A clinical protocol for immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser.

BACKGROUND: Placement of dental implants into fresh extraction sockets offers some advantages, such as reduced treatment times and enhanced patient comfort. The Er,Cr:YSGG (Erbium, Chromium-doped: Yttrium, Scandium, Gallium, and Garnet) laser can significantly reduce bacterial concentration after the extraction of a compromised tooth. The aim of this article is to provide a clinical protocol for the management of implants placed in infected extraction sites decontaminated with Er,Cr:YSGG laser. METHODS: A compromised tooth, which was an abutment for a fixed bridge, with clinical and radiological signs of infection was extracted. The infected site was treated and decontaminated with an Er,Cr:YSGG laser device (Biolase iPlus®) and two implants (Straumann®) were placed in the same surgery, in order to rehabilitate the edentulous area. The intervention was completed by tissue regeneration with biomaterials. RESULTS: Prosthetic rehabilitation after the surgical phase allowed us to provide correct function and satisfactory esthetics. In the follow-up visit, clinicians found good tissue healing and did not observe any complications, such as implant loss or peri-implantitis. The technique used in our study is repeatable and predictable, but patient selection is very important for this type of protocol as the presence of contraindications can lead to failure. The photoacoustic effect exerted by this type of laser has been proven to be effective against many pathogens. Several authors have previously demonstrated the effectiveness of this technique. CONCLUSIONS: Immediate implantation in infected sites decontaminated with Er,Cr:YSGG laser does not seem to contribute to an increased risk of failure; however, it is necessary to follow a certain set of protocols and procedures to prevent peri-implantitis and other complications.

Immediate dental implant placement in post-extraction-infected sites decontaminated with Er,Cr:YSGG laser: a retrospective cohort study.

Dental implants placed in fresh extraction alveoli provide several advantages, including shorter treatment periods and improved patient comfort. After a compromised tooth extraction, the Er,Cr:YSGG laser can considerably reduce bacterial concentration. The objective of this controlled study conducted after at least 1 year of follow-up was to compare the use of immediate post-extraction implants in infected sites treated with laser (test group) versus conventional implants in edentulous sites (control group) through an analysis of pre- and post-operative radiographs. The study was based on a series of patients treated between 2014 and 2019, with a 1-year minimum follow-up, and up to over 4 years. An analysis of the clinical history of the treated patients and pre- and post-operative radiographs was performed to evaluate the implant success and to measure the marginal bone level (MBL). Overall, 149 implants were studied. There was only one failure in the test group (1%) and no failures in the control group. The test group gained 0.1 mm of the MBL compared to the baseline, while the control group lost 0.1 mm of the MBL. The difference between the two groups of only 0.2 mm was not statistically significant (P = 0.058). Immediate dental implants in infected sockets debrided and decontaminated using Er,Cr:YSGG laser do not appear to enhance the likelihood of failure; however, peri-implantitis and associated problems must be avoided by following a certain set of protocols and procedures.

Microbial Association with Genus Actinomyces in Primary and Secondary Endodontic Lesions, Review.

The main reason for root canal treatment failure is the persistence of microorganisms after therapy, or the recontamination of the root canal system due to an inadequate seal. In the mouth, Actinomyces spp. constitute a significant part of the normal flora, which is indicative of their ability to adhere to oral tissue and resist cleansing mechanisms, such as salivary flow. This review, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), aims to clarify the prevalence of microbial genera that are associated with the genus Actinomyces in primary and secondary endodontic infections (primary outcome), and to identify the most prevalent species of the Actinomyces genus in endodontic lesions (secondary outcome). A total of 11 studies were included in the qualitative and quantitative analysis, and a total of 331 samples were analyzed. Bacteria of the genus Actinomyces were found in 58 samples, and 46 bacterial genera were detected in association with bacteria of the genus Actinomyces. Bacteria of the genus Streptococcus and Propionibacterium were those most frequently associated with Actinomyces in the endodontic lesions considered, and Actinomyces israelii was the most frequently involved species.

