LASER ENDODONTIC THERAPY

What is Endodontics?

Endodontics is the area of dentistry dealing with the prevention, diagnosis, and treatment of disorders of the dental pulp.
Endodontic therapy (root canal) is a treatment modality that will save diseased or injured teeth. The alternative to endodontics is extraction. Typically, a severely decayed tooth or a tooth with a large filling will begin to ache. The pain might be intermittent at first and over time progress to a constant dull throbbing pain or a severe ache that might be felt on all the teeth on the affected side. Sometimes there is no pain and an abscess might be discovered on a routine x-ray.

The pulp is the soft tissue that is located inside the tooth structure. It contains nerves, arteries, veins, and lymph tissue. It is contained in the canals located in thin tube-like spaces in the roots and in the pulp chamber located within the crown of the tooth.

This image shows how the progression of decay, if not treated, will lead to destruction of the tooth's hard tissue and pulp. If treated at the beginning of the decay process (first image), a small filling would resolve the problem. If allowed to continue as in the last image, root canal therapy would be necessary.

Decay progressing from a white spot lesion(A), into the enamel(B), into the dentin(C), towards the pulp(D), into the pulp(E), resulting in the formation of an abscess in the jaw bone.

When the pulp is diseased or injured and unable to repair itself, it becomes infected. Left untreated, the pulp will die and become necrotic. Pus can build up at the root tip, forming an abscess that can destroy the bone surrounding the tooth. Endodontic treatment is the removal of the diseased pulp tissue, which will enable the body's defense system to repair the damage caused by the infection.
Endodontic therapy normally takes two or three visits to complete.

The following steps are involved in the treatment of the tooth:

- A local anesthetic is used so the procedure will be pain free. The tooth will then be isolated by placing a rubber dam over it. This thin sheet of rubber provides a clean and aseptic working environment.

- An opening is then made through the top of the tooth into the pulp chamber.

- The pulp is removed from the pulp chamber and the root canals are cleaned, enlarged, and shaped to a form that can be filled and sealed latter.

- A temporary filling is placed in the the opening in the tooth to seal it between visits. There can be some discomfort in the area of the tooth for a day or two following the initial visit. Occasionally the pain can be more severe.

- During the next stage of treatment, the temporary filling is removed and the root canals are filled and sealed. This completes the endodontic treatment.

The dark area at the end of
the root is a large abscess
before endodontic treatment.

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This shows the healed abscess
after endodontic treatment.

Following completion the tooth will need to be restored. Due to the large amount of tooth structure usually lost from decay and old fillings the preferred restoration is a crown. A post may be placed into the root to give additional structural support.

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ROOT CANAL/ENDODONTIC PROCEDURES

• Tooth preparation to obtain access to root canal
• Root canal preparation including enlargement
• Root canal debridement & Cleaning - (Surgical excision of dead, devitalized, or contaminated tissue and removal of foreign matter from a wound).
• Flap preparation – incision of soft tissue to prepare a flap and expose the bone
• Cutting bone to prepare a window access to the apex (apices) of the roots
• Apicoectomy - removal of the tip of the root.
• Root end preparation for retrofill
• Removal of pathological tissues and hyperplastic tissue (An abnormal increase in the number of cells in an organ or a tissue with consequent enlargement).

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LASER ENDONDONTIC THERAPY

Dentistry has now been introduced to a new root canal treatment using the Er,Cr:YSGG (erbium, chromium:yttrium scandium gallium garnet) laser to provide additional important benefits to our patients. This new system should help reduce patient fear and improve their general attitude towards dentistry. The device that provides such a treatment is the Waterlase Hydrokinetic Hard and Soft tissue laser (Biolase Technology, Inc), the only laser system to receive FDA clearance for complete endodontic therapy involving enamel, dentin, pulp and other root canal procedures. This laser uses specialized fibers of various diameters and lengths that provide access to effectively remove pulpal tissues and tooth structure from the root canal walls, and prepared the canal for opturation.

From my experience with the Waterlase Hydrokinetic system on patients, the most important benefit of this revolutionary technology for endodontic treatments is the ease of using the system and the great degree of patient comfort during and after the procedure. Also, I have found a reduced need-and in some cases no need to all-for prescription pain medication. Furthermore, postoperative complications such as inflammation, swelling, and pain were significantly reduced. In addition, the possibility exists that more root canal therapy can be performed without any anesthesia. Also, due to the antibacterial effect of the YSGG laser, it is my opinion that this will lead to a reduction in the need for postoperative antibiotics. All of these factors help to improve patients’ attitude towards dentistry.

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