This document discusses the use of lasers in dentistry. It provides a brief history of lasers, describing their development from theoretical concepts in the early 20th century to practical applications starting in the 1960s. It then covers various types of lasers used in dentistry and their wavelengths and interactions with tissue. The main applications of lasers described include uses in diagnostics, endodontics, periodontics, orthodontics, oral surgery, and treatment of conditions like cancers and snoring. Safety measures for laser use are also mentioned.

1. CELEBRATING
LASERS IN
DENTISTRY
18/06/2020

2. CONTEN
TS
 INTRODUCTION
 HISTORY OF LASERS
 HOW LASERS WORK?
 APPLICATION OF LASERS IN VARIOUS FIELDS
 TYPES OF LASERS
 APPLICATIONS OF LASERS IN DENTISTRY
DIAGNOSTICS
ENDODONTICS
PERIODONTICS
ORTHODONTICS
PROSTHODONTICS
ORAL SURGERY
CANCERS
ORAL LESIONS
SNORING
 SAFETY MEASURES
 CONCLUSION
 PUBLIC HEALTH SIGNIFICANCE
 REFERENCES

3. L
A
S
E
R
Light Amplification by the Stimulated
Emission of Radiation

4. INTRODUCTION
• LASER is a innovative tool in Non-invasive Dentistry
• No drill, No pain
• Stress free
• Esthetic needs
LASER is a solution seeking a problem

5. LASER vs NORMAL LIGHT
• Coherent
• Directional
• Monochromatic
• Can be focused to a very sharp
point

6. COMPONENTS OF FIRST RUBY LASER

8. HISTORY OF LASERS
• Created the foundations for LASER ie. Light
is made up of photons-tiny discrete particles.
1917

9. HISTORY OF LASERS
• Theoretical basis for LASER
1951
Charles H Towne

10. HISTORY OF LASERS
• Successfully tested Worlds 1st
LASER
1960
Theodore Maiman
-American Engineer

11. HISTORY OF LASERS
• Introduced LASER into medical
field.
• Father of LASER Medicine.
• Used to treat Retinal tumors.
1961
Leon Goldman
American Surgeon

12. HISTORY OF LASERS
1964
• Leon Goldman et al reported
the impact of LASER on
Dental Caries
• Complete disappearance of
carious tissue.
• Whightening was also seen.
• Not hot outside, even after
repeated impacts.

13. HISTORY OF LASERS
1964 • Bell Laboratories-Nd:YAG LASER and CO2 LASER were developed
(soft tissues)
1989 • Myers and Myers-developed application of LASERS in General
Dentistry

14. • In consumer devices such as DVD players, laser printers, and barcode scanners
• In medicine for laser surgery and various skin treatments
• In industry for cutting and welding materials
• In military and law enforcement devices
APPLICATION OF LASERS IN VARIOUS FIELDS

16. TYPES OF DENTAL LASERS
• CO2 Laser
• Nd:YAG Laser
• Diode Laser
• Argon Laser
• Er,Cr:YSGG and Er:YAG Laser
• Ho:YAG Laser
Lasers applied in dentistry are named after the
chemical elements, molecules or compounds that
compose the active medium which is stimulated

17. TYPES OF DENTAL LASERS
• Soft LASERS
• Hard LASERS
Based on the wavelength
Compact Laser (Soft Laser) : has Therapeutic effect of pain
management / infection control / re-generation
Hard Laser (Surgical Laser) : which removes , burns , cuts

18. TYPES OF DENTAL LASERS
• Ultraviolet lasers (100- 350nm)
• Visible lasers (350-750nm)
• Infra red lasers (750nm and above)
Based on wavelength

19. 1. The UV range (ultra-spectrum approximately 100- 350 nm).
2. The VIS range (visible spectrum approximately 350-750 nm).
3. The IR range (infra-red spectrum which is approximately >750 nm) to the microwave
spectrum

20.  Reflection
 Transmission
 Scattering and
 Absorption
LASER-Biological Effects

21. Reflection results in little or no absorption, so
that there is no thermal effect on the tissue.

22. When scattered, light travels in different
directions and energy is absorbed over a greater
surface area, producing a less intense and less
precise thermal effect

23. • Absorption of the laser light by the target tissue is the
primary and beneficial effect of laser energy
• When absorbed, light energy is converted into thermal
energy

24. • Transmission of light transfers energy through the tissue without
any interaction and thus does not cause any effect or injury.
• This interaction is also highly dependent on the wavelength of
laser light.

