4544 A Review Studyof Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No.

4
Indian Journal

Lasers in Endodontics- A Review of Literature

P.A.Vasishta1, K Anjaneyalu2, Vinay Sivaswamy3, K Anjaneyalu4

1Research Associate, 2Reader, Department of Conservative and Endodontics, 3Associate Professor, Department of
Prosthodontics, 4Reader, Department of Conservative and Endodontics, Saveetha Dental College and Hospitals,
Saveetha Institute of Medical and Technical Science (SIMATS), Saveetha University, 162, PH Road, Chennai-77,
Tamilnadu, India

Abstract
Lasers are commonly used to reshape our gums during root canal procedures and to kill bacteria. Application
of lasers in dentistry has been increased due to its safety and effectiveness in dental treatments. Lasers have
been used as coadjuvant treatment in endodontic therapy with respect to both low-intensity laser therapy
(LILT) and high-intensity laser treatment (HILT) to improve clinical procedures’ success rate. The major
procedures done with lasers in endodontics are dentin hypersensitivity, removal of carious tissues, tooth
preparations, pulp capping or pulpotomy and also in root canal treatment.Lasers are often used to remove
mouth lesions and to soothe discomfort. A thorough literature search was performed using the database
like Pubmed, google scholar, BioRxiv, MESH database using the keywords ‘light amplification device’
and ‘Endodontics’ and also their types with no date and year restrictions.12 articles with similar data have
been found which were analysed and have been included in this study. Talulation were done using google
documents. The recent articles discussed in this study help us in gaining further knowledge about lasers and
their usage in endodontics. The various methods of using lasers discussed in this article has been widely
used by dental practitioners with 100% success rate. So it has been concluded that lasers are well established
instruments. Upcoming research based on lasers are showing more benefits and ability to perform less
invasive procedures with greater comfort of patients has led to the development of lasers in modern dentistry
especially in endodontics.

Keywords: Endodontics; Light amplification devices; Soft tissue and hard tissue lasers; Diode lasers
ablation; Analgesic effects.

Introduction Application of lasers in dentistry has been increased

Lasers are generally used to reshape our gums due to its safety and effectiveness in dental treatments.
during root canal procedures and to kill bacteria. Lasers The major procedures done with lasers in endodontics
can also be used for excising a small piece of tissue to are dentin hypersensitivity, removal of carious tissues,
examine cancer cells known as biopsy or removal of tooth preparations, pulp capping or pulpotomy, enamel
lesions. Lasers are also used to remove mouth lesions erosion , and also in root canal treatment. Lasers are
and soothe pain1. also used for tooth bleaching and diagnosis of dental
pulp vitality. Root canal preparation can also be done
during Rotary instruments but dealing with lasers is
Corresponding author:
comparatively easier1,2.
K Anjaneyalu
Reader, Department of Conservative and Endodontics The term LASER is an abbreviation for ‘Light
Saveetha Dental College and Hospitals Amplification by The stimulated Emission of
Saveetha Institute of Medical and Technical Science radiation’. There are various types of application of
(SIMATS) Saveetha University, 162, PH Road, lasers in endodontics that are mainly classified as hard
Chennai-77, Tamilnadu, India. tissue lasers and soft tissue lasers. Paste containing
Email ID: kanjaneyulu.sdc@saveetha.com Bioactive Glass and Topical cream containing Casein
Contact no: 9566151527 Phosphopeptide has the ability to remineralize the tooth
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4 4545

structures3. The various hard tissue applications are to the database like Pubmed,google scholar, BioRxiv,
prevention of caries, bleaching, restorative removal and MESH database using the keywords ‘light amplification
curing, cavity preparation, dentinal hypersensitivity and device’ and ‘Endodontics’ and also their types with no
for various diagnostic purposes. Whereas incase of soft date and year restrictions. The language is restricted to
tissue application it includes wound healing, removal English. 12 articles with similar data have been found
of hyperplastic tissue, Photodynamic therapy and also which were analysed and have been included in this
photostimulation of few lesions. Usage of lasers has study. Talulation were done using google documents.
been proved as the most effective treatment as it provides
a painless, specific, efficient, cost efficient, scoreless Result and Discussion
and comfortable dental treatment4. When compared to Applications of lasers in endodontics
previous studies post operative pain is felt after using
endodontic needle and endoactivator which is now The main usage of lasers in endodontics will
replaced by painless laser therapies. Carbon Dioxide, be discussed in this chapter. The first and foremost
Neodymium Yttrium aluminium garnet and Er.YAG application as a diagnostic tool for endodontics is the
used in case of both hard and soft tissue application but analgesic effects of laser, Dentin hypersensitivity,
this is quite an expensive treatment so not recommended Treatment of vital pulpal tissue by pulpectomy and
most of the time and it may also cause pulpal injury. direct pulp capping12.
Usage of low cost devices is preferred widely known as
Root canal disinfection and irrigation, Access
Low level laser therapy or biostimulation3,5.
cavity preparation and root canal orifice enlargement13,
Lasers after approaching an appropriate wavelength Root canal wall preparation, sweeping of the root canal
for melting the hard tissue, This is said to be the main and irrigation, sterilisation or disinfection of the root
application of laser technology In surgical endodontics6. canals14, obturation with gutta percha or resin, removal
Chlorhexidine with sodium hypochlorite, neem and tulsi of the temporary cavity filling materials- Root canal
can be used for irrigation during endodontic surgeries7,8. sealing materials and also fractured instruments inside
Lasers used for Dentinal hypersensitivity can be classified the root canal15.
into low output power lasers and Middle output power
Lasers are also used incase of vertical root fracture
lasers. Initially a low out power laser has been used to
diagnosis and treatment16, laser assisted obturation
support wound healing and also healing of fractures9.
removal and gutta percha obturation material17.
They also have an anti-inflammatory effect which helps
in stimulation of nerve cells10. Usage of lasers in endodontic surgeries include:
Flap preparation, cutting bond to prepare window access
Microwave Amplification by stimulated emission
to the apex of the roots18, Apicoectomy, Root end
radiation was developed later. Lasers are used in
preparation for retro fill amalgam or composite and also
determination of pulp vitality and also in Apicoectomy,
for removal of pathological and hyperplastic tissue19 .
Retrograde and endodontics apical cavity preparation
and periapical curettage10. Variation in between hard and soft tissue lasers
and their application in endodontics
There are lasers Generate visible light, ultraviolet
rays, Infrared rays, Invisible rays. Generally, electrons Hard tissue application is for prevention of caries,
jump from higher energy levels to lower energy levels bleaching, restorative removal and curing, cavity
to emit light photons. Lasers are also used to diagnose preparation and also for diagnostic purposes but soft
Dental pulp vitality. The main aim of our study is to tissue laser application is for wound healing, removal
provide knowledge about usage and purpose of lasers in of hyperplastic tissues to uncover the impacted tooth20.
Endodontics11.
Mechanism of lasers
Materials and Methods
The first and foremost mechanism of lasers is the
A thorough literature search was performed using direct application of laser irradiation on the electric
4546 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No.4

activity of nerve fibres which happens within the dental Tests showed that the Er : YAG laser was 60 mJ, 2
pulp21. Hz and the Nd : YAG laser is useful for decreasing at
1.5 W, 15 Hz permeability to the dentin. Laser efficiency
The second mechanism of lasers modification of
for treating DH varies from 5% to 100%, depending
the tubular structure of dentin by melting or fusing of
on the laser type and parameters to diagnosis. Studies
hard tissue layer or smear layer and then subsequently
suggested the Nd: YAG Laser, Er : YAG laser and
dentinal tubules are sealed22.
Ga-Al-A reduced laser low-level hypersensitivity to
Lasers use Photo-Thermal and photomechanical dentine25.
effects which is resulting from the interaction of different
Root canal shaping
wavelengths and various other parameters on the target
tissue. Especially dentine, Smear layer, debris, residual The shaping of root canals aims at removing organic
pulp and bacteria in their aggregate forms23. tissues and facilitates irrigation and the obturation of
canals. Laser spotlights can be delivered via an optical
This can also be told as a light beam from the optical
fiber that enables better delivery the root canals are open.
fibre entering the tissue has been Absorbed in the blood
The technique requires more extension of the root canal
cells and fibre tips and collects the scattered light which
before the laser probes by conventional methods can be
inturn provides information about the pulp vitality. This
put into a canal26.
provides a painless, invasive and scarless treatment but
takes longer than other vitality determination techniques. Use of lasers in periradicular surgery

Lasers for diagnosing pulp vitality Apicectomy is an surgical procedure in which the
root apex is used removes; removes adjacent periapical
LASER Doppler flowmetry is a minimally - intrusive
tissues and curetted simultaneously. LASER which is
assessment technique and measures the flow of pulp
used for surgery in a bloodless Surgical environment by
tissue through blood. Benefits include; The technique is
vaporization and coagulation of tissue and the sealing of
more objective and more reliable in evaluating the Pulp
little blood vessels. Where the cut surface irradiates, the
Tissue Safety. These have benefits in data storage, for
surface is sealed and sterilised. Er : YAG laser could even
Measurements which are to be compared later. Includes
cut hard dental tissue without substantial use damage to
drawbacks, Its technique is sensitive and requires putty
thermal or to structure. Miserendino which uses CO2
splint preparation to hold the probes, and it’s costly24.
lasers. The diagnosis of secondary apical abscess in an
Dentinal hypersensitivity apicoectomy was capable of sealing the dentinal tubules
in the apical portion of the rooting and sterilization of
Lasers used in treatment are divided into two the Gouw-Soares region under investigation use of the
different groups: 1. Lasers with low power output (He- Er: YAG, Nd: YAG and Ga-Al-As periapical lasers
Ne and Gallium / Aluminum/ Lasers with arsenide clinically performed surgery27.
[Ga / Al / As]), 2. Lasers with low power output (Nd
: YAG and CO2 Lasers) Lasers. Clinically and under Photodynamic therapy for malignancies
SEM, Kumar and Mehta assessed the Nd : YAG Laser
This therapy has been employed Incase of oral
Irradiation Effectiveness alone and in combination 5%
mucosa malignancies particularly multi focal squamous
Sodium fluoride varnish used in dentine care feeling
cell carcinoma. Here there will be a generation of
hypersensitive. They discovered Nd : YAG combination
reactive oxygen species which inturn damages the cells
Laser and 5 percent varnish of sodium fluoride appeared
associated with the blood vascular network directly and
to be impressive effectiveness as compared with a single
triggers necrosis and apoptosis. This activates the host
therapy, Aranha et al. evaluated dentine hypersensitivity
immune response and promotes the anti tumour immunity
in the treatment of Impact of the lasers Nd : YAG and
by activating macrophages and T lymphocytes28. This
Er: YAG on dentine reduction permeability through
treatment is very successful and approximately has a
sealing of open tubules.
success rate of 90%.
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4 4547
Analgesic effects of the laser Co2 lasers have been available in the medical and
dental field for the past 25 years. They possess 10,600 nm
Nd-YAG is widely used as an analgesia in
of infrared wavelength that is highly absorbed by water.
endodontics. Wavelength of Nd-YAG interferes with
They are continuous wave lasers that can be operated in
the Sodium pump mechanism which inturn change the
gated wave modes including super pulsed modes. Co2
cell membrane permeability and also alter the endings
lasers have a bactericidal action but there are no reports
of sensory neurons temporarily, Which leads to block
shouting nerve analgesic Irradiation effects of Co2 lasers
depolarisation of C and A fibres of the nerves I.e fast
in endodontics33. This laser can be used for performing
and slow conduction fibres. Evaluation of pulp vitality
root canal procedures.
can be done using an electric pulp tester28,29. This
application in the oral cavity reduces the firing frequency Application of nd yag lasers in endodontics:
of the nociceptors (Pain receptors). Local carbon dioxide
ND YAG lasers have a wavelength of 1064 nm and
laser irradiation will reduce the pain associated with
can be used to extract bacteria from contaminated teeth34.
orthodontic force application without involvement of
This is the first true pulsed laser introduced in dentistry.
the tooth30.
ND YAG lasers are used for cleaning and shaping in
Indications and contraindications of laser in endodontics and they also play a role of analgesia. They
endodontics: are very effective in prevention of dental decay35.

Indication of lasers in endodontics are teeth with Xenon fluoride lasers

lateral canals which leads to periodontal involvement,
Xenon fluoride lasers are used to seal the
Pulp necrosis and purulent pulpitis, gangrenous changes,
exposed dentinal tubules. They are also used for pulp
periapical lesions upto 5mm or more31.
capping,checking the pulp vitality and for root canal
Laser treatments cannot be done in person who treatments In endodontics. They have a visible light of
have advanced periodontitis caries, deep crown and root 400nm -750nm and this is commonly used in endodontic
fracture and obliterated root canals in endodontic treated treatments. Chlorhexidine helps in local intensity
teeth32. enhancement of lasers36.

Application of carbon dioxide lasers in

endodontics:

Table: 1: Lasers in Endodontics:

Lasers in endodontics wavelength uses in endodontics

Beam of Infrared light with the principle Dentinal hypersensitivity, pulp capping and
CO2 wavelength bands cantering on 9.4-10.6 pulpotomy, modifications of root canal walls,
micrometers sterilisation of root canal system

488nm(Blue)- peak and 514nm(green)-

Argon caries removal, Root canal and tooth preparation
Relatively short

used for root canal wall preparation, smear layer

Nd:YAG infrared-1064nm can be eradicated completely with sealing of
dentinal tubules.

access cavity preparation, root canal shaping and

Er:YAG infrared light-2940 nm
cleaning
4548 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No.4
Laser safety Conflict of Interest: No potential conflict of interest
relevant to this article was reported.
Even though lasers are very easy to use there are
few precautions that have to be taken care of while using Ethical Clearance: As it is a review article so it is
lasers. First precaution is usage of protective eye wear not required.
with a specific wavelength. Warning sign supposed to be
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