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3 authors, including:
Yuichi Kimura
Petra Wilder-Smith
Ohu University
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REVIEW
Blackwell Science, Ltd
Department of Endodontics, Showa University School of Dentistry, Japan; and 2Beckman Laser Institute and Medical Clinic,
University of California, Irvine, California, USA
Abstract
Kimura Y, Wilder-Smith P, Matsumoto K. Lasers in
endodontics: a review. International Endodontic Journal, 33,
173185, 2000.
Introduction
Since the ruby laser was developed by Maiman (1960),
researchers have investigated laser applications in dentistry. A laser is a device which transforms light of various
frequencies into a chromatic radiation in the visible,
infrared, and ultraviolet regions with all the waves in
phase capable of mobilizing immense heat and power
when focused at close range. Stern & Sognnaes (1964)
and Goldman et al. (1964) were the first to investigate
the potential uses of the ruby laser in dentistry. They
began their laser studies on hard dental tissues by
investigating the possible use of a ruby laser to reduce
subsurface demineralization. Indeed, they did find a
reduction in permeability, to acid demineralization, of
enamel after laser irradiation.
After initial experiments with the ruby laser, clinicians
began using other lasers, such as argon (Ar), carbon
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Lasers
HeNe
(633 nm)
GaAlAs
(810830 nm)
a
Penetration ability
(enamel and dentine
at the thickness of 3 mm)
Specificity
Sensitivity
2.11%
good
poor
3.91%
poor
good
174
Parameters
References
HeNe
(632.8 nm)
GaAlAs
(780 nm)
GaAlAs
(830 nm)
Nd:YAG
(1.064 m)
CO2
(10.6 m)
6 mW for 23 min
6 mW for 13 min
30 mW for 0.53 min
30 mW for 0.53 min
30 mW for 0.53 min
30 mW for 5 min
10 W for 0.52.5 s
10100 mJ/p for 2 min
0.5 W for 530 s
1 W for 510 s
84
90
> 85
94.6
83.9
58
100
100
98.6
100
175
176
177
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Apicectomy
Apicectomy is a surgical procedure in which the root
apex is removed; the adjacent periapical tissues are
removed and curretted at the same time. The indications for resection are mainly when previous root canal
treatment has not been successful. If a laser is used for
the surgery, a bloodless surgical field should be easier to
achieve due to the ability of the laser to vaporize tissue
and coagulate and seal small blood vessels. If the cut
surface is irradiated, the surface is sterilized and sealed.
Moreover, the potential of the Er:YAG laser to cut hard
dental tissues without significant thermal or structural
damage would eliminate the need for mechanical drills.
Clinical investigations into laser use for apicectomy
began with the CO2 laser (Miserendino 1988), which
was successfully used for the treatment of a secondary
apical abscess. The use of this laser was expected to seal
the dentinal tubules in the apical portion of the root and
to sterilize the affected area. Subsequently, CO2 laser
suitability for this purpose was examined using
extracted teeth in vitro (Neiburger 1989, Read et al.
1995, Moritz et al. 1997b) and dogs in vivo (Friedman
et al. 1991a,b, 1992). Laser use during surgery
appeared not to affect treatment results or hinder healing. However, when this laser was applied to patients
receiving apicectomies (Bader & Lejeune 1998), it did
not improve the healing process. Next, clinical studies
were performed using the Nd:YAG laser (Sumitomo &
Furuya 1988). Using extracted teeth in vitro (Stabholz
et al. 1992a,b, Arens et al. 1993, Wong et al. 1994), the
Nd:YAG laser was found to reduce the penetration of
dye or bacteria within resected roots. In the above investigations, the laser was used after root resection. When
the laser was used for resection itself, either in extracted
human teeth in vitro or in rats in vivo (Maillet et al.
1996), tissue repairs of the low-resected root surfaces
were delayed when compared with those resected with
a bur. In vitro studies using the Er: YAG laser for root
resection itself in extracted teeth (Paghdiwala 1993,
Yokoyama et al. 1996, Ebihara et al. 1997) achieved
excellent results with the smooth, clean resected root
surfaces, devoid of charring. Clinically, the use of this
laser resulted in improved healing and diminished postoperative discomfort (Komori et al. 1996a,b, 1997a).
Use of this laser for retrograde cavity preparation in
extracted teeth showed that the working time with the
Er:YAG laser is significantly less than with ultrasonic
tools, but no significant differences were reported
between the groups treated with the Er:YAG laser
and the ultrasonic tools with regard to dye penetration
Conclusion
With the development of thinner, more flexible and
durable laser fibres, laser applications in endodontics
will increase. Since laser devices are still relatively costly,
access to them is limited. Ideally, the laser in the future
will have the ability to produce a multitude of wavelengths and pulsewidths, each specific to a particular
application. Once our knowledge of optimal laser
parameters for each treatment modality is complete,
lasers can be developed that will provide dentists with
the ability to care for patients with improved techniques
and equipment.
References
Absi EG, Addy M, Adams D (1987) Dentine hypersensitivity.
A study of the patency of dentinal tubules in sensitive and
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