25. Laser effect on tissues
• Photo thermal interaction
• Photo chemical interaction
• Photo mechanical interaction
• Photo electrical interaction

26. PHOTO THERMAL INTERACTIONS

27. There are photochemical effects from the laser light that can stimulate chemical reactions
(e.g. the curing of composite resin) and breaking of chemical bonds (e.g. using
photosensitized drugs exposed to laser light to destroy tumor cells, a process called
photodynamic therapy).
PHOTO CHEMICAL INTERACTIONS

28. PHOTO MECHANICAL INTERACTION
•Photo-disruption – shock waves by laser –rupture the intermolecular and atomic
bonds
•Photo-disassociation - which is the breaking apart of structures
•Photo-acoustic interactions- Removal of the tissue with Shockwave therapy

29. PHOTO ELECTRICAL INTERACTIONS
Photo plasmolysis, tissue is removed through the formation of electrically charged
ions

30. TYPES OF LASER LIGHT DELIVERY SYSTEM
• Articulated arm delivery system
• Fiber optic delivery system

31. Articulated arm delivery system

32. Fiber optic delivery system

33. Contact mode:
The distal end of the fibro optic is
placed in direct contact of the target
tissue
MODES OF USE

34. Noncontact mode- The hand piece is held
away from the tissue and a guide is provided
to focus the beam at the desired target tissue
MODES OF USE..

35. CO2 LASERS
• The CO2 laser first developed by patel et al in 1964 and has a
wavelength of 10,600 nanometers.
• Co2 lasers have an affinity for wet tissues regardless of tissue
color. The laser energy weakens rapidly in most tissues because
it is absorbed by water.
• Because of the water absorption, the co2 laser generates a lot of
heat, which readily carbonizes tissues. They are highly absorbed
in oral mucosa, which is more than 90% water
• Of all the lasers for oral use, CO2 is the fastest in removing
tissue.
• Work in a non-contact mode

38. Nd: YAG Laser
• A crystal of yttrium – aluminum – garnet is doped with neodymium.
• Wavelength of 1,064 nm
• It is not well absorbed by water but are attracted to pigmented tissue
• Work either by a contact or non-contact mode
• Delivered fiber optically and many sizes of contact fibers are available
multiple soft tissue procedures such as gingivectomy,
frenectomy, and biopsy

39. • Lasing media- aluminium gallium and arsenide
• Wavelength 800-980 nm
• The chief advantage of the diode laser is one of a smaller size
portable instrument
• Useful in soft tissue surgeries, ablative procedure &
periodontal treatment
• The power output utilized by the soft-tissue diode laser is
typically between .1 and 10 watts
DIODE LASER

40. DIODE LASER..
• Poorly absorbed by tooth structure so that soft tissue surgery can be performed safely
in close proximity to enamel, dentine and cementum
• An excellent soft tissue surgical laser indicated for cutting and coagulating gingiva
and mucosa and for soft tissue curettage, or sulcular debridement.

41. Er:YAG laser
• Yttrium aluminum garnet doped with Erbium
• They have a wavelength of 2.94μm
• Highest absorption in water
• High affinity for hydroxyapatite Cutting, Contouring and Resection of Osseous Tissue
Osteotomy
Crown Lengthening
Caries removal
Soft tissue surgeries
Bone cutting
Tooth preparation

42. MODES IN LASER EMISSION

43. LASERS-APPLICATIONS IN DENTISTRY

44. • A laser examination tool for the early detection of decay.
• At the specific wavelength that the device operates(655 nm), clean healthy tooth
structure exhibits little or no fluorescence, resulting in very low scale readings on the
display.
• However, carious tooth structure will exhibit fluorescence, proportionate to the degree
of caries, resulting in elevated scale readings on the display.
DIAGNODENT

