Potential Applications of Erbium: YAG Laser in Periodontics This article is a review of Er: YAG laser application for periodontic

therapy. Laser therapy has been a common therapy in medical field since 1960. Stern, Sognnaes and Goldman who introduced laser in dentistry in 1964, but it was not popular to dental practitioners. Laser composes of active medium and pumping source enclose in an optical cavity. Laser medium can be gas (CO2) or solid state yttrium and aluminum (YAG). Er:YAG showed higher absorption in water and it causes less tissue interaction surface and less thermal effect when using with water irrigation if compared with another. During laser therapy heat generation will occur by tissue absorption, so it can remove tooth structure and inflammation pulp. CO2 and Nd:YAG can be used to cut hard tissue structure, but they form toxic substances. However, Er:YAG showed better result due to micro-explosion associated with water evaporation. According to the effective of hard tissue ablation an less tissue damage, Er:YAG was introduced for cavity preparation and caries removal. Since the conventional scaling and root planing procedures are time consuming and residual plaque and calculus, Err:YAG has been reported in vitro and vivo showing similar effective as ultrasonic scaler. In addition, Err: YAG demonstrated a better effective in removing subgingival plaque and calculus without cracking the root surface than Nd:YAG and CO2. Er:YAG has bactericidal properties against periopathic bacteria and their virulence products. Meanwhile, it also can remove the smear layer on the root surface without toxic formation that interfere reattachment. The effectiveness of Er:YAG for periodontal therapy are still in contradiction. However, it demonstrated a minimal invasive to periodontal tissues over the conventional nonsurgical periodontal instruments. Besides the benefits of the Er:YAG, it needs more attention when using to avoid risks during operation. For examples, using Er:YAG with 100mJ/pulse causes delaying gingival growth and adhesion than 60 mJ/pulse. Heat formation is the risk of the laser, so water irrigation is required. Er:YAG have been introduced for gingival de-pigmentation with no postoperative discomfort or gingival recession. Using Er:YAG for cutting bone is not common, yet several literatures has proved in vitro that Er:YAG shows increasing healing rate than drilling, and it is safer than CO2. Er:YAG has been addressed the capability in removing granulation tissues in vitro studies, and it showed better effect in removing micro-organism around implant fixture without causing any harmful to the adjacent tissues. In conclusion, Er:YAG is an effective laser machine for periodontal therapy due to the many advantages. However, clinical studies should be investigated the effective of this laser machine in vivo.