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Svrha ovog rada je objasniti teorijske osnove laserski aktiviranog ispiranja (LAI) korijenskih kanala te dati sažeti kritički prikaz dosadašnjih istraživanja o uporabi lasera kao nadopuni kemo-mehaničke obrade korijenskih kanala. Cilj endodontskog liječenja je ukloniti mikroorganizme, pulpno tkivo i dentinski debris iz korijenskih kanala, a postupak uključuje mehaničku instrumentaciju i kemijsku obradu sredstvima za ispiranje. Ipak, postoje određena ograničenja endodontskog liječenja koja su posljedica anatomske kompleksnosti i prisutnosti lateralnih kanala. Konvencionalno ispiranje iglom i špricom nedovoljno je učinkovito u dezinfekciji lateralnih kanala te predstavlja rizik za ekstruziju irigansa u periapikalno područje. Kako bi se izbjegli navedeni nedostaci konvencionalnog ispiranja, razvijaju se tehnike aktivacije irigansa koje povećavaju disperziju irigansa u sustav korijenskih kanala. Napretkom laserske tehnologije, laserska zraka također nalazi primjenu u tehnici LAI korijenskih kanala. Primjenom pulsne tehnologije erbij lasera, laserska zraka u irigansu izaziva fototermalni učinak i stvaranje prolaznih kavitacija koje rezultiraju nastankom tlačnih šok-valova i smičnog naprezanja na dentinske zidove, što pospješuje uklanjanje zaostatnog sloja i bakterijskog biofilma. Daljnjim tehnološkim napretkom lasera razvijaju se nove tehnike, fotonima inducirano fotoakustično strujanje (engl. photon-induced photoacoustic streaming, PIPS) i emisija fotoakustičnog strujanja pojačana udarnim valom (engl. Shock Wave Enhanced Emission of Photoacoustic Streaming, SWEEPS). U literaturi trenutno ne postoji dovoljno radova visoke kvalitete, na temelju kojih bi se preporučila uporaba lasera u nadopuni kemo-mehaničke obrade. This study aims to explain the theoretical principles of laser-activated irrigation of root canals and give a concise critical review of previous studies about using lasers as a supplement to the chemo-mechanical treatment of root canals. The goal of endodontic treatment is to remove microorganisms, pulp tissue, and dentine debris from the root canals, in a procedure that involves mechanical instrumentation and chemical treatment with irrigants. However, endodontic treatment has certain limitations due to anatomical complexity and the presence of lateral canals. The conventional needle and syringe irrigation technique is insufficiently effective in disinfecting lateral canals and poses a risk for irrigation extrusion into the periapical area. To avoid these disadvantages of conventional rinsing, irrigation activation techniques are being developed to increase the dispersion of irrigants into the root canal system. With the advancement of laser technology, laser beams also found application in the technique of laser-activated irrigation (LAI) of root canals. By applying pulsed technology of erbium laser, the laser beam in the irrigant causes a photothermal effect and the creation of transient cavitations, which result in the formation of pressure shock waves and shear stress on the dentinal walls, which facilitates the removal of smear layer and bacterial biofilm. With further technological progress in laser technology, new techniques are being developed, including photon-induced photoacoustic streaming (PIPS) and shock wave enhanced emission of photoacoustic streaming (SWEEPS). Currently, there are not enough high-quality studies in the literature to recommend laser as a supplement to chemo-mechanical treatment. |