46. Goel A, Chawla HS, Gauba K , Goyal A. Comparison of validity of DIAGNOdent with conventional methods for detection of occlusal
caries in primary molars using the histological gold standard: An in vivo study. J Indian Soc Pedod Prevent Dent 2009;27(4):227-234
DIAGNOdent showed higher sensitivity and accuracy as compared with other conventional
methods for detection of enamel caries, whereas for detection of dentinal caries, even
though the sensitivity was high, accuracy of the DIAGNOdent device was similar to other
conventional caries diagnostic methods.
• To compare the in vivo effectiveness of diagnodent with other conventional methods (visual, tactile and bitewing
radiographs) for the detection of occlusal caries in primary molars.
• Eighty-four primary molars in 52 children (aged 8–12 years), which were indicated for extraction, were selected and
evaluated for dental caries using diagnodent, visual and tactile examination and bitewing radiographs.
• Histological examination of the sections, prepared subsequent to extraction of the teeth, served as the gold standard for
comparison of the above-mentioned methods.

47. LASER DOPPLER FLOWMETRY
• Laser Doppler flowmetry is a modern non-invasive method for tissue hemodynamics
assessment.
• Laser light is transmitted to pulp by means of fibro optic probe
• The technique is based on measuring the Doppler shift induced by moving red blood
cells to the illuminating coherent light.
 Measurement of blood flow in dental pulp
 Measurement of blood flow in gingiva
 Measuring blood flow using laser Doppler in
other orofacial tissues

48. LASER DOPPLER FLOWMETRY..
It was proven that LDF better indicates pulpal vitality than traditional vitality
tests.
Orekhova LY, Barmasheva AA. Doppler flowmetry as a tool of predictive, preventive and personalised dentistry. EPMA J. 2013;4(1):21-27.

49. LASERS IN ENDODONTICS
Asnaashari M, Moeini M. Effectiveness of Lasers in the Treatment of Dentin Hypersensitivity. J Lasers Med Sci 2013; 4(1):1-7
DENTIN HYPERSENTIVITY
• Dentin hypersensitivity is a common clinical condition that is difficult to treat because the
treatment outcome is not consistently successful.
• Two chief methods of treatment of dentin hypersensitivity are tubular occlusion and
blockage of nerve activity.
• Carbon Dioxide Laser (CO2), neodymium- or erbium-doped yttrium aluminum garnet
(Nd:YAG, Er:YAG lasers) and erbium, chromium doped: yttrium, scandium, gallium and
garnet (Er,Cr:YSGG) lasers
The laser tip has to be placed as close as possible to the tooth surface in noncontact mode

50. LASERS IN ENDODONTICS..
Kumar NG, Mehta DS. Short-term assessment of the Nd:YAG laser with and without sodium fluoride varnish in the
treatment of dentin hypersensitivity—a clinical and scanning electron microscopy study. Journal of Periodontology.
2005; 76(7):1140–1147
DENTIN HYPERSENTIVITY
The combination use of laser irradiation with chemical agents such as sodium
fluoride and stannous fluoride can enhance treatment effectiveness by more than
20% over that of laser treatment alone.

51. LASERS IN ENDODONTICS..
PULP CAPPING
• The sealing of exposed pulp is still required after laser treatment
• Researchers have reported reparative (secondary) dentin formation due to laser radiation
CO2 laser; Nd:YAG laser;
diode laser; Er:YAG laser;
Er,Cr:YSGG laser

52. LASERS IN ENDODONTICS..
CAVITY PREPARATION
• Strongly absorbed by hydroxyapatite and water
• Conservative preparation achieved than conventional
preparations.
• The Erbium lasers, for example, produce absolutely no
vibration as there is no need for contact of the laser tip
with the tooth structure. The vibratory noise generated by
a handpiece is more than 120dB.

