Advanced Laser Endodontic Therapy – What is it?

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

Root canal system of a molarThere 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 really good result for the main canal and miss the sometimes myriad of lateral, accessory and anastomoses (connectors) within the canal system of teeth.

The problem is the tools dentists have had available to them are not efficient and don’t remove all of the bacteria and infected, necrotic tissue inside the tooth.  You have all heard of the adage, ‘Use the right tool for the job.’  Root canals traditionally have been done with small hand files (pictured below).  Up till now, these have been the primary instruments available to do root canals and try to remove the necrotic tissue inside the tooth.  Now there is another way, more on this later.

How the Procedure is Usually Done

Files used to remove infection from root canalsHere is a picture of the files dentists use during root canal therapy.  While hand files do a pretty good job of removing bacteria and infection from the main canal of the tooth, they do a poor job of removing the infected tissue in the other canals present in the root canal system.  The simple reason for this is that these files cannot reach these canals.

Imagine for a moment using one of the files to the left and trying to clean out the curved canals and channels in the tooth imaged above.  First of all, it is anatomically impossible for these files to reach all the canals present.  Secondly, the shape of the file does not match the shape of the canals present in teeth.  Rarely if ever does a tooth canal present as a relatively perfect cylinder, oval or circle.  Most canals turn and curve like a river, making it virtually impossible to navigate with these files.  It’s the way of nature.

Dentinal Tubules in toothThe third reason classical endodontics (root canal treatment) doesn’t always work is the microtubules of the roots.  Here is an electron microscope image of the root surface of a tooth.  See all the tiny holes?  These are microtubules which usually carry micronutrients into the tooth and house immune cells and odontoblasts that can lay down more tooth structure when necessary.   When laid down side by side, the microtubules will span a distance of 1-2 miles.  That is a lot of tubules!

In Weston Price’s groundbreaking research done a century ago 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 in your body.

 

Here is another image of microtubules, now filled with bacteria after a tooth becomes infected.  The reason this is important is that the metabolic byproducts of bacteria (essentially ‘bacteria poop’) is toxic to our bodies.  Some people with immune compromised conditions shouldn’t have root canal procedures done because of the additional stress it will put on an already taxed and stressed immune condition.  I have seen many patients with auto Immune conditions, fibromyalgia or Lyme disease who could not tolerate root canals.  For more information on systemic inflammation and root canals go to this article I wrote on the importance of checking certain blood markers before major dental work: Inflammation May Cause Failure in Extractions, Root Canals and Implants: A Case Study

To highlight the above points, I am going to quote what the Journal of Endodontics (printed by the American Association of Endodontists) has stated about root canals performed with four different nickel /titanium file systems.   To quote the article’s conclusion, ‘All instrumentation techniques left 35% or more of the canals’ surface area unchanged. Whilst there were significant differences between the three canal types investigated, very few differences were found with respect to instrument types.’ (1)

Possibly leaving 35% of the tooth surface untouched after root canal therapy is a staggering thought.  Imagine doing a root canal at your local dentist because you have an infected tooth and being told you’re good to go even though that the dentist was only able to clean 65% of your tooth.  Would you consider that a success?  I wouldn’t.  No wonder root canals fail as often as they do.  It’s because there is still bacteria left behind to fester in your tooth!

Introducing Advanced Laser Endodontic Therapy

Thankfully, a treatment protocol has recently been developed that solves the two deficiencies of traditional endodontics mentioned above. Using the PIPS and SWEEPS modes of the Fotona Erbium laser, virtually all the bacteria present in infected teeth is eliminated.  Let’s see how it works:

Fast, effective and minimally invasive treatments

  • During Advanced Laser Endodontic Therapy (ALET for short) 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 to kill bacteria during root canal therapy.
  • At the end of treatment, an Nd:YAG laser wavelength is utilized to create bio-stimulation that helps to heal the gums and bone around the tooth.

A game changer in root canal therapy

tubules in root canalTake a look at the electron microscope images in this graphic.  On the image to the left, you see the bacteria that usually gets embedded into the microtubules of the tooth root after a tooth gets infected and needs a root canal.  On the second image, you see the microtubules after treatment with the Fotona laser in PIPS mode.  There are NO MORE BACTERIA in the tubules of the root!

Before now, we couldn’t be sure how much bacteria we were leaving behind when we did a root canal on a tooth.  How would you know, as you can’t see them on x-rays?  However, 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.

This is absolutely a game changer and a paradigm shift in dentistry, in my opinion.  In my 33 years as a practicing dentist, I don’t think I have seen a more important development to resolve infections in the mouth.  This is why I am so excited about this laser and specifically the PIPS and SWEEPS modes to remove bacteria from infected teeth.  I think that Weston Price as well as George Meinig, if they were alive today, would be as excited about this technology as I am.

Why PIPS and SWEEPS are perfect for healing root canals infections

OK, for the geeks out there like me who want to hear more about the technical stuff here goes:  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 the photon-induced photoacoustic shock waves on a microscopic level.

Here is an early video animation showing how PIPS works:

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.

If you are local to San Diego, you can call Victoria and get set up for an evaluation with me to see if PIPS would help in your individual situation.  Call her at 760-632-1304.

To read more about laser root canals, here is another article on the subject:  Should I Treat My Root Canal Infection or Extract My Tooth. 

 

Reference:

  1. Root Canal Preparation with a Novel Nickel-Titanium Instrument Evaluated with Micro-computed Tomography: Canal Surface Preparation over Time;  Ove A. Peters, DMD, MS, PhD,* Claudia Boessler, DDS,† and Frank Paque´, Dr med dent†:  Int Endod J. 2001 Apr;34(3):221-30.