The Application of Lasers in Dentistry

1. Frank A. Licht, RDH, BSDH
University of Tennessee Health Science Center
MDH 706
Capstone
Dr. Nancy Williams
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2. Frank Licht, RDH, BSDH
Clinical Supervisor
Tennessee State University
The University of Michigan
Graduated in 2004
Certifications
Local Anesthesia
Nitrous Oxide Administration
Nitrous Oxide Monitoring
Periodontal Laser Therapy
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3. • Brief History and Science of
Lasers
• Lasers and their use in Dentistry
• Lasers in the Treatment of
Periodontal Disease
• LBR and LAPT Procedures
• What else you can do with this
knowledge
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6. First Laser Developed by:
Theodore Maiman
A ruby based laser
He called it “Maser”
1960
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7. 1965 Gold used Ruby and CO2 Lasers
1970’s CO2 and Nd:YAG tooth Prep
1980’s Emphasis switched to incision
of soft tissue with CO2
1990’s Introduction of Diode and
Er:YAG and pulsed Nd:YAG
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8. Diode – 810, 940, 980 nm
Nd:YAG – 1064 nm
Er:YAG – 2780 nm
CO2 – 10,000 nm
A Nanometer (nm) equals 10 to the -9th Power
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9. Light Amplification by
Stimulated Emission of
Radiation was
developed by
ALBERT EINSTEIN
1916
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10. Stimulated Emission
• Atoms of the active medium
are stimulated to a higher
energy level
• This energy is released as a
photon as the atom returns to
a more stable energy level
• Released photons can go on to
stimulate more atoms in the
crystal thus producing more
photons (Amplification)
Single Photon Enters Atom
Two Photos Exit Atom
External Stimulus
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13. Wavelength
The Distance from Wave Crest to Wave Crest
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14. The overall effect of Laser Light on it’s target is
dependent on it’s wavelength
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15. Monochromatic Light
Collimated
Coherent
Light Amplified by
Stimulated Emission of Radiation
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17. Laser Mediums – Gas, Liquid or Solid
Medium determines Wavelength (Frequency)
Wavelength Absorbed Differently by H2O and Tissue
Absorption Depth Determined by Wavelength
Pulse and Duration focus and concentrate Energy
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19. Continuous emission of laser energy will non-selectively
ablate tissue
Pulsed Energy increases Wattage to area and reduces
Duty Cycle (time laser on) by ½
Generally Nd:YAG runs 0.2% of time. This reduces
thermal effects on tissue
Varying the Pulse Duration can provide additional
benefits such as ablating tissue and hemostasis
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21. Laser Effects On Tissue
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22. Absorption Affects infected tissue
**** Most Important Affect***
Reflection: Dissipates quickly
Scattering: May Harm Surrounding Tissue
Transmission May Harm Surrounding Tissue
Hemostasis Blood Coagulation
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23. Bio-Stimulation
What is accomplished while
performing Bio-Stimulation?
1. Increase Collagen Formation
2. Increase Circulation
3. Increase Fibroblastic Activity – Tissue Regeneration
1. Increase Osteoblastic Activity – Bone Regeneration
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24. Bio-Stimulation
What is accomplished while
performing Bio-Stimulation?
1. Reduce or Eliminate Bacteremias
2. Reduce or Eliminate Cross-Contamination
3. Kill Periodontal Infections before loss of attachment
occurs
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25. CO2
Diode
Erbium
Neodymium
Argon
Holmium
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26. 10,000 nm mostly continuous wave (millisecond pulsing
offered in some)
Non contact.
Absorbed by Water and Hydroxyapatite.
Excellent for cutting soft tissue and surface
ablation
Hollow tube Delivery
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27. 940nm (810nm and 980nm also)
Produced from a Solid Medium
Absorbed by:
Water
Hydroxyapetite
Hemoglobin
Melanin
Continuous wave with programmable
pulsed setting
Disposable fiber-optic Delivery
940nm creates a cleaner cut and less
char than other wavelengths.
