Evaluation of Apical Irrigant Extrusion Using Two Er:YAG Laser-Activated Irrigation Modes with Three Types of Laser Tips – an Ex Vivo Model

The purpose of this study is to evaluate the amounts of apically extruded 3% sodium hypochlorite using two modes of Er:YAG laser-activated irrigation (LAI), super short pulse (SSP) and shock wave enhanced emission photoacoustic streaming (SWEEPS®), combining three types of laser tips (FT) and conventional syringe needle irrigation (SNI). Methods: Twenty extracted human maxillary central incisors prepared using Reciproc® instruments (size 40, taper 0.06). Irrigant volumetric flow (IVF) was accurately standardized using a precision syringe pump with constant irrigant delivery through the 27G needle. The tested irrigation protocols (60 s) were groups 1: 27-G SNI with 0.05 ml/s constant IVF; group 2: SSP (10 mJ, 15 Hz, pulse duration 50 μs) + Radial SWEEPS FT; group 3: SSP + photon-induced photoacoustic streaming (PIPS) FT; group 4: SSP+SWEEPS FT; group 5: AutoSWEEPS (20 mJ, 15 Hz, pulse duration 25 µs) + Radial SWEEPS FT; group 6: AutoSWEEPS+PIPS FT; group 7: AutoSWEEPS+SWEEPS FT. Each protocol was evaluated in 10 repetitions each. Apically extruded irrigant was collected, and the net weighted. Results: There were significantly lower amounts of extruded irrigant with SNI and SSP using radial SWEEPS and PIPS FTs compared to the other tested laser protocols (p<0.05). In the AutoSWEEPS groups, all three FTs had similar amounts of extruded irrigant (p>0.05). Conclusion: In straight root canals, the use of various fiber FTs in the AutoSWEEPS mode exhibited a higher potential for irrigant extrusion.