Lasers and its applications in conservative dentistry

Presented by:
Preeti Rastogi, MDS 2nd year
Dept. of Conservative dentistry
and Endodontics

Introduction
Laser physics
Component of laser device
Laser delivery system
Classification of lasers
Mechanism of laser tissue interaction
Wavelength of laser used in dentistry
Laser used in conservative dentistry
Laser used in Endodontics
Laser hazards
Laser hazard control measures
Advantage and disadvantage of laser
Conclusion
References
LASERS AND ITS APPLICATION IN CONSERVATIVE AND ENDODONTIC
DENTISTRY
2

Most patients still associate the sound and vibration of the drill with pain. However, with the new
advancements in this field, several options have become available to progressive dentists to allay fears and
offer patients state of the art treatment.
One such advancement is the advent of the laser technology presenting new vistas for dentists in fields of
dentistry.
• Laser is a device that transforms light of various frequencies into a chromatic radiation in the
visible, infrared and ultraviolet regions with all the waves in a phase capable of mobilizing immense
heat and power when focused at a close range
LASER is acronym for ‘Light Amplification by Stimulated
Emission of Radiation.’
The rapid development in the field of laser technology, modern lasers with a
wide range of characteristics are now available and being used in the field of
dentistry, most importantly in the field of conservative dentistry.
DENTISTRY
3

In 1917, Albert Einstein laid the foundation for the invention of the laser by
theorizing that photoelectric amplification could emit a single frequency, or
stimulated emission.
A predecessor of the laser, called the MASER ,for "Microwave Amplification by
Stimulated Emission of Radiation",was developed in 1954 at Columbia
University by Charles Townes and Jim Gordon and in Russia by Nicolay Basov.
The term LASER was first introduced to the public in 1959, in an article by a
Columbia University graduate student, Gordon Gould.
In early 1960s, the first working laser was invented by Theodore Maiman at the
Hughes Research Laboratories in Malibu,built the first functioning laser who inserted
a ruby rod into a photographic flashlamp by using a mixture of helium and neon.
The second laser to be developed was the neodymium laser by Snitzer in 1961.
DENTISTRY
4
Albert
Einstein
[DCNA -2004]

LASERS AND ITS APPLICATION IN CONSERVATIVE AND ENDODONTIC DENTISTRY
5
Design and built of the first working ruby laser
Dr. Theodore H. Maiman
July 11, 1927 - May 5,
2007

In 1971, The first use of lasers in endodontics was reported by Weichman and Johnson, as they utilize high power
infrared CO2 laser to seal the apical foramen in vitro
In 1962, the argon laser was developed, whereas, the ruby laser became the first medical laser to coagulate retinal
lesions, when it was used in 1963.
In 1964, Ralph Stern and Reidar Sognnaes used the ruby laser to vaporise enamel and dentine.
The first laser that had truly both hard and soft tissue application was the CO2 laser, invented by Patel in 1964.
The Nd:YAG laser was also developed in 1964 by Geusic, which is thought to have a better interaction with dental hard
tissues.
The first report of laser exposure to a vital human tooth was given in 1965 by Leon Goldman .
In 1970’s, researchers began to find the clinical oral soft tissue uses of medical CO2 and neodymium doped: yttrium
aluminum garnet (Nd:YAG) lasers.
In 1969 Leon Goldman used the laser clinically on enamel and dentine.
DENTISTRY
6

LASER PHYSICS
BASIC LASER SCIENCE

LIGHT
The basic unit of this radiant energy is called a photon; wave of photons travels at the speed of
light and it can be defined by two basic properties.
The first is amplitude, which
is defined as the total height
of the wave oscillation from
the top of the peak to the zero
line on a vertical axis. This is
an indication of the amount
of intensity in the wave:
larger the amplitude, the
greater the amount of useful
work that can be performed.
The second property is the
wavelength, which is the
horizontal distance between
any two corresponding points
on the wave. Dental lasers
have wavelengths in the
order of much smaller units
by using the terminology of
either nanometres (10-9 m) or
microns (10-6 m).
As the waves travel, they
oscillate several times per
second and this is termed as
‘frequency’.
Frequency is inversely
proportional to the
wavelength: The shorter the
wavelength, the higher the
frequency and viceversa.
Light is a form of electromagnetic energy that exists as a particle, travel in waves at a constant velocity.
DENTISTRY
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DENTISTRY
9

LASERS AND ITS APPLICATION IN CONSERVATIVE AND ENDODONTIC DENTISTRY 10
Comparison between ordinary visible light and laser light
Ordinary light usually appearing
white, is the sum of the many colors of
the visible spectrum – violet, blue,
green, yellow, orange and red.
Multiple wavelength =
white light (Polychromatic)
Non-directional
Non-focused
Unorganised , incoherent
Low Intensity
0.1 W/cm2
Laser energy is one specific color, a
property called “ monochromaticity” in
dental applications that color may be
visible or invisible.
Highly focused and directional-
collimated beam
Organised ,
Coherent Energy
High Intensity
108-1016 W/cm2
REGULAR LIGHT IS POLYCHROMATIC LASER LIGHT IS MONOCHROMATIC

The German physicist Max Planck introduced quantum theory in 1900 which was further conceptualized
as relating to atomic architecture by Neils Bohr, a physicist from Denmark.
When a quantum, the smallest unit of energy, is absorbed by the electrons of an atom and a molecule, a brief
excitation occurs.
Since natural orders prefers substances to be in a resting state, the quantum is soon released, a process called
spontaneous emission.
The emitted energy packet was previously described as a photon.
In 1916 Albert Einstein theorized that an additional photon travelling in the field of the excited atom that
has the same excitation energy level would result in a release of two quanta, or coherent wave of two
photons, a phenomenon he termed stimulated emission.
DENTISTRY
11

If this process were to continue, more atoms would be energized, more identical photons would be emitted
and further propagation of this stimulatory wave would result.
At some point, a population inversion occurs, meaning that a majority of the atoms of the active medium are
in the elevated rather than the resting state.
A pumping mechanism offering a constant supply of energy is necessary to maintain this excitation.
The photons are reflected back and forth within the active medium to further enhance stimulated emission and
successive passes through the active medium increase the power of and ultimately collimate the photon beam.
This the process of amplification.
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The laser energy produced is radiated in a specific form of
electromagnetic energy.
The entire array of wave energy is described by the
electromagnetic spectrum, with a range from gamma rays,
whose wavelength are typically less than10-10m, to
radiowaves, whose wavelength can be thousand of meters in
size.
Very short wavelengths below approximately 350nm are
termed ionizing and can deeply penetrate biologic tissue,
produce charged atoms and molecules and have a mutagenic
effect on cellular DNA.
Wavelength greater than 350nm cause excitation and
heating of the tissue with which they interact.
The accepted dividing line between ionizing and non-
ionizing wavelengths is at the junction of ultraviolet and
visible violet light on the spectrum.
All available dental laser devices are classified as non-
ionizing because their emission wavelength exceed 350nm.

