Laser Dentistry:

Science vs. Hype

Christopher J. Walinski, DDS

9-10 March 2006

Pacific Dental Conference  Vancouver, BC
 What Will We Discuss?
Part I: Essential Concepts of Laser Dentistry
CO2, Nd:YAG, Argon, Diode and
Erbium wavelengths
Part II: Soft Tissue discussion
Part III: Hard Tissue discussion
Part IV: Laser Assisted Periodontics
Part V: Laser Assisted Endodontics
Part VI: Laser Assisted Surgical Procedures
Part VII: Where do we go from here?
 LASER
L ight
A mplification by
S timulated
E mission of
R adiation

First postulated by...

 Albert Einstein

In 1916, in his treatise, “Zur Quantum

Theorie der Strahlung,” Albert Einstein
developed the theory of spontaneous
and stimulated emission of radiation.
What is important from his treatise is
that as an atom absorbs a quantum of
energy it is pumped to an excited state
or higher energy level.
 Laser Historical Landmarks

• Early 1900’s: Niels Bohr quantified energy levels

involved.
• MASER: Microwave Amplification by Stimulated
Emission of Radiation. Townes and Schalow.
• 1960: Theodore H. Maiman produced the first
ruby laser by inserting a ruby rod into a
photographic flashlamp.
• 1964: Townes, Basov and Prokhorov receive the
Nobel Peace Prize for the development of the
laser.
• 1964: Stern and Sognnaes used the ruby laser to
vaporize enamel and dentin.
 Laser Historical Landmarks
• 1966: Leon Goldman used the laser
clinically on enamel and dentin. Goldman,
Stern and Sognnaes are recognized as the
first to use lasers on tooth structures. One
of their findings was that the heat buildup in
teeth generated by early continuous wave
lasers caused damage to the pulp.
• 1989: Introduction of the first true dental
laser.
 Bohr’s Model
Electrons have separate energy levels, E0 and E1.

N E0

E1

A quantum of energy can be gained or lost by the

atom, and there will be movement from one level to
another. The atom prefers the stable, normal state
 Spontaneous Emission

Spontaneous Emission occurs as the

atom decays from the excited state to
the lower energy state, emitting the
excess energy as a photon, or quanta of
light.
 Stimulated Emission

During stimulated emission an outside

source is used to excite the already excited
atoms to release stored energy. Here, the
excited photon and the released photon
stimulate two more excited atoms producing
a chain reaction.
The end result is photons of identical
wavelength traveling in the same direction
as well as oscillating together in phase.
 Electromagnetic Waves
Wavelength
Amplitude

Velocity

Frequency is the number of complete oscillations

of the wave per second.
 Electromagnetic Waves
Wavelength is the physical property that
determines the classification of
electromagnetic energy and lasers are named
by their characteristic wavelength and active
medium.
Wavelength is the distance a photon travels
through one complete oscillation and is
measured from corresponding point to
corresponding point.
Wavelength is measured in meters.
Micrometer (µm) = 10-6 meters or micron
 Diode (980nm)

HeNe (632nm) ErCr:YSGG (2780nm)

Utraviolet Visible Infrared

100 nm 400 nm 750 nm 10,000 nm

Argon (488nm) Diode (810nm) CO2 (10.6µm)

Argon (514nm) Er:YAG (2940nm)

Nd:YAG (1064nm)
 Characteristics of Laser
Light

Spatial and temporal beam

Coherency - Laser light is in
phase (same time and space)
 Characteristics of Laser
Light

Monochromaticity - Laser light is

all one wavelength (the same
color)
 Characteristics of Laser
Light

Collimation - Laser light travels in

a straight line.
Characteristics of Ordinary
Visible Light
Multiple wavelengths = white light
Non-Directional
Non-Focused
 Laser Cavity

