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Apical periodontitis results from cultivable bacteria found within an infected root canal system that elicits host defences [1]. Elimination of the intracanal microbiome, or reduction to a subcritical level, is essential for periapical healing to occur [2]. Chemomechanical preparation that removes organic tissue, infected dentin and dislodges biofilms has been shown to be clinically effective in elimination of patient symptoms with concomitant radiographic healing [3,4]. Bacterial contamination related to non-healing apical lesions healing is the primary etiology of post-treatment disease requiring retreatment, periapical surgery or extraction [5]. A significant challenge for instrumentation and disinfection is the inability of contemporary techniques to address all the complexities of root canal systems [6]. A determinant factor for endodontic success is creating convenience form and canal shape that permits canal disinfection, specifically addressing areas of the root canal system that remain untouched by instruments. A recent change in the study of bacterial colonization of root canals has moved the focus from single organism laboratory-based planktonic cultures to the biofilm mode of growth [7]. Within the confines of the root canal system, residual biofilm is common even following irrigation with 5% sodium hypochlorite [8]. Furthermore, oral mixed biofilms are more resistant to removal having a greater adhesion to dentin [9]. Many alternative irrigation techniques intended to replace or serve as adjuncts to standard needle irrigation have been investigated including: passive or active ultrasonics [10,11]; sonic agitation [12]; photo-activated dyes (PAD) [13]; negative apical pressure devices [14]; and most recently photon-initiated photoacoustic streaming (PIPS) [15]. Laser activation of intracanal irrigant creates large elliptical vapor bubbles that expand and subsequently implode, causing a cavitation and shock wave effect that promotes debridement and smear layer removal and the release of energy further down the canal [16]. Previous studies have shown PIPS to be effective in biofilm elimination [17], smear layer removal [16], and debris removal from complex nonseparated systems [18]. Apical size and taper size have been studied in the past by multiple studies, with varying conclusions reflecting the needs of obturation and irrigation techniques Volume 7 Issue 2 2017

In-Vitro Evaluation of the Efficacy of PIPS Irrigation System on Disinfection of Type 2 Canal Systems in Molars