Lasers in endodontics /certified fixed orthodontic courses by Indian dental academy

1,424 views

Published on



The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078




The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

Published in: Education, Business, Technology
0 Comments
12 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,424
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
38
Comments
0
Likes
12
Embeds 0
No embeds

No notes for slide

Lasers in endodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. LASERS IN ENDODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION L A S E R – light amplification of stimulated emission of radiation, is a form of electromagnetic energy in which photons are generated from a medium by stimulating the medium from external energy source. Emergence : 1960 First use in clinics : 1980 Today available in different wavelengths. www.indiandentalacademy.com
  3. 3. ADVANTAGES Excellent visibility.  Reduced operating time.  Reduced post operative sequelae.  Negotiates curves and folds in oral cavity.  Vaporize, coagulate or cut tissue.  Pain is reduced 90% of the time.  Portable and less expensive newer models  Patient’s high acceptance .  www.indiandentalacademy.com
  4. 4. HISTORY  Early 1900 – Quantum mechanics by Bohr Einstein's atomic theory.  1950 – Townes first amplified microwave frequencies.  1960 – Maiman developed first laser or Maser.  1960 – Pulsed Ruby laser(0.694 µm).  1961 – Neodymium laser by Snitzer. HAD DENTAL RESEARCHERS FOCUSSED ON Nd. LASER SOONER, LASER DENTISTRY MAY HAVE PROGRESSED TO ITS www.indiandentalacademy.com PRESENT STATUS 10 YRS EARLIER
  5. 5. EPIDEMIOLOGY  IN 1987 Mecler studied Co2 laser and found it to induce secondary dentin formation and sterilize dentin.  Nd:YAG Laser after apicoectomy and retrofil reduced permeability of resected roots. -Adam stabholz (1992). www.indiandentalacademy.com
  6. 6.  CO2 Laser delivered by Agcl fibers in root canal opened dentinal tubules and fused hydroxyapatite. Banu onal et al (1993).  Nd:YAG laser effectively inhibited the growth of bacteria in root canal. Steve E Fegan (1995). www.indiandentalacademy.com
  7. 7.  Argon laser is efficient in removing intra canal debris. -Josjna Moshorow(1995).  Nd:YAP Laser in combination with hand instruments is an effective device for root canal preparation. -Piesse frage et al(1998). www.indiandentalacademy.com
  8. 8.  Er:YAG laser with a cone shaped tip gave cleaner dentin surface in root canals, compared to rotary instrumentation. -Shigeru shoji (2000).  Apical leakage after obturation in canals prepared with Er:YAG laser is not affected as compared to canals prepared with conventional methods. -Y.Kimura (2001). www.indiandentalacademy.com
  9. 9. LASER PHYSICS  L ight A mplified by S timulated E mission of R adiation.  LASER light is Monochromatic and finely focussed.  Collimation and Coherency makes it unique.  Collimation: constant beam size and shape.  Coherency: waves with identical amplitude and identical frequency. www.indiandentalacademy.com
  10. 10. QUANTUM THEORY  An Atom at excited state releases photon. www.indiandentalacademy.com
  11. 11. EINSTEIN’S THEORY  An energized atom can absorb additional energy to release 2 identical coherent photons, these photons energizes more atoms and releases more photons resulting in amplification of light energy. www.indiandentalacademy.com
  12. 12.  Dental lasers have emission wavelengths of 500µm – 10,600µm.  All dental lasers emit either visible light beam or an invisible infra red light beam.  Dental lasers are named after the chemical elements/ compounds that compose the medium. - Gas :- argon / co2 - Solid crystal rod :- Ga, Al, Arsenide, Garnet, Yttrium, -Added elements :- Cr, Nd, Ho, Erbium. www.indiandentalacademy.com
  13. 13. ANATOMY OF LASER UNIT  LASER CHAMBER IS CALLED – “CAVITY”.  M1 - PARTIALLY REFLECTIVE MIRROR.  M2 - TOTALLY REFLECTIVE MIRROR.  EXTERNAL SOURCE www.indiandentalacademy.com OF ENERGY IS CALLED PUMPING.
  14. 14. LASER DELIVERY SYSTEM  FLEXIBLE HOLLOW WAVE GUIDE TUBE It has interior mirror finish. Laser energy reflected along this tube strikes the tissue in non contact fashion.  GLASS FIBER OPTIC CABLE Glass fiber is encased in a resilient sheath. Cannot be bent into sharp angle. fiber fits snugly into hand piece protruding at the tip or sometimes with attached glass tip. www.indiandentalacademy.com Used in contact fashion.
