (Featherstone & Nelson 1987. 1993. Anic et al.64 µm (Gomi et al. Sekine et al. 2000 11:08 AM Kimura et al. The Nd:YAG laser is more popular. 1997) have also been used for this purpose. 2000). Takahashi et al. Dankner et al. which can cause bacterial dissemination (Hardee et al. Miserendino et al. 1995) and 9. 1993. and dentine permeability was reduced (Miserendino et al. Using the Nd:YAG laser Weichman et al. April 17. precautions such as a strong vacuum pump system must be taken to protect against spreading infections when using lasers in the root canal (McKinley & Ludlow 1994). 1997b) caused significant removal of peritubular dentine at relatively high fluence (10~15 J/cm2). and the Nd:YAP laser emitting at 1.4 µm FEL irradiation caused selective ablation of phosphoric acid ion and annealing. Zhang et al. 1997a. 2000 177 .0 µm (Hoke et al. and laser irradiation in the presence of Ag(NH3)2F solution enhances the effect (Zhang et al. These result suggest that 3. 1997). 1995. Machida et al. Ramskold et al. Thus. There appears to exist a potential for spreading bacterial contamination from the root canal to the patient and the dental team via the smoke produced by the laser. Fegan & Steiman 1995. Anic et al. 1998) was suggested as an effective device for root canal preparation in endodontic retreatment. 1995. (1972). 1997. The removal of smear layer and debris by lasers is possible. Argon laser irradiation can achieve an efficient cleaning effect on instrumented root canal surfaces (Moshonov et al. 1997). 1989b. 1995. 1988. Marques et al. 1995). because the laser is emitted straight ahead. the results were inhomogeneous. Laser applications for endodontics morphological changes were observed (Tanji & Matsumoto 1994. 1994. 1996. 1999). 1994). 1995. 1995. Takeda et al. Stabholz et al. 9. 1998a. 1997a). The effects of holmium (Ho):YAG laser irradiation emitted at 2. Moreover.b. 1995) irradiation was able to remove smear layer and debris from root canals. The development of a thin fibre for the Nd:YAG laser stimulated its application in root canals. 1996. Harashima et al. Harashima et al. melting and resolidification of the dentinal smear layer being observed under the SEM. Bahcall et al. the Er:YAG laser emitted at 2. 1999). Kimura et al. The effects of a Page 177 Monday. Sterilization of root canals Numerous studies into the sterilization of root canals have been performed using CO2 (Zakariasen et al. 1996. Farge et al. 1998. However. it potentiates laser effects on root canals (Zhang et al. Potassium titanyl phosphate (KTP) laser (wavelength of 532 nm) (Tewfik et al. The CO2 laser emitting in the 9. debris removal and morphological changes were facilitated by the laser irradiation with diamine silver fluoride [Ag(NH3)2F] (Eto et al. Goodis et al. caused surface fusion and inhibition of subsequent lesion progression in dentine and improved the bonding strength of a composite resin to dentine depending on laser parameters. Er:YAG laser irradiation was more effective in removing the smear layer and debris on root canal walls than the Ar or Nd:YAG laser (Takahashi et al. 1998a. 1996a. Onal et al. Debris and smear layer were removed using appropriate laser parameters (Morita 1994. Koba 1995. the effects of free-electron laser (FEL) (operating in the 2–10 µm region of the infrared) on dentine were investigated at 3. Lopes et al. and at higher energy densities thermal damage was observed. because a thin fibre-optic delivery system for entering narrow root canals is available with this device. 1999a). 1994. 1995. 1998b). 1993a. 1993. a pattern not prominent with Er:YAG laser ablation.0 µm FEL irradiation affects hydroxyl apatite crystal more than the interrod substance. the xenon chlorine (XeCl) laser (wavelength of 308 nm) can melt dentine and seal exposed dentinal tubules (Pini et al. Wilder-Smith et al. Khan et al. 1993b. 33. Cernavin 1995) demonstrated that this laser is an effective means of ablating dentine and may be suitable for cutting dentine. Since absorption of Nd:YAG laser irradiation is enhanced by black ink. In the research. Gutknecht et al. Saunders et al. 1996).b. a diode laser emitting at 810 nm (Moritz et al. Ebihara et al.4 µm (Ogino et al. however it is hard to clean all root canal walls. The Ar-fluoride (F) excimer laser emitting at © 2000 Blackwell Science Ltd 193 nm (Stabholz et al.c. 1996). 1996. International Endodontic Journal. Lopes et al. Koba et al.34 µm (Blum et al.3–10. Goodis et al. Matsuoka et al. 1998. Matsuoka et al. making it almost impossible to irradiate the lateral canal walls. 173–185. 1995. Khan et al. 1995. 1997). 1998) demonstrated that this laser irradiation can achieve complete smear layer removal. Many other lasers such as the XeCl laser emitting at 308 nm (Stabholz et al. 1995.10 µm (Stevens et al. 1984. 1996). Lee et al. 1997). All lasers have a bactericidal effect at high power that is dependent on each laser. Moshonov et al. Many reports on Nd:YAG laser preparation of root canals have been published (Dederich et al. 1993c). 1998). At specific fluences.

