[Downloaded free from http://www.sidj.org on Saturday, December 12, 2020, IP: 111.92.50.

231]

Review Article

Access this article online

Quick Response Code:
Lasers in prosthodontics
Sakshi Kaura, Anuj Wangoo, Ramanpreeet Singh, Simratdeep Kaur

Abstract:
The introduction of lasers in the field of prosthodontics has replaced many conventional surgical and technical
Website: procedures and is beginning to replace the dental handpiece. Since its first experiment for dental application
www.sidj.org in the 1960’s the use of the laser has increased rapidly in a couple of decades. Today lasers have become an
integral part of effective treatment planning. This article reviews the literature on lasers with the aim of providing
DOI:
10.4103/2454-3160.161795
a complete understanding of fundamentals of lasers and their applications in various fields of prosthodontics.
Key words: crown, dental lasers, prosthodontics

T he laser is an acronym, which stands for

light amplification by stimulated emission
of radiation. Lasers were developed and actually
research laboratories, of 0.694 mm and in 1961  s
laser neodymium (Nd) laser by Snitzer.

used in light shows and for other purposes. Today
the laser is used in the scanners at the grocery
store, in compact disc players, and as a pointer for
lecturer and above all in medical and dental field.
The image of the laser has changed significantly
over the past several years.
With dentistry in the high tech era, we are
fortunate to have many technological innovations
to enhance treatment, including intraoral video
cameras, computer‑aided design‑computer‑aided
manufacturing units, RVGs and air‑abrasive units.
However, no instrument is more representative
of the term high‑tech than, the laser. Dental
procedures performed today with the laser are
so effective that they should set a new standard
of care.
Invention of Laser
Einstein’s atomic theories on controlled radiation
can be credited as the foundation for lasers
technology in 1917.
Department of Nearly 40 yearly, American physicists Townes
Prosthodontics, Luxmi first amplified microwave frequencies by the
Bai Institute of Dental stimulated emission process and the acronym
Sciences and Hospital, microwave amplification by stimulated emission
Patiala, Punjab, India
of radiation (MASER) came into use.
Address for
correspondence: In 1958, Schawlow and Townes extended the
Dr. Sakshi Kaura, MASER principle to the optical portion of the
1, Ranbir Marg, Near electromagnetic field; hence the name laser.
Model Town Police Post,
Patiala, Punjab, India.
E‑mail: sakshikaura@ In 1960, the first working laser, a pulsed ruby
gmail.com instrument, was built by Maiman of Hughes
© 2015 The Saint's International Dental Journal | Published by Wolters Kluwer - Medknow 11
Goldman in 1962 established the first laser in
Medical Laboratory at University of Cincinnati,
as he is recognized as the first physician to use
laser technology initially working with the ruby
laser.
L’esperence was the first to use argon laser in
1988 in ophthalmology. Keifhabes et al. in 1977
first to use Nd:yttrium‑aluminum‑garnet (YAG).
Different Laser Systems Used in
Prosthodontics
Argon laser
The argon laser system uses argon as an active
medium and is fiberoptically delivered in the
wave and gated pulsed modes. Argon lasers have
two wavelengths used in dentistry: 488 nm (blue)
and 514  nm  (blue‑green) in the spectrum of
visible light. The 488  nm wavelength is used
for curing composite restorative materials, light
activation of whitening gels and impressions and
in caries detection. Advantages of using argon
curing system include better physical properties
of resins when compared with a resin cured with
ordinary blue filtered light and shorter curing
This is an open access article distributed under the terms of the
Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non‑commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com
How to cite this article: Kaura S, Wangoo A, Singh R, Kaur
S. Lasers in prosthodontics. Saint Int Dent J 2015;1:11-5.
[Downloaded free from http://www.sidj.org on Saturday, December 12, 2020, IP: 111.92.50.231]
Kaura, et al.: Lasers in prosthodontics
time.[1] The 514  nm wavelength is used for oral soft tissue
surgeries like acute inflammatory periodontal disease and
highly vascularized lesions, such as hemangiomas because
of its peak absorbance in tissues containing hemoglobin,
hemosiderin, and melani.[2]
Diode laser
The diode laser is a solid state semiconductor laser which
uses a combination of gallium, arsenide, aluminum, and
indium. The wavelengths used in dentistry are in a range of
800–980  nm and are poorly absorbed in water, but highly
absorbed in hemoglobin and other pigments. This laser is
excellent for soft tissue procedures as these do not interact
with dental hard tissues. Diode laser systems as low laser
therapy have also been used for biostimulation of osteoblasts
around implants.[3]
Neodymium:yttrium aluminum garnet laser
Nd:YAG laser is a pulsed wave, free running laser with a
wavelength of 1064 nm. Since these lasers are easily absorbed
in water, they are useful for soft tissue surgeries and produce a
thick coagulation layer on the lased surfaces, thereby creating
a strong hemostasis. These lasers are well absorbed by dark
substances; hence Indian ink or other kinds of black pigment
are often applied to increase the efficiency of ablation.[4]
These lasers are commonly used in surgeries of potentially
hemorrhagic soft tissues, removal of enamel caries, periodontal
procedures, bleaching, welding of titanium components of
prostheses and in implant disinfection.
