A Revolutionizing Purview of Diode Laser in The Endodontics –An in Vitro Study

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 5, October – 2025, Page No. : 97 - 102 Corresponding Author: Dr. Pragyan Paliwal, ijdsir, Volume – 8 Issue - 5, Page No. : 97 - 102 Page97 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 A Revolutionizing Purview of Diode Laser in The Endodontics –An in Vitro Study 1Dr. Pragyan Paliwal, Associate Professor & Research Scholar, Department of Conservative & Endodontics, Sardar Patel Post Graduate College of Dental Sciences, Lucknow 2Dr. Swati Gupta, Professor, Department of Prosthodontics, Lucknow 3Dr. Aditi Singh, Professor, Amity Institute of Biotechnology, Amity University, Uttar Pradesh, Lucknow Campus, India 4Dr. Neerja Singh, Professor, Department of Preventive & Paediatric Dentistry, Babu Banarasi Das College of Dental Sciences, Lucknow 5Dr. Anamika Singh, Senior Lecturer, Department of Conservative and Endodontics, MMDCH, Darbhanga Corresponding Author: Dr. Pragyan Paliwal, Associate Professor & Research Scholar, Department of Conservative & Endodontics, Sardar Patel Post Graduate College of Dental Sciences, Lucknow. Citation of this Article: Dr. Pragyan Paliwal, Dr. Swati Gupta, Dr. Aditi Singh, Dr. Neerja Singh, Dr. Anamika Singh, “A Revolutionizing Purview of Diode Laser in The Endodontics –An in Vitro Study”, IJDSIROctober – 2025, Volume – 8, Issue – 5, P. No. 97 – 102. Copyright: © 2025, Dr. Pragyan Paliwal, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Laser in dentistry is most widely accepted mode of treatment in various specialties including endodontics. The aim and objective of the study was to evaluate and compare the antimicrobial efficacy of a diode laser irradiation and chlorhexidine in the root canal treatment against enterococcus faecalis, gram positive, facultative anaerobic bacteria in single-rooted canals after rotary method of bio mechanical preparation Single rooted teeth were selected, biomechanical preparation was done. The teeth were inoculated with Enterococcus faecalis. They are disinfected with, Chlorhexidine and Diode laser. The antimicrobial efficacy was evaluated under spectrophotometer. The results were statistically significant with p-value <0.05. The P-value for samples indicates that there is sufficient evidence and to explore the differences among the means of the samples. The efficacy of diode laser is found 73% whereas 90% with chlorhexidine. The study concluded that application of Diode laser and clorhexidine has antibacterial effect against Enterococcus faecalis. Keywords: Enterococcus Faecalis, Root Canal Treatment, Disinfection. Introduction The foremost objective of endodontic treatment is eradication of debris, microbial load and their byproducts from the tooth complex system. Chemomechanical preparation plays a main role although, according to Dr. Pragyan Paliwal, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 Page98 literature & studies showed that due to the complex anatomy of the root canal systems the dentinal walls may remain untouched after mechanical preparation1. Enterococcus faecalis are the Gram-positive, nonsporing, facultative anaerobe that is usually found in chronic periodontitis and root canal retreatment cases predominant microorganism found in infected root canals2. E. faecalis. Biofilm is a community of microorganisms that are firmly attached to the surface and encased in a self-made extracellular polymeric substance. The use of antibacterial root canal irrigants is mandatory to achieve success of the endodontic treatment. Commonly used root canal irrigtants cause adverse effect on the physical properties of dentin and also bacterial resistance is increasing with these irrigants Thus, a continuous search for alternative protocols for enhancing disinfection is needed. It was proven that high power diode laser is capable of disinfecting the root canal system and has the ability to reach the complex anatomical structures. The advantages of using the laser are balanced by several significant disadvantages. Multiple laser systems can be used as auxiliary tools to promote root canal disinfection. Laser beams can penetrate deeply into the dentinal tubules without being absorbed by the hard tooth tissue, leading to a reduction in the bacterial population by 63% at a depth of 750 μm Methodology Single rooted teeth extracted due to the periodontal reasons with prior consent of the patient were collected. Endodontic access was achieved using endo access bur & the patency was checked. Working length was taken at 1mm short of apical foramen. Biomechanical preparation was done with Protaper Gold files. The canals were washed with NaOCL(Pyrax), distilled water and with EDTA.1 To unlock the smear layer kept for 5 mins in NaOCl. All canals washed with 5ml of normal saline. Teeth were mounted in self cure acrylic resin in microtubes and autoclaved at 121˚C for 15 lbs for 15 min1. Groups samples