53. Dixit V, Dixit M, Hegde V, Sathe S, Jadhav S. Clinical evaluation of conventional and laser tooth preparation using visual analogue scale. J Dent
Lasers 2013;7:27-9.
• Conventional vs laser tooth
preparation
• Pain perception
• Laser tooth preparation is
much more painless,
comfortable

54. • Access cavity and canal preparation- Er,Cr:YSGG (2780nm) and Er:YAG (2940nm) can be
used for access cavity preparation, root canal shaping and cleaning.
• When the laser fiber is unable to be inserted into the canals, reamers and files are to be used,
followed by lasers.
• Sweeping of Root canal and irrigation are done in Straight, slightly curved and wide canals
with lasers.
• Removal of pulp remnants, control of hemorrhage, and stimulation of cells surrounding the
root apex as well as debridement on the surface.
• Sterilization or disinfection of infected canals are done with Nd:YAG, diode,CO2, Er:YAG
lasers are much better than conventional methods.
Kathari A, Ujariya M. Lasers in endodontics- A review. J Res Adv Dent 2014; 3:1:209-211
LASERS IN ENDODONTICS..
ROOT CANAL TREATMENT

55. LASERS IN ORTHODONTICS
Lasers in etching
• Application of laser energy to an enamel surface causes localized melting and
ablation and therefore removal of enamel
• von Fraunhoufer et al. studied the effectiveness of a commercial Nd: YAG laser in
etching dental enamel for direct bonding of orthodontic appliances
Laser for de-bonding procedure
• Application of Nd: YAG and CO2 lasers have shown satisfying results, and minimal
side effects from the increase in pulp temperature

56. LASERS IN ORTHODONTICS..
Laser welding
Recent method employed for joining metal frameworks is laser welding to weld dental
alloys, crystals of YAG, with added neodymium are mainly used to emit laser beams.
The advantages of laser-welding is-no solder, and thus no corrosion at the joint, small focus
and an argon shielding atmosphere prevents the oxidation around the welding zone

57. LASERS IN ORTHODONTICS..
TOOTH MOVEMENT & PAIN
Guram G, Reddy RK, Dharamsi AM, Syed Ismail PM, Mishra S, Prakashkumar MD. Evaluation of Low-Level Laser Therapy on Orthodontic Tooth Movement: A
Randomized Control Study. Contemp Clin Dent. 2018;9(1):105-109.
• Low Level LASER Therapy(LLLT) can reduce the fixed Orthodontic tooth movement timing
and pain experience.
• Increased tooth movement in LLLT may be due to increased revascularization, bone
remodeling, and college synthesis.
• This randomized double-blind splint-mouth controlled
clinical study includes 20 (8 males and 12 females)
orthodontic patients requiring bilateral canine retraction.
Time taken for canine retraction with LLLT (Group A) over
control (Group B) quadrant on the same patient was assessed
along with pain experience using facial pain scale.
• The laser was applied to the buccal and palatal aspect of the
tooth for 80 s weekly for 21 days

58. LASERS IN PERIODONTICS
Periodontal pocket treatment:
• One of the possible advantages of laser treatment of periodontal pockets is the debridement
of the soft tissue wall.
• Gold and Vilaridi reported that Nd: YAG laser is safe for removal of the sulcular epithelium
in periodontal pockets. It has an added advantage of protecting the underlying connective
tissue by causing necrosis or carbonization.

59. LASERS IN PERIODONTICS
GINGIVAL DEPIGMENTATION
Patel D, Agrawal C, Patil US, Dholakia P, Chokshi R, Patel B. Efficacy of Various Depigmentation Techniques: A Comparative Evaluation
with A Case Report. Int J Oral Health Med Res 2016;2(5):99-102.

60. LASERS IN PERIODONTICS
GINGIVAL DEPIGMENTATION
Patel D, Agrawal C, Patil US, Dholakia P, Chokshi R, Patel B. Efficacy of Various Depigmentation Techniques: A Comparative Evaluation
with A Case Report. Int J Oral Health Med Res 2016;2(5):99-102.
Upper
right
Lower
anteriors
Lower
posteriors
Upper
left

61. LASERS IN PERIODONTICS
GINGIVAL DEPIGMENTATION
Patel D, Agrawal C, Patil US, Dholakia P, Chokshi R, Patel B. Efficacy of Various Depigmentation Techniques: A Comparative Evaluation
with A Case Report. Int J Oral Health Med Res 2016;2(5):99-102.

