LASERS IN ENDODONTICS AND CONSERVATIVE DENTISTRY

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LASERS IN ENDODONTICS AND CONSERVATIVE DENTISTRY

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LASERS IN ENDODONTICS AND CONSERVATIVE DENTISTRY

  1. 1.  An acronym for Light Amplification by the Stimulated Emission of Radiation.. A device that creates a uniform and coherent light that is very different from an ordinary light bulb. dr. Blagoja Lazovski 2
  2. 2.  Also can be described as a device for generating a high-intensity, ostensibly parallel beam of monochromatic(single wavelength) electromagnetic radiation. Laser light can be focused down to a tiny spot as small as a single wavelength. dr. Blagoja Lazovski 3
  3. 3.  The possibility of stimulated emission predicted by Einstein-1917.. Based on work of Gordon in 1955 & Schawlow n Townes in 1958, MAIMAN created the 1st operatinal laser in 1960, a ruby laser emitting a brillant red beam of light.. dr. Blagoja Lazovski 4
  4. 4.  photo of the development of the helium- neon laser taken at AT&Ts Bell Laboratories in 1964.dr. Blagoja Lazovski 5
  5. 5.  Basic components.. An ACTIVE LASING MEDIUM :- - cn be a solid, liquid or gas Enclosed within a LASER CAVITY bounded by two perfectly parallel reflectors(mirrors) PUMP SOURCE – high energy radiation pumped into the active medium dr. Blagoja Lazovski 6
  6. 6.  POPULATION INVERSION :- condition when energyfrom pump source is absorbed by active medium until the majority of atoms, ions or molecules are raised to their upper energy state.. And this condition is NECESSARY to generate laser light.. dr. Blagoja Lazovski 7
  7. 7.  TWO PARALLEL REFLECTORS – situated at end of laser cavity act to constarin light along n within the axis of cavity.. So light is repeatedly bounced b/w the reflectors One of the mirrors is only partially reflective, enabling some of the light to escape the cavity as a beam of laser light.. dr. Blagoja Lazovski 8
  8. 8.  Working of laserdr. Blagoja Lazovski 9
  9. 9.  Working of laserdr. Blagoja Lazovski 10
  10. 10.  Processing of matter without contact. High working speed Outstanding precision dr. Blagoja Lazovski 11
  11. 11.  Soft, quiet, vibration-free operation As fast as the high-speed turbine CO2 laser cuts and coagulates soft tissue without bleeding No risk of cross-infection dr. Blagoja Lazovski 12
  12. 12.  Sterilization of operating field Fewer cracks than with turbine Multiple quadrant dentistry No need for etching Pulsing minimizes charring and thermal necrosis dr. Blagoja Lazovski 13
  13. 13. Lasers are still in the pioneering stage, but there are many current uses.. There are three types of Dental lasers: Surgical Laser (soft tissue) Curing Laser Tooth Laser (hard tissue) dr. Blagoja Lazovski 14
  14. 14. 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 abnormalitiesdr. Blagoja Lazovski 15
  15. 15.  Surgically assist in arresting herpes lesions and canker sores Assist in biopsies Treat infant tongue/frenum problems which can hinder proper chewing/sucking Treat child/adult frenum problems which can cause speech impediments, gum disease, and teeth to grow apart rather than together dr. Blagoja Lazovski 16
  16. 16.  This laser spectrum light source is used for rapid teeth whitening and placing all tooth- colored restorations (fillings) and repair procedures.  Bonds created by this advanced instrument result in dentistry that is twice as strong !dr. Blagoja Lazovski 17
  17. 17.  The light source increases gradually during the curing process to create the best bond available in dentistry today. 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.. dr. Blagoja Lazovski 18
  18. 18.  TOOTH LASER (hard tissue) Third type of laser is used to remove cavities. But since this laser cannot be used on existing metal fillings, we use micro dentistry.. MICRO DENTISTRY one of the greatest advancements in the field of dentistry. offers the ultimate flexibility and capability. It is also the most tooth conservative dentistry available. dr. Blagoja Lazovski 19
