Effects of Nd:YAG laser on apical seal of teeth after apicoectomy and retrofill

Photobiomodulation Therapy and Pulp-Regenerative Endodontics: A Narrative Review

Regenerative endodontic procedures (REPs) were used to recover the dental pulp’s vitality in order to avoid the undesirable outcomes of conventional endodontic treatment and to promote dentinal formation, especially for immature permanent teeth. Photobiomodulation therapy (PBMT) exhibits photobiological and photochemical effects for improving the root canal’s environmental conditions by compensating for oxidative stress and increasing the blood supply to implanted stem cells and improving their survival. Basic research has revealed that PBMT can modulate human dental pulp stem cells’ (hDPSCs) differentiation, proliferation, and activity, and subsequent tissue activation. However, many unclear points still remain regarding the mechanisms of action induced by PBMT in REPs. Therefore, in this review, we present the applications of laser and PBMT irradiation to the procedures of REPs and in endodontics. In addition, the effects of PBMT on the regenerative processes of hDPSCs are reviewed from biochemical and cytological perspectives on the basis of the available literature. Furthermore, we consider the feasibility of treatment in which PBMT irradiation is applied to stem cells, including dental pulp stem cells, and we discuss research that has reported on its effect.

A New Combined Protocol to Treat the Dentin Hypersensitivity Associated with Non-Carious Cervical Lesions: A Randomized Controlled Trial

The goal of this research is to assess the desensitizing effect of a diode laser on non-carious cervical lesions (NCCLs) responsible for dentin hypersensitivity (DH) in two separate output forces implemented both independently and in sequential combination modalities. A randomized controlled trial for this study was applied. Sixty-nine NCCLs responsible for DH pain with severity between 6 and 9 on the VAS scale were considered. Three study groups were developed using just one lesion from three different quadrants of the oral cavity of each patient. All treatment procedures were conducted using a laser diode (810 nm, 5 W) with varying power outputs used separately or in combination. The pain by DH was evaluated at baseline, at treatment completion, and at 15 days and 3 months after each laser procedure. Data analysis was performed using a Wilcoxon test for paired samples, a one-way ANOVA test, and an unpaired t-test. The significant reduction of the mean VAS score was estimated in each study group immediately and at 15 days and 3 months after the end of treatment and compared with the baseline mean VAS score (p-value < 0.0001). The best result concerning the improvement of DH symptomatology was assessed when a combined protocol of two different output powers of the diode laser was used. The authors conclude that the diode laser (810 nm) therapy procedure combining two separate output forces (low and high power) can improve the painful symptoms of DH from NCCLs.

Effect of combined application of high- and low-intensity lasers on dentin hypersensitivity: A randomized clinical trial

Background. Diode lasers (DLs) have demonstrated equal or better desensitizing effects than fluoride varnish, 10% potas-sium nitrate (NK) gel and Gluma. The current study evaluated the desensitizing effect of combined application of DLs with two different output powers and compared it with single DL therapy. Methods. Sixty-two hypersensitive teeth were allocated randomly into two groups: the single group was treated with 3-W DL beam once and in the combined group, the teeth were irradiated three times (the first time with 0.2-W and then with 3-W and the second and third times, 48 and 96 hours after the baseline visit, with 0.2-W DL beams). The amount of dentin hyper-sensitivity (DH) was evaluated, immediately before and after each visit, and 1 week and 1 and 3 months after the first visit. Data analysis was performed using chi-squared test, repeated measurement of ANOVA and Mann-Whitney U test. P<0.05 was considered statistically significant. Results. Statistically significant changes were observed in the means of VAS indices between all the measurement intervals and pretreatment measures, in both experimental groups (P<0.001). The difference in VAS reduction among the groups was not significant when the hypersensitive teeth were stimulated by a periodontal probe and a jet of air (P=0.63 and P=0.12). Conclusion. The results of the present study showed that using both high-intensity and combined DL beams gives rise to significant reductions in DH. There was no significant difference between combined and single laser therapies in the treatment of tooth hypersensitivity.

Low level laser therapy induces increased viability and proliferation in isolated cancer cells

OBJECTIVES

Low level laser therapy (LLLT), which stimulates natural biological processes in the application region, is frequently used in dental treatments. The aim of our study was to evaluate the effects of LLLT which could activate precancerous cells or increase existing cancerous tissue in case of clinically undetectable situations.

MATERIALS AND METHODS

Saos-2 osteoblast-like osteosarcoma cells and A549 human lung carcinoma cells were used. Twenty-four hours after preparation of cell culture plates, laser irradiation was performed 1, 2 and 3 times according to the test groups using Nd:YAG laser with the power output 0.5, 1, 2 and 3 W. Cell proliferation analysis was performed by MTT assay at the 24th hour following the last laser applications.

RESULTS

Generally, it was observed that the proliferation rates increased as the number of applications increased, when compared to the controls, especially in those cases in which the irradiation was performed 2 or 3 times more.

CONCLUSION

The findings of this study have led to the conclusion that LLLT increases cancer cell proliferation, depending on the power output level of the laser and the number of applications. In addition to the proliferation and mitotic activity of the cancer tissue cells, we concluded that LLLT, which is frequently used in dental practice, could activate precancerous cells or increase existing cancerous tissue.

Lasers in Apicoectomy: A Brief Review

Since the invention of laser, various applications for lasers in endodontics have been proposed, such as disinfection of the root canal system, canal shaping, pulp diagnosis, and apico-ectomy. One of the major applications of laser in endodontics is apicoectomy. The aim of this article is to review the benefits and drawbacks of laser applications in apicoectomy, including effect on apical seal, effect on dentin permeability, effect on postsurgery pain, effect on crack formation, effect on root-end morphology, effect on treatment outcome, and connective tissue response to laser-treated dentin.

A comparison of Er, Cr: YSGG laser with ultrasonic preparation on the seal of retrograde cavities

BACKGROUND AND AIM

The aim of this in vitro study was to compare Er, Cr: YSGG laser with ultrasonic preparation on the seal of retrograde cavities.

