INTRODUCTION OF LASERS IN ORAL AND MAXILLOFACIAL SURGERY
INITIAL USE IN ORAL AND MAXILLOFACIAL SURGERY
CHARACTERISTICS OF LASER LIGHT
CLASSIFICATION OF LASERS
TISSUE INTERACTION
TYPES OF LASERS
ADVANTAGES AND DISADVANTAGES
LASER SAFETY IN SURGERY AND ANESTHESIA
PATIENT SELECTION
APPLICATIONS
SURGICAL LASER TECHNIQUE
APPLIED ASPECTS
RECENT ADVANCES
COMPLICATIONS
Lasers in oral & maxillofacial surgery/oral surgery courses by indian dental ...Indian dental academy
This document provides an overview of lasers used in oral and maxillofacial surgery. It discusses the history of lasers, laser physics including population inversion and stimulated emission, laser design components, methods of laser light delivery including articulated arms and optical fibers, laser focusing modes, and different types of lasers including CO2, Nd:YAG, and argon lasers. The key properties and applications of each laser type are described.
The document summarizes different types of lasers used in oral and maxillofacial surgery (OMFS). It discusses the historical background and components of lasers. The most commonly used lasers in dentistry are carbon dioxide lasers, erbium lasers, argon lasers, Nd:YAG lasers, KTP lasers, and diode lasers. Each laser type is characterized by its active medium and wavelength, which determine its absorption in different tissues and clinical applications.
This document summarizes the history and uses of lasers in dentistry. It discusses how lasers work through processes like stimulated emission and outlines the active mediums and components of different laser types. It describes common dental lasers like CO2, diode, Nd:YAG and Er:YAG lasers and their applications. These include soft tissue procedures, caries detection and removal, periodontal therapy, implant treatment, bleaching and more. Precautions, advantages and disadvantages of each laser are also summarized.
The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.
This document provides an overview of lasers and their use in dentistry. It begins with the history and fundamentals of lasers, including how they work and their properties. Commonly used dental lasers such as Nd:YAG, CO2, and diode lasers are then described. The applications of lasers in dentistry are discussed, including procedures on hard and soft tissues. Some advantages of lasers are their precision and reduced pain compared to traditional methods. Protection measures for laser use are also outlined. The document concludes that lasers provide alternatives to conventional surgery and are an effective "new scalpel" in dentistry.
This document discusses several laser dentistry systems and their applications. It provides information on the Philips ZoomWhiteSpeed light-activated whitening system, which can whiten teeth up to 8 shades in under an hour. It also discusses the Waterlase laser system which uses water and air to cut tissue without heat, vibration or pressure. Finally, it summarizes several other dental laser systems including models from Dentmat, CAO Group, Sirona, AMD, and Epic by Biolase.
Lasers in oral & maxillofacial surgery/oral surgery courses by indian dental ...Indian dental academy
This document provides an overview of lasers used in oral and maxillofacial surgery. It discusses the history of lasers, laser physics including population inversion and stimulated emission, laser design components, methods of laser light delivery including articulated arms and optical fibers, laser focusing modes, and different types of lasers including CO2, Nd:YAG, and argon lasers. The key properties and applications of each laser type are described.
The document summarizes different types of lasers used in oral and maxillofacial surgery (OMFS). It discusses the historical background and components of lasers. The most commonly used lasers in dentistry are carbon dioxide lasers, erbium lasers, argon lasers, Nd:YAG lasers, KTP lasers, and diode lasers. Each laser type is characterized by its active medium and wavelength, which determine its absorption in different tissues and clinical applications.
This document summarizes the history and uses of lasers in dentistry. It discusses how lasers work through processes like stimulated emission and outlines the active mediums and components of different laser types. It describes common dental lasers like CO2, diode, Nd:YAG and Er:YAG lasers and their applications. These include soft tissue procedures, caries detection and removal, periodontal therapy, implant treatment, bleaching and more. Precautions, advantages and disadvantages of each laser are also summarized.
The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.
This document provides an overview of lasers and their use in dentistry. It begins with the history and fundamentals of lasers, including how they work and their properties. Commonly used dental lasers such as Nd:YAG, CO2, and diode lasers are then described. The applications of lasers in dentistry are discussed, including procedures on hard and soft tissues. Some advantages of lasers are their precision and reduced pain compared to traditional methods. Protection measures for laser use are also outlined. The document concludes that lasers provide alternatives to conventional surgery and are an effective "new scalpel" in dentistry.
