role of laser in periapical surgery

1. Role of laser in
periapical surgery
By : Rania Mahmoud Asaad
National institute of laser science
(NILES)
department of medical laser application

2. •Periapical surgery Also known as
apicoectomy
apical osteotomy
apicoectomy
apicectomy
root resection
periapical surgery
periapical endodontics root end surgery
apical microsurgery,
surgical endodontics

3. Definition:
• Periapical surgery is
an endodontic
therapy through a
surgical flap which
focuses on removing
a portion of a root .
Reference : Oral and Maxillofacial Surgeryfor the Clinicianbook

4. Diagnosis
•Clinical
•Tissue histology
•Radiograph
Oral and MaxillofacialSurgery for the Clinician

5. Clinical oral
investigation
• tooth pain
• swelling in the gums
• Abscess
• Sinus tract
• Tenderness
• Fistula
• Drainage
• Pus

6. Radigragh

7. Radiograph
radiography provide adequate information
• 2D representation CBCT

8. Tissue
histology
Med. oral patol. oral cir.bucal (Internet) vol.12 no.8 dic. 2007

9. indications for periapical surgery
• 1. Persistent periapical lesion after endodontic treatment,
size from 5 mm to 2cm.
• 2. Periapical pathology, which increases after endodontic
treatment, detectable radiographically or by other imaging
studies.
• 3. Significant extrusion of obturating material,
which interferes with healing and leads to
objective symptomatology
KrastevB, FilipovI. Periapical Surgery. Epidemiology, indications andcontraindications. Review. J of IMAB. 2020 Apr-Jun;26(2):3114-3121. DOI: https://doi.org/10.5272/jimab.2020262.3114

10. indications for periapical surgery
• 4. Access for periradicular
curettage, biopsy or access to
additional root, if necessary.
• 5. Access for retrograde
preparation or obturation, if
necessary.
• 6. When the apical part of a
tooth with periapical
pathology can not be cleaned,
shaped and obturated.

11. indications for periapical surgery
• 7. Anatomical abnormalities :
- Highly curved root canals
- Intracanal calcifications in teeth
- External and internal root resorption
- Apical perforations
Teeth with underdeveloped roots
Krastev B, Filipov I. Periapical Surgery. Epidemiology, indications and contraindications. Review. J of IMAB.
2020 Apr-Jun;26(2):3114-3121.DOI:https://doi.org/10.5272/jimab.2020262.3114

12. factors that may affect the procedure :
• 1-The presence or absence of a root-end filling material is
an essential factor in the long-term prognosis of surgical intervention. It is possible to increase the success rate by 10–
13%, using retrograde obturation
• 2-The size of the apical lesion
significantly higher healing rate in teeth with smaller ( <5 mm ) preoperative lesions
• 3-Tooth location
The maxillary lateral incisors have the highest healing rate by scar tissue formation The maxillary premolars appear to
exhibit poorer outcomes compared to the anterior teeth .
• 4-The amount of alveolar bone loss can affect the outcome of surgery
Considerable loss of the bony plate or marginal bone has a detrimental effect on the outcomes of periapical surgeries .
Ahmed, M.A.; Mughal, N.;Abidi, S.H.; Bari, M.F.;Mustafa, M.; Vohra, F.;Alrahlah, A. Factors Affecting theOutcomeofPeriapicalSurgery; a Prospective LongitudinalClinicalStudy.Appl. Sci. 2021,
Ahmed, M.A.; Mughal, N.;Abidi, S.H.; Bari, M.F.; Mustafa, M.; Vohra, F.; Alrahlah, A. Factors Affecting the Outcome of Periapical Surgery; a Prospective Longitudinal Clinical Study. Appl. Sci. 2021,

13. procedure of preapical surgical
operation usually takes between 30-90 minutes
1)anesthetic being applied to numb
the area around the infected
tooth

14. 2) cut through the gum

15. 3)move the tissue
away

16. 4)reach the
root

17. 5) clean the
infected
tissue and
root

18. 6)filling is
used to seal
the end of
the root .

19. 7)take an X-ray
to confirm
there are no
other spaces
for infection

20. 8) we suture the
gum and tissue
around the
tooth, allowing
everything to
heal back in
place.

