Endodontide Lazer Kullanımı: Temel Prensipler, Klinik Uygulamalar ve Güncel Yaklaşımlar
Özet
Lazerler, kök kanal sisteminin karmaşık anatomisi nedeniyle geleneksel yöntemlerle tam olarak uzaklaştırılamayan mikroorganizmaların eliminasyonunda önemli avantajlar sunmaktadır. Lazer ışığının monokromatik, koherent ve kolimatik özellikleri sayesinde dentin tübüllerinin derinliklerine nüfuz edebilmesi, fotoakustik ve fototermal etkiler oluşturarak dezenfeksiyon etkinliğini artırmaktadır. Endodontide en sık kullanılan lazer türleri arasında Er:YAG, Er,Cr:YSGG, Nd:YAG, diyot ve CO₂ lazerler yer almakta olup, her birinin doku etkileşim mekanizmaları ve klinik kullanım alanları farklıdır. Özellikle Erbiyum lazerler, lazer destekli irrigasyon (LAI) uygulamalarında kavitasyon etkisi oluşturarak irrigantların erişemediği alanlarda etkili temizlik sağlar. PIPS ve SWEEPS gibi gelişmiş teknikler, bu etkinliği daha da artırmaktadır. Ayrıca lazerler, smear tabakasının uzaklaştırılması, dentin tübül penetrasyonunun artırılması, rejeneratif endodontide doku iyileşmesinin desteklenmesi ve postoperatif ağrının azaltılmasında önemli rol oynamaktadır. Bununla birlikte yüksek maliyet, standart protokol eksikliği ve termal hasar riski gibi sınırlamalar mevcuttur. Sonuç olarak lazer teknolojisi, uygun endikasyon ve parametrelerle kullanıldığında endodontik tedavi başarısını artıran güçlü bir yardımcı araçtır.
Lasers provide significant advantages in the elimination of microorganisms that cannot be completely removed by conventional methods due to the complex anatomy of the root canal system. Owing to the monochromatic, coherent, and collimated properties of laser light, it can penetrate deeply into dentinal tubules and enhance disinfection efficacy through photoacoustic and photothermal effects. The most commonly used laser types in endodontics include Er:YAG, Er,Cr:YSGG, Nd:YAG, diode, and CO₂ lasers, each with distinct tissue interaction mechanisms and clinical applications. In particular, erbium lasers generate a cavitation effect in laser-activated irrigation (LAI), enabling effective cleaning in areas inaccessible to irrigants. Advanced techniques such as PIPS and SWEEPS further enhance this efficacy. Moreover, lasers play an important role in smear layer removal, increasing dentinal tubule penetration, promoting tissue healing in regenerative endodontics, and reducing postoperative pain. However, limitations such as high cost, lack of standardized protocols, and the risk of thermal damage still exist. In conclusion, when used with appropriate indications and parameters, laser technology serves as a powerful adjunct that enhances the success of endodontic treatment.
Referanslar
Sachelarie L, Cristea R, Burlui E, et al. Laser technology in dentistry: from clinical applications to future innovations. Dentistry journal. 2024;12(12):420. https://doi.org/10.3390/dj12120420
Alharbi KH, AlMarwani WT, Alsulami RA, et al. New Insight Into Laser Applications in Endodontic Dentistry: A Comprehensive Review. Australian Endodontic Journal. 2025;51(2):527-535. https://doi.org/10.1111/aej.12959
Coluzzi, D.J. and R.A. Convissar, 2 - Laser Fundamentals, in Principles and Practice of Laser Dentistry. 2011, Mosby: Saint Louis. p. 12-26.
Nammour S, El Mobadder M, Namour M, et al. Success Rate of Direct Pulp Capping with Conventional Procedures Using Ca (OH)2 and Bioactive Tricalcium Silicate Paste vs. Laser-Assisted Procedures (Diode 980 nm, CO2, and Er: YAG). Photonics. 2023;10(7):834. https://doi.org/10.3390/photonics10070834
Huang D, Wang X, Liang J, et al. Expert consensus on difficulty assessment of endodontic therapy. International Journal of Oral Science. 2024;16(1):22. https://doi.org/10.1038/s41368-024-00285-0
Meire M, De Moor RJ. Principle and antimicrobial efficacy of laser‐activated irrigation: A narrative review. International Endodontic Journal. 2024;57(7):841-860. https://doi.org/10.1111/iej.14042
Stenhoff S, Mills J. Basic principles of lasers. Anaesthesia & Intensive Care Medicine. 2024;25(2), 133-137.
