The effectiveness of the SWEEPS modality in an Er:YAG laser to treat complex anatomy in three challenging clinical cases

Igor Križnar
Pages: onlineFirst

The goal of endodontic therapy is to eliminate pathogenic substances from the root canal system. Endodontic treatment often presents the clinician with several challenges, including the complex morphology of the root canal system, the dentinal walls and tubules are heavily infected, and in cases of immature teeth, the canals are very wide and the remaining dentin root walls are thin and prone to root fracture. Mechanical over-shaping and widening of the root canals is contraindicated in certain clinical cases, therefore we must rely on irrigation methods to provide sufficient disinfection of the root canal system. Since root formation often ceases due to pulp necrosis in immature teeth, there is also no physiological apical constriction, and the apical foramen is often very patent.

This presents the clinician with the challenge of preventing extrusion of the irrigants as well as the filling material during endodontic treatment.

Different disinfection methods and technologies have been introduced with the goal to improve the efficacy of the standard syringe root canal irrigation procedure. One of the most recent techniques involves SSP/SWEEPS® laser- assisted irrigation (LAI) using an Er:YAG (erbium-doped yttrium aluminum garnet) laser with extremely short laser pulses, generating photon-induced photoacoustic streaming of the irrigant throughout the complex root canal system.

Three cases are presented including treatment of acute apical periodontitis in an immature maxillary central incisor with a very patent apical foramen, treatment of an irreversible pulpitis in a maxillary second molar tooth with extreme canal curvature and treatment of a mandibular molar tooth with chronic apical periodontitis and periodontal involvement using the SWEEPS LAI protocol. Results showed successful treatment outcomes with 1-year follow-ups. The SWEEPS LAI technique may represent a paradigm shift in the way we perform minimally invasive endodontic treatments, by decreasing the amount of mechanical instrumentation, thus avoiding possible treatment complications associated with difficult root canal anatomies and improving disinfection.

Keywords: Er:YAG, SSP, SWEEPS, laser-assisted irrigation, laser endodontics, photon-induced photoacoustic streaming, shockwave enhanced emission photoacoustic streaming, root canal treatment, endodontic treatment, minimally invasive endodontics, acute apical periodontitis, complicated root canal morphology, endo-perio lesion
Article: J. LA&HA, Vol. 2024, No.1; onlineFirst. Received: March 27, 2020; Accepted: May 20, 2024

The effectiveness of the SWEEPS modality in an Er:YAG laser to treat complex anatomy in three challenging clinical cases