21. Role of
laser
in
periapical
surgery

22. objective
The main objective
• is to seal the root canal
system.
• enabling healing by
forming a barrier
between the irritants of
the affected root and
the periapical tissue.

23. 1-anesthetic being applied to numb the area around the
infected tooth

24. 2-clean cut incision
to access the
periapical region by
using
• Er:YAG2940 nm
• Nd:YAG1064 nm
• Diode
• CO2 10600 nm
1) Payer M, Jakse N, Pertl C, Truschnegg A, Lechner E, Eskici A. The clinical effect of LLLT in endodontic surgery: a
prospective study on 72 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(3):375-9.

25. Advantage of laser
in this step
• less pain
• reduced scarring.
• fasten the healing of wound.
• providing relatively bloodless.
• reduces the amount of bacteria
and other oral pathogens in the
surgical field
• provide good hemostasis with
reduced need for sutures.
Payer M, Jakse N, Pertl C, Truschnegg A, Lechner E, Eskici A. The clinical effect of LLLT in endodontic surgery: a prospective
study on 72 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(3):375-9.

26. 3-section the apex of the root
Type of laser used in this step :
• Er:YAG 2940 nm
• Er,Cr:YSGG 2780 nm
• Co2 9300 nm
Advantage of laser in this step
• sterilization
• selective absorption
• fasten the healing of wound
Reference :
Arslan H, DoganayE, Karatas E, Unlu MA, Ahmed HM. Effect of lowlevel laser therapy on postoperative pain after root canal
retreatment:A preliminaryplacebo-controlled, triple-blind, randomizedclinical trial. J Endod. 2017;43(11):1765-9.

27. 4- root canal wall preparation
Type of laser used:
• Nd:YAG (1064 nm)
• ( 15 Hz/1.5 W)
• (pulsed mood )
Role of laser in this step:
• sealing of dentinal tubules
• destroying of smear layer
Reference :
Kathari A, Ujariya M (2014) Lasers in endodontics - A review. J Res Adv Dent 3: 209-211

28. 5- root-end filling
Laser used in this step :
• the Er:YAG laser via
(0.9mm-wide cylindrical quartz fiber tip)
parameters:
pulsed mode
15 Hz, 4.5 W
Air-water spray (water on 3 , air on 5.)
In the QSP mode, a
standard laser pulse of 600 μs
advantage of laser in this step :
higher bond strength than bioceramic root-end filling material
Reference :
SnježanaKadić, Anja Baraba,Ivana Mileti,etal. Influence of differentlaser-assistedretrogradecavity preparationtechniques on
bond strength of bioceramic-based materialto root dentine . Lasers in Medical Science 2020; 35:173–179

29. 6- antibacterial during root canal treatment
of infected periapical lesions ( sterilization )
Laser used in this step :
• diode laser 810 nm
Parametars:
via optical fiber 200-μm diameter
power output of 1.5 W
advantage of laser in this step :
• better disinfecting action for both microorganisms
(but on long duration)
(Laser treatment had a poor, almost negligible
effect on elimination of bacterial cells in large
periapical lesions. Application of a laser might
serve as an adjuvant method to standard
irrigation with sodium hypochlorite.)
Agron Bytyqi, Xhevdet Aliu, Merita Barani,et. Disinfection of Infected ArtificialDental Periapical Lesions with Diode Laser. 2021

30. 7- Low Level Laser in a treatment in periapical
lesions
Role of laser in this step :
•Vasodilatation of lymphatic vessels
•reduction in the permeability of blood vessels
Reference :
Alipanah Y, Asnaashari M, Anbari F. The effect of lowlevellaser (GaAlAs) therapy on the
post-surgical healingof full thickness wounds in rabbits.Med Laser Application. 2011;
26(3): 133-8.

31. Over all choosing laser over surgical
o fasten the healing of wound.
o providing relatively bloodless
o no postsurgical pain.
o selective and precised interaction with diseased tissues.
o Laser also reduces the amount of bacteria and other oral
pathogens in the surgical field.
o There is less pain in most cases.
o Laser applications provide good hemostasis with reduced need for
sutures
o reduced scarring
o sterilization
-Agron Bytyqi, Xhevdet Aliu, Merita Barani,et. Disinfection of Infected ArtificialDental PeriapicalLesions with Diode Laser. 2021

32. Thank you