Holmium:yttrium aluminum garnet lasers
The manufacture of the only holmium  (Ho) laser dental
instrument ceased several years ago. It is a solid crystal of YAG
sensitized with chromium and doped with Ho and thulium with
a wavelength of 2100 nm. It is absorbed by water 100 times
greater than Nd:YAG and used in oral surgery for arthroscopic
surgery on the temporomandibular joint and has many medical
applications.[2]
Erbium lasers
Two distinct wavelengths that use erbium are erbium,
chromium:yttrium scandium gallium garnet (Er:Cr:YSGG) and
Er:YAG. Er:Cr:YSGG has a wavelength of 2780 nm and the
active medium is a solid crystal of yttrium, scandium, gallium
garnet that is doped with Er:Cr. Er:YAG is a solid medium of
yttrium, aluminum garnet that is doped with erbium and has
a wavelength of 2940 nm. The absorption of Er:YAG laser
in water is greatest because its high wavelength coincides
with the large absorption band for water and thus is very well
absorbed by all biological tissues that contain water molecules.
Er:Cr:YSGG are more highly absorbed by hydroxyl ions
and have a performance similar to that of the Er:YAG lasers.
These properties make erbium family of lasers ideal for use
in soft tissue procedures as well as hard tissue procedures
such as caries removal, cavity preparation, tooth preparation,
osteotomy and implant site preparation.[2]
12 The Saint’s International Dental Journal - Vol 1, Issue 1, January-June 2015
CO2 Lasers
The CO2 laser has a gas‑active medium which is pumped
via the electrical discharge current. The wavelength of these
lasers is 10,600 nm and is placed at the end of the mid‑infrared
invisible nonionizing portion of the electromagnetic spectrum.
This wavelength is well absorbed by water, second only to the
erbium family. Due to its property of easy cutting, coagulability
and shallow depth of penetration into tissues, CO2 lasers are
important in treating mucosal lesions and vaporizing dense
fibrous tissue.[2]
Applications of Lasers in Prosthodontics
Fixedprosthetics/esthetics
1. Crown lengthening
2. Soft tissue management around abutments
3. Osseous crown lengthening
4. Troughing
5. Formation of ovate pontic sites
6. Altered passive eruption management
7. Bleaching[5]
8. Veneer removal[5]
9. Tooth preparation for veneers and full coverage crowns
and bridges[6]
10. Removal of the carious lesion and faulty composite
restorations before placement of final restorations.[7]
11. Crown fractures at the gingival margins
12. Enamel and dentin Etching.[8]
Crown lengthening
Lasers have an advantage in crown lengthening regard as
they cut only at the tip and can be held parallel to long axis of
the tooth to remove bone immediately adjacent to cementum
without damaging it.[6] Furthermore, using lasers is less
complicated and achieves maximum patient comfort.
Soft tissue management around abutments
Argon laser energy has peak absorption in hemoglobin,
thus lending itself to providing excellent hemostasis and
efficient coagulation and vaporization of oral tissues.[9] These
characteristics are beneficial for retraction and hemostasis of
the gingival tissue in preparation for an impression during a
crown and bridge procedure.[10] Argon laser with 300 um fiber,
and a power setting of 1.0 W, continuous wave delivery, and
the fiber is inserted into the sulcus in contact with the tissue.
Modification of soft tissue around laminates
The removal and re‑contouring of gingival tissues around
laminates can be easily accomplished with the argon laser.[5]
Osseous crown lengthening
Like teeth mineralized matrix of bone consists mainly
of hydroxyapatite  (HA). The water content and HA are
responsible for the high absorption of the Er:YAG laser light
in the bone. Er:YAG laser has the very promising potential
for bone ablation.[5]
[Downloaded free from http://www.sidj.org on Saturday, December 12, 2020, IP: 111.92.50.231]
Kaura, et al.: Lasers in prosthodontics
Laser troughing
Lasers can be used to create a trough around a tooth before
impression taking. This can entirely replace the need for
retraction cord, electrocautery, and the use of hemostatic
agents.[9] The results are predictable, efficient, minimize
impingement of epithelial attachment, cause less bleeding
during the subsequent impression, reduce postoperative
problems, and reduce chair time.[6] It alters the biological width
of gingiva. Nd:YAG laser is used.