• Monochromatic
• Coherence
• Collimation
• Monochromatic means that the light produced by a particular laser will be of a
characteristic wavelength. If the light produced is in the visible spectrum (400 nm
to 750 nm), it will be seen as a beam of intense color. It is important to have this
property to attain high spectral power density of the laser.
• Coherence means that the light is all perfectly in phase as they leave the laser.
That means that unlike a normal light source, their individual contributions are
summated and reinforce each other. In an ordinary light source, much of the
energy is lost as out of phase, waves cancel each other.
Common principles on which all lasers work is
generation of monochromatic, Coherent and
collimated beam

• Collimation means that the laser light beam is perfectly
parallel when leaving the laser aperture. This property is
important for good transmission through delivery systems.
• The main differentiating characteristic of lasers is wave
length which depends on the laser medium and excitation
diode, i.e. continuous wave or pulsed mode.
DENTISTRY
15
Collimated and uncollimated beam

All laser devices have the following main constituents:
a) Active medium:- A laser medium can be a solid, liquid or gas. Lasing medium decides the
wavelength of emitted light from the laser and the laser is named after the lasing medium Eg: CO2
laser: If CO2 is used as active medium/lasing medium.
b) External power source:- It excites or pumps the atom in the laser medium to their higher energy
levels. This causes the population inversion. A population inversion happens when there are more
atoms in the excited state pumped by the electrical charge rather than a non-excited state. Atoms in
the excited state spontaneously emit photons of light, which bounce back and forth between the two
mirrors in the laser tube. As they bounce within the laser tube, they strike other atoms, stimulating
more spontaneous emission. Photons of energy of the same wavelength and frequency escape
through the transmitive mirror as the laser beam.
c) Optical cavity:- To contain and amplify the photon chain reaction that results from stimulated
emission in a population of excited atoms, it is necessary to place this reaction within an optical
cavity. An optical cavity contains two parallel mirrors placed on either side of the lasing medium. In
this configuration, photons bounce off the mirrors and re-enter the medium to stimulate the release of
more photons. If some form of energy is provided to continuously pump atoms up to the excited
state, the population inversion can be maintained and high intensity light circulating back and forth
between two mirrors can be generated.
DENTISTRY
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d) Cooling system:- Heat production is a by-product of laser light propagation. It
increases with the power output of the laser and hence, with heavy-duty tissue
cutting lasers, the cooling system represents the bulkiest component. Co-axial
coolant systems may be air or water-assisted.
e) Mirror:- The mirror collimates the light, photons hits perpendicular to the mirrors
and re-enters the active medium, while those off-axis leave the lasing process. If
one mirror is totally reflective and other mirror is partially transmissive, the light
that escapes through partially transmissive becomes the laser beam. The lasing
medium is located within resonating chamber, which has a cylindrical structure
with a fully reflecting mirror on one side and partially transmissive mirror at other
site. These mirrors are precisely mounted so that they are exactly parallel to one
another. This arrangement allows for the reflection of photons of light back and
forth across the chamber, eventually resulting in the production of an intense
photo resonance within the medium.
.

In clinical practice, a laser must be able to
effectively deliver laser energy to the target site.
The existing range of laser delivery systems
involves:
• Articulated arms:- Laser light can be delivered
by articulated arms, which are very simple but
elegant devices.
• Mirrors are placed at 45 degree angle to the
tube carrying the laser light. The tubes can
rotate above the normal axis of the mirrors.
DENTISTRY
18
Articulated arm delivery
system

• Hollow waveguides:- The laser
energy is reflected along this tube
and exits through a handpiece at the
surgical end with the beam striking
the tissue in a noncontact mode.
• An accessory tip of sapphire or
hollow metal can be connected to
the end of the waveguide for contact
with the surgical site.
DENTISTRY
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Waveguide delivery system

• Fiber optics:- The fiber-optic system can be used in both contact or
noncontact modes. Mostly it is used in contact mode, directly touching the
surgical site. All conventional dental instruments: hand or rotary, physically
touch the tissue being treated.
20
Fiberoptic cables

a. 'Constant on'
Emission: It is the
continuous wave in which
the beam is emitted at
only one power level for
as long as the operator
depresses the foot switch.
b. 'Pushed on and off'
Emission: This is a gated
pulse mode having
periodic alterations of the
Laser energy, much like a
blinking light. This mode is
achieved by the opening
and closing of a
mechanical shutter in front
of the beam pathway of a
continuous wave
emission.
c. Free running pulse
mode: In this mode a very
large Laser energy is
emitted for an extremely
short span, in
microseconds followed by
a relatively long time in
which the Laser is off.
21
The dental Laser device can emit the light energy in three modalities as a function of
time:

• This is the interaction of photons with the atoms or molecules
of the target. Lasers have five different interactions with the
target tissue.
1) Photobiological interactions
2) Photochemical interactions
3) Photothermal interactions
4) Photomechanical interactions
5) Photoelectrical interactions

1. Reflection: During reflection, the
incident laser beam redirects itself
without affecting the target tissues.
2. Absorption: The second interaction is
the absorption of laser energy by the
intended target tissue. This effect is
desirable and the amount of energy that
is absorbed by the tissue depends on the
tissue characteristics, such as
pigmentation and water content; and on
the laser wavelength and emission
mode. Argon has a high affinity for
melanin and haemoglobin in soft tissue.
3. Transmission: The third interaction is
the transmission of laser energy directly
through the tissue without affecting it.
4. Scattering: The fourth interaction is
scattering. Scattering of the reflected
light weakens the intended energy and
possibly produces no useful biologic
effect.
PHOTOBIOLOGICAL INTERACTIONS
FOUR BASIC TYPES OF LASER
INTERACTION OCCURS WHEN LIGHT
HITS THE TARGET TISSUE

