The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photo stimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.
Tooth decay. Lasers are used to remove decay within a tooth and prepare the surrounding enamel for receipt of the filling.
Gum disease. Lasers are used to reshape gums and remove bacteria during root canal procedures.
Biopsy or lesion removal. Lasers can be used to remove a small piece of tissue (called a biopsy) so that it can be examined for cancer. Lasers are also used to remove lesions in the mouth and relieve the pain of canker sores.
Teeth whitening. Lasers are used to speed up in-office teeth whitening procedures. A peroxide bleaching solution, applied to the tooth surface, is ''activated" by laser energy, which speeds up of the whitening process.
Compared to the traditional dental drill, lasers:
May cause less pain in some instances, so reduces the need for anesthesia May reduce anxiety in patients uncomfortable with the use of the dental drill
Minimize bleeding and swelling during soft tissue treatments May preserve more healthy tooth during cavity removal
The disadvantages of lasers are that: Lasers can't be used on teeth with fillings already in place.
Lasers can't be used in many commonly performed dental procedures. For example, lasers can't be used to remove defective crowns or silver fillings, or prepare teeth for bridges. Traditional drills may still be needed to shape the filling, adjust the bite, and polish the filling even when a laser is used.
Lasers do not eliminate the need for anesthesia. Laser treatment tends to be more expensive the cost of the laser is much higher than a dental drill.
Advantages of Laser
High bactericidal capacity with laser irradiation
Reduced use of local anesthesia
Minimal wound contraction
Retaerd epithelial root surface to enhance periodontal tissue regeneration
Reduced noise factor
LASER DENTISTRY, CLINICAL USES:
Laser Hard Tissue Applications
Class I, II, III, IV and V cavity preparation
Caries removal Hard tissue surface roughening or etching
Enameloplasty, excavation of pits and fissures for placement of sealants
Laser Soft Tissue Applications:
Soft Tissue Procedures Including Pulpal Tissues
Excisional and incisional biopsies
Exposure of unerupted teeth
Flap preparation - incision of soft tissue to prepare a flap and expose the bone
Flap preparation - incision of soft tissue to prepare a flap and expose unerupted teeth (hard and soft tissue impactions)
Frenectomy and frenotomy
Gingival troughing for crown impressions
Gingival incision and excision
Hemostasis Implant recovery
Incision and drainage of abscesses
Laser soft tissue curettage of the post-extraction tooth sockets and the periapical are during apical surgery Leukoplakia
Operculectomy Oral papillectomies
Pulpotomy as an adjunct to root canal therapy
Root canal debridement and cleaning
Reduction of gingival hypertrophy
Removal of pathological tissues (i.e., cysts, neoplasm or abscess) and hyperplastic tissues (i.e., granulation tissue) from around the apex Soft tissue crown lengthening Sulcular debridement (removal of diseased and inflamed soft tissue) Treatment of canker sores, herpetic and aphthous ulcers of the oral Mucosa Vestibuloplasty
Bone Surgical Procedures:
Cutting, shaving, contouring and resection of oral osseous tissues (bone)
Root Canal / Endodontic Procedures
Laser root canal disinfection after endodontic treatment
Tooth preparation to obtain access to root canal Root canal preparation including enlargement Root canal debridement and cleaning
Flap preparation - incision of soft tissue to prepare a flap and expose the bone Cutting bone to prepare a window access to the apex (apices) of the roots
Apicoectomy Root end preparation for retrofill amalgam or composite
Removal of pathological tissues (i.e., cysts, neoplasm or abscess) and hyperplastic tissue (i.e., granulation tissue) from around the apex
LASER PERIODONTAL THERAPY
Laser Periodontal Procedures Waterlase MD™/iPlus™ Er,Cr:YSGG assisted new attachment procedure (cementum-mediated periodontal ligament new attachment to the root surface in the absence of long junctional epithelium). Full thickness flap
Partial thickness flap
Split thickness flap
Laser soft tissue curettage
Laser removal of diseased, infected, inflamed and necrosed soft tissue within the periodontal pocket Removal of highly inflamed edematous tissue affected by bacteria penetration of the pocket lining and junctional epithelium
Removal of granulation tissue from bony defects Sulcular debridement (removal of diseased or inflamed soft tissue in the periodontal pocket to improve clinical indices including gingival index, gingival bleeding index, probe depth, attachment loss and tooth mobility) Osteoplasty and osseous recontouring (removal of bone to correct osseous defects and create physiologic osseous contours)
Ostectomy (resection of bone to restore bony architecture, resection of bone for grafting, etc.) Osseous crown lengthening Removal of subgingival calculi in periodontal pockets with periodontitis by closed or open curettage
Laser dentistry can be a precise and effective way to perform many dental procedures. The potential for it to improve dental procedures rests in the dentist's ability to control power output and the duration of exposure on the tissue (whether gum or tooth structure), allowing for treatment of a highly specific area of focus without damaging surrounding tissues.