Bleaching
Aesthetics and smile have become important issues in modern
society. Bleaching has become the common method for tooth
whitening. Bleaching using diode lasers results in immediate
shade change and less tooth sensitivity and is preferred among
in‑office bleaching systems.[5]
Veneer removal
Lasers like Er:YAG and Er Cr:YSGG can be used remove
unwanted or failed veneers.[4]
Crown fractures at the gingival margins
Er:YAG or Er, Cr:YSGG lasers can be carried out to allow
correct exposure of the fracture margin.[11]
Formation of ovate pontic sites
The use of an ovate pontic receptor site is of great value when
trying to create a natural maxillary anterior fixed bridge. This
is easily accomplished with the use of a laser.[7]
Implantology
1. Second stage uncovering.
2. Implant site preparation.
3. Peri‑implantitis
Implant recovery
One advantage of the use of lasers in implantology is that
impressions can be taken immediately after second stage
surgery because there is little blood contamination in the
field due to the hemostatic effects of the lasers.[9] There also is
minimal tissue shrinkage after laser surgery, which assures that
the tissue margins will remain at the same level after healing
as they are immediately after surgery. [12,13]
Implant site preparation
Lasers can be used for the placement of mini implants
especially in patients with potential bleeding problems, to
provide essentially bloodless surgery in the bone.[13]
Removal of diseased tissue around the implant
The diode lasers alone or with toluidine O dye, CO2 lasers,
and Er:YAG lasers have been used for implant maintenance,
because of their bactericidal effect and technical simplicity.[14]
Debridement of implant abutment surface with lasers can
effectively decontaminate the surfaces, reduce the bacterial
count and improve the success rate of ailing implants.
The Saint’s International Dental Journal - Vol 1, Issue 1, January-June 2015 13
Schwarz  et  al. demonstrated the effectiveness of Er:YAG
laser treatment to remove subgingival calculus from surfaces
of titanium implant fixtures without any thermal damage.[10]
Among the disadvantages of using lasers for the purpose are
that not all the lasers can be used, for example, Nd:YAG lasers
and Ho:YAG lasers are unsuitable for peri‑implantitis and
caused melting, loss of porosity and other surface alterations
even with the lowest settings.[15]
Removable prosthetics
1. Tuberosity reduction
2. Torus reduction
3. Soft tissue modification
4. Epulis fissurata
5. Denture stomatitis
6. Residual ridge modification
7. Treatment of flabby ridges
8. Vestibuloplasty
9. Sulcus deepening
10. frenectomies
11. Osseoectomy during tooth/root extraction or ridge
recontouring
12. Treatment of soft tissue and hard tissue undercuts.
Treatment of unsuitable alveolar ridges
Hard tissue surgery may be performed with the erbium family
of wavelengths.[5]
Treatment of undercut alveolar ridges
Osseous surgery may be performed with the erbium family
of lasers.[5]
Treatment of enlarged tuberosity
The soft tissue reduction may be performed with any of the
soft tissue lasers. Erbium laser is the laser of choice for the
osseus reduction.[5,9]
Surgical treatment of tori and exostoses
Soft tissue lasers may be used to expose the exostoses and
erbium lasers may be used for the osseous reduction.[5]
Laser applications in the dental laboratory
1. Laser titanium sintering
2. Laser ablation of titanium surfaces
3. Laser‑assisted HA coating
4. Laser welding of titanium components of the prostheses.
Lasers have been used for deposition of HA thin films on
titanium implants pulsed laser deposition has proven to be a
promising method to produce pure, crystalline and adherent HA
coatings which show no dissolution in a simulated body fluid.[6]
Use of lasers for surface treatment of titanium castings for
ceramic bonding have shown improved bond strength when
compared to acid etching techniques which are commonly
used. Lasers can also be used for welding.[7]
[Downloaded free from http://www.sidj.org on Saturday, December 12, 2020, IP: 111.92.50.231]
Kaura, et al.: Lasers in prosthodontics
Lasers in maxillofacial rehabilitation
1. Planning the shape and position of the prostheses
2. Three‑dimensional acquisition of optical data of the
extraoral defects.