 Photochemical interaction:- It include
biostimulation, which described the
stimulatory effects of laser light on
biochemical and molecular processes that
normally occur in tissues such as healing
and repair.
 Photothermal interaction:- It manifest
clinically as photoablation or the removal
of tissue by vaporization and superheating
of tissue fluids; coagulation and
hemostasis and photopyroysis or the
burning away of tissues.
DENTISTRY
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 Photomechanical interaction:- It include photo-disruption or
photo-disassociation, which is the breaking apart of structures by
laser light. Photo-acoustic interactions, which involve the removal
of tissue with shock-wave generation.
 Photoelectrical interaction: It include photo-plasmolysis which
describes how tissue is removed by the formation of electrically
charged ions and particles that exist in a semi-gaseous, high-energy
state.
DENTISTRY
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1. Lasers can be classified according to its Hardness, Spectrum
of light and Material used.
2. Lasers are also classified as:
a) Soft tissue lasers
b) Hard tissue lasers
3. Classification of laser based on its spectrum:
4. Classification of laser according to the material used:
DENTISTRY
26

a) Soft tissue lasers
Soft tissue lasers generally utilize diodes.
Clinical applications includes: healing of localized osteitis, healing of aphthous ulcers,
reduction of pain and treatment of gingivitis. Soft tissue lasers in clinical use are:
1. Helium-Neon (He-N) at 632.8 nm (red, visible).
2. Gallium-Arsenide (Ga-As) at 830 nm (infra-red, invisible).
b) Hard tissue lasers
Hard tissue lasers (surgical) can cut both soft and hard tissues. Newer variety can
transmit their energy via a flexible fiber optic cable.
Commonly used hard lasers are:
1. Argon lasers (Ar) at 488 to 514 nm
2. Carbondioxide lasers (CO2) at 10.6 micro-meter
3. Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) at 1.064
micrometer.
4. Neodymiumm Yttrium-Aluminum-Perovskite (Nd:YAP) at 1,340 nm.
DENTISTRY
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1) UV Light
a. Spectrum is 100 nm – 400 nm
b. Use: Not used in dentistry.
2) Visible Light
a. Spectrum is 400 nm – 750 nm
b. Use: Most commonly used in dentistry (Argon and Diagnodent)
3) Infrared light
a) Spectrum is 750 nm – 10000nm
b) Use: Most dental lasers are in this spectrum.
DENTISTRY
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A. Gas lasers:
• Argon
• Carbon-dioxide
B. Liquid:
• Dyes
C. Solid:
• Nd:YAG
• Erbium: Yttrium Aluminum
Garnet (Er: YAG)
• Diode
D. Semiconductor:
• Hybrid silicon laser
E. Excimers:
• Argon-fluoride
• Krypton-fluoride
• Xenon-fluoridesers
DENTISTRY
29

• This laser has an active medium of ionized argon gas, energized by a high current electrical discharge,
and the laser light is delivered fiber-optically in continuous wave and gated pulsed modes.
• There are two emission argon laser wavelengths used in dentistry: 488 nm (blue) and 514 nm (blue
green).
• Both wavelengths are poorly absorbed in the enamel and dentin which is advantageous during cutting
and sculpting gingival tissues as there is minimal interaction with the dental hard tissue without
causing any damage to the tooth surface.
• Both wavelength is used as an aid for caries detection When the argon laser light illuminates the
tooth, the carious area appears as a dark orange-red color and is easily discernible from the
surrounding healthy structures.
• Argon lasers are indicated in periodontics, as they possess bactericidal properties against Prevotella
intermedia and Porphyromonas gingivalis and also used to treat vascular malformations such as a
hemangioma.
• Potential complications of this laser treatment include granuloma formation, bleeding or non-
resolution of the lesion.

• The diode laser is manufactured from solid semiconductor crystals made from a
combination of aluminum (with wavelength of 800 nm) or indium (900 nm), gallium
and arsenic.
• These wavelengths penetrate deep into the mucosa and highly attenuated by the
pigmented tissue, although hemostasis is slow as compared with the argon laser.
• These lasers are excellent soft tissue surgical lasers, so surgery can be performed safely as
these wavelengths are poorly absorbed by the dental hard tissue.
• This laser is indicated for gingivoplasty, sulcular debridement and deeper
coagulation process on gingival and mucosa.
• The chief advantage of the diode lasers is one of a smaller size, portable instrument.
These lasers can also stimulate fibroblastic proliferation at low energy levels.

• Nd:YAG has a solid active medium, which is a garnet crystal combined with rare earth
elements yttrium and aluminum, doped with neodymium ions.
• The available dental wavelength of 1064 nm is indicated for various soft-tissue
procedures such as cutting and coagulating of gingival and sulcular debridement.
• This laser provides good hemostasis provides a clear operating field during soft-tissue
procedures.
• The laser is also indicated for the removal of incipient caries, although the working
efficiency is less in comparison with the Er: YAG, or Er, chromium (Cr):YSGG lasers.
• When used in a noncontact, defocused mode, this wavelength can penetrate several
millimeters which can be used for procedures such as treatment of aphthous ulcers or
pulpal analgesia.
• However, due to a decrease in pulpal function, sometimes damage to the dental pulp can
results
DENTISTRY
32

33

Erbium, Cr:YSGG (2780 nm)
• Erbium, Cr: YSGG (2780 nm) which has an active medium of a solid crystal of
yttrium scandium gallium garnet doped with erbium and chromium.
Erbium:YAG (2940 nm)
• Erbium: YAG (2940 nm) which has an active medium of a solid crystal of yttrium
aluminum garnet doped with erbium.
• Both lasers aid in caries removal. The laser produces clean, sharp margins during
cavity preparation.
• Since, depth of penetration of laser wavelength is less, so pulpal damage is minimal.
During caries removal, since the laser has an anesthetic effect, the analgesia is not
routinely indicated in the majority of patients.
• The laser also assists in removal of endotoxins from root surfaces so providing an
anti-microbial effect.
• These lasers are comfortable to the patients as vibration produces from the laser are
less severe in comparison to the conventional high-speed drill. Thus, they are less
likely to provoke intraoperative discomfort or pain

The Er-Cr:YSGG Laser
• This laser is widely indicated in restorative
and etching procedures.
• During cavity preparation, the laser provides
rough surfaces for bonding without causing
any significant cracking in the dental hard
tissue.
• The advantage of this laser for restorative
dentistry is that a carious lesion in close
proximity to the gingiva can be treated and the
soft tissue recontoured with the same
instrumentation.
• Furthermore, tissue retraction for uncovering
implants is safe with this wavelength, because
there is minimal heat transferred during the
procedure.
• However, the rough surface produced during
etching procedures will have a wide range of
strengths of enamel bonds which is unreliable.
• Therefore, the procedure still requires acid
etching to obtain equivalent bond strength
Er: YAG Laser unit (screen)