62. LASERS IN PERIODONTICS
GINGIVAL DEPIGMENTATION..
• LASER offers better patient compliance and shorter treatment time. CO2 lasers remove a thin
layer of epithelium cleanly thus causing minimum damage to the periosteum and the
underlying bone.
• The laser wound is a sterile inflammatory reaction but it heals faster than the scalpel wound.
• A dressing is not needed when the gingiva and mucosa are treated with LASER. So, there
will be faster re-epithelialization and faster wound healing

63. LASERS IN PERIODONTICS
Keylaser3™
CALCULUS DETECTION AND REMOVAL
• Keylaser3™ combines a 655nm diode for detection of calculus and a 2940nm Er: YAG
laser for treatment.
• Lasers when compared to ultrasonic instruments for their efficacy in calculus removal
lasers have shown inferior results to ultrasonic instruments.

64. LASER TOOTHBRUSH
• Treats dentin hypersensitivity by hindering the delivery of stimulant through the dentinal
tubules or by blocking the delivery of painful stimuli by closing the matrix region of the
tubules.
• Laser toothbrush is designed to provide an antibacterial effect in oral cavity using an
irradiating laser beam of 630 nm laser.
Cost-35$-70$

65. • Laser toothbrush vs
non-laser Sensodyne
brushes
• 40 patients
• Visual analogue scale
and ice spray was
used at 1month and
2month interval
• Both brushes
improves DH, but
laser brush led to
better results in short
period

66. • The most popular procedures such as Crown lenghthening, Gingivectomy, Gingivoplasty,
and frenectomy which carried out using a laser.
• Compared with the use of a conventional scalpel, lasers can cut, ablate, easily reshaping
of the oral soft tissue, less bleeding and a little pain with a few sutures. Laser surgery
occasionally requires no anesthetic or only topical anesthetics
LASERS IN PERIODONTICS
SOFT TISSUE APPLICATIONS

67. LASERS IN PROSTHODONTICS
Crown
lengthening
Modification of
soft tissues
around abutment
Removal of
veneer
Bleaching
Implant
uncovering
surgery
DIODE LASERS

68. VENEER REMOVAL

69. LASERS IN BLEACHING
• Laser-assisted bleaching uses laser beam to accelerate release of free radicals within
the bleaching gel to decrease time of whitening procedure. Lasing is also capable of
minimizing post-bleaching hypersensitivity, loss of enamel microhardness and gingival
irritation due to lack of hydrogen peroxide use.
• Diode, Er:YAG, Nd:YAG LASERS can be used.

70. LASERS IN
ORAL
LESIONS

71. Pre-operative

74. LASERS IN DENTAL LABORATORY
• LASER welding
• LASER assisted 3D printing

75. LASERS IN CANCERS
Laser confocal refractive microscopy(diagnosis)
• Laser confocal refractive microscopy can be used in the detection of precancerous lesions
and potentially malignant disorder.(488nm)
• This noninvasive aid is patient-friendly but needs more time. It is technique sensitive and
needs more training in handling the devices.
• However, certain artifacts and image distortion are also hindering this noninvasive
method.
Sameen RJ, Bindushree V, Vasudevan V, Mathew NS, Devaraju D, Shrihari TG. Laser confocal refractive microscopy and early detection of
oral cancer: A narrative review. J Dent Res Rev 2019;6:77-82.

76. LASERS IN CANCERS
CO2 LASER surgery
• Top left: patient presented with a multinodular lesion of the
ventrolateral tongue. Incisional biopsy confirmed squamous
cell carcinoma.
• Top right: the nodules are identified and marked with an ink
before excision.
• Bottom left: intraoperative CO2 laser excision of the tumor.
• Bottom right: complete tumor excision and laser of the base
to achieve hemostasis.
Jerjes W, Upile T, Hamdoon Z, Mosse CA, Akram S, Hopper C. Prospective evaluation of outcome after transoral CO(2) laser
resection of T1/T2 oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Aug;112(2):180–7