MATERIALS AND METHODS

Twenty-eight maxillary anterior teeth were used in this study. After removing the crowns, the canals were prepared with the step-back technique and filled with guttapercha. Three millimeters below the apex; each root was cut with a fissure diamond bur. The root surfaces were then covered with nail polish and three millimeters deep retrograde class I cavities were prepared, using Er, Cr: YSGG laser (group L=12 roots) or ultrasonic retro-tip (group U=12 roots). Four roots were arranged for negative and positive control groups. Retrograde cavities were then filled with mineral trioxide aggregate (MTA) and teeth were placed in 2% methylene blue dye for 72 hours. The amount of dye penetration in sagittal sections of each tooth was measured with a stereomicroscope. An independent sample t-test was used for statistical analysis.

RESULTS

Cavities prepared with the Er, Cr: YSGG laser (1.61 + 0.81) showed significantly less micro-leakage than those prepared with the ultrasound (2.55+ 1.84) (P value =0.02).

CONCLUSIONS

Under the conditions of this research, the use of Er, Cr: YSGG laser for retrograde cavity preparation causes significantly less apical leakage and may increase the success rate of endodontic surgeries.

Effect of Nd: YAG laser on the apical seal after root-end resection and MTA retrofill: a bacterial leakage study

Laser irradiation has been investigated in terms of preventing leakage in retrofilled root canals. The aim of the present study was to evaluate the effect of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser on the bacterial leakage of mineral trioxide aggregate (MTA)-retrofilled roots. In this ex vivo experimental study, 90 single-rooted incisor teeth were filled with gutta-percha and AH26 sealer. The apical 3 mm of all the roots were resected and 3-mm retrocavities were prepared by an ultrasonic device. The specimens were randomly divided into two experimental (n = 25), one positive control (n = 10), and two negative control (n = 10) groups. In the laser + MTA group, the cavity walls were irradiated by Nd: YAG laser prior to MTA placement. In the MTA group, MTA was placed without laser irradiation. The root surfaces were covered with two layers of nail varnish except for the apical 2 mm. The specimens were then embedded in a bacterial leakage test system and examined daily for 90 days. Contamination periods were recorded. Data were analyzed by Kaplan-Meier and Mann-Whitney U tests (α = 0.05). Five teeth with and five teeth without laser irradiation underwent scanning electron microscopic evaluation. The specimens in the laser + MTA group were contaminated earlier than those in the MTA group (p < 0.05). Comparison of survival times between the two groups showed significant differences (p < 0.05). Nd: YAG laser irradiation can decrease the sealing capacity of MTA in comparison to the apical seal achieved by MTA without laser irradiation. Further studies are recommended to provide a better seal for the MTA-retrofilled teeth after laser irradiation.

MATHEMATICAL MODELING FOR THE PREDICTION AND IMPROVEMENT OF TOOTH THERMAL PAIN: A REVIEW

Tooth pain, especially tooth thermal pain, is one of the most important symptoms and signs in dental clinic and daily life. As a special sensation, pain has been studied extensively in both clinic and experimental research aimed at reducing or eliminating the possible negative effects of pain. Unfortunately, the full underlying mechanism of pain is still unclear, because the pain could be influenced by many factors, including physiological, psychological, physical, chemical, and biological factors and so on. Besides, most studies on pain mechanisms in the literature are based on skin pain sensation and only few are based on tooth pain. In this paper, we present a comprehensive review on both neurophysiology of tooth pain mechanism, and corresponding thermal, mechanical, and thermomechanical behaviors of teeth. We also describe a multiscale modeling approach for quantifying tooth thermal pain by integrating the mathematic methods of engineering into the neuroscience. The mathematical model of tooth thermal pain will enable better understanding of thermal pain mechanism and optimization of existing diagnosis and treatment in dental clinic.

An in vitro evaluation of apicoectomies and retropreparations using different methods

OBJECTIVES

The aim of this study was to evaluate: 1) the apical root surface, gutta-percha interface, and preparation time of root-end resections made with burs, ultrasound, or laser; and 2) the thickness of surrounding dentin after laser or ultrasonic root-end cavity preparation.

STUDY DESIGN

1) Thirty root-filled teeth were resected as follows: Zekrya bur in group I, Chemical Vapor Deposition (CVD) ultrasonic tip (9.5107-8) in group II, and ErCr:YSGG (Waterlase) in group III. The preparation time was recorded. Replicas of the resected root-ends were examined under a scanning electron microscope (SEM). 2) Thirty root-filled teeth were submitted to apicectomies and root-end cavities were prepared by using: CVD (6.1107-6) ultrasonic retrotips (group IV), EMS (DT-060) ultrasonic retrotips (group V), and ErCr:YSGG laser tips (group VI). Replicas of the root apices were examined under a SEM.

RESULTS

There were no fissures or fractures on root-end surfaces. The bur produced the smoothest surface (P < .05). Group I had the lowest preparation time (P < .05). The best adaptation between the filling and the root canals walls was observed in group III, but it was not significantly different from group II (P < .05). No resected root-ends had cracks after preparation. Group VI showed the least minimum dentin thickness (P < .05).

CONCLUSIONS

The 3 methods evaluated did not cause any injury to the root-end surface, but they harmed the apical adaptation. Laser tips removed more dentin than ultrasonic retrotips and should be used with care to avoid overpreparation.

An evaluation of different treatments for recurrent aphthous stomatitis and patient perceptions: Nd:YAG laser versus medication

OBJECTIVE

The aim of this randomized controlled clinical trial was to determine the anxiety levels of patients with recurrent aphthous stomatitis (RAS) prior to therapy with the Nd:YAG laser or medication, and to compare the effects of these different treatment methods on the degree of post-treatment pain, discomfort, and functional complications (eating and speech) experienced.

MATERIALS AND METHODS

Twenty patients with RAS-related oral problems were included in the study. Levels of pre- and post-treatment pain and functional complications were assessed at patient visits on days 1, 4, and 7.

RESULTS

The results indicated that patients treated with the Nd:YAG laser had less post-treatment pain and fewer functional complications, and reported immediate relief of pain and faster healing (p +/- 0.05). However, only after 5 d was there a significant reduction in the pain levels of the patients treated with medication.

CONCLUSION

Our results suggest that the Nd:YAG laser has better patient acceptance, shorter treatment time, and lower rates of pain and post-treatment adverse events among patients with RAS.