• The CO2 laser is water or air cooled gas discharge,
containing a gaseous mixture with CO2 molecules, that
helps in producing a beam of infrared light.
• The light energy, whose wavelength is 10,600 nm, well
absorbed by water and is delivered through a hollow
tube-like waveguide in continuous or gated pulsed mode.
• The laser wavelength can easily assists in cutting and
coagulation of soft tissue, thus providing a clear
operating field.
• The laser is indicated for the treatment of mucosal
lesion, since it has a limited penetration depth.
• Post-operative pain usually is minimal to none as it
reduced pain by inducing local neural anesthesia as a
function of neuron sealing and decreased pain mediator
release.
• CO2 laser also has some disadvantages. However, there
is delayed wound healing for a few days, as a result of
delayed re-epithelization and a different pattern of
wound contraction.
• Furthermore, the loss of tactile sensation could pose a
disadvantage for the surgeon, but the tissue ablation can
be precise with careful technique.
DENTISTRY
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CO2 Laser unit

The following limitation of CO2 and Nd: YAG Laser led to the development of
Excimer laser.
• Vaporization and carbonization of dental tissue.
• Thermal side effect, which may damage pulp and periodontal tissue (Temperature
may rise up to 65°C).
• Caries removal leads to structural changes such as cracks, zones of necrosis, etc.
Excimers work by the process of ablative photo decomposition, which implies bond
breaking of molecules with minimal thermal side effects (Temperature increase is
approximately 12°C). Residual energy is converted into kinetic energy by expansion
of residual gaseous phase. Excimers are emitted in UV spectral range.
The available Excimers are:
ArF
KrF
XeCl
XeF
193nm
248nm
308nm
351 nm

• Argon-fluorine Excimer laser has the following advantages:
• Thermal effects are minimal (The temperature rise of pulp was 5°C).
• Prepare cavities in dental hard tissue without side effects.
• It has bacteriological effect on prepared surface.
• The possibility of tissue identification during the treatment process in
selective removal of affected tissues.
• The zone of necrosis is small so there is no residual debris.
• The experiments have observed no carcinogenic effect.
38

Preventive effects
(CO2, Nd:YAG,
Excimers)
Caries
treatment
(CO2,
Nd:YAG,
Excimers,
Er:YAG)
Composite Resin
Light Curing
(Argon, Dye)
Tooth
surface
Conditioni
ng
(Excimers,
CO2,
Nd:YAG,
Er:YAG)

Laser fluorescence:- Laser
fluorescence (LF) can be
used as an integrated with
standard methods for
detection of occlusal caries.
The portable diode laser-
based system explain the
emitted fluorescence on the
occlusal surface agree with
the extent of
demineralization in the tooth.
DENTISTRY
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The Diagnodent is used
for caries and calculus
detection by emitting a
non ionising laser beam at
a wavelength of 655nm
(at a 900 angle) towards a
specific darkened groove
on the occlusal surface of
a patient’s tooth where
bacterial decay is
suspected, or along the
long axis of a root surface
to detect the presence of a
bacteria-laden calculus.
This diagnostic
technology, in which the
photons of this laser
wavelength are absorbed
into any existing bacteria
in these areas of the
patient’s tooth, is called
Laser induced
fluorescence.
The instrument’s digital
display indicates the
number of bacteria in this
area of the tooth and it
may correspond to the
extent of decay of the
tooth.
LASERS AND ITS APPLICATION IN CONSERVATIVE AND
ENDODONTIC DENTISTRY
41
DIGNODENT

• Commonly used Lasers for this purpose are CO2, Nd:YAG and Excimers.
• CO2 laser is thought to be ideally suitable since its long wavelength can easily
be absorbed by enamel. Only the shallow depth is affected thereby minimizing
possible harmful effects on the pulp.
• The most effective wavelength for inhibiting artificial caries was found to be
9.3 μm to 10.6 μm.
• Nd:YAG Laser is used as pit and fissure sealant. It removes inorganic and
organic debris in pit and fissure without injuring the surrounding healthy
enamel. The laser effect would weld hydroxyl apatite crystals blocking the
pits/fissures.
• Following two features are important for Lasers to help in caries prevention:
• Minimum energy density is required to avoid damaging the soft tissues especially dental pulp.
• The ability to direct the Laser beam within the restricted space by means of a flexible beam
guide.
• Earlier authors opined that Nd:YAG Laser may increase the acid resistance of tooth enamel.
This effect is caused by melting of a thin glaze like surface layer of enamel.

43
Nelson, et al (1978) was of the view that caries preventive effect of Laser was
due to reduction of enamel permeability and also reduction of enamel solubility.
Oho and Morio (1990) observed that the lased enamel was found to have a high
positive birefringence, which might be due to presence of micropores.
Laser act in the following ways:
•The enamel surface gets sealed and becomes less permeable to diffusion by ions into and out of
enamel during demineralization.
•The composition of enamel is altered (reduced carbonate content of apatite crystals), which
reduces its solubility and permeability.
•The application of Laser is most effective when the emitted Laser light is matched to the
absorption of target tissue.
•The degree of difference between these two wavelengths determine the amount of Laser energy,
i.e. reflected or absorbed into the target tissue; for example, when applied to enamel and dentin,
treatment of tooth is different.
•Enamel and dentin have different peak absorption values of 9.6 μm and 2.9 μm respectively.
• As a result, no single Laser has proven fully versatile when applied to oral tissues. Unfortunately,
commercial available Lasers operate at one predetermined wavelength that cannot be changed to
accommodate the absorption values of treated teeth.

• The "Laser Drill" has been successful in replacing the conventional bur for cavity preparation.
• CO2 Laser has been successfully used to remove carious dentin without damage to pulp.
• Nd:YAG Laser is being used to remove caries. A small amount of Laser initiatior was applied to
enamel to facilitate absorption of laser energy.
• The patient feels slightly warm sensation.
• When dentition is vaporized by Laser, its surface becomes darkened by carbonization. This can be
easily removed by applying a steady stream of water while simultaneously lasing the area.
• Due to alteration of surface structure, the lased tooth becomes resistant to decay. In case of root
caries, the placement of restorative material may not be necessary after Laser application.

