Advanced Laser Endodontic Therapy (ALET)

Advanced Laser Endodontic Therapy – What is it?

In the vast majority of cases, root canals are caused by infections, and the bacteria that cause root canal infections are difficult to remove completely once they get into the tooth and the bone around the tooth.

When teeth get infected, the tubules get filled with bacteria and traditional root canal therapy doesn't have an effective way of dealing with the bacteria in the tubules of the root.

Advanced Laser Endodontic Therapy (ALET) successfully addresses the two major disadvantages of traditional root canal therapy: the inability to clean and sanitize anatomically complex root-canal systems and to deeply disinfect dentinal walls and tubules.

Why is ALET Superior to Classical Root Canal Therapy?

There is no way classical root canal therapy can completely clean all the infection present in the root canals of a tooth. Dentists usually think that it is enough to fill the main canal of the tooth and their job is done. They can get a good result for the main canal and miss the sometimes myriad of lateral, accessory and connecting canals within the canal system of teeth.

The problem is the tools dentists have had available are not efficient and don't remove all of the bacteria and infected, necrotic tissue inside the tooth. Root canals have traditionally been done with small hand files. Up till now, these have been the primary instruments available.

The Microtubule Problem

The third reason classical root canal treatment doesn't always work is the microtubules of the roots. These tiny channels usually carry micronutrients into the tooth and house immune cells. When laid down side by side, the microtubules span a distance of 1-2 miles. That is a lot of tubules!

In Weston Price's groundbreaking research and George Meinig's book, "The Root Canal Cover-Up," it was postulated that the microtubules were actually filled with bacteria and contributing to the body burden of toxicity.

To highlight this issue, the Journal of Endodontics stated that all instrumentation techniques left 35% or more of the canals' surface area unchanged. Leaving 35% of the tooth surface untouched after root canal therapy is a staggering thought.

How the Procedure is Usually Done

While hand files do a reasonable job of removing bacteria and infection from the main canal of the tooth, they do a poor job of removing infected tissue in other canals present in the root canal system. The simple reason is that these files cannot reach these canals. The shape of the file does not match the natural curves and turns of the canals. Most canals turn and curve like a river, making it virtually impossible to navigate with straight files.

Introducing Advanced Laser Endodontic Therapy

Using the SWEEPS modes of the Fotona Erbium laser, virtually all the bacteria present in infected teeth is eliminated. Here is how it works:

Fast, effective and minimally invasive treatments

• During ALET, an Erbium laser uses a unique photoacoustic streaming method to create non-heat producing photoacoustic waves. Following this, the canals and sub-canals are left clean and the dentinal tubules are free of contamination and debris.
• In the second step, the antibacterial and oxygenating properties of ozone flush out and penetrate into the microtubules of the tooth. Research has shown that ozone is more effective at killing bacteria than even bleach, which is the traditional solution dentists use.
• At the end of treatment, an Nd:YAG laser wavelength is utilized to create bio-stimulation that helps heal the gums and bone around the tooth.

A Game Changer in Root Canal Therapy

With the use of electron microscopy, we can actually show the microtubules and the fact that they are devoid of bacteria after using PIPS during root canal therapy. Before the laser treatment, bacteria are embedded in the microtubules. After treatment, the microtubules are completely clean.

In Dr. O'Rielly's 40 years as a practicing dentist, he considered this one of the most important developments to resolve infections in the mouth.

Why SWEEPS are Perfect for Healing Root Canal Infections

In PIPS and SWEEPS mode, the laser operates on a super-short 50-microsecond pulse duration. This combined with the specific design of the Erbium tip allows for the lowest possible energy per pulse and repetition rate. This minimizes thermal effects and maximizes the propagation of photon-induced photoacoustic shock waves on a microscopic level.

Conclusion

PIPS and SWEEPS are revolutionary laser frequencies for cleaning and disinfecting the root canal system. The strategy of using PIPS when combined with traditional irrigation as well as ozone water has the potential to fully heal previously unhealthy and infected teeth. Once we eliminate the bacteria in the tooth, the body can still maintain a biological connection with the tooth through the periodontal ligament.

Reference: Peters OA, Boessler C, Paqué F. Root Canal Preparation with a Novel Nickel-Titanium Instrument Evaluated with Micro-computed Tomography: Canal Surface Preparation over Time. Int Endod J. 2001 Apr;34(3):221-30.

Frequently Asked Questions

What is Advanced Laser Endodontic Therapy (ALET)?

ALET is an innovative approach to root canal therapy, now made possible through advances in technology and a bio-friendly new protocol. It uses specialized rinses, ozone, and a dual Erbium/NdYAG laser to sterilize and sanitize the canals and tubules of the tooth and to stimulate healing.

Why haven't I heard of this before? Why aren't other root canal specialists doing this?

While the Fotona laser has been used with good effect for about a decade, the specific protocol currently being used by Dr. Evans is relatively new. Most dentists haven't heard of it yet!

Why is this different from traditional root canal procedures?

Traditional endodontic therapy is not able to sanitize and sterilize the complex root canal system in most teeth, let alone reach the myriad of microtubules in the roots. For more on this, see Dr. O'Rielly's blog posts.

Won't I Still Have a "Dead Tooth" in My Mouth?

The tooth isn't "dead." Although after root canal therapy the canals are filled with inert material, the ligament around the tooth is still viable and vital. This ligament provides blood flow, nerve signals, and serves as a shock absorber for the tooth. As long as it is viable and present, the tooth maintains its biological connection to the body.

Why Do I Need Two Appointments for My ALET Procedure with Dr. Evans?

On the first visit, Dr. Evans opens up the canals and clears out the infection. Then she gives the tooth two weeks to maximize healing before finishing the procedure on the second appointment. She finds that using the protocol twice only improves her results and ensures all the bacteria and biofilm has been removed from the canals and tubules.

Will I Still Need a Crown? What if I Already Have a Crown?

If you already have a crown, Dr. Evans may be able to go through it from the biting surface and maintain it by sealing it. Otherwise you will probably need a new crown. Each case is different.

What About Weston Price's Research and George Meinig's Book?

The conclusion of Price's research and Meinig's book was that it's impossible to reach all the canals in a root canal system and open up the millions of microtubules in the roots. Now, with the Fotona laser, ozone and chelators like EDTA, the bacteria and endotoxins associated with them can be removed. Dr. Evans' position is that the body doesn't have a problem with the tooth as long as you can get to all the bacteria, and now you can with the ALET protocol. Technology has changed a lot since Price and Meinig. Dr. O'Rielly has discussed this in his blog posts.