LASERS IN

DENTISTRY

CONTENTS

Introduction
Fundamentals
History
Laser
Working of laser
Advantages & disadvantages
Tissue response to lasers
Lasers in dentistry
Hazards of lasers
conclusion

introduction
LASER is an acronym , which stands
for Light Amplification By Stimulated
Emission Of Radiation
Device that converts
electrical/chemical energy into light
energy
device that creates a uniform and
coherent light that is very different
from an ordinary light bulb

 Also can be described as a device for

generating a high-intensity, parallel
beam of monochromatic(single
wavelength) electromagnetic
radiation.
Laser light can be focused down to a
tiny spot as small as a single
wavelength.

Fundamentals of lasers

Light
Amplification by the
Stimulated
Emission of
Radiation

HISTORY

1960-first laser
1993 Nd:YAG Laser
1993 Kinetic Cavity Preparation
1994 CO2 Laser, Argon Laser
1996 Laser welder
1997 Nd:YAP Laser
1998 Er:YAG Laser

Light
Form of electromagnetic energy
Properties of laser :
Monochromatic
Collimation
Coherency
intense

 Monochromatic-Characterized by radiation in which

all waves are of same frequency and wavelength.
Collimated: all the emitted waves are parallel and
the beam show very low divergence. This property is
important for good transmission through delivery
systems.
Coherency: indicating that the light waves produced
by a laser have a specific form of electromagnetic
energy which are in phase with one another.
Intense in nature

 A- Amplification
means that a very bright intense beam of
light can be created.
The laser may be activated by a few
photons which then act to produce many
more, and the initial light generated is
computed to make a very bright compact
beam

 S Stimulated
E-Emission
If an atom in the excited state is struck by
a photon of identical energy as the photon
to be emitted, the emission could be
stimulated to occur earlier than would
occur spontaneously. This stimulated
interaction causes two photons that are
identical in frequency and wavelength to
leave the atom.

THE LASER

Basic components..
An ACTIVE LASING MEDIUM :can be a solid, liquid or gas
Enclosed within a LASER CAVITY
bounded by two perfectly parallel
reflectors(mirrors)
PUMP SOURCE high energy
radiation pumped into the active
medium

POPULATION INVERSION : condition when energy from pump

source is absorbed by active medium
until the majority of atoms, ions or
molecules are raised to their upper
energy state.
this condition is NECESSARY to
generate laser light

TWO PARALLEL REFLECTORS

situated at end of laser cavity act to
focus light along within the axis of
cavity.
So light is repeatedly bounced b/w
the reflectors
One of the mirrors is only partially
reflective, enabling some of the light
to escape the cavity as a beam of
laser light

 Process of supplying energy for

amplification- pumping

Laser interaction with biologic

tissues
Four different interaction :
Reflection
Scatter
Absorption
Transmission

 Reflection:the laser reflecting or redirecting itself away

from the tissue surface & having no effect on the target
tissue
Absorption: this depends on the tissue charecteristics
like water content & the level of pigmentation & on laser
wavelength and emission mode
Transmission:the tissue transmits the laser energy
through the tissue ,with no effect on the target tissue
Scattering: this process will weaken the energy of
thebeam & produces no useful biological effect. Causes
heat transfer to adjacsent tissue& thermal damage.

ADVANTAGES OF LASER
Processing of matter without contact.
High working speed
Outstanding precision

BENEFITS

Soft,
quiet,
vibration-free operation
As fast as the high-speed turbine
CO2 laser cuts and coagulates soft tissue without
bleeding
No risk of cross-infection
Sterilization of operating field
Fewer cracks than with turbine
Multiple quadrant dentistry
No need for etching
Pulsing minimizes charring and thermal necrosis

LASER IN DENTISTRY
Lasers are still in the pioneering
stage, but there are many current
uses
There are three types of Dental lasers:
Surgical Laser (soft tissue)
Curing Laser
Tooth Laser (hard tissue

SURGICAL LASER
This laser replaces traditional surgery
for many gum and soft tissue dental
applications and is gentler than
traditional surgical procedures.
This laser used for :
Improve treatment results for gum
disease
Contour gums for smile enhancement
Surgically correct oral abnormalities

 Surgically assist in arresting herpes

lesions and canker sores
Assist in biopsies
Treat infant tongue/frenum problems
which can hinder proper
chewing/sucking
Treat child/adult frenum problems
which can cause speech
impediments, gum disease, and
teeth to grow apart rather than

Curing laser
This laser spectrum light source is
used for rapid teeth whitening and
placing all tooth- colored restorations
(fillings) and repair procedures.
Bonds created by this advanced
instrument result in dentistry that is
twice as strong

 The light source increases gradually

during the curing process to create the
best bond available in dentistry today.
Appointment length is also reduced
because it is 500% more powerful than
standard equipment.
Less than 1% of dental offices nationwide
have this instrument, making it one of the
newest tools in dentistry.