• The Er:YAG laser has shown more promising results.
• It is absorbed by water and hydroxyapatite, which partially
accounts for its efficiency in cutting enamel and dentin.
• When cutting the vital tooth, it can be lased for about 10 seconds
and after that cutting or cavity preparation can be carried out
without discomfort.
• Cozean, et al (1997) reported that Er:YAG laser was equivalent to
high speed drill in its ability to make cavity preparations in
enamel and dentin. The procedure can be carried out without
anaesthesia.
DENTISTRY
45

• The first mechanism implies the direct effect of laser irradiation on the electric activity of nerve
fibers within the dental pulp, whereas the second involves modification of the tubular structure
of the dentin by melting and fusing of the hard tissue or smear layer and subsequent sealing of
the dentinal tubules.
• The lasers used for the treatment of dentinal hypersensitivity are divided into two groups:
• low output power lasers (helium neon and gallium/ diode) and
• middle output power lasers (Nd:YAG and CO2).
• Low output power laser therapy is used to support wound healing, shows anti-inflammatory
effect, has the ability to stimulate nerve cells.
• Low output laser uses an output power of only 6 mW, which do not affect the morphology of the
enamel or dentin surface but allows a small fraction of the energy to reach the pulp tissue.
• He-Ne laser affects the peripheral A-delta or C-fiber nociceptor.
• Laser energy of Nd:YAG are indicating thermally mediated effects and pulpal analgesia. CO2
lasers mainly seal the dentinal tubules as well as reduce the permeability.

DENTISTRY 47
v. Treatment of tooth erosion
• Dental erosion is caused by a series of extrinsic and intrinsic factors.
Extrinsic factors largely include the consumption of acidic foods.
• Carbon dioxide lasers have been mostly used in the prevention of erosion,
due to its efficient interaction with hydroxyapatite crystals.
vi. For removal of restorative materials
• The Er:YAG laser is capable of removing all dental cements and composite
resin restorations.
• Lasers should not be used to ablate amalgam restorations, because of the
potential release of mercury vapour.
• The Er:YAG laser is incapable of removing gold crowns, cast restorations
and ceramic materials because of the low absorption of these materials and
the reflection of the laser light.
• These limitations highlight the need for adequate operator training in the use
of lasers.

• Laser etching has been evaluated as an alternative to the acid etching of enamel and dentine.
• Er:YAG , CO2 and Nd :YAG Laser are being used for etching of enamel.
• The Er:YAG laser produces micro-explosions during hard tissue ablation that result in microscopic
and macroscopic irregularities.
• These micro-irregularities make the enamel surface microretentive and offer a mechanism of adhesion
without acid etching to composite resin.
• However, it has been shown that adhesion to the dental hard tissues after Er:YAG laser etching is
inferior to that, which is obtained with conventional acid etching.
• CO2 laser is preferred because of its favorable absorption characteristics in dental hard tissue. In
addition, CO2 laser can be placed at localized area when used with appropriate delivery system. This
results in etching to a specific area of enamel.
• A black dye is placed on enamel surface to increase absorption of Laser beam.
• Total clinical time is reduced (seven seconds for conditioning and fifteen seconds for acid etching) as
there is no need of washing or drying.
DENTISTRY
48

Argon laser [488nm of wave length] is a promising source, as the wavelength of the
light which is emitted by this laser is optimal for the initiation of polymerisation of
the composite resin.
• Argon laser wavelength activates camphorquinone, a photo-initiator that causes
polymerisation of the resin composites.
• The argon laser radiation is also able to alter the surface chemistry of both the
enamel and root surface dentin, which reduces the probability of the recurrent caries.
• Advantages
• Shorter curing time
• Better physical properties
• Increased depth of cure
• Better polymerization
• Reduced polymerization shrinkage n composite resins.
Studies also showed the positive effects of the argon laser compared to halogen light:
1) Increased hardness,
2) Increased diametral tensile strength, transverse flexural strength, and
compressive strength of the polymerised composite resin,
3) Increased depth of curing
4) reduction in the residual monomer of composite resin.
DENTISTRY
49

• The light source increases gradually during the curing process to create the best bond available in
dentistry today.
• Most dental curing lights deliver light in that is between 400 and 500 nm
• Appointment length is also reduced because it is 500% more powerful than standard equipment.
• Less than 1% of dental offices nationwide have this instrument, making it one of the newest tools
in dentistry.
• It is established that dentinal bonding is substantially increased (up to 300%) if the dentin is
pretreated with a pulsed CO2 laser prior to bonding.
• Improved dentin bonding with Argon or Nd :YAG Lasers has also been reported.
• The enamel surface to receive composite can first be Laser etched to provide enamel the desired
roughness.
• After restoration, the restoration-tooth interface is Laser treated to reduce the marginal gap,
subsequently the recurrent caries.
DENTISTRY
50

Two types of Lasers are usually used:
• The Argon Laser that emits a
visible blue light and
• CO2 Laser that emits invisible
infrared light.
• The Laser energy rapidly decompose
H2O2 to O2 and H2O.
Argon laser is best for removal of
initial dark stains than CO2 laser.
DENTISTRY
51

52
•The objective of laser bleaching is to achieve the ultimate power bleaching
process using the most efficient energy source while avoiding any adverse
effects.
•Using the 488-nm argon laser as an energy source to excite the hydrogen
peroxide molecule offers more advantages than other heating instruments.
•The argon laser rapidly excites the already unstable and reactive hydrogen
peroxide molecule; the energy then is absorbed into all intermolecular and
reaches eigenstate vibrations.
•Lasers can enhance bleaching by photo-oxidation of colored molecules in the
teeth or by interaction with the components of the bleaching gel through
photochemical reactions. The result is a visually whitened tooth surface.

• This technology eliminates the need for conventional
intra-oral impression materials.
• Instead, laser scanners take an optical impression of a
prepared tooth and the opposing dentition, and they
take a bite registration to produce an interactive three
dimensional image.
• This three-dimensional laser-based imaging
technology enables the dentist to take an optical
impression and to create a computer file with this data.
• A virtual model is created, based on the transmitted
data and a precise master model is made.
• The physical model is sent to the laboratory where a
final restoration is made.

