Using The Literature To Make A Case For Caution When Employing Laser-Activated Irrigation Systems
What I am trying to embrace in this post is the negative reaction to my mentioning the precautions one particular company included in their instructions for use, namely, not to use it where open apices exist or near sinuses. The reason for this is evidently that the power of the laser is great enough to potentially damage periapical tissues and teeth with open apices allow that energy to be transmitted beyond the confines of the root. Also, evidently, roots in intimate contact with sinuses are also more likely to allow the laser-activated irrigants to potentially cause damage. From these stated precautions I extrapolated to what would appear to be another logical precaution, not to use such irrigation systems when the roots are in close proximity to the inferior alveolar nerve.
Having stated these thoughts I was ridiculed by the critic as well as one other laser-irrigation enthusiast that I was completely clueless on the subject. For sure, I am no expert on the subject, but I did some further research on the topic and posted a 2023 meta analysis study out of Iran that clearly states the potential of laser-activated irrigation systems as well as ultrasonic activation to produce dentinal micro-cracks.
The take away from this information is to introduce a note of caution, that there are potential consequences of its usage beyond canal debridement and we should be well aware of undesirable side effects. The critic took great umbrage that I introduced a note of caution when reviewing the case that a colleague of his did with spectacular results on x-ray. Yet, it is that very case where the cleansing power although several mms away from the laser tip displayed action at a distance that evidently is sufficient to induce dentinal micro-cracks. This fact along with the precautions stated from one of the better known high energy irrigation manufacturers seems to underline the precautions that should be taken. Perhaps, there is more to the subject and it is worth a continuing discussion, but to dismiss the implications of this meta analysis as a tool I use to unfairly throw doubt on a system I am not even competing with is entirely out of place.
There seems to be a flaw in our nature that affects some people more than others. I would describe that flaw as a need to personally attack someone who disagrees with one’s own strongly held opinions. From my perspective, the disagreement over technical issues be they instrumentation systems or laser irrigation systems means the discussions should entail an examination of the available data on these precise issues without any personal allusions to one’s character or mental faculties. Disagreement over technical issues happens all the time and the illumination that often results from those discussions is beneficial. To feel threatened by those who you are in disagreement with is in the eye of the beholder and should never call for personal remarks on either side.
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For those who are entertained by the personally aggressive remarks, it reminds me of the man who said, “let’s you and him fight.” I would discourage any remarks that stimulate this form of behavior. It never leads to anything good.
Regards, Barry
Chair & Program Director, Endodontics
8 个月I already did that with your cases. How do you not remember that? But of course you do and this is just another tactic of yours. Most vendors don’t behave like this.
Chair & Program Director, Endodontics
8 个月Please share your knowledge! If you say that you critically evaluate the lit, you certainly must have some understanding of what you are talking about. So, how were these teeth stored? Do you know why that question is important? What laser wavelength, what settings, what specific protocols were used? Do you know why that question is important? This should be interesting!