 TOOTH LASER (hard tissue)

Third type of laser is used to remove cavities.
But since this laser cannot be used on
existing metal fillings, we use micro dentistry.
MICRO DENTISTRY
one of the greatest advancements in the field
of dentistry.
offers the ultimate flexibility and capability. It
is also the most tooth conservative dentistry
available

 About 50% of cavities are

candidates for this technique and
there is no drilling, no needle, no
extra fee, and no pain
And because this process is so
efficient, it reduces appointment
length

Hard tissue application

Desensitize exposed root surfaces
Diagnosis of non-cavitated caries
To arrest demineralization and
promote remineralization of enamel.
Debond ceramic orthodontic
brackets

DIAGNOdent caries detector

can find cavities that other dental
instruments can miss.
is designed as an adjunct to a
traditional oral examination in the
detection of occlusal decay.
Teeth that are suspicious for caries
can be surveyed with the device

Treatment of dentin hypersensitivity.

In bleaching
Adhesion of pit & fissure sealant
Most obvious application controlled
removal of dental enamel, dentin,
bone or cementum.
Replacement of dental drill is a real
possibility for the future

Lasers used in dentistry

Nd:YAG
Diode
Co2 laser
Er:YAG
Er,Cr:YSGG
Argon

Nd:YAG laser
Solid active medium containing crystal of
yttrium-aluminium-garnet doped in
neodymium
Wavelength :1064nm (invisible beam in
infrared range)
1st laser designed exclusively for dentistry
Fibereptically derived in a pulsed mode & is
most often used in contact with the tissue
The pulsed Nd:YAG laser is ideal for soft
tissue procedures & rootcanal sterlization

 Nd: YAG laser

DIODE LASER
Solid semiconductor laser that uses a
combination of aluminium,galium,arsenide that
converts electrical energy to light energy
Wavelegth:800-980nm
Fiberoptically derived in continuous or in pulsed
mode & used in contact with soft tissue
Pooorly absorbed by tooth structure ,hence,soft
tissue surgery can be safely performed
Welll absorbed by pigmented tissue
Advantage being- compact,portable & ecnomical

advantages
Portable
No special power
No cooling
connection
No heat
Quiet Affordable
More powerful,
less traumatic

Sulcular
debridement
Root canal
treatment

Co2 laser
Gas active medium laser
Wavelength :10,600nm
Derived through hollow tube via handpiece &
cannot be delivered by fiberoptics
Not suitable for hard tissues
Ideal laser for soft tissues, especially for cutting
dense fibrous tissueCo2 gas as lasig /active
medium
Delivery system uses an articulated arm (a
series of hollow tubes connected together through
a series of six to eight articulating mirrors).

Er:YAG
Er:YAG is a solid active medium crystal
containing yytrium,aluminium,garnet that is
doped with erbium
Wavelength:
Er:YAG-2940
Delivered through a fiberoptic system in a
pulsed modeThe Er:YAG laser can be used to
disinfect cavity prep , in case of residual
bacteria contaminating, otherwise intact
enamel or dentin, or in fissures prior to sealing

Application of laser in
endodontics

Vascular vitality asssessment of pulp

Pulp capping & pulpottomy
Sterilisation of rootcanals
Obturation
Apical surgery

Cavity preparation
Efect of ruby laser radiation on
enamel Goldman, Stern &
Sognnaes, 1964
Carbondioxide laser-Lobene et all
1968
Nd:YAG laser Yamamoto & Ooya
1974
Argon laser Goodman & Kaufmann
1977

 In removal of enamel n dentin

thermal side effect occoured.
Superpulsed carbon dioxide laser
removal of dentin without thermal
side effect possible.
Transversal stimulation or carbon
dioxide TEA (the Alexandrit laser with
double frequency) most efficent
carb.dioxide laser for dental hard
tissue ablation.

 Drying the surface with laser is very

quick , efficient and gentle.
Erbium laser has bactericidal abilities.
Because high surface temperature can be
achieved for a short time by irradiation.
Irridation of caries by a sequence of laser
pulses leads to consecutive dessication
and sterilization.

Dentin hypersensitivity
Best results obtained whn affected areas
exposed to co2 , Nd:YAG, Er:YAG, Diode
laser radiation
Colojoara et al showed that dentin
hypersensitivity can be reduced without any
damages to pulp vitality by using co2 laser.
They also showed that when using co2 laser
, in parallel direction with dentin tubules,
the desensiting effect ws obvious aftr three
exposures.

