LASERS IN DENTISTRY

-By

Devika Kishnan(10BMD0014)

Introduction
Laser dentistry can be a precise and effective way to perform many dental procedures. The potential for laser dentistry 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.

Advantages of a laser
(compared to the traditional dental drill)
May cause less pain in some instances, therefore reducing the need for anesthesia. May reduce anxiety in patients uncomfortable with the use of the dental drill. Minimize bleeding (high-energy beam photocoagulation) and swelling during soft tissue treatments. May reduce bacterial infections because the high-energy beam sterilizes the area being worked on. May preserve more healthy tooth during cavity treatment.

Laser disadvantages
Lasers cant be used on teeth with fillings that are already in

place. Lasers can't be used in many commonly performed dental procedures. For example, lasers can't be used to fill cavities located between teeth, cavities around old fillings, and large cavities that need to be prepared for a crown, nor can they 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 since the cost of the laser is much higher.

Classification:

Soft tissue lasers

Hard tissue lasers

Diagnostic lasers

Soft tissue lasers:

Why? Reduced bleeding during surgery Less pain post operation How? Vaporization of intra and extracellular water

Need? Uncovering an implant, correcting abnormalities, removing benign lesions, excisional biopsy etc

EXAMPLES:

Most commonly used lasers:

Diode (810 nm, 940 nm, 980nm,1,064nm), Nd:YAG (1,064 nm), CO2(10,600 nm), Er:YAG (2,940nm), Er,Cr:YSGG (2,780 nm) Potassium-titanylphosphate(KTP)(532nm)

Hard tissue lasers:

Why? no significant thermal effects, collateral damage to tooth structure, or patient discomfort How? Photo ablation Absorption by water Need?
effective caries removal, cavity preparation, desensitization of cervical dentine, laser analgesia

Examples:

Laser used:

Caries and calculus removal Er:YAG(2940 nm), Er:YSGG(2790 nm) and Er,Cr:YSGG(2780 nm) lasers Other procedures CO2, argon, and KTP Lasers, Nd-YAG

Diagnostic lasers:

Why?

Greater sensitivity Lack of risk of ionizing radiation How? Presence or absence of Laser induced fluorescence Need? Detection of caries and calculus Optical impressions-CAD/CAM

Advances:
Optical

Coherence Tomography:

Imaging of hard and soft tissues Uses an intense, safe laser light beam Offers resolution of up to 10 times Detailed characterization of the dental microstructures

 Titanium

Sapphire laser:

Femtosecond

lasers Accurate and ultrafast Hard tissue ablation without any thermal damage of natural tooth structure Drawbacko the acoustic damage (mechanical vibration) in underlying tissues o manifests as fractures and cracks within the healthy parts of the tooth

 Photoactivated
Photochemical

Dye technique

activation of oxygen

releasing dyes Kills bacteria in complex biofilms, such as subgingival plaque Does not cause sensitization and killing of adjacent human cells such as fibroblasts and keratinocytes Residual reactive oxygen species are rapidly dealt with by the enzymes

 Photodynamic
Laser-activation

therapy

of a sensitizing dye generates reactive oxygen species Damages cells and the associated blood vascular network, triggering necrosis and apoptosis Photofrin dye Activates the host immune response and promotes anti-tumor immunity

References:
The current status of laser applications in dentistry-LJ Walsh* Clinical applications of dental lasers-Mitchell A. Lomke, DDS Internet- Google