ER:YAG laser for 3-dimensional debridement of canal systems: use of photon-induced photoacoustic streaming.

Laser-activated irrigation at subablative levels has the potential for complete tubular dentin disinfection in endodontics. In spite of the cost of the laser hardware, being able to reach the panacea of bacterial elimination and debris removal is a remarkable achievement and could be a paradigm shift in success rates for endodontic cases. Moreover, with the trend toward more conservative canal preparation and single instrumentation techniques, canal disinfection with an irrigating needle that cannot deliver sufficient volume to the canal terminus, PIPS seems likely to remove the gross canal enlargement impediment. Further investigation into smaller canal preparation sizes are ongoing. Any office that performs soft and hard tissue already understands the benefits of a laser. Adaptation of laser-activated irrigation to endodontics is a simple transition that is already understood by the hundreds of participants already trained in PIPS laser-activated irrigation. Similarly, a protocol for elimination of microbes from periodontal pockets using PIPS has the potential for selective removal of both inflamed and ulcerated epithelial tissues commonly seen in periodontal pathoses. The fact that the PIPS photoacoustic effect does not create thermal damage and will travel 3-dimensionally wherever there is fluid, makes it advantageous as a treatment modality for removing biofilms associated with periodontal pockets that are in difficult to access furcation areas and interproximal vertical defects.