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28. 2780 nm Wavelength
Absorbed by water and Hydroxyapatite
High Surface absorption
Excellent for hard tissue removal
Non-Selective for Soft tissue removal
Fiberoptic Delivery
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29. Nd:YAG 1064Nm
Fiber-optic Delivery 200u 300u 450u size
7 Variable Pulse Settings
Absorbed by Hemoglobin and pigmented tissue
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31. Effects of Exposure Duration
The Zone of Necrosis is the area of tissue affected by the laser’s energy and heat.
***The Diode laser’s Zone of Necrosis is smaller than
that of other Electro-Surgical Devices.***
The Zone of Necrosis is affected
by the length of exposure
and the power
Setting of the Laser.
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32. Frenectomy
Gingivectomy
Caries Detection
Periodontal Disease Treatment - L.B.R. – L.A.P.T.
Tooth Preparation
Bio-Stimulation
Uncovering implants
Cutting Teeth
Gingival Sulcus Debridement
Biopsy
Curettage
Apthous Ulcer Treatment
Teeth Desensitizing
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33. • Herpetic Lesion Treatment
• Aphthous Ulcer Treatment
• Teeth Desensitizing
• L.B.R – Laser Bacterial Reduction
• L.A.P.T – Laser Assisted Periodontal Therapy
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34. Increase patient comfort
Increase effectiveness of treatment
Improve patient acceptance of care
Increase reparative and regenerative healing
Increase types of procedures available
Improve office image
Benefits of Laser Treatment
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35. High Bactericidal effect
Reduce Post-op Inflammation & Edema
Increased productivity – Less wait time
Greater Hemostasis
Minimal wound contraction – skin shrinkage
Retard epithelial proliferation apically along healing
root surface to enhance periodontal tissue regeneration
Reduce Noise factor
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36. Laser irradiation can interact with tissues even in the
non-activated mode. Meaning laser beams can reach
the client’s eye and other tissues surrounding the target
in the oral cavity
You need specific eyewear according to wavelength for
client and clinician
Cost and size will constitute an obstacle for clinical
application in Dental Hygiene.
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37. Patients on Blood Thinners are not required to stop
medication… Why?
High BP – Epinephrine is contraindicated
Client allergic or hypersensitive to Epinephrine.
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38. Dental lasers can NOT be implemented in the
following clients.
Patient suffers from a skin disease, and is allergic to
light
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40. Glasses
Each laser must have several pairs of protective
eyewear related to its wavelength. You and your
patient MUST wear protective eyewear to avoid any
possible retinal damage.
Signage
It is recommended that signs are posted in the
cubicle where laser therapy will be performed. Make
sure other employees know not to enter when the sign
is posted.
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42. 200 Million US Adults and nearly 95% have some form
of Periodontal disease with 30% having Moderate to
Severe Periodontitis
Only 3% of the Moderate to Severe actually get
treatment!
When Detected and Treated Early this Disease Does not
have to be as Destructive regarding, Function,
Phonetics, Esthetics or Systemic Implications!
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44. Prophylaxis
Scaling & Root Planing
Anti-mocrobial Medications
Antibiotics
Flap Surgery
Bone Graft
Tissue Graft
Laser Therapy
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46. • Surgical manipulation of tissue with consequences
• Increased sensitivity and risk of root decay
• Cost of Procedure
• Fear of Surgical Procedure
• Must have Patients Cleared of Any Medical Issues
i.e. clotting concerns
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47. • Recession
• Sensitivity
• Morbidity
• Cost
• Long Junctional
Epithelium Loss
Consequences of
Traditional Therapy:
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48. Periodontal Disease Manifests Clinically as Red Inflamed Tissue.
The Disease is initiated by Anaerobic Bacteria
that invade tissue and cementum
Porphyromonas Gingivalis
Tannerella forsythia
Mutans streptococci
Streptococcus mutans
Streptococcus sobrinus
Streptococcus Intermedius
Prevotella intermedia
Treponema denticola
Lactobacilli
Aggregatibacter actinomycetemcomitans
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49. Ultrasonic debridement results in a smooth surface which
still contains debris, bacteria, contaminated root cementum
and sub-gingival plaque.
