University Of Salahaddin

College Of Science
Department Of Physics




The Importance of Choosing the Right Laser
Irradiation Parameters for Effective Laser
Ablation of Dental Hard Tissue


Prepared By
Ali Mahmood Ali


Supervised By
Eman E. Said



May
2014 A.D.
i

Abstract
Various kinds of laser-dental hard tissue interaction mechanisms may occur by
altering the laser irradiation parameters (laser wavelength, pulse duration, fluence,
and intensity). The goals of this collection are to determine the most suitable
interaction mechanism for preparing dental hard tissues, and to determine the most
suitable laser type to do that interaction mechanism with less potential for
collateral damage to the tissues surrounding the target tissue.





















ii

TA B L E O F C O N T E N T S
C H A P T E R 1
The Energy That Causes the
Target Ablation: The Laser
1-1 Characteristics of Laser Systems 1
1-2 Parameters of Laser Beam 4
1-3 Laser delivery systems and modes of
operation 5
C H A P T E R 2
The Target Tissue That is Will
Be Exposed to Laser Beam: the
Tooth

2-1 Tooth Structure and Its Chemical
Composition 8
2-2 The Properties of Dental Hard
Tissues and the Thermal Relaxation
Time 10
2-2-1 Optical Properties 10
2-2-2 Thermal Properties 14
2-2-3 Thermal Relaxation Time 15
C H A P T E R 3
The Mechanisms of Laser-Tissue
Interaction and the Ablation of
Dental Hard Tissues

18
3-1 Photochemical Interaction 19
3-2 Thermal Interaction 20
3-3 Photoablation 24
3-4 Plasma-Induced Ablations 25
3-5 Photodisruption 26
Conclusion 28
References 30


1


C H A P T E R 1
The Energy That Causes the Target Ablation: The Laser

1-1 Characteristics of Laser Systems
Transitions between two energy levels in an atom can occur by stimulated
absorption, spontaneous emission, and stimulated emission. Einstein, in 1917, was
the first to point out a third possibility, stimulated emission, in which an incident
photon of energy hv causes a transition from upper state E
1
to lower state E
0

1
,
Figure 1. The basis of laser system is based on this theory.

Figure 1: Schematic drawing of stimulated emission
3
.
Laser energy is unique in that laser light is coherent this means that laser light has
four distinct properties that distinguish it from regular light. Ideal laser light is
monochromatic (composed of a single wavelength of light), collimated (the light
waves run parallel to each other instead of diverging), and uniphasic (the peaks
and valleys of the waves are synchronous [Figs. 2-1 and 2-2]). It is also extremely
intense
2
.
2


Figure 2-1: Regular light, showing the different wavelengths
present and the random spread of the beam. Laser
demonstrating uniform, coherent light.
2


Figure 2-2: Laser light, showing monochromatic wavelength,
collimation, and uniformity of phase, which constitute
coherent light.
2

An important result of these four properties is that laser light can be targeted with
great precision and is extremely powerful. Because the laser beam does not
diverge significantly over distance, the source can be positioned at great length
from the target tissue or can be very efficiently focused down to a small spot with
a convex focusing lens
2
. Fundamental components of a laser energy producing
devices are illustrated in figure 3 and as follows:
a. Active lasing medium
3

b. Energy source
c. Optical (Resonating) cavity
d. Cooling system
e. Delivery system.
3


Figure 3: Laser system illustration
3

The lasing medium can be a solid (e.g. Ruby laser), a liquid (e.g. Dye laser) or a
gas (e.g. Argon laser). The different types of laser are always named according to
the lasing medium. For example, the Nd:YAG laser has a solid lasing medium
which is a crystal of Yttrium Aluminum Garnet (YAG), doped with Neodymium
(Nd) . When the doping material is changed from Neodymium to Erbium (Er) for
the YAG laser, this laser is named the Er:YAG laser .The CO
2
laser has a carbon
dioxide gas as the lasing medium. The atoms or molecules of the lasing medium
are required to be excited in order to emit photons of laser light
4
. The pump
delivers energy to the active medium so that there can be a population inversion.
Population inversion is an ensemble of atoms having a greater population density
in the upper state than the lower state
5
. Usually pumping process is performed in
one of the following two ways:
4

(i) Optically, i.e. by the continuous wave or pulsed light emitted by a powerful
lamp or by a laser beam. The light Pumping sources include flash-lamps for
producing (pulse current), arc lamps (continuous current) and other lasers (laser
pump). Flash lamps generate much higher intensities.
(ii) Electrically, i.e. by a continuous wave, radio-frequency, or pulsed current
flowing in a conductive medium such as an ionized gas or a semiconductor
6
.
Of the main components of laser system is resonator cavity that surrounds active
lasing medium and energy source for pumping. Photons generated in the cavity
travel inside the cavity and reflected by two parallel mirrors one on either pole of
lasing cavity, so that they can be reflected in between until a parallel beam profile
is yielded. During excitation procedure, especially with high power laser systems,
also excessive amount of heat is generated that may rise up to levels that may
damage the system. Even low power laser systems may necessitate a cooling
system around the lasing medium and energy source
3
.