The use of lasers in the maxillofacial prosthetics is mainly
for the initial workup of three dimensional acquisitions of
optical data of the extraoral defects. Laser technology has
proved to be particularly useful for planning the shape and
position of the prostheses. Lasers can totally eliminate the
need for conventional impression techniques and associated
disadvantages like deformation of the soft tissue and
discomfort to patients. Lasers also overcome the drawbacks
of three‑dimensional computed tomography and magnetic
resonance imaging reconstruction as the patient is not exposed
to considerable radiation and any stress.[6]
Laser Hazards
The subject of dental laser safety is broad in scope, including not
only an awareness of the potential risks and hazards related to
how lasers are used, but also recognition of existing standards of
care and a thorough understanding of safety control measures.
Laser hazard class for according to ANSI and OSHA standards:
Class I : Low powered lasers that are safe to view
Class IIa : Low powered visible lasers that are hazards only
when viewed directly for longer than 1000 s.
Class II : Low powered visible lasers that are hazardous
when viewed for longer than 0.25 s.
Class IIIa : M edium powered lasers or systems that are
normally not hazardous if viewed for  <0.25 s
without magnifying optics.
Class IIIb : Medium powered lasers (0.5 W max) that can be
hazardous if viewed directly.
Class IV : High powered lasers (>0.5 W) that produce ocular,
skin and fire hazards.
The types of hazards can be grouped as follows
1. Ocular injury
2. Tissue damage
3. Respiratory hazards
4. Fire and explosion
5. Electrical shock.
Ocular Injury
Potential injury to the eye can occur either by direct emission from
the laser or by reflection from a specular (mirror like) surface or
high polished, convex curvature instruments. Damage can be
manifested as injury to the sclera, cornea, retina and aqueous
humor and also as cataract formation. The use of carbonized and
nonreflective instruments has been recommended.
Tissue hazards
Laser‑induced damage to skin and others non‑target tissues
can result from the thermal interaction of radiant energy
14 The Saint’s International Dental Journal - Vol 1, Issue 1, January-June 2015
with tissue proteins. Temperature elevation of 21°C above
normal body temp  (37°C) can produce cell destruction by
denaturation of cellular enzymes and structural proteins.
Tissue damage can also occur due to cumulative effects of
radiant exposure. Although there have been no reports of laser
induced caroinogenesis to date, the potential for mutagenic
changes, possibly by the direct alteration of cellular DNA
through breathing of molecular bonds, has been questioned.
The terms photodisruption and photoplasmolysis have been
applied to describe these type of tissue damage.
Respiratory
Another class of hazards involves the potential inhalation of
airborne biohazardous materials that may be released as a result
of the surgical application of lasers. Toxic gases and chemical
used in lasers are also responsible to some extent.
During ablation or incision of oral soft tissue, cellular products
are vaporized due to the rapid heating of the liquid component
in the tissue. In the process, extremely small fragments of
carbonized, partially carbonized, and relatively intact tissue
elements are violently projected into the area, creating airborne
contaminants that are observed clinically as smoke or what is
commonly called the ‘laser plume’. Standard surgical masks are
able to filter out particles down to 5 nm in size. A particle from
laser plume, however, may be as small as 0.3 nm in diameters.
Therefore, evacuation of laser plume is always indicated.
Fire and explosion
Flammable solids, liquids and gases used within the clinical
setting can be easily ignited if exposed to the laser beam.
The use of flame‑resistant materials and other precautions,
therefore, is recommended. Flammable materials found in
dental treatment areas.
Solids : Clothing, paper products, plastics, waxes, and resins
Liquids : Ethanol, acetone, methyl methacrylate, solvents
Gasses : Oxygen, nitrous oxide, general anesthetics, aromatic
vapors
Electrical hazards
These can be:
• Electrical shock hazards
• Electrical fire or explosion hazards.
Precaution and Management of Laser
The laser safety is an issue limited not only to the performances
of treatment with dental operators, but one that also
encompasses the interrelationship among the health care
providers, educational institutes, and government.
Personnel protective equipment
While using lasers one must wear adequate eye protection,
including the patient. This can be provided by either safety
goggles or screening devises. However the means selected
[Downloaded free from http://www.sidj.org on Saturday, December 12, 2020, IP: 111.92.50.231]
Kaura, et al.: Lasers in prosthodontics
must be designed specifically for use with the particular
wavelength of laser radiation.
While selecting appropriate protective eyewear following
should be considered:
• Wavelength of laser emission
• Maximum permissible exposure limits.
• Degradation of absorbing media or filter.
• Optical density of eyewear
• Radiant exposure limits
• Need for corrective lenses
• Multiple wavelength requirements
• Restriction of peripheral vision
• Comfort and fit.
