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18 I I special _ laser disrupt and kill intratubular bacteria. This effect is most effective in a dry mode, as the laser energy is not absorbed by the water spray and can exert its full effect on the bacteria. This was confirmed by Gordon etal., who achieved a 99.7% kill rate for E.faecalis in thedrymode.2 Techniqueforthedisinfectionphaseis the same as the cleaning phase but with different laser settings in the dry mode. _Clinical applications While this protocol is recommended for all endo- dontic treatments (Figs. 10–13), it is most valuable in the following clinical situations: _infected cases with apical, lateral and/or furcal radiolucencies; _retreatments with peri-apical periodontitis; _acutely inflamed cases, especially those diagnosed with Cracked Tooth Syndrome; _internal and external resorption; _persistent infections not responding to conven- tional endodontic treatment; and _unexplained, prolonged post-operative discomfort. _Summary A root-canal cleaning, shaping and disinfection protocol has been described that maximises the removal of tissue, debris, smear layer and bacteria from root-canal systems. Utilising a combination of working width management with LightSpeed LSX instruments, high-volume apical negative pressure irrigation and evacuation with the EndoVac system and intra-canal laser therapy with radial-firing tips using the Waterlase MD laser, the ability to eliminate bacteria from infected root-canal systems may soon be within our grasp._ _References 1.Siqueira JF, Rocas IN: Clinical Implications and Microbiology of Bacterial Persistence after Treatment Procedures. J Endod. 2008;34(11):1291–1301. 2.Gordon W, Atabakhsh VA, Meza F, Doms A, Nissan R, Rizoiu I, Stevens R:The antimicrobial efficacy of the erbium,chromium: yttrium-scandium-gallium-garnetlaserwithradialemittingtips on root canal dentin walls infected with Enterococcus faecalis. JADA.2007;138(7):992–1002. 3.KouchiY,Ninomiya J,Yasuda H,Fukui K,MoriyamaT,Okamoto H: Location of streptococcus mutans in the dentinal tubules of openinfectedrootcanals.JDentRes.1980;59:2038–46. 4.Haapasalo M, Orstavik D: In vitro infection and disinfection of dentinaltubules.JDentRes.1987;66(8):1375–9. 5.Berutti E, Marini R, Angeretti A: Penetration ability of different irrigantsintodentinaltubules.JEndod.1997;23:725–7. 6.Zou L, Shen Y, Li W, Haapasalo M: Penetration of Sodium HypochloriteintoDentin.JEndod.2010;36(5):793–6. 7.Schoop U, Barylyak A, Goharkhay K, Beer F, Wernisch J, Geor- gopoulosA,SperrW,MoritzA:Theimpactofanerbium,chromium: yttrium-scandium-gallium-garnet laser with radial-firing tips on endodontictreatment.LasersMedSci.2007;24(1):59–65. 8.Allen F: In vivo study of apical cleaning. General Dentistry. 2007;449–56. 9.Kerekes K, Tronstad L: Morphometric observations on root canalsofhumanmolars.JEndod.1977;3:114–8. 10.Wu MK,R’orisA,Barkis D,Wesselink P:Prevalence and extent oflongovalcanalsintheapicalthird.OOO.2000;89(6):739–43. 11.Chow TW: Mechanical effectiveness of root canal irrigation. JEndod.1983;9(11):475–8. 12.Tay FR, Gu L, Schoeffel GL,Wimmer C, Susin L, Zhang K,Arun SN,Kim J,Looney JW,Pashley DJ:Effect ofVapor Lock on Root CanalDebridementbyusingaSide-ventedNeedleforPositive- pressureIrrigantDelivery.JEndod.2010;36(4):745–50. 13.Schoeffel J:The EndoVac Method of Endodontic Irrigation,Part 2–Efficacy.DentistryToday.2008;27(1). 14.NielsenBA,BaumgartnerJC:ComparisonoftheEndoVacSystem toNeedleIrrigationofRootCanals.JEndod.2007;33(5):611–5. 15.Prashanth VS: Evaluation of New System for Root Canal Irriga- tiontoConventional:AnExVivoStudy.DiscusDental,CulverCity, CA:TheEndoFilesNewsletter.2008. 16.Sung E, Rankin DD, Rizoiu I, Chueh P: Biolase Technology. unpublishedstudy.2008. 17.PetersO,BarbakowF:EffectsofIrrigationonDebrisandSmear Layer on Canal Walls:A Scanning Electron Microscopic Study. JEndod.2000;26(1):6–10. roots2_2011 Fig. 12 Fig. 13 Fig. 12_Lower premolar treated with laser protocol. Fig. 13_Lower molar treated with laser protocol. Dr Justin Kolnick 222WestchesterAv. Suite 402 White Plains,NY 10604 USA info@westchesterendo.com _contact roots