  15. 15. EMISSION MODE 1. CONTINUOS WAVE MODE. Beam is emitted at one power level continuously as the foot switch is pressed. 2. GATED PULSE MODE. Periodic on and off by the mechanical shutter in front of a continuous wave laser at a duration of few milli seconds. 3. FREE RUNNING PULSE MODE. High energy of laser light is emitted for a few micro seconds followed by a relative long time gap. This is computer controlled. www.indiandentalacademy.com
  16. 16. PRINCIPLE OF EMISSION  Light energy strikes tissue for a certain length of time producing thermal interaction, then a time gap for the tissue to cool before the next pulse of laser energy is emitted. www.indiandentalacademy.com
  17. 17. LASERS USED IN DENTISTRY LASER λ LASER λ Argon 488-514 nm Nd:YAP 1.34 µm Diode 600-908 nm Ho:YAG 2.12 µm He-Ne 632 nm Er:YSGG 2.79 µm Ruby 694.3 nm Er:YAG 2.94 µm Nd:YLF 1.053 µm CO2 9.3,10.6 µm Nd:YAG 1.064 µm XeF 0.351 µm www.indiandentalacademy.com
  18. 18. LASER SAFETY IN DENTAL PRACTICE  A Responsibility that is shared by a Dentist, Educator, Manufacturer and scientist, each having a role from design and development to practical application.  Given the proper training and appropriate precautions, lasers may be used safely for the mutual benefit of both the patient and the dentist. www.indiandentalacademy.com
  19. 19.  CDRH – Center for Devices and Radiological Health.  ANSI – American National Standards Institute.  OSHA – Occupational Safety and Health Administration. www.indiandentalacademy.com
  20. 20. LASER HAZARD CLASSIFICATION – ANSI & OSHA CLASS I DESCRIPTION Low powered lasers that are safe to view. IIa Low powered visible lasers that are hazardous when viewed directly for longer than 1.000 sec. II Low powered visible lasers that are hazardous when viewed for longer than 0.25 sec IIIa Medium powered laser or systems that are non hazardous if viewed for less than 0.25 sec with out magnifying optics. IIIb Medium powered lasers (0.5 w) are hazardous if viewed directly. IV High powered lasers(>0.5 w) produce ocular,skin and fire hazards. www.indiandentalacademy.com
  21. 21. According to CDRH and ANSI system of classification CLASS IV are Potentially Hazardous from either direct or diffuse reflection. They emit power greater than 5 w. HAZARDS ENCOUNTERED IN CLINICAL PRACTICE 1. OCCULAR INJURY. 2. TISSUE DAMAGE. 3. RESPIRATORY HAZARDS. 4. COMBUSTION & ELECTRICAL HAZARDS. www.indiandentalacademy.com
  22. 22. LASER SAFETY OFFICER (L.S.O.)  Identifies and assess the Hazard .  Determines the potential hazard zone.  Establishes standard operating procedures.  Approves use of protective equipment.  Ensures safety of all persons within the operating field. www.indiandentalacademy.com
  23. 23. SAFETY RECOMMENDATIONS  All class IV Dental lasers are potentially hazardous. Manufacturer safety precautions must be followed.  Fire and electric hazards can be avoided by • Dry floor. • Soaking surgical drapes and gauze in sterile saline. • Avoid flammable liquids and gases.  Personal protective equipment. • Safety goggles • Mouth masks • High vacuum evacuation • Re – circulatory air filter system • Proper ventilation www.indiandentalacademy.com
  24. 24. LASERS IN ENDODONTICS A. LASER DOPPLER FLOWMETRY. He-Ne (λ=632.8) and Ga Al As (780-820) Semiconductor diode lasers at 1 or 2 mw power are used. Principal is based on the changes in the red blood cell flux in the pulp tissue. DISADVANTAGE. • Difficult to obtain laser reflection in molar tooth. ADVANTAGE. •Painless diagnosis. •Useful vital and non vital diagnosis of tooth. www.indiandentalacademy.com
  25. 25. B. HEAT TEST  Pulsed Nd:YAG laser can be used as an alternative to Hot gutta-percha method. ADVANTAGE. Nd:YAG Laser induced pain is mild and tolerable.  Pain response can be obtained in tooth with thick enamel and dentin. www.indiandentalacademy.com
  26. 26. DIFFERENTIAL DIAGNOSIS OF PULPITIS A. NORMAL PULP VS ACUTE PULPITIS. ▪ Nd:YAG laser at 2w power and 20 pulses/sec at a distance of 10 mm from the tooth surface, pain is produced within 20-30 secs and disappears in a couple of seconds. - NORMAL PULP. ▪ If pain is induced immediately after laser application and continues for more than 30 sec after removing the stimulus. - AUTE PULPITIS www.indiandentalacademy.com