Computer-assisted evaluation of microleakage after apical resection with laser and conventional techniques

The purpose of this in vitro study was to observe the morphological changes and apical dye penetration at apical dentin surfaces after apicoectomy with conventional techniques and laser beam. Sixty single-rooted extracted teeth were selected for the study. The crowns were resected below the cemento-enamel junction. Then, these teeth were treated endodontically and filled with gutta-percha using AH-26 root canal sealer. The teeth were randomly divided into four groups of 15 teeth in each. The roots were resected perpendicular to its long axis 3 mm from the apex using Er: yttrium-aluminium-garnet (YAG) laser irradiation in groups 1 and 2, and the resected root surfaces were lased with Nd:YAG laser in group 2. The apexes were resected by a high-speed handpiece in groups 3 and 4, and the resected root surfaces were lased with Nd:YAG laser in group 4. Ten teeth in each group were used for leakage studies, and the other five teeth were used for scanning electron microscopic examinations. Seven sections were obtained from each root to assess the microleakage, and the sections were analyzed in a computer-assisted manner. No statistically significant differences were observed between the leakage percentage of groups 1 and 3 and groups 2 and 4 (p>0.05). Morphological differences were observed between apical dentin surfaces resected with conventional techniques and laser beam.

Effects of Nd:Yag laser irradiation on osteoblast cell cultures

The application of Nd:YAG lasers in endodontics has been explored by many investigators for different purposes. The aim of this in vitro study is to evaluate the effects of Nd:YAG laser on osteoblast cell cultures. A 1,064 nm Nd:YAG laser was used to irradiate human osteoblast-like cells (Saos-2) in noncontact mode for 10 s with different energy settings. The settings varied were pulse energy (20-120 mJ), pulse repetition rate (10-30 Hz), and power output (0.2-3.6 W). He-Ne, the aiming beam of Nd:YAG laser, was used in noncontact mode for 10 s. After 7-, 14-, and 21-day incubation period, cell viability and proliferation were evaluated with methylthiazoletetrazolium (MTT) colorometric method. The comparison of average MTT values gave no statistically significant difference between 20 mJ, 10 Hz, He-Ne, and control (p < 0.05). The differences between all other groups were significant (p < 0.05). Increase in the pulse energy, pulse repetition rate, and power output has a negative effect on the cell viability and proliferation.

Effects of Nd:YAG Laser Irradiation on Root Canal Dentin Wall: A Scanning Electron Microscopic Study

OBJECTIVE

The purpose of this study was to evaluate, by scanning electron microscopy (SEM), the effects of Nd:YAG laser irradiation applied perpendicular or parallel to the root canal dentin wall.

METHODS

Thirty human teeth were divided into two groups: Group A (20 roots), laser application with circular movements, parallel to the dentin root surface; and Group B (10 roots), roots cut longitudinally and laser applied perpendicular to the root surface. Group A was subdivided into A1 (10 roots), laser application with 100 mJ, 15 Hz and 1.5 W; and A2 (10 roots) with 160 mJ, 15 Hz, and 2.4 W. Group B was subdivided into B1 (10 hemisections) and B2 (10 hemi-sections) with parameters similar to A1 and A2. Four applications of 7-sec duration were performed, with a total exposure of 28 sec. SEM evaluations were made in the cervical, middle, and apical thirds, with 500x and 2000x magnifications. Morphological changes scores were attributed, and the results were submitted to Kruskal Wallis statistical test (5%).

RESULTS

Significant statistical differences were found between groups Aand B (p = 0.001). In groups A1 and A2, few areas of dentin melting were observed. In groups B1 and B2, areas of melting dentin covering dentin surface were observed.

CONCLUSIONS

It was concluded that intracanal laser application with circular movements (parallel to the surface) produces limited morphological changes in root canal dentin wall.

Removal of Two Types of Root Canal Filling Material Using Pulsed Nd:YAG Laser Irradiation

OBJECTIVE

The aim of this study was to examine the usefulness of a pulsed Nd:YAG laser in removing two types of endodontic obturation material from the root canal in vitro.

BACKGROUND DATA

Recently, a fine flexible glass fiber made of quartz has been developed to transmit the laser beam more effectively and permit its concentration in a specific area. This has increased the potential usefulness of the Nd:YAG laser in root canal treatment.

METHODS

The time required for removing the root canal obturation material (Gutta-percha cones and, Sealapex or AH26) by means of either Nd:YAG laser irradiation or a conventional method (Gates Glidden drills and K files) was measured. Contact microradiography was used to assess the radiopacity of the root canals before and after the removal of obturation material. The surfaces of the root canal after removal of the obturation materials were also observed by scanning electron microscopy.

RESULTS

Although none of the methods used in this study resulted in complete removal of debris from the root canal wall, the time required for the removal of any of the root canal obturation materials using laser ablation was significantly shorter than that required using the conventional method (p < 0.05). It appeared that some orifices of the dentinal tubules were blocked with melted dentin following laser irradiation.

CONCLUSIONS

Nd:YAG laser irradiation is an effective tool for the removal of root canal obturation materials, and may offer advantages over the conventional method.

Scanning Electron Microscopy (SEM) and Optical Microscopy: Effects of Er:YAG and Nd:YAG Lasers on Apical Seals after Apicoectomy and Retrofill

OBJECTIVE

This study evaluated the dentinal and marginal permeability of the cut surface after apicoectomy, treatment and retrocavity preparation with Er:YAG and Nd:YAG lasers. Furthermore, scanning electron microscopy (SEM) analysed the morphological alteration of dentin caused by laser irradiation through an optical fiber.

BACKGROUND DATA

Numerous studies have shown the beneficial effects of laser treatment upon sealing dental apex, avoiding the changes of organic fluids, microorganisms and their by-products between the root canal system and periapex.

MATERIALS AND METHODS

Twenty-four extracted and endodontically treated teeth were divided into three groups: GI, apices were resected with Er:YAG laser (350 mJ; 4 Hz) treatment of cut dentinal surface and retrocavity were lased with this same laser (120 mJ; 4 Hz; bur 2051) using the optical fiber 50/10; GII, apicoectomy was performed similar to GI, however the cut dentinal surface was treated with Nd:YAG laser through optical fiber, as well as the retrocavity preparation (100 mJ; 15 Hz; 1.5 W); and GIII (control group), high speed burs were used.

RESULTS

Analysis of methylene blue dye penetration into dentin demonstrated that the specimens of the groups irradiated with laser showed to have lower infiltration indices than the control group. These results were compatible with structural and morphological injuries, evidenced by SEM.

CONCLUSION

Under the conditions of the present study, apicoectomy using Er:YAG laser, followed by dentinal surface irradiation and retrocavity preparation with Nd:YAG laser, showed to be an alternative clinical tool able to reduce the dentinal permeability.