were divided into three groups 10 teeth in each group including the control groups. n=10 The autoclaved samples were inoculated with Enterococcus faecalis and incubated at 37˚ C for 24 hrs respectively. Enterococcus faecalis secured from Research Institute, Chandigarh. These prepared strains were used. Autoclaved teeth with prepared root canal were inoculated with strains of Enterococcus faecalis 106 CFU / ml and incubated at 37˚C for 24 hrs. Sample from each root canal was taken with the help of a sterile paper point, prior to the treatment and put into the nutrient media. The turbidity was evaluated. The optical density was observed at 600nm in a spectrophotometer. The n=10 samples of each 3 groups which were inoculated with Enterococcus faecalis were disinfected with Laser, Chlorhexidine and normal saline separately. Post treatment samples from each root canal were taken with the help of a sterile paper point, and transferred into the nutrient media. The vials were further incubated for 24hrs at 37˚C and were observed for inhibition. The BIOEPIC LASER 940+10μm wavelength, each root canal irradiated with head diameter of 200μm & 1mm shorter than the apex continuously with rotational & epicoronal motions for 30 sec. Tips used of 20mm length (1mm short of apex). Every time it is repeated 3 times giving rest for 10 sec between the laser irradiation. Pretreatment and Post treatment samples were taken and percentage inhibition & optical density was calculated. The similar methodology was followed with the Chlorhexidine (2%, Neelkanth). Statistical Analysis done by ‘Statistical Data Analysis’ Comparison between the Dr. Pragyan Paliwal, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 Page99 two groups is done by t-paired test (p<.001) shows significant. Mean Inhibition percentage was calculated. Figure 1: Disinfection of sample with diode laser and chlorhexidine Results The results of the study was found with the disinfection done with the Diode Laser is percentage inhibition -73.53% and chlorhexidine percentage is 90%. The diode laser also shows the significant reduction in the microbial count. Table 1: Mean of OD Preswab and Postswab taken of Diode Laser Table 2: Mean of OD preswab and postswab taken of CHLOROHEXIDINE Sample OD Preswab OD Postswab % Inhibition(α) CHLOR1 0.711 0.026 96.34 CHLOR2 0.812 0.027 96.67 CHLOR3 0.788 0.025 96.83 CHLOR4 0.76 0.029 96.18 CHLOR5 0.807 0.129 84.01 CHLOR6 0.765 0.126 83.53 CHLOR7 0.731 0.128 82.49 CHLOR8 0.811 0.037 95.44 CHLOR9 0.801 0.13 83.77 CHLOR10 0.734 0.108 85.29 Mean 90.06 Dr. Pragyan Paliwal, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Page100 Table 3: Comparison of mean percent inhibition of Chlorhexidine and Diode laser % Inhibition(α) Laser Chloro Mean 73.53 90.05 Standard Error 0.66 2.09 Median 73.76 90.36 Standard Deviation 2.10 6.61 Range 6.51 14.33 Minimum 70.11 82.49 Maximum 76.62 96.82 Sum 735.31 900.55 Count 10 10 Largest(1) 76.62 96.82 Smallest(1) 70.11 82.49 Confidence Level (95.0%) 1.50 4.73 Graph 1: Comparison graph showing individual samples inhibition. X axis shows - Samples Y axis shows-Percentage inhibition mean According to the results of tukey hoc test, intercomparison of the group is done, there was a significant decrease in the number of bacterial colonies after the intervention (p < 0.05) and present descriptive values of E. faecalis colonies before and after the intervention and reduction percentage of colony count. Highest reduction percentage of E. faecalis colonies was observed in the Chlorhexidine group, indicating that this disinfectant acted as the best disinfectant with an efficiency of 90%, and with the diode laser group with an efficiency of 73.5%. Discussion Success of endodontic treatments is related to disinfection of root canal system. E. faecalis is a Gram positive coccus which is very frequently found in canals needing retreatment. Special attention to this Dr. Pragyan Paliwal, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 Page101 microorganism is because of its resistance against intra canal medicaments such as calcium hydroxide. The laser used in the study was diode laser as it has favorable antibacterial properties and relative safety and also more suitable price, this kind of laser has gained popularity. Numerous studies have proven that the bactericidal effect of a diode laser (810 nm) is based on thermal properties; furthermore, bacteria cannot develop resistance to laser exposure.4,5 Although some in vitro studies have shown higher antibacterial efficiency of CHX than NaOCl, in in vitro environment, dentinal components can reduce the efficiency of CHX. The present study is in agreement with Eldeniz et al., who compared the efficacy of Er, Cr: YSGG and NaOCl against E. faecalis. Results showed %100 elimination of bacteria by %3 NaOCl; whereas efficacy of laser was significantly lower. The diode laser technique has been performed in endodontics treatment for a decade. It is well