  27. 27. ACUTE SEROUS PULPITIS vs ACUTE SUPPURATIVE PULPITIS  If the Electric current resistance is greater than 15.1 mΏ and patient experiences continuous pain for more than 30 secs. - ACUTE SEROUS PULPITIS.  If the electric resistance is less than 15.1 mΏ and the pain is continuous for more than 30 sec. - ACUTE SUPPURATIVE PULPITIS. INFERENCE: Carious impedance of less than 15.1 mΏ indicates that no hard healthy dentin exists b/w caries and Pulp chamber. www.indiandentalacademy.com
  28. 28. DESENSITIZING HYPERSENSITIVE DENTIN   PULSED Nd:YAG laser is the choice. Parameters : 1w, 20 pps at 2-3 mm distance and coating the surface with black ink. 3 DIFFERENT APPROACHES. 1.Stimulating the mucosal surface. • In Root hypersensitivity • Duration - 10 sec. • In mild hypersensitive cases. 2. Stimulating the crown portion. • Tooth surface adjacent to sensitive area is exposed. • 0.5 sec/exposure for 2-3 times. 3. Stimulating the surface of dentin. • Sensitive dentin is directly exposed. • Brings morphologic changes in dentin and stimulates central pulpal neurons. • In severe cases. www.indiandentalacademy.com
  29. 29. PULP CAPPING A. INDIRECT PULP CAPPING. Discovery of closure of dentinal tubules and sedative effects on Pulpitis has led to the use of lasers in direct pulp capping. • Deep hypersensitive cavities are indicated. • Nd:YAG laser of 2w, 20pps for < 1 sec is used after coating tooth surface with black ink and air spray cooling to prevent pulp damage. B. DIRECT PULP CAPPING. CO2 Laser has shown 89% success due to ▪ Control of hemorrhage ▪ Sterilization and Carbonization. ▪ Stimulation of dental pulp cells. • Irrigate the exposure site with 3% Naocl & 3% H2O2 for 5 min. • CO2 irradiation is performed at 1 or 2 w for 5 min. • CaOH is placed overwww.indiandentalacademy.com cavity sealed. the exposed site and
  30. 30. ROOT CANAL TREATMENT ACCESS CAVITY. Er:YAG and Er Cr:YSGG Laser which ablate Enamel and Dentin can be applied at 5w and 6Hz under water spray. ROOT CANAL PREPARATION. 1. Laser tip must slide gently from the apex to the coronal by gently pressing the tip against the wall under water spray. 2. Er:YAG Laser at 8 Hz and 2w power. 3. Pulsed Nd:YAG at 2w power,20pps for 1sec with 5 sec interval b/w pulses removes pulp remnants, debris and stimulated apical cells. 4. Nd:YAG with 38% AgNH4 effectively killed micro organisms. www.indiandentalacademy.com
  31. 31. PERIAPICAL LESIONS WITH SINUS TRACT INDICATIONS.    CASES FOR WHICH APICOECTOMY OR PERIAPICAL CURRETAGE CANNOT BE PERFORMED. CASE WITH DEEP POST IN THE ROOT CANAL. ADJUNCT TO STANDARD ENDODONTIC /SURGICAL RX. LASER: PULSED Nd:YAG AND CO2. PROCEDURE: • AT 20W AND 20PPS THE LASER TIP IS INSERTED INTO THE SINUS TRACT AT THE APEX AND DRAWN SLOWLY TO THE OPENING OF SINUS TRACT. • IT IS PERFORMED 3-4 TIMES DURING ONE VISIT AT 1 OR 2 VISITS PER WEEK TILL SINUS DISAPPEARS. www.indiandentalacademy.com
  32. 32. UNDER RESEARCH  APICOECTOMY, RETROGRADE CAVITY PREPARATION AND PERIAPICAL CURRETAGE . - Nd:YAG & CO2.  CLOSURE OF APICAL FORAMINA.  LASER RX WITH STEREO MICROSCOPE /FIBEROSCOPE.  - Pulsed Nd:YAG. ▪ TO REMOVE POLYPS, FRACTURED INSTUMENTS DEBRIS, PULP REMNANTS, POST SPACE PREP’N UNDER VISUAL FEED BACK. ROOT CANAL SWEEPING AND IRRIGATION WITH CAVITATION.  STRENGTHENING ROOT CANAL WALL WITH AgNH4 SOLUTION & LASER.  ROOT CANAL FILLING USING GUTTAPERCHA OR RESIN WITH LASER. www.indiandentalacademy.com
  33. 33. STRENGTHENING ROOT CANAL TREATED TOOTH  PULPLESS TEETH HAVE TENDENCY TO FRACTURE.  TEETH LASED WITH 38% AgNH4 SOLUTION BECAME DIFFICULT TO FRACTURE.  Pulsed Nd:YAG , CO2 , AND ARGON LASERS CAN BE USED. PROCEDURE: Laser irradiation is performed in combination with 38% AgNH4 solution at 2-3 w for 20 secs under air cooling until the tooth surface becomes silver and mirror like. www.indiandentalacademy.com
  34. 34. RANGE OF LASERS IN ENDODONTICS LASER INDICATION HeNe , Diode Laser Doppler vitality CO2 , Nd:YAG Deep Caries RX Nd: YAG , CO2 , Ho:YAG Sterilization of Root canals CO2 , Nd:YAG Vital pulp amputation Nd:YAG , Excimer, Er:YAG Root canal preparation www.indiandentalacademy.com
  35. 35. CONCLUSION  WITH THE NEED FOR, ▪ Fiber optic delivery system. ▪ Multitude wavelengths and pulse widths. ▪ Economical devices. LASER TODAY OFFERS AN ENDODONTIST NOT ONLY A WINDOW BUT A DOOR INTO THIS HI-TECH, REWARDING AND POTENTIALLY PROFITABLE ARENA. www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com

×