Apical Extrusion of Root Canal Irrigants When Using Er:YAG and Er,Cr:YSGG Lasers with Optical Fibers: An In Vitro Dye Study

doi:10.1016/j.joen.2008.03.003

Journal of Endodontics

Volume 34, Issue 6, June 2008, Pages 706-708

https://doi.org/10.1016/j.joen.2008.03.003 Get rights and content

Abstract

Because of the potential for irritant reactions in the periapical region, irrigant solutions must be constrained within the root canal. We examined fluid extrusion beyond the apical constriction by pressure waves generated by pulsed middle infrared lasers using needles and Max-I-Probes (Dentsply) as controls. Both free-running pulsed Erbium: Yttrium Aluminum Garnet (Er:YAG) and Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) lasers with bare or conical fiber tips at distances of 5 or 10 mm from the apex displaced fluid past the apex. Larger apical openings showed greater extrusion of fluid. The volume of extruded fluid was similar to conventional 25-G needles, but fluid was distributed further from the apex. Because pulsed lasers create pressure waves in irrigant fluids within the root canal, the potential for extrusion of fluid from the apex should be considered when assessing intracanal laser treatments in endodontics.

Section snippets

Sample Preparation

A total of 16 recently extracted single-rooted human maxillary anterior teeth that had been collected from older adult periodontal patients undergoing clearances were stored in water saturated with thymol. The teeth comprised 6 maxillary incisors and 10 maxillary canines. All teeth had straight root canals of similar size to reduce effects of canal size and curvature on the extrusion of irrigant. Patency of the apical opening was confirmed with an International Organization for Standardization

Results

Dye extrusion was seen in all groups, except for the Max-I-Probe when used at a 10-mm distance from an ISO #15 apex. There were significant effects for needle type (conventional > Max-I-Probe), treatment type (laser = conventional needle > Max-I-Probe), and apex size (ISO #20 > #15). There were no significant effects for the variables of laser type (Er:YAG = Er,Cr:YSGG) or optical tip design (straight = conical ends). The variable of distance of the instrument tip from the apex was only

Discussion

This study shows that apical extrusion occurred with both lasers when used with different fiber types and at different working distances. Because the laser fibers were placed passively in the canals and did not occupy the majority of the canal space, no dye extrusion occurred merely from the action of placing the fiber.

In contrast to laser treatment and conventional irrigating needles, the Maxi-I-probe gave very little extrusion. The conventional 25-G needle showed the same extent of apical

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Cited by (91)