Lasers in endodontics

With the rapid development of laser technology, new lasers with a wide range of characteristics are now available and being used in various fields of dentistry. In the past two decades, much experience and knowledge has been gained. This article provides an overview of the current and possible future clinical applications of lasers in endodontics, including their use in alleviating dentinal hypersensitivity, modification of the dentin structure, pulp diagnosis, pulp capping and pulpotomy, cleaning and shaping of the root canal system, and endodontic surgery. Endodontic procedures for which conventional treatments cannot provide comparable results or are less effective are emphasized.

Comparative Study of Dentine Permeability after Apicectomy and Surface Treatment with 9.6 µm TEA CO2and Er:YAG Laser Irradiation

Failure of apicectomies is generally attributed to dentine surface permeability as well as to the lack of an adequate marginal sealing of the retrofilling material, which allows the percolation of microorganisms and their products from the root canal system to the periodontal region, thus compromising periapical healing. The purpose of this study was to evaluate dentine and the marginal permeability after apicectomy and surface treatment with 9.6 micro m TEA CO(2) or Er:YAG 2.94 micro m laser irradiation. Sixty-five single rooted human endodontically treated teeth were divided into five experimental groups: group I (control), apicectomy with high speed bur; group II, similar procedure to that of group I, followed by dentinal surface treatment with 9.6 micro m CO(2) laser; group III, similar procedure to group I followed by dentinal surface treatment with Er:YAG laser 2.94 micro m; group IV, apicectomy and surface treatment with CO(2) 9.6 micro m laser; and group V, apicectomy and surface treatment with Er:YAG laser 2.94 micro m. The analysis of methylene blue dye infiltration through the dentinal surface and the retrofilling material demonstrated that the samples from the groups that were irradiated with the lasers showed significantly lower infiltration indexes than the ones from the control group. These results were compatible with the structural morphological changes evidenced through SEM analysis. Samples from groups II and IV (9.6 micro m CO(2)) showed clean smooth surfaces, fusion, and recrystallized dentine distributed homogeneously throughout the irradiated area sealing the dentinal tubules. Samples from groups III and V (Er:YAG 2.94 micro m) also presented clean surfaces, without smear layer, but roughly compatible to the ablationed dentine and without evidence of dentinal tubules. Through the conditions of this study, the Er:YAG 2.94 micro m and the 9.6 micro m CO(2) laser used for root canal resection and dentine surface treatment showed a reduction of permeability to methylene blue dye.

Effects of Er:YAG and Nd:YAG laser irradiation on radicular dentine permeability using different irrigating solutions

BACKGROUND AND OBJECTIVES

To evaluate the effect of Er:YAG and Nd:YAG laser on radicular dentine permeability when using distilled and deionized water and 1% NaClO as irrigating solutions.

STUDY DESIGN/MATERIALS AND METHODS

Thirty human maxillary canines were divided randomly into six groups. The root canals were instrumented with K files and the step-back technique. Group I, irrigation with distilled and deionized water; Group II, irrigation with 1% NaClO; Group III, irrigation with distilled and deionized water and Er:YAG laser application (140 mJ input, 61 mJ output 15 Hz, 300 pulses, and 42 J); Group IV, irrigation with 1% NaClO and Er:YAG laser application (same parameters as Group III); Group V, irrigation with distilled and deionized water and Nd:YAG laser application (150 mJ, 15 Hz, 2,25 W); Group VI, irrigation with 1% NaClO and Nd:YAG laser application (same parameters as Group V). During laser application the teeth were always filled with the irrigating solution. The tip was withdrawn gently in helicoidal movement from the apex to the cervical portion. The teeth were processed for histochemical evaluation.

RESULTS

The Tukey test showed that the cervical and middle thirds were statistically similar (P > 0.05) and significantly greater than the apical third (P < 0.05). The Scheffé test showed significantly greater dentine permeability in root canals in which water and Er:YAG laser were used and were significantly different from the other treatments (P < 0.05).

CONCLUSIONS

The use of distilled and deionized water and Er:YAG laser showed the greater increase of dentine permeability. The use of 1% NaClO with Nd:YAG laser, distilled, and deionized water with Nd:YAG laser and the use of water increased dentine permeability less than the other groups. The use of 1% NaClO with and without Er:YAG laser application were positioned intermediately among the treatments.

Influence of the EDTA, Nd:YAG laser and association of both on the filling of artificial lateral root canals

This study aimed at evaluating the influence of EDTA, Nd:YAG laser and the combination of both for filling of artificial lateral root canals. Forty-five human mandibular premolars were employed, on which three artificial lateral root canals were prepared by means of a reamer with a similar diameter to a K file #15. The teeth were instrumented through the stepback technique employing Gates Glidden burs at the middle and cervical thirds and manual files at the apical portion, and irrigation with 1% sodium hypochloride. The teeth were divided in three groups: Group 1 -EDTA for 5 minutes; Group 2 -application of Nd:YAG laser at 15 Hz, 100 mJ and 1.5 Watts; and Group 3 - association of both. Roots were filled through the Tagger's hybrid technique, radiographed and the radiographs were digitized. Scores were assigned to the filling of the lateral root canals. Statistical analysis revealed no significant differences between the entire groups and also on the analysis of each third.

Ultrastructural changes of human dentin after irradiation by Nd:YAG laser

BACKGROUND AND OBJECTIVE

The use of Nd:YAG laser has been proposed for endodontic treatment. However, its ability to reduce dentin permeability, which is important for the success of root canal treatment, remains controversial.

STUDY DESIGN/MATERIALS AND METHODS

Nd:YAG laser irradiation was performed in pulsed mode on human dentin. The parameters were: pulse energy (100 mJ), rate (10 pps), and total irradiation time (4 seconds). The crystalline phases, electron diffraction patterns, morphology, and microstructure of specimens after laser irradiation were observed by dark-field emission transmission electron microscope (TEM).

RESULTS

Three ultrastructural zones could be delineated in the dentin: (1) an outer zone with an ordered columnar structure composed of hydroxyapatite and beta-tricalcium phosphate, (2) an intermediate zone composed of an amorphous substance (about 40-70 nm in diameter), and (3) an inner zone of well-crystallized hydroxyapatite grains. These three zones were free of pores or voids.

