Lasers in Dentistry


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Lasers in Dentistry

  1. 1. Lasers in DentistryBy: Dr. David HornbrookDr. Hornbrook, D.D.S. is an icon of the new generation of aesthetic dentistry and has been voted by his peers as one of the top three lecturing dentists in the nation. A graduate of the UCLA School of Dentistry, he has pioneered the concept of dental excellence through hands-on courses using all the latest technologies, including lasers. Dentistry has changed The hemostatic nature of the lasertremendously over the past decade eliminates the need for retraction cordto the benefit of both the clinician during restorative procedures, and theand the patient. New materials minimal zone of necrosis of the actualand technologies have improved laser “cut” provides a very stable finalthe efficiency and predictability of contour that will not change afterrestorative dentistry for clinicians. The the definitive restoration is has increased its influence in The “recontouring” is useful during 4) Pre-existing condition with unaesthetic gingival levelsthe dental field with digital radiography anterior aesthetic reconstruction asand photography, and CAD-CAM well as a means to remove excessrestoration fabrication. New techniques gingival tissue that compromises anand philosophies have also benefited ideal width to height ratio of anteriorour patients by providing alternatives teeth. Often times, tissue recontouringto aggressively prepared teeth and the combined with teeth whitening canuse of aesthetic-compromising metal. change an unaesthetic smile into one One technology that has that is dazzling! (see figures 1-11)become increasingly utilized in clinical 5) Tooth length is measured revealing a very short clinical dentistry is that of the laser. Initially crownintroduced as an alternative to thetraditional halogen curing light, thelaser now has become the instrumentof choice, in many applications, forboth periodontal and restorativecare. Although the laser offers manyadvantages over other modalities oftreatment, probably the greatest impact 1) A pre-existing direct bonded restoration with poor width to height-to-width ratio is evaluated for tissue recontouring it has made is the ability to be used for using the periodontal probe. 6) Periodontal probing performed to evaluate the ability to remove gingival tissue without violating biological widthboth hard and soft tissue, often timeswithout the need for anesthesia. Thefollowing are just a few examples of themany applications of lasers in dentistry. Gingival Recontouring: Theapplication of the laser in gingivalrecontouring has become the treatmentof choice for the aesthetic clinician 7) At least 2.5-3.0 mm between free gingival margin and os-as a means to optimize the smile seous crest must remain to eliminate violation of biological 2) The diode laser is used to recontour the tissue to a more width when evaluating whether gingival recontouring can design process since the mid 1990’s. favorable level be performed without osseous reductionPrior to the use of the laser, tissuerecontouring resulted often times indiscomfort for the patient and lack ofpredictability for the clinician. The useof the laser, more specifically the Diodelaser (Odyssey [Ivoclar], DioDent II[Hoya ConBio]), has provided a meansto very predictably reshape andrecontour the gingival tissue to optimize 3) After laser recontouring and veneer placement, a much 8) The tissue was marked to ideal using a fine permanentsymmetry and maximize aesthetics. more favorable aesthetic result is obtained black marker
  2. 2. Periodontal treatment: The use of lasers in periodontal treatment has been well documented over the past 10 years. When used in deep periodontal pockets with associated bony defects, the laser not only9) A Diode laser was used to remove the excess, unaes- removes the diseased granulationthetic gingival tissue tissue and associated bacteria, it also promotes osseoclast and osseoblast activity, often resulting in bone 17) An occlusal view of the ovate pontic site regrowth. (See figures 14 & 15)10) The appearance, and dramatic difference after the right side was treated using the Diode laser 14) A 12.0 mm periodontal pocket was present mesial of the Mandibular right second molar 18) The definitive resin-bonded bridge after placement. The ovate pontic provided a very natural appearance. Hard tissue applications:11) Immediate result after tissue recontouring was per-formed. Notice the lack of bleeding or tissue trauma Recent advancements in laser technology have also allowed for its Frenectomies: Whether it use in hard tissue applications. Thisis the result of a recommendation is especially true with the Erbium-YAGfrom an orthodontist or for aesthetic laser (VersaWave [Hoya ConBio]).concerns, the use of the laser is This includes enamel, dentin, caries,ideal for both maxillary and lingual and osseous tissues. The Erbium isfrenectomies. Since the laser seals 15) After 4 laser treatments, the pocket was reduce to 5.0 mm and new bone actually filled into the defect. The radio- also excellent as a soft tissue laser,both nerve endings and capillaries, graph was taken 8 months post laser treatment. performing procedures similar topost-operative discomfort and Ovate Pontics: The ovate those of the