Effect of SWEEPS and PIPS techniques on dye extrusion in photodynamic therapy procedure after root canal preparation
2023, Photodiagnosis and Photodynamic Therapy
The aim of this study is to measure and compare the amount of apical extrusion of the methylene blue as photosensitizer using Laser-activated irrigation(LAI) techniques (SWEEPS, PIPS) and photodynamic therapy (PDT).
40 single-rooted premolar teeth were selected and their root canals were cleaned and prepared. The photosensitizer, Methylene blue (MB), was used as dye which applied inside the root canals and the access cavities. Then the teeth were randomly allocated to 4 groups. Different techniques (SWEEPS, PIPS, PDT) were used in 3 groups. One group received no activation. Data related to the concentration of the extruded methylene blue was measured using ultraviolet and visible (UV–Vis) absorption spectroscopy. Absorption peak intensity of MB in the wavelength of 668 nm was considered as the concentration index according to Beer Lambert law. Taking into account the normal distribution of this data, one-way ANOVA analysis was used to evaluate the effects of the independent variables on the amount of apical extrusion of the irrigant.
Based on the results of ANOVA analysis, there was no significant difference between the amounts of apical extrusion of MB between different groups (p = 0.628)
Using SWEEPS and PIPS techniques, despite diffusion of the photosensitizer, didn't lead to any difference in the amount of apical extrusion. Therefore, these LAI techniques can be used safely for root canal irrigation.
Comparative effects of erbium-doped yttrium aluminum garnet laser, the shock wave-enhanced emission photoacoustic streaming, and the conventional needle irrigation on apical extrusion of irrigants
2022, Photodiagnosis and Photodynamic Therapy
This study compared the effects of erbium-doped yttrium aluminum garnet (Er:YAG) laser with the shockwave-enhanced emission photoacoustic streaming (SWEEPS) protocol and the conventional needle irrigation (CNI) on extrusion of irrigants through the root apex of molar teeth with different apical diameters.
In this ex vivo experimental study, access cavities were prepared in 120 extracted maxillary and mandibular molars in 12 groups of conventional needle irrigation (CNI), auto-SWEEPS, ultra-short pulse (USP), and super-short pulse (SSP), each with 0.25, 0.4 and 0.8 mm apical diameters (n = 10). The root canals were prepared and mounted in resin blocks. Periodontal pressure was simulated by a capillary tube of water in the apex. The volume of extruded irrigant was quantified spectrophotometrically, and analyzed by the Kruskal-Wallis test.
Apical extrusion in CNI was the same in the three apical diameters, and was maximum compared with others groups. The amount of extruded irrigant through the apex was different among the three apical diameters in auto-SWEEPS (P = 0.002) and USP (P = 0.001) modes. The SSP mode caused maximum extrusion of irrigant with no significant difference among different apical diameters (P = 0.681) followed by auto-SWEEPS. The USP mode caused the lowest extrusion in 0.25 mm diameter (P = 0.006). In auto-SWEEPS, 0.25 mm diameter had a significant difference with 0.8 mm. In USP, 0.25 mm had a significant difference with 0.4 and 0.8 mm diameters. In 0.25 mm, USP and SSP (P < 0.05), and USP and auto-SWEEPS (P < 0.05) had significant differences. In 0.4 mm, only SSP and USP had a significant difference (P < 0.05).
. CNI with a 27-gage needle caused greater irrigant extrusion than the SWEEPS modes. The USP mode caused minimum extrusion of irrigant.
Effect of tip insertion depth and irradiation parameters on the efficacy of cleaning calcium hydroxide from simulated lateral canals using Er:YAG laser- or ultrasonic-activated irrigation
2021, Journal of Dental Sciences
Citation Excerpt :
However, for root canal irrigation to be performed effectively while avoiding irrigant extrusion outside the apical foramen, it is preferable if the effects of irrigation can be obtained with the tip located away from the root apex. With LAI, the amounts of pressure outside the apical foramen and of the extruded irrigant increase depending on the tip insertion depth and output energy,21–26 and the cleaning efficacy decreases as the distance from the tip increases.27 However, opinions remain divided on the capacity of LAI to clean areas away from the tip, with some studies finding greater efficacy than UAI15 and others reporting similar efficacy to syringe irrigation.28
Laser-activated root canal irrigation (LAI) with an Er:YAG laser is considered more effective than other irrigation methods, whereas the effectiveness of LAI in cleaning lateral canals far from the laser tip remains unclear. This study aimed to compare the efficacy of removing calcium hydroxide [Ca(OH)₂] paste from lateral canals using LAI or ultrasonic-activated irrigation (UAI), and to examine the effect of tip insertion depth and laser irradiation parameters on cleaning efficacy.
Radiopaque Ca(OH)₂ paste (Calcipex II) was injected into lateral canals 6 mm from the root apex in 192 J-shaped simulated root canal models. LAI (Erwin AdvErl; 30 or 70 mJ; 10 or 20 pulses per second; laser tip R200T or R600T) and UAI (ENAC SE10; output setting: 3) were performed 3 times for 20 s. The laser tip was placed at 8–0 mm coronal to the lateral canal location. The volume of Ca(OH)₂ paste before and after the experiment was measured using micro-CT (SMX-100CT).
The Ca(OH)₂ removal rate by LAI was significantly higher than UAI at all tip insertion depths. Ca(OH)₂ removal rate in LAI was significantly lower at the 8 mm position compared with other positions (P < 0.05). When the tip insertion depth was fixed at this position, Ca(OH)₂ removal rate increased significantly when pulse energy and tip diameter were increased (P < 0.05).
LAI removed Ca(OH)₂ paste from lateral canals away from the tip more effectively than UAI. Increasing the pulse energy and tip diameter improved the removal efficiency.
Principle and antimicrobial efficacy of laser-activated irrigation: A narrative review
2024, International Endodontic Journal
Influence of pulse energy, tip design and insertion depth during Er:YAG-activated irrigation on cleaning efficacy in simulated severely curved complex root canal systems in vitro
2024, International Endodontic Journal
Transient apical peak pressure measurement of Er:YAG laser–activated irrigation in different in vitro tooth models using a high-frequency sensor system
2023, Lasers in Medical Science

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: Dr George was supported by a University of Queensland International Postgraduate Research Award.

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Basic research—technologyApical Extrusion of Root Canal Irrigants When Using Er:YAG and Er,Cr:YSGG Lasers with Optical Fibers: An In Vitro Dye Study

Abstract

Section snippets

Sample Preparation

Results

Discussion

J Endod

J Endod

J Endod

J Endod

J Endod

Basic research—technology
Apical Extrusion of Root Canal Irrigants When Using Er:YAG and Er,Cr:YSGG Lasers with Optical Fibers: An In Vitro Dye Study