Harnessing Fluid Engineering and Bioactivesto Refigure Root Canal Treatment

by Anil Kishen, BDS, MDS, PhD

Over the decades, cleaning the root canal system has been considered the pivotal step in endodontic treatment. The clinical recommendations have been to adequately enlarge the canal to uphold effective irrigation with bleach and obturation of the root canals with sealers and gutta-percha. However, as the importance of preserving natural tooth structure continues to evolve, there has been a growing interest in performing root canal treatment through tiny access openings and minimally enlarged root canals. This treatment model is promoted as minimally invasive endodontics. Recent advances in imaging technologies and dental biomaterials have also contributed to this switch in treatment philosophy.

Minimally invasive treatment procedure routinely aims at minimizing iatrogenic effects on patients. In endodontics, it should succeed in the objectives of therapeutic efficacy and periapical healing, no less effective than currently achieved by established treatment modalities. For this paradigm shift to happen, research and planning should support the clinical guidelines. The irrigation devices industry has exploded recently, but the cost, efficiency and patient experience can only be confirmed by studying the patient-centred outcomes while considering the rising cost of health care.

The SyAct system* created cutting-edge fluid engineering and bioactive biomaterial technologies, which will be available in 2024. The system utilizes a customized blend of solutions not only to eliminate residual root canal biofilm but also to strengthen the remaining root structure, regulate biological periapical healing, and facilitate three-dimensional obturation in minimally prepared root canals. This technology employs low-energy visible light activation of solutions tailored to be an effective antimicrobial in minuscule-size root canals. This step is followed by another sequence of light activation and root canal conditioning steps with bioactive biomaterials to ensure root strengthening, enhanced obturation quality and periapical healing (topical immune modulation.1-5 The goal is to maintain healthy and functional teeth in our patients’ mouths for an extended period.

*SyAct International LLC, FL was founded by Drs. S. Kuttler, J.W.W. Chang and A. Kishen


  1. Teed C, Hussein H, Kishen A. Synchronized Microbubble Photodynamic Activation to Disinfect Minimally Prepared Root Canals. J Endod. 2023;49(2):198-204.
  2. Del Carpio-Perochena A, Nicholson E, Singh CV, Camilleri J, Kishen A. Impact of Dentin Conditioning and Sealer Modification With Chitosan-Hydroxyapatite Nanocomplexes on the Antibacterial and Mechanical Characteristics of Root Dentin. J Endod. 2022;48(10):1319-1326.
  3. Hussein H, Kishen A. Proteomic profiling reveals engineered chitosan nanoparticles mediated cellular crosstalk and immunomodulation for therapeutic application in apical periodontitis. Bioact Mater. 2021;11:77-89.
  4. Suresh N, Subbarao HJ, Natanasabapathy V, Kishen A. Maxillary Anterior Teeth With Extensive Root Resorption Treated With Low-level Light-activated Engineered Chitosan Nanoparticles. J Endod. 2021;47(7):1182-1190.
  5. Li FC, Nicholson E, Singh CV, Kishen A. Microtissue Engineering Root Dentin with Photodynamically Cross-linked Nanoparticles Improves Fatigue Resistance of Endodontically Treated Teeth. J Endod. 2020;46(5):668-674.

About the Author

Dr. Anil Kishen is the Professor & Dr. Lloyd and Mrs. Kay Chapman, Chair in Clinical Sciences Graduate Coordinator, Graduate Education, Faculty of Dentistry at the University of Toronto. He is also the Associate Scientist in the Dept. of Dentistry at Mount Sinai Hospital, Sinai Health System