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Volume 6
Journal of Oral Hygiene & Health
Endodontics & Orthodontics 2018
August 17-18, 2018
Page 12
conference
series
.com
AUGUST 17-18, 2018 TOKYO, JAPAN
ANNUAL CONGRESS ON
Endodontics, Orthodontics,
Prosthodontics and Dental Implants
Surg and rescue: Saving the natural implant throughmodernminimally-invasive, laser-assisted apical microsurgery
A
s dentists, our goal should always be to save the natural tooth or “natural implant.” Extraction should only be the last
resort. Adequate training, experience through continual practice, and specialized equipment provide the adequate context
to address cases that represent an unusual challenge. In the case of complex anatomy where the root apex cannot be properly
cleaned and periapical healing cannot be obtained, the dentist or endodontist is faced with the challenges of diagnosing properly,
planning adequately and executing effectively without causing unnecessary harm to the patient. In such cases, apical micro-
surgery is recommended to complement the orthograde endodontic treatment, with the ultimate goal of saving the natural
tooth. It is unfortunately not uncommon to find general dentists and endodontists recommend against apical surgery due to lack
of training or practice and therefore fear of performing apical surgery. This fear factor is enhanced even further with the concern
of causing further harm to structures such as the sinus or mental foramen. In addition, apical surgery is often underestimated as
to its ability to induce periradicular healing. Such concerns could be much alleviated if accuracy and effectiveness is warranted
when performing such procedure. Even though CBCT is highly accurate in all 3 dimensions, its high cost deters many clinicians
from owning such technology and using it in their day-to-day practice. CBCT scans improve accuracy in visualization of apical
pathosis, critical anatomical structures (mental foramen, sinus) and root anatomy. Additional benefits include effectiveness in
locating all main root canals, analysis of resorptive lesions and pre-surgical assessment prior to apical surgery. Effectiveness
is enabled through the use of the Er,Cr:YSGG iPlus laser. Laser irradiation provides an extremely precise cut through the
interaction of laser energy with the tooth surface. Its optimal zone of ablation lies within 2 to 3mm from the laser tip. Therefore,
when the iPlus laser is coupled with enhanced magnification, the clinician is capable of delivering an unrivaled level of precision.
In addition to precision, the iPlus is also known to be superior to mechanical methods in eradicating bacteria from dentinal
tubules at a depth of 1000μm; when applied to the removal of the root apex, accelerated post-surgical healing can be attributed
to the laser’s ability to remove the smear layer and its excellent bactericidal potential. Fianlly, the minimally-invasive effect of the
Er,Cr:YSGG iPlus laser is undeniable. The level of cell necrosis is 30:1 ratio when comparing the scalpel to the Er,Cr:YSGG laser.
Diode lasers on the other hand are well known for their ability to induce biostimulation, also known as LLLT or Low Level Laser
Therapy. In such process, low levels of laser energy enhance healing while decreasing the deleterious effects of inflammation
and therefore unnecessarily prolonged periods of pain. In sum, the Er,Cr:YSGG iPlus and diode EpicX lasers paired with CBCT
technology and the Dental Operating Microscope, should be more widely taught and used in endodontics. Unfortunately, poor
training and misuse of these devices have led to misunderstanding and suspicion of their true capabilities. A combination of
open-mindedness and concerted educational effort is needed from educators, researchers, clinicians and vendors to provide
our patients with the modern technology that they deserve at the dawn of the 21
st
century. In this lecture, Dr. Nguyen will
demonstrate the scientific evidence, indications, clinical step-by-step and tremendous patients benefits of laser-assisted apical
microsurgery. Clinical cases and videos will be used to illustrate the principles
Tuong Nguyen Nguyen
Case Western Reserve University, USA
Tuong Nguyen Nguyen, J Oral Hyg Health 2018, Volume 6
DOI: 10.4172/2332-0702-C1-007