• Fundamentals Of Laser Operation
• Classification Of Lasers
• Current Uses
• Technique For Use Of Laser In OMFS
• Laser Safety
• Advances in technology are increasing and changing the
ways that patient experience dental treatment. Technology
helps to reduce treatment time and treatment more
• 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 for the patient.
1917- Einsteen Theory of stimulated emission
1958 – Townes & Schawlow Laser principle
1960 - Maiman Ruby laser
1961 - Johnson Neodymium ion doped yttrium aluminium
1964 - Patel CO2 Laser
1977 - Shafir First documented case in OMFS using
1989 – Terr Myers First Dental Laser – Nd:YAG
Fundamentals Of Laser Operation
• Components -
Active medium [ Lasing Medium ]
Laser Delivery System
Properties Of LASER
Photobiology Of Lasers
Biostimulation - Stimulatory effects of laser
on biochemical and molecular processes that
normally occur in tissues such as healing and
Photodynamic Therapy – induce reactions in
tissues for the treatment of pathologic condition.
Tissue fluorescence - used as a diagnostic
method to detect light reactive substance in
• Photo thermal interactions-
Photo ablation – removal of tissue by
vaporization and super heating of tissue fluids
, coagulation, and hemostasis.
Photo disruption - breaking apart of
structures by laser light.
Photoaccoustic interaction- involve
removal of tissue with shock wave generation.
• Photoelectrical Interaction- include
photoplasmolysis which describes how tissue
is removed through the formation of
electrically charged ions and particles that
exist in a semi gaseous high energy state.
• Photocoagulation : Laser heats the tissues to 60
deg C for a limited time leading to coagulation of the
tissues with minimal alteration in the appearance of
tissue structure. As a result of these proteins
enzymes cytokines and other bio active molecules
Classification Of Lasers
Class 1 Non Hazardous Producing Laser
Class 2 Hazard producing when passed through
Class 2 M Safe, if not viewed through optical
Class 3 R Safe with restricted beam viewing
Class 3 B Direct viewing hazardous to eye
Class 4 Serious injury potential to eye and skin
Laser Classification as per medium Used
Solid State Laser Eg-Neodymium-yttrium aluminium garnet
Gas Laser Eg- Helium & Helium Neon
Excimer Laser Uses reactive gases like chlorine and
fluorine eg : argon laser
Dye Laser Complex dyes like Rhodamine 6G
High Power Lasers-
Used for surgical
Low power Lasers-
Used to promote
General Medical Uses Of Laser
• Cancer diagnosis
• Cancer treatment
• Laser hair removal , tattoo removal
• Medical imaging
• Optical coherence tomography
Uses In Dentistry
• Hard tissue ablation/ Dental Caries removal.
Argon Fluoride / Xenon fluoride lasers are
used. They have a wave length from193nm to
• Carbon dioxide lasers are used for intra oral and
implant soft tissue surgery , aphthous ulcer ,
melanin pigmentation. Has a wavelength of
10600nm. Color- Infrared
• Helium Neon Lasers has a wavelength of 637nm
and is used for dentin hypersensitivity , analgesia
• Argon lasers having a wavelength of 488nm & are
used for tooth whitening , curing of composites ,
curettage etc Color-Blue
• Indium Gallium Arsenide Phosphorous are
used for caries and calculus detection and has
wavelength of 655nm. The color of the laser is
• Gallium Aluminum Laser – Intra oral Surgery ,
Implant soft tissue surgery , sulcular
debridement , Pulpotomy , root canal
disinfection removal of enamel caries etc,
Wavelength- 840nm Color-Infrared
Solid state Laser
• Neodymium:YAG Laser – Intra oral soft tissue
surgery , sulcular debridement , analgesia ,
Pulpotomy , root canal treatment, removal of
gingival melanin pigmentation . Has a wave
length of 1064nm and is infrared.
• Erbium:YAG is used for modification of enamel and
dentin surface , implant soft tissue surgery , sulcular
debridement , osseous surgery , treatment of dentin
hypersensitivity , apthous ulcer treatment etc
Techniques For Incisional Biopsy
• Provide local or general anesthesia.
• Outline the intended superficial incision line without deep
• Connect the outline marks.
• Excise the specimen.
• Obtain Homeostasis.
• Consider the need for suturing.
• Consider tagging the biopsy margins.
Technique for ablation and vaporization
• Laser vaporization is an effective , non-morbid ,
inexpensive , quick , and relatively painless method of
managing pre malignant lesions.
• A spot size of 1.5 to 3mm is typical for most intra oral
vaporization procedures. The beam is transverse in
• A constant speed must be maintained to create a
uniform depth. Increasing depth can be accomplished by
• Allows for removal of a surface lesion in layers.
• Lasers are also used in arthroscopic
surgery of TMJ
• Scar revision is also made possible
these days with the help of pulsed dye
lasers[PDL]. PDL have hb as their
chromophores and penetrate the
epidermis without de-epithelisation.
They reduce scar tissue erythema and
induce collagen remodeling to flatten
and soften scars. Indicated in cases
Low level Laser therapy
• Also known as therapeutic laser treatment.
• Promotes tissue healing , reduces edema ,
inflammation and pain.
• Used in cases of – dermatological conditions , neural
ailments , mucoskeletal ailments etc
• Easy and safe to handle
• Improved surgical versality- ability to vaporize coagulate
and incise tissue.
• Reduces / Eliminate bleeding.
• Spot coagulation and vaporization gives excellent
• Reduces Operating Time.
• Anesthesia free soft and hard tissue cutting
• No need for suturing
• Instant sterilization of surgical site
• No sensory disturbances
• No functional /mobility disorder
• Cannot be used in teeth with restoration and
• Hazard to patient , operating and assisting team.
• Maintenance requirements
• Electrical hazards of laser equipments
• Expense of laser equipments
• Specialized arrangements
• Fire hazards
• Primary Hazards: Caused directly by laser beam.
Endangers mainly two organs- Eyes and Skin
In case of eyes it damages retina , cornea , & the lens and
slight carelessness can destroy vision permanently.
• Secondary Hazards : Its related to operation of the laser and
are independent of radiation characteristics.
Operating Room Safety
• Use of non inflammable materials
• Use of eye shields for the patient
• Use of laser resistant shielding materials for
surgical field and for protecting anesthesia
• Certain anesthesia techniques may also
decrease potential hazard
• Post signs that lasers are being used
• Eye shields to be worn by all personnel in
• Safety shields must be used
• A laser safety officer should be stationed at the
• Use only wet cloth in operative field
• Use only non-combustible anesthetic agent
• Avoid alcohol based topical anesthetic and gauze
• Protect tissues adjacent to surgical site
Sterilization And Infection Control Of
• Steam sterilization is the standard of care
• Protective housing around the laser and
articulating arm should receive spray
• The past decade has seen a variable explosion
of research into clinical application of lasers in
dental practice. Laser treatment not only is
helpful in treating general problems of the
teeth but also helps to reduce the fear and
anxiety of the patient towards the treatment.