Dr. Devi MDS Amrita School of dentistry

1. LASER IN
PROSTHODONTIC
S
DEVI
2ND YR PG
1
13-3-17 JOURNAL CLUB

2. Contents
 Introduction
 History
 Fundamentals of lasers
 Commonly used lasers in dentistry
 Application of lasers prosthodontics
 Review of literature
 Conclusion
2

3. Introduction
 The word laser is an acronym standing for
“Light Amplification by Stimulated Emission
of Radiation.”
3
british dental journal volume 202 no. 1 jan 13
2007, s. Parker-❶

4.  A device that generates an intense beam of coherent,
monochromatic light (or other electromagnetic radiation) by
stimulated emission of photons from excited atoms or
molecules.
 Lasers are used in drilling and cutting, alignment and
guidance, and in surgery.
4

5. HISTORY
 The first ruby laser was developed in
1960 and many other lasers were
created rapidly thereafter.
 Dental researchers began investigating
lasers’ potential, Stern and Sognnaes
reported in 1965 that a ruby laser could
vaporize enamel.
 Other wavelengths were studied over the
ensuing decades for both hard and soft
tissue applications.
5
1960-first laser
1993 Nd:YAG Laser
1993 Kinetic Cavity
Preparation
1994 CO2 Laser, Argon Laser
1996 Laser welder
1997 Nd:YAP Laser
1998 Er:YAG Laser

6. Classification
Based on application
Soft tissue lasers
Eg:argon,CO2,diode, Nd:YAG
Hard tisssue lasers eg : Er:
YAG
Resin curing laser eg :argon
Mode of
action
Contact mode eg :
He:YAG, Nd; YAG
Non contact mode eg:
CO2
6

7. Based on level of energy
emission
Soft lasers
eg :He- Neon
Hard lasers
eg : Er: YAG
Based on the radiant
energy generation
Continuous
Discrete
Multiple timed
7

8. 8Lasers in Dentistry:
 Dental lasers exert their desired clinical effect on a patient’s
target tissue by a process called absorption.
 Dental lasers function by producing waves of photons
(quanta of light) that are specific to each laser wavelength.
 This photonic absorption within the target tissue results in
an intracellular and/or intercellular change to produce the
desired result.

9. 9
Laser interaction with biologic tissues
 Four different interaction
 Reflection
 Scatter
 Absorption
 Transmission

10. MECHANISM OF DENTAL
LASERS
 A laser is a device that changes electrical or
chemical energy into a very fine, intense beam
of light energy that
 alters light of several frequencies into an
intense, small, and nearly non-divergent beam
of monochromatic radiation, within the visible
range.
10

11.  Laser Light - Laser light used for dental procedures is a
form of electromagnetic energy that has four
characteristic features
 – monochromatic (laser light is of one specific colour/
single wavelength unlike ordinary white light which is a
sum of many colours of the visible spectrum),
 collimation (refers to the beam having specific spatial
boundaries which ensure a constant size and shape of
the beam emitted from the laser cavity).
11

12.  Coherency (means that the light waves created in the
instrument are in phase with one another and have
similar wave shapes,
 i.e. all the peaks and valleys are equivalent), and
efficiency (at very low average power levels lasers can
produce the required energy to perform their specific
function,
 e.g. 2 watts of Nd: YAG laser light provides the thermal
energy to precisely incise a gingival papilla).
12

13.  Amplification - Amplification is part of a process that
occurs in the laser.
 Lasers are generically named for the material of the
active medium, which can be a container of gas, a
crystal, or a solid-state semi-conductor.
 The electromagnetic energy is generated by excitation
of an active medium like argon, CO2, yttrium,
aluminium, gallium, neodymium, or erbium that supply
source of energy.
 It is raised by two mirrors which are placed parallel at
each end of the optical cavity and emerges as laser
light.
13

14. Painless,
Bloodless
& Clean
surgical
field.
No or
minimal
need for
anesthesia.
Laser kills
bacteria,
risk of
infection is
reduced
No post
operative
discomfort,
and
swelling.
Superior
and faster
healing
LASER
14

15. 15Advantages
 No anesthesia, no drill
 Less blood loss, Less pain
 Reduce post –operative edema
 Early healing, rapid regeneration, reduce
post sensitivity in restorations
 Less chances of metastasis
 Sterilization of treatment site-no infection

16. 16
Uses of laser in Dentistry:
1- Hard Tissue(cutting enamel and dentine):
 Class I, II, III, IV and V cavity preparation.
 Caries removal.
 Hard tissue surface roughening and etching.
 Enameloplasty, excavation of pits and fissures for placement of
sealants.