  19. 19.  About 50% of cavities are candidates for this technique and there is no drilling, no needle, no extra fee, and no pain!  And because this process is so efficient, it reduces appointment length.dr. Blagoja Lazovski 20
  20. 20.  Desensitize exposed root surfaces Diagnosis of non-cavitated caries To arrest demineralization and promote remineralization of enamel. Debond ceramic orthodontic brackets. dr. Blagoja Lazovski 21
  21. 21.  The DIAGNOdent can find cavities that other dental instruments can miss. The device is designed as an adjunct to a traditional oral examination in the detection of occlusal decay. Teeth that are suspicious for caries are ideal candidates for survey with the device dr. Blagoja Lazovski 22
  22. 22. Key Benefits: A laser examination tool for the early detection of caries. Even very small lesions can be detected at the earliest stages. Over 90% accurate! Earlier treatment - Better outcomes dr. Blagoja Lazovski 23
  23. 23.  Diagnodent is a pen- like probe that sends a safe, painless laser beam into the tooth. A numeric display & alarm signals when there are signs of hidden decay.dr. Blagoja Lazovski 24
  24. 24. dr. Blagoja Lazovski 25
  25. 25.  These pictures show how the Diagnodent finds cavities that other dental instruments can miss.dr. Blagoja Lazovski 26
  26. 26.  The Diagnodent device measures laser fluorescence within the tooth structure. As the incident laser light is propagated into the site, two-way hand-piece optics allows the unit to simultaneously quantify the reflected laser light energy. At the specific wavelength that the device operates (655 nm), clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display. Carious tooth structure exhibits fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display dr. Blagoja Lazovski 27
  27. 27.  Roughen tooth surfaces ,in lieu of acid etching in preparation for bonding procedure dr. Blagoja Lazovski 28
  28. 28. dr. Blagoja Lazovski 29
  29. 29. dr. Blagoja Lazovski 30
  30. 30.  Treatment of dentin hypersensitivity.. In bleaching Adhesion of pit & fissure sealant Most obvious application – controlled removal of dental enamel, dentin, bone or cementum. Replacement of dental drill is a real possibility for the future. dr. Blagoja Lazovski 31
  31. 31.  1968 – use of carbon dioxide laser – in oral and maxillofacial surgery – Goldman et all. Restricted mostly to incising and excising masses from the mucosa and gingiva in oral cavity. Vaporize exces tissue as in gingivoplasty, gingivectomyy and labial /lingual frenectomy. dr. Blagoja Lazovski 32
  32. 32.  Remove or reduce hyperplastic tissue. Remove and control hemorraging of vascular lesions such as hemangiomas. In endodontics dr. Blagoja Lazovski 33
  33. 33. LASER WAVEL SPECTRAL MODE TYPICAL TYPE ENGTH REGION MAX POWER CO2 10,600nm Mid- CW& 100w infrared Gated CW &superp ulsed Holmiu 2,100 Near Pulsed 15Wavg. m nm infrared Nd:YAG 1,064 Near CW & 100Wdr. Blagoja Lazovski nm infrared pulsed CW 34
  34. 34. Diode 800- Near CW >50W 890nm infrared KTP/KD 532nm visible Pulsed 25Wavg. P Argon 488/514 Visible CW 20W nm Excimer 190nm Ultaviole Pulsed 550mJ ArF-XeCl t Erbium: 308nm Ultraviol Pulsed 250mJ YAG(Er: et YAG)dr. Blagoja Lazovski 35
  35. 35.  Co2 gas as lasig /active medium Delivery system – uses an articulated arm (a series of hollow tubes connected together through a series of six to eight articulating mirrors). USED- cutting & vaporising tissue in open proceures or in procedures where rigid endoscopyis acceptable.. dr. Blagoja Lazovski 36
  36. 36.  Efect of ruby laser radiation on enamel – Goldman, Stern & Sognnaes, 1964 Carbondioxide laser – Lobene et all 1968 Nd:YAG laser – Yamamoto & Ooya 1974 Argon laser – Goodman & Kaufmann 1977 dr. Blagoja Lazovski 37
