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Lasers in Dentistry: Minimally Invasive Instruments for the Modern Practice
Endodontic Applications

Course Author(s): Steven R. Pohlhaus, DDS

Endodontic Applications

Nd:YAG, Erbium Lasers and diodes have been studied extensively as an adjunct to endodontic treatment. Many of these studies have shown improved smear layer removal and disinfection in the apical third of the tooth. There is the concern of negative thermal effects within the confined space of the root canal.

Recently a phenomenon known as PIPS (Photon Induced Photoacoustic Streaming) has been discovered. The extremely high peak power and affinity for water of the Er:YAG laser creates an interesting phenomenon when specially shaped radial firing tips are place in irrigant solutions. When these special tips are submerged in solution each pulse sends a powerful wave of acoustic energy throughout the solution. The laser is used at a setting that creates very little thermal effect. The resultant shock wave propagates throughout the complete three-dimensional root canal system, even the tiniest accessory canals. Scanning electron microscope and microbiological studies have shown extremely thorough cleansing and disinfection of the total root canal complex.18,19 The PIPS technique allows the dentist to instrument less aggressively and still achieves a thoroughly clean root canal system.

A modified PIPS technique called SWEEPS ((Shock Wave Enhanced Emission Photoacoustic Streaming) has been recently developed. This technique uses a second variably timed pulse to enhance the shockwave of PIPS by about 30 percent.

Figure 43. Endodontics.
This image depicts tooth 5 instrumented to a size 25 hand file and treated with the PIPS (Photon Induced Photoacoustic Streaming) using sodium hypochlorite, sterile water and EDTA.
Tooth 5 instrumented to a size 25 hand file and treated with the PIPS (Photon Induced Photoacoustic Streaming) using sodium hypochlorite, sterile water and EDTA. EndoRez cement (Ultradent Products) was used with a single gutta percha cone per canal. There are multiple lateral canals filled with cement both mid root and apically.
Figure 44. Photon Induced Photoacoustic Streaming (PIPS).
This image depicts a molar that was treated with PIPS only with no mechanical instrumentation and then sealed with EndoRez to demonstrate the effectiveness of the procedure.
This molar was treated with PIPS only with no mechanical instrumentation and then sealed with EndoRez to demonstrate the effectiveness of the procedure. Multiple lateral canals were cleaned and sealed effectively.
Photo courtesy of Dr. Enrico DiVito.
Figure 45. Laser treated canal.
These two images depict normal instrumentation and irrigation leaves significant smear layer on the left and the PIPS treated dentin on the right is free of smear layer.
Normal instrumentation and irrigation leaves significant smear layer on the left.  The PIPS treated dentin on the right is free of smear layer.
Photo courtesy of Dr. Enrico DiVito.
Figure 46. Treated Lateral Canal.
This image depicts a lateral canal in a PIPS treated tooth is free of debris.
A lateral canal in a PIPS treated tooth is free of debris.
Photo courtesy of Dr. Enrico DiVito.
Video 4.
No narrative to video.
PIPS is being performed on the mesiobuccal 1 canal and debris can be seen rising up from the mesiobuccal 2 canal on this upper molar. When the resin cement is injected into the mesiobuccal one canal it can be seen coming up the mesiobuccal 2 canal via anastomoses that have been thoroughly cleaned by PIPS. This phenomenon is commonly observed in various teeth by PIPS practicing dentists. (Er:YAG laser with special PIPS tip).
Source: Dr. Mark Colonna.
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