77. • Oral mucositis is a common complication followed by chemo and radiotherapy.
• Low level laser therapy represents more than a promising agent to prevent or treat cancer–
therapy induced OM
• Diode lasers-630-950nm
• Therapy should be repeated daily during RT or depending upon the staging until lesion
recur.
LASERS IN CANCER SUPPORTIVE CARE

79. LASERS IN SNORING & SLEEPAPNEA
• Snoring and sleep apnea result from obstructed airways. This can be an outcome of many
different factors such as anatomic deviations, tumors, polyps, allergy, large adenoids and
tonsils, large uvula or a long soft palate.
• Oral appliances, weight loss, alternative medicine and continuous positive airway pressure
(cpap) masks.
• Laser-assisted uvulopalatoplasty (laup) or uvulopalatopharyngoplasty (uppp)

80. Laser Treatment Option: NightLase®
• There are many benefits of the NightLase® treatment, such as no need for anesthesia, no
pain and only three short 20-minute sessions with immediate results.
• Er:YAG laser
• Among other treatments, a minimally invasive laser treatment is now available. In this
method, laser light is used for non-ablative thermal heating of the tissue, which
subsequently causes shrinking of the collagen fibers. This phenomenon opens up the
airways and reduces snoring and sleep apnea

81. The patient was a 46-year-old female
patient
After the third treatment, patient reported
improvement better than 85%.
Improvement after one treatment session
was 51% and after the second session,
61%
Long-lasting effects –from one year up to 36 months – allow
for high overall satisfaction among patients.
Sippus J. CASE REPORT: NightLase® Procedure – Laser Snoring and Sleep Apnea Reduction Treatment. J of the Las and
Hea Acad.2015;11(3):1-5.

82. LASERS IN STERILIZATION
• Autoclaving
• Carbon dioxide laser sterilization(per surface 3 sec)
• Chemical sterilization (with glutaraldehyde) and
• Glass-bead sterilization
Venkatasubramanian R, Jayanthi , Das UM, Bhatnagar S. Comparison of the effectiveness of sterilizing endodontic files by 4 different
methods: An in vitro study. J Indian Soc Pedod Prevent Dent. 2010;28(1):1-5.
• Autoclave and lasers were completely
sterile.
• Glass bead were 90% sterile and
• Glutaraldehyde were 80% sterile

83. LASER HAZARDS IN DENTISTRY
Classification of laser hazards
according to ANSI and OHSA
standards

84. LASER HAZARDS IN DENTISTRY
Classification of laser hazards
according to ANSI and OHSA
standards
• Dental lasers belong to
category IV which is the
most hazardous of all the
lasers.

85. According to Miserendino et al. (1995), the types of hazards that can be encountered within the clinical practice of
dentistry are grouped as follows:
i.Ocular injury
ii. Tissue damage
iii. Respiratory hazards
iv. Fire and explosion
v. Electrical shock

86. LASER SAFETY
1.The manufacturers manual of the instrument
2. The personal protection of the surgical team and the patient.

87. EYE GLASSES COOLING OF THE LASER
TIP WITH WATER

88. Windows, doors and all surfaces
should be non-reflective

89. CONCLUSION

90. CONCLUSION…

91. • LASERS are found to be effective in cavity preparation, caries removal, restoration
removal, etching, and treatment of dentinal sensitivity, caries prevention and
bleaching.
• At present, only very few applications of laser treatment have become well accepted
methods.
• Feasibility is still questionable because of its high economy.

92. REFERENCES
• Bader H. Use of lasers in periodontics. Dent Clin North Am.2000;44:779–92.
• Stern RH, Sognnaes RF. Laser beam effect on dental hard tissues. J Dent
Res.1964;43(5):873(abstract 307).
• Goldman L, Gray J, Goldman J, et al. Effect of the laser beam impacts on teeth. J Am Dent
Assoc 1965;70(3):601-06.
• Maiman TH. Stimulated optical radiation in ruby. Nature.1960;187(4736):493-84.
• Ana PA, Bachmann L, Zezell DM. Lasers effects on enamel for caries prevention. Laser
Phys. 2006;16(5):865-75

93. Rs.4,20,000 !!!!!!!!
MULTI PURPOSE LASER DEVICE

94. Thank you