Disinfection of Root Canals with Photon-initiated Photoacoustic Streaming

Introduction: This study set out to compare the efficacy of laser-activated and ultrasonically activated root canal disinfection with conventional irrigation, specifically its ability to remove bacterial film formed on root canal walls. Methods: Seventy human premolars were shaped to an apical size #20, taper .07, sterilized, and contaminated in situ with oral bacteria for 1 week and incubated for 2 more weeks. Irrigation was done with 6% NaOCl (group 1), NaOCl ultrasonically activated with blunt inserts (group 2), or a pulsed erbium:YAG laser at nonablative settings (group 3) for a total of 60 seconds each. Positive and negative controls were also included. Aerobic bacterial sampling was performed, and the incidence of positive samples after 24 and 48 hours as well as bacterial counts (colony-forming units) were determined. Fixed and demineralized sections 1 mm and 4 mm off the apex were Brown-Brenn stained and assessed for remaining intracanal bacteria/biofilm and dentinal tubule penetration. Results: All 3 canal disinfection protocols significantly reduced bacterial counts (P < .001). None of the 3 techniques predictably generated negative samples, but laser-activated disinfection was superior to the other 2 techniques in this aspect (P < .05). Histologic sections showed variable remaining bacterial presence in dentinal tubules at the 4-mm level and significantly less bacterial biofilm/necrotic tissue remaining at the 1-mm level after laser-activated irrigation (P < .05). Conclusions: Under the conditions of this combined in situ/in vitro study, activated disinfection did not completely remove bacteria from the apical root canal third and infected dentinal tubules. However, the fact that laser activation generated more negative bacterial samples and left less apical bacteria/biofilm than ultrasonic activation warrants further investigation. (J Endod 2011;37:1008-1012)