Erbium:Yttrium Aluminum Garnet Laser-Activated Sodium Hypochlorite Irrigation: A Promising Procedure for Minimally Invasive Endodontics

Objective: This study was to evaluate the potential of Erbium:Yttrium Aluminum Garnet laser-activated sodium hypochlorite irrigation (Er:YAG + NaOCl) for minimally invasive endodontics (MIE). Background data: Er:YAG laser irradiation can dramatically enhance the penetration of NaOCl, which may be a promising protocol for MIE. Methods: Extracted human teeth were contaminated with Enterococcus faecalis for 4 weeks. The infected canals were then shaped to different apical terminal working widths (ATWW, 15#/0.04, 20#/0.04, 25#/0.04, 30#/0.04, and 40#/0.04) and treated with either Er:YAG + NaOCl (0.3 W, 20 sec) or NaOCl alone. Then, the ATWW were fixed at 15#/0.04, and the canals were treated with Er:YAG + NaOCl at 0.3 W for 40 and 60 sec, or at 0.5 and 1.0 W for 20 sec. Finally, bacterial reductions were evaluated using the cell count method. Results: Er:YAG + NaOCl showed a higher disinfection efficacy at each ATWW compared with NaOCl alone (p < 0.001). The maximum bacterial reduction was 99.9% for the 40#/Er:YAG + NaOCl group and 93.6% for the 40#/NaOCl group. To achieve similar disinfection efficacy, the Er:YAG + NaOCl group needed a smaller ATWW than the NaOCl group. At a fixed ATWW, increasing the output power of the Er:YAG laser was more effective than increasing the radiation time to improve the disinfection efficacy of Er:YAG + NaOCl. The 15#/Er:YAG + NaOCl group reached the maximum bacterial reduction of 99.2% when the Er:YAG laser was activated at 1.0 W for 20 sec. Conclusions: The 15#/Er:YAG + NaOCl with the Er:YAG laser irradiation at 1.0 W for 20 sec may be considered a promising procedure for MIE.