Diode listed above, butbleeding are almost non-existent, and pontic has become the choice of has expanded opportunities withthe need for post-operative suturing is pontic design for both aesthetics and the ability to actually “cut” or removeeliminated as well. (see figure 12 & 13) cleansibility reasons. Success of the hard tissue as well. Although the ovate pontic is a result of developing laser has not replaced the high speed an ideal site into the gingival tissue. handpiece in most tooth preparations, Since the ovate pontic actually replaces it certainly has become a very useful part of the natural tooth root form, it is modality to remove defective enamel imperative to establish a recess in the and dentin. Ideal applications of gingival tissue on the alveolar ridge lasers in restorative dentistry include to accept the pontic form. Utilization class I, II, III, and V preparations. of the laser, as opposed to other preparations. More often than not, methods such as electrosurgery or these types of preparations can12) A labial frenectomy was performed after consultation scalpel surgergy, allows for immediate be performed without the need forwith an orthodontist to aid in the diastema closure. No suture was placed impression of the site for the definitive anesthesia, so the marketing benefits restoration. (see figures 16-18) of laser dentistry has more than established its value, especially in pedodontic or adolescent-based practices. Although not as fast as conventional handpieces, the elimination of the time needed for anesthesia usually compensates for the lack of speed, and often times the total time for preparation and restoration13) 6 months post-op. The space has completely closed, 16) An ovate pontic site being prepared with an Er: YAG is shorter. (See figures 19-22).even without orthodontic treatment, and healing is excellent laser. Notice the lack of any bleeding
  3. 3. weeks to ensure osseous and soft tissue stability. With the Erbium laser, the gingival tissue is removed to the desired level, regardless of the biological width. Using a 400 micron tip, with a setting specific to osseous tissue, the laser is then placed parallel19) Decay present on the facial of the maxillary left lateral incisor to the tooth surface and placed under 27) The Erbium laser was then used to remove osseous the gingiva. The osseous tissue is tissue without the need to lay a gingival flap then recontoured to the ideal level to establish a healthy biological width. Although long term clinical studies are certainly indicated, anecdotal and short term clinical experience indicates that the osseous levels remain at the newly contoured level and many clinicians actually take definitive impressions 28) New probing revealed a 2.5 mm biological width.20) The Erbium laser used to remove the decay. No anes- for restoration at the time of osseousthesia was required. recontouring. (See figures 23-29) 29) Immediate appearance after soft tissue and osseous removal. The veneer will now be removed and the tooth 23) The placement of all-ceramic veneers yielded reason- prepared to achieve more ideal symmetry between the two 21) After caries removal and preparation is complete able results, but due to the lingual displacement of the left centrals. central incisor, there was significant asymmetry between gingival heights of the left and right central incisors. As technology advances into dentistry, whether it is laser or another exciting venue, the options available to clinicians will continue to increase. Although the use of lasers in dentistry is relatively new, the future looks very bright. Admittedly, more long term clinical and scientific research needs22) Definitive direct bonded restoration after preparationwith the Erbium laser to be done to validate anecdotal 24) Probing revealed approximately 2.5 mm, which limits the ability to remove only soft tissue without osseous clinical experience and claims, but As far as osseous applications, removal to establish more ideal symmetry preliminary use and experiencethe benefit of the Erbium-YAG is the appear very positive. As with all newability to recontour osseous tissue technologies and philosophies, properwithout the discomfort and healing case selection and understanding oftime commonly seen with traditional the contraindications and limitationsmethods. In terms of aesthetic is mandatory for predictable success.dentistry, the use of the Erbium laserin crown lengthening in the anteriorhas created an entirely new dimensionin smile design. With soft tissue onlyremoval, the extent of gingival tissue 25) The laser was used to remove the gingival tissue to achieve ideal symmetry For information on aesthetic coursesremoval is limited by biological width, using lasers please contact thewhich requires a minimum of at least Hornbrook Group at 1.866.467.62762.5-3.0 mm between the free gingivalmargin and the osseous crest. If therequirement to optimize aestheticsviolates this measurement, the onlyoption is to remove osseous tissue to 47733 Fremont Blvdestablish a healthy biological width. Fremont, CA 94538With traditional surgical methods, 1.800.532.1064 26) New probing revealed less than 0.5 mm biological width the healing time is usually 12-16 which would result in chronic marginal inflammation © 2006 Hoya ConBio PN 992.9165 Rev A