Lasers in Oral & Maxillofacial           Surgery
L   ightA   mplification byS timulatedE mission ofR   adiation
Contents• Historical background• Laser physics• Photobiology of Lasers• Laser safety• Types of Lasers• Clinical Applicatio...
Historical background•Albert Einstein   – 1917 – Quantum theory•Theodore Maiman – 1960 – 1st Laser using Ruby crystal•Java...
Laser physics        ELECTROMAGNETIC SPECTRUM                                                          ALEXANDRITE        ...
Generation of Laser EnergyCertain laser medium or LASANT with in the resonator  space is energized by internal or external...
The basic requirements for the laser activity are   – Active medium – LASANT   – Energy input – external or internal   – A...
Laser CavityFundamental components of laser system include    • Resonator cavity housing active medium    • Energy input –...
• The mirrors are essentially parallel to each other and  placed at the either end of the cylinder• The mirrors are separa...
OUTPUT MODES
OUTPUT MODES
OUTPUT MODES
TISSUE EFFECTS  Temperature      Visual Change       Biological changes37-60˚C         No change          Warming, welding...
PATTERNS
DOSIMETRY1. ENERGY2. POWER3. POWER DENSITY4. FLUENCE5. SPOT SIZE6. PULSE ENEGEY7. THERMAL RELAXATION TIME
COMPLICATIONS1. Herpes Simplex2. Dyschromias3. Scarring4. Eye and Teeth Injuries
LASER SAFETYReflection Electrical Pollution   Fire Shutdown
OCULAR PROTECTION
OCULAR PROTECTION
COMMONLY USED LASERS               TYPE                                  USE1) Erbium:YAG (pulsed)               Ablative ...
3)   Alexandrite (755 nm)QS                             Pigmented lesions,                               blue/black/green ...
First Laser
PRESENT LASERS
PRESENT LASERS
HAND PIECE
HAND PIECE
RECENT ADVANCES1. Improvements & Combinations2. Laser Phototherapy : Vitiligo:examiner laser : 308 nm3. Non – ablative las...
CLINICALAPPLICATIONS
FACIAL SKIN RESURFACINGIndications:1. Photo damage: Dyschromias & Rhytides2. Atrophic (depressed) scars : Post acneChromop...
TECHNIQUE
PHOTO DAMAGE
DEPRESSED SCARS
VASCULAR LESIONSChromophore – OxyhaemoglobinAbsorption wavelengths – 418, 542, 577 nmLaser of Choice : FPPDL – wavelength ...
PORTWINE HAEMANGIOMA
Nasal Telangiectasias
HYPERTROPHIC SCARS, KELOIDS &      STRIAE DISTANSAEFPPDL (585nm) – Laser of ChoiceFluence – 3 J/cm2Spot Size – 10 mmMechan...
POST TRAUMATIC SCAR
POST SURGICAL SCAR
NASOLABIAL SCAR
PIGMENTED LESIONS    QS Nd: YAG  QS ALEXANDRITE
PERIORBITAL PIGMENTATIONS
Seborrheic Keratosis
Tattoos1. Black pigment     QS Nd:YAG (1046NM)     QS ALEXANDRITE (755 NM Versa                           pulse coherent)2...
AMATEUR TATTOO
PROFESSIONAL TATTOO
MULTICOLOURED   TATTOO
HAIR REMOVALHair follicle thermal relaxation time : 10-100 milli secondsCooling system: Decreases epidermal injuryLasers &...
HAIR REMOVAL
HAIR REMOVAL
CONCLUSION Principles – simple  Technique – easyApplications – uniqueResults - outstanding
THANK YOU
Lasers in oral surgery
Lasers in oral surgery
Lasers in oral surgery
Lasers in oral surgery
Lasers in oral surgery
Lasers in oral surgery
Lasers in oral surgery
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Lasers in oral surgery

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Lasers in oral surgery

  1. 1. Lasers in Oral & Maxillofacial Surgery
  2. 2. L ightA mplification byS timulatedE mission ofR adiation
  3. 3. Contents• Historical background• Laser physics• Photobiology of Lasers• Laser safety• Types of Lasers• Clinical Applications• Medico legal considerations in Laser Surgery• Future Trends
  4. 4. Historical background•Albert Einstein – 1917 – Quantum theory•Theodore Maiman – 1960 – 1st Laser using Ruby crystal•Javan – 1961 – HeNe Continuous mode of laser•Johnson – 1961 – Nd:YAG Laser•Leon Goldman – 1963 – Father of modern lasers•Patel – 1964 – CO2 Laser•Anderson RR & – 1983 – Selective PhotothermolysisParrish JA
  5. 5. Laser physics ELECTROMAGNETIC SPECTRUM ALEXANDRITE ERBIUM-YLF KRYPYON EXCIMER Nd: YAG Ho:YAG ARGON HE NE RUBY KTP CO2 X - RAYS TV & RADIO WAVESFrequency 1020 1019 1018 1017 1016 1015 1014 1013 1012 1011 1010 109 108 107 106 105 104 103 102 101 100 3AO 3nm 3µm 3mm 3cm 3mWave length 3km MICROWAVES GAMMA WAVES ULTRAVIOLET VISIBLE LIGHT INFRARED IONISING NON - IONISING
  6. 6. Generation of Laser EnergyCertain laser medium or LASANT with in the resonator space is energized by internal or external energy to produce an excited population of atoms, molecules and rare gases (SPECIES). The energy with in the resonator reaches a population inversion in which the greatest cohort of species is in an excited state and in which photons are emitted and amplified within a laser cavity. The radiant energy is released as a laser beam.
