Comparison of Disinfection of Different Irrigants using SWEEPS Laser Activation

Objectives: Effective irrigation has been shown to be a key factor in achieving endodontic treatment success. Laser activated irrigation (LAI) has been proposed to create shockwaves in irrigant fluid that improves the cleaning of complex canal systems. This study first evaluated existing models for antimicrobial testing of endodontic treatments using extracted teeth in combination with Enterococcus faecalis infection. These models were compared for optimization, followed by evaluation of treatment with different irrigants using LAI. The purpose of this study was to compare the efficacy of different irrigants activated by laser in disinfection of root canals.
Methods: Extracted single rooted teeth were accessed and shaped to produce similar cavity volumes. The external root surfaces were sealed with a bonding agent, sterilized by autoclaving and incubated in medium to confirm complete sterilization. Subsequently, the teeth were inoculated with E. faecalis at different incubation periods in a CO2 chamber. E. faecalis colonization was confirmed via colony forming units (CFU). Selected inoculation and incubation protocols were then tested for their utility as model systems for efficacy testing of endodontic treatments. Endodontic treatment was performed with sodium hypochlorite (NaOCL), MTAD, ozonated water and saline. All irrigants were laser activated using the SWEEPS modality. Survival of E. faecalis was determined via CFU, pre- and post-treatment, to assess efficacy of the irrigants.
Results: The different incubation protocols demonstrated that one-time inoculation produces similar colonization with E. faecalis as daily inoculations. Results also showed that all endodontic irrigants have significantly lower CFU counts as compared to the control.
Conclusions: Currently the gold standard in irrigating during endodontic treatment is sodium hypochlorite, despite the potential for adverse outcomes. Improved effectiveness with LAI gives scope for consideration of different irrigants in endodontic treatment, which are associated with less adverse outcomes.