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LASERS IN ENDODONTICS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
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.
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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 .


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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
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PRESENT STATUS 10 YRS EARLIER
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


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


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


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).
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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.
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QUANTUM THEORY



An Atom at excited state releases photon.
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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


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.
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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.
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.
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Used in contact fashion.
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.
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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
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

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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


CDRH – Center for Devices and Radiological
Health.



ANSI – American National Standards
Institute.



OSHA – Occupational Safety and Health
Administration.
www.indiandentalacademy.com
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.
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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.
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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
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
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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.
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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.

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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

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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.
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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.
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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
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.
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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.
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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
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
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
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
www.indiandentalacademy.com

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

  • 1. LASERS IN ENDODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 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. 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. 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. 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.  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.  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.  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. 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. QUANTUM THEORY  An Atom at excited state releases photon. www.indiandentalacademy.com
  • 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.  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. 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. 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. 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. 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. 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. 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.  CDRH – Center for Devices and Radiological Health.  ANSI – American National Standards Institute.  OSHA – Occupational Safety and Health Administration. www.indiandentalacademy.com
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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