| |
|
|
| Year : 2013 | Volume
: 24
| Issue : 1 | Page : 14-18 |
|
| The efficiency of root canal disinfection using a diode laser: In vitro study |
|
|
Anjali Kaiwar, HL Usha, N Meena, P Ashwini, Chethana S Murthy
Department of Conservative Dentistry and Endodontics, V.S. Dental College and Hospital, Bangalore, Karnataka, India
Click here for correspondence address and email
| Date of Submission | 22-Jul-2011 |
| Date of Decision | 25-Aug-2011 |
| Date of Acceptance | 11-Dec-2012 |
| Date of Web Publication | 12-Jul-2013 |
|
|
 |
|
 Abstract | | |
Aims: The aim of this study is to verify the disinfection of diode laser, following chemo-mechanical procedures against Enterococcus fecalis.
Materials and Methods: Crowns of 30 extracted premolar teeth were sectioned at the cemento- enamel junction. The canals were shaped using step-back technique to K-file #40. The teeth were randomly assigned to three groups and placed into nutrient broth containing bacterial suspension of Enterococcus fecalis. Group A received no laser radiation. Specimens of group B and C were treated with diode laser (Sirona) with energy set at 1.5 and 3 W, respectively. After laser irradiation, the teeth were placed in vials, which contained 2 mL of the nutrient broth. The vials were incubated at 37°C for 24 h. Grown colonies were identified by standard methods.
Statistical Analysis Used: Statistical analysis used was the nonparametric Kruskal-Wallis test, with comparison using the Bonferroni methods of means.
Results: Higher mean CFU/mL is recorded in Group A (without laser disinfection) followed by Group B (with 1.5 W laser disinfection) and Group C (with 3 W laser disinfection), respectively. The difference in CFU/mL between the three groups is found to be statistically significant ( P < 0.001).
Conclusions: The results of this research show that the 980 nm diode laser can eliminate bacteria that has immigrated into dentin, thus being able to increase the success rate in endodontic therapy. Keywords: Colony-forming unit, Enterococcus fecalis, 980 nm diode lasing techniques
How to cite this article:
Kaiwar A, Usha H L, Meena N, Ashwini P, Murthy CS. The efficiency of root canal disinfection using a diode laser: In vitro study. Indian J Dent Res 2013;24:14-8 |
How to cite this URL:
Kaiwar A, Usha H L, Meena N, Ashwini P, Murthy CS. The efficiency of root canal disinfection using a diode laser: In vitro study. Indian J Dent Res [serial online] 2013 [cited 2023 Jun 5];24:14-8. Available from: https://www.ijdr.in/text.asp?2013/24/1/14/114916 |
In Endodontics, disinfection of the root canal system is essential step for ensuring successful root canal therapy. The contamination of the root canals with microorganisms and its propagation in remnants of necrotic soft tissue are considered one of the main reasons for failure in endodontic treatment. [1] The eradication of persisting microorganisms in distant areas of the tubular system is a major challenge in today's treatment regimens and is crucial for the long-term preservation of the endodontically treated tooth.
Studies have shown that microorganisms present in failed root canal cases are distinct from those present in infected root canals before endodontic treatment. [1],[2] Enterococcus fecalis is a facultative anaerobic Gram positive coccus, which is present in oral flora and is identified in persistent root canal infections and is also related to the failure of endodontic treatment. [3] They form intra and extra radicular biofilms, which are difficult to remove and they cause persistent or reinfection. [4],[5]
Irrigating solutions used during root canal treatment act through direct contact with the bacteria targeted. However irrigants that have insufficient penetration depth as a result of these microorganisms in the deeper layers are not destroyed. [6] Lasers have become latest choice to eradicate microorganisms in the root channel, especially in the lateral dentinal tubuli. This has been achieved by the development of a fiber delivery system. It has been proved in numerous studies that an emission of laser light directly in the root canal does have bactericidal effect. [7] The antibacterial effect of a laser beam is based on thermal properties of laser tissue interaction. [8] The high-power diode laser has been used in several areas of dentistry, with promising results in relation to dentinal disinfection. [9],[10],[11] Diode laser has been proved to be resource worth testing. The aim of this study is to verify the disinfection of diode laser with a wavelength of 980 nm, following chemo-mechanical procedures against E. fecalis.