The use of lasers in endodontics has been studied since the early 1970s, and lasers have been more
widely used since the 1990s
1. Lasers as a Diagnostic Tool for Endodontics
2. Analgesic Effects of Laser
3. Laser & Dentin Hypersensitivity
4. Treatment of vital pulpal tissue-Pulpotomy and Direct pulp capping and pulp
amputation
5. Root canal disinfection and irrigation-
• Access cavity preparation and root canal orifice enlargement.
• Root canal wall preparation.
• Sweeping of Root canal and irrigation.
• Sterilization or disinfection of infected canals.
• Obturation with gutta percha or resin.
• Removal of temporary cavity sealing materials, root canal sealing materials, and
fractured instruments in root canals
6. Vertical root fracture diagnosis and treatment
7. Laser Assisted Obturation and removal of gutta percha obturation material.
8. Endodontic surgery-
• Flap preparation – incision of soft tissue to prepare a flap and expose the bone.
• Cutting bone to prepare a window access to the apex (apices) of the roots
• Apicoectomy – amputation of the root end
• Root end preparation for retro fill amalgam or composite
• Removal of pathological tissues (i.e., cysts, neoplasm or abscess) and hyperplastic
tissues (i.e., granulation tissue) from around the apex.

a. Laser Doppler Flowmetry (LDF): LDF was developed to assess blood flow in microvascular
systems. This technique uses helium-neon and diode lasers at a low power of 1 or 2 mW.
Electrical vitality testing works on stimulating nerve ending but LDF detects blood circulation in pulp
potentially a much more reliable and less uncomfortable for the patient.
• The laser beam is directed through the crown of the tooth to the blood vessels within the pulp.
Moving red blood cells causes the frequency of the laser beam to be Doppler shifted and some of the
light to be backscattered out of the tooth .
• The reflected light is detected by a photocell on the tooth surface and its output is proportional to the
number and velocity of the blood cells.
• The main advantage of this technique, in comparison with electric pulp testing or other vitality tests,
is that it does not rely on the occurrence of a painful sensation to determine the vitality of a tooth.
• .
55
Laser doppler line scanning
procedure

• Laser Doppler flowmetry has some limitations.
• It may be difficult to obtain laser reflection from certain teeth.
• Generally, the anterior teeth, in which the enamel and dentin are thin, do not
present a problem.
• Molars, with their thicker enamel and dentin and the variability in the position of
the pulp within the tooth, may cause variations in pulpal blood flow.
• Furthermore, differences in sensor output and inadequate calibration by the
manufacturer may dictate the use of multiple probes for accurate assessment.
• Laser Doppler flowmetry assures objective measurement of pulpal vitality.
• When equipment costs decrease and clinical application improves, this
technology could be used for patients who have difficulties in communicating or
for young children whose responses may not be reliable.

Thermal testing:
• In this pulsed Nd: YAG laser is applied instead of hot burnisher or hot
gutta-percha.
• Pain produced by laser is mild and tolerable when compared to
conventional pulp tester.
• Differential diagnosis of normal pulp and acute pulpitis:
• On stimulation by Nd: YAG laser at 2 W and 20 pulses per second, at
distance of 1 cm from the tooth, pain occurs within 20-30 seconds but
also disappears soon after laser is removed.
• But in case of acute pulpitis pain lingers on even after removal of laser.
DENTISTRY 57

• The role of LASER in direct and indirect pulp capping has proved to be useful in endodontics.
• Melcer et al in 1987 first described laser treatment of exposed pulp tissues using the CO2 laser in
dogs to achieve hemostasis.
• The first laser pulpotomy was performed using CO2 lasers in dogs in 1985.
• Melcer et al showed that the CO2 laser produced new mineralized dentin formation without cellular
modification of pulpal tissue when tooth cavities were irradiated in beagles and primates.
• Moritz et al used a CO2 laser in patients in whom direct pulp capping treatment was
indicated. An energy level of 1 W at 0.1-second exposure time with 1-second pulse intervals
was applied until the exposed pulps were completely sealed. They were then dressed with
calcium hydroxide . In the control group, the pulps were capped with calcium hydroxide only.
Symptoms and vitality were examined after 1 week and monthly for 1 year: 89% of the
experimental group had no symptoms and responded normally to vitality tests versus only 68%
of the control group.
DENTISTRY
58

• In cases of deep and hypersensitive cavities, indirect pulp capping should be
considered. A reduction in the permeability of the dentin, achieved by sealing the
dentinal tubules, is of paramount importance. Nd:YAG and 9.6 µm CO2 lasers can be
used for this purpose.
• The 9.6 µm CO2 laser energy is well absorbed by the hydroxyapatite of enamel and
dentin, causing tissue ablation, melting, and resolidification.
• The effect of Nd:YAG laser energy on intrapulpal temperature was investigated by
White et al.
• They found that the use of a pulsed Nd:YAG laser with an energy level of below 1 W, a
10-Hz repetition rate, and an overall 10-second exposure time did not significantly
elevate the intrapulpal temperature.
• According to their results, these parameters may be considered safety parameters because
the remaining dentinal thickness in cavity preparations cannot be measured in vivo.
• It is therefore recommended that clinicians choose laser parameters lower than these
safety limits.
DENTISTRY
59

• Endodontic instrumentation produces organic and mineral debris on the
walls of the root canal.
• Although this smear layer can be beneficial in that it provides
obstruction of the tubules and decreased dentinal permeability. It may
also harbor bacteria and bacterial byproducts.
• For these reasons, use of laser for the removal of the smear layer and its
replacement with the uncontaminated chemical sealant or sealing by
melting the dentinal surface has become a goal.
• The removal of smear layer and debris by lasers is possible however, it
is hard to clean all root canal walls because the laser is emitted straight
ahead, making it impossible to irradiate lateral wall.
60

• The long-term success of an endodontic therapy often fails due to remaining bacteria in the
root canal or dentin tubules, which cannot be sufficiently eliminated through the classical
root canal preparation technique or through rinsing solutions.
• Laser light which penetrates up to > 1000 μm into the dentin has scope for complete canal
sterilization.
• The laser is an effective tool for killing microorganisms because of the energy and
wavelength characteristics.
• Sterilization: Commonly used laser are Nd: YAG, argon CO2, Er: YAG and
semiconductor diode. PAD (Photoactivated Disinfection of root canals).
• Laser irradiation has the ability to kill the bacteria, remove debris, and smear layer from the
root canal walls following biomechanical instrumentation.
• Infected root canals are an indication for this laser treatment, but its application in extremely
curved and narrow infected root canals appears difficult.
• The application of excimer lasers in dentistry for the treatment of dental root canals is
reported in studies. High-energy UV radiation emitted by a XeCl excimer laser (308 nm)
and delivered through suitable optical fibers can be used to remove residual organic tissue
from the canals.

• LAI with an erbium laser has been introduced as a
method for activating the irritant.
• The effect is based on cavitation; in water, activation
of the laser at sub-ablative settings may result in the
formation of large elliptical vapor bubbles, which
expand and implode.
• These vapor bubbles may cause a volumetric
expansion of 1600 times the original volume, which
increases pressure and drives fluid out of the canal.
• When the bubble implodes after 100–200 μs, an under
pressure develops and sucks fluid back into the canal,
inducing secondary cavitation effects.
• Therefore, the laser works as a fluid pump.

