Postoperative Pain After Using Er,Cr,YSGG Lazer Irradiation During Root Canal Treatment
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Irrigation with sodium hypochlorite (NaOCl) during chemo-mechanic preparation for effective
      root canal disinfection is a standard protocol in root canal treatment. NaOCl is an alkali
      irrigant with pH 11.0 -12.0. Nearby its high antimicrobial efficacy, cytotoxic features make
      it questionable when it comes contact with periradicular tissues. Several irrigation
      materials were investigated less cytotoxic, more or equal antimicrobial to avoid such adverse
      effects. Calcium hypochlorite, chlorhexidine, chitosan and antibiotics are some of the
      chemicals tested. Laser is not a chemical but its action may show antibacterial effect.
      Studies showed that Er,Cr:YSGG laser is strongly antibacterial against Enterococcus faecalis
      biofilm. This antibacterial effect were frequently obtained with laser activated irrigation
      (LAI) or photon-induced photoacoustic streaming (PIPS) in the literature. The aim of this
      study was to evaluate whether disinfection procedure with laser provides more or less benefit
      in terms of postoperative pain when compared with the conventional NaOCl irrigation method.
    

Detailed description: 
      Both for maxillary and mandibular teeth, infiltration anesthesia were achieved by local
      anesthetic with 2 ml articaine hydrochloride with 1:200000 epinephrine (Maxicaine, VEM İlaç,
      Ist, Turkey). Endodontic access preparations were performed using diamond round burs. After
      the canals became visible, patency was checked with a K hand file (VDW, Munich, Germany), and
      a rubber dam was placed for isolation. The working length (WL) was determined with an
      electronic apex locator (Raypex 6, VDW) and accepted when three green bars were reached.

      A crown-down preparation technique was performed using Reciproc nickel-titanium instruments
      (VDW, Munich, Germany) R#50 according to the manufacturers' instruction until the WL. During
      the instrumentation procedures, the root canals were irrigated with 6 ml of 2,5% NaOCl
      between each file.

      In laser group, each root canal was dried with paper points and then Er,Cr:YSGG (Biolase™,
      Waterlase™, San Clemente, CA, USA) was used for intracanal disinfection with the following
      parameters: panel output power of 0,75 W, pulse frequency of 20 Hz, and 1% water pressure to
      10% air pressure ratio laser with RFT3 tips (415 µm diameter radial firing tip RFT3 Endolase,
      Biolase Technology, Inc; calibration factor of 0.85). The fiber was placed at 1mm short of
      the WL. Irradiation was delivered along the entire length of the root canal with helicoradial
      movements, 1mm per seconds in speed. This procedure was repeated three times and kept for 20
      seconds between each irradiation.

      In control group, each canal were irrigated with 6 ml of 2,5% NaOCl. For the final
      irrigation, 5 ml of sterile saline were used. During irrigation, needle was inserted 1 mm
      short of the WL.

      At the end of disinfection procedures, each root canal was dried with paper points and the
      largest gutta-percha cone that reached the WL without any resistance was used as the master
      cone. Measurements from the electronic apex locator were confirmed radiographically. In cases
      of discrepancies between the radiographic and electronic measurements, the latter was
      selected. All root canals were filled with gutta-percha and root canal sealer (Adseal Meta
      Biomed Co, Korea) using the lateral condensation technique. The teeth were coronally sealed
      with composite resin (Premise, Kerr, Salerno, Italy). After the completion of the root
      fillings, postoperative instructions were given to all patients and prescribed 200 mg
      ibuprofen only one tablet if it is needed within the 0- to 6-hour time interval after the
      treatment and then one for every 8 hours in the event of pain.
    

Intervention name(s): Er,Cr:YSGG Laser; Sodium hypochlorite
Intervention type(s): Device; Other
Intervention description(s): Er,Cr:YSGG Laser is used for disinfection of the root canals.; Sodium hypochlorite is used for disinfection of the root canals
Intervention MeSH terms: Sodium Hypochlorite; Eusol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: root canal treatment; intracanal irrigation; Laser