| Materials and Methods | |  |
Sample preparation
Thirty extracted uniradicular premolar teeth were stored in 5.2% NaOCl solution for 30 min to remove organic residues and left in saline solution until the procedure began. The crowns were sectioned at the cemento-enamel junction using high-speed diamond disk to obtain root canal length of 15 mm [Figure 1]. Access opening was done. #10 K-file (Dentsply-Maillefer) was introduced into each canal until it appeared at the apical foramen. The working length was established by subtracting 0.5 mm from this length. The canals were shaped using step-back technique to #40 K-file (Denstply Maillefer). Irrigating solution used after each instrument was 5 mL of 2.5% sodium hypochlorite. The coronal third of the root canals was flared with #2, #3 and #4 Gates Glidden drills. The teeth were then allowed to air-dry overnight at room temperature and apical foramen was sealed externally and waterproofed with coats of clear nail polish. The teeth underwent sterilization in 121 o C autoclave for 15 min at 15 lbs pressure.
Preparation of the medium for E. faecalis
The strains of microorganisms used for the study were standard strains of E. fecalis ATCC29212, which were sub-cultured in UTI Hichrome agar plate (selective medium) and was incubated at 37°C for 24 h.
A pure, single E. fecalis colony was isolated from the same cultured plate and Gram's staining was done to confirm its growth, which was observed under microscope and then inoculated with a brain heart infusion (BHI) broth. The BHI broth was incubated at 37°C for a 24-h period and checked for bacterial growth by changes in turbidity. A drop of BHI containing E. fecalis was placed into saline solution and checked for correct bacterial concentration with a spectrophotometer. The density of the bacterial suspension is standardized by comparing the broth at a density equivalent to the barium sulphate standard of 0.5 McFarland units, which is equivalent to 1.5 × 10 8 colony forming units per milliliter (CFU/mL).
Before irradiation, a micropipette with a sterile needle was used to inoculate the canals with 10 mL of the bacterial suspension in nutrient broth. The teeth were randomly assigned to three groups and placed into nutrient broth containing bacterial suspension.
Laser procedure
The specimens were randomly divided into three groups where two groups B, C received laser treatment. Group A received no laser radiation. Specimens of Groups B and C were treated with diode laser (Sirona) with energy set at 1.5 and 3 W, respectively. Irradiation followed oscillatory technique developed by Gutknecht et al. [12] The optical fiber is introduced 1 mm short of the apex and is recessed in helicoidal movements at a speed of approximately 2 mm/s for 5 s, repeated 4 times at intervals of 10 s, between each one. This rest period between irradiation avoided temperature change. After laser irradiation, the teeth were placed in vials, which contained 2 mL of the nutrient broth.
Bacteriological analysis
The vials were incubated at 37°C for 24 h. The vials were checked for turbidity after 24 h incubation. Dilution of the sample was maintained at 10 3 . Overall 6 mL of broth, in duplicate, from all the samples together was collected and seeded on a Petri dish More Details containing UTI Hichrome agar in order to count the CFUs. Incubation lasted 48 h at 37°C. Grown colonies were seen in all groups and were identified by standard methods [13] [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] and [Figure 7].
| Results | | |
Colony counts were done with the aid of a magnifying lens. Statistical analysis used was the non-parametric Kruskal-Wallis test, with comparison using the Bonferroni methods of means. The mean numbers for CFUs/mL of groups were: Group A: 126/10 3 , Group B: 42/10 3 and Group C: 8/10 3 Statistical analysis demonstrated significant differences among the groups. Level of significance: α = 0.05.
Computations
The tables below give us the various computations and the P value [Table 1].
Higher mean CFU/mL is recorded in Group A followed by Group B and Group C, respectively. The difference in CFU/mL between the three groups is found to be statistically significant (P < 0.001) [Table 2].
In order to find out among which pair of groups there exist a significant difference, we carry out multiple comparisons using the Bonferroni method.