This document discusses several laser dentistry systems and their applications. It provides information on the Philips ZoomWhiteSpeed light-activated whitening system, which can whiten teeth up to 8 shades in under an hour. It also discusses the Waterlase laser system which uses water and air to cut tissue without heat, vibration or pressure. Finally, it summarizes several other dental laser systems including models from Dentmat, CAO Group, Sirona, AMD, and Epic by Biolase.
This document outlines the principles and techniques of biopsy for oral and maxillofacial lesions. It discusses the importance of a systematic approach including health history, lesion history, clinical and radiographic exams, and laboratory tests. Different types of biopsies are described such as incisional, excisional, needle, and intraosseous. Key principles of biopsy surgery are emphasized like anesthesia, hemostasis, specimen handling, and closure. The goal is to obtain an adequate tissue sample for accurate histopathologic evaluation while following principles of safe excisional surgery.
This document provides an overview of lasers in dentistry. It discusses the history and development of lasers, how lasers are designed and how laser light interacts with tissues. It describes common dental lasers like CO2 and argon lasers, and their applications. CO2 lasers are well absorbed in oral tissues and useful for soft tissue procedures. Argon lasers are absorbed by hemoglobin and melanin, making them good for coagulation. The document outlines the benefits of lasers for various dental procedures.
1. Lasers are used in oral and maxillofacial surgery for excising both benign and malignant lesions with advantages over conventional surgery like more tissue preservation, less blood loss, and optional for further treatment.
2. The CO2 laser is commonly used as its wavelength is absorbed by water, providing hemostasis while limiting thermal damage. It allows precise excision of soft tissue lesions.
3. Proper laser safety equipment and protocols must be followed to prevent injury to patients and operators from beam reflection and potential fires from surgical drapes and airway tubes near the operative site.
Skin grafts in oral and maxillofacial surgeryShibani Sarangi
Skin grafts can be either split-thickness or full-thickness. Split-thickness grafts contain some dermis while full-thickness grafts contain the full dermis and epidermis. The success of a skin graft depends on reestablishing blood flow to the grafted area either through connecting existing vessels or growing new vessels. Donor site selection is based on the type of graft needed and matching the color and characteristics of the recipient site while minimizing morbidity at the donor location.
This document provides an overview of the use of lasers in conservative dentistry. It discusses the history and development of lasers, classifications of lasers based on power output and wavelength, laser physics principles, and common types of lasers used such as Nd:YAG, Er:YAG, CO2, and diode lasers. Applications of lasers in conservative dentistry are described, including caries detection, cavity preparation, and restoration removal. Advantages include precision and control, while disadvantages include the high cost of laser systems.
This document discusses the use of lasers in dentistry. It begins with an introduction and history of lasers, then covers the fundamentals of laser operation and classification of lasers. The main uses of lasers in dentistry include soft tissue procedures like biopsy and surgery. Techniques for ablation, vaporization, and low level laser therapy are described. Benefits are reduced pain and bleeding, while risks include hazards to patients and staff if not used properly. Proper safety protocols and sterilization of laser equipment are emphasized.
This document provides an overview of lasers used in dentistry, including their history, mechanisms of action, applications, and safety measures. It discusses how lasers were first developed in the 1960s and introduced to dentistry in the 1990s. The main types of lasers used include CO2, Nd:YAG, Er:YAG, and KTP lasers. Lasers can be used for both hard and soft tissue procedures, such as caries removal, gingivectomies, and lesion removal, with advantages like reduced pain, bleeding, and recovery time compared to traditional techniques. Safety precautions must be followed when using lasers to protect patients and operators.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
Lasers have various applications in operative dentistry including cavity preparation, caries detection, bleaching, and composite resin polymerization. Different types of lasers such as Er:YAG, CO2, and diode lasers can be used to ablate dental hard tissues with little pulp damage. Lasers also increase the resistance of enamel and dentin to caries, aid in caries diagnosis, and accelerate tooth whitening. Their precision and ability to coagulate tissues make lasers beneficial for various dental procedures with advantages such reduced pain and scarring.
