Advantages of Lasers How Lasers WorkApplications in Dentistry
AdvantagesAdvantages/Benefits of Laser Surgery Compared to SteelBlade Surgery Superior ability to:• Minimize Hemorrhage• Minimize Collateral Damage• Minimize Infection (sterilize surgical site)• Minimize Pain
How Lasers WorkHyperthermia:• The tissue is elevated above normal temperature but not destroyed• The tissue whiten or blanch• This phenomenon is useful because it will remove diseased tissue but allow healthy tissue to remain intact
How Lasers WorkCoagulation:• Irreversible damage to tissue• Causes congealing of liquid into a semi-solid mass (clot)• Clinician will see a bloodless surgical site contraction of the vessel wall
How Lasers WorkWelding:• Occurs when there is adherence of layers• Due to collagen’s helical structure unfolding and intertwining with adjacent segments
How Lasers WorkVaporization:• This is also called ablation• There is a physical change of state; the solid and liquid components turn into vapor in the form of smoke or steam• Excision of tissue commences at this temperature
How lasers workCarbonization:• Tissue is dehydrated and then burned in the presence of air• Carbon, as the end product, absorbs all wavelengths• If laser energy continues to be applied, a heat sink will occur and prevent normal tissue ablation• The heat that is conducted can cause collateral thermal trauma to a wide area
Periodontal Therapy• An important use of laser technology is within the periodontal pocket• This has become a topic of much interest and is a promising field in periodontal therapy• Why would we want to use laser technology for treatment of the periodontal pocket?
Periodontal Therapy1) The FDA approved the Diode laser for sulcular debridement in 1988. Due to the diode laser’s wavelength it is safe to use near dental hard tissue where the CO2 would cause major thermal damage2) The thin (400 micron = 0.4 mm) diode fiber less traumatic than conventional instruments3) Hot-tip fiber action is thought to: A) Decreases inflammation (biostimulation effects) B) Vaporize necrotic soft tissue (if can be maintained at hyperthermal effect) C) Reduce bacterial populations… Result is reduced pocket depths over several weeks of healing
Periodontal Treatment PROTOCOL: For adjunctive treatment of scaling, polishing, and root planing: • Pulse Mode • Power 0.8-1.2 W • 10-15 sec/pocket
Periodontal TherapyNumerous human dental studies:One of the first and many to follow:Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W. Treatment of periodontal pockets with a diode laser. Lasers in Surgery and Medicine 1998;22:302-311.Findings:1) Reduction of pocket depth2) Inhibition of bacteria3) Preserves healthy tissues
Soft TissueOn the bactericidal setting the diode laser can be a powerful tool during wound management:
Important Notes1) The important principle: light energy strikes the tissue for a certain length of time, producing a thermal interaction.2) The targeted tissue needs time to cool before the next pulse of laser energy is emitted.3) Of paramount importance to use the least amount of energy or power to perform the treatment objective.
Advantages & Benefits1) Bio-stimulate tissue2) Sterilize surgery site3) Never produce resistant microorganisms4) Hemostasis4) Surgical versatility (furcations and distal sites of molars)5) Reduced intraoperative and postoperative pain/discomfortRemember: Diode Lasers have FDA clearance for use in the periodontal pocket
Periodontal Therapy1) In the periodontal pocket, the root surface is contaminated with plaque and calculus, as well as infiltration of bacteria into cementum2) Complete removal of these harmful substances is essential for healing3) Since the periodontium is composed of gingiva, periodontal ligament, cementum, and alveolar bone, both soft and hard tissues are always targeted when using lasers for the treatment of periodontal lesions4) Due to the diode laser’s wavelength it is safe to use near dental hard tissue were the CO2 would cause major thermal damage
Advantages1) Hemostasis2) Surgical versatility3) Reduced intraoperative and postoperative pain/discomfort4) Reduced need for sutures5) Sterilization of surgery site