• As microorganisms play a crucial role in the development
of pulpal and periapical disease, the prognosis of
endodontic therapy is intimately related to the presence
of bacteria within the root canal system.
• Microorganisms may persist in the apical region of the
root canal system despite chemomechanical preparation.
• The usefulness of Nd: YAG, diode, potassium titanyl
phosphate [KTP], and Er: YAG for photothermal
disinfection of the root canal has been demonstrated in
numerous studies.
• An alternative approach to microbial killing in the root
canal system by laser light involves the use of low-power
lasers to drive a photochemical reaction that produces
reactive oxygen species, a technique termed PAD.

• Using exogenous photosensitisers such as tolonium chloride,
killing of all types of bacteria can be achieved.
• In vitro studies of PAD have demonstrated its ability to kill
photosensitized oral bacteria (such as E. faecalis), and more
recently, microbial killing in vivo in the root canal system
has been demonstrated.
• While PAD can be undertaken as part of the routine
disinfection of the root canal system, it also has potential use
for eradicating persistent endodontic infections for which
conventional methods have been unsuccessful.

• Root canal shaping represents an important step in the
endodontic procedure as it aids in removal of organic
tissues and facilitates irrigation and canal obturation
• Ar, CO2 and Nd:YAG laser have been used to soften
gutta-percha.
• The 308 nm excirmer laser is the only system that offers
precise ablation of tissue, fiber delivery and bactericidal
effects.
• Good transmission through water and enamel surface
conditioning in one system.
• It is useful to use lasers as adjuncts to conventional
treatment, but it is not possible to use lasers alone for
treatment.
65
Laser beam is directed
towards root canal for
endodontic therapy

Lasers are using in repairing incomplete vertical fractures by
causing fusion of the fracture.
• If laser is used for surgery, a bloodless surgical field should be
easier to achieve. If the cut surface is irradiated, it gets sterilized
and sealed.
• Clinically the use of Er: YAG laser resulted in improved healing
and diminished postoperative discomfort.

This laser replaces traditional surgery for
many gum and soft tissue dental
applications and is gentler than traditional
surgical procedures. This laser used for :
• Improve treatment results for gum disease
• Contour gums for smile enhancement
• Surgically correct oral abnormalities.
• Surgically assist in arresting herpes lesions
and canker sores
• Assist in biopsies
DENTISTRY
67

• Patient may sometimes experience pain the day after endodontic treatment. This is
particularly common after the treatment of chronic complaints.
• This can be managed by Low Level Laser therapy (LLLT). LLLT includes light-
emitting diodes and other light sources.
• It is effective for reducing pain and inflammation after endodontic treatment and can
be used as a diagnostic tool for pulp hyperemia.
• Laser irradiation increases circulation, and thus, a patient will feel a sharp pain when
the laser is applied to a tooth with a hyperemic pulp.
• LLLT seems to be an effective and non-pharmacological approach for the reduction
of post-endodontic treatment pain.
68

• LLLs refer to the use of red-beam or near-infrared lasers with a
wavelength between 600 and 1000 nm power from 5 to 500
mW.
• These lasers of its effect is unknown, it is theorized that, due to
the low absorption by human skin, the laser light can penetrate
deeply into the tissues where it has a photobiostimulation effect.
• Light in infrared spectrum at specific wavelength penetrates the
tissue and is absorbed where the light energy is converted into
biochemical energy, restoring normal cell function.
• The therapy performed with such lasers is often called LLLT, and
the lasers are called “therapeutic lasers.”
• The appropriate dose appears to be between 0.3 and 19 J/cm2.
Dental LLLT unit
Intraoral application of LLLT

• Analgesic effect of the laser
• In vivo studies of the analgesic effect of LLLT on nerves supplying
the oral cavity have shown that LLLT decreases the firing frequency
of the nociceptors, with a threshold effect seen in terms of the
irradiance required to exert maximal suppression.
• There have been claims that successful analgesia following oral
surgery can be achieved with all major LLLT wavelengths from 632
nmto 904 nm.
• Local CO2 laser irradiation will reduce the pain associated with
orthodontic force application, without interfering with tooth
movement.
70

Nerve repair and regeneration
• Low level laser therapy has been seen to reduce the production of
inflammatory mediators of the arachadonic acid family from injured
nerves, and to promote neuronal maturation and regeneration following
injury.
• The LLLT protocols used, typically involve daily irradiation for
prolonged periods, for example, 10 days at 4.5 J per day.
• The direct application of this technique to dentistry has yielded positive
results in promoting the regeneration of inferior dental nerve (IDN)
tissue, damaged during surgical procedures.
Post surgical pain
• A single episode of LLLT (irradiance 0.9-2.7 J) is 100% effective for
apical periodontitis following root canal treatment and post-extraction
pain.
• There are conflicting results with regard to pain reduction post extraction
by LLLT verses placebo controls.

• Laser can be used in variety of other fields such as:
• Nd:YAG Laser is widely used for welding
• CO2, Nd:YAG, Argon Laser can be used to sterilize dental instruments and to
kill bacteria on culture media, glass slides, etc.
• Exposure of dentin to Laser leads to activation of dentinogenesis.
• Laser can produce 3-D images of objects. These images are called holograms.
The study casts, etc. can be saved as holograms.
• The three dimensional co-ordinates of a crown can be relayed to a computer,
which controls a milling machine designed to produce the final restoration.
• The cavity treated with laser offers better adaptation of glass-ionomer
cements.
• Laser produces effective analgesia and has replaced the need for local
anaesthesia.
• Laser is effective in soft tissue management during cavity and crown
preparations.
• Effective in detecting vertical root fractures.
DENTISTRY
72

It is painless, bloodless that results in clean surgical field and fine incision with precision.
The risk of infection is reduced as a more sterilized environment is created, as laser kills microorganisms -
Sterilization of operating field
No post-operative discomfort, minimal pain and swelling, generally doesn't require medication.
Superior and faster healing, offers better patient compliance
Reduced operator chair time
Minimal invasive cavity preparation
Bactericidal effect
Haemostatic effect
Increased depth of penetration; makes it possible to cure thicker increments of composite resin.
DENTISTRY
73
[DCNA -2004 &
INGLE]

High working speed. As fast as the high-speed turbine
Outstanding precision
Soft, quiet, vibration-free operation
No risk of cross-infection
Fewer cracks than with turbine
Multiple quadrant dentistry
No need for etching
Pulsing minimizes charring and thermal necrosis
DENTISTRY 74

Relatively high cost.
Requires specialized training for the
clinician.
Modification of clinical technique is
required.
Harmful to eyes and skin of both
clinician and patients if exposed
adversely.
No single wavelength of laser will
optimally treat all dental diseases
Lasers don't completely eliminate the
need for anesthesia
DENTISTRY
75

