Efficacy of Er:YAG Laser PIPS/SWEEPS in Removal of Calcium Hydroxide Paste from Anatomically Complex Root Canals

doi:10.13701/j.cnki.kqyxyj.2023.01.007

Abstract

Abstract: Objective: To evaluate the efficacy of two Er:YAG laser-activated irrigation techniques, i.e. photon-initiated photoacoustic streaming (PIPS) and shock wave enhanced emission photoacoustic streaming (SWEEPS), in removing calcium hydroxide from anatomically complex root canal systems. Methods: Seventy-five human freshly extracted single-canal premolars were selected and the root canals were instrumented with WaveOne Gold Primary. Each tooth was split longitudinally into 2 halves, with a groove made in the apical segment of one half and a semicircular cavity on the other half. The root canals were then filled with calcium hydroxide paste. The teeth were randomly assigned to 5 groups to remove calcium hydroxide from root canals using PIPS, SWEEPS, EDDY, passive ultrasonic irrigation (PUI), and conventional needle irrigation (CNI), respectively. Before and after irrigation, photographs were taken under microscope to calculate the percentages of residual calcium hydroxide, and the amount of remaining medicament in the irregular areas (grooves and semicircular cavities) were evaluated using a scoring system. Results: The ranking of the effectiveness of calcium hydroxide removal from the most to the least was: SWEEPS, PIPS, EDDY/PUI, and CNI, with no statistical difference between PUI and EDDY (P>0.05). SWEEPS showed the best removal efficacy in irregular areas, PIPS and EDDY less, and PUI and CNI the least, with no significant difference between PIPS and EDDY, and between PUI and CNI (P>0.05). Conclusion: Both Er:YAG laser-activated irrigation techniques were effective in removing calcium hydroxide from anatomically complex root canal systems. The best efficacy is obtained by SWEEPS.

Key words: calcium hydroxide, Er:YAG laser, laser-activated irrigation, photon-initiated photoacoustic streaming, shock wave enhanced emission photoacoustic streaming

YANG Lan, LI Ying, BAO Pingping. Efficacy of Er:YAG Laser PIPS/SWEEPS in Removal of Calcium Hydroxide Paste from Anatomically Complex Root Canals[J]. Journal of Oral Science Research, 2023, 39(1): 37-41.