  37. 37.  In removal of enamel n dentin – thermal side effect occoured.. Superpulsed carbon dioxide laser – removal of dentin without thermal side effect possible. Transversal stimulation or carbon dioxide TEA (the Alexandrit laser with double frequency) – most efficent carb.dioxide laser for dental hard tissue ablation. dr. Blagoja Lazovski 38
  38. 38.  Clinical perespactive of lasers increased by introduction of Er:YAG, Er, Er:YSGG lasers have advatages of - reduced thermal effects - creating precise contour of the section zone. dr. Blagoja Lazovski 39
  39. 39.  Also in meantime new lasers -Nd:YAG -excimer -holmium -argon -diode dr. Blagoja Lazovski 40
  40. 40.  In thermomechanical , micro-abrasion like explosion – much less energy is needed. If soft tissue is softened by caries,the laser ablation rate increases… Rough surfaces produced by laser ablation provide good retension dr. Blagoja Lazovski 41
  41. 41.  Dentin surfaces r less rough aftr ablation and hence less problamatic. High bond n shear strength can be achieved with simple defocused radiation.. For conditioning less time is needed than when etching conventionaly.. dr. Blagoja Lazovski 42
  42. 42.  Drying the surface with laser is very quick , efficent and gentle. Erbium laser has bactricidal abilities. Bcz high surface temperature can be achieved for a short time by subalative irradiation.. Irridation of caries by a sequence of laser pulses leads to consecuetive dessication and sterlization. dr. Blagoja Lazovski 43
  43. 43.  The Er:YAG laser can be used to disinfect cavity prep , in case of residual bacteria contaminating, otherwise intact enamel or dentin, or in fissures prior to sealing. dr. Blagoja Lazovski 44
  44. 44.  Best results obtained whn affected areas exposed to co2 , Nd:YAG, Er:YAG, Diode laser radiation Colojoara et al showed that dentin hypersensitivity can be reduced without any damages to pulp vitality by using co2 laser.. They also showed that when using co2 laser , in parallel direction with dentin tubules, the desensiting effect ws obvious aftr three exposures. 45 dr. Blagoja Lazovski
  45. 45.  The first materials introduced in 1970’s (photopolymerised composites) wr cured by ultraviolet light.. Power et al showed that an argon laser requires shorter curing times & th ematerials dentin bond strength was stronger whn compared with laser. dr. Blagoja Lazovski 46
  46. 46.  Variables that control the depth &extent of cure include - time of exposure - composite material - wavelength - intensity of light - particle size of filler dr. Blagoja Lazovski 47
  47. 47.  Current reserches report that used at the power of 250 +/- 50 mW for 10sec per increment , the argon laser provides good curing of light activated restorative material in shorter period of time with equal or better physical properties than the conventional halogen curing light.. dr. Blagoja Lazovski 48
  48. 48.  With todays technology, laser teeth whitening through the use of the Diode Laser is the quickest and most dramatic way to brighten your smile if porcelain laminates are not an option. All tooth whitening procedures use hydrogen peroxide or carbamide peroxide to bleach out stains on your tooth enamel, but this is where the similarity ends when comparing standard bleaching procedures such as whitening performed with a light cure to laser whitening. dr. Blagoja Lazovski 49
  49. 49.  Laser whitening is superior to all other whitening techniques since 1.laser whitening products contain the highest concentration of peroxide 2.the laser provides the highest light intensity available 3.the procedure is done in the office at chairside thus allowing us to concentrate in those areas of your mouth where the type and location of discoloration is worse. Laser technology allows us to whiten your teeth with amazing results in just one hour! dr. Blagoja Lazovski 50
  50. 50. 1.the type of stain on your teeth2.where the stain is located3.the amount of time the whitening gel is used4.the peroxide concentration in the whitening gel5.the intensity of the light activating the whitening gel dr. Blagoja Lazovski 51
  51. 51.  In Laser-Assisted Tooth Whitening, the laser enhances the effect of bleaching agents for faster, more comfortable and more effective results.  By stimulating the bleaching gel to react faster, the bleaching agent (mainly peroxide) spends less time on the tooth.  This leads to increased comfort levels, adr. Blagoja Lazovski reduction in reaction from 52 gums both during and
  52. 52.  Types of hazards Ocular hazards # injury to eye – direct emission or by reflection from mirror like surface. # irreversible retinal burns- by conversion of incident radiation to heat energy. dr. Blagoja Lazovski 53
  53. 53. * damage to skin & other non-target tissue result from thermal interaction of energy with tissue proteins* temperature elevations can produce denaturation of cellular enzymes &structural proteins which interrupt basic metabolic processes dr. Blagoja Lazovski 54
  54. 54.  Are referred to as non-beam hazards Capable of producing smoke , toxic gases and chemicals. Laser plume – composed of vaporised water (steam), carbon particles, cellular products.. dr. Blagoja Lazovski 55
  55. 55.  The greatest producers of smoke are co2, erbium lasers followed by Nd:YAG Lasers.. dr. Blagoja Lazovski 56
  56. 56.  High energetic & short pulsed laser light lead to a fast heating of dental tissue. Energy dissipates explosively in vol of expansion – accompanied by fast shockwaves.. The shockwaves lead to high pressure – destroy or damage adjacent tissue. dr. Blagoja Lazovski 57
  57. 57.  Characteristically pulp tissue cannot survive environment of elevated temp for protracted periods when tooth structure is irridated with lasers. Use of combination of air and water spray before during or immediately after laser irridation may be more effective.. dr. Blagoja Lazovski 58
  58. 58.  Flammable solids , liquids, gases used within the surgical setting can be easily ignited if exposed to laser beam.. dr. Blagoja Lazovski 59
  59. 59.  Can be in form of - electric shock - fire - explosion dr. Blagoja Lazovski 60
  60. 60.  Temperature < 60 celcius ~ tissue hyperthermia ~ enzymatic changes ~ edema Temperature > 60 celcius ~ protein denaturation dr. Blagoja Lazovski 61
  61. 61.  Temperature < 100 celcius ! Tissue dehydration ! Blanching of tissue Temperature > 100 celcius ! Super heating ! Tissue ablation&shrinkage dr. Blagoja Lazovski 62
  62. 62.  Operatory must be dry Control panel & its electrical power unit should be protected from any kind of splashing.. dr. Blagoja Lazovski 63
  63. 63.  Can cause charring Coagulation of blood elements dr. Blagoja Lazovski 64
  64. 64.  Highly reflective instruments & those with mirror surfaces should be avoided. Tooth protection is needed, whenever , the beam is directed at angles other than parallel to the tooth surface. A no.7 wax spatula can be inserted into gingival sulcus to serve as an effective shield for teeth dr. Blagoja Lazovski 65
  65. 65.  If anesthesia is required in place of standard PVC tubes , rubber or silastic tubes should be used. For further protection tube should be wraped with an aluminium tape. dr. Blagoja Lazovski 66
  66. 66. dr. Blagoja Lazovski 67
  67. 67. dr. Blagoja Lazovski 68
  68. 68.  The plume from a laser ablation deposition: A Nd:YAG laser hits ZnTedr. Blagoja Lazovski 69
  69. 69.  The 514nm line of the cw laser, a few 100 mW, going through a prism. Do not try this at home!dr. Blagoja Lazovski 70
  70. 70.  Figure 1A— Maxillary left first permanent molar with occlusal enamel hypoplasiadr. Blagoja Lazovski 71
  71. 71.  Figure 1B— Waterlase MD. used to remove (ablation).dr. Blagoja Lazovski 72
  72. 72.  Completed cavity preparation after using Waterlase MDdr. Blagoja Lazovski 73
  73. 73.  Completed restoration with resinomerdr. Blagoja Lazovski 74
  74. 74. Thank You  dr. Blagoja Lazovski 75

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