It requires additional training and education for various
clinical applications and types of lasers.
High cost required to purchase equipment, implement
technology and invest in required education.
More than one laser may be needed since different
wavelengths are required for various procedures.
DENTISTRY
76

A risk is something which is potential to cause injury. Their are a number of risks related to the use
of lasers in clinical environment, the most used the laser light itself. The Centre for Devices and
Radiological Health (CDRH) of Food and Drug Administration (FDA) of USA sets forth the
standards governing the manufacturing of laser equipment in the Code of Federal Regulations(CFR).
1. Ocular Hazards: Eye abrasion occurs either by direct emission from laser source or by the
iatrogenic reflection of laser light from mirror surfaces used during dental treatment. Dental
instruments have ability to create reflections that may result in tissue injury to both the clinician
and patient.
2. Tissue Damage: Thermal interaction of laser radiant energy with tissue proteins can result in injury
to the skin and other non target tissues (oral tissue).
Temperature elevations of 21ºC above the normal body temperature (37ºC) can create cell
destruction by denaturation of cellular enzymes and structural proteins, which interrupt basic
metabolic processes.
3. Respiratory Hazards: It includes the potential inhalation of air borne biohazard: materials are
delivered as a result of surgical application of lasers. These secondary hazards belong to a group of
‘potential laser hazards’ (also called as ‘non beam hazards’).
DENTISTRY
77

4. Combustion Hazards: Lasers can cause combustion in the presence of flammable
materials. The dental surgical setting can be easily erupted, if exposed to the laser
beam which is used by flammable solids, liquids and gases.
5. Electrical Hazards: Laser systems include high potential, high power electrical supplies.
The most serious accidents with lasers have been electrocution. There are various
associated hazards that may be potentially harmful .
Electrical hazards are grouped as:
1. Shock hazards
2. Fire hazards or explosion hazards.

DENTISTRY
79
Class Description
I Low powered lasers that are safe to oral
II Low powered visible lasers that are hazardous when viewed for
larger than 0.25sec
III Low powered visible lasers that are hazardous when viewed for
larger than 1000sec
IIIa Medium powered lasers that are normally not hazardous if
craves for less than 0.25sec without magnifying optics
IIIb Medium powered lasers (0.5w) that can be hazardous viewed
directly
IV High powered lasers (>0.5w) that produce ocular, skin, and fire
hazards.
[DCNA -2004]

1. According to OSHA guidelines and ANSI standards, for the safe use of lasers in
dentistry, Control measures are:
A. Engineering Controls: Engineering controls are planned and built into the laser
equipment to give safety. Engineering controls involves enclosures, interlocks and
beam stops. Very constructive at removing hazards.
B. Personal protective equipment: All personal within the dental treatment room must
wear adequate eye protection, including the patient. Eyewear is an integral part of the
protection plan for both the patient and clinical staff. The safety glasses must meet
specifications with the most important criteria being optical density. This eyewear has
to meet a standard that allows the wearer to be able to gaze directly at the laser beam.
C. Procedural controls: Some dental procedures require general anesthesia. If general
anaesthesia is used during dental procedure, in place of the standard PVC intubation
tube, a red rubber or silastic tube should be used. A wax spatula or periosteal elevator
should be used to shield the tissue near the teeth. Always check the foot switch before
each procedure to make sure it does not get stuck in position while operating. Many
laser accidents can be easily avoided by simply following the recommended control
measures.
DENTISTRY
80

Fire and Electrical Control Measures
To avoid an electrical hazard, the operatory must be kept dry. The control panel and its electrical power
unit should be protected from any kind of splashing.
Personal Protective Equipment
• Eye Protection : Light produced by all class IV lasers by definition presents a potential hazards for
ocular damage by either direct viewing or reflection of the beam. Therefore all people must wear
adequate eye protection, including the patient. When selecting appropriate eye wear several factors
should be considered:
1. Wavelength permissible emission
2. Restriction of peripheral vision
3. Maximum permissible exposure limits
4. Degradation of the absorbing media
5. Optical density of the eye wears
6. Need for corrective lenses
7. Comfort and fit.
LASERS AND ITS APPLICATION IN
CONSERVATIVE AND ENDODONTIC
DENTISTRY
81
Information about eye protection printed on the safety
glasses must include the optical density and protected
wavelengths, as shown.

Control of Airborne Contamination
• Airborne contamination must be controlled by ventilation, evacuation or other
method of respiratory protection. Adequate suction should be maintained at all
times especially when treating a pathologic condition as it can spread through
laser plume.
Procedural Controls
1. Highly reflective instruments and those with mirror surfaces should be
avoided.
2. Tooth protection is needed, whenever, the beam is directed at angles
other than parallel to the tooth surface.
3. A No. 7 wax spatula can be inserted into the gingival sulcus to serve as
an effective shield for the teeth.
4. If anesthesia is required, in place of standard PVC tubes, rubber or
silastic tubes should be used. For further protection the tube should be
wrapped with an aluminum tape.
DENTISTRY
82

Lasers provide
the clinicians,
the ability to
better care for
patients with
advanced
diagnostic
methods and
improved
treatment
techniques.
Further scientific
and medical
research in the
development of
advanced laser
systems, will
revolutionize its
clinical use much
more significantly
in the field of
conservative
dentistry and
endodontics.
With laser
technology, the
dentist is
armed with
more and
better
treatment
options than
without a laser,
resulting in
delivery of the
best, state of
the art care
possible for the
patient.
The demand
for lasers in
dentistry is
growing
rapidly. Lasers
provide
absolute
versatility in
substitution of
drills or blades,
with more
accuracy and
precision, and
comfort to the
patient
.Lasers will be
in the forefront
of that growth.
83

• Ingle’s endodontics – 6th edition
• Textbook of operative dentistry – Vimal K Sikri
• The dental clinics of north america (DCNA)- Lasers in endodontics Dent
Clin N Am 48 (2004)
• The dental clinics of north america (DCNA)- Laser dentistry practice
management Dent Clin N Am 48 (2004)
• The dental clinics of north america (DCNA)- Erbium lasers in dentistry
Dent Clin N Am 48 (2004)
• The dental clinics of north america (DCNA)- Low-level laser therapy in
dentistry
• The dental clinics of north america (DCNA)- Dental laser safety
• Shirish kumar et.al Lasers and its applications in conservative dentistry:
a review Vol. IX Issue 1 Jan–Apr 2017
• David CM, Gupta P. Lasers in Dentistry: A Review. Int J Adv Health Sci
2015;2(8):7-13.
84

85

Lasers and its applications in conservative dentistry

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