د حاتم البيطار Dr hatem el bitar mob 01005684344

1. dr hatem bitar mob{01005684344}
‫الرحيم‬ ‫الرحمن‬ ‫ال‬ ‫بسم‬
research
On role of laser
in periapical lesion
‫البيطار‬ ‫حاتم‬ ‫د‬
‫الطلب‬ ‫تحت‬ ‫طبي‬ ‫محاضر‬
Dr Hatem El Bitar
EGYPTIAN FELLOWSHIP
Lecturer in British board Academy
Lecturer in Egyptian Center
Lecturer in Emide Center
Mob: 01005684344

2. dr hatem bitar mob{01005684344}
ABSTRACT
-The problem in cases of healing resistant
periapical lesions is to eradicate the contamination
at the periapical area,so it need
-Paraendodontic surgery (apisectomy)
consists of the mechanical removal of
harmful agents to promote healing and periapical health
-Need for complete removal of microbial contamination was done by
cutting the apical one third with retrograde fillings
Which also not sucessful,that is make laser is the best choice for
treatment of these cases

3. dr hatem bitar mob{01005684344}
Introduction
periapical infection results from microorganizmes
colonizing the apex of the teeth
Treatment
1Endodontic therapy isthe first step to treat periapical lesions.
)However, in some cases periapical lesions persist ,even after proper
treatment(
Tronstad et al. reported the presence of periapical bacterial
biofilm on resistant periapical lesions
Lin et al. suggested that successful treatment
is only possible with total removal of the irritating agents

4. dr hatem bitar mob{01005684344}
introduction
2Periapical surgery is indicated for cases with no sign of
healing after retreatment.
3apical curettage can be used to remove
infected tissue around the apex.
)However, the removal of infected cementum and
surrounding tissue is not easy(,
which may explain the persistence of a small number
of lesions that do not heal even after apical surgery.

5. dr hatem bitar mob{01005684344}
is surgical technique used to treat periapicals
pathologies, when it is practically impossible
to be treated with conventional endodontic
treatment
apisectomy
.

6. dr hatem bitar mob{01005684344}
Fig1 shows xrays for periapical lesion

7. dr hatem bitar mob{01005684344}
apisectomy
the aim: remove infection or other pathology
from around the end of the root of a tooth.
causes: It is usually carried out when a normal
root filling has failed or is impractical

8. dr hatem bitar mob{01005684344}
procedures
carried out under a local anaesthetic and is usually
painless
making flap &reflection of gingiva to expose the
underlying bone
removal of bone with surgical bur under cooling
water,saline
cutting in the infected apex (removal of apical one
third with) retrograde filling
flap is repositioned and sutured
every step will be disscused in details

9. dr hatem bitar mob{01005684344}
procedures
FIG.2,3 SHOWING PROCEDURES OF APISESCTOMY
FIG.2
FIG.3

10. dr hatem bitar mob{01005684344}
the flap
def: used to expose area of operation
increase accessibility to the field
types of flap design
a-surgical technique,using scalpel
have many design acc to no. of incision line
such as mucogingival,semilunar
b-by using co2 laser
.

11. dr hatem bitar mob{01005684344}
A-surgical flap
fig 4 showing flap design,muco gingival flap

12. dr hatem bitar mob{01005684344}
complication of surgical flap
bleeding from surgical incision in the gum
There is usually some post operative pain
post operative swelling in the first few days
following surgery
but healing is usually complete within a week

13. dr hatem bitar mob{01005684344}
b-by using co2 laser
CO2 laser is 1st laser for soft tissue surgery
Why
Laser surgery has benefits such as
1Non-contact surgery
2No or less bleedinig
3Improved visibility of surgical site
4No or less pain during and after surgery
5Reduced surgical time
6Minimal discomfort
7Killing bacteria on laser site
8Faster healing
9No or less dressing
10Reduced healing time

14. dr hatem bitar mob{01005684344}
Retograde filling
def: a suitable root-end filling material is inserted.used
to seal the root-end cavities and
prevent leakage of microorganisms and their
by-products
ideal requirments
1should be non-toxic
2non-carcinogenic
3biocompatible with the tissue fluids and
4dimensionally stable
5The presence of moisture should not affect its sealing
ability
6should be easy to use
7radio-opaque to be recognized on the radiograph

15. dr hatem bitar mob{01005684344}
retrograde fillings
types of retrograde filling
1Metals such as: gold-foil,silver posts
titanium screws,tin posts,amalgam
2sealers such as: ZnOE,Super
EBA,cavit,zinc-polycarboxylate
glassIonomer,mta,calcium phosphate
cement