The difference in mean CFU/mL between Group A and Group B is found to be statistically significant (P < 0.001). The difference in mean CFU/mL between Group A and Group C is also found to be statistically significant (P < 0.001). Statistically significant difference is observed between Group B and Group C with respect to the mean CFU/mL (P < 0.001) [Figure 8].
| Discussion | | |
Infections of the root canal system consist of polymicrobial flora with approximately equal proportions of gram-positive and gram-negative bacteria. [14],[15] Studies demonstrated that microorganisms are capable of invading the peri-luminal dentin up to a depth of 1100 micro meter, whereas the chemical irrigants penetrate no more than 130 micrometer into the dentin. [16],[17]
In recent years, different laser systems are used in endodontic field, which are effective for root canal disinfection. Initially Nd: YAG laser was first used for root canal disinfection, introduced by Hardee [18] and Myers and McDaniel. [19] The diode laser is a compact device and now used in diverse areas of dentistry. [9],[20] Moritz et al. introduced use of diode laser for root canal disinfection. [21]
E. fecalis is a non-sporiferous vegetative microorganism and is resistant to high temperatures, [22] frequently found in cases of therapy resistant infection. Because of its resistant to heat, E. fecalis was preferred in this study in order to investigate the effect of the laser heat. Single rooted premolar teeth were instrumented up to #40 K-file to obtain the adequate size and easy access for the fiber tip.
In the present study, the cell concentration at the time of initial inoculation was 10 cells/mL [8] before the laser treatment. The methodology used for counting the CFUs in the present study showed that the diode laser irradiation provoked a higher level of disinfection than other group without laser disinfection with significant statistical difference.
The high-power diode laser reduces dentine permeability, although it does not provoke the dentine melting unlike neodymium laser. [8],[9] The diode laser device is composed of two layers of semiconductor material interlaced with a non-conductive layer. Its light presents a spectrum that allows for greater absorption by water than dental tissues when compared with Nd: YAG laser. This characteristic means greater laser light penetration through the dentin with little interaction on the dentin, making it possible to act on the microorganisms present in the dentinal tubules.
The fine diameters of optic fibers (200-320 μm) enable effective delivery of laser light to the root canal to help with reduction of bacterial contamination. The antibacterial effect observed reaches over 1 mm deep into the dentin, [23] surpassing the effective range of chemical disinfectants, such as NaOCl and displaying moderate effectiveness against E. fecalis even in the deeper layers of dentin. Diode laser effectiveness in relation to diverse microorganisms has been demonstrated by many authors. [19],[20]
Moritz et al., [21] determined that irradiation with a diode laser in two subsequent sessions resulted in almost complete elimination of bacteria and suggested that the diode laser could be considered equal to the Nd: YAG laser in endodontic treatment. Schoop et al., [23] reported that Nd: YAG and diode lasers at 1 W are efficacious for E. fecalis; while the power increased to 1.5 W; only the diode laser was effective against the microorganisms. In the present study, the diode laser was used in both 1.5 W and 3 W. Although complete sterilization cannot be achieved, a significant bacterial reduction was seen.
The parameters used in this study were considered safe in accordance with Radaelli et al. [19] However the choice of the essential precautions and the correct laser parameters is crucial for a safe and efficient way of therapy. Studies should be done in vivo to check whether the radiation can cause cellular damage to periodontal ligament. [24] The diode laser used can be applied by all means as a support in endodontic treatment, thus increasing the success rate through its antibacterial effect in endodontic treatment, which should be confirmed by performing clinical studies.
| Conclusion | | |
The results of this research show that the 980 nm diode laser can eliminate bacteria that has immigrated into dentin, thus being able to increase the success rate in endodontic therapy.
| Acknowledgment | | |
We wish to extend our sincere gratitude to Sourav Bhattacharya, Department of Microbiology, Geniohelix Lab, Chamarajpet; Bangalore, India for guiding us in microbiology field for this research work. We also wish to thank all the faculties and their supporting staff members for their invaluable help for successful completion of the present study.
| References | | |
| 1. | Gomes BP, Lilley JD, Drucker DB. Clinical significance of dental root canal microflora. J Dent 1996;24:47-55. 
[PUBMED] |
| 2. | Haapasalo M. Bacteroides spp. in dental root canal infections. Endod Dent Traumatol 1989;5:1-10.
