Since 1974, when Herbert Schilder established his principles of root canal shaping as the main approach to endodontic treatment, almost nothing has changed. We all try to perform root canal shaping procedures to achieve a tapered preparation shape, keep the apical foramen as small as possible and prepare the space for irrigants to perform successive disinfection of the root canal systems. Unfortunately, the root canal shaping procedure does not enable the removal of all the infected tissue from the root canal and using rotary files produces a great deal of hard-tissue debris, which accumulates in isthmuses, fins, ramifications and accessory canals. Although the conventional procedure has drawbacks, so far we have not known of a better procedure.
Various concepts for root canal shaping and irrigation protocols have been introduced that are intended to eliminate the vast majority of the hard-tissue debris. Techniques such as the in and out technique introduced by Grzegorz Witkowski were developed to eliminate much more debris during instrumentation than the most commonly used multiple-stroke mechanical preparation does. Shaping protocols with continuous flow of sodium hypochlorite (NaClO) have also been introduced. Finally, the GentleWave irrigation device (Sonendo) has been introduced, preceded by much less preparation of the root canal space than we are used to.
The introduction of lasers to dentistry was not promising in the very beginning, especially in endodontic treatment. The issue of thermal damage caused by ruby lasers meant that these kinds of lasers could not be used for root canal disinfection. Fortunately, the development of new laser technologies resulted in laser devices suitable for root canal therapy, especially laser-activated irrigation.
In light of the above, I have developed a new shaping and irrigation protocol, the Less-Prep Endo (LPE) concept. In this article, I will discuss the origin of the idea, the first in vitro trials of the LPE concept and cases performed according to this protocol.
The origin
Micro-CT scans allowed clinicians to improve their knowledge about the complexity of the root canal system. This kind of image can help the clinician to understand the network of blood vessels inside the roots, especially in the molars. Comparison of micro-CT scans with radiographs available on the internet reveals that there is a visible difference between the micro-CT scans and the postoperative radiographs regarding the quality of obturation. The most visible difference is in the area of the apical delta and isthmuses between the canals. This difference led us to deduce that, even though root canal therapy procedures are very successful, a great deal of root canal space is not cleaned of hard-tissue debris and filled with obturation material.
Fotona’s SWEEPS (shock wave-enhanced emission photoacoustic streaming) technology is based on a laser pulse with a wavelength of 2,940 nm for a few microseconds. This very short laser pulse creates a great deal of energy, producing bubbles which collide with each other and collapse, creating a shock wave. This concept is described in the literature as the one of the most effective in terms of hard-tissue debris removal and disinfection of dentinal tubules.
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