• Active Medium: Solid, liquid or gas supplies

the photons that determine the output
wavelength and power energy. Suspended in
an optical cavity.
• Laser Resonator: Optical subsystem. The
simplest system being two mirrors. This
houses the active medium and is responsible
for amplification.
• Power Supply or Excitation Source:
Responsible for pumping or exciting the
 Active Medium
• Solid State Laser: Active medium is
suspended in a transparent crystal. The host
material is grown in or “doped” with atoms
that will create the desired wavelength.
Erbium, Neodynium, Holmium, etc.
• Gas Lasers: Have a hollow tube filled with
the appropriate gas or mixture of gases.
Carbon dioxide, argon.
• Liquid Dye Lasers: Have the dye dissolved
in methanol or water solvent.
• Diode Laser: Semiconductor crystals.
Pumped electronically.
 How
How Lasers
Lasers Work
Work
High Voltage Power Supply
= atoms
cathode anode Beam output

Discharge Tube
100% Reflective Mirror 98% Reflective Mirror
 Laser Light Properties
• Passing laser light through selected
medium can alter the wavelength. An
example is frequency doubling crystals.

• Any medium with a density greater

than air will cause some divergence of
the laser beam.
• Laser light travels in a straight
line until it is absorbed or reflected.
 Laser Light Properties

• Divergence is that property where

the beam diameter of the laser light
increases with the distance from the
laser.
• A highly directional laser has a low
divergence or the laser is well-
collimated.
• As laser energy exits a fiber or
waveguide it is no longer collimated.
 Definitions
• Joule = Unit of ENERGY, ability to do work

• Watt = Unit of POWER, rate of doing

work
• 1 Watt = 1 Joule/second
• Pulses per second (number of firing cycles
per second) is measured in HERTZ
 Laser Light

• Focal point is that distance where the beam

is reduced to some minimum diameter.
• The diameter of the beam at the target
tissue surface is called the irradiated spot
size, laser spot size or spot size.
• Power Density = Watts/cm2. The smaller
the diameter, the higher the Power Density.
 Laser Power Density

Power Density = Watts/cm2

Garden Hose
 Laser Power vs. Laser
Energy

Laser Power refers to the rate at which

energy is generated by a laser.
Expressed as either Joules/second or
Total Energy refers to the energy used
Watts.
during the procedure. If a 1 Watt laser
is used for 10 seconds, we would have
generated 10 Joules of energy to the
target tissue.
 Absorption Characteristics of
Dental Lasers
Alexandrite (2x) 377nm Calculus
Argon 488&515nm Hemoglobin, Melanin,
Resin Catalyst
HeNe 632nm Melanin
Diode 810-980nm Melanin, Water
Nd:YAG 1064nm Melanin, Water, Dentin
Ho:YAG 2120nm Water, Dentin
Erbium 2780&2940nm Water, Hydroxyapatite
CO2 10,600nm Hydroxyapatite, Water
 Relative Absorption of
Laser Light
Water
Hydroxyapatite
Pigment

Log Scale
Argon Diode Nd: Ho: Er,Cr: CO2
488-515 810-830 1064 2120 2780 10600
 Laser Delivery Systems
Fixed lens and mirror

The oldest and least flexible system consists of a

series of fixed lenses and mirrors which allow the
energy to be focused to a specific point in space.
Such a setup is still in use for those wavelengths
which cannot be transmitted through other means.
 Laser Delivery Systems
Articulated Arm

More flexible than a fixed lens and mirror system,

an articulated arm consists of mechanical arms
connected to flexible joints and fitted with mirrors.
Laser energy is reflected off each mirror until it
 Laser Delivery Systems
Hollow Waveguide

A flexible tube designed to confine and direct the

laser energy in a direction determined by the
waveguide’s actual physical boundaries.
 Laser Delivery Systems
Optic Fiber

Cladding

Jacket Core

More flexible still is an optic fiber, typically

consisting of a flexible glass core surrounded by a
cladding and a protective jacket. Can be used in
the contact mode. Not all laser wavelengths are
 Continuous Wave Mode
Peak power and average power are the same
LASER Settings
Power = 3.0 Watts
3 Watts

0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

Time in Seconds
 Gated/Chopped Mode
Average power is 1.5 Watts
LASER Settings
Power = 3.0 Watts, Pulse Length = 0.5 second
3 Watts

1.5 W

0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

Time in Seconds
 Free-Running Pulsed Mode
Average power is 2.0 Watts
LASER Settings
Energy = 100 mJ, Pulse Length = 100 µsecond
Peak Power = 1000 W
Watts