1-2 Parameters of Laser Beam
The clinician can adjust many parameters of the laser instrument emission, except
the wavelength, which has its unique photon energy .these photon produce a tissue
effect, known in basic physics as work. The ability to perform work is termed
energy and is expressed as joules or milli joules. The measurement of the work
completed over time is called power, and is measured in watts. One watt equals 1
joule delivered for 1 second, and the power can be selected by the operator on
each device. As discussed in a subsequent section, unless set in a continuous
mode, lasers can produce multiple pulses of energy in one second. The length of
each pulse, called pulse width or pulse duration, can be a short as a few ten-
thousandths of a second on certain instruments. The word hertz describes pulses
per second. Each pulse of laser light can have a much higher peak power, which is
numerically expressed as the energy per pulse divided by the pulse duration. For
those lasers with millisecond pulse durations, individual pulses of hundreds or
thousands of watts could be produced
7
. Depending on the length of on/off periods
5

(pulse duration/intervals between pulses) transferred energy varies, as well as
amplitude (Figure 4).


Figure 4: Transferred energy amount is related with pulse duration and intervals between two
pulses. Given energy is related with magnitude of power (W) and pulse length in one pulse
cycle, and repetition rate (Hz) in unit time.
3

Though same amount of energy output is yielded; different pulse durations or
repetitions rates affect the target in different ways
3
. Once the beam is focused, the
total energy it delivers is a function of the intensity of the beam, the time of
exposure, and the area affected. These are used to calculate the exposure dose
"Fluence
8
. Fluence, expressed in joules per square centimeter, is also called
energy density; the term power density describes the watts per square centimeter
7
.


1-3 Laser delivery systems and modes of operation
Scientific and commercial lasers produce highly collimated beams, but such a
beam is potentially dangerous in clinical situations
8
. Therefore, the collimated
beam is directed to the target site by various delivery systems
9
. And several
different delivery methods exist, depending upon wavelength, operating power,
desired spot size and accessibility of the target
10
. The shorter wavelength
instruments (visible and near infrared radiation), like argon, diode, and Nd:YAG,
have small, flexible glass fiber-optic delivery systems, with bare fibers that are
6

usually used in contact with the target tissue
11
. In addition, these fibers are small
in size (the diameter of fiber cores ranges from 5 to 500 m), which enables
minimally invasive surgical techniques (MIS)
12, 13
.Unfortunately, not all
wavelengths (e.g., CO
2
, Er: YAG) (10600nm, 2940 nm) can be transmitted
through the currently used quartz fiber-optic fibers
2
. Therefore, some
manufacturers have chosen to use semiflexible hollow wareguides or rigid
sectional articulated arms to deliver the laser energy to the surgical site. Some of
these systems use additional small quartz or sapphire tips that attach to the
operating handpiece; other systems simply are used out of contact with the tissue.
In addition, the erbium family of dental lasers uses a water spray for hard-tissue
procedures
11
. Although articulated arm delivery is functional for superficial
tissues, it is less than glass fibers for deeper tissues or areas of difficult access,
such as the oral cavity, the hollow waveguide system has dramatically improved
the dentist's ability to provide convenient, precise delivery within the oral cavity
2
.
There are two basic modes of laser emissions:
1. Continuous wave (CW) mode: in this basic mode the laser emits continuous and
constant laser energy as long as the device is activated
4
. Continuous wave output
transfers energy to the target without interruption that creates high thermal effect
at collision site. Its mostly used to destroy the aimed target by loading excessive
energy and rise the temperature until its burned out (Figure 5a)
3
. These lasers,
which emitted in CW mode, are sometimes equipped with a mechanical shutter
with a time circuit or a digital mechanism to produce gated or super-pulsed
energy. Pulse durations can range from tenths of a second to several hundred
microseconds
14
.
2. Free-running pulse mode: this mode is produced by a flash lamp
7
or by pulsed
current. With free-running pulse, very short bursts of laser energy, in the scale of a
few ten-thousandths of a second, emanate from the instrument (Figure 5b)
11
.
7


Figure 5: Working modes of laser. Line graphic show (a.) continuous wave and (b.) pulsed
beam profiles.
3

Longer pulses act like CW and tend to create more thermal damage on the target
and heat it easily; while short pulses create mechanical beat effect with less or
minor thermal damage like hammering. With this purpose shorter pulse rates
(ultrafast lasers) were introduced at microsecond (10
-6
second), nanosecond (10
-
9
second), picosecond (10
-12
second) and femtosecond (10
-15
second) ranges.
Depending on the type of laser system optically methods like mode locking or
pumping power modulation (gain switching) or Q switching techniques are used to
generate pulse mode operations
3
.