Diaci J, Gaspirc B. Comparison of Er: YAG and Er, Cr: YSGG lasers used in dentistry. J laser health Acad. 2012;1(1):1-13.
Ribeiro L, Fischer B, Vitali F, et al. Advances in laser-assisted regenerative endodontic procedures: a scoping review. Journal of Dentistry. 2025;158:105783. https://doi.org/10.1016/j.jdent.2025.105783
Vogel, A. and V. Venugopalan, Mechanisms of pulsed laser ablation of biological tissues. Chem Rev, 2003. 103(2): p. 577-644. https://doi.org/10.1021/cr010379n
Bordea I, Hanna R, Chiniforush N, et al. Evaluation of the outcome of various laser therapy applications in root canal disinfection: A systematic review. Photodiagnosis and photodynamic therapy, 2020;29:101611. https://doi.org/10.1016/j.pdpdt.2019.101611
De Moor RJG, Meire M, Goharkhay K, Moritz A, Vanobbergen J. Efficacy of ultrasonic versus laser-activated irrigation to remove artificially placed dentin debris plugs. Journal of endodontics. 2010;36(9):1580–3. https://doi.org/10.1016/j.joen.2010.06.007
Cheng X, Wang X, Liu N, et al. Effect of various laser-activated irrigation protocols on endodontic sealer penetration into the dentinal tubules: A confocal laser scanning microscopy study. Photobiomodulation, Photomedicine, and Laser Surgery. 2021;39(8):544–9. https://doi.org/10.1089/photob.2020.4924
Trindade AC, De Figueiredo JAP, Steier L, Weber JBB. Photodynamic Therapy in Endodontics: A Literature Review. Photomedicine and laser surgery. 2015;33(3):175–82. https://doi.org/10.1089/pho.2014.3776
Matsumoto H, Yoshimine Y, Akamine, A. Visualization of irrigant flow and cavitation induced by Er: YAG laser within a root canal model. Journal of endodontics. 2011; 37(6):839-843. https://doi.org/10.1016/j.joen.2011.02.035
Swimberghe RCD, Tzourmanas R, De Moor RJ, et al. Explaining the working mechanism of laser‐activated irrigation and its action on microbial biofilms: a high‐speed imaging study. International Endodontic Journal. 2022;55(12):1372-1384. https://doi.org/10.1111/iej.13824
Koch JD, Jaramillo DE, DiVito E, et al. Irrigant flow during photon-induced photoacoustic streaming (PIPS) using Particle Image Velocimetry (PIV). Clinical oral investigations. 2016;20(2):381-386. https://doi.org/10.1007/s00784-015-1562-9
Gregorčič P, Jezeršek M, Možina J. Optodynamic energy-conversion efficiency during an Er: YAG-laser-pulse delivery into a liquid through different fiber-tip geometries. Journal of biomedical optics. 2012;17(7):075006-075006. https://doi.org/10.1117/1.JBO.17.7.075006
Lukač N, Jezeršek M. Amplification of pressure waves in laser-assisted endodontics with synchronized delivery of Er: YAG laser pulses. Lasers in medical science. 2018;33(4):823-833. https://doi.org/10.1007/s10103-017-2435-z
Jezeršek M, Lukač N, Lukač M. Measurement of simulated debris removal rates in an artificial root canal to optimize laser‐activated irrigation parameters. Lasers in Surgery and Medicine. 2021;53(3):411-417. https://doi.org/10.1002/lsm.23297
Peters O, Bardsley S, Fong J, et al. Disinfection of root canals with photon-initiated photoacoustic streaming. Journal of endodontics. 2011;37(7):1008-1012. https://doi.org/10.1016/j.joen.2011.03.016
Badami V, Akarapu S, Kethineni H, et al. Efficacy of laser-activated irrigation versus ultrasonic-activated irrigation: a systematic review. Cureus. 2023;15(3):e36352. https://doi.org/10.7759/cureus.36352