2.0 W

0 50 100 150 200 250 300 350

Time in µseconds
 Laser - Tissue Interaction
• Thermal Relaxation is the time that the
laser energy is off. This is the time during
which the target tissue is allowed to cool.
• If we want to cool tissue we can change
thermal relaxation time by switching from
Continuous Wave to Gated. Free-running
Pulsed laser has a longer thermal relaxation
time than does gated.
• Always use the lowest power setting that
will achieve the desired results in a
reasonable amount of time.
 Argon Laser
• Gas Laser
• 488 nm & 514 nm
• Visible spectrum (blue & green)
• Soft-Tissue & Photopolymerization
• Highly absorbed by pigment
• Used in contact or non-contact mode
 Diode Laser
• Solid State - Semiconductor Laser
• 810-980 nm
• Near Infrared spectrum
• Soft-Tissue, PBM & Whitening
• Highly absorbed by pigment
• Used in contact or non-contact mode
 Nd:YAG Laser
• Solid State Laser
• 1064 nm
• Near-Infrared spectrum
• Soft-Tissue Only
• Highly absorbed by pigment
• Used in contact or non-contact mode
 Erbium Lasers
• Er,Cr:YSGG & Er:YAG
• 2780nm & 2940nm
• Mid-Infrared spectrum
• Hard and Soft-Tissue
• Highly absorbed by hydroxyapatite and
water
• Lower absorption in pigmented tissue
 Erbium Lasers

• Hard Tissue - Very little heat transfer

• Soft Tissue - Little or no topical or
local anesthetic necessary
• Er:YAG & Er,Cr:YSGG
Carbon Dioxide Laser
• Gas Laser
• 10600nm = 10.6µ
• Far-Infrared spectrum
• Soft-Tissue Only
• Highly absorbed by pigment,
hydroxyapatite and water
• Used in non-contact mode
 Laser Effects on Tissue
Reflection - Laser light is bounced off the surface of
the target tissue without penetration or interaction
 Laser Effects on Tissue
Scattering - individual molecules and atoms take the
laser beam and deflect the beam power into
directions other than the intended direction.
 Laser Effects on Tissue
Transmission - Laser light travels through the tissue
unchanged.
 Laser Effects on Tissue
Absorption - Atoms and molecules that make up the
tissue convert the laser light energy into heat,
chemical, acoustic or non-laser light energy.
 Thermal Effect of Laser on
Tissue

Tissue Temp (ºC) Observed Effect

40-50 Hyperthermia
60 Coagulation, Protein
Denaturation
70-90 Welding
100 Vaporization
200 Carbonization
 Laser Safety Officer
• Operation characteristics of the laser being
used
• Biological effects and potential hazards
• Requirements of ANSI and OSHA
• Practical safety control measures for lasers
• Provide laser safety training for all in the
working environment
• Protective equipment - laser-specific glasses
• Warning signs and labels
 Laser Safety Officer
• Combustible materials
• Determination of the potential hazard zone -
nominal hazard zone (NHZ)
• Establish the standard operating procedure for
the operation of the laser within the facility
• Actively involved in assurance of safe practices
and policies
• Keeper of the keys
• Implementing medical surveillance and
accident reports
Eye Protection
 Damaging Effects of Laser
on Eye & Skin
Invisible Ionizing Invisible Thermal Radiation
Visible

Ultraviolet Infrared

100nm 300nm 400nm 760nm 1000nm 3000nm 10,000nm

Color/Night Vision
Degradation

Photokeratitis Retinal Burns Corneal Burns

Erythema Thermal Skin Burns

Plume Components
Carbonized tissue and blood
Potential virus and bacteria
Hard tissue fragments
Polycyclic aromatic
hydrocarbons (benzene,
toluene, formaldehyde,
acrolein)
Steam
Plume Can Be Dangerous

Effects of Plume
• Eye irritation (burning,
watery eyes)
• Nausea
• Systemic absorption of
toxins, bacteria, etc.
 Laser Advantages