17. 1- Hard Tissue(cutting enamel and dentine):
Advantages:
 Reduce and even eliminate the smear layer
associated with traditional rotary instruments
which can improve surface adhesion and
bond strength for restorations.
 Prohibit the pain response.
 Most procedures can be completed without
the aid of injected anesthetic.
17

18. 2- Bone Surgery:
Cutting, shaving, contouring and resection of
oral osseous tissues
• Osteoplasty and osseous recontouring.
• Ostectomy.
• Osseous crown lengthening.
Advantages:
 Procedure can be completed without laying a
flap, suturing, or damage to the bone
18

19. 3- Soft Tissue:
• Treatment of canker sores, herpetic and
aphthous ulcers of the oral mucosa and
leukoplakia.
• Exposure of unerupted teeth.
• Flap preparation.
• Frenectomy.
• Gingivectomy or gingivoplasty.
• Gingival troughing for crown impressions.
• Hemostasis.
• Vestibuloplasty.
19

20. 20Uses of laser in Dentistry:
3- Soft Tissue:

21. 214- Soft Tissue:
Advantages:
 Capability to atraumatically treat
soft tissue with little to no
bleeding, little edema, and
positive post-operative results.

22. 22
5- Root Canal treatment:
• Root canal preparation
including enlargement.
• Pulpotomy.
• Apicoectomy –
amputation of the root end.

23. 23
6- Periodontology:
• Sulcular debridement (removal of
diseased or inflamed soft tissue in
the periodontal pocket).
• Laser soft tissue curettage of the
post-extraction tooth sockets or the
periapical area during apical
surgery.
• Flap preparation.

24. 245- Root Canal:

25. 257- Others:
 Diagnostic laser for caries and calculus detection.
 Composite curing laser.
 Optical impression like CAD/CAM.
 Teeth bleaching.

26. Laser applications in Fixed
Prosthodontics
 Gingival retraction
 Recontouring of the gingival margin for crown
lengthening
 Edentulous site preparations
 Osseous Recontouring for crown
lengthening
26
Atlas of laser applications in dentistry , Donald J Coluzzi, Robert A. Convissar

27.  Removing intrusive or extrusive tissue
around the margins of tooth
preparations , increasing the length of
clinical crowns, or contouring
edentulous sites for fixed partial
dentures
27
Walsh L J . The current status of laser applications in
dentistry . Aust Dent J 2003; 48: 146-155

28. Laser instruments provide
 Excellent surgical precision
 Hemostasis
 Tissue healing
28
Janda P , Sroka R , Mundweil B, Betz Comparison of thermal tissue effects
induced by contact application of fibre guided laser systems . Lasers Surg
Med 2003 ; 33 : 93-101

29.  All dental lasers may be used for soft tissue
procedures, but only the erbium (Er) family of
lasers is effective in removing and
recontouring bone .
 Conventional modalities are not yet replaced
with laser
 Er lasers are used for complete tooth
preparations of crowns or veneers
29
The Er:Cr:YSG Laser in various restorative treatments ,
Schalter R , J Acad Laser Dent 2005;13:26-29

30.  Successful fixed prosthodontics ensure
excellent esthetics, improved occlusion and
healthy periodontium and dental lasers can
be used to achieve these results
30
Parker S. The use of lasers in fixed
prosthodontics . Dent Clin North Am 2004; 48;
971-978

31. Gingival retraction for
impressions
 Diode and neodynium – doped
yitrium aluminium garnet
(Nd:YAG)
 Longer wave length of Er and
CO2
31

32. 32
•Wave length settings :
Nd: YAG laser set to 20Hz, 100mJ with a 320um fibre

33. 33
Diode laser set to .6 W continous wave with a 400um fibre

34. 34SOFT TISSUE MANAGEMENT
AROUND ABUTMENTS
 ARGON laser provide excellent
Hemostasis and Coagulation
 Gingival Retraction for making
impression during a crown and
bridge procedure becomes easy

35. Recontouring of the gingival
margin for crown lengthening
 It can be used to re-establish biologic width
when tooth preparation must encroach on
this area
 Gingival re-contouring may be performed
with all dental laser wavelength
35

36.  Diode laser , 810nm set to 0.8 W continuous wave with
a 400uk fiber
 Nd: YAG 3 W continuous wave with 250um sapphire
tip
 Nd: YAG laser set to 100 mJ, 20 Hz with a 320um fiber
 CO2 laser, 10600 nm, 6 W
36

37. 37

38. Edentulous site preparation
 Edentulous site often need to be reshaped to provide
esthetic emergence profile for restorations
 Both soft tissue and alveolar crest can be contoured
with laser instruments
 Any laser can be used to reshape soft tissue but only
Er lasers can be used to recontour the underlying
osseous structure
38