Peeters HH, De Moor RJG, Suharto D. Visualization of removal of trapped air from the apical region in simulated root canals by laser-activated irrigation using an Er,Cr:YSGG laser. Lasers in Medical Science. 2015;30(6):1683-1688. https://doi.org/10.1007/s10103-014-1643-z
Violich DR, Purton DG, Chandler NP, Monteith BD. Effect of the smear layer on a pulp proximity-indicating instrument. Odontology. 2012;100(1):47–53. https://doi.org/10.1007/s10266-011-0014-5
George S, Kishen A, Song P. The role of environmental changes on monospecies biofilm formation on root canal wall by Enterococcus faecalis. Journal of endodontics. 2005;31(12):867-872. https://doi.org/10.1097/01.don.0000164855.98346.fc
Botero T, Chrepa V, Shrestha A, et al. Web-Based Survey on Regenerative Endodontic Practices among Members of the American Association of Endodontists. Journal of endodontics. 2024;50(9):1281-1288. https://doi.org/10.1016/j.joen.2024.05.016
Kolberg-Babrzyńska I, Grzech-Leśniak K, Kiryk J. Effects of endodontic retreatment by conventional therapy compared to combined therapy with an Er: YAG laser and photobiomodulation: A randomized clinical trial. Dental and Medical Problems. 2025; 26. https://doi.org/10.17219/dmp/188864
Pandey P, Jasrasaria N, Bharti R, et al. Clinical, radiographic, and biomarker perspectives of low-level laser therapy during regenerative endodontic procedures in necrotic immature young teeth: a randomized clinical study. Lasers in Medical Science. 2025;40(1):504. https://doi.org/10.1007/s10103-025-04764-6
Ismail H, Obeid M, Hassanien E. Efficiency of diode laser in control of post-endodontic pain: a randomized controlled trial. Clinical Oral Investigations. 2023;27(6):2797-2804. https://doi.org/10.1007/s00784-023-04864-z
Referanslar
Sachelarie L, Cristea R, Burlui E, et al. Laser technology in dentistry: from clinical applications to future innovations. Dentistry journal. 2024;12(12):420. https://doi.org/10.3390/dj12120420
Alharbi KH, AlMarwani WT, Alsulami RA, et al. New Insight Into Laser Applications in Endodontic Dentistry: A Comprehensive Review. Australian Endodontic Journal. 2025;51(2):527-535. https://doi.org/10.1111/aej.12959
Coluzzi, D.J. and R.A. Convissar, 2 - Laser Fundamentals, in Principles and Practice of Laser Dentistry. 2011, Mosby: Saint Louis. p. 12-26.
Nammour S, El Mobadder M, Namour M, et al. Success Rate of Direct Pulp Capping with Conventional Procedures Using Ca (OH)2 and Bioactive Tricalcium Silicate Paste vs. Laser-Assisted Procedures (Diode 980 nm, CO2, and Er: YAG). Photonics. 2023;10(7):834. https://doi.org/10.3390/photonics10070834
Huang D, Wang X, Liang J, et al. Expert consensus on difficulty assessment of endodontic therapy. International Journal of Oral Science. 2024;16(1):22. https://doi.org/10.1038/s41368-024-00285-0
Meire M, De Moor RJ. Principle and antimicrobial efficacy of laser‐activated irrigation: A narrative review. International Endodontic Journal. 2024;57(7):841-860. https://doi.org/10.1111/iej.14042
Stenhoff S, Mills J. Basic principles of lasers. Anaesthesia & Intensive Care Medicine. 2024;25(2), 133-137.
Diaci J, Gaspirc B. Comparison of Er: YAG and Er, Cr: YSGG lasers used in dentistry. J laser health Acad. 2012;1(1):1-13.
