Abstract

Objective: This study attempted to evaluate the efficacy of Sodium hypochlorite activation using two types of laser; Diode laser and Er: YAG laser utilizing PIPS tip as compared to conventional Sodium hypochlorite syringe irrigation on biofilm eradication, smear layer removal and topographic surface changes.

Methods: For biofilm eradication analysis, 21 single-rooted premolar human teeth were prepared and inoculated with E. faecalis, then divided into three groups of seven roots each. All teeth were subjected to irrigation with 10 ml 2.5% Sodium hypochlorite either with, conventional syringe irrigation (CSI) in Group I, Diode laser activation (940 nm) in Group II, or Er: YAG laser activation utilizing PIPS tip in Group III. Biofilm eradication was evaluated using Confocal Laser Scanning Microscope CLSM. For comparing the smear removal efficacy and surface topographic changes, another 21 single-rooted premolar human teeth, were irrigated with saline during instrumentation and assigned to three groups as mentioned. Scanning Electron microscope was used to score the presence of a smear layer at different root canal levels and analyze the topographic surface changes by detecting the presence of dentinal tubules changes.

Results: Er: YAG Group utilizing PIPS tip showed significantly higher biofilm eradication when compared to CSI Group and Diode laser activation Group (p < 0.0001 and 0.004 respectively). SEM analysis presented Group III with significantly higher smear layer removal in the coronal and middle thirds as compared to the other two Groups (p = 0.031). Analysis of topographic surface changes showed a statistically significant higher incidence of dentinal tubules changes in both laser activation groups when compared to CSI only in the coronal third (p = 0.04).

Conclusions: Activation of Sodium hypochlorite irrigant using Er: YAG laser utilizing PIPS technique enhanced the biofilm eradication capability and smear layer elimination potentiality. Yet, the dentinal tubules changes remain higher when laser is used.

Keywords: LAI Laser Activated Irrigation; PIPS Photon Initiated Photoacoustic Streaming; Biofilm Smear Layer; Dentin Changes; Irrigation; Confocal Laser Microscopy; Scanning Electron Microscope

