Differences between traditional endodontic treatment and laser endodontic treatment

Today, dental lasers complement or even replace drills and other traditional instruments for some dental procedures, including root canals. According to the American Association of Endodontists (AAE), millions of teeth are treated and, more importantly, saved each year with endodontic treatment, which becomes necessary when the dental pulp, the living tissue deep inside the tooth, becomes inflamed and/or infected.

 

Why is endodontic treatment necessary?

 

Root canal treatment may be necessary for several reasons, including:

• deep degradation;
• repeated dental procedures on a tooth, including decay around old fillings or crowns;
• cracks and other trauma to the teeth - resulting in pulp injury.

At this point it is useful to familiarize yourself with the basic anatomy of a tooth. The crown or outer surface of the visible part of the tooth is made of enamel; beneath this is a second layer made of dentin, a hard bone-like material that also contains the root or roots of the tooth. Within the dentin is the pulp, which contains blood vessels, nerves and connective tissue.

 

Root canal treatment (RCT) or endodontic treatment ("endo" = inside and "dont" = tooth) is used to treat a tooth and to alleviate the pain that is associated with pulp damage. During a traditional root canal procedure, the dentist or endodontist (root canal specialist) will use local anesthesia to numb the tooth. A small opening is made by drilling into the back of a front tooth or the occlusal surface of a back tooth to access the pulp. The inflamed or infected pulp is removed and the root canal system inside the tooth is cleaned, shaped and disinfected. It is then filled and sealed with a rubber-like material called gutta-percha. Finally, the tooth is restored with a filling or crown and a successful procedure ensures that a tooth continues in normal function.

 

Laser-assisted endodontic treatment

 

Dental lasers use beams of light to remove or modify soft and hard tissues in the mouth. The Food and Drug Administration (FDA) has approved the use of various lasers as an adjuvant in endodontic treatment. Lasers essentially emit an intense focused light whose particular properties can interact with biological tissues. Lasers can now be used to open the surface of a tooth to access the root canal, remove diseased tissue, clean, disinfect and shape the canal and fill it.

According to an AAE position paper, the use of lasers to aid in root canal disinfection is more promising than in root canal preparation. Lasers can be used to remove dental pulp and organic debris and even to modify (shape and clean) the dentin walls of root canals. Once the preparation is complete and the root canal is sealed (usually with gutta-percha), the laser can be used to soften and move the sealant to the root canal system.

 

The pros and cons of using lasers in endodontic treatment

 

The dental laser can annihilate bacteria and infected material with greater precision, sometimes preserving more of the healthy tooth structure. It can also reduce discomfort by eliminating the disturbing sounds of the exercises, as well as limiting the need for local anesthesia. There are reports of less bleeding during root canal surgical procedures and reduced postoperative discomfort and infection.

 

A disadvantage is that the laser light travels in a straight line, whereas root canal spaces are rarely straight, and traditional instruments offer an advantage because they can be curved to follow the shape of the tooth root. Also, the interactions involved between the laser energy and the tooth tissues can cause an increase in temperature, which can damage the root canal space and sometimes even extend to the outer surfaces of the tooth.

 

Laser canal irrigation vs. conventional canal irrigation

 

A recent scientific study comparing the effectiveness of dental laser irrigation of root canals with conventional irrigation to disinfect them found favorable results for laser technology. Laser-activated irrigation for eradicating bacteria and preventing the growth of new bacteria was more effective than conventional irrigation delivered through a syringe.

While there is a body of evidence regarding the antibacterial efficacy of high-power laser endodontic treatment, the evidence is inconclusive as to whether lasers provide superior sealing or higher clinical success rates than conventional techniques. More research is needed to determine whether laser-assisted endodontic treatment is the preferred technique, particularly given the high success rate of non-laser procedures. Meanwhile, some dentists combine both laser and traditional techniques for optimal effects.

 

Discuss laser-assisted root canal treatment with your dentist or endodontist to help weigh the pros and cons to suit your individual needs.