Removal of gutta-percha from root canals using an
Nd:YAG laser
D. Viduc­ic̈1, S. Jukic̈2, Z. Karlovic̈2, Zí. Boz­ic̈3, I. Miletic̈2 & I. Anic̈2
1
Department of Microbiology, School of Dental Medicine,Tokushima University, Japan; 2Department of Dental Pathology,
School of Dentistry; University of Zagreb, Croatia; and 3Private practice, Prestranek, Slovenia
Abstract
Viduc­ic̈ D, Jukic̈ S, Karlovic̈ Z, Boz­ic̈ Zí, Miletic̈ I,
Anic̈ I. Removal of gutta-percha from root canals using an Nd:YAG
laser. International Endodontic Journal, 36, 670^673, 2003.
Aim To examine the use of an Nd:YAG laser in removing
gutta-percha ¢llings from root canals when used in con-
junction with eucalyptol, dimethylformamide (DMF) or
no solvent.
Methodology Root-canal ¢llings (sealer and gutta-
percha) were removed with laser irradiation of 20 Hz/
1.5 W from 30 roots randomly divided in three groups.
In group1, the solvent was eucalyptol; in group 2, the sol-
vent was DMF; and in group 3, no solvent was used. Laser
irradiation was performed until the temperature mea-
sured on the root surface increased by 4 8C over room
temperature. The treatment was deemed complete when
the apical foramen was reached with the optical ¢bre
and a reamer. The samples were split longitudinally,
and the area of remaining gutta-percha on the root-
canal walls was determined with the aid of a computer
program. The total number of laser pulses to achieve
length and the highest temperature recorded was
Introduction
The bene¢ts of lasers in endodontic therapy have been
demonstrated in studies on root-canal instrumentation
(Levy 1992), bactericidal e¡ects (Moshonov et al. 1995,
Ramsko«ld et al.1997, Le Go¡ et al.1999), dentinal perme-
ability (Anic̈ et al.1996) and removal of debris and smear
layer (Harashima et al. 1998). Early development of the
Correspondence: Ivica Anic̈, Department of Dental Pathology,
School of Dentistry, University of Zagreb, Gundulic̈eva 5,10 000
Zagreb, Croatia (Tel.: ‡385 1480 2128; fax: ‡385 1480 2159;
e-mail: ivica. anic1@zg.tel.hr).
670 International Endodontic Journal, 36, 670^673, 2003
determined for each tooth. The results were statistically
analysed using Student's t-test (P < 0.05) for indepen-
dent samples.
Results The average temperature increase in group 1
was 9.17  0.56 8C; in group 2, 9.56  0.28 8C; and in
group 3, 8.29  0.41 8C. The shortest time to achieve
length was in group 3 (6.4  0.49 min), then in group 1
(6.7  0.85 min) and group 2 (7.05  0.79 min). The area
of remaining gutta-percha was the largest in group 2
(6.13  5.76%), whilst the smallest was for group 3
(4.69  4.03%), but the di¡erence was not statistically
signi¢cant. The number of pulses was not statistically
signi¢cant between the groups.
Conclusions Use of an Nd:YAG laser alone is capable of
softening gutta-percha. The addition of solvents did not
improve the retreatment, either in terms of the time
required for the procedure or in terms of the area of
remaining gutta-percha on root-canal walls.
Keywords: dimethylformamide, eucalyptol, Nd:YAG
laser, retreatment.
Received11July 2001; accepted 9 June 2003
¢breoptic system of Nd:YAG laser, which enables the
delivery of the light in a narrow root canal, made this
laser the most widely used in endodontic research (Levy
1992, Moshonov et al. 1995, Anic̈ et al. 1996, Ramsko«ld
et al.1997), as well as in the daily practice of those posses-
sing laser equipment. Laser irradiation is, unfortunately,
related to temperature increases that can be deleterious
to the tissues surrounding the tooth. An increase of
10 8C above body temperature for 1 min is considered
to be the safety threshold for the periodontal tissue (Anic̈
et al.1996, Ramsko«ld et al.1997). Bone is more susceptible
to thermal injuries than the periodontal membrane
because of its lower degree of vascularization. Because
of possible thermal damage, the temperature on the root
ß 2003 Blackwell Publishing Ltd

surface should be known before any laser treatment
within a root canal is attempted in vivo.
The removal of existing canal-¢lling material and
orthograde retreatment is the procedure of choice before
considering surgical treatment. Removal of gutta-
percha (Kerr, Romulus, MI, USA) can be achieved by
mechanical, thermal or chemical methods (Wourms
et al. 1990). These procedures carry the risk of root per-
forations, fractured instrument or overheating. Chemi-
cal solvents can be used to dissolve gutta-percha,
although chloroform has been identi¢ed as a possible
carcinogen by the U.S. Public Health and Human Service
(1985). The other solvents, such as xylene, are known to
be toxic or have an unpleasant odour. In addition, euca-
lyptol oil has to be heated in order to increase its e¡ective-
ness in dissolving gutta-percha (Wourms et al. 1990).