Laser Treatment roughens the root surface enhancing
adhesion of fibroblasts…
Leads to greater periodontal attachment
Laser treatment initially blocks the growth of epithelium
which in effect enhances periodontal attachment.
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50.  Uses heat to “Melt” Tissue
 Excellent for Hemostasis and effective clotting
 Can penetrate 2 – 3 mm in depth
 ONLY indicated for soft tissue applications
 Electromagnetic energy from the laser beam is absorbed
by the carbonized tip. The molecules in the tip are
converted to heat energy, then the tip emits visible
infrared light.
 Has been shown to regenerate cementum
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52. Want to Destroy Quantity and Quality of Bacteria
Want to De-Epithelialize (Infected tissue)
Want to Penetrate into cementum and gingival
tissue
Want to Minimize damage to healthy tissue
Want to Stimulate Regeneration 52

53. • Laser irradiated surfaces removed bacteria from
biofilm and hard surfaces
• Abrupt decrease in bacterial ATP = cell mortality
• Effective bacterial ablation and slower rate of
recolonization
• 55% bacterial reduction from laser alone,
independent of heat or wavelength
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54. Addresses all Treatment Objectives
Better Decontamination of Pocket
Bio-Stimulatory and Regenerative
Shorter Treatment - weeks vs. months or years
Less Invasive and Lower risk than Surgery
Not Necessary to Go Off Anti-Coagulants
Better Patient compliance
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55. Laser Function
The laser functions in such a way that it can cut
or affect soft tissue and cut it with precision.
It can Coagulate blood in the treatment area
It can reduce Post-op inflammation and edema
These area all desired effects of Laser Treatment.
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56. • Decrease Bacterial Levels
• Reduce Inflammation
• Eliminate Infected tissue
• Reduce Pocket Depths
• Gain Clinical attachment
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57. L.A.P.T.
Laser Assisted Periodontal Therapy
What is accomplished while performing L.A.P.T.?
• Laser Bacterial Reduction – Reduction in Bacterial Load
• Bio-Stimulation – Stimulation of bone and tissue
Growth
• Guided Tissue Regeneration – Gingival Contouring
• Laser Curettage – Removing diseased tissue
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58. • Full Mouth Treatment completed in several visits
• Diode laser used to Reduce Bacterial Load (LBR)
• Ultrasonic Instrumentation of roots
• SRP Per Quads
• Laser Curettage with Activated Tip.
• Diode laser used to Bio-stimulate Bone and Gingival
Tissue
• LBR Recommended at all recall appointments 4 months or
greater.
Laser Assisted Periodontal Therapy
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59. • One Day liquid / soft diet
• Soft food for one month – Nothing real crunchy
• Two weeks Q-tip cleaning of area (No Brushing)
• Chlorhexidine on Q-tip or rinse two weeks.
• Soft toothbrush for one month – then sonic brush
• No flossing for two weeks
• Flossing after two weeks to gum line only
– one month
• Maintenance visit one to two months after last
session of LAPT
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60. • No Probing for three months
• No sub-gingival scaling for three months
• Hand scalers and coronal polish – Supra Only
• Ultrasonic on low power just to gingival margin
• Fluoride treatment OK
• Low level laser treatment OK for LBR
- 1 to 2 mm Subgingival only.
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61. http://www.youtube.com/watch?feature=player
_embedded&v=l5rOvglzjD0
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62. Certification
You must be certified to provide laser therapy to your patients. The State
Of Tennessee requires that you be taught by someone who has had laser
training.
Over 30 states currently allow hygienists to use lasers
in the course of their duties.
You can get certification through the following site.
• You must also perform hands on prior to becoming certified*
Advanced Laser Training Inc.
2651 Quarry Lane
Fayetteville, AR 72704
(877) 527-3766
(479) 361-8853
mowens@advancedlasertraining.com
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63. What can you do with this knowledge…???
