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LASER
LASERS AND ITZ APPLICATIONS IN DENTISTRY

By: Lokender Yadav

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Introduction
History
Fundamentals Of Laser Operation
Classification Of Lasers
Current Uses
Technique For Use Of Laser In OMFS
Laser Safety
Conclusion
 Introduction 3

Advances in technology are increasing and

changing the ways that patient experience dental
treatment. Technology helps to reduce treatment
time and treatment more comfortable.
One of the milestones in technological
advancements in dentistry is the use of LASERS.
The term Laser is the acronym for Light
Amplification by Stimulated Emission of Radiation.
They provide more efficient , more comfortable and
more predictable outcomes for the patient.
HISTORY 4

1917- Einsteen Theory of stimulated

emission
1958 Townes & Schawlow Laser principle

1960 - Maiman Ruby laser

1961 - Johnson Neodymium ion doped

yttrium aluminium garnet rod
1964 - Patel CO2 Laser

1977 - Shafir First documented case in

OMFS using lasers
1989 Terr Myers First Dental Laser Nd:YAG
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3 Mechanisms of Light
Emission 6

For atomic systems in thermal equilibrium with their

surrounding, the emission of light is the result of:
Absorption
And subsequently, spontaneous emission of energy
There is another process whereby the atom in an upper
energy level can be triggered or stimulated in phase with
the an incoming photon. This process is:
Stimulated emission
It is an important process for laser action

Therefore 3 process 1. Absorption

of light emission:
2. Spontaneous Emission
3. Stimulated Emission
Absorption 7

E1

E2
Spontaneous Emission 8
Stimulated Emission 9
 Background Physics 10

In 1917 Einstein predicted that:

under certain circumstances a photon incident upon a
material can generate a second photon of
Exactly the same energy (frequency)
Phase
Polarisation
Direction of propagation
In other word, a coherent beam resulted.
 Fundamentals Of Laser Operation 11

Components -
Active medium [ Lasing Medium ]
Pumping mechanism
Optical Resonators
Laser Delivery System
Cooling system
Control Panel
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 E2 E2 E2 13
h h
h h In
Out
h

E1 E1 E1

(a) Absorption (b) Spontaneous emission (c) Stimulated emission

Absorption, spontaneous (random photon) emission and stimulated

emission.
1999 S.O. Kasap, Optoelectronics (Prentice Hall)
Stimulated Emission 14
Properties Of LASER 15

Monochromaticity
Directionality
Coherence
Brightness
Photobiology Of Lasers 16

Photochemical
Biostimulation - Stimulatory effects of laser on
biochemical and molecular processes that
normally occur in tissues such as healing and
repair.
Photodynamic Therapy induce reactions in
tissues for the treatment of pathologic condition.
Tissue fluorescence - used as a diagnostic
method to detect light reactive substance in
tissue.
 Photo thermal interactions- 17
Photo ablation removal of tissue by vaporization and
super heating of tissue fluids , coagulation, and
hemostasis.
Photopyrolysis

Photomechanical

Photo disruption - breaking apart of structures by laser light.

Photoaccoustic interaction- involve removal of tissue with shock wave

generation.
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Photoelectrical Interaction- include photoplasmolysis
which describes how tissue is removed through the
formation of electrically charged ions and particles
that exist in a semi gaseous high energy state.
LASER INTERACTION WITH 19

ORAL BIOLOGIC TISSUE

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Photocoagulation : Laser
heats the tissues
to 60 deg C for a limited time
leading to coagulation of the
tissues with minimal alteration in the
appearance of tissue structure. As
a result of these proteins enzymes
cytokines and other bio active
molecules get denatured.
Classification Of Lasers 21
General Classification

Class 1 Non Hazardous Producing

Laser
Class 2 Hazard producing when
passed through magnifying
optics
Class 2 M Safe, if not viewed through
optical instruments
Class 3 R Safe with restricted beam
viewing
Class 3 B Direct viewing hazardous to
eye
Class 4 Serious injury potential to
eye and skin
Laser Classification as per medium
Used
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Solid State Laser Eg-Neodymium-yttrium aluminium

garnet laser

Gas Laser Eg- Helium & Helium Neon

Excimer Laser Uses reactive gases like chlorine and

fluorine eg : argon laser

Dye Laser Complex dyes like Rhodamine 6G

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High Power Lasers-

Used for surgical
purpose
Medical
Classification Of
Lasers
Low power Lasers-
Used to promote
tissue regeneration
General Medical Uses Of Laser 24

Angioplasty
Cancer diagnosis
Cancer treatment
Laser hair removal , tattoo removal
Dermatology
Medical imaging
Microscopy
Ophthalmology
Optical coherence tomography
Prostatectomy
Surgery
Laser Dentistry
Photodynamic Therapy 25
Uses In Dentistry 26

Excimer Lasers
Hard tissue ablation/ Dental Caries removal.
Argon Fluoride / Xenon fluoride lasers are used.
They have a wave length from193nm to 308nm.
 Gas Laser 27