The aim of this study was to examine the use of an
Nd:YAG laser in removing gutta-percha and sealer root
¢llings without solvent or with eucalyptol or dimethyl-
formamide (DMF) (KemiG, Zagreb, Croatia) as solvents.
Materials and methods
Laser device
The laser used in this study was the pulsed Nd:YAG laser
(Twinlight Dental Laser, Fotona, Slovenia) operating at
a wavelength of 1064 nm with pulse duration of 125^
160 ms, pulse repetition rate of 10^100 Hz, and energy
of 0.5^8 W. The beam was delivered through an optical
¢bre system with a 320 mm diameter.
Tooth and root-canal preparation
After radiographic examination, 30 permanent maxil-
lary central incisors with natural crowns, straight roots
and fully developed apices were selected. They had been
extracted for periodontal reasons and stored in 10% for-
malin solution. The outer surfaces of the teeth were
mechanically cleaned by curette and by an ultrasonic
device under water spray. Crowns were removed at the
cervical level, using a high-speed diamond bur with
water spray to leave 15  1 mm of the root. The working
length of each root canal was determined 1 mm short
of the apical foramen, using size15 K-type ¢le (Dentsply,
Maillefer, Ballaigues, Switzerland). Canal preparation
was achieved initially by a coronal £are with Gates^
Glidden burs (Dentsply, Maillefer) sizes 3 and 4. The root
canals were instrumented using a standard step-back
technique (Ingle et al. 2002). The last ¢le used at the apex
was K-¢le size 50. During preparation, the root canals
ß 2003 Blackwell Publishing Ltd
Viduc­ic̈ et al. Removal of gutta-percha using a laser
were irrigated with 2.5% NaOCl. The samples were ¢lled
with Diaket sealer (ESPE, Seefeld, Germany) and gutta-
percha using the cold lateral condensation technique.
Access cavities were temporarily sealed with Cavit G
(ESPE, Seefeld, Germany) and stored in 0.9% saline solu-
tion at 37 8C. After 7 days, the teeth were removed, air-
dried and radiographed; ¢llings that were short or con-
tained voids were excluded from the study.
Temperature measurement
The temperature was measured to the sensitivity of
0.1 8C (MD 3150, Beckmann-Eagle GmbH, Kernen,
Germany). The measurements were performed using
two thermoprobes that were attached to the middle third
of the external root surface on opposite sides. The probes
were held in position with a Styrofoam holder.The initial
temperature was19  0.5 8C. After the temperature rise
reached 4 8C, the lasing was stopped and the tempera-
ture was monitored until its maximum level.This highest
temperature on the root surface was recorded.
Retreatment procedures
The two solvents used were eucalyptus oil (Eucalyptoli
Aethorolum, Kemig, Zagreb, Croatia) and DMF (103034,
Merck Whitehouse Station, NJ, USA). The samples were
randomly divided into three groups of 10 teeth each:
Group 1: Filling inside root canal was lased in the pre-
sence of eucalyptus oil (0.02 mL).
Group 2: Filling inside root canal was lased in the pre-
sence of DMF (0.02 mL) as a solvent.
Group 3: Removing gutta-percha bylaser without using a
solvent (laser group).
The same laser parameters (20 Hz/1.5 W) were used
for all groups. Lasing was performed using a pulse beam
and contact mode. Duration of each cycle of lasing was
calculated from the number of pulses delivered to each
sample. For the eucalyptol group, it was 18 s, for the
DMF group 16 s, and for the laser group 15 s.
The recording of temperature started after one drop
(0.02 mL) of eucalyptol or DMF solvent had been injected
into the reservoir in the coronal aspect of the root canal
of groups1and 2. Lasing of the root canals was continued
until a temperature increase of 4 8C was registered.
The next pulse of irradiation was performed when a
stable temperature equal to the room temperature was
recorded. The time needed for the procedure (lasing,
heating and cooling) was recorded for each sample.
The retreatment was assumed to be complete when the
tip of the laser ¢bre reached the working length (apical
International Endodontic Journal, 36, 670^673, 2003 671
 Removal of gutta-percha using a laser Viduc­ic̈ et al.
Table 1 Means and standard deviations for observed parameters
DT (temperature
increase, 8C)
Group 1 (eucalyptol) 9.17  0.56
Group 2 (DMF) 9.56  0.28
Group 3 (laser without solvent) 8.29  0.41
stop). The total number of laser pulses was recorded for
each tooth. No instrument was used inside the root canal
except the laser ¢bre. The gutta-percha remnants on
the optical ¢bre were constantly removed to eliminate
the possibility of in£uencing the lasing parameters. Dur-
ing the experiment, it became apparent that lasing
should be performed thrice to achieve length. After the
last lasing, a size 35 reamer (Maillefer, Ballaigues,
Switzerland) was used to check the working length.