known that different parameters of lasers and fibers, the output power of the laser, and the duration of application have different effects on disinfection5. The thermal effect is the most important point to be considered in laser applications. A temperature rise to a critical level could have deleterious effects on the tissues surrounding the tooth. The temperature increases by approximately 10 °C and a treatment duration of 1 min can cause irreversible injury to periodontal tissues. Gutknecht et al.12 demonstrated that diode laser irradiation for 5 s, with 10 s of resting time, should be considered to avoid a temperature rise to an undesired level. Schoop et al. 22 also drew similar conclusions that a diode laser showed the lowest temperature increases compared with other laser devices and was suitable for the disinfection of root canals. Therefore, according to the information, we adopt a safe mode of diode laser to perform root canal therapy. Several studies have shown that a 3.0 W diode laser with an 810-nm wavelength could eliminate bacteria when used on permanent teeth4. Kimura et al. suggested that although removal of debris and smear layer is possible by laser, it is difficult to clean all of root canal walls because the laser energy is emitted straight ahead, making it almost impossible to irradiate the lateral canal walls13,14. Using side firing tips may enable the lasers to irradiate all areas of root canal walls and increase. There is a direct relation between disinfection of root canal system and success of endodontic treatments. therapy has shown great promise in removal of the smear layer, bacteria and infection in endodontics. Studies have shown that conventional instrumentation together with irrigant solution can only remove partially14. Diode laser wavelengths balance between absorption and penetration to bring energy below dentinal surface without tending to damage it. Diode laser energy is able to activate chemical irrigants to increase their bactericidal effects. Conclusion The diode laser is a boon to the dentistry and can be combine with other adjunct as a it has the antibacterial activity and help in the root canal disinfection. References 1. Topcuoglu G, Topcuoglu HS, Akpek F. Evaluation of apically extruded debris during root canal preparation in primary molar teeth using three different rotary systems and hand files. Int J Paediatr Dent. 2016;26(5):357–63. 2. Pinheiro ET, Gomes BP, Ferraz CC, Sousa EL, Teixeira FB, Souza-Filho FJ. Microorganisms from canals of root-filled teeth with periapical lesions. Int Endod J. 2003;36(1):1–11 3. Peters OA, Schonenberger K, Laib A. Effects of four Ni-Ti preparation techniques on root canal geometry Dr. Pragyan Paliwal, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 Page102 assessed by micro computed tomography. Int Endod J. 2001;34(3):221–30. 4. Asnaashari M, Safavi N. Disinfection of contaminated canals by different laser wavelengths, while Performing Root Canal Therapy. J Lasers Med Sci. 2013;4(1):8–16. 5. De Souza EB, Cai S, Simionato MR, Lage-Marques JL. High-power diode laser in the disinfection in depth of the root canal dentin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(1):e68–72. 6. Gutknecht N, Franzen R, Schippers M, Lampert F. Bactericidal effect of a 980-nm diode laser in the root canal wall dentin of bovine teeth. J Clin Laser Med Surg. 2004;22(1):9–13. 7. Pearson GJ, Schuckert KH. The role of lasers in dentistry: present and future. Dent update. 2003;30(2):70–74, 76. 8. Wang X, Sun Y, Kimura Y, Kinoshita J, Ishizaki NT, Matsumoto K. Effects of diode laser irradiation on smear layer removal from root canal walls and apical leakage after obturation. Photomed Laser Surg. 2005;23(6):575–81. 9. Mathew J, Emil J, Paulaian B, John B, Raja J, Mathew J. Viability and antibacterial efficacy of four root canal disinfection techniques evaluated using confocal laser scanning microscopy. J Conserv Dent. 2014;17(5):444–8. 10. Cheng X, Guan S, Lu H, Zhao C, Chen X, Li N, Bai Q, Tian Y, Yu Q. Evaluation of the bactericidal effect of Nd:YAG, Er:YAG, Er,Cr:YSGG laser radiation, and antimicrobial photodynamic therapy (aPDT) in experimentally infected root canals. Lasers Surg Med. 2012;44(10):824–31. 11. Moritz A, Gutknecht N, Schoop U, Goharkhay K, Doertbudak O, Sperr W. Irradiation of infected root canals with a diode laser in vivo: results of microbiological examinations. Lasers Surg Med. 1997;21(3):221–6. 12. Gutknecht N, Franzen R, Meister J, Vanweersch L, Mir M. Temperature evolution on human teeth root surface after diode laser assisted endodontic treatment. Lasers Med Sci. 2005;20(2):99–103. 13. Comparison of the Bactericidal Effects of Two Different Diode Laser Wavelengths 810 NM And 980 NM within the Treatment of E. Faecalis-Infected Root Canals Kimura Y Thamer MM, Alkurtas A S (2022) Volume 10, Issue 7 14. Y. Kimura, P. Wilder-Smith, K. Matsumoto Lasers in endodontics: a review 24 December 2001. Pages 173-185