• Ability to seal blood vessels

• Seal lymphatic vessels
• Seal nerve fibers
• Reduces mechanical trauma
• Minimal scarring
• Precision
• Reduced need for sutures
 Laser Advantages
• Dry operating field with increased
visibility: little or no hemorrhage
• Minimal postoperative swelling
• Clinically we see a 90% reduction in
postoperative pain due to a decrease in
pain conduction
• Less damage to non-target tissue
• Reduces bacterial counts, so we can:
Treat patients at risk with bacteremias
safely after lasing bacteria on a surface
 Techniques
• Gingival Recontouring

• Anesthetic usually not

necessary.
• Final impression can be
taken at the same
appointment.
 Techniques
• Gingival Recontouring

• Laser vs.
• Scalpel
• Electrosurgery
 Benefits of Laser Surgery
• Decreased or no anesthetic
• Decreased risk of infection
• Decreased sensitivity
• Less chair time
• Less bleeding
• Less postoperative discomfort
 TAC 20% Alternate
Topical Anesthetic Gel
Lidocaine 20%, Tetracaine 4%,
Phenylephrine 2%

20 g jar has 200 applications

Professional Arts Pharmacy
1-888-237-4737
AGD Journal, May, 2004
 Soft Tissue

• Soft Tissue Studies

“Er,Cr:YSGG appeared to have a less
traumatic effect on target tissue and offered
improved post-operative healing, faster
recovery time, and less trauma than
traditional surgical modalities.”

“Irritation fibroma removal: A comparison

of two laser wavelengths.”
Walinski, CJ
 SoftTissue

• Soft Tissue Studies

“Effective hemostasis was achieved after
Er,Cr:YSGG laser surgery. In conclusion, the
Er,Cr:YSGG laser allows precise surgical ablation
with minimal thermal damage to adjacent tissues
in vivo. The overall subsequent healing was
favorable.”
“In vivo study of the healing processes that
occur in the jaws of rabbits following
perforation by an Er,Cr:YSGG laser.”
Wang, X, et. al.
Lasers Med Sci. 2005 Apr 1
 Hard Tissue

• Bone Studies
“Er,Cr:YSGG laser cuts canine mandibular bone
effectively without burning, melting, or altering
the calcium:phosphorus ratio of the irradiated
bone.”

“Effects of erbium,chromium:YSGG laser

irradiation on canine mandibular bone.”
Kimura Y, et al.
J Periodontol, 2001 Sep
 Hard Tissue

• Bone Studies
“Er,Cr:YSGG laser allows for precise surgical bone
cutting and ablation with minimal thermal
damage to adjacent tissue.”

“Morphological changes of bovine mandibular

bone irradiated by Er,Cr:YSGG laser: an in vitro
study.”
Wang X, et al.
J Clin Laser Med Surg, 2002 Oct
 Techniques
• Hard Tissue Benefits
• Local anesthetic usually not
necessary
• Precision
• No vibration - preserve tooth
structure
• Conservative micropreparations
 Techniques
• Hard Tissue Benefits (cont.)
• Surface roughness (etched)
• Removal of smear layer for
stronger bond
• Surface decontamination
• Caries inhibition
 Techniques
• Laser vs. Air Abrasion

• Ability to remove “rubbery”

caries
• Adjacent tooth damage
preparing Class II restoration
• No messy overspray
 Laser Analgesia

• Desensitization Studies

“Nd:YAG laser irradiation can be used to seal the

exposed dentinal tubules.”

“Morphologic study of Nd:YAG laser usage in

treatment of dentinal hypersensitivity.”
Lan WH, et al.
J Endod, 2004 Mar
 Laser Analgesia

• Desensitization Studies

“The sealing depth of Nd:YAG laser on human

dentinal tubules was approximately 4 microns.”

“Sealing depth of Nd:YAG laser on human

dentinal tubules.”
Liu HC, et al.
J Endod, 1997 Nov
 Laser Analgesia

• Desensitization Studies
“Er:YAG laser influences only on morphology and
diffusion processes of root surfaces, while Nd:YAG
laser also alters the chemical structure of root
proteins.”