The specimens were grooved longitudinally with a
diamond bur with water cooling and split with rongeurs,
placed on a graduated paper, examined under binocular
loupe (magni¢cation 1.5), and photographed using a
camera (SZx12, Olympus Optical Co., Japan) connected
to the PC (Portage 2010 Series,Toshiba, Neuss, Germany)
for determination of the area of remaining gutta-percha
on root-canal walls. The area of remaining gutta-percha
was measured with the aid of a computer program ISSA
(VAMS, Zagreb, Croatia). The results were analysed sta-
tistically using Student's t-test (P < 0.05) for indepen-
dent samples.
Results
The average rise in temperature for group 1 (eucalyptol)
was 9.17  0.56 8C; for group 2 (DMF), 9.56  0.28 8C;
and for group 3 (only laser), 8.29  0.41 8C. The di¡er-
ences in temperature rise were statistically signi¢cant
(P < 0.05) between all groups. The duration of the high-
est temperature recorded on the specimens was 2^3 s,
after this time it began to fall to room temperature.
The time for the complete treatment in group 1 was
6.7  0.85 min; in group 2,7.05  0.79 min; and in group
3, 6.45  0.49 min. The di¡erence was statistically sig-
ni¢cant (P < 0.05) between group 2 (DMF) and group 3
(laser).
All teeth had residual gutta-percha on the root-canal
walls. The area of remaining gutta-percha was the lar-
gest for group 2 (DMF) (6.13  5.76%) and the smallest
for group 3 (laser) (4.69  4.03%), but the di¡erence
was not statistically signi¢cant. The number of pulses
required per tooth was higher in group 1 (eucalyptol)
(1085  91) than in group 2 (984  90) and in group 3
(laser) (944  111) (P < 0.05). The di¡erences between
672 International Endodontic Journal, 36, 670^673, 2003
Time required for No. of pulses Area of remaining
retreatment (min) received gutta-percha (%)
6.70  0.85 1085  91 5.68  3.74
7.05  0.79 984  90 6.13  5.76
6.45  0.49 944  111 4.69  4.03
all the groups for the amounts of pulses were statistically
signi¢cant. The results are summarized in Table 1.
Discussion
Laser devices with di¡erent wavelengths that could be
absorbed in di¡erent tissues and materials seem promis-
ing for removing gutta-percha and sealer. The heating
e¡ect of the laser beam is largely responsible for achiev-
ing this goal. In the case of the Nd:YAG laser, the absorp-
tion of energy in pigments could contribute to removal
of gutta-percha and the sealer. In addition, the heating
of chemical solvents may be advantageous, as they are
more e¡ective at higher temperature (Wourms et al.
1990, Kaplowitz 1994).
Various root-canal procedures cause temperature
increases on the root surface: warm gutta-percha tech-
niques, postspace preparation and lasing inside the root
canal (Cohen et al. 1996). Although a de¢nite answer
regarding the relation between the temperature changes
and vitality of periodontal tissue has not been reported,
it is accepted that the temperature transmitted from
the root canal through the dentine and cementum to
the periodontium causes enzyme denaturation, espe-
cially of alkaline phosphatase. The root may then
undergo external resorption. Eriksson et al. 1982) found
that irreversible bone injury occurred at a temperature
of 53 8C. According to the study by Saunders (1990),
the temperature elevations dissipated more rapidly
in vivo than in vitro. She assumed this was caused by
the cooling e¡ect of the microvasculature of periodontal
membrane. Although we assume that the increase seen
in this study in vitro was larger than the increase that
could be expected in clinical conditions, caution should
be taken during laser procedure because temperature
increases in groups 1 and 2 including standard devia-
tions, in some cases, exceeded 10 8C. We proposed that
even lower energy parameters and shorter periods of
lasing should be used in clinical work for safety of the
periodontal tissue.
Chloroform has been used for dissolving gutta-percha
in root canals. Several studies investigated the e¡ective-
ness of various gutta-percha solvents (Ibarrola et al.
1993, Wilcox 1995, Gorduysus et al. 1997). It seems that
ß 2003 Blackwell Publishing Ltd

some of the new solvent agents introduced for this pur-
pose gave better results when they were heated before
use (Wourms et al.1990).The results of this study showed
that laser heating of eucalyptol and DMF inside the root
canal did not improve removal of gutta-percha.
Complete removal of debris during retreatment is dif-
¢cult to accomplish, and the results from this study are
in agreement with previous ¢ndings (Zuolo et al. 1994,
Bramante & Betti 2000). The percentage of the remain-
ing gutta-percha on the root-canal walls was smaller
than that reported byWilcox (1995); however, they used
di¡erent solvents (chloroform and halothane). In the
study reported by Friedman et al. (1993), the technique
of root-canal ¢lling in£uenced the amount of residual
gutta-percha on dentine walls. Canals ¢lled with the lat-
eral condensation technique had larger amounts of deb-
ris in the apical region.
Conclusion
The Nd:YAG laser is capable of softening gutta-percha
in vitro, but the addition of solvents did not improve its
removal.
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