8

C H A P T E R 2
The Target Tissue That is Will Be Exposed to Laser Beam: the
Tooth

2-1 Tooth Structure and Its Chemical Composition
A clear understanding of laser and target tissue interactions enables the clinician to
choose the appropriate wavelength for specific procedures
9
. The tooth tissues can
best be explained by describing some of their chemical, optical, and thermal
properties. The teeth are composed of enamel, pulp-dentin complex, and
cementum. Dentin forms the largest portion of the tooth structure, extending
almost the full length of the tooth. Externally, dentin is covered by enamel on the
anatomic crown and cementum on the anatomic root. Internally, dentin forms the
walls of the pulp cavity (pulp chamber and pulp canal[s]) (Figure 6)
8
.

Figure 6: Human molar.
16

9

The pulp contains nerves, blood vessels, fibroblasts, and lymphocytes, while the
mineralized organs (hard tissues) of the tooth include enamel, dentin, and
cementum. Enamel makes up the uppermost 12 mm of the tooth crown and
contains a high mineral content, giving it a high modulus but also making it
susceptible to cracking
17
. Chemically, Enamel is the hardest biological substance
of human body and comprises 92% hidroxyapatite, 6% water and 2% organic
matter (insoluble protein fibers), while dentin composition is 47% Hidroxyapatite,
30% organic matter (strong meshwork of collagen fibers)and 23% water by
volume
18
. The junction between enamel and dentine is called the amelodentinal
junction (ADJ). The degree of mineralization increases from the ADJ to the
surface of the tooth, and that deciduous teeth have a lower mineral concentration
and higher porosity than permanent teeth. Hidroxyapatite (HA) has the chemical
formula Ca
10
(PO
4
)
6
(HO)
2
, but substituents such as Cl
-
, F
-
,Na
+
, K
+
, Mg
+2
and
CO
3
-2
exist in the crystal lattice. The last substituent, carbonate, is the most
important of all, representing 3% to 5% by weight. This mineral is organized in
hexagonal crystallites that have an average diameter of 40 nm and length of 40 nm
to 1 m (see Fig. 7), which in turn organize into larger structures, called the
enamel rods or prisms. The enamel rods have an average diameter of
approximately 5 m, and extend from the enamel-dentine junction to the free
surface of the tooth, being approximately perpendicular to that surface
15
.


(a) A schematic representation of a single crystallite.
(b) Electron micrograph of enamel crystallites. Organic material and water exist in the spaces
between the crystallites.
Figure 7: Enamel crystallites
15
.
10

Water and organic material are mainly located in micropores at the interface
between crystallites; the region of highest porosity is the boundary between
enamel rods, the rod sheath (figure 8)
15
.


Figure 8: Illustration of an enamel cross-section
19
.

2-2 The Properties of Dental Hard Tissues and the Thermal Relaxation
Time
2-2-1 Optical Properties
The optical properties of hard tissue play a major role in the ablation process
20
.
Laser beams may reflect off, transmit through, scatter (break up) within, or be
absorbed by organic target tissue
2
. When the laser light reflects off the surface
without penetration or interaction of the light energy with the tissue defined as
"Reflection"
4
. The second effect is transmission, in this way, the beam enters the
medium, but there is no interaction between the incident beam and the medium.
The beam will emerge distally, unchanged or partially refracted
21
. This effect is
also highly dependent on the wavelength of laser light. Water, for example, is
relatively transparent to the diode (810nm-980nm) and Nd:YAG (1064 nm)
wavelengths ( figure 10)
14
. If some laser energy is absorbed into a component of
11

the tissue, this is known as "Absorption". Lastly, when the laser light is scattered
within the tissue without producing a noticeable effect on the tissue, this is known
as "Scattering
4
. Scattering of the laser beam could cause heat transfer to the
tissue adjacent to the surgical site, and unwanted damage could occur. However a
beam deflected in different directions would be useful in facilitating the curing of
composite resin
14
.

Figure 9: incident laser light interaction with tissue event possibilities.
21

Selecting the appropriate laser for a given procedure usually is a simple matter of
determining which laser wavelength is best absorbed by the target tissue while
producing the least reflection, scatter, and transmission
2
. The total attenuation of
light intensity is then given by the extinction coefficient
t
=
a
+
s
22
. For the
efficient and gentle laser ablation with minimal thermal side effects, a small
light penetration depth is needed
20
. Therefore, for cutting the dental hard tissue
(enamel dentin and cementum), the suitable wavelength of the laser beam should
be maximally absorbed by hydroxyapatite (HA) and water
4
. Regarding
wavelength absorption graphic in (figure 10), erbium (Er:YAG and Er:Cr:YSGG)
family and CO
2
lasers had a great affinity to water and hydroxyl-apatite crystal
and their photons leave their energy on HA and water. Therefore, health care
professionals dealing with tooth or bone in their operational practice or researchers
should prefer wavelengths between 2780 to 10600nm to obtain highest efficacy
3
.
12