[PUBMED] |
| 3. | Distel JW, Hatton JF, Gillespie MJ. Biofilm formation in medicated root canals. J Endod 2002;28:725-7.
|
| 4. | Spratt DA, Pratten J, Wilson M, Gulabivala K. An in vitro evaluation of the antimicrobial efficacy of irrigants on biofilms of root canal isolates. Int Endod J 2001;34:300-7.
[PUBMED] |
| 5. | Berutti E, Marini R, Angeretti A. Penetration ability of different irrigants into dentinal tubules. J Endod 1997;23:725-7.
[PUBMED] |
| 6. | Goodis HE, White JM, Marshall SJ, Marshall GW Jr. Scanning electron microscopic examination wall dentin: Hand versus laser treatment. Scanning Microsc 1993;7:979-87.
|
| 7. | Rooney J, Middsm, Leeming J. A laboratory investigation of the bacteriocidal effect of a Nd: YAG laser. Br Dent J 1994;176:61-4.
|
| 8. | Souza EB, Amorim CV, Lage-Mrques JL. Effect of diode laser irradiation on the apical sealing of MTA. Braz Oral Res 2006;20:231-4.
|
| 9. | Pearson GJ, Schuekert KH. The role of lasers in dentistry: Present and future. Dent Update 2003;74:838-43.
|
| 10. | Klim JD, Fox DB, Coluzzi DJ, Neekel CP, Swick MD. The diode laser in dentistry. Rev Wavelengths 2000;8:13-6.
|
| 11. | Gutkneeht N, Van Gogswaardt D, Conrads G, Apel C, Schubert C, Lampert F. Diode laser irradiation and its bactericidal effect in root canal wall dentin. J Clin Laser Med Surg 2000;18:57-60.
|
| 12. | Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH. Manual of clinical microbiology, 7 th edition. Washington DC: American Society for Microbiolgy Press; 1999.
|
| 13. | Tsatsas B, Tzamouranis A, Mitsis F. A bacteriological examination of root canals before filling. J Br Endod Soc 1974;7:78-80.
[PUBMED] |
| 14. | Sundqvist G. Taxonomy, ecology and pathogenicity of root canal flora. Oral Surg Oral Med Oral Pathol 1994;78:522-30.
[PUBMED] |
| 15. | Kouchi Y, Ninomiya J, Yasuda H, Fukui K, Moriyama T, Okamoto H. Location of streptococcus mutans in the dentinal tubules of open infected root canals. J Dent Res 1980;59:2038-46.
[PUBMED] |
| 16. | Berutti E, Marini R, Angeretti A. Penetration ability of different irrigants into dentinal tubules. J Endod 1997;23:725-7.
[PUBMED] |
| 17. | Hardee MW, Miserendino L, Kos W, Walia H. Evaluation of the antibacterial effects of intracanal Nd: YAG laser irradiation. J Endod 1994;20:377-80.
|
| 18. | Myers TD, McDaniel JD. The pulsed Nd: YAG laser: Review of clinical applications. J Calif Dent Assoc 1991;19:25-30.
[PUBMED] |
| 19. | Radaelli CM, Zezell DM, Cai S, Antunes A, Gouw-Soares SC. Effect of a high power diode laser irradiation in root canals contaminated with Enterococcus faecalis. "In vitro study". Int Congr Scr 2003;1248:273-6.
|
| 20. | Moritz A, Gutknecht N, Goharkhay K, Schoop U, Wernisch J, Sperr W. In vitro irradiation of infected root canals with a diode laser: Results of microbiological examinations. Quintessence Int 1997;28:205-9.
[PUBMED] |
| 21. | Mortiz A, Doertbudak O, Gutknecht N, Goharkhay K, Schoop G, Sperr U. Nd: YAG laser irradiation of infected root canals in combination with microbiological examinations. J Am Dent Assoc 1997;128:1525-30.
|
| 22. | Nair PN, Sjögren U, Krey G, Sundqvist G. Therapy resistant foreign body giant cell granuloma at the periapex of a root-filled human tooth. J Endod 1990;16:580-8.
|
| 23. | Schoop U, Kluger W, Moritz A, Nedjelik N, Georgopoulos A, Sperr W. Bactericidal effect of different laser systems in the deep layers of dentin. Lasers Surg Med 2004;35:111-6.