Laser Therapy for Infected Sites and Immediate Dental Implants in the Esthetic Zone: A Case Report and Review of Literature.

Placement of postextraction dental implants has become a common practice. Here, we reviewed current literature, along with clinical procedures, outcomes, and incidence of complications, associated with immediate implants in infected postextraction sites. The YSGG (yttrium, scandium, gallium, and garnet) laser can significantly reduce the bacterial concentration after extracting a compromised tooth. We treated a 40-year-old woman with a compromised tooth in the esthetic zone, presenting clinical and radiological signs of infection, particularly a periapical periodontitis. The tooth was extracted after administering local anesthesia using Optocain® (mepivacaine and adrenalin 1 : 100,000), following which the site was treated with an ErCr : YSGG (erbium, chromium-doped yttrium, scandium, gallium, and garnet) 2780 nm laser device (Biolase iPlus®). The implant (Straumann® fixture) was inserted with minimum 35 N torque, 1 mm below the most apical bone peak. Bio-Oss® and resorbable membrane were applied to improve bone healing. The use of ErCr : YSGG laser has ensured success of implant therapy performed on an infected site. There were no complications such as peri-implantitis or loss of peri-implant bone. The implant achieved good primary stability, immediate placement into an infected site did not increase complications, and the 5-year follow-up confirmed the treatment success.

Effect of Laser Radiation on Infected Sites for the Immediate Placement of Dental Implants.

Objective: The study aims to evaluate the feasibility of erbium-chromium: yttrium-scandium-gallium-garnet (ErCr:YSGG 2780 nm) laser irradiation on infected and/or inflamed post-extraction sites for the immediate placement, and when possible, immediate loading, of endosseous implants. Background: Post-extraction site infection is a serious complication. Surgical and nonsurgical options are available to treat such event, together with various decontamination methods. However, there is still no consensus on which treatment is the most effective. Materials and methods: Sixty-six patients were included in the study for a total of 94 post-extraction implants, inserted in the maxilla and mandible. All patients were eligible for implant therapy, having at least one compromised tooth requiring extraction, along with sign of inflammation and/or infection. Surgery and socket decontamination were performed using an ErCr:YSGG laser. To improve bone healing, Bio-Oss® and resorbable membrane were used in 57 patients. Eleven implants were immediately loaded, whereas 83 were loaded within 3-6 months, depending on the extraction site. Intraoral radiographs were taken at 1, 3, 6, 9, and 12 months from the implant placement to assess the alveolar bone level and treatment's outcome. Albrektsson criteria were chosen to evaluate the treatment success rate. Results: Follow-up went from 6 months to 4 years. Success rate was 94.6% (89/94): three implants failed to integrate due to poor patient compliance, being expelled during the second week, whereas two implants presented factory defects (abutment). No sockets presented signs of residual infection during follow-up. Conclusions: The combination of mechanical, chemical, and laser treatment was proven to be highly effective for the disinfection of post-extraction sites. The ErCr:YSGG laser is a useful tool, not only for his practicality as a surgical device but also as a disinfection tool, granting optimal results after implant surgery.

Evaluation of bradykinin, VEGF, and EGF biomarkers in gingival crevicular fluid and comparison of PhotoBioModulation with conventional techniques in periodontitis: a split-mouth randomized clinical trial.