Dental material curing

The first materials introduced in
1970s (photopolymerised
composites) wr cured by ultraviolet
light.
Power et al showed that an argon
laser requires shorter curing times &
the materials dentin bond strength
was stronger when compared with
laser

 Variables that control the depth

&extent of cure include
- time of exposure
- composite material
- wavelength
- intensity of light
- particle size of filler

 current reserches report that used at

the power of 250 +/- 50 mW for
10sec per increment ,
the argon laser provides good curing
of light activated restorative material
in shorter period of time with equal
or better physical properties than the
conventional halogen curing light

laser teeth
whitening(bleaching)
With todays technology, laser teeth whitening
through the use of the Diode Laser is the
quickest and most dramatic way to brighten
your smile if porcelain laminates are not an
option.
All tooth whitening procedures use hydrogen
peroxide or carbamide peroxide to bleach out
stains on your tooth enamel, but this is where
the similarity ends when comparing standard
bleaching procedures such as whitening
performed with a light cure to laser whitening.

 Laser whitening is superior to all other whitening

techniques since
1.laser whitening products contain the highest
concentration of peroxide
2.the laser provides the highest light intensity
available
3.the procedure is done in the office at chairside
thus allowing us to concentrate in those areas of
your mouth where the type and location of
discoloration is worse. Laser technology allows us to
whiten your teeth with amazing results in just one
hour!

Whitening techniques will vary with

every individual depending on:
1.the type of stain on your teeth
2.where the stain is located
3.the amount of time the whitening
gel is used
4.the peroxide concentration in the
whitening gel
5.the intensity of the light activating
the whitening gel

 In Laser-Assisted Tooth Whitening,

the laser enhances the effect of
bleaching agents for faster, more
comfortable and more effective
results.
By stimulating the bleaching gel to
react faster, the bleaching agent
(mainly peroxide) spends less time
on the tooth.
This leads to increased comfort

BLEACHING

APPLICATIONS -GENERAL

Eye surgery
Cancer treatment
Removal of tattoos
Cosmetic surgery
Hair removal
Cold Sores
Nerve Regeneration

 Removal of old restoration-gold,

ceramic
Root canal therapy
Temporomandibular Joint Treatment:
reduce pain and inflammation

Crown lengthening

Soft tissues
Frenectomy
Tongue tie
Incisional and excisional biopsies
Inflammatory papillary hyperplasia
Aphthous ulcer
Operculectomy
Removal of hyperkeratotic lesions
Removal of malignant lesions

Soft tissue crown lengthening

Vestibuloplasty
Removal of granulation tissue
Removal of vascular lesionsHemangioma
Pyogenic granuloma
Implants Stage II at the time of
recovery

Laser Gingivectomy
A Gingivectomy is a periodontal surgery
that removes and reforms diseased gum
tissue or other gingival buildup
Performed in a dentists office, the
surgery is primarily done one quadrant
of the mouth at a time under local
anesthetic.
CO2 laser with wavelength of 10,600nm

GINGIVECTOMY

FRENECTOMY

Hazards of laser
Types of hazards
Ocular hazards
# injury to eye direct emission or by
reflection from mirror like surface.
# irreversible retinal burns- by
conversion of incident radiation to
heat energy

Tissue damage
damage to skin & other non-target
tissue result from thermal interaction
of energy with tissue proteins
temperature elevations can produce
denaturation of cellular enzymes
&structural proteins which interrupt
basic metabolic processes

Environmental hazards
Are referred to as non-beam hazards
Capable of producing smoke , toxic
gases and chemicals.
Laser plume composed of
vaporised water (steam), carbon
particles, cellular products

Mechanical effects
High energetic & short pulsed laser
light lead to a fast heating of dental
tissue.
Energy dissipates explosively in vol
of expansion accompanied by fast
shockwaves..
The shockwaves lead to high
pressure destroy or damage
adjacent tissue

Electrical hazards

Can be in form of
electric shock
fire
explosion

 LASER HAZARD CONTROL

MEASURESThe small flexible fiber
optic , hand pieces or tipmust be
steam sterilized in sterilizing
pouchesUse of protective wearUse of
screen & curtains should be
promoted

Combustion hazards
Flammable solids , liquids, gases
used within the surgical setting can
be easily ignited if exposed to laser
beam.

thermal effects of laser irradiation

Temperature < 60 celcius ~ tissue
hyperthermia ~ enzymatic changes
~ edema
Temperature > 60 celcius ~ protein
denaturation
Temperature < 100 celcius ! Tissue
dehydration ! Blanching of tissue
Temperature > 100 celcius ! Super
heating ! Tissue ablation&shrinkage