Figure 10: Outline absorption coefficients (hydroxyapatite and water) relative to laser
wavelength
21
.
The CO
2
laser is strongly absorbed by the mineral of dental hard tissues near =9
m, due to the phosphate group of hydroxyapatite. The absorption coefficient of
dental enamel has been determined to be approximately 8000 cm at =9.6 m
and 5250 cm at =9.3 m, which is approximately 10 times higher than for the
conventional =10.6 m CO
2
laser wavelength used in medicine today and is
markedly higher than for any other laser wavelengths throughout the visible and
IR spectra (see table 3.1)
23
. But, a very high (>> 1000 cm
-1
) absorption coefficient
like CO
2
laser near =9 m will imply that most of the energy will be absorbed in
a layer of material less than 10 m thick. Therefore, the depth of material ablated
per pulse will be somewhat small, which indicates that ablation will proceed
slowly unless high repetition rates are used. However, repetition rates may not be
raised indefinitely, since at some point heat accumulation will occur from one
pulse to the next and thermal damage will be more likely to occur. On the other
hand, if the material has an absorption coefficient lower than 100 cm
-1
, most of the
radiation will be absorbed in a layer over 0.1 mm thick, which clearly does not
enable us to obtain the necessary precision. This implies that the most adequate
wavelengths will have an absorption coefficient in enamel and dentine between
13

100 and 1000 cm
-1
, perhaps slightly
15
. Examples of this include the Er:YAG laser
at (2.94 m) and the CO
2
laser at (10.6 m) (see table 1).The Er:YAG (2.94
m)and the CO
2
(10.6 m)lasers are absorbed equally well by enamel (absorption
coefficient 800 cm
-1
for both wavelengths ) and have similarly low reflectance
(5 13%) in enamel. The reflectance of enamel varies widely in the mid-IR
spectral region, between a minimum of 5% near 3m to a maximum of 50% at 9.6
m. Scattering is known to be very small at CO
2
wavelengths. Other wavelengths
in this region were not investigated, although in general it is expected to be
small
15
.
Table 1: Optical properties of human dental enamel obtained experimentally.
15

Wavelength Absorption
coefficient (cm)
Scattering
coefficient (cm)
Reflectance (%)
HeNe (633 nm) 66 66
Er:YSGG (2.79 m) 47747 52%
Er:YAG (2.94 m) 79585 51%
CO
2
(9.3 m) 5500 small 37.50.5
CO
2
(9.6 m) 8000 small 49.41
CO
2
(10.6 m) 81962
82525
small

13.20.2

The light attenuation in material with negligible scattering is described by the
Lambert-Beer law:
20

I (z) = I
0
e
- z
(1)
I
0
,

is the incident irradiance , is the linear optical absorption coefficient and I(z)
is the irradiance at the depth z in the absorber. The depth at which the irradiance
drops to the 1/e (~ 37%) level is called optical penetration depth d and is given
by:
20

d = 1 /
a
(2)

14


2-2-2 Thermal Properties

Considering the laser irradiation in dental hard tissues, it is necessary to know and
to understand the thermal behavior of these tissues when submitted to heating
24
.
During the laser-tissue interaction, the main cause of the resulting thermal damage
is the heat transfer, which includes heat conduction, heat convection and heat
radiation. Usually, due to the moderate temperature achieved in most laser-tissue
interactions and the low perfusivity of most tissues, heat radiation and convection
can be neglected. Heat conduction is the primary mechanism by which heat is
transferred to unexposed tissue structures
25
. Thermal parameters include thermal
diffusivity and thermal conductivity, which refer to the rate and amount of heat
diffusion through a medium, respectively. Thermal diffusivity is an important
thermo-physical parameter given by:
26

= / C (3)
Where is the thermal diffusivity, is the thermal conductivity, is the density
and C is the heat capacity
26
. Several studies about thermal parameters
measurement in hard dental tissues have been published. Results of these studies
are summarized in table 2.
Table 2: Thermal parameters of dental hard tissues (enamel and dentin) and water.
24

Thermal parameter Enamel Dentin Water
Specific Heat (J/g C) 0.71 1.59 4.18
Thermal conductivity (W/cm C). 9.3410
-3
5.6910
-3
6.110
-3

Thermal diffusivity (cm/s) 4.69 10
-3
1.8610
-3
1.310
-3


Although these thermal values are well-established in literature and can be used
for supporting clinical applications, it is important to consider that all parameters
were measured at room temperatures. In the moment of laser irradiation of dental
hard tissues, the temperature increase can lead several chemical and ultra-
15

structural changes on enamel and dentin; as a consequence, the tissue thermal
characteristics of tissue may change during laser irradiation. Dentin and cementum
have higher water and organic compound percentage when compared to the
enamel and, due to this composition, they are more susceptible to heat storage than
the enamel. Dentin has low thermal conductivity values and offers more risk when
lasers irradiate in deeper regions, considering that dentinal tubules area and
density increase at deepest regions, and subsequently, can easily propagate the
generated heat. As an example, considering the use of CO
2
lasers in dentistry
(wavelength of 9.6 m or 10.6 m), the absorption coefficient for dentin tissue is
lower than enamel due to its low inorganic content; also, the thermal diffusivity is
approximately three times smaller, which can lead a less heat dissipation amount
and, as a consequence, can induce higher pulp heating
24
. A rise in pulpal
temperature results in a hyperaemic reaction of the pulpal blood flow. This
intensified blood circulation is reversible if the intrapulpal temperature rise ranges
between 6-12C. If more than 12 C rise, an irreversible pulp necrosis occurs
27
.

