Er:YAG Laser PIPS: Is the Radial Shaped Tip Necessary?

I have been performing PIPS endodontics since August, 2010 and have never felt so good about doing endo in my life. Just watching all that junk pour out of the tooth is very satisfying.  However, one thing has always bothered me about this procedure; the cost of the PIPS Endo tips!  $250 each.  I must have gotten a bad batch (5 tips) last time because they break way too fast for my taste.  The last new PIPS tip I used broke inside the sheathing on my very first try!  There are only so many times you can call up the company and complain before they start wondering about you.  I wasn't doing anything tricky with the tip, just PIPSing.  So, I keep going back to this one tip that is worn off and seems to be working just fine.  I get great action out of the PIPSing affect with junk streaming out like usual.  But, always in the back of my mind I wonder if this old tip is working as well as a new radial PIPS tip.  Maybe it is more of a function of the laser settings? So far it is a mystery. I took heat sensitive FAX paper and made these observations: New PIPS Tip: The laser pattern is just like they showed us in class. It blasts out the end in a conical pattern.  Don't really see any need to have the sheathing stripped away from the tip since no laser light is emitted from the shaft of the PIPS tip in this picture.  Having the sheathing all the way to the tip may actually make the tip stronger.  Wait, isn't that what the WPT radial perio tip looks like and it is $100 less expensive. New Perio Radial tip (above): This tip has the very same pattern as the Endo PIPS tip. In this picture I just didn't cook the paper as long. A conical shaped laser light pattern may actually explode more water to send shock waves down the root canal system, but a worn off tip directs the blast pattern straight down the canal. The Perio PIPS tip (0.6mm) is a larger diameter than the Endo patented PIPS tip (0.4mm) carrying more light to the source and may compensate for the lack of using the Endo PIPS tip or it may give more power and cause a better PIPSing action.  More research will need to be done. Worn off PIPS tip: This is the old worn out tip that I keep going back to because my "new" Endo PIPS tips keep breaking prematurely.  Looks like the laser light "blast" pattern is more in the direction of the canal.  I still get a good amount of PIPSing affect with serious popping inside the canals.  Lateral canals look cleaned out, hooked and "river delta" looking apices appear to be obturated well. In my course, I asked Dr. Mark Colonna why the PIPS tip was so much more expensive than the other tips and he answered me by saying it was patented (by him) and it took a lot of research to develop the tip with the right angles.  I accepted this at the time because I had nothing to compare it to, but now I'm not so sure.  He also told us that we could expect 50 canals out of each tip!  So far, I have almost 50 canals on my old trustworthy worn off tip!  Maybe that was what he was implying in the course.  That even though the radial tip wears off pretty quickly, you still can expect a good PIPSing affect from a blunted off tip?  He did say that if you used the Perio WPT radial tip to treat your root canals you would be outside the norm for the procedure and would not be included in any accumulated studies in the future.  With the Endo PIPS tip wearing off so rapidly, I'm not so sure there is any norm established in this procedure in the first place.  Plenty of unanswered questions are ahead involving PIPS. Now that all of that is said, you really cannot help but like Drs. Mark Colonna and Enrico DiVito for what they are doing for the field of Endodontics.  Two general dentists out there fighting the establishment with their own money trying to figure out a better way to do root canals for the benefit of all of us in the dental field.  I for one am very grateful they are both so dedicated to their cause. One day a laser physicist may lay this issue to rest and finally give us the definitive answer to wether or not a radial tip is essential to successfully performing photon-induced photo acoustic streaming inside the tooth's neural vascular system.  Until then, my worn out tips are doing pretty good PIPSing.  Or are they?

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