39. 39
Er:YAG LASER 2940nm , 50mJ ,
30hz with water spray

40. Osseous Recontouring for
crown lengthening
40

41. Laser applications in
removable prosthodontics
 Treatment of inflamed soft tissue
 Soft tissue denture base modification
 Torus reduction
 Reduction of residual ridge and maxillary
tuberosity
41
Atlas of laser applications in dentistry , Donald J
Coluzzi, Robert A. Convissar

42. TUBEROSITY REDUCTION
The most common reason for
enlarged Tuberosity usually is
soft tissue hyperplasia
 It affects stability of prosthesis
 Surplus soft tissue should be excised
using soft tissue lasers
42

43. RESIDUAL RIDGE MODIFICATION
 For proper retention, stability and support
for the prosthesis, residual ridge
modification is done with lasers, in pre
prosthetic preparation phase for
• Under cuts
• Flabby tissue
43

44. Treatment of inflamed soft
tissue
44

45. Soft tissue denture base
modification
45
SOFT TISSUE LESIONS
Epulis fissurata, Denture
stomatitis

46.  Persistent trauma from a sharp denture
flange
 Over compression of the posterior dam area
 The lesion can be excised with any of the soft
tissue lasers and the tissue allowed to re
epithelialize
46

47. Torus reduction
 Tori and exostoses are formed
mainly of compact bone.
 They may cause ulceration of
oral mucosa.
 They may also interfere with
lingual bars or flanges of
mandibular prostheses.
 Soft tissue lasers may be use to
expose the exostoses and
Erbium lasers may be use for the
osseous reduction.
47

48. IMPLANTOLOGY
 Second stage uncovering.
 Implant site preparation.
 Peri-implantitis.
48

49. 49SECOND STAGE UNCOVERING
 Following the placement of implant and its Osseo
integration, Er:YAG laser can be used to uncover
implants
 Little blood contamination (haemostatic effects)
 Minimal tissue shrinkage
 Eliminate trauma to the tissues during flap reflection
 Impressions can be obtained at the same appointment
ADVANTAGES OVER CONVENTIONAL
SURGERY

50. 50
Excess soft
tissue being
removed using
laser

51. 51
Immediately healing caps are
laser exposed and soft tissue is
re contoured
Soft tissue healing within 2
weeks

52. 52
IMPLANT SITE PREPARTION
 Lasers can be used for the placement of mini
implants especially in patients with potential
bleeding problems, to provide essentially
bloodless surgery in the bone

53. 53
 Lasers can be used to repair ailing implants by
decontaminating their surfaces with laser
energy.
 Lasers can also be used to remove inflamed
granulation tissue around an already
osseointegrated implant.
 Diode, CO2 & Er:YAG lasers can be used for
this purpose.

54. 54

55.  Topologic data of the patient’s deformity is
acquired using laser surface digitizing, the
procedure is called Laser Holography
Imaging
 Lasers aid in creating a visually realistic
prosthesis that can provide an illusion of
normal appearance.
55
Optic letters vol.24, issue 5 pg 291-293;
1999

56. 56Laser welding
 No need for investment and soldering alloy
 Working time is decreased
 Easy to operate
 Minimal heat damage to denture base resin
Advantages over Conventional
Soldering
An alternative method to join dental casting
alloys such as broken clasp

57. 57
 Laser scanning of casts can be linked to
computerized milling equipment for fabrication of
restorations from porcelain and other materials.

58. Conclusion 58
Lasers - alternative to
conventional surgical systems
Lasers are a “new and
different scalpel” (optical knife,
light scalpel)

59. References :
 Atlas of laser applications in dentistry , Donald J Coluzzi, Robert A.
Convissar
 Introduction, history of lasers and laser light production; S.
Parker1BRITISH DENTAL JOURNAL VOLUME 202 NO. 1 JAN 13 2007 1-
9
 Kesler G Clinical applications of lasers during removable prosthetic
reconstruction. Dent Clinic North Am 2004: 48:963-969
 Bareli. Er: YAG laser in oral soft tissue surgery . J Oral Laser Appli 2001; 24
 Priya Nachrani Rajeev Umesh Vivek. Laser in rosthodontics –review
.NJDSR number 2, vol 1, jan 2014
 Laser and it’s Application in Prosthetic Dentistry . Shaista Durrani .Int J Dent
Med Res | MAR- APR 2015 | VOL 1 | ISSUE 6
59

60.  Adams TC , Pang PK. Lasers in asthetic dentistry. Dent Clinc North Am
2004:48
 Ishika I, Aoki A, Takaski AA. Potential applications of Erbium: YAG laser in
periodontics. JnPriodont Res 2004;39: 275-285
60

61. 61