Control of airborne contaminants
The laser plume, which is the smoke or vapor emitted from
the site of surgery during exposure to laser energy, is a
special concern. The plume should be regarded as potentially
hazardous both in terms of particulate matter and infectivity.
Airborne contaminants can be controlled by ventilation,
evacuation or other methods of respiratory protection. Airborne
contaminants should be removed as near as possible from the
point or origin by evacuation and ventilation to the outside if
possible. Adequate suction in the cut surgical field must be
maintained at all times, especially when treating pathologic
conditions that are suspected of being viral in origin to limit
the possibility of spreading that virus via the laser plume.
Accordingly, the evacuation system should be able to remove
particle as small as 0.3  µm with at least 80% efficiency.
Surgical staff should wear a mask to remove the particles.
Eyewear, face shield, and caps or gowns should be worn to
protect the personnel from splatter and laser light.
Beam alignment
The beam alignment should be checked before any surgical
procedure by using a moistened tongue depressor and firing
the laser to prevent combustion.
Reflected energy
Polished instruments should not be used because of the
potential for reflected lasers energy to cause damage only
anodized ones should be used.
Fire protection
The use of fire is always a concern when the laser is used
when using laser noncombustible materials should be used. All
combustible materials must be kept in closed cabinets, and any
combustion fluids that are used in surgical preparation must
be dried before surgery.
Anesthesia
When the laser is used for nasotrachial surgery, the moist pack
must be used to protect the tube from accidental laser damage
because any exposure of the anesthetic agent to the laser beam
can cause combustion in biomaterial system.
The Saint’s International Dental Journal - Vol 1, Issue 1, January-June 2015 15
Tissue damage
When the laser is used for tissue incisions, the power density
and the time used by the laser should be respected. It can
cause tissue damage, and it can be prevented by preventing
carbon arcing, the tissue should be regularly wiped clean
of CO2.
Conclusion
The laser has become a ray of hope in dentistry. When used
efficaciously and ethically, lasers are an exceptional modality
of treatment for many clinical conditions that dentists treat on
a daily basis. However, laser has never been the “magic wand”
that many people have hoped for. It has got its own limitations.
However, the future of dental laser is bright with some of the
newest ongoing researches.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Powell GL, Blankenau RJ. Laser curing of dental materials. Dent Clin
North Am 2000;44:923‑30.
2. Coluzzi DJ. Fundamentals of dental lasers: Science and instruments.
Dent Clin North Am 2004;48:751‑70, v.
3. Dörtbudak O, Haas  R, Mallath‑Pokorny  G. Biostimulation of
bone marrow cells with a diode soft laser. Clin Oral Implants
Res 2000;11:540‑5.
4. Parker S. Surgical laser use in implantology and endodontics. Br Dent
J 2007;202:377‑86.
5. Jyothy JR, Satapathy SK, Annapurra PD. Lasers in prosthetic dentistry.
Indian J Appl Res 2013;3:369‑70.
6. Nagaraj KR. Use of lasers in prosthodontics: A review. Int J Clin Dent
2012;5:91‑112.
7. Bertrand C, Le Petitcorps Y, Albingre L, Dupuis V. The laser welding
technique applied to the non precious dental alloys procedure and results.
Br Dent J 2001;190:255‑7.
8. Gökçe B, Ozpinar B, Dündar M, Cömlekoglu E, Sen BH, Güngör MA.
Bond strengths of all‑ceramics: Acid vs laser etching. Oper Dent
2007;32:173‑8.
9. Punia V, Lath V, Khandelwal M, Punia SK, Lakhyani R. The current
status of laser application in Prosthodontics. Natl J Integr Res Med
2012;3:170‑5.
10. Allen EP. Use and abuse of lasers in periodontics. J Esthet Restor Dent
2005;17:329‑31.
11. Convissar RA. The biologic rationale for the use of lasers in dentistry.
Dent Clin North Am 2004;48:771‑94, v.
12. Manni JG. Dental Applications of Advanced Lasers. Barlington (VT):
JGM Associates; 1996.
13. Strauss RA. Lasers in oral and maxillofacial surgery. Dent Clin North
Am 2000;44:851‑73.
14. Bach  G, Neckel  C, Mall  C, Krekeler  G. Conventional versus
laser‑assisted therapy of periimplantitis: AQA five‑year comparative
study. Implant Dent 2000;9:247‑51.
15. Kreisler M, Götz H, Duschner H. Effect of Nd:YAG, Ho:YAG, Er:YAG,
CO2, and GaAIAs laser irradiation on surface properties of endosseous
dental implants. Int J Oral Maxillofac Implants 2002;17:202‑11.