2. Advances in technology are increasing and changing
the ways that the patient experience dental treatment.
One of the milestones in technological advancements
in dentistry is the use of lasers.
The term laser is the acronym for” Light Amplification
by Stimulated Emission of Radiation”
They provide more efficient , more comfortable and
more predictable outcomes of the patient.
3. Theory of stimulated emission1917-Einsteen
Laser principle1958-
Townes&Schawlow
Ruby laser1960-Maiman
Neodymium ion doped yttrium
aluminum garnet rod
1961-Johnson
Co2 laser1964-Patel
First documented case in
OMFS using laser
1977-Shafir
First dental laser ND:YAG1989-Terr Myers
History
9. The main differentiating characterstics of laser is
wavelength which depends on the laser medium and
the excitation mode .
10. Classification based on light spectrum
Not used in dentistry100 nm - 400 nmUV Light
Most commonly used in dentistry (
Argon & Diagnodent Lasers)
400 nm to 750 nmVisible light
Most dental lasers are in this
spectrum
750 nm to 10000 nmInfrared light
11. The following four laser instruments emitt
visible light:
. Aragon laser :blue wave length of 488nm.
.Aragon laser: blue-green wavelength of 514nm
.frequency doubled laser ND:YAG also called
potassium titanyl phosphate(KTP) : green
wavelength of 530nm
.low level lasers red non surgical wavelength of 600
to 635 nm for photomodulation and 655nm for
caries detection
12. These include photomodulation devices
.Diode lasers various wavelengths between 800 and
1064nm
.ND:YAG laser 1064nm
.Erbium ,chromium doped ytrium scandium gallium
garner (Er:Gr:Ysgg)2780nm
.Co2 laser :9300nm and 10,600nm
Other dental lasers emitt invisible laser light
13. Classification according to the materials used
solidliquidgas
Diodes
Nd:YAG, Er:YAG,
Er:Cr:YSGG, Ho :YAG
Not so far in
clinical use
Argon
Carbon dioxide
16. Shorter wavelength instruments, such as Ar, diode,
and Nd:YAG lasers, have small, flexible fiber-optic
systems with bare glass fibers that deliver the laser
energy to the target tissue.
17.
18. Because the Erbium and Co2 are absorped by water
which is a major component of coventional glass
fibers, these wavelengths cannot pass through these
fibers
19. Erbium and co2 laser devices are therefore constructed
with special fibers capable of transmitting these
wavelengths with semiflexible hollow waveguides or
articulator arms.
20. The Er family of dental lasers provides a cooling water
spray for hard tissue procedures that can be switched
off for soft tissue surgeries.
21. In the noncontact use the beam is aimed at the target
some distance away, with the loss of tactile sensation
the surgeon must pay attention to the tissue
interaction with the laser energy.
23. There are two basic modes of wavelength emission for dental
lasers:
Continuous wave emission
• means that laser energy is
emitted continuously
produces constant tissue
interaction.
• CO2, Ar, and diode lasers
operate in this manner
Free-running pulse emission
• occurs with very short
bursts of laser energy
• KTP, Nd:YAG, Er:YAG, and
Er,Cr:YSGG devices operate
as free-running pulsed
lasers.
24. Continuous wave emission Free-running pulse emission
• provides target tissue with
thermal relaxation time to
cool
•They are equipped with a
mechanical shutter with a time
circuit to produce gated or
super-pulsed energy.
•To minimize some of the
undesirable residual thermal
damage.
25. Regardless of the emission mode, all lasers produce a
thermal effect on target tissues, and the operator must
pay strict attention to the temperature of the surgical
site and ensure that the laser energy is correctly
controlled
27. Depending on the optical properties of the tissue, laser
may have four different interactions with the target
tissue.
1. Reflection
2.Transmission
3.Scattering
4.Absorption
28. The primary and beneficial goal of laser
energy is therefore
absorption of the laser light by the
intended biological tissue.
