Forums Nd:YAG lasers General Nd:YAG Forum Nd:YAG and Endo

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  • #2701 Reply

    etienne
    Spectator

    I had a patient that presented today with a huge lesion apical to tooth # 24. I could only manage to pass a number 6 file up to the calcification that is evident on the pre-op x-ray. I did not take another x-ray at this point.[img]https://www.laserdentistryforum.com/attachments/upload/pre-op_resize1.JPG[/img]

    After trying unsuccesfuly to get down further into the root canal I used my Nd:YAG laser at 100mJ, 15Hz and 300usec PD to try and remove the calcification. The reasoning was that the 1064nm wavelength would selectively remove the dark secondary dentine (and calcification). It seemed to work perfectly!!

    [img]https://www.laserdentistryforum.com/attachments/upload/post lase_resize1.JPG[/img]

    Take care
    Etienne

    #5389 Reply

    djackson
    Spectator

    very cool. Thanks for this tip!

    #5402 Reply

    Robert Gregg DDS
    Spectator

    Excellent Etienne!

    Nice job!   It works……..

    http://bookstore.spie.org/index.cfm?fuseaction=DetailPaper&ProductId=137376&coden

    Bob

    #5399 Reply

    whitertth
    Spectator

    Nice job…why not try and go to the apical area as well to obliterate the lesion before filling the tooth with sealer and GP? Just a thought…..

    #5391 Reply

    etienne
    Spectator

    Thanks guys! The idea is to use the laser again up to the apex after shaping has been completed. This was just an emergency procedure between regular patients. I’ll post the x-ray when the endo is completed and then also try to get a follow up later on.
    Take care
    Etienne
    PS: Sorry, there was a mistake in the original post, PD was 50usec. The fiber was 200micron.

    #5396 Reply

    etienne
    Spectator

    Hi Bob
    Thanks for the LINK. I should have known you have done this!!! ;))
    Take care
    Etienne

    #5392 Reply

    etienne
    Spectator

    Hi, I saw my patient for a follow up appointment today. He reported NO pain at all after his previous appointment. I prepared the canal, used the laser again and placed Ca(OH) into the canal.

    This is a picture that I took today.

    [img]https://www.laserdentistryforum.com/attachments/upload/Ca(OH)resize.JPG[/img]

    In my opinion bone growth has started after only 6 days..what do you guys think?

    Take care
    Etienne

    #5400 Reply

    Robert Gregg DDS
    Spectator

    Etienne,

    I think you’d best adjust the bite and composite splint. Look at the mid-root defect. That’s from trauma…..

    Bob

    #5393 Reply

    etienne
    Spectator

    Thanks Bob! I was wondering whether somebody would pick it up 😉

    Do you think bone regeneration is evident or is this a case of seeing what I want to see?
    Take care
    Etienne

    #5403 Reply

    Robert Gregg DDS
    Spectator

    Probably too early to see bone at 6 days, but if you splint it, the bone will come.

    #5397 Reply

    etienne
    Spectator

    Hi Bob
    I guess what it boils down to is the question whether there is an advantage in using laser for endo. I am fairly sure that getting bone regeneration with conventional endo in this case would have been possible. Does the laser make it more predictable? Does it happen quicker? I know what my purely anecdotal, biased feelings are. Prove one way or the other would be nice. If there is no difference, it is just an expensive gimmick…What are your feelings about this?
    Take care
    Etienne

    #5404 Reply

    Robert Gregg DDS
    Spectator

    Well Etienne,

    I think that is a good question.

    Sure, bone will fill in these defects cuz we create a “closed system” when we do a decent RCT. Antibiotics and anti-inflamatories tip the healing in favor of complete resolution.

    Will it be more predictable? Perhaps, since we get a measure of disinfection where pathogens may have penetrated into deeper tublues and accesory canals beyond our NaOCL alone.

    Will it be faster? Again, the evidence suggests it might. There is evidence that all laser wavelengths, from visible red to far infra-red have anabolic effects in injured/diseased tissue.

    I tend to reserve it for acute, septic, draining lesions for an added measure of decontamination. If the canal PEO is large enough, I will even run the fiber out the apex and into the peri-apical lesion, and lase for about 15 seconds.

    Bob

    #5390 Reply

    etienne
    Spectator

    Hi Bob
    My thoughts are that the dentinal tubuli are approx 2um in diameter. Research has suggested that a half hour soak with warm NaOCL will sterilize up to 100um into the tubulis but that bacteria can penetrate up to 1000um into the tubulis. Because laser (FRP Nd:YAG) can decontaminate up to 1300um by penetrating through the tissue (not reliant on penetrating into the tubuli) in about 15 seconds it sure makes sense to me. The other benefit is of course the biostimulation in the periapical lesion which facalitates healing.
    Am I on the right track here?
    Any other thoughts?
    Take care
    Etienne

    #5405 Reply

    Robert Gregg DDS
    Spectator

    Hi Bob

    My thoughts are that the dentinal tubuli are approx 2um in diameter. Research has suggested that a half hour soak with warm NaOCL will sterilize up to 100um into the tubulis but that bacteria can penetrate up to 1000um into the tubulis.

    1000 microns = 1mm

    So 100 microns (or the diameter of a human hair) isn’t very deep to clean with a 30 minute soak in NaOCL, I don’t think…..

    Because laser (FRP Nd:YAG) can decontaminate up to 1300um by penetrating through the tissue (not reliant on penetrating into the tubuli) in about 15 seconds it sure makes sense to me.

    Harris has shown 2mm or 2000 microns depth of kill into root dentin, and I forget the exposure time or light dose.  But it might be on his website:

    http://www.biomedicalconsultants.com/projectandpublications.html

    The other benefit is of course the biostimulation in the periapical lesion which facalitates healing.

    Am I on the right track here?

    I think so….Our references are similar.

    Any other thoughts?

    Not right now.

    You too,

    Bob

    Take care
    Etienne

    #5398 Reply

    etienne
    Spectator

    Hi Bob, just thinking out loud here…the laser can’t heal anything, can it? It can just contribute to creating an environment where the body can heal itself. By biostimulating it can also enhance the healing mechanism and speed up certain intracellular recations. Am I on the right track here? Any other thoughts? Anybody else?
    Take care
    Etienne

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