“Morphology, chemical structure and diffusion

processes of root surface after Er:YAG and
Nd:YAG laser irradiation.”
Gaspirc B & Skaleric U
J Clin Periodontol, 2001 Jun
 Laser Analgesia

• Analgesia Studies

“Over 98% of the patients in this study

comparing Er,Cr:YSGG prepared teeth for Class I,
III and V lesions reported no discomfort during
preparation.”

“A laser-powered hydrokinetic system for

caries removal and cavity preparation.”
Hadley J, et al.
J Am Dent Assoc, 2000 June
 Laser Analgesia

• Analgesia Studies

“94% of cases were prepared without anesthesia.

No adverse reaction was observed in any of the
cases.”

“Clinical assessment of Er,Cr:YSGG laser

application for cavity preparation.”
Matsumoto K, et al.
J Clin Laser Med Surg., 2002 Feb.
 Laser Analgesia

• Analgesia Studies

“The use of the YSGG laser eliminates the need

for local anesthesia in extensive caries/stainless
steel crown cases.”

“Laser pediatric crowns performed without

anesthesia: a contemporary technique.”
Jacobson B, et al.
J Clin Pediatr Dent, 2003 Fall.
 Laser Effects

• Hard Tissue Studies

“Er,Cr:YSGG laser has a good cutting effect on
root surface and causes no burning or melting
after laser irradiation.”

“Effects of Er,Cr:YSGG laser irradiation on root

surface: morphological and atomic analytical
studies.”

Kimura Y, et al.
J Clin Laser Med Surg, 2001 April
 Laser Effects

• Pulpal Studies
“Pulpal temperatures associated with the
hydrokinetic system either showed no change or
decreased by up to 2 degrees C. Wet bur
preparations resulted in a 3 degrees to 4 degrees
C rise.”

“Pulpal thermal responses to an erbium,

chromium:YSGG pulsed laser hydrokinetic
system.”
Rizoiu I, et al.
 Hard Tissue

• Hard Tissue Studies

“Er,Cr:YSGG laser device is considered as one of the
most effective and safe devices for cavity preparation
because of its many advantages. This includes easy
delivery system, minimal thermal damage to the
surrounding tissues, minimal thermal-induced
changes of dental hard tissue compositions, and
favourable surface characteristic.”

“Anatomic analysis and knoop hardness measurement

of the cavity floor prepared by Er,Cr:YSGG laser
irradiation in vitro.”
Hossain M, et al.
 Hard Tissue

• Hard Tissue Studies

“Er,Cr:YSGG laser has a good cutting effect on
dental hard tissues and offers advantages of no
burning or melting after laser irradiation.”

“Morphological and atomic analytical studies

on enamel and dentin irradiated by an
Er,Cr:YSGG laser.”
Yu DG, et al.
J Clin Laser Med Surg, 2000 June
 Hard Tissue

• Hard Tissue Studies

“Er,Cr:YSGG laser irradiation with and without
water mist appears to be effective for increasing
acid resistance.”

“A study on acquired acid resistance of

enamel and dentin irradiated by Er,Cr:YSGG
laser.”
Hossain M, et al.
J Clin Laser Med Surg, 2001 June
 Laser Endodontics

• Decontamination Studies

Bacterial penetration to a depth of ~1,000µm

- Kouchi, et al, J Dent Res 1980 Dec; 59 (12)

Chemical irrigants disinfect to a depth of 100µm

- Berutti, et al, J Endod 1997 Dec; 23 (12):725-727.

Laser disinfection to a depth of >1,000µm

- Moritz, et al, Las Surg Med 2000, 26 (3):250-261
 Laser Endodontics

• Endo Studies
“Er:YAG laser radiation helps to attain antibacterial
effect, not only in the root canal walls, but also in
the surrounding tissues. Therapeutic doses of laser
radiation guarantee one-step disinfection, including
of anaerobic microorganisms.”
microorganisms.
- Endodontic treatment with application of
Er:YAG laser waveguide radiation disinfection.

