Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › Laser use in endo
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AnonymousGuestAs some of you know, I just retured from taking Barry Musikant’s Safesider course. I had not done any endo in about a dozen years or so. Now, of course, I have all these questions about incorporating lasers in endo.
I would like to get some feedback on how lasers are being used in endo, in the real world (also posted some of the lit. in the endo literature section).
In your feedback could you include what wavelength ( ndYAG, erYAG ,er,crYSGg, diode, etc), what it is you’re trying to achieve with the laser (preparation, sterilization,etc.), irrigant used (water, sodium hypochlorite,etc), and laser parameters?
Thanks!
Glenn on the roadSpectatorRon I will send you the latest chapter in Dental Clinics of North America tonight at home by PDF on endo written by Dr. Stabholtz from Israel.
Read it last night and it was good.
Hope that will help you. It wont shape the canals but I use it before I fill for 30 secs (erbium) , in between visits on 2 appt. endos, and also on retreatments as bleach wont kill enterococcus Faecalis but lasers will.
Diodes , NdYags will close the tubules, erbium family open them up.
Real problem is the apical 2 mm unless you have the cool looking tip from Opus (cheese grater) which is not end cutting but side cutting. The other laser companies need to make one like that . It would prevent iatrogenic widening of the apical foramen if you get the laser to the last two mm.
Glenn
PS send me an email to remind me of the PDF information
Glenn
2thlaserSpectatorGlenn,
I have used “side cutting” endo fibers from Biolase. They work really cool. In addition, I think everyone forgets that even at .5W one gets nice ablation in dentin. Also, everyone needs to remember that even 3mm past the tip, there is sufficient energy to ablate, and “clean” out the periapex. I have started a study on minimally invasive endodontics that should be quite interesting I think. Especially with today’s latest resin sealing techniques that seem to be on the way of eliminating the use of GP in canals. I can post some SEM’s that Jim Jesse had done at Loma Linda if everyone wants, just have to resize them for the forum, very interesting stuff. I think with opening the tubules, you combine the hydrophillic resin sealers, and so far, I have seen incredible results, I add, without using ANY NaOCl irrigation whatsoever, due to the smear layer removal of the wavelengths.Mark
jetsfanSpectatorRon,
I purchased Barry’s safe siders at last years GNYDM. It is a simple system to use. Iwill almost always finish up(sterilize and open tubules) with the Ztips for the waterlase. I will use it at 1.25W 24W 34A. I always start no closer than 3mm from apex.
The one complaint I have is that is is difficult to tell the Z3 and Z4 tips apart.
From time to time I will just instrument apex to a 30 file , then use the Z tipsFor shaping, sterilzation and opening tubules). I will always go back to the apex with the last hand instrument. For irrgation I like chlorox, but I keep cholox out of the canal when I use the laser.Robert
drkddsSpectatorHi All.
My Hoya rep recently gave me an endo tip. I am still not ready to use it, however. From what I’m reading – 0.5W w/ air and H2O, start no less than 3mm from apex. Pull out slowly (~30 sec.). No Clorox in the canal w/ laser. How many times to do this? Why air/H2O? Will the air/H2O actually get into the canal?
drnewittSpectatorHey Ron
one of the area you may want to look into is PAD (photo activated disinfection) technology in Endo Treatment. Dr Laurence Walsh at the Uni or Queensland has done a lot of work with PAD and is working on PAD in endodontics.
The results look promising with very high bacterial kill rates. The lasers generally used in PAD are the 635 nm diode laser or a 632.8 nm HeNe, along with a specific bacterial stain. ( tolonium chloride for example)
The technology is also being used in perio treatment and studies are ongoing with respect to many other areas of laser activated disinfaction, including mutans, candida, and onychomycosis.
comming soon to a laser dentist near you.
Paul
whitertthSpectatorglenn, can u send me the chapter as well..I would be interested to read it..
Thanks
Glenn van AsSpectatorRon, please send me an email……….
Then I will send it to you.
I have lost alot of the emails I had when I switched over to Outlook from Express.
