Plasma in Endodontics

Plasma is the fourth state of matter and can be used to disinfect during Endodontic treatments

Dr. Riccardo Tonini talks about his researches in collaboration with the Universities of Bologna and Brescia (Italy) about a revolution in Endodontics: Plasma. Plasma can be used in endodontics to provide better disinfection in the root canal system. Find out more about this interesting topic: watch the whole lecture on POP Dentistry:


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Lesson transcript

Welcome to Pop Dentistry. The real place where you can find endodontics on-demand. I'm Riccardo Tonini, gold certified member of Style Italiano Endodonticss.

And today my talk will be about plasma, plasma in dentistry. What is plasma? Plasma is a pure energy, energy that we need in our daily practice for many many reasons. First of all: disinfection. Plasma, we discovered that plasma has an incredible power againts disinfection and in the second place I would like to place adhesion, adhesion of our adhesive systems for the hybrid layer or our composite. So plasma is a something that we can define as a magic wand. But what is plasma so plasma I can define plasma as a magic wand because plasma is a ionized gas able to conduct heat and the electricity, consisting of electrons, neutrons, radicals and ions. The plasma project starts with the cooperation between two universities one that is Brescia University of Dentistry and the second one that is the University of Engineer of Bologna and the owner of this University, the professor Colombo, and met me in a Congress, and we started agreed since the beginning a great collaboration and that we started with the idea of transforming something that is basically inside the laboratories in something that maybe we can use in our daily practice in endo and the rest of practice. 

Physically, what is plasma? Plasma is the fourth state of matter. We have a solid. We have liquid, and we have gas and we have plasma in the middle and on right, you can see a picture that we recently published on Science. This can really explain you what is plasma.

So how can we produce plasma. It's simple because it is enough to have to apply a sufficiently high energy in betweens two dielectric parts. And we can see that in the middle of two dielectric parts we have a gas, and we can see that the particles are starting colliding each are. When a gas in this way becomes plasma it contains a relatively equal number of positive and negative particles. In addition with neutron particles. As a result electrons and iones are producer and the gas has an electric charge. This state of matter is clearly called plasma which is the fourth state of matter, as I said before.

Here there is a brief video that's going to explain you how it works. We apply an high voltage and we can see that the particles we can break the bonds between particles and we produce lot of reactive parts like ROS, like hydroxide radicals. These kind of radicals are really important against bacteria because they are able to digest and break the bacteria membranes. So basically thanks to all of these active particles we are able to fight and destroy a lot of bacteria. 

This is the clear theory of plasma okay. But how can we transfer for from a laboratory to our dental office. It's easy because it enough to modify and work on the device with a small tip. A tip that maybe we can use as for adhesion and for disinfecting dentine instead of clorhexidine. Or maybe is smaller tip that we can apply inside the pulp chamber and we can see that maybe plasma can penetrate in an easy way inside the root canal system. Why? Because plasma is attracted by the root canal system. So this gas has no pressure and can penetrate easily inside the any part of root canal system better than any kind of liquid. And by yourself maybe you understood the importance of these research and the powerful idea of plasma. 

But let's talk about the device. I want to share also with you the device that we designed and maybe the future of this device and the researches that we did about it inside our device. And we have for sure it a tip and that we need a generator, a generator able to produce enough energy. After that we moved from the lab and we designed a prototype of this medical device. And basically sequences that we have inside the generator and we have inside a helium tank. The last part, here, is the handpiece. a small handpiece that can easily go inside the mouth. This is the the part that we keep inside our in our hands. We have a removable and autoclavable terminal glass capillary but glass and maybe also made in plastic, if we want to reach the apical region, we have the other most important part that took us lot of time in development is an insulator and the dielectric inside this device we can produce plasma directly here. So the generator is only a energy generator. Our plasma is produced inside this handpiece directly not on the back. We tested, we try to test it and we understood that plasma is something safe, first of all, that can penetrate in an easy way inside the root canal system. Is a gas without any pressure, is a plump. So something that is gently can really touch all the surface of our root canal system. 

This is what happens when we apply the plasma on a dentine disk. We can see that surface tension is basically close to zero. So thanks to a treatment of 20 second of plasma, we can apply a drop of any liquid and we can see the capacity of the liquid to touch any part of the dentine disk. Instead, if we apply a drop of liquid on on a dentine disk without any kind of treatment, we can see that the drop remains exactly where we place it. So the difference is extremely high. Is evident. We need plasma. We understood that we need plasma. Now I want to show you what happens inside the root canal system.

This is a simulator of a root canal system: we apply plasma inside and the plasma is attracted from the external or so part of the periodontal. As we can see from these images, we can appreciate how plasma can penetrate easily in the endodonto anatomy and can also penetrate in a lateral canal. So plasma is also attracted from the periodontum and it means that it's safe, is not dangerous. Why? Because plasma usually it's in is adopted has a treatment for the wound of the patient. So you know plastic surgery or everywhere for his efficacy. We started  with some investigation. First of all antibacterial efficacy of plasma and so how can we apply plasma. Can we apply it directly inside the root canal system and while we are using maybe hypoclorite? Or is better to apply it in a dry condition? The other choice coulr be also to treat our irrigant, any kind of irrigant outside the mouth of the patient and introduce it only once it's activated from plasma.

 We did a lot of samples. We did a lot of experiments and at the end we understood that the best way of employing plasma in endodontics is use it in a dry condition. It means that the efficacy of plasma is really high when the root canal system is completely dry, not wet. It means that the gas is able to penetrate better inside dentinal tubules and inside the lateral canals and is able to do something that our liquids are not able to do. So plasma in endodontics can be used first of all at the end of the treatment in order to induce a really deeper antibacterial efficacy and disinfection.

 So at the end of our root canal treatment, at the end of our cleaning protocol the employment of plasma for one or two minutes is extremely suggested in dry condition. And plasma also can when we treat the surface of plasma, try to imagine during filling, what can happen. So try to imagine also what can happen when we have to seal our root canal system. We treated the surface with plasma. Now while our surface is active ready to receive our sealer and gutta percha and we found, we discovered that the sealer penetration is higher and the gutta percha adhesion isn't really high. And in terms of numbers we can say that the gutta percha alone when we treat the root canal system first has a better sealing and the better adhesion power then we can when we use sealer and gutta percha together. So plasma is able to improve our sealing, our filling with gutta percha and any kind of sealer and is something that is absolutely extremely useful, also during this stage of our root canal treatment during filling. 

The next step of our root canal treatment is the resto or part, the adhesion inside the root canal system. The adhesion may be of our fiber post and composite end adhesives, and we tested also these we treated dentine and we apply, We treat the dentine with plasma and we apply our conventional lootings system bonding and composite. We discovered that plasma can really increase the adhesion and that we are talking about 30 40 percent more in terms of push out bond strength. It means that plasma can really enhance, can really help us, also during this procedure. 

So you discover it with me, how much is important with powerful energy something that maybe can disinfect and sterilize our root canal system something that can induce improve the adhesion of our root filling materials and something that can really improve the adhesion of our composite and adhesives disease improving the hybrid layer. So plasma source is something incredible. Is it really a magic wand! Something that in my dreams is for the next future a new device that we can use now our daily practice in order to disinfect and maybe, why not, we can use also the ultraviolet light that is produced by plasma, so a double use of plasma.

And in my opinion exactly: this is not the end. It's only the beginning. Follow us on Pop Dentistry and you will discover next development on this fantastic technology.

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Really interesting for the future of endo

Ahmed nabil Mohamed

So what further investigations regarding plasma in Endodontics should be directed to?be done