Lasers have been successfully applied in dentistry for several decades. Although reportedly available as early as the 1960s, it wasn’t until the early 1990s that they were first approved by the US Food and Drug Administration for the treatment of gum conditions. In 1996 they were approved for hard tissue treatments but their use in the specialty of endodontics has been limited.
An article in the BDJ in 2007 outlined why the use of lasers was considered controversial at that time. In essence, this was due to the photothermal action – generating a lot of heat – of high-powered lasers with potential for collateral damage. There were also risks associated with operating ‘blind’ in the tiny internal space of a tooth.
But nearly ten years on, the picture is changing. This is partly due to the advent of a new design of tip attachment for the erbium:YAG laser.
This has given rise to the concept of PIPS, Photon Induced Photoacoustic Streaming. Pulses of laser energy are directed into a bath of hypochlorite inside the tooth. These extremely short bursts of energy pump debris out of the canals and debride, disinfect and sterilize each canal down to the tip and then out into additional lateral canals.
It’s well documented that decontamination of the root canal is one of the major challenges in endodontic therapy. In specialist practice we have developed a robust approach combining mechanical measures supplemented by antimicrobial solutions.
But my mind is always open to new and improved methods of cleansing the canals to eradicate the potential for the regrowth of micro-organisms. Where there is good research, I will listen. I am impressed by the work carried out in the US by Enrico DiVito and others which demonstrates that PIPS achieves high efficacy and can be used as an additional tool in the decontamination of infected root canals.
It’s not just the efficacy of PIPS that has excited me, however, but the potential for bringing endodontic therapy into the fold of Minimally Invasive Biomimetic Dentistry (MIBD).
Until recently, it wasn’t possible to describe endodontics as minimally invasive. I grateful to Mark Malterud for his inspiring article on this topic in the publication of the Association of General Dentistry. Rigorous instrumentation is needed to give the clinician access to root canals for thorough cleansing prior to obturation (filling). This has led to canals being over-shaped and enlarged, losing precious tooth structure and potentially making the tooth vulnerable to fracture in the future.
By contrast PIPS technology allows for the clinician to place the tip into the coronal aspect of the preparation without penetrating into the canal system, reducing the need for instrumentation. The end result is a tooth with more of its structure retained.
Given that thorough eradication of micro-organisms from the root canal system is a major predictor for endodontic success I believe that if the price of lasers continues to decline, all dentists and endodontists will want one, me included.