2-2-3 Thermal Relaxation Time
There are some other thermal parameters related to the heat propagation. The
thermal penetration length (z
thermal
) is a parameter that describes the propagation
extension per time, and it is given by:
24

z
thermal
(t) =(4t)
1/2
(4)
Where is the tissue thermal diffusivity and t is the time. Other important
parameter is the thermal relaxation time (
thermal
), which is obtained
mathematically correlating the optical penetration length (from eq. 2) with thermal
penetration length (from eq.4) (if the laser spot is large compared to the depth of
penetration of radiation):
24, 15
d = z
thermal
(5)
Then, t is called thermal relaxation time
thermal

16

1 /
a
= (4
thermal
)

(6)

thermal
= 1 / 4.
a
2
. (7)
The thermal relaxation time describes the necessary time to the heat propagates
from the surface of irradiation until the optical penetration length and is
particularly important when the intention is to cause a localized thermal damage,
with minimal effect in adjacent structures. This parameter can be interpreted as
follows: if the time of the laser pulse (
p
) is smaller than the relaxation time, the
heat would not propagate until a distance given by the optical penetration length d
(fig.11-a, fig. 11-b). So the thermal damage will happen only in the first layer
where the heat is generated. On the other hand, if the time of the laser pulse (
p
) is
higher than the relaxation time, the heat would propagate for multiple of the
optical penetration length d, resulting in a thermal damage in a bigger volume to
the adjacent structures (fig.11-c)
24
. Therefore, the optimal pulse durations are
ultimately a function of the optical properties of the material. For high absorption
wavelengths, with absorption coefficients on the order of 100 to 10000 cm
1
, the
thermal relaxation times are on the order of milliseconds to tenths of
microseconds, as can be seen in Table 3
15
.

Table 3: Thermal relaxation time for various optical absorption coefficients. Calculated using
the material parameters for enamel: thermal diffusivity = 0.47 mm/s, density = 3100 kg/m,
specific heat = 880 J/kg/C. The thermal relaxation times for dentine are similar.
15

Absorption coefficient
(cm)
Optical penetration
depth (m)
Thermal relax. time (s)
1 10000 50
10 1000 0.5
100 100 0.005
1000 10 5 10
5

10000 1 5 10
7

17

Pulse durations longer than the values references in Table 3 will inevitably cause
more extensive thermal damage and will thus be less preferable than shorter
pulses, unless some sort of cooling mechanism such as water spraying is used
15
.


Figure 11: Heat propagation in biological tissue. Optical penetration depth d is the depth at
which the irradiance drops to the 1/e (~ 37%) level (i.e., I = 0.37 I
0
).




18

C H A P T E R 3
The Mechanisms of Laser-Tissue Interaction and the Ablation of
Dental Hard Tissues

Various kinds of interaction mechanisms may occur when laser light is applied to
biological tissue
28
. For laser tissue interaction, there are mainly five categories of
interaction types:
1. Photochemical interactions
2. Thermal interactions
3. Photoablation
4. Plasma-induced ablation
5. Photodisruption
25

However, most interactions do not fall clearly into one of these categories, and
often multiple processes are competing with each other
25
. All these seemingly
different interaction types share a single common datum: the characteristic energy
density ranges from approximately 1 J/cm to 1000 J/cm. It is surprising, that the
power density varies over 15 orders of magnitude. A double logarithmic map with
the five basic interaction types is shown in (fig.12) as found in several
experiments. The ordinate expresses the applied power density or irradiance in
W/cm
2
the abscissa represents the exposure time in seconds
28
.
19


Figure 12: Double logarithmic plot of the power density as a function of exposure time. The
circles show the laser parameters required from a given type of interaction with biological
tissue
29
.

3-1 Photochemical Interaction
The group of photochemical interactions originates from empirical observations
that light can induce chemical effects and reaction within macromolecules or
tissues. Photochemical interaction occurs at very low power densities (typically 1
W/cm) and long exposure times in the range of seconds to CW
28
. There are
photochemical effects that the laser can stimulate chemical reactions, such as the
curing of composite resin
14
. Careful selection of laser parameters yields a
radiation distribution inside the tissue that is determined by scattering. In most
cases wavelengths in the visible range are used because of their efficiency and
their high optical penetration depths
10
.
20


3-2 Thermal Interaction
The thermal interaction is of primary importance for surgical applications
10
.
Energy of the photons is absorbed by the tissue and transformed into heat, and,
depending on heat propagation and deposition in tissues, the photothermal effects
originate
3
. The basic parameters that govern thermal effects are summarized in the
following figure 13. Heat generation is determined by laser parameters and optical
tissue properties (irradiance, exposure time and the absorption coefficient, which
is a function of the laser wavelength). Heat transport is characterized by thermal
tissue properties such as heat conductivity and heat capacity. Finally, Heat effects;
depend on the type of tissue and the temperature achieved inside the tissue
30
.