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64. Operculectomy
- 980 nm
Operculectomy
- 940 nm
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65. You can use Diode lasers to work around around metal
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71. Contouring
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72. Gingivectomy
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73. Aphthous Ulcer Treatment
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74. Curettage
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75. Contouring
Gingivectomy
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93. Please remember to fill out course
evaluations and sign your name on the
attendance sheet.
This course presentation is the final
requirement for my Masters Capstone.
Thank you for attending!!!
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94. Frank Licht, RDH, BSDH
Tennessee State University
Clinical Supervisor
flicht@tnstate.edu
(615) 963-1475
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95.  Aykol, G., Baser, U., Maden, L., Kazak, Z., Onan, U., Tanrikulu-Kucuk, S., ... Yalcin, F.
(2011, March 2011). The Effect of Low-Level Laser Therapy as an Adjunct to Non-Surgical
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http://www.ncbi.nlm.nih.gov/pubmed/20932157
 Blayden, J., & Mott, A. (2013). Soft-Tissue Lasers in Dental Hygiene. Ames, Iowa: Wiley-
Blackwell.
 Christodoulides, N., Nikolidakis, D., Chondros, P., Becker, J., Schwarz, F., Rossler, R., &
Sculean, A. (2008, September 2008). Photodynamic Therapy as an Adjunct to Non-
Surgical Periodontal Treatment: A Randomized Clinical Trial. Journal of Periodontology,
79, 1638-1644. Retrieved from
http://www.helbo.de/fileadmin/docs/wissenschaft/Christodoulides_et_al._PDT_JP_090
8.pdf
 Goldstep, F. (2009). Diode Lasers for Periodontal Treatment: The Story So Far. Retrieved
from http://www.oralhealthgroup.com/news/diode-lasers-for-periodontal-treatment-
the-story-so-far/1000349901/
 Infective Endocarditis. (2014). Retrieved from
http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCo
ngenitalHeartDefects/Infective-Endocarditis_UCM_307108_Article.jsp
 Kamma, J. J., Vasdekis, V. G., & Romanos, G. E. (2006). The Short-Term Effect of Diode
Laser (980 nm) Treatment on Aggressive Periodontitis. Evaluation and Clinical
Microbiological Parameters. The Journal of Oral Laser Applications, 2, 111-121. Retrieved
from www.ncbi.nlm.nih.gov/pubmed/19196111
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96.  Lui, J., Corbett, E. F., & Jinn, L. (2011). Combined Photodynamic and Low-Level Laser
Therapies as an Adjunct to Nonsurgical Treatment of Chronic Periodontitis. Journal of
Periodontal Research, 46, 89-96. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/20860592
 Moritz, A., Schoop, U., Goharkay, K., Schauer, P., Doertbudak, O., Wernisch, J., & Sperr,
W. (1998). Treatment of Periodontal Pockets With a Diode Laser. Lasers in Surgery and
Medicine, 22, 302-311. Retrieved from www.ncbi.nlm.nih.gov/pubmed/9671997
 Qadri, T., Miranda, L., Turner, J., & Gustafsson, A. (2005). The Short-Term Effects of
Low-Level Lasers as Adjunct Therapy in the Treatment of Periodontal Inflammation.
Journal of Clinical Periodontology, 32, 714-719. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15966876
 Qadri, T., Poddani, P., Javed, F., Turner, J., & Gustafsson, A. (2010, August 2010). A Short-
Term Evaluation of Nd:YAG Laser as an Adjunct to Scaling and Root Planing in the
Treatment of Periodontal Inflammation. Journal of Periodontology, 81, 1161-1166.
Retrieved from http://www.joponline.org/doi/pdf/10.1902/jop.2010.090700
 Ustun, K., Erciyas, K., Sezer, U., Gundogar, H., Ustun, O., & Oztuzcu, S. (2014). Clinical
and Biochemical Effects of an 810 nm Diode Laseras an Adjunct to Periodontal Therapy:
A Randomized Split-Mouth Clinical Trial. Photomedicine and Laser Surgery, 32, 61-66.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24444428
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