CONCLUSIONS

Our study demonstrated that laser-irradiation might be used to reduce dentin permeability.

In vitro study of the effects of Nd:YAG laser irradiation on the apical sealing of endodontic fillings performed with and without dentin plugs

OBJECTIVE

The aim of this study was to evaluate the effects of Nd:YAG laser irradiation on the apical sealing of root canal fillings with or without a dentin plug.

BACKGROUND DATA

Previous studies have shown that Nd:YAG laser irradiation of root canal wall dentin promotes its melting, recrystallization, and therefore a less permeable surface.

MATERIALS AND METHODS

Thirty extracted and endodontically treated teeth were divided into three groups. Eight specimens of each group were evaluated by means of quantitative analysis, measuring the marginal apical dye leakage. The remaining two specimens were evaluated by means of qualitative analysis, using the scanning electron microscopy (SEM). For the quantitative analysis, the samples of group I were obturated. In group II, the apical third of the samples were irradiated by the Nd:YAG laser at four exposures of 100 mJ/pulse, 1 W, 10 Hz, 3 sec, and obturated. In group III, an apical dentin plug was condensed and lased using the same parameters of group II, and the root canals were obturated. The samples evaluated by SEM were prepared as those analyzed quantitatively; however, their root canals were not filled.

RESULTS

There were statistically significant differences among the groups regarding dye leakage. Group II showed the minor leakage average, followed, in order, by groups I and III. SEM analysis revealed open dentinal tubules in group I; melting and recrystallizing of the apical root dentin in group II; and melting and recrystallizing of a portion of the dentin plug in group III.

CONCLUSION

The Nd:YAG laser irradiation of the root canal apical third without the presence of dentin plug significantly improved the quality of the apical sealing under the experimental conditions tested.

Morphology, chemical structure and diffusion processes of root surface after Er:YAG and Nd:YAG laser irradiation

OBJECTIVES

The aim of this in vitro study was to evaluate the effects of Er:YAG and Nd:YAG lasers on morphology, chemical structure and diffusion processes of the root surface.

MATERIAL AND METHODS

60 root samples were irradiated for 1 min each either with 60 mJ/p, 80 mJ/p and 100 mJ/p using Er:YAG laser or with 0.5W, 1.0W and 1.5W using Nd:YAG laser. Scanning electron microscopy (SEM) was used to determine the morphology, infrared (IR) spectroscopy to assess the alterations in chemical structure and one dimensional electron paramagnetic resonance imaging (1-D EPRI) was used to estimate the diffusion coefficients in dental root samples.

RESULTS

Er:YAG laser treatment resulted in deep crater formation with exposed dentin. Morphological alterations of root surface after Nd:YAG laser irradiation included cracks, crater formation, meltdown of the root mineral and resolidified porous globules formation. Er:YAG laser failed to alter the intensity of Amide peaks I, II or III. In contrast, treatment with Nd:YAG laser, using the highest power setting of 1.5W, reduced the intensity of Amide peak II and III in comparison to the control. The diffusion coefficients were increased significantly in all Er:YAG and Nd:YAG treated root samples.

CONCLUSION

This study demonstrated that Er:YAG laser influences only on morphology and diffusion processes of root surfaces, while Nd:YAG laser also alters the chemical structure of root proteins.

Safety of the ArF193 excimer laser for the removal of dental plaque and calculi: an in vitro histological study

OBJECTIVE

To assay the safety of the ArF excimer laser in the integrity of human pulp elements.

BACKGROUND DATA

The use of lasers in dentistry remains controversial, in spite of their increasing application in medical practice. The main reason for this discrepancy is the frequent report of damage to surrounding tissues and the dental pulp, due to the energy transfer, from the site of laser impact. The progress made on laser technology during the last 10 years, could overcome this obstacle and allow the use of lasers in dentistry.

METHODS AND RESULTS

The present study reports the use of the ArF 193 excimer laser, under conditions of strict control of frequency and fluency, for the ablation of dental carries, plaque, and calculi, by the use of a new, articulated arm. We have tested 10 teeth, extracted for prosthetic reasons, immediately after extraction. Our in vitro results show that the ArF193 excimer laser does not produce any harm to the dental pulp (at least at the photo- or electronic microscopy level), whereas in a matter of seconds, it can be effective in removing all dental deposits. In addition, the use of the flexible articulated arm, makes this treatment comfortable and easier for both the dentist and patient.

CONCLUSION

Under a strict control of laser technology, and the use of the new articulated arm presented, the use of the ArF excimer laser in dentistry is safe and comfortable.

Effects of nanosecond pulsed Nd: YAG laser irradiation on dentin resistance to artificial caries-like lesions

BACKGROUND AND OBJECTIVE

Previous investigations have demonstrated improved enamel caries resistance after laser irradiation. In this study, effects of nanosecond pulsed Nd:YAG laser irradiation on crown/root dentin susceptibility to caries-like lesions were investigated.

STUDY DESIGN/MATERIALS AND METHODS

Extracted human molar teeth were irradiated using a Q-switched nanosecond pulsed Nd:YAG laser. All teeth except controls were irradiated at: fluence, 1 or 5 J/cm2; spot size, 3 mm; and then subjected to demineralization. Measurements of caries lesion depth using scattering light microscopy and SEM were performed.

RESULTS

Lesion depth measurements did not differ significantly between controls and irradiated samples (P < 0.01), but SEM results showed some irradiation-induced alterations on crown and root dentin surfaces. Irradiated surfaces were partially melted, with sometimes narrowed or occluded tubules.

CONCLUSION

No consistent caries-protective effect of Q-switched nanosecond pulsed Nd:YAG laser irradiation on crown and root dentin was determined, but laser-induced morphological changes were observed.

Lasers in endodontics: a review

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.

Study on removal effects of filling materials and broken files from root canals using pulsed Nd:YAG laser

OBJECTIVES

The aims of this study were to investigate the capability of removing the filling materials or broken files from root canals with pulsed Nd:YAG laser irradiation at three parameters, and to evaluate the temperature rises on root surfaces and morphological changes of root canal walls in vitro.

SUMMARY BACKGROUND DATA

There has been no report on removing the filling materials and broken instruments from root canals with laser irradiation.

MATERIALS AND METHODS

Thirty-six extracted human incisors were divided into two groups of 18 each. Eighteen root canals were shaped and obturated with gutta-percha and root canal sealer. In another 18 specimens, 3-mm long fractures of files were performed intentionally during root canal preparation. A pulsed Nd:YAG laser irradiation was performed repeatedly at three parameters of 1, 2, and 3 W to remove the filling materials or file fragments. Temperature rises on root surfaces during laser irradiation were measured by thermography, and the remaining of obturated materials and morphological changes of root canal walls were evaluated by stereoscopy and scanning electron microscopy.

RESULTS

In more than 70% of the teeth, the obturated materials were completely removed by laser, and in more than 55% of the teeth, the broken files were successfully removed. Temperature rises ranging from 17 degrees C to 27 degrees C were measured from 6 to 11 repeated times.

CONCLUSION

These results demonstrated that a pulsed Nd:YAG laser irradiation has the capability of removing the obturated materials in root canals and is useful for removing the broken files in same if the counter-measure reducing the temperature rise is performed.

A comparative study on the effects of three types of laser irradiation at the apical stop and apical leakage after obturation

OBJECTIVE

The purposes of this study were to determine the degree of apical leakage using a dye penetration method after argon, pulsed Nd:YAG with or without black ink, or Er:YAG laser treatment and obturation, and to compare the results of three types of laser irradiation in vitro.

SUMMARY BACKGROUND DATA

There have been only a few reports of the laser effect on apical leakage after laser treatment and obturation.

METHODS

Seventy-five human extracted single root teeth were divided into five groups of 15 teeth each and prepared up to a #60 K-file size. One group served as the control and was not irradiated. The other four groups were irradiated with an argon laser at 0.3 W for 3 seconds at continuous mode, pulsed Nd:YAG laser at 2 W and 20 Hz for 4 seconds with or without black ink, and Er:YAG laser at 50 mJ per pulse and 4 Hz for 5 seconds. In each group, ten teeth for the apical leakage study were obturated and immersed in rhodamine B solution for 48 hours at 37 degrees C, and the others were used for the observation by scanning electron microscopy (SEM). All teeth were longitudinally bisected and observed by stereoscopy or SEM.

RESULTS

After pulsed Nd:YAG laser treatment with black ink and obturation, the apical leakage degree (mean score: 0) was reduced compared to that in the control (mean score: 1.2) significantly (p < 0.05). SEM findings showed that specimens irradiated by pulsed Nd:YAG laser with black ink presented clean root canal walls with debris and smear layer evaporated, melted, fused, and recrystallized in most cases.

CONCLUSION

These results suggest that pulsed Nd:YAG laser irradiation with black ink at the apical stop is useful for the reduction of apical leakage after obturation.

A clinical study on the effects of pulsed Nd:YAG laser irradiation at root canals immediately after pulpectomy and shaping

OBJECTIVE

The effects of pulsed Nd:YAG laser irradiation for the treatment of root canals immediately after pulpectomy and shaping with regard to improvement of symptoms were evaluated clinically.

SUMMARY BACKGROUND DATA

The effects of pulsed Nd:YAG laser irradiation for the treatment of root canals were experimentally investigated using an animal model, but not under clinical conditions.

MATERIALS AND METHODS

Thirty-eight teeth from 29 patients were diagnosed as normal or irreversible pulpitis were used. After extirpation of pulp and shaping using a step-back technique and cleansing with 5% sodium hypochlorite (NaOCl) and 3% hydrogen peroxide (H2O2), laser irradiation was applied at 1 W and 15 pps for 1 second in 23 teeth (laser-treated group). Root canals were then obturated with gutta-percha points and sealer by the lateral condensation method. The condition of the obturations was confirmed radiographically. The control teeth were treated in the same way, but without laser irradiation. Occurrence of spontaneous pain was recorded 1 day after treatment and occurrence of percussion pain was recorded 1, 2, and 3 weeks after treatment.

RESULTS

Effective ratio, which was the ratio of the number of "none" teeth to total teeth number in the laser-treated group, was higher than that in the control group, but there was no significant difference between 2 groups with regard to spontaneous and percussion pain (p > 0.05).

CONCLUSION

These results suggest that the clinical application of pulsed Nd:YAG laser might be advantageous for the one-visit treatment of root canals immediately after pulpectomy shaping and to reduce postoperative pain.

Dycal versus Nd:YAG laser and Vitrebond for direct pulp capping in permanent teeth

PURPOSE

To determine the efficacy of laser-assisted direct pulp capping by comparing the survival rates of permanent teeth treated with Nd:YAG laser and Vitrebond (3M Corporation, St. Paul, MN) direct pulp caps to permanent teeth treated with the traditional calcium hydroxide direct pulp cap over intervals of up to 54 months.

SUMMARY BACKGROUND DATA

While there are case reports and evaluations of various laser techniques in the literature, statistical studies comparing the success of laser-assisted applications to traditional techniques are needed. This is a retrospective investigation of one such laser assisted application.

METHODS

A retrospective chart review of all active and inactive patients resulted in the identification of 83 patients who received direct pulp caps in a total of 93 permanent teeth; 29 with calcium hydroxide and 64 with Nd:YAG laser and Vitrebond.

RESULTS

Life table analysis of the data of this retrospective study demonstrated that the teeth treated with the laser and Vitrebond direct pulp cap showed significantly greater survival rates than those treated with Dycal direct pulp cap over intervals of nine to 54 months postoperatively. The cumulative proportion of teeth surviving postoperatively for the Dycal (L.D. Caulk Corporation, Milford, CT) direct pulp cap was 89.7% at 1 month declining to 79.4% at 3 months and 76% at 6 months and then continued to decline in the final two intervals finishing after 54 months at 43.6%. For the laser and Vitrebond direct pulp cap the cumulative proportion surviving stood at 98.4% after 1 month, declining to 93.8% at 3 months and 90.3% after 6 months but then held steady in the final 2 intervals finishing at 90.3% after 54 months.

CONCLUSION

The laser and Vitrebond direct pulp cap produces a significantly more predictable pulpal response after the first 6 months than the Dycal direct pulp cap. The survival rate of teeth treated with the laser and Vitrebond direct pulp cap is significantly greater than those treated with the Dycal direct pulp cap over intervals of 9 to 54 months. Direct pulp capping is a worthwhile procedure that should be performed when indicated, especially in light of the 90.3% survival rate achieved with the laser and Vitrebond direct pulp cap at 54 months.

Post-operative symptoms and healing after endodontic treatment of infected teeth using pulsed Nd:YAG laser

Forty-four teeth in 38 patients, diagnosed with chronic apical periodontitis, were endodontically treated. Root canals were shaped using a step-back technique with 5% NaOCl and 3% H2O2 as irrigants. In half of the teeth the canal terminus was irradiated with pulsed Nd:YAG laser (1 W, 15 pps, 1 s). All canals were then obturated with laterally condensed gutta-percha points and sealer, and final radiographs were obtained. Occurrence of spontaneous pain was recorded 1 day after treatment. Percussion pain was recorded after 1 week, and then at 3 and 6 months after treatment. Radiographic follow-up was performed at 3 and 6 months. Percussion pain was significantly less (P < 0.05) in the laser-treated group than in the control group, both 1 week and 3 months after treatment. Other differences between the groups were not significant. These results suggested that the clinical application of pulsed Nd:YAG laser might be advantageous for the treatment of infected root canals.

Temperature elevation on the root surface during Nd:YAG laser irradiation in the root canal

Nd:YAG lasers have been suggested as a potential tool in endodontic therapy because of their sterilizing and sealing effects on the dentinal tubules. However, the generation of heat in the root canal by laser irradiation may produce potentially harmful effects on adjacent tissues. The purpose of this study was to evaluate the temperature elevation on the root surface when Nd:YAG laser was irradiated in the root canal. The apical third area of 90 single-rooted teeth were irradiated with normal pulsed Nd:YAG laser (50, 80, 100, 150, and 200 mJ/pulse; 20, 25, and 30 pulses/s). The temperature elevation was measured and recorded on the root surface simultaneously. The temperature elevation did not exceed 10 degrees C only when the laser energy output was below 100 mJ/pulse and under 20 pulses/s.

Susceptibility of Nd:YAG laser-irradiated root surfaces in replanted teeth to external inflammatory resorption

Nd:YAG laser-induced modification of the root surface may inhibit development of external inflammatory resorption in replanted teeth. This study tested this hypothesis in vivo. The pulp chambers of six mandibular premolars in each of two dogs were accessed, inoculated with plaque, and sealed (Groups 1, 2). Two additional premolars in each dog were endodontically treated without inoculation (Groups 3, 4). After 2 weeks, teeth were hemisected and extracted. Each root had a 2 x 3 mm surface area denuded of cementum on the buccal and lingual surface. In Groups 1 (n = 12 roots) and 3 (n = 4), the denuded surfaces were wiped with 15% EDTA, coated with black ink, and irradiated with Nd:YAG laser (0.75 W, 15 pps, 300 microns tip, 20 s). In Groups 2 (n = 12) and 4 (n = 4), the surfaces were wiped with 15% EDTA, and rinsed with sterile saline for 20 s. Roots were replanted within 5 min. The dogs were perfusion-euthanised 10 weeks after replantation. Block specimens were removed, decalcified, embedded and horizontally sectioned (6 microns) at 180-microns intervals, resulting in 10 to 14 cross-sections of each root. From these, the middle five consecutive sections were stained with hematoxylin and eosin, and observed by light microscopy for occurrence of surface, inflammatory and replacement resorption on the denuded surfaces. No obvious differences were noted between the laser-irradiated and non-irradiated surfaces. Inflammatory resorption was frequent in Groups 1 and 2, and absent in Groups 3 and 4. Replacement resorption was minimal in Groups 1 and 2, and frequent in Groups 3 and 4. Differences between Groups 1 and 2, and between Groups 3 and 4 were not significant, whereas the differences between the two pairs of groups were statistically significant (chi-square and two-way ANOVA, P < 0.006). These results did not support the hypothesis, and questioned the clinical validity of the surface modification in Nd:YAG laser-irradiated dentin. Therefore, the clinical application of Nd:YAG laser to the root surfaces of replanted teeth is not warranted.

The carbon dioxide laser as an aid in apicoectomy: an in vitro study

OBJECTIVE

To achieve the required goal of optimally sealing the apical section and the root-canal when performing an apicoectomy, the authors decided to use the CO2 laser as an additional aid.

SUMMARY BACKGROUND DATA

The CO2 laser has previously shown to have an excellent sealing effect on dentin surfaces.

METHODS

In this in vitro study, the authors examined the effects of CO2 laser application in apicoectomies with the help of color penetration tests and scanning electron microscopic (SEM) examinations. Sections and root canals were irradiated with low power (0.5 W) in continuous wave mode for totally 20 sec. The thermal stress for the adjacent tissues attaching thereto is moderate as shown by infrared-spectroscopy.

RESULTS

A comparison with nonirradiated samples revealed that CO2 laser irradiation reduced color penetration at the section to a minimum. Also, irradiation of the root-canal wall resulted in satisfactory sealing of the surface. These findings were supported by the results of the SEM examinations.

CONCLUSIONS

CO2 laser treatment optimally prepares the tooth for final intraoperative filling because of sealing of the dentinal tubules, the resultant elimination of niches for bacteria and the sterilizing effect of the laser.

In vitro study of a Nd:YAP laser in endodontic retreatment

Nd:YAP laser is a dental laser with a 1340 nm wavelength. The laser beam is carried by a 200 to 300 microns fiberoptic and is suitable for endodontic therapy. We used the Nd:YAP laser in an in vitro experiment to study its effectiveness in endodontic retreatment. Temperature measurements and irradiation parameters were first defined. Then Nd:YAP laser irradiation was used, alone or in combination with hand instruments, to remove various canal sealers and broken instruments. Clinical parameters were monitored and scanning electron microscopic observations were conducted. When used at 200 mJ--with a pulse duration of 150 ms, an exposure time of 1 s and a frequency of 10 Hz--Nd:YAP laser preserved the dentinal walls of the root canal and enabled root canal retreatment without thermic elevation harming periodontal tissue. It is concluded that, in combination with hand instruments, the Nd:YAP laser is an effective device for root canal preparation in endodontic retreatment.

Prospective study of two retrograde endodontic apical preparations with and without the use of CO2 laser

This article covers a 4-year study that reports 320 cases in which endodontic surgery was performed for residual apical lesions or lesions that could not be treated in a conventional way. Four groups of 80 teeth each were formed and they were followed up after a 12-month interval. The first group comprised cases treated with a micro bur, retrograde filling and IRM; the second, cases treated at the apical and radicular portions with a CO2 laser; the third, cases in which the retrograde cavity was prepared with an ultrasonic device instead of a micro bur; and the fourth group comprised cases treated in a similar way to the second group, i.e., cases treated at the apical and radicular portions, but with a CO2 laser instead of a micro bur. After 12 months, the results showed a better prognosis with ultrasonic treatment. Regardless of technique, the CO2 laser did not improve the healing process.