30. Three primary photothermal laser-tissue interactions
Incision/excision
Ablation/vaporization
Hemostasis/coagulation
31. 1. Laser beam in focus with a small spot size is used
for
incision/excision procedures
2. Laser beam with a wider spot size ablation
3. Laser beam out of focus will produce hemostasis/
coagulation
36. Photochemical effects occur when the laser is used to
stimulate chemical reactions, such as the curing of
composite resin.
A laser can be used in a nonsurgical mode for
biostimulation for more rapid wound healing, pain relief.
The pulse of laser energy on hard dentinal tissues can
produce a shock wave, which is an example of the
photoacoustic effect of laser light. This process is often called
spallation.
Certain biologic pigments, when absorbing laser light of a
specific wavelength, can fluoresce, which can be used for
caries detection on occlusal surfaces of teeth.
39. The successful construction of removable full and
partial dentures mainly depends on the preoperative
evaluation of the supporting hard and soft tissue
structures and their proper preparation.
A comprehensive prosthodontic treatment plan may
need to incorporate surgery to maximize this support.
40. removal of a torus vestibuloplasty
contouring of
irregular ridge
anatomy
removal of
hyperplastic or
redundant soft
tissue
reduction of a
hard or soft tissue
tuberosity
Surgery of healthy tissues
may include
41. Dental lasers can be successfully used for all of these
procedures because laser energy :
1. reduces bacteria at the surgical site
2. coagulates blood vessels.
3. minimizes scar formation.
4. reduces swelling and postoperative
pain.
5. facilitates the overall treatment of
prosthodontic patients.
42. All dental wavelengths can perform soft tissue
surgeries, but the erbium (Er) family of lasers is the
only group of lasers indicated for treatment of osseous
tissue.
43. Vestibuloplasty
maxilla (a) with both a buccal vestibuIe of inadequate depth and an anterior
frenum attached to the crest of th aIveolar ridge. and a mandible (b) with a
buccal vestibule of inadquate depth.
44. Immediate postoperative views of the maxilla (c) following the
frenectomy and vistibuloplasty and the mandible
(d) following vistibuloplasty.
46. Any laser can be used to reduce soft tissue tuberosities. For
hard tissue tuberosity reduction, the Er family of lasers is
necessary to ablate bone.
47. Removal of a mandibular torus
An Er laser cuts the osseous protuberanceLarge torus on the lingual aspect of
the left mandible
48. Reflection of the soft tissue flap and hemostasis can be
accomplished using any wavelength. However, the osseous
reduction can only be performed with Er family lasers.
Torus removal with a hemostat. Immediate postoperative view.
49. Contouring of the maxillary denture base
Preoperative view showing a partially
edentulous maxilla immediately following
extraction of the anterior dentition.
50. Laser removal of the granulomatous and the
recontouring the soft tissue will create a
better support base for the prosthesis.
51. Although any dental laser will work, a wavelength with superior hemostatic ability (ie,
CO2, diode, or Nd:YAG) will ensure that blood clots formed in the coagulated
extraction sockets will not be displaced and cause new bleeding.
53. Immediate postoperative view of the
soft tissue denture base.
The l month postoperative view shows
complete healing.
54. Surgery may also be indicated to treat irritated or inflamed tissues
underneath or adjacent to a denture base, such as removal of an
epulis or management of generalized denture stomatitis.
Irritated epulis fissurata with the denture
in place
Immediate postoperative view of the affected
area.
56. Treatment of undercut alveolar ridges
• Naturally occurring undercuts such those
found in the lower anterior alveolus or where
a prominent pre-maxilla is present.
• This causes soft tissue trauma, ulceration, and
pain when prosthesis is placed on such a
ridge.
• Soft tissue surgery may be performed with any
of the soft tissue lasers. Osseous surgery may
be performed with the erbium family of lasers
59. The advantages of using lasers in implant dentistry are
the same as for any other soft tissue dental procedure.
Increased
visibilty due
to
hemostasis
Reduced
swelling and
infection
Reduced pain
Minimal
damage to
the
surrounding
tissue
60. Impressions for restorative procedures
can be taken immediately after second-
stage surgery because the surgical field
will be clean and dry.