If you consider yourself somewhat of an anxious dental patient and are seeking extreme safety and comfort, you might consider looking for dentists who have incorporated laser techniques into their practices and treatments. It is estimated that 6 percent of general dentists own a laser for soft-tissue applications, with that number expected to increase over time.
As the applications for dental lasers expand, greater numbers of dentists will use the technology to provide patients with precision treatment that may minimize pain and recovery time.
Procedures performed using soft tissue dental lasers may not require sutures (stitches) Certain procedures do not require anesthesia. Bacterial infections are minimized because the high-energy beam sterilizes the area being worked on. Damage to surrounding tissue is minimized.
Wounds heal faster and tissues can be regenerated.
The application of lasers in dentistry opens the door for dentists to perform a wide variety of dental procedures they otherwise may not be capable of performing. Dentists using lasers have become adept at incorporating the state-of-the-art precision technology into a number of common and not-so-common procedures.
Hard Tissue (Tooth) Procedures
Cavity Detector: Low intensity soft tissue dental lasers may be used for the early detection of cavities by providing a reading of the by-products produced by tooth decay.
Dental Fillings/Tooth Preparation: Hard tissue dental lasers may eliminate the need for a local anesthetic injection and the traditional turbine dental drill. Lasers used in dental filling procedures are capable of killing bacteria located in a cavity, potentially leading to improved long term tooth restorations. However, dental lasers are not appropriate for the replacement of amalgam fillings, onlays or crowns.
Tooth Sensitivity: Dental lasers may be used to seal tubules (located on the root of the tooth) that are responsible for hot and cold tooth sensitivity.
Soft Tissue (Gum) Procedures
Crown Lengthening: Dental lasers can reshape gum tissue (soft tissue laser) and bone (hard tissue laser) to expose healthier tooth structure. Referred to as crown lengthening, such reshaping provides a stronger foundation for the placement of restorations.
Gummy Smile: Dental lasers can reshape gum tissue to expose healthy tooth structure and improve the appearance of a gummy smile.
Muscle Attachment (Frenula): A laser frenectomy is an ideal treatment option for children who are tongue tied (restricted or tight frenulum) and babies unable to breast feed adequately due to limited tongue movement. A laser frenectomy may also help to eliminate speech impediments.
Soft Tissue Folds (Epulis): Dental lasers may be used for the painless and suture-free removal of soft tissue folds often caused by ill-fitting dentures.
Viewing Tooth and Gum Tissues:Optical Coherence Tomography is a safer way to see inside tooth and gums in real time.
Benign Tumors: Dental lasers may be used for the painless and suture-free removal of benign tumors from the gums, palate, sides of cheeks and lips.
Cold Sores: Low intensity dental lasers reduce pain associated with cold sores and minimize healing time.
Nerve Regeneration: Photobiomodulation can be used to regenerate damaged nerves, blood vessels and scars. Sleep Apnea: In cases where sleep apnea is a result of a tissue overgrowth in areas of the throat (which sometimes occurs with age), a laser assisted uvuloplasty or laser assisted uvula palatoplasty (LAUP) procedure can be performed to reshape the throat and relieve the correlating breathing problems associated with sleep apnea.
Teeth Whitening: Low intensity soft tissue dental lasers may be used to speed up the bleaching process associated with teeth whitening.
Temporomandibular Joint Treatment: Dental lasers may be used to quickly reduce pain and inflammation of the temporomandibular jaw joint.
Lasers represent an innovative and more precise technology for specific hard and soft tissue applications. If you choose a laser dentist, you may find that you feel more comfortable and less anxiety during your treatments.