- Extraoral radiographs are used to examine large areas of the skull and jaws when intraoral films cannot be used. This document discusses various extraoral radiographic techniques including panoramic, skull, mandible, maxillary sinus, and temporomandibular joint views.
- Panoramic radiographs produce a single tomographic image of the facial structures and are commonly used. Skull views like lateral cephalograms evaluate facial growth while other views examine the skull vault or sinuses.
- Mandible views include lateral obliques of the body and ramus as well as posteroanterior projections. Maxillary sinus views use modifications of the Water's view.
- Temporomandibular
This document discusses the bisecting angle technique for intraoral radiography. It explains that the bisecting angle technique involves positioning the x-ray beam perpendicular to the long axis of the tooth by bisecting the angle between the tooth and the film. The document notes that proper horizontal and vertical angulation is needed to avoid issues like overlap or shortening/lengthening of teeth. It concludes with a thank you.
This document provides an overview of lasers used in dentistry. It discusses the fundamentals of laser operation including different types of lasers and their properties. Common lasers used in dentistry include CO2, Nd:YAG, erbium, and diode lasers which are used for both soft and hard tissue applications. Lasers offer advantages over traditional methods like reduced pain and bleeding, faster healing, and more precise tissue interaction. Safety measures must be followed when using lasers to avoid injury to patients and operators.
Lasers convert electrical or chemical energy into light energy. There are several types of dental lasers including CO2 lasers (wavelength 10.6 μm) used for soft tissue procedures. Nd:YAG lasers (wavelength 1.06 μm) are similar to CO2 lasers but can penetrate deeper, risking collateral damage. Er:YAG lasers (wavelength 2.94 μm) are used for caries removal and cavity preparation while protecting the pulp due to low penetration. Argon lasers (wavelength 457-502 nm) are used for resin curing, bleaching, and soft tissue procedures. The wavelength determines tissue absorption and penetration depth, affecting the thermal effects on tissues.
Radiation safety and protection for dental radiographyNitin Sharma
1) Licensed dentists must maintain radiation exposures as low as reasonably achievable and understand the health risks of radiation.
2) Dental radiographic equipment must be registered and follow safety protocols to protect patients and staff, such as using protective gear and collimation.
3) Dentists are responsible for quality assurance programs to ensure proper functioning and calibration of dental X-ray machines and processing of films. Guidelines help prescribe radiographs appropriately.
This document discusses common errors that can cause faulty radiographs. Good radiographs require optimum density, contrast, and minimal distortion. Errors can occur in operating the x-ray machine, exposure techniques, or film processing. Underexposure is caused by too short exposure time or low kVp, while overexposure results from excessive time or high kVp. Technique errors include improper positioning, cuts, blurring, and distortions. Processing errors involve contaminated chemicals, improper development or fixing, expired film, dust, and improper drying. Specific errors can also occur with panoramic radiographs like ghost images or incorrect Frankfort plane positioning.
This document summarizes the effects of radiation therapy on oral tissues. Radiation is commonly used to treat oral cancers. It is delivered in small daily doses over 6-7 weeks for a total of 60-70 Gy. This causes damage to oral mucosa, taste buds, salivary glands, teeth, bone, and muscles. Oral mucositis is a common side effect, along with loss of taste, xerostomia, and rampant dental caries due to changes in saliva. Teeth may have arrested development. Long term risks include osteoradionecrosis and trismus. Management involves oral hygiene, pain control, fluoride application, and sometimes surgery.
Cryotherapy and its implications in Oral surgeryShibani Sarangi
Cryosurgery involves applying low temperatures to living tissues in a controlled manner to induce irreversible damage. It has been used for over 100 years to treat skin lesions. The document discusses the history, indications, contraindications, cryogens, and mechanisms of cryosurgery. It describes open systems using liquid nitrogen spray and closed systems using cryoprobes. Cryosurgery can treat premalignant and benign oral lesions using 1-2 minute freeze/thaw cycles and is an effective minimally invasive treatment option in oral and maxillofacial surgery.
The evolution of oral and maxillofacial surgery began in ancient Egypt and Greece with early treatments involving bandages soaked in honey and egg white for mandibular fractures and tooth extractions using loosening agents. Significant developments occurred during the Middle Ages with the separation of medicