Multiple Applications with Er:YAG Laser in Apicoectomy - A Clinical Case Report

Abstract

An apicoectomy is usually performed after a failed root canal treatment. During the operation, the infected tissue should be removed thoroughly, and the tooth should be examined with care. If the tooth is cracked or fractured, extraction will be recommended. Surgical endodontics could be performed using Er:YAG laser on patients exhibiting periapical pathosis. It has attracted attention because of the possibility of cutting hard and soft tissues with extremely minor thermal effects. Other benefits also include bactericidal effect, and biostimulation to increase wound healing by LLLT (Low Level Laser Therapy). All of the above could promise the best prognosis to patients and the best outcome to dentists. In this article, all procedures were performed using Er:YAG laser (2940nm, LiteTouch Dental Laser, Light Instrument, Israel) with copious saline coolant under local anesthesia. The laser treatments included: incision and reflection of the mucoperiosteal flap, osteotomy over the lesion, removal of granulation tissues and gutta-percha fragments, root-end resection without retrofilling, and LLLT after wound sutures. The clinical condition of the patient was evaluated at 1 week, 1 month, and 3 months after surgery. No adverse reactions were seen during the laser irradiation procedure, and radiolusency lesion area was smaller and more opacity at 3 month checks. It is concluded that apicoectomy using Er:YAG laser would offer another option for dentists and patients to save the problematic tooth. However, improvement of the laser device and more education for dentists and patients may afford considerable advantages.