after laser irradiation. The results indicate that an Ar laser coupled to an optical fibre could become a useful modality in endodontic therapy. 1999a). 1999b). The results showed that the laser-treated 178 International Endodontic Journal.b). Koba 1995. No adverse effects by lasers on periodontal tissues were observed if appropriate parameters were selected.b. To achieve these goals various methods have been advocated to render the canal walls free of irregularities. 1994) and composite resin (Anic et al. The immediate drying effect of Nd:YAG laser may be due to the evaporating effect of irradiation on the exudate leaving the suspended materials to precipitate inside the canals followed by haemostatic and healing effect with subsequent inhibition of the inflammatory condition of the periapical lesion. 1997. Koba et al. 1999b). Root canal shaping and obturation Root canal shaping represents an important step in the endodontic procedure. It is necessary to improve the fibre tip and the method in order to irradiate all areas of root canal walls. Laser systems operate in various modes. Sekine et al. Ar. Koba et al. and the results showed that 60% of irradiated cases showed no or mild inflammation. The first report on the effect of the Nd:YAG laser on periodontal tissues was performed using dogs (Bahcall et al. An SEM examination revealed that laterally compacted resin fillings showed fewer voids than those obtained by vertical compaction. Inamoto et al. 1995). Effect on periodontal tissues The tooth root is in contact with the alveolar bone via the periodontal membrane and ligament. Gutknecht et al. freedom from complaints on completion of the treatment (negative percussion. the root surface temperature rise remained below 2. Since that time. Full root canal treatment The Nd:YAG laser was investigated by several researchers for clinical endodontic treatment (Morita 1994. such as continuous wave. and Nd:YAG lasers have been used to soften gutta-percha (Anic & Matsumoto 1995a. © 2000 Blackwell Science Ltd . and results indicate that the Ar laser can be used for this purpose to produce a good apical seal. 173–185. Koba et al. pulsed. The effect of Nd:YAG laser on apical postoperative exudative status was evaluated. walls are rough and uneven. many other studies on periodontal effects of lasers in dogs and rats have been published (Morita 1994. However. and Q-switched. 1998). It is useful to use lasers as an adjunct during conventional treatment. as it aids the removal of organic tissues and facilitates irrigation. It is hard to irradiate root canal walls. 1997. 1996b.2 °C (Cohen et al. 2000 teeth exhibited ankylosis. use of the Q-switched nanosecond pulsed mode is beneficial (Kimura et al. Hassan 1995. the effects on periodontal tissues must be considered. Since clean and regular root canal walls can be achieved using Nd:YAG laser irradiation. (1996b) reported a clinical success rate of 82% on the following criteria: objective reduction of apical translucence after 3–12 months. After irradiation by an Er:YAG laser. Several studies investigating laser-induced thermal effects on the pulp have been published. and major bone remodeling. To minimize the rise in tissue temperature within the target and around areas. During laser usage for intracanal applications. 2000 11:08 AM Laser applications for endodontics Kimura et al. Similar studies have been performed using the obturation material AH-26 (Zaman et al. but few studies have dealt with the effects on the periradicular tissues from energy introduced into the root canal. To make the treatment successful. It is necessary to select an appropriate laser parameter. but it is not possible to use lasers alone for treatment. 33. CO2. 1996). 1996. the root canal surface appeared smooth in the light microscope and scale-like when viewed by Page 178 Monday. April 17. 1991). The photopolymerization of camphorquinone-activated resins for obturation is possible using an Ar laser emitting at 477 and 488 nm (Potts & Petrou 1990. 5 Hz and total energy 58 J. Koba 1995. If the Ho:YAG laser was used within the root canal at the parameter below 1 W. root canal shaping using this modality has been suggested (Levy 1992). and canal obturation. chopped-wave. occlusal load without discomfort). Gutknecht et al. root canal orifices were prepared (Mazeki et al. 1998b). whereas 70% of teeth showed severe inflammation in nonirradiated cases (Hassan 1995).IEJ280. 1992). Eriksson & Albrektsson (1983) found that the threshold level for bone survival was 47 °C for 1 min. cemental lysis. Sterilization of root canals by lasers is problematical since thermal injury to periodontal tissues is possible. Using an Er:YAG laser. the parameters used in this study (3 W and 25 pps for 30 s) were excessive. Clinical follow-up examination of infected teeth at 3 or 6 months after laser irradiation and root canal filling revealed that postoperative discomfort or pain in the laser-treated group was significantly reduced compared to the nonlaser-treated group (Koba 1995. 1998a. thermal injury to periodontal tissues is of concern. It is very important to select the appropriate parameter and method.