Figure 13: Flow chart with important parameters for modeling thermal interaction.
30
Thermal interaction represents a large group of interaction types, where the
increase in local temperature is the significant parameters change. Thermal effects
can be induced by either CW or pulsed laser radiation
28
. Thermal interactions
usually happen for pulse duration of s or higher
25
. With photothermal effects,
there is no specific pathway, and the photons may be absorbed by any biomolecule
and still lead to a thermal effect
31
. However, depending on the duration and peak
value of the tissue temperature achieved different effects like vaporization,
carbonization, and melting may be distinguished
28
. Vaporization at temperatures
21

above 100 C leads to destruction of the cellular water. The increase in
temperature leads to an increase in pressure as water within the hydroxyapatite of
a dental hard tissue tries to expand in volume. This leads to localized
microexplosions and is thus sometimes referred to as a thermomechanical effect
10
.
Through this mechanism, whole tissue fragments are ejected and a hole is cut in
the tooth, with little or no alteration to the mineral itself (Fig.14)
32
.The resulting
ablation is called thermal decomposition (thermomechanical ablation) and must be
distinguished from photoablation which is discussed in a following section. This
vaporization is sometimes advantageous, since the vapor generated carries away
excess heat and helps to prevent any further increase in the temperature of
adjacent tissue
10
. Carbonization happens at temperature above about 150C and
will lead to a blackening in color
25
. Finally beyond 300 C, melting can occur
depending on the target material
10
. For example, Enamel surface melting requires
heating up to 1200
0
C
33
.

Figure14. Theoretical zones of tissue change associated with hard dental tissue exposure to
laser light
21
.
For the ablation process to be effective and sparing for the surrounding tissue, a
fast energy deposition is obviously required. It is necessary to guarantee that the
22

internal pressure build-up is faster than the heat diffusion. Only in this case will
the main part of the deposited energy be used for the ablation itself and the heat
will leave the tissue together with the ejected tissue particles (debris) and vapor. It
is obvious that the ablation efficiency directly influences the thermal side
effects
20
. In addition, to minimize the thermal damage of the surrounding dental
tissue during laser treatment, should be selected a wavelength that is preferentially
absorbed by the target tissue with a laser exposure duration that should be shorter
than the thermal relaxation time of the tissue
27
. Therefore, CW or long-pulse
lasers are not appropriate to drill tunnels through enamel or dentine in a clinically
safe manner and with the necessary precision
15
. The Continuous-wave lasers and
pulsed lasers with pulse durations in the microsecond range but higher than the
relaxation time generate considerable heat in the region of the pulp chamber
during the irradiation process
27
. The adjustment of repetition rate is important to
assure that the inter-pulse period is longer than the thermal relaxation time of
tissues; in this way, it is possible that the temperature of the irradiated tissues
decrease between laser pulses
34
. Due to the dependence of the optical penetration
depth on the absorption coefficient
a
the thermal relaxation time becomes
proportional to
thermal
~
a
-2
and is dependent on the wavelength. As a result, the
thermal relaxation time is the shortest at the wavelength where absorption is the
strongest. Stronger absorption leads to steeper temperature gradients and, with
that, to faster heat diffusion
20
. The Er:YAG (2.94 m)and the CO
2
(10.6 m)lasers
which are absorbed equally well by enamel (absorption coefficient ~ 800 cmfor
both wavelengths)
15
, for enamel with thermal diffusivity = 4.710
-3
cm/s
24
, the
thermal relaxation time for these lasers is (~8.3 s).Therefore, to achieve efficient
thermomechanical ablation with minimum damage to the surrounding dental
enamel tissue, the pulse duration of the Er:YAG and CO
2
lasers must be
significantly less than 8.31 s. (This value is only estimation due to the variation
in the material constants of tooth tissue. In (Ivanenko et al., 2005) the values
estimated for the two thermal relaxation times from the literature material
constants are 11.3 s and 5.6 s for 2.94, and 10.6 m, respectively.) .
Theoretically, (lateral) thermal damage of tissues is limited when the laser
intensity is high and the interaction time is short: e.g., the Q-switched Er:YAG
23

laser operating with a pulse length below the thermal relaxation time of the
irradiated tissue. However, (Dayem et al) found that nanosecond Er:YAG laser
pulses used at a high repetition rate and high power resulted in crack formation at
the edges or the bottom of the crater, because of an abrupt rise in temperature
and/or the stress transients induced In contrast, the free-running Er:YAG laser was
considered to be very effective, although the reduced energy deposition time of
short pulses results in smaller volume heating, and the threshold energy for
ablation decreases (see Table 4)
35
. The cracks and fissures are certainly not
desirable since they may serve as an origin for the development of new decay.
Table 4: acoustical relaxation time for Each Er:YAG (2.94 m) and CO
2
(10.6 m) lasers.
[When the speed of sound (v
S
) in the enamel = 6500 m/s]
36
.
Wavelength Absorption coefficient
(cm)
Acoustic relax. time