61. The erbium (Er) family of lasers, with its capacity for
osseous ablation, can be used in osteotomy
preparation and for removal of diseased osseous tissue
around areas of inflammation."
62. Although Nd:YAG has been a particularly popular
wavelength to use for soft tissue second-stage surgery,
several investigators contend that it is contraindicated
to use with implants.
Due to
1. the transmission of heat to the bone from the
heated implant surface.
2. the potential for pitting and melting, and the
porosity of the implant surface.
63. whereas the diode, Er family, and carbon dioxide (C02)
lasers can be used .
Because they are reflected away from metal surfaces,
they interact only minimally with the implant.
67. Implant Uncovering Surgery
diode laser at a maxillary central
incisor implant site at the beginning of
implant uncovering
Immediate postoperative view of the
implant site. The soft tissue hat covered
the implant has been ablated. The
surgical field is clean and dry and
requires no sutures.
68. CO2 laser removing soft tissue during
second-stage implant surgery.
Immediate postoperative view showing
three uncovered Implants
69. Implant Placement
Partially edentulous posterior
maxilla.
The Er:YAG laser begins soft tissue
preparation.
After soft tissue ablation is completed
the surgical site is ready for pilot holes.
70. The Er:YAG laser begins osseous pr
eparation.
Implant placement with
supragingival healing caps.
Three months postoperative view of implants
72. One of the most interesting uses of lasers in implant
dentistry is the possibility of salvaging ailing implants
by decontaminating their surfaces with laser energy.
Diode, ER:YAG, CO2 lasers can be used for this purpose
Nd:YAG wavelength did not sterilize dental implants.
In addition,melting, loss of porosity, and other surface
alterations.
73. In some clinical sitiuations using laser may be the best
choice
A patient with potential bleeding problems could be
treated with a laser to provide essentially bloodless
surgery in the bone. This practice could be particularly
useful in the placement of mini-implants
74. Sinus lift procedure
• The procedure can be done by making the
lateral osteotomy with a decreased incidence
of sinus membrane perforation.
• The yttrium-scandium-gallium-garnet (YSGG)
laser is the optimal choice for not cutting the
sinus membrane
75. Bone grafts done with lasers have been
demonstrated to decrease the amount of
bone necrosis from the donor site and the
osteotomy cuts are narrower, resulting in
less postoperative pain and edema
76. The impact laser use have on the prostheses that are
manufactured for
implant restoration
One of the hallmarks of the osseointegration
technique is a passive fit of the prosthesis on
the implants.
one of the ways to obtain a true passive fit is by
the elimination of the casting technique.
The expansion and contraction during casting
can lead to a nonpassive fit of the implant
prosthesis when placed onto multiple
implants
77. To that end, the proposed
laser welding of
titanium components
has been advocated and
used with some
mixed success.
78. One of the issues was the learning curve for the
technicians and that as familiarity with the procedure
increased, success rates improved
79. LASER APPLICATION IN DENTAL LABORATORY
• Laser holographic imaging is a well established method
for storing topographic information, such as crown
preparations, occlusal tables, and facial forms for maxillofacial
prosethsis.
• Holography is the science of recording the reflected light
waves from an object onto a hologram and subsequently
reconstructing the stored image of the object in the space
where the original object had been. The terms holo, meaning
complete, and gram, meaning message, give rise to the
hologram or complete message.
• The three-dimensional aspect of the hologram image is
unique.
80. Ultraviolet (helium-cadmium) laser-initated polymerization of
liquid resin in a chamber, to create surgical templates for
implant surgery and major reconstructive oral surgery
81. Laser scanning of casts can be linked to computerized milling
equipment for fabrication of restorations from porcelain and
other materials
82.
83. Safety regulations
•.
Using high volume plum
evacuaton system
wearing wavelength-specific
protective eyewear,
Restricting access to the laser surgery area,
minimizing reflective surfaces and normal
protocol for infection control
