Efficacy and Safety of Photon Induced Photoacoustic Streaming for Removal of Calcium Hydroxide in Endodontic Treatment.

Markus Laky,Hermann Agis,Andreas Moritz,Melanie Volmer,Barbara Cvikl,Muazzez Arslan

doi:10.1155/2018/2845705

Markus Laky, Hermann Agis + Show 4 more

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https://doi.org/10.1155/2018/2845705

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Abstract

Calcium hydroxide removal from the root canal by photon induced photoacoustic streaming (PIPS) compared to needle irrigation and irrigation using sonic activation was investigated. Additionally, safety issues regarding apical extrusion were addressed. In endodontic treatment temporary intracanal medication like calcium hydroxide should be completely removed for long term success. For analysis, 60 artificial teeth were prepared, filled with calcium hydroxide, and divided into four groups. The teeth were assigned to needle irrigation, irrigation using a sonic device, PIPS with a lower energy setting (10 mJ, 15 Hz), or PIPS with a higher energy setting (25 mJ/40 Hz). For comparison the weight of each tooth was measured before and after calcium hydroxide incorporation, as well as after removing calcium hydroxide using the four different methods. Regarding safety issues another 24 samples were filled with stained calcium hydroxide and embedded in 0.4% agarose gel. Color changes in the agarose gel due to apical extrusion were digitally analysed using Photoshop. No significant differences were found for calcium hydroxide removal between the two laser groups. Sonic assisted removal and needle irrigation resulted in significant less calcium hydroxide removal than both laser groups, with significantly more calcium hydroxide removal in the ultrasonic group than in the needle irrigation group. For apical extrusion the higher laser (25 mJ/40 Hz) group resulted in significant higher color changes of the periapical gel than all other groups. PIPS with the setting of 10 mJ/15 Hz achieved almost complete removal of calcium hydroxide without increasing apical extrusion of the irrigation solution.

Highlights

In endodontic treatment elimination of bacteria in the root canal is crucial for the long term success of endodontic therapy [1, 2]
In the 10 mJ, 15 Hz photon induced photoacoustic streaming (PIPS) group 99,5%±10.4% of the calcium hydroxide was removed, which was similar to the 25 mJ, 40 Hz group with a removal rate of 106.7%±12.4%
Using sonic activation for removing calcium hydroxide resulted in a removal of 90%±3,6% which was significantly different to all other groups (p < 0.05) (Figure 2)

Summary

Introduction

In endodontic treatment elimination of bacteria in the root canal is crucial for the long term success of endodontic therapy [1, 2] This elimination is achieved by means of mechanical root canal preparation, antibacterial irrigation solutions, and temporary intracanal medication. Needle irrigation is the most basic procedure to clean the root canal from calcium hydroxide as well as from remaining debris This procedure lacks efficacy in the removal of bacteria and debris within the numerous ramifications in the root canal system [6]. The introduction of ultrasonic devices has greatly improved the accessibility of irrigation solutions to the root canal system Another recently introduced method for activation is photon induced photoacoustic streaming (PIPS) by means of an Er:YAG laser [7,8,9]

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