  7. 7. The basic requirements for the laser activity are – Active medium – LASANT – Energy input – external or internal – A population inversion through quantum electronics – Some form of optical feedback or optical resonator
  8. 8. Laser CavityFundamental components of laser system include • Resonator cavity housing active medium • Energy input – external or internal.The cavity is bound by two mirrors • One totally reflecting • Other partially reflecting
  9. 9. • The mirrors are essentially parallel to each other and placed at the either end of the cylinder• The mirrors are separated by a fixed distance (d) forming a Fabry-Perot interferometer.• Principle of interference. Two or more waves simultaneously penetrate some material, forms a combied wave. Resulting a larger wave. » Constructive interference » Destructive interference
  10. 10. OUTPUT MODES
  11. 11. OUTPUT MODES
  12. 12. OUTPUT MODES
  13. 13. TISSUE EFFECTS Temperature Visual Change Biological changes37-60˚C No change Warming, welding60-65 ˚C Blanching Coagulation65-90 ˚C White/gray Protein denaturization, necrosis90-100 ˚C Puckering Drying100-150 ˚C Plume Vaporization150-210 ˚C Carbonization Potential Scar
  14. 14. PATTERNS
  15. 15. DOSIMETRY1. ENERGY2. POWER3. POWER DENSITY4. FLUENCE5. SPOT SIZE6. PULSE ENEGEY7. THERMAL RELAXATION TIME
  16. 16. COMPLICATIONS1. Herpes Simplex2. Dyschromias3. Scarring4. Eye and Teeth Injuries
  17. 17. LASER SAFETYReflection Electrical Pollution Fire Shutdown
  18. 18. OCULAR PROTECTION
  19. 19. OCULAR PROTECTION
  20. 20. COMMONLY USED LASERS TYPE USE1) Erbium:YAG (pulsed) Ablative skin resurfacing, epidermal(2490 nm) lesions2) Nd: YAG, frequency-doubled (532 Pigmented Lesions,nm) red/orange/yellow tattoosNd : YAG (1064 nm)QS Pigmented lesions, blue/black tattoosNormal mode Hair removal, leg veins, non- ablative dermal remodellingNd: YAG, long- pulsed Non-ablative dermal remodelling(1320 nm)
  21. 21. 3) Alexandrite (755 nm)QS Pigmented lesions, blue/black/green tattoosNormal mode Hair removal, leg veins4) Pulsed dye (510 nm) Pigmented lesions (585-595 nm) Vascular lesions, hypertrophic/keloid scars, striae, verrucae, nonablative dermal remodelling
  22. 22. First Laser
  23. 23. PRESENT LASERS
  24. 24. PRESENT LASERS
  25. 25. HAND PIECE
  26. 26. HAND PIECE
  27. 27. RECENT ADVANCES1. Improvements & Combinations2. Laser Phototherapy : Vitiligo:examiner laser : 308 nm3. Non – ablative lasers Nd :YAG (1320 nm) Diode (1450 nm) Er-glass laser (experimental)4. Optical imaging a) Confocal Scanning Laser Microscope - Diagnosis & Marginal Clearance without biopsy b) Optical Coherence Tomography - Skin Tumours and Bullous disease
  28. 28. CLINICALAPPLICATIONS
  29. 29. FACIAL SKIN RESURFACINGIndications:1. Photo damage: Dyschromias & Rhytides2. Atrophic (depressed) scars : Post acneChromophore : waterMechanism : Thermal ablation of Epidermis & papillary dermisPost op CareLasers a) Single pass CO2
  30. 30. TECHNIQUE
  31. 31. PHOTO DAMAGE
  32. 32. DEPRESSED SCARS
  33. 33. VASCULAR LESIONSChromophore – OxyhaemoglobinAbsorption wavelengths – 418, 542, 577 nmLaser of Choice : FPPDL – wavelength – 585, 590,595, 680 nmCooling SystemFiltersFluence –5-14 J/cm2Spot Size – 2-10 mmDensity – Less than 10%Pulse Duration : 1.5-40 millisecondsDelay between pulses – 10-500 milliseconds
  34. 34. PORTWINE HAEMANGIOMA
  35. 35. Nasal Telangiectasias
  36. 36. HYPERTROPHIC SCARS, KELOIDS & STRIAE DISTANSAEFPPDL (585nm) – Laser of ChoiceFluence – 3 J/cm2Spot Size – 10 mmMechanism – UnclearSessions – 4-6 weekly intervalsFutureAtrophic scars : Non-ablative lasers
  37. 37. POST TRAUMATIC SCAR
  38. 38. POST SURGICAL SCAR
  39. 39. NASOLABIAL SCAR
  40. 40. PIGMENTED LESIONS QS Nd: YAG QS ALEXANDRITE
  41. 41. PERIORBITAL PIGMENTATIONS
  42. 42. Seborrheic Keratosis
  43. 43. Tattoos1. Black pigment QS Nd:YAG (1046NM) QS ALEXANDRITE (755 NM Versa pulse coherent)2. Blue & green pigments QS ALEXANDRITE (755 nm)3. Red, orange & yellow QS Nd:YAG (532nm) FPPDL (510nm)
  44. 44. AMATEUR TATTOO
  45. 45. PROFESSIONAL TATTOO
  46. 46. MULTICOLOURED TATTOO
  47. 47. HAIR REMOVALHair follicle thermal relaxation time : 10-100 milli secondsCooling system: Decreases epidermal injuryLasers & IPL (600-1200nm)QS & LP Nd:YAG (1064 nm)LP Alexandrite (775 nm)Pulsed Diode (800 nm)IPL (590-1200 nm)
  48. 48. HAIR REMOVAL
  49. 49. HAIR REMOVAL
  50. 50. CONCLUSION Principles – simple Technique – easyApplications – uniqueResults - outstanding
  51. 51. THANK YOU
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