- Dostalova, T, et al, J Clin Laser Med Surg 2002

Jun; 20(3):135-9
 Periodontal Disease
Major Health Risks Linked to
Gum Disease
• Heart Disease 168% more likely
• Stroke 250% more likely
• Diabetes 300% more likely
• Respiratory 500% more likely
• Osteoporosis 200% more likely
Low birth weight babies 700% more likely
 Periodontal Disease
Leading Causes of Periodontal
Disease
• Stress 2 times greater risk
• Smokers 5 times greater risk
• Diabetics 3 times greater risk
• Smokers c Diabetes 20 times greater risk
Nutritionally Deficient 2 times greater risk
 Treatment Options
• Guided Tissue Regeneration
• Tissue and bone grafts
• Scaling, root planing, curettage & surgery
• Occlusal adjustment/balancing
• Chemotherapeutics applied/prescribed
• Lasers
• Bone producing factors
 Laser Soft-Tissue Applications
• Tissue welding
• LANAP (Laser Assisted New Attachment
Procedure)
• Curettage (open or closed)
• Laser assisted periodontal surgery

• Flap incision
• Degranulation
• Epithelial retardation
 Lasers in Perio
“The diode laser reveals a bactericidal
effect and helps to reduce inflammation in
the periodontal pockets in addition to
scaling. The diode laser therapy, in
combination with scaling, supports healing
of the periodontal pockets through
eliminating bacteria.”
A. Moritz, et.al.
Treatment of periodontal pockets with a diode laser.
Lasers Surg Med. 1998;22(5):302-11.
 Lasers in Perio

“The Er,Cr:YSGG laser has a good cutting

effect on root surface and causes no
burning or melting after laser irradiation.”

M. Frentzen, A. Braun and D. Aniol, Laser Scaling of

Diseased Root Surfaces, J Perio 2002; 73:524-530.
 Lasers in Perio
“In studies, the Erbium laser has demonstrated that
it removes 15µ of root tissue at 40mJ. At 60 mJ the
erbium laser removed 37µ of root surface. At 150mJ
the erbium laser removed 485µ of root surface when
the laser was used perpendicular to the root surface.
At the lower energy levels, calculus is removed more
selectively, leaving the harder cementum.”
“Erbium lasers can remove bacteria found deep within dentinal
tubules.”
Fuji, T. et.al, Scanning electron microscopic study of the effects of Er:YAG laser
on root cementum, J Perio, 1998 Nov.
Folwacny, M. et.al, Root substance removal with Er:YAG laser radiation at
different parameters using a new delivery system, J Perio, 2000 Feb.
Folwacny, M. et.al, The effect of working tip angulation on root substance
removal using Er:YAG laser radiation: an in vitro study, J Clin Perio, 2001 Mar.
 Lasers in Perio
“The culturing of fibroblasts did not show any
significant differences regarding the number and the
density of the cells among the different groups.
However, significantly more spindle shaped cells
were found on laser irradiated roots. This indicates a
better adherence of the cells to those surfaces. The
trend was better cell adherence on lased plus scaled
surfaces. Lased root surfaces seem to provide an
ideal foundation for periodontal regeneration when
compared to scaled only surfaces.”
U. Schoop, et.al,
Changes in root surface morphology and fibroblast adherence after
Er:YAG laser irradiation, J Oral Laser Applications, 2002.
 Lasers in Perio
Dr. P. Polenik compared the efficiency of Er,Cr:YSGG
laser treatment of periodontitis in comparison to
deep scaling with an ultrasonic scaler. Twenty
patients with advanced periodontal disease had half
their dentition treated with the YSGG and half the
teeth treated with an ultrasonic scaler. Probing
depth reduction was reduced from 6.8mm to 4.2mm
on average with ultrasonic scaler. The laser sites
were reduced from 7.2mm to 3.6mm on average.
The PAL gain was 1.6 for the ultrasonic scaler and
3.2 for the laser sites.
P Polenik
Efficiency of subgingival treatment performed with Er,Cr:YSGG laser, J
 Lasers in Perio
“The clinical variables i.e. probing pocket depth,
plaque and gingival indices were reduced more on
the laser side than on the placebo one. Additional
treatment with low-level lasers reduced periodontal
inflammation.”
T. Qadri, et.al
The short-term effects of low-level lasers as adjunct therapy in the
treatment of periodontal inflammation. Lasers Surg Med. 2004;35(2):111-
6.
 Periodontal Therapy

