This document discusses the use of lasers in periodontal treatment. It begins by introducing several types of lasers approved for soft tissue treatments in dentistry, including CO2, Nd:YAG, and diode lasers. The Er:YAG laser is also noted as being approved for hard tissue treatments. The document then lists advantages of laser surgery over conventional treatments. It provides examples of soft tissue applications like gingivectomy, gingivoplasty, and frenectomy. Hard tissue applications mentioned include scaling and root planing, bone procedures, whitening, and crown lengthening. Specific case examples are also included to illustrate laser procedures.

1. Prepared by:
Athraa A. Mahmood
M.Sc. of Periodontics

2. Introduction
High power lasers such as:
• Carbon dioxide (CO2)
• Neodymium- doped: Yittrium-Aluminium-Garnet (Nd:YAG)
• Diode lasers
were approved for soft tissue treatment in oral cavity because of their excellent soft
tissue ablation and homeostatic characteristics.
• The Erbiumdoped: Yittrium-Aluminium-Garnet (Er:YAG) laser: was approved in
1997 for hard tissue treatment in dentistry. which will be able to clinical dental
practice, in particular periodontal treatment. It was introduced as an
alternative or an adjunctive to conventional scaling and root debridement.

3. Advantages of Laser Surgery
1. Decreased tissue damage and thus enhanced healing: No incisions,
stitches, post-op bleeding, swelling, pain, gum recession, tooth
sensitivity.
2. Patient comfort :less chair time.
3. Hemostasis and coagulation are possible, making the laser
essential for medically compromised patients.
4. Some procedures can be performed with topical anesthesia only.
5. The concept of minimally invasive dentistry (MID) can be achieved.
6. Lasers are safe to use if the user adheres to protocols.
Disadvantages
• Laser irradiation
• the cost and size of laser device

4. A. Soft tissue applications
B. Hard tissue applications
APLICATION OF LASER IN PERIODONTIC

5. 1. Gingivectomy
• When patients present with problems of tissue overgrowth or
hyperplasia from various causes, laser are used effectively to
perform laser gingivectomy.
A. Soft tissue applications

6. 2. Gingivoplasty
• For small tissue aberrations, pseudopockets seen after
periodontal surgery, or small areas of reverse tissue architecture
with an otherwise healthy periodontium.
• all of the dental lasers are effective in performing gingivoplasty.

7. 3. Frenectomy
All types of laser systems can be used ; however, Depth of
penetration of Diode & Nd:YAG more than Erbium & CO2.

8. Lingual frenectomy

10. 4. Removal of benign lesions
Before 3 Months post operation

11. 5. Incisional or excisional biopsy
Before
6 Weeks post operation

12. 6. Exposure of Implants
Before After
• Lasers can be used to uncover implants, whether single or multiple

13. 7. Mucogingival surgery
• For coagulation of bleeding areas, seal of soft-tissue graft
(donor sites), lasers are excellent in controlling the bleeding.
• Recontour of recipient area and more esthetic results

14. • For vestibuloplasty:
Before
Two-day postoperative Two-week postoperative

15. • Lasers are effective for crown lengthening related to excessive
soft tissue or in areas of passive eruption.
• laser type : Diode, Nd:YAG & CO2.
8. Soft tissue crown lengthening

16. 9. The Laser Assisted New Attachment Procedure
Periodontal probe
indicates excessive
pocket depth.
Laser irradiation, selectively
dissects epithelium, diseased tissue
& pathological proteins, tactile
feedback from the fiber alerts the
practitioner to the presence of root
roughness, & opens that pocket for
access & visibility.
Ultra sonic & special
hand instruments
used to remove root
roughness.

17. The tissue is compressed against the
root surface & a stable fibrin clot
forms at the gingival crest.
Laser finishes debriding pocket
& establishes coagulation.

18. 10. Melanin hyperpigmented gingiva
Melanin
hyperpigmented gingiva
Post-operative
result in 2 weeks
Final result after orthodontic
and restorative treatment
• Diode & Nd:YAG are attracted by hyperpigmented tissue
with melanin so we need less power than coral pink
gingiva.

19. B. Hard tissue applications
1. Scaling &
root planning.
2. Bone procedures.

20. 3. Whitening procedure

21. 4. Hard tissue crown lengthening
• Alter underlying osseous structure >> Erbium Laser to
clear removal of bony defect.
Preoperative views
Immediate postoperative views