[PUBMED] |
| 24. | Souza LC, Brito PR, de Oliveira JC, Alves FR, Moreira EJ, Sampaio-Filho HR, et al. Photodynamic therapy with two different photosensitizers as a supplement to instrumentation/irrigation procedures in promoting intracanal reduction of enterococcus faecalis. J Endod 2010;36:292-6.
[PUBMED] |
Correspondence Address:
Anjali Kaiwar
Department of Conservative Dentistry and Endodontics, V.S. Dental College and Hospital, Bangalore, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.114916
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
[Table 1], [Table 2] |
|
| This article has been cited by | | 1 |
Demographic Assessment of Laser Therapies in 0–18-year-olds: A Retrospective Study |
|
| Shivani Mathur, FNU Priyanka, Nancy P Saharia | | Journal of South Asian Association of Pediatric Dentistry. 2023; 6(1): 9 | | [Pubmed] | [DOI] | | | 2 |
Comparative Evaluation of the Antibacterial Efficacy of Chlorhexidine and 810 nm Diode Laser in the Disinfection of Root Canals Contaminated With Enterococcus faecalis: An In Vitro Study |
|
| Teris Mathew, Shanthala BM, Prashanth GV, Jubin Jose | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 3 |
Comparative evaluation of the efficacy of diode laser, EndoActivator, passive ultrasonic irrigant, and manual irrigation activation systems in debridement of root canal isthmus: An in vitro study |
|
| ArunKurian Varghese, SV Satish, Basavana Gowda, Roshan Uthappa, AshwiniM Patil | | Endodontology. 2022; 34(1): 27 | | [Pubmed] | [DOI] | | | 4 |
Comparative efficacy of laser disinfection versus chemical disinfection in primary root canal – An In vitro antimicrobial study |
|
| Nikhil Khandare, Prashant Bondarde, Sudha Patil, Shoeb Mujawar, Aruna Vishwakarma | | International Journal of Medical and Oral Research. 2022; 7(1): 1 | | [Pubmed] | [DOI] | | | 5 |
Impact of Adjunctive Laser Irradiation on the Bacterial Load of Dental Root Canals: A Randomized Controlled Clinical Trial |
|
| Johannes-Simon Wenzler, Wolfgang Falk, Roland Frankenberger, Andreas Braun | | Antibiotics. 2021; 10(12): 1557 | | [Pubmed] | [DOI] | | | 6 |
Comparative evaluation of photoactivated disinfection and sonic irrigation as an adjunct to conventional irrigation on Enterococcus faecalis in root canals: An in vitro study |
|
| Tushar Kohli, Namrata Mehta, Garima Garima, Alpa Gupta, Shakila Mahesh, Dax Abraham, Arundeep Singh | | Endodontology. 2021; 33(1): 15 | | [Pubmed] | [DOI] | | | 7 |
COMPARATIVE EVALUATION OF ROOT CANAL DISINFECTION USING 3% SODIUM HYPOCHLORITE, 940NM DIODE LASER AND PHOTODYNAMIC THERAPY IN SINGLE SITTING PULPECTOMY: AN IN-VIVO STUDY |
|
| Thomas T Parakkal, Pulkit Jhingan, Shivani Mathur, Vinod Sachdev | | INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH. 2020; : 1 | | [Pubmed] | [DOI] | | | 8 |
The Number Of Lactobacillus acidophilus After Using Chlorhexidine 2%, Laser Diode (405 nm), And Combination Of Chlorhexidine 2% With Laser Diode (405 nm) |
|
| Sri Kunarti, Sukaton Sukaton, Nadya Nathania | | Conservative Dentistry Journal. 2020; 9(2): 77 | | [Pubmed] | [DOI] | | | 9 |
EFFICACY OF DIODE LASSER 405 NM WITH CHLOROPHYLLS AS PHOTOSENSITIZER ON Enterococcus faecalis |
|
| Sri Kunarti, Amellia Tjandra, Edhie Arif Prasetyo | | Conservative Dentistry Journal. 2019; 8(2): 91 | | [Pubmed] | [DOI] | | | 10 |