Periodontal disease is a chronic progressive inflammatory process leading to damage of tooth-supporting tissues. This comparative study assessed the effect of PhotoBioModulation (PBM) versus conventional therapy, and investigated biomarkers involved in the healing process. The test group comprised twenty systemically-healthy non-smoking subjects with chronic periodontitis with the presence of two matched contro-lateral premolar sites (probing depth > 5 mm); twenty subjects without chronic periodontitis (CP) served as control group. Patients were treated at baseline, either with scaling and root planing (SRP group) or with a procedure entailing SRP supported by PBM (PBM group). The laser used was a diode laser operating at 645 nm wavelength, 10 J/cm2, and 0.5 W/cm2 with a 600 µm fiber optic. Crevicular fluid levels of bradykinin (BK), vascular endothelial growth factor (VEGF), and epidermal growth factor z (EGF) were determined at both sites. Crevicular fluid specimens from both groups were analyzed with the ELISA TEST. Clinical differences in analyzed outcomes were observed in favor of PBM treatment. Taking average values as 100%, the reduction in BK concentration was 47.68% with SRP and 68.43% with PBM on day 3; the VEGF concentration decreased by 35.73% with SRP and 48.59% with PBM on day 7; the EGF concentration increased by 55.58% with SRP and by 58.11% with PBM on day 21.Clinical parameters improved significantly in both groups (pooled mean values of probing depth decreased from 5.6 to 4.5 mm; gingival index from 1.92 to 1.1; and bleeding on probing from 49.67 to 23.23) but did not vary significantly between the PBM and the SRP group. The results confirmed that PBM have beneficial effects in the early phases of the healing process playing a role in modulation of BK, EGF, and VEGF in gingival crevicular fluid levels; both groups had significant clinical improvement over control but there was no significant difference between them, only a trend for PBM group. The overall results of the study suggest a potential benefit of PBM in conjunction with SRP in treating chronic periodontitis.

Prevalence and concordance of oral and genital HPV in women positive for cervical HPV infection and in their sexual stable partners: An Italian screening study.

OBJECTIVES: This cross-sectional study aimed to evaluate the prevalence and type of oral HPV-infection in women with a cervical HPV-lesion and in the oral and genital mucosa of their male partners. METHODS: The study group comprised 44 sexually-active women, 20-45 years with abnormal PAP smear, not more than 6 months prior to referral together with the male partners cohabiting in stable partnerships. A detailed questionnaire was administered concerning the HPV-related risk factors. Oral swabs, oral rinses, cervical swabs and urine samples were collected. HPV DNA was detected using two different polymerase chain reactions (PCRs): MY09-11 and FAP59-64. Positive samples were genotyped by Sanger sequencing and the INNO-LiPA HPV Genotyping Extra II probe assay. The association with risk factors was assessed by fitting a generalized model, using the General Linear Model function in the R-software; correlations were calculated between all data. RESULTS: HPV was detected in 84% of Cervical Samples, in 24.3% of oral samples and in one urine sample. Only 27% of the HPV-positive results were identical with both PCR DNA assays. 8 male had oral HPV-positive samples different from women cervical samples. In one couple the urine-male sample had the same HPV present in the female-cervical sample. A significant association resulted between women/oral sex practices and men/n. of partners. CONCLUSIONS: This study reports that women (20.4%) with a diagnosis of cervical-HPV and their male partners (30,7%) are at high risk for subclinical oral HPV infection.

Advanced 3D Models Cultured to Investigate Mesenchymal Stromal Cells of the Human Dental Follicle.

The human dental follicle (hDF) contains the developing tooth and is involved in regulating tooth maturation and eruption. To investigate the mesenchymal stromal cells of the dental follicle, 2 three-dimensional (3D) culture models were used, based on a dynamic bioreactor: the Rotary Cell Culture System (RCCS™) and the 3D culture of precursor cells isolated from follicular tissue (human dental follicle cells [hDFCs]). The hDFCs were obtained from impacted third molars of 20 patients. Two 3D culture models were tested. In the first model, intact hDF explants were cultured in 3D conditions, preserving the original tissue architecture; they were studied using histomorphological and molecular analyses. The second model involved the 3D culture of hDFCs, which were characterized to evaluate their multipotency in terms of differentiation capability. Of the biomarkers known to characterize hDFCs, hDF precursors were selected for our study. The immunophenotype and in situ immunocytochemistry were evaluated for markers CD44, CD90, CD146, CD105, CD31, CD34, and CD45 Ag. The results show that the conditions provided by the RCCS preserve the original organizational architecture of the cells. The 3D conditions of the model enhanced differentiation in response to adipogenic, osteogenic, and chondrogenic inductive growth media. The immunophenotype and the immunocytochemistry showed generally high expression of CD90, CD44, and CD105, while CD146 expression was more restricted to ∼30% of cells. No expression was observed for CD31, CD34, and CD45 Ags. Two 3D tissue- and cell-based ex vivo models of the hDF supported the long-term maintenance of hDF-specific cell phenotypes and their ability to recapitulate typical cellular differentiation states. As such, these ex vivo models could be used to study the physiopathology of human odontogenesis. In addition, in a therapeutic context, they could be used to examine the role of specific chemical signals (e.g., new therapeutic agents) in the processes of dental tissue repair and regeneration.

Drug Loaded Gingival Mesenchymal Stromal Cells (GinPa-MSCs) Inhibit In Vitro Proliferation of Oral Squamous Cell Carcinoma.

Human mesenchymal stromal cells (MSCs) have been widely investigated both for regenerative medicine and their antinflammatory/immunomodulatory capacity. However, their ability to home pathological tissues suggested the development of strategies for using MSCs as carrier to deliver drug into tumor microenvironment. MSCs obtained from different tissues can be loaded in vitro with anti-cancer drugs by a simple procedures. In this report, we studied MSCs isolated and expanded from gingival papilla (GinPa-MSCs), by testing their ability to uptake and release three important anti-neoplastic drugs: Paclitaxel (PTX), Doxorubicin (DXR) and Gemcitabine (GCB). The efficacy of drugs releasing GinPa-MSCs was studied on a pancreatic cancer cell line and confirmed in vitro against a line of tongue squamous cell carcinoma (SCC154). Our results demonstrated that GinPa-MSCs efficiently incorporate the drugs and then released them in active form and in sufficient amount to produce a dramatic inhibition of squamous cell carcinoma growth in vitro. If compared with other MSCs sources, the collection of GinPa-MSCs is poorly invasive and cells can be easily expanded and efficiently loaded with anti cancer drugs. In particular, gemcitabine loaded GinPa-MSCs provide a good "cell-mediated drug delivery system" for a future potential application in the context of the oral oncology.

Dental Abnormalities in Pituitary Dwarfism: A Case Report and Review of the Literature.

Hypopituitarism is a disorder caused by a reduced level of trophic hormones that may be consequent on different destructive processes. The clinical manifestations depend on the type of hormone involved. A deficiency of growth hormone (GH) in children causes the lack of growth known as pituitary dwarfism. The case is reported of a patient with pituitary dwarfism, multiple dental anomalies, functional prosthetic problems, and a revision of the literature. She was subjected to prosthetic rehabilitation without surgical intervention, using zirconium substructures, thus eliminating the potential complications that may require trauma surgery. The therapeutic approach adopted led to excellent results and restored an aesthetic smile.

A Rare Case of Hydrocystoma of the Labial Commissure: Histopathology and Clinical Picture.

OBJECTIVE: Hydrocystomas (HCs) are rare, benign, skin adnexal cystic tumors that may be either eccrine or apocrine. BACKGROUND DATA: Apocrine-HCs are cystic lesions that arise from the apocrine secretory coil, whereas eccrine-HCs are retention cysts of the eccrine duct. The commonest site is around the eyes, on the ears, scalp, chest, shoulders, or feet; HCs of the oral cavity are very rare. METHODS: The case is reported of a 36-year-old man with a nodular lesion that was 7 × 5 mm in size on the labial commissure. The lesion was treated in direct contact with a diode laser that was 980 nm in continuous wave mode, with a 320 µm fiber at 1.8-2.0 W of power. RESULTS: Complete healing occurred within 15 days. There were no adverse effects. The patient was carefully followed up, and there has been no recurrence. Histopathologically, the lesion was a multilocular cyst lined with a single-, and in some areas a double-layered epithelium with eosinophilic cytoplasm. Immunohistochemically, the secretory epithelium was positive for S-100 protein and negative for cytokeratin 5/6. CONCLUSIONS: The histopathological and immunohistochemically diagnosis was of eccrine HC. The report stresses differential diagnosis versus cystic lesions of the labial commisure.