References

1. Ordinola‐Zapata R., et al. “Biofilm removal by 6% sodium hypochlorite activated by different irrigation techniques”. International Endodontic Journal 47.7 (2014): 659-666.
2. Da Costa Lima GA., et al. “Comparison of smear layer removal using the Nd: YAG laser, ultrasound, ProTaper Universal system, and CanalBrush methods: an in vitro study”. Journal of Endodontics 41.3 (2015): 400-404.
3. Ashofteh K., et al. “In vitro comparison of the antibacterial effect of three intracanal irrigants and diode laser on root canals infected with Enterococcus faecalis”. Iranian Journal of Microbiology 6.1 (2014): 26.
4. Zhu X., et al. “Comparison of the antibacterial effect and smear layer removal using photon-initiated photoacoustic streaming aided irrigation versus a conventional irrigation in single-rooted canals: an in vitro study”. Photomedicine And Laser Surgery 31.5-8 (2013): 371-377.
5. Mehrvarzfar P., et al. “Additive effect of a diode laser on the antibacterial activity of 2.5% NaOCl, 2% CHX and MTAD against Enterococcus faecalis contaminating root canals: an in vitro study”. Journal of oral Science 53.3 (2011): 355-360.
6. Nasher R., et al. “The effectiveness of the Erbium: Yttrium aluminum garnet PIPS technique in comparison to different chemical solutions in removing the endodontic smear layer— an in vitro profilometric study”. Lasers in Medical Science 31.9 (2016): 1871-1882.
7. Takeda FH., et al. “A comparative study of the removal of smear layer by three endodontic irrigants and two types of laser”. International Endodontic Journal (1999): 32-39.
8. Da Costa Ribeiro A., et al. “Effects of diode laser (810 nm) irradiation on root canal walls: thermographic and morphological studies”. Journal of Endodontics 33.3 (2007): 252-255.
9. Peters OA., et al. “Effects of four Ni–Ti preparation techniques on root canal geometry assessed by micro computed tomography”. International Endodontic Journal 34.3 (2001): 221-230.
10. De-Deus G., et al. “Micro-CT evaluation of non-instrumented canal areas with different enlargements performed by NiTi systems”. Brazilian Dental Journal 26.6 (2015): 624-629.
11. Versiani MA., et al. “Micro– computed tomography study of oval-shaped canals prepared with the Self-adjusting File, Reciproc, WaveOne, and Protaper Universal systems”. Journal of Endodontics 39.8 (2013):1060-1066.
12. Zuolo ML., et al. “Micro‐CT assessment of the shaping ability of four root canal instrumentation systems in oval‐shaped canals”. International Endodontic Journal 51.5 (2018): 564-571.
13. Baumgartner JC., et al. “Geographical differences in bacteria detected in endodontic infections using polymerase chain reaction”. Journal of Endodontics 30.3 (2004): 141-144.
14. Portenier I., et al. “Enterococcus faecalis–the root canal survivor and ‘star’in post‐treatment disease”. Endodontic Topics 6.1 (2003): 135-159.
15. Tronstad L and Sunde PT. “The evolving new understanding of endodontic infections”. Endodontic Topics 6.1 (2003): 57-77.
16. Love RM. “Enterococcus faecalis–a mechanism for its role in endodontic failure”. International Endodontic Journal 34.5 (2001): 399-405. 
17. Nagayoshi M., et al. “Antimicrobial effect of ozonated water on bacteria invading dentinal tubules”. Journal of Endodontics 30.11 (2004): 778-781.
18. Podbielski A., et al. “Additive antimicrobial activity of calcium hydroxide and chlorhexidine on common endodontic bacterial pathogens”. Journal of Endodontics 29.5 (2003): 340-345.
19. Hazlett KR., et al. “Inactivation of the gbpA Gene of Streptococcus mutans Alters Structural and Functional Aspects of Plaque Biofilm Which Are Compensated by Recombination of the gtfB andgtfC Genes”. Infection and Immunity 67.8 (1999): 3909-3914.
20. S Senia ES., et al. “The solvent action of sodium hypochlorite on pulp tissue of extracted teeth”. Oral Surgery, Oral Medicine, Oral Pathology 31.1 (1971): 96-103.
21. Chow TW. “Mechanical effectiveness of root canal irrigation”. Journal of Endodontics 1983 9.11 (1983): 475-479.
22. Stabholz A., et al. “The use of lasers in dentistry: Principles of operation and clinical applications”. Compendium of Continuing Education in Dentistry 24.12 (1995): 935-948.
23. Olivi G. “Laser use in endodontics: evolution from direct laser irradiation to laser-activated irrigation”. Journal of Laser Dentistry 21.2 (2013): 58-71.
24. Blanken J., et al. “Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 1: a visualization study”. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 41.7 (2009): 514-519.
25. Moritz A., et al. “Oral laser application”. Chicago, Ill: Quintessence (2006).
26. Peters OA., et al. “Disinfection of root canals with photon-initiated photoacoustic streaming”. Journal of Endodontics 37.7 (2011): 1008-1012.
27. Cheng X., et al. “Evaluation of the bactericidal effect of Nd: YAG, Er: YAG, Er, Cr: YSGG laser radiation, and antimicrobial photodynamic therapy (aPDT) in experimentally infected root canals”. Lasers in Surgery and Medicine 44.10 (2012): 824-831.
28. Al Shahrani M., et al. “Enhanced removal of Enterococcus faecalis biofilms in the root canal using sodium hypochlorite plus photon-induced photoacoustic streaming: an in vitro study”. Photomedicine and Laser Surgery 32.5 (2014): 260-266.
29. Mathew J., et al. “Viability and antibacterial efficacy of four root canal disinfection techniques evaluated using confocal laser scanning microscopy”. Journal of Conservative Dentistry: JCD 17.5 (2014): 444.
30. Cheng X., et al. “Bactericidal effect of Er: YAG laser-activated sodium hypochlorite irrigation against biofilms of Enterococcus faecalis isolate from canal of root- filled teeth with periapical lesions”. Photomedicine and Laser Surgery 35.7 (2017): 386-392.
31. Golob BS., et al. “Efficacy of photon-induced photoacoustic streaming in the reduction of Enterococcus faecalis within the root canal: different settings and different sodium hypochlorite concentrations”. Journal of Endodontics 43.10 (2017): 1730-1735.
32. Armengol V., et al. “Temperature rise during Er: YAG and Nd: YAP laser ablation of dentin”. Journal of Endodontics 26.3 (2000): 138-141.
33. Levy G., et al. “Pressure waves in root canals induced by Nd: YAG laser”. Journal of Endodontics 22.2 (1996): 81-84.
34. Guidotti R., et al. “Er: YAG 2,940-nm laser fiber in endodontic treatment: a help in removing smear layer”. Lasers in Medical Science 29.1 (2014): 69-75.
35. Mancini M., et al. “Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study”. Journal of Endodontics 39.11 (2013): 1456-1460.
36. Faria MI., et al. “Effects of 980-nm diode laser on the ultrastructure and fracture resistance of dentine”. Lasers in Medical Science 2013 28.1 (2013): 275-280.
37. Esteves-Oliveira M., et al. “Of dentin root canal permeability and morphology after irradiation with Nd: YAG, Er: YAG, and diode lasers”. Lasers in Medical Science 25.5 (2010): 755-760.
38. Lopes FC., et al. “Effects of different lasers on organic/inorganic ratio of radicular dentin”. Lasers in Medical Science 31.3 (2016): 415-420.
39. Klinke T., et al. “Antibacterial effects of Nd: YAG laser irradiation within root canal dentin”. Journal of Clinical Laser Medicine and Surgery 15.1 (1997): 29-31.
40. Brugnera Jr A., et al. “Effects of Er: YAG and Nd: YAG laser irradiation on radicular dentine permeability using different irrigating solutions”. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 33.4 (2003): 256-259.
41. Alfredo E., et al. “Morphological alterations of radicular dentine pretreated with different irrigating solutions and irradiated with 980‐nm diode laser”. Microscopy Research and Technique 72.1 (2009): 22-27.
42. Ali Saghiri M., et al. “Effect of laser irradiation on root canal walls after final irrigation with 17% EDTA or BioPure MTAD: X-ray diffraction and SEM analysis”. Quintessence International 43.10 (2012).
43. Jahan KR., et al. “An assessment following root canal preparation by Er, Cr: YSGG laser irradiation in straight and curved roots, in vitro”. Lasers in Medical Science 21.4 (2006): 229-234.
44. Minas NH., et al. “In vitro preliminary study to evaluate the capability of Er, Cr: YSGG laser in posterior teeth root-canal preparation with step-back technique”. Lasers in Medical Science 24.1 (2009): 7-12.

Citation

Citation: Radhwa Refaat Otaify., et al. “Evaluation of Competency of Diode Laser and Er: YAG Laser Activation on Sodium Hypochlorite Capability for Biofilm Eradication and Smear Layer Removal: A Comparative In vitro Study”.Acta Scientific Dental Sciences 4.2 (2020): 28-36.

Copyright

Copyright: © 2020 Radhwa Refaat Otaify., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.