Ribeiro L, Fischer B, Vitali F, et al. Advances in laser-assisted regenerative endodontic procedures: a scoping review. Journal of Dentistry. 2025;158:105783. https://doi.org/10.1016/j.jdent.2025.105783
Vogel, A. and V. Venugopalan, Mechanisms of pulsed laser ablation of biological tissues. Chem Rev, 2003. 103(2): p. 577-644. https://doi.org/10.1021/cr010379n
Bordea I, Hanna R, Chiniforush N, et al. Evaluation of the outcome of various laser therapy applications in root canal disinfection: A systematic review. Photodiagnosis and photodynamic therapy, 2020;29:101611. https://doi.org/10.1016/j.pdpdt.2019.101611
De Moor RJG, Meire M, Goharkhay K, Moritz A, Vanobbergen J. Efficacy of ultrasonic versus laser-activated irrigation to remove artificially placed dentin debris plugs. Journal of endodontics. 2010;36(9):1580–3. https://doi.org/10.1016/j.joen.2010.06.007
Cheng X, Wang X, Liu N, et al. Effect of various laser-activated irrigation protocols on endodontic sealer penetration into the dentinal tubules: A confocal laser scanning microscopy study. Photobiomodulation, Photomedicine, and Laser Surgery. 2021;39(8):544–9. https://doi.org/10.1089/photob.2020.4924
Trindade AC, De Figueiredo JAP, Steier L, Weber JBB. Photodynamic Therapy in Endodontics: A Literature Review. Photomedicine and laser surgery. 2015;33(3):175–82. https://doi.org/10.1089/pho.2014.3776
Matsumoto H, Yoshimine Y, Akamine, A. Visualization of irrigant flow and cavitation induced by Er: YAG laser within a root canal model. Journal of endodontics. 2011; 37(6):839-843. https://doi.org/10.1016/j.joen.2011.02.035
Swimberghe RCD, Tzourmanas R, De Moor RJ, et al. Explaining the working mechanism of laser‐activated irrigation and its action on microbial biofilms: a high‐speed imaging study. International Endodontic Journal. 2022;55(12):1372-1384. https://doi.org/10.1111/iej.13824
Koch JD, Jaramillo DE, DiVito E, et al. Irrigant flow during photon-induced photoacoustic streaming (PIPS) using Particle Image Velocimetry (PIV). Clinical oral investigations. 2016;20(2):381-386. https://doi.org/10.1007/s00784-015-1562-9
Gregorčič P, Jezeršek M, Možina J. Optodynamic energy-conversion efficiency during an Er: YAG-laser-pulse delivery into a liquid through different fiber-tip geometries. Journal of biomedical optics. 2012;17(7):075006-075006. https://doi.org/10.1117/1.JBO.17.7.075006
Lukač N, Jezeršek M. Amplification of pressure waves in laser-assisted endodontics with synchronized delivery of Er: YAG laser pulses. Lasers in medical science. 2018;33(4):823-833. https://doi.org/10.1007/s10103-017-2435-z
Jezeršek M, Lukač N, Lukač M. Measurement of simulated debris removal rates in an artificial root canal to optimize laser‐activated irrigation parameters. Lasers in Surgery and Medicine. 2021;53(3):411-417. https://doi.org/10.1002/lsm.23297
Peters O, Bardsley S, Fong J, et al. Disinfection of root canals with photon-initiated photoacoustic streaming. Journal of endodontics. 2011;37(7):1008-1012. https://doi.org/10.1016/j.joen.2011.03.016
Badami V, Akarapu S, Kethineni H, et al. Efficacy of laser-activated irrigation versus ultrasonic-activated irrigation: a systematic review. Cureus. 2023;15(3):e36352. https://doi.org/10.7759/cureus.36352
Peeters HH, De Moor RJG, Suharto D. Visualization of removal of trapped air from the apical region in simulated root canals by laser-activated irrigation using an Er,Cr:YSGG laser. Lasers in Medical Science. 2015;30(6):1683-1688. https://doi.org/10.1007/s10103-014-1643-z
Violich DR, Purton DG, Chandler NP, Monteith BD. Effect of the smear layer on a pulp proximity-indicating instrument. Odontology. 2012;100(1):47–53. https://doi.org/10.1007/s10266-011-0014-5
George S, Kishen A, Song P. The role of environmental changes on monospecies biofilm formation on root canal wall by Enterococcus faecalis. Journal of endodontics. 2005;31(12):867-872. https://doi.org/10.1097/01.don.0000164855.98346.fc
Botero T, Chrepa V, Shrestha A, et al. Web-Based Survey on Regenerative Endodontic Practices among Members of the American Association of Endodontists. Journal of endodontics. 2024;50(9):1281-1288. https://doi.org/10.1016/j.joen.2024.05.016
Kolberg-Babrzyńska I, Grzech-Leśniak K, Kiryk J. Effects of endodontic retreatment by conventional therapy compared to combined therapy with an Er: YAG laser and photobiomodulation: A randomized clinical trial. Dental and Medical Problems. 2025; 26. https://doi.org/10.17219/dmp/188864
Pandey P, Jasrasaria N, Bharti R, et al. Clinical, radiographic, and biomarker perspectives of low-level laser therapy during regenerative endodontic procedures in necrotic immature young teeth: a randomized clinical study. Lasers in Medical Science. 2025;40(1):504. https://doi.org/10.1007/s10103-025-04764-6
Ismail H, Obeid M, Hassanien E. Efficiency of diode laser in control of post-endodontic pain: a randomized controlled trial. Clinical Oral Investigations. 2023;27(6):2797-2804. https://doi.org/10.1007/s00784-023-04864-z