Carbon dioxide lasers are used for intra oral and implant
soft tissue surgery , aphthous ulcer , melanin pigmentation.
Has a wavelength of 10600nm. Color- Infrared
Helium Neon Lasers has a wavelength of 637nm and is used
for dentin hypersensitivity , analgesia etc. Color-Red
Argon lasers having a wavelength of 488nm & are used for
tooth whitening , curing of composites , curettage etc
Color-Blue
 Diode Lasers 28

Indium Gallium Arsenide Phosphorous are used for

caries and calculus detection and has wavelength of
655nm. The color of the laser is Red.
Gallium Aluminum Laser Intra oral Surgery , Implant
soft tissue surgery , sulcular debridement , Pulpotomy ,
root canal disinfection removal of enamel caries etc,
Wavelength- 840nm Color-Infrared
 Solid state Laser 29

Neodymium:YAG Laser Intra oral soft tissue surgery ,

sulcular debridement , analgesia , Pulpotomy , root
canal treatment, removal of gingival melanin
pigmentation . Has a wave length of 1064nm and is
infrared.
Erbium Group 30

Erbium:YAG is used for modification

of enamel and dentin surface ,
implant soft tissue surgery , sulcular
debridement , osseous surgery ,
treatment of dentin hypersensitivity
, apthous ulcer treatment etc
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Techniques For Incisional Biopsy 32

Provide local or general anesthesia.

Outline the intended superficial incision
line without deep penetration.
Connect the outline marks.
Excise the specimen.
Obtain Homeostasis.
Consider the need for suturing.
Consider tagging the biopsy margins.
Lesions treated 33

Fibroma
Mucocele
Papilloma
Gingival lesion
Salivary stones
Malignancy removal
Vestibuloplasty
Incisional and excisional biopsy
Tongue lesion treatment
Technique for ablation and vaporization 34

Laser vaporization is an effective , non-

morbid , inexpensive , quick , and relatively
painless method of managing pre malignant
lesions.
A spot size of 1.5 to 3mm is typical for most
intra oral vaporization procedures. The beam
is transverse in vertical strokes.
A constant speed must be maintained to
create a uniform depth. Increasing depth can
be accomplished by increasing power.
Allows for removal of a surface lesion in
layers.
Uses Of Laser Ablation 35

Solar chelitis
Leukoplakia
Dysplasia
Lichen Planus
Oral melanosis
Nicotine stomatitis
Tissue hyperplasia
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Lasers are also used in arthroscopic surgery of TMJ
Scar revision is also made possible these days with the help of pulsed dye
lasers[PDL]. PDL have hb as their chromophores and penetrate the epidermis
without de-epithelisation. They reduce scar tissue erythema and induce
collagen remodeling to flatten and soften scars. Indicated in cases with
erythematous and hypertrophic scars of maxillofacial region.
Low level Laser therapy 37

Also known as therapeutic laser

treatment.
Promotes tissue healing , reduces
edema , inflammation and pain.
Used in cases of dermatological
conditions , neural ailments ,
mucoskeletal ailments etc
 Easy and safe to handle 38
Improved surgical versality- ability to vaporize
coagulate and incise tissue.
Reduces / Eliminate bleeding.
Spot coagulation and vaporization gives
excellent hemostasis.
Reduces Operating Time.
Anesthesia free soft and hard tissue cutting
No need for suturing
Instant sterilization of surgical site
No sensory disturbances
No functional /mobility disorder
Demerits 39

Cannot be used in teeth with

restoration and prosthesis.
Hazard to patient , operating and
assisting team.
Maintenance requirements
Electrical hazards of laser equipments
Expense of laser equipments
Specialized arrangements
Fire hazards
 Laser Hazards 40

Primary Hazards: Caused directly by laser beam.

Endangers mainly two organs-
Eyes and Skin
In case of eyes it damages retina , cornea , & the
lens and slight carelessness can destroy vision
permanently.

Secondary Hazards : Its related to operation of the

laser and are independent of radiation
characteristics.
 Operating Room Safety 41

Patient Safety

Use of non inflammable materials

Use of eye shields for the patient
Use of laser resistant shielding materials for surgical
field and for protecting anesthesia equipments
Certain anesthesia techniques may also decrease
potential hazard
Personnel Safety 42

Post signs that lasers are being used

Eye shields to be worn by all personnel in
operating room
Safety shields must be used
A laser safety officer should be stationed at the
laser unit
Use only wet cloth in operative field
Use only non-combustible anesthetic agent
Avoid alcohol based topical anesthetic and
gauze
Protect tissues adjacent to surgical site
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Sterilization And Infection Control Of Laser Unit 44

Steam sterilization is the standard of care

Protective housing around the laser and
articulating arm should receive spray disinfectant
Treatment Process 45
 Conclusion 46

The past decade has seen a variable explosion of research

into clinical application of lasers in dental practice. Laser
treatment not only is helpful in treating general problems of
the teeth but also helps to reduce the fear and anxiety of the
patient towards the treatment.
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