ac
(ns)
Er:YAG (2.94 m) 79585
15

2170
20

1.930.19
0.71
CO
2
(10.6 m) 81962
15

3080
20

1.880.14
0.5

A laser pulse whose duration is shorter than
a
= d
ABS
/v
S
builds up mechanical
energy within the optically affected zone in the form of acoustic waves. This
condition is called the stress confinement condition
37
. Under stress confinement
conditions, the stress transients are normally much higher than the quasi-static
thermal stress generated in the material and, consequently, mechanical damage
such as cracks is much more likely to occur
15
. One can conclude that, using
microsecond-long pulses, the thermal interactions dominate and the transient
stresses induced in the material are likely not playing a determinant role in
ablation
37, 15
. With sub-microsecond laser pulses, photomechanical interactions
result from the conversion of laser energy into mechanical energy by the rapid
temperature increase
37, 15
. Additionally a sufficient quantity of driving material
is necessary for the micro-explosions, i.e. enough tissue water
20
. Because
24

externally applied water, serves multiple purposes during ablation. The first
purpose, and easiest to understand, is that of a coolant: applied water is
indispensable to cool the ablation site for IR lasers. Secondly, water plays a role
during ablation, and influences the ablation rates
15
.

3-3 Photoablation
In the case of UV laser radiation, the ablation mechanism is usually described as
photoablation or direct photoablation. This means the laser photons have enough
energy to break molecular bonds i.e. the photon energy is high enough to create
repulsive states in which the molecule breaks apart, thus causing tissue ablation
20
.
At pulse durations in the range of nanoseconds, the typical threshold values of
power densities for this type of interaction are 10
7
10
8
W / cm
2

30
.Lasers emitting
in this region are ArF at 193 nm (6.4 eV), KrF at 248 nm (5.0 eV), XeCl at 308
nm (4.0 eV) and XeF at 351 nm (3.5 eV), among others. The absorbers in this
region will most likely be the covalent bonds existing in the organic material
making up enamel and dentine. Under these conditions the material decomposes
because the energy of the photons is sufficient to break existing covalent bonds, as
can be seen in Table 5. The excess energy not used in the dissociation of the
molecule remains in the molecular fragments as kinetic energy and these
subsequently leave the material
15
.
Table 5: Dissociation energies of selected chemical bonds
39
.


25

The fact that the main absorber of UV radiation should be the organic material
existing in dental hard tissue, conjugated with its inhomogeneous distribution in
enamel and dentine, suggests that the mesostructure of the material will play a role
during ablation. It also indicates that the preferably ablated regions at the
irradiated surfaces should be the dentinal tubule content, in dentine, and the rod
boundaries in enamel. This may have an influence on the surface morphology of
the irradiated site and, consequently, on the ability of the surface to bond to filling
materials subsequently to ablation. In general, ablation with UV wavelengths does
not lead to significant melting or carbonization, thus making these lasers
potentially good choices to drill long tunnels through enamel and dentine
15
.
Although they provide very precise cuts there is a concern of potentially
dangerous mutagenic cell effects caused by the energetic UV photons
38
.
Additionally, the ablation rates in the UV are extremely small, measuring typically
in the tens of nm/pulse regime
20
. Furthermore, the UV pulse duration is rather
close to the acoustic relaxation time of materials, which means that it is possible
that these lasers induce mechanical damage (cracks) in the material, because of the
stress transients created
15
.

3-4 Plasma-Induced Ablations
The laser creates numerous ionized molecules and free electrons. These ionized
molecules and electrons are ejected from the surface and form a localized cloud
called plasma (which reaches a state called optical breakdown)
37, 15
. Picosecond
(
p
<10 ps) and femtosecond lasers are available, plasmas can be generated while
keeping the photodisruptive effects to a minimum
31
and, therefore, the ablation
mechanism in question here is plasma-induced ablation. The plasma-induced
ablation concerns very clean and well defined removal of tissue without evidence
of thermal or mechanical damage, if the appropriate laser parameters are chosen
30
.
In fact, femtosecond laser ablation can occur even at wavelengths very poorly
absorbed by the material
15
. The generation of a plasma, spatially confined to the
focal region of the laser, can be used to ablate tissue in a very controlled and
precise way
31
. The typical threshold intensities of optical breakdown for
26

picosecond pulses are 10
11
W / cm
2
, whereas the corresponding electric field
amounts to approximately 10
7
V / cm, which is comparable to the intramolecular
Coulomb electric fields and provides the necessary conditions for plasma
ionization
30
. One should note that the depth of the layer in which most of the
energy is deposited is approximately 1 m. Kruger et al. investigated the outcome
of a = 615 nm femtosecond laser (pulse duration = 300 fs, repetition rate = 3 Hz,
fluence per pulse = 0.5 3 J/cm
2
, 100 pulses per spot) on enamel and dentine,
without water cooling, and found that both materials could be ablated very
precisely, with little or no evidence of melting, charring or cracking, and using
much lower fluencies (1 J/cm
2
) than those necessary with longer laser pulses
15
.