Thanks and take care
Glenn
Robert Gregg DDSSpectatorRon,
My list for FRP Nd:YAG in endo:
1. Pulp tester to determine hyperemia, necrotic canalas, etc. (20Hz)
2. Find calcified canals (10Hz)
3. Open calcified canals (10Hz)
4. Vaporize cement around silver points (10Hz)
5. Vaporize cement around posts. (10Hz)
6. Vaporize screw pins in dentin. (10Hz)
7. Vaporize gutt percha (20Hz)
8. Vaporize broken SS files (10Hz)
9. Decontaminate canals prior to fill with NaOCL. (15Hz)
10. Melt GP after packing (repaces Heat N’ Touch). Safer than HNT. (100Hz)Always short pulse duration = 100usec.
250 to 300 mj/p for settings at (10Hz). 150- 200 mj/p for (20Hz). 40 mj/p doe (100Hz)
Bob
Dan MelkerSpectatorRon,
My son is in his second year of Endo at Fla. and we have been talking alot about the laser. Just thoughts and questions:
1. Laser obviously does great job with the smear layer, any thoughts on th isthmus and fin areas where the laser cannot directly contact?
2 Curves are a problem for the laser?
3. An article about apicos showed where lasers contacted surface area there were no fibroblasts?
Ron, I know you just took a course and I am real curious about what you learned, especially my son.
Thanks,
Danny
Glenn van AsSpectatorDanny send me an email and I will send you something on lasers and endo…… a chapter for you to forward to your son.
Glenn
AnonymousGuestDanny,
I’ve been out of the office a week so today is a zoo. I’ll be brief but revisit this in the future.The class I took was using Safesiders in endo and it was not laser related. There has been some discussion about using lasers in endo and I wanted to get an idea where things stood.
As far as your questions,
1. those areas and curves could be a problem although the er,crYSGG has some tips that bend pretty well. The ‘end cutting’ only still seems to be a problem, at least in my thinking. The ndYAG fiber is very flexible and isn’t as strongly absorbed in h20 so there will be more penetration. The target is also pigment so it seems to me to be a better option for ‘sterilizing’ canals or getting to the tissue you described.
2. thanks for the article, just scanned it. Somewhere I have some lit. that shows stimulation of fibroblasts so this may be a wavelength/target isssue.Finally, I plan to investigate a little more. Maybe Bob can comment, why not use the ndYAG also w/ NaOCL in the canal since some believe in warming the NaOCL?
Dan MelkerSpectatorRon,
I am realy seeing how this process with the laser is transforming. Seems like with all literature the outcome can be determined before the experiment.
Let me know the otherside of the coin please.
Thanks,
Danny
Dan MelkerSpectatorThanks Ron,
As I suspected! Thanks for the otherside. It will give my son something to read.
Danny
Robert Gregg DDSSpectatorQUOTEQuote: from Ron Schalter DDS on 1:03 pm on Nov. 29, 2004Finally, I plan to investigate a little more. Maybe Bob can comment, why not use the ndYAG also w/ NaOCL in the canal since some believe in warming the NaOCL?
Ron,
My list for FRP Nd:YAG in endo:
1. Pulp tester to determine hyperemia, necrotic canalas, etc. (20Hz)
2. Find calcified canals (10Hz)
3. Open calcified canals (10Hz)
4. Vaporize cement around silver points (10Hz)
5. Vaporize cement around posts. (10Hz)
6. Vaporize screw pins in dentin. (10Hz)
7. Vaporize gutt percha (20Hz)
8. Vaporize broken SS files (10Hz)
9. Decontaminate canals prior to fill with NaOCL. (15Hz) :biggrin:
10. Melt GP after packing (repaces Heat N’ Touch). Safer than HNT. (100Hz)Always short pulse duration = 100usec.
250 to 300 mj/p for settings at (10Hz). 150- 200 mj/p for (20Hz). 40 mj/p doe (100Hz)
Bob
Total Posts: 1017 | Joined Sep. 2002 | Posted on: 11:09 am on Nov. 28, 2004 | IP -
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