16. dr hatem bitar mob{01005684344}
Why laser is used to eradical contamination in
periapical lesions
no material has been found that fulfills
all or most of the properties
for ideal retrograde filling material
also, the removal of infected
cementum and surrounding
tissue is not easy
which may explain falirue of many cases &
number of lesions that do not
heal even after apical surgery
so we use laser to eradicate microbial flora
with no recurrence

17. dr hatem bitar mob{01005684344}
Why laser is used
LASER
is very special type of Light( lightAmplification by
Stimulated Emission of Radiation)characterized by
Coherent,monochromic,high
power,unidirectional,collimated.
Lasers are composed of three main elements:
the optical amplifier,pump and optical
resonator

18. dr hatem bitar mob{01005684344}
Fig.4 shows types of laser machine
Types of laser
1solid laser such as ruby laser,er:yag,nd:yag
2gas laser such as argon laser ,co2 laser
3liquid laser such as dye laser
4semiconductor such as diode lasers

19. dr hatem bitar mob{01005684344}
The purpose of this study was
to assess the results of Er:YAG
laser irradiation on the apical root
third
of newly extracted teeth
to eliminate microbial contamination
on root apex surface

20. dr hatem bitar mob{01005684344}
Material and Methods
-Erbium yttrium aluminum garnet (Er:YAG)
laser of 2.94 µm wavelength is strongly
absorbed by water
-human teeth with periapical lesions extracted
and soaked in saline and stored in a sterile
flask until use.

21. dr hatem bitar mob{01005684344}
Technique of work
The teeth were fixed, submerged in
a flask with water
and irradiated with the laser
Er:YAG laser device of 2.94 µm
wavelength was used in this study
using an experimental
chisel-shaped contact tip of 0.256 mm²
Continue<<

22. dr hatem bitar mob{01005684344}
Er:YAG laser device of 2.94
µm wavelength was used in
this study. The specimens
were irradiated with
-3.5 W peak power
-3 times
-on the apical 3 mm of the root
- at an agle of 60°
-during approximately 3 s

23. dr hatem bitar mob{01005684344}
The lased specimens were
dehydrated in 99.5% ethanol
critical-point dried
suppter-coated with gold using an
ion coater
and examined under scanning
electron microscopy
at 25 kV.

24. dr hatem bitar mob{01005684344}
Results
based on a morphological
analysis
of SEM micrographs
Er:YAG laser irradiated area
at high magnification (3000X)
shows vaporization of
microbiological apical biofilm

25. dr hatem bitar mob{01005684344}
At the same magnification
(3000X)
the non-lased area with biofilm
firmly attached to root apex
surface
show the presence of cocci and
rods
on the root surface in this
biofilm layer

26. dr hatem bitar mob{01005684344}
Fig.5 shows sem micrographs of apical one third
of study specimens

27. dr hatem bitar mob{01005684344}
Discussion
The treatment of apisectomy failures
is very difficult because periapical
lesions usually do not respond well
to mechanical, chemo-pharmacological
Therefore laser irradiation has been presented
as a promising method for providing
morphological changes on
dentin and cementum surfaces
as well as for biofilm removal.

28. dr hatem bitar mob{01005684344}
The Er:YAG laser has been
recently introduced to dentistry
and has potential for different
clinical applications
with excellent results Studies
have shown that dental
hard substances can be removed
by pulsed Er:YAG laser
irradiation
conclusions

29. dr hatem bitar mob{01005684344}
entionYAG laser has attracted attthe ER:
due to
1 its capacity for ablating hard tissue
2 extremely small thermal effects
3 The 2.94 µm wavelength is highly
absorbed by water
4 causes little damage on hard tissues
5 HAS minimal or no pain
6 induces little temperature rise leading to
safe clinical use

30. dr hatem bitar mob{01005684344}
Role of laser in biostumlation
low powered lasers are believed to increase the
production of collagen which provides healing for
non-healing tissues and to stimulate the production of
enzymes which remove or reduce the byproducts of
tissue inflammation and thereby reduce swelling
leading to the alleviation of pain and swelling

31. dr hatem bitar mob{01005684344}
Role of laser in biostumlation
types of lasers used for biostimulation
HeNe at 635nm
diodes at between 820to904nm
technique & parameter
are used either in CW or pulsed modes at
between15 to 60 mW levels.They are usually
applied for a few minutes at each treatment, and
are repeated on a daily or weekly basis until relief from
the symptoms is achieved

32. dr hatem bitar mob{01005684344}
Thank you