3-5 Photodisruption
For pulse durations between 10 ps and 100 ns and high radiation intensity (10
11

10
16
W/cm
2
)
15
, optical breakdown is associated with shock wave formation
30
.
When the laser pulse duration exceeds the onset of plasma formation, the plasma
further absorbs and scatters the incident laser energy, which consequently gives
rise to plasma shielding. As a result of this, the plasma expands rapidly and
eventually collapses. The rapid expansion of plasma can induce shock waves that
produce photomechanical fragmentation
37
. Additionally, if the optical breakdown
takes place inside soft tissues or fluids, cavitation which occurs when focusing the
laser beam not on the surface of a tissue but into the tissue, and jet formation may
be observed. Since the effect appears mechanical impact, the most appropriate
term to use is disruption (Figure 15)
30
.
27


Figure 15: Schematic illustrations of shock wave induced ablation. (a) The
initiation of optical breakdown (ionization process). (b) Plasma formation and its
shielding of the incident light in an early stage. (c) Plasma expansion
accompanied with generation of shock waves. (d) Photoacoustical ablation with
mechanical fractures inside the crater
37
.

The shock waves in photodisruption are able to travel outside the optical
breakdown area, thus causing damage outside it also. This damage is, non-
intuitively, more intense with longer (nanosecond) pulses, where it can affect areas
on the order of millimeters, than with shorter pulses. The mechanism in question
at these pulse durations and irradiation intensities strongly suggests that these will
be less than adequate to ablate brittle materials such as dental hard tissues, because
of the risk of developing deep cracks
15
.





28

Conclusion
Dental hard tissue experiences ablation by doing thermaly, opticaly, or chemicaly
interaction with laser beam. A laser so as to be used instead of conventional tissue
removal methods, it it should be able to do somethings that they can not do. But,
neither of the types of laser-tissue interaction (photothermal, photochemical,
photo-optical, photomechanical) is entirely useful, and completely safe. Because
all of them can expose undesirable effect to the tissues surrounding the target
tissue. Therefore, before a laser being comparised with the conventional tissue
removal technique, must be determined that which one of the laser-hard tissue
interaction mechanisms have more good sides. The most importance one between
the desired effects which required from a laser in the processing the hard tissue is
decreasing the risk of damage to the surrounding tissues. For example, occuring
such event as (crack generation on the irradiated surfaces, carbonisation, pulp
necrosis, or DNA mutation in dental hard tissues) is never wanted. For this reason,
must be avoided from occring the UV specific photo ablation which causes
mutation in DNA and the photo-disruption which generates the shock waves,
which in turn are able to form cracks. The plasma mediated ablation mechanism
and the photo-thermal interaction will remain. Although the plasma mediated
ablation technique has got very effective efficacies (it does not display thermal or
mechanical damage) , its ablation rate is very low which determines that the
operation duration will have increased for removing a great volme of target tissue,
which in turn is an undesired condition. n addition, the ablated surfaces appear to
be very smooth with this technique and thereby decreases the adhesion of
composite material to the tooth structure. Conversely, in photo-thermal effect,
laser with an appropriate wavelength, pulse duration, and fluence produces micro-
explosions during hard tissue ablation that result in microscopic and macroscopic
irregularities increase the adhesion of the composite resin. The laser device, which
is operated in the plasma induced ablation technique, is very expensive
15
. n many
directions, it seems that utilization of photo-thermal effect will be more suitable. in
order to benefit from photo-thermal effect, the law of thermal relaxation time must
be understood. This law function as association linkage between the optical
penetration depth and the thermal penetration depth.therefore, this is exceedingly
29

important in controlling thermal damage to the surrounding tissue. The Er:YAG
(at = 2.9 m) and the CO
2
laser (at = 10.6 m), which operate in free-running
mode, are deemed suitable lasers, which achieve photo-thermal interaction with
the dental hard tissue. Although they irradiate the dental hard tissue with pulse
duration longer than the thermal relaxation time, an effect that can cause
undesirable thermal damage, this problem is solved by using laser supported with
water spray. The ablation rates of enamel by Er:YAG lasers are higher when a
water layer is previously applied to the ablation site. On the other hand, ablation
rates by the CO
2
laser at 9.6 m when water is used are lower than when water is
not applied, and it is likely that the same behavior is observed for = 10.6 m,
since these wavelength is highly absorbed by the mineral, the added water in effect
decreases the efficiency of the energy coupling to the material thus making
ablation less efficient
15
.According to this collection, among the many laser-hard
tissue interaction mechanism that have been expressed, one of the most suitable is
the photothermal interaction. In addition, the free-running Er:YAG laser is the
most suitable one to achieve this interaction.











30

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