Cell-mediated drug delivery by gingival interdental papilla mesenchymal stromal cells (GinPa-MSCs) loaded with paclitaxel.

OBJECTIVE: Gingival tissue is composed of cell types that contribute to the body's defense against many agents in oral environment, wound healing and tissue regeneration. Thanks to their easy and scarcely invasive withdrawal procedure, interdental papilla provide a good source of mesenchymal stromal cells (GinPa-MSCs). We isolated GinPa-MSCs and verified their ability to uptake/release the anticancer agent Paclitaxel (PTX). METHODS: In vitro expanded GinPa-MSCs were characterized for CD markers by FACS, tested for differentiation ability and analyzed by TEM. Their ability to uptake/release PTX was assessed according to a standardized procedure. RESULTS: The CD expression and chondro-adipo-osteo differentiation ability confirmed the mesenchymal feature of GinPa-MSCs. Surprisingly, 28% of GinPa-MSCs expressed CD14 marker and had an impressive pinocytotic activity. GinPa-MSCs were able to take up and release a sufficient amount of PTX to demonstrate effective in vitro activity against pancreatic carcinoma cells, suggesting that the drug was not inactivated. CONCLUSIONS: The procedure to obtain MSCs from interdental papilla is less invasive than that used for both bone marrow and adipose tissue, GinPa-MSCs are easy to expand and can be efficiently loaded with PTX. Taken together these qualities suggest that GinPa-MSCs may prove to be a good tool for cell-mediated drug delivery in cancer, particularly if related to stomatognathic system.

Microtensile strength of resin cement bond to indirect composite treated by different output powers of Er:YAG laser.

The study aimed to evaluate the effect of different output powers of Er:YAG laser on microtensile bonding strength of indirect composite to resin cements.36 indirect composite blocks (GC Gradia DA2, Japan) size 15 × 10 × 10 mm(3) were constructed, and divided into 12 groups, as follows:G1: control group (no treatment); Groups G2 to G6: treated with Er:YAG laser (2,940 nm) in noncontact mode, frequency 20 Hz, pulse duration 470 µs, with output power ranging from 2W to 6W; Groups G7 sandblasting, Groups 8 to G12: as Groups G2 to G 6 with preparatory sandblasting. One specimen from each group was analyzed by SEM; each specimen was fixed to a specialized metal jig using cyanoacrylate (Mitreapel, Beta Kimya San. Ve TIC, Iran) and debonded under tension with a universal testing machine (Zwick, Germany) at a crosshead speed of 0.5 mm min(-1). Sandblasting and laser can improve bond strength above an energy level of 150 mJ. SEM evaluation of laser-treated specimens showed irregularities and deep undercuts. T test analysis showed no significant difference between sandblasted and non-sandblasted group, with laser output power of 0, 100, or 150 mJ (P = 0.666, P = 0.875, and P = .069); in the specimens irradiated with energy output of 200, 250, or 300 mJ, sandblasted specimens showed higher bond strength than non-sandblasted ones. The results demonstrate that, in composite resin irradiated with laser at energy output of 200-300 mJ, sandblasting might be a suitable procedure to enhance bond strength of resin cement.

Neurofibromas of the Oral Cavity: Clinical Aspects, Treatment, and Outcome.

OBJECTIVE: This study aimed to evaluate the efficacy of diode laser for the surgical treatment of neurofibromas (NF), in terms of clinical outcome and therapeutic success. BACKGROUND DATA: The NF is a benign tumor of the peripheral nerve sheath, characterized by the proliferation of Schwann cells, perineural cells, and endoneural fibroblasts. NF may occur as a solitary lesion, or as part of a generalized neurofibromatosis syndrome; much more rarely it occurs in the form of multiple neurofibromas with no associated syndrome. Two distinct variants of neurofibromatosis have been described: types I and II. METHODS: Ten cases are reported (6 women and 4 men, age range 43-70 years) with smooth, painful, or painless lesions of the oral mucosa. Lesions were completely excised using a diode laser at 980 nm wavelength, average power 2.0 W, in continuous wave mode, with 320 µm optical fibers, for 45 sec average time. RESULTS: Complete healing occurred within 20 days. There were no adverse effects; patients were carefully followed up and there have been no recurrences after an interval of 3 months to 3 years. CONCLUSIONS: The results of this diode laser treatment of NF demonstrate good effectiveness of this novel therapy, which may replace conventional surgical procedures.

Accuracy of a flapless protocol for computer-guided zygomatic implant placement in human cadavers: expectations and reality.

BACKGROUND: This work evaluated the accuracy and safety of a protocol for minimally-invasive flapless zygomatic implant placement that uses computer-guided stereolithographic mucosa-supported surgical templates. METHODS: A total of six zygomatic implants were placed in three formalin-fixed human cadaver heads, with edentulous and severely atrophic posterior maxillae. CT scans of each cadaver head were performed after zygomatic implant placement, to evaluate the lateral error (LE) at implant tip and base, and the angular error (AE) of the implant body. RESULTS: Excluding the implant placed outside the drilling channel, the LE at the implant base was less than 1 mm in all cases. The average LE at the tip was 3.86 mm, and the AE was less than 6° in all cases, with an average of 4.5°. CONCLUSION: Computer-guided minimally-invasive flapless zygomatic implant surgery remains challenging. Careful planning and perfect stability of the surgical guide are essential.

Prevalence of sinonasal disease in children with Juvenile idiopathic arthritis.

OBJECTIVES/HYPOTHESIS: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is caused by a multitude of well-studied disorders. However, the association between JIA and/or its treatment and sinonasal inflammatory disease (SNID) has never been studied. We therefore investigated this relationship to gain more insight into burdening pathologies connected to JIA. STUDY DESIGN: Retrospective evaluation. METHODS: A retrospective evaluation according to the Lund-Mackay score of cone-beam computed tomography scans (CBCT) performed in 70 children affected by JIA and compared to CBCT scans of 124 healthy controls was conducted. The prevalence of sinonasal opacification and adenoid hypertrophy in patients affected with JIA was compared with findings obtained in unaffected children. RESULTS: JIA was significantly associated with SNID (P = .030). Of patients with JIA, 18.6% had SNID, whereas in children without JIA, only 8.1% had SNID. The odds ratio values were 5.38 (95% confidence interval [CI]: 1.90-15.26) for treated and 0.92 (95% CI: 0.18-4.83) for untreated JIA. No clear difference was found depending on the duration of JIA. No association was found between adenoid hypertrophy and SNID (P = .816). CONCLUSIONS: Our data suggest that JIA patients, especially when undergoing immunosuppressive therapy, should be subjected to an ear, nose, and throat evaluation. A prospective study including clinical evaluation would be of the utmost importance to provide evidence on which to base comprehensive healthcare for these patients. LEVEL OF EVIDENCE: 3b.

Accidental aspiration of foreign bodies in dental practice: clinical management and prevention.

OBJECTIVE: Foreign body aspiration is a possible complication of dental treatment that may result in a life-threatening situation. The foreign body is often spontaneously ejected from the airway, but in other cases, surgical intervention is needed. Prevention, diagnostic procedures, treatment and complications are discussed. MATERIALS AND METHODS: Three cases of aspiration of dental instruments are described: the piece was localised in the right main bronchus in two cases and in the left main bronchus in one case. RESULTS: All three cases underwent surgery (resection and bronchoscopy); in one case, the surgical attempt failed, and the foreign body was not located by radiography; it was assumed to have been expelled spontaneously. CONCLUSION: The management of dental materials and instruments requires particular care, especially if the patient is supine or semi-recumbent. The dentist must be able to manage emergency situations in which patients accidentally inspire or swallow dental instruments or materials during treatment. Preventive techniques must be put in place because these incidents are preventable if the correct precautions are taken.