• Laser De-epithelization Rule of Threes

• Subtract 3 from the pocket measurement to

determine the number of treatments

• Example: 6mm pocket - 3 = 3 treatments

 Periodontal Therapy
Reattachment Procedure
First Appointment

• Remove the inner lining of the pocket

and the external epithelium to 5mm from
the free gingival margin. Debride and
root plane with the YSGG, then use
curettes to finish treatment.
 Periodontal Therapy
Reattachment Procedure
Next Appointments

• Remove the inner lining of the pocket to

1mm from the base of the remaining
pocket
• Remove the external epithelium 5mm
from the free gingival margin
• Debride root with curettes
Laser Periodontal Surgery
Technique
• Go to base of pocket, retract 1mm
and activate laser
• Move fiber up and down along width
of pocket

• Repeat in a diagonal direction

• Direct beam toward soft-tissue
Laser Periodontal Surgery
Evaluate Tissue Response
• Do not re-probe for three
months
• Any pockets which haven’t
responded should be treated
again
 Pocket Therapy
Modified Widman Procedure

Ramfjord Technique:
Scalloping Inverse Bevel
Rateitschak, K & E, Wolf, H, &Hassel, T (1989) Color Atlas of
Dental Medicine (2nd Rev. ed) New York: Thieme
 Pocket Therapy
Modified Widman Procedure

Ramfjord Technique:
Flap Reflection
Rateitschak, K & E, Wolf, H, &Hassel, T (1989) Color Atlas of
Dental Medicine (2nd Rev. ed) New York: Thieme
 Pocket Therapy
Modified Widman Procedure

Ramfjord Technique:
Horizontal Incision
Rateitschak, K & E, Wolf, H, &Hassel, T (1989) Color Atlas of
Dental Medicine (2nd Rev. ed) New York: Thieme
 Pocket Therapy
Modified Widman Procedure

Ramfjord Technique:
Removal of Pocket Epithelium and Granulation
Rateitschak, K & E, Wolf, H, &Hassel, T (1989) Color Atlas of
Dental Medicine (2nd Rev. ed) New York: Thieme
 Pocket Therapy
Modified Widman Procedure

Ramfjord Technique:
Closure and Coverage of Interdental Defects
Rateitschak, K & E, Wolf, H, &Hassel, T (1989) Color Atlas of
Dental Medicine (2nd Rev. ed) New York: Thieme
 What Is PBM?
• Laser Biostimulation
• Low Level Laser Therapy (LLLT)
• Low Intensity Laser Therapy (LILT)
• Healing Laser Therapy
• Laser Acupuncture
• Photo Bio Modulation
• What’s Next??
Low Level Laser Therapy

Low Level Laser Therapy:

- The photochemical & photobiological
stimulation of intracellular
enzyme systems, a “cascade of
events.”
“Generally speaking, biostimulating effect of
low level laser treatment (LLLT) is in its anti-
inflammatory, analgesic and anti-edematous
effect on tissues. There is absolute increase
in microcirculation, higher rates of ATP, RNA
and DNA synthesis, and thus better tissue
oxygenation and nutrition. There is also
increase in the absorption of interstitial fluid,
better tissue regeneration and stimulation of
the analgesic effect. The past three decades
of laser medicine and surgery have shown
great progress and promise for the future.”
1: Med Pregl 1998 May-Jun;51(5-6):245-9
[Diagnostic and biostimulating lasers]
Takac S, Stojanovic S.
Zavod za sudsku medicinu, Medicinski fakultet
 Biostimulation Applications with the
Diode:

Promotes healing and post op comfort:

Scl/RP and laser perio treatment
Root canal therapy
Implant placement & recovery
Soft tissue surgery/extractions
Hyperemic pulpal tissues
Diabetic Ulcerations
Aphthous Ulcers
TMD: joints and muscles
Tuner, Hodes, et.
al.
1-800-973-8003 www.wcmid.com
 Thank you for your
attention!!
Christopher J. Walinski, DDS
673 Robeson Street
Fall River, Massachusetts 02720
+1-508-676-8268