References

[1] Kirmizi D, Aksoy U, Orhan K. Efficacy of laser-activated irrigation and conventional techniques in calcium hydroxide removal from simulated internal resorption cavities: Micro-CT study [J]. Photobiomodul Photomed Laser Surg, 2021, 39(10): 674-681.
[2] Uygun AD, Gündodu EC, Arslan H, et al. Efficacy of XP-endo finisher and TRUShape 3D conforming file compared to conventional and ultrasonic irrigation in removing calcium hydroxide [J]. Aust Endod J, 2017, 43(2): 89-93.
[3] Tavella E, Silva NC, Gibin JT, et al. Calcium hydroxide paste removal strategies and bond strengths of epoxy- and silicate-based sealers [J]. Aust Endod J, 2021, 47(2): 236-244.
[4] Chawla A, Kumar V. Evaluating the efficacy of different techniques and irrigation solutions for removal of calcium hydroxide from the root canal system: A scanning electron microscope study [J]. J Conserv Dent, 2018, 21(4): 394-400.
[5] Marques-da-Silva B, Alberton CS, Tomazinho FSF, et al. Effectiveness of five instruments when removing calcium hydroxide paste from simulated internal root resorption cavities in extracted maxillary central incisors [J]. Int Endod J, 2020, 53(3): 366-375.
[6] Donnermeyer D, Wyrsch H, Bürklein S, et al. Removal of calcium hydroxide from artificial grooves in straight root canals: Sonic activation using EDDY versus passive ultrasonic irrigation and XPendo finisher [J]. J Endod, 2019, 45(3): 322-326.
[7] Yang Q, Liu M, Zhu L, et al. Comparison of needle, ultrasonic, and laser irrigation for the removal of calcium hydroxide from mandibular molar root canals [J]. Photobiomodul Photomed Laser Surg, 2021, 39(5): 349-354.
[8] de Oliveira RL, Guerisoli DMZ, Duque JA, et al. Computed microtomography evaluation of calcium hydroxide-based root canal dressing removal from oval root canals by different methods of irrigation [J]. Microsc Res Tech, 2019, 82(3): 232-237.
[9] Balvedi RP, Versiani MA, Manna FF, et al. A comparison of two techniques for the removal of calcium hydroxide from root canals [J]. Int Endod J, 2010, 43(9): 763-768.
[10] Li D, Jiang S, Yin X, et al. Efficacy of needle, ultrasonic, and endoactivator irrigation and photon-induced photoacoustic streaming in removing calcium hydroxide from the main canal and isthmus: an in vitro micro-computed tomography and scanning electron microscopy study [J]. Photomed Laser Surg, 2015, 33(6): 330-337.
[11] Güven Y, Ali A, Arslan H. Efficiency of Endosonic Blue, Eddy, Ultra X and Endoactivator in the removal of calcium hydroxide paste from root canals [J]. Aust Endod J, 2022, 48(1):32-36.
[12] Shi L, Wu S, Yang Y, et al. Efficacy of five irrigation techniques in removing calcium hydroxide from simulated S-shaped root canals [J]. J Dent Sci, 2022, 17(1): 128-134.
[13] Arslan H, Akcay M, Capar ID, et al. An in vitro comparison of irrigation using photon-initiated photoacoustic streaming, ultrasonic, sonic and needle techniques in removing calcium hydroxide [J]. Int Endod J, 2015, 48(3): 246-251.
[14] Laky M, Volmer M, Arslan M, et al. Efficacy and safety of photon induced photoacoustic streaming for removal of calcium hydroxide in endodontic treatment [J]. Biomed Res Int, 2018, 2018: 2845705.
[15] Lloyd A, Navarrete G, Marchesan MA, et al. Removal of calcium hydroxide from Weine Type Ⅱ systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study [J]. J Appl Oral Sci, 2016, 24(6): 543-548.
[16] Lukac N, Muc BT, Jezersek M, et al. Photoacoustic endodontics using the novel SWEEPS Er: YAG laser modality [J]. J Laser Health Acad, 2017, 1: 1-7.
[17] van der Sluis LW, Wu MK, Wesselink PR. The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies [J]. Int Endod J, 2007, 40(1):52-57.
[18] Nasab Mobarakeh NM, Taheri A, Rahmanian H, et al. Effect of various irrigating devices on the removal of two different forms of calcium hydroxide from internal resorption cavities [J]. Int J Dent, 2020, 2020: 8881177.
[19] Ma JZ, Shen Y, Al-Ashaw AJ, et al. Micro-computed tomography evaluation of the removal of calcium hydroxide medicament from C-shaped root canals of mandibular second molars [J]. Int Endod J, 2015, 48(4): 333-341.
[20] Do QL, Gaudin A. The efficiency of the Er: YAG laser and photonInduced photoacoustic streaming (PIPS) as an activation method in endodontic irrigation: A literature review [J]. J Lasers Med Sci, 2020, 11(3): 316-334.
[21] Su Z, Li Z, Shen Y, et al. Characteristics of the irrigant flow in a simulated lateral canal under two typical laser-activated irrigation regimens [J]. Lasers Surg Med, 2020.
[22] 赵斯佳,何新宇,李依洲,等.不同脉冲宽度Er: YAG激光激活根管荡洗的研究[J].口腔医学研究,2022,38(5):454-458.
[23] Bao P, Shen Y, Lin J, et al. In vitro efficacy of XP-endo finisher with 2 different protocols on biofilm removal from apical root canals [J]. J Endod, 2017, 43(2): 321-325.