Human papilloma virus lesions of the oral cavity: healing and relapse after treatment with 810-980 nm diode laser.

This study evaluated the therapeutic efficacy of laser therapy in treating oral human papilloma virus (HPV) lesions. In particular, mode of action, healing, postoperative patient compliance, visual numeric scale (VNS) pain index, and recurrence were analyzed. During 2001-2012, in 170 patients (80 women and 90 men), 174 intraoral and lip HPV lesions were detected and excised by diode laser of different wavelengths (810-980 nm), with an average power of 2.1 W, in continuous wave mode, using 300 to 320 µm optical fibers. In most cases (95.4%), complete healing occurred in the first 30 days. There were no adverse effects and all patients were carefully followed up until complete healing occurred, documenting any complications. There was only one recurrence, which was later treated successfully; the mean VNS pain score was below one. In treating HPV lesions, the diode laser is not only a valuable tool for their eradication but especially it reduces relapses, thanks to the characteristics of the laser light.

Complete pre-eruptive idiopathic crown resorption.

The purpose of this paper was to present the unique case of complete pre-eruptive idiopathic crown resorption, few of which have ever been reported, because most have concerned partial idiopathic crowns. Crown resorption affects only a part of the crown and begins when crown mineralization is complete, leading to hypomineralization of the teeth. Treatment usually consists of restorative/endodontic care or extraction. A 12-year-old-boy presented with complete idiopathic resorption of the permanent mandibular left third molar and secondary failure of eruption of the permanent mandibular left first molar. The finding was incidental during routine radiographs for orthodontic treatment and was documented using cone beam computed tomography and computed tomography (one-mm slices). Follow-up, using a panoramic radiograph, occurred after one year, confirming the absence of the third molar. No preventive or therapeutic regimen is known.

Disinfection efficacy of photon-induced photoacoustic streaming on root canals infected with Enterococcus faecalis: an ex vivo study.

BACKGROUND: In 2010, one of the authors proposed that lasers could be used to enhance the decontaminating action of sodium hypochlorite (NaOCl). The authors conducted a study to compare the disinfection efficacy of laser-activated irrigation (LAI) by using a photon-induced photoacoustic streaming (PIPS) tip with conventional irrigation and specifically LAI's ability to remove bacterial film formed on root canal walls. METHODS: The authors shaped 26 human anterior teeth to a master apical file size of International Organization for Standardization 25/06 (size 25 tip and size .06 taper) and then sterilized the teeth, infected them with Enterococcus faecalis and incubated them for four weeks. The authors used two irrigation protocols. Group A received two cycles of 30 seconds each of 5 percent NaOCl laser activation and one cycle of 30 seconds with laser activation involving the use of 17 percent ethylenediaminetetraacetic acid (EDTA). The erbium:yttrium-aluminum-garnet (Er:YAG) laser's settings were 20 millijoules, 15 hertz, 50-microsecond pulse duration, and it had a 600-micrometer PIPS tip. Group B received two cycles of 30 seconds each of 5 percent NaOCl and 17 percent EDTA irrigation alone, delivered via a syringe with a 25-gauge needle. RESULTS: The authors found that group A had significantly better disinfection compared with group B (P < .05). The results of cultures obtained after 48 hours showed that disinfection was maintained better in group A compared with group B (P < .0001). Scanning electron microscopic images showed absence of bacterial biofilm remaining after LAI using PIPS. CONCLUSIONS: Er:YAG laser activation of 5 percent NaOCl and 17 percent EDTA was more effective than conventional irrigation for eradicating E. faecalis and preventing new bacterial growth ex vivo. Additional clinical studies are needed to clarify the effect on endodontic treatment outcomes. PRACTICAL IMPLICATIONS: PIPS appears to be effective in enhancing the effect of the irrigants commonly used in endodontics.