Scanning electron microscopic study of dentin lased with argon, CO2, and Nd:YAG laser

The purpose of this study was to compare morphological changes on the dentin surface induced by laser light delivered perpendicular or parallel to the dentin surface. The surface of the dentin slices and the root canal walls were lased with argon, CO2, and Nd:YAG lasers. When the laser beam was parallel to the dentin, the effects of the laser energy ranged from no effect to eroding and melting of the smear layer and dentin in the samples. When the laser beam was perpendicular to the surface, all three lasers produced well-shaped craters. From this, it was concluded that the angle of the laser beam in relation to the target surface can be a deciding factor of how much energy will be absorbed by the dentin and consequently of the morphological changes induced by the laser.

Connective tissue response to root surfaces resected with Nd:YAG laser or burs

PROBLEM

The Nd:YAG laser beam may be used for root resection, but the tissue compatibility of the resulting root surface has not been confirmed.

OBJECTIVE

This study assessed the connective tissue response over time to implanted root segments with Nd:YAG laser-cut or bur-cut surfaces.

STUDY DESIGN

Endodontically treated roots of 25 extracted human teeth were cross sectioned to form 3.5 mm thick disks by alternating a water-cooled Nd:YAG laser with a high-speed water-cooled tungsten fissure bur. A total of 63 disks were implanted into the dorsal subcutaneous tissue of 16 rats, then recovered with the surrounding tissue after periods of 3, 7, 14, 28, 60, and 90 days, and processed for light microscopic examination. Tissue against the cut surfaces was assessed for intensity and extent of inflammation and fibrous capsule thickness.

RESULTS

A two-factor analysis of variation showed statistically significant (p < 0.05) differences between the laser-cut and bur-cut surfaces.

CONCLUSION

Tissue repair about the root surfaces resected with Nd:YAG laser was delayed when compared with those resected with a bur.

Dentin ablation with three infrared lasers

BACKGROUND AND OBJECTIVE

Lasers are used for caries removal in enamel and dentin, but are currently limited in their ability to remove sound tooth structure. In this study plasma interaction regimes are investigated as the principal factor determining the ablation characteristics.

STUDY DESIGN/MATERIALS AND METHODS

Three ablation parameters are considered: ablation rates (AR), surface temperatures (ST), and surface morphological characteristics. The three lasers investigated were Er:YSGG with wavelength (WL) of 2.94 mu m and pulse duration (PD) of 250 mu s, Ho:YSGG at 2.1 mu m and 250 mu s and an Nd:YAG with WL of 1.06 mu M and PD of 15ns.

RESULTS

The highest surface temperatures were observed during Er:YSGG treatment (> 300 degrees C), moderate temperatures with the Ho:YSGG (150 degrees C), and lowest with the Nd:YAG (with highest surface temperature generally lower than 80 degrees C). Ablation rates were also compared and were shown to be highest with the Er:YSGG and Ho:YSGG, and lower with the Nd:YAG (< 3 mu m). In all systems, efficient ablation was observed only in the presence of plasma. In spite of their different wavelengths, for similar spot sizes, energy, and pulse duration, ablation rates of Ho:YSGG and Er:YSGG were found to be comparable. These were an order of magnitude larger than the ablation rates observed with the nanosecond system.

CONCLUSION

Possible explanation for these observations is given in terms of plasma characteristics.

Dentin ablation with three infrared lasers

BACKGROUND AND OBJECTIVE

Lasers are used for caries removal in enamel and dentin, but are currently limited in their ability to remove sound tooth structure. In this study plasma interaction regimes are investigated as the principal factor determining the ablation characteristics.

STUDY DESIGN/MATERIALS AND METHODS

Three ablation parameters are considered: ablation rates (AR), surface temperatures (ST), and surface morphological characteristics. The three lasers investigated were Er:YSGG with wavelength (WL) of 2.94 mu m and pulse duration (PD) of 250 mu s, Ho:YSGG at 2.1 mu m and 250 mu s and an Nd:YAG with WL of 1.06 mu M and PD of 15ns.

RESULTS

The highest surface temperatures were observed during Er:YSGG treatment (> 300 degrees C), moderate temperatures with the Ho:YSGG (150 degrees C), and lowest with the Nd:YAG (with highest surface temperature generally lower than 80 degrees C). Ablation rates were also compared and were shown to be highest with the Er:YSGG and Ho:YSGG, and lower with the Nd:YAG (< 3 mu m). In all systems, efficient ablation was observed only in the presence of plasma. In spite of their different wavelengths, for similar spot sizes, energy, and pulse duration, ablation rates of Ho:YSGG and Er:YSGG were found to be comparable. These were an order of magnitude larger than the ablation rates observed with the nanosecond system.

CONCLUSION

Possible explanation for these observations is given in terms of plasma characteristics.

Comparative evaluation of the antibacterial effects of intracanal Nd:YAG laser irradiation: an in vitro study

The purpose of this study was to determine if the Nd:YAG laser was capable of disinfecting contaminated root canals in vitro. Eighty canals of extracted single-rooted teeth were prepared to size 35 K-file. The teeth were sterilized with ethylene oxide gas and then inoculated with Bacillus stearothermophilus. Eight groups were treated as follows: 1, sterility control; 2, positive control, no treatment; 3, hand instrumentation with sterile water filling chamber; 4, hand instrumentation with NaOCl (5.25%) filling chamber; 5, ultrasonic instrumentation with sterile water; 6, ultrasonic instrumentation with NaOCl; 7, laser exposure with sterile water; and 8, laser exposure with NaOCI. All instrumentation times were 1 min. Teeth were then flushed with 1.0 ml of sterile water onto blood agar plates, and the number of colony forming units were determined. Results indicate that: (i) all groups treated with NaOCI effectively inhibited the growth of B. stearothermophilus; (ii) hand and ultrasonic instrumentation with sterile water did not effectively disinfect root canals; and (iii) the Nd:YAG laser was effective in inhibiting the growth of B. stearothermophilus. The effects of the Nd:YAG laser on other bacteria more commonly found in root canal systems should be evaluated.