Case Study: Dual Wavelength Treatment of a Calcified Canal With the Fotona Lightwalker Class Laser

Thursday, April 4, 2013

Lasers have been commercially available in Dentistry since 1989 .Soft tissue lasers such as the Nd:YAG were the first dental lasers for clinical use. The introduction of hard tissue lasers several years later revolutionized how we can treat our patients.

Of the commercially available hard tissue lasers, the Erbium:YAG lasers have the highest absorption in water as its chromofore versus the Erbium-Chromium:YSGG which is the other presently approved hard tissue laser.

In my practice we have chosen the Er:Yag laser because of this increased level of performance, and patient comfort.

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Figure 1: A preoperative radiograph of tooth #7.

In this case study, the patient, an 80-year-old female presented for endodontic treatment of tooth #7 after fracturing it and having a provisional placed while on vacation. Radiographically the canal was evident faintly in the middle and apical thirds. We accessed it using our Global microscope, but no canal was evident even under high magnification.

We then used the Nd:YAG laser on our LightWalker laser at low power to locate the remnants of the canal. The canal becomes evident by sparking as it interacts with the pigment of the tissue remnants of its chromofore.

This was followed up by using the Er:YAG laser and PIPS (Photon Induced Photo accoustic Streaming) technology to open up the canal.

The working distance was determined with a Root ZX II Apex Locator. Having an adequate chamber for the solutions used for the PIPS protocol is very important, as is having completely sealed isolation.

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Figure 2: A postoperative radiograph of tooth #7.

Instrumentation was initiated with hand files and the completed with Waveone reciprocal engine drive action. Irrigation was accomplished with PIPS using Sodium hypochloride, EDTA and water per the PIPS protocol. The tooth was then obturated with EndoREZ and gutta percha, which was then covered with Flow Purple and Cavit to adequately seal the coronal access until the tooth was definitively restored with a full coverage crown.

Conclusion:

The results of this case clearly show the possibilities of the powerful combination of the two laser wavelengths (Er:YAG and Nd:YAG) in the Fotona LightWalker class laser. The laser allows us to treat cases that would possibly not be treatable without this technology.

Disclosure: Dr. Harvey Shiffman has no financial interest in any of the companies mentioned in this article and received no compensation for writing this article.

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