In vitro studies using the Er: YAG laser for root resection itself in extracted teeth (Paghdiwala 1993. fusion of the fractured root halves was not achieved. laser applications in endodontics will increase. 2000 179 . tissue repairs of the low-resected root surfaces were delayed when compared with those resected with a bur. CO2. the use of this laser resulted in improved healing and diminished postoperative discomfort (Komori et al. the Nd:YAG laser was found to reduce the penetration of dye or bacteria within resected roots. 1997a). but no significant differences were reported between the groups treated with the Er:YAG laser and the ultrasonic tools with regard to dye penetration © 2000 Blackwell Science Ltd (Ebihara et al. SEM evaluation showed a sharp surface at the base of the pulp stone after the removal. 1996). Use of this laser for retrograde cavity preparation in extracted teeth showed that the working time with the Er:YAG laser is significantly less than with ultrasonic tools. 1992). CO2. 2000 11:08 AM Kimura et al. 1997b) and dogs in vivo (Friedman et al. Yokoyama et al. If the cut surface is irradiated. Arens et al. Laser use during surgery appeared not to affect treatment results or hinder healing.b. lasers can be developed that will provide dentists with the ability to care for patients with improved techniques and equipment. 1994). devoid of charring. Powell & Whisenant 1991). regardless of the reapproximation Page 179 Monday. more flexible and durable laser fibres. Ideally. CO2 and Nd:YAG lasers have been used for the attempted treatment of root fractures (Arakawa et al. There have been no reports on clinical use of this laser for apicectomy. Clinical investigations into laser use for apicectomy began with the CO2 laser (Miserendino 1988). Results indicated all three lasers (Ar. 33. laser type. The sealing ability of this laser was less than that of the Er:YAG laser. it is necessary to investigate their effects. Hooks et al. Ebihara et al. Laser applications for endodontics Apicectomy Apicectomy is a surgical procedure in which the root apex is removed. clean resected root surfaces. It may be possible to use lasers for other treatments. but it takes more time to perform when compared to more conventional methods. either in extracted human teeth in vitro or in rats in vivo (Maillet et al. energy. Adams D (1987) Dentine hypersensitivity. April 17. which was successfully used for the treatment of a secondary apical abscess. Clinically. however. Nd:YAG lasers) have been used successfully to sterilize dental instruments (Adrian & Gross 1979. appropriate irradiation systems need to be developed. clinical studies were performed using the Nd:YAG laser (Sumitomo & Furuya 1988). and other parameters used. but before they can be recommended. 1991a. Nd:YAG lasers) are capable of sterilizing selected dental instruments. Moritz et al. However. Conclusion With the development of thinner. Once our knowledge of optimal laser parameters for each treatment modality is complete. 1998). The use of this laser was expected to seal the dentinal tubules in the apical portion of the root and to sterilize the affected area. 1996c. The indications for resection are mainly when previous root canal treatment has not been successful. Using extracted teeth in vitro (Stabholz et al. CO2 laser suitability for this purpose was examined using extracted teeth in vitro (Neiburger 1989. Wong et al. Moreover. 1992a. References Absi EG. Lasers (Ar. Read et al. The Ho:YAG laser has also been evaluated for apicectomy in extracted teeth (Komori et al. 1980.b. However. 1996. 1997b). the argon laser was able to do so consistently at the lowest energy level of 1 W for 2 min. In the above investigations.IEJ280. Next. 1994). 1996a. the laser was used after root resection. access to them is limited. 1995. Since laser devices are still relatively costly. Addy M. Before application of this knowledge to the clinical situation. 1993. when this laser was applied to patients receiving apicectomies (Bader & Lejeune 1998). the adjacent periapical tissues are removed and curretted at the same time. If a laser is used for the surgery. When the laser was used for resection itself. A study of the patency of dentinal tubules in sensitive and International Endodontic Journal.b. Other applications for the endodontic treatment A pulsed dye laser emitted at 504 nm was used for the removal of a calcified attached denticle (Rocca et al. a bloodless surgical field should be easier to achieve due to the ability of the laser to vaporize tissue and coagulate and seal small blood vessels. The use of laser for apicectomy procedure has some merits. it did not improve the healing process. the laser in the future will have the ability to produce a multitude of wavelengths and pulsewidths. each specific to a particular application. 1997) achieved excellent results with the smooth. 1996). the surface is sterilized and sealed. Subsequently. the potential of the Er:YAG laser to cut hard dental tissues without significant thermal or structural damage would eliminate the need for mechanical drills. 173–185.

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