Evaluation and comparison between the bactericidal effect of diode laser irradiation (970 nm) and silver nanoparticles on Enterococcus faecalis bacterial strain (an in vitro study) |
|
| Doaa M. Sadony,Karim Montasser | | Bulletin of the National Research Centre. 2019; 43(1) | | [Pubmed] | [DOI] | | | 11 |
Evaluation and comparison between the bactericidal effect of diode laser irradiation (970 nm) and silver nanoparticles on Enterococcus faecalis bacterial strain (an in vitro study) |
|
| Doaa M. Sadony,Karim Montasser | | Bulletin of the National Research Centre. 2019; 43(1) | | [Pubmed] | [DOI] | | | 12 |
Outcome of 940-nm diode laser-assisted endodontic treatment of teeth with apical periodontitis: a retrospective study of clinical cases |
|
| Monika Masilionyte,Norbert Gutknecht | | Lasers in Dental Science. 2018; 2(3): 169 | | [Pubmed] | [DOI] | | | 13 |
Outcome of 940-nm diode laser-assisted endodontic treatment of teeth with apical periodontitis: a retrospective study of clinical cases |
|
| Monika Masilionyte,Norbert Gutknecht | | Lasers in Dental Science. 2018; 2(3): 169 | | [Pubmed] | [DOI] | | | 14 |
Thermal Changes in Root Surface of Primary Teeth During Root Canal Treatment With Diode Lasers: An In Vitro Study |
|
| Bahman Seraj,Zahra Moosavi Garmaroodi,Nasim Chiniforush,Sara Ghadimi | | Journal of Lasers in Medical Sciences. 2018; 9(4): 237 | | [Pubmed] | [DOI] | | | 15 |
Thermal Changes in Root Surface of Primary Teeth During Root Canal Treatment With Diode Lasers: An In Vitro Study |
|
| Bahman Seraj,Zahra Moosavi Garmaroodi,Nasim Chiniforush,Sara Ghadimi | | Journal of Lasers in Medical Sciences. 2018; 9(4): 237 | | [Pubmed] | [DOI] | | | 16 |
Temperature Development on the External Root Surface During Laser-Assisted Endodontic Treatment Applying a Microchopped Mode of a 980?nm Diode Laser |
|
| Franziska Beer,Eleftherios Terry R. Farmakis,Josip Kopic,Christoph Kurzmann,Andreas Moritz | | Photomedicine and Laser Surgery. 2017; 35(4): 206 | | [Pubmed] | [DOI] | | | 17 |
Temperature Development on the External Root Surface During Laser-Assisted Endodontic Treatment Applying a Microchopped Mode of a 980?nm Diode Laser |
|
| Franziska Beer,Eleftherios Terry R. Farmakis,Josip Kopic,Christoph Kurzmann,Andreas Moritz | | Photomedicine and Laser Surgery. 2017; 35(4): 206 | | [Pubmed] | [DOI] | | | 18 |
Root Canal Disinfection Potential of 5.25% Sodium Hypochlorite, 2% Chlorhexidine and 810nm Diode Laser-A Comparative In vitro Antimicrobial Study |
|
| AA Agrawal | | International Journal of Oral and Craniofacial Science. 2016; : 035 | | [Pubmed] | [DOI] | | | 19 |
Clinical Approach of High Technology Techniques for Control and Elimination of Endodontic Microbiota |
|
| Nasim Chiniforush,Maryam Pourhajibagher,Sima Shahabi,Abbas Bahador | | Journal of lasers in medical sciences. 2015; 6(4): 139 | | [Pubmed] | [DOI] | | | 20 |
Clinical Approach of High Technology Techniques for Control and Elimination of Endodontic Microbiota |
|
| Nasim Chiniforush,Maryam Pourhajibagher,Sima Shahabi,Abbas Bahador | | Journal of lasers in medical sciences. 2015; 6(4): 139 | | [Pubmed] | [DOI] | |
|
|
|
|
|
|
|
|
|
|
|
|
| Article Access Statistics | | | Viewed | 14137 | | | Printed | 602 | | | Emailed | 9 | | | PDF Downloaded | 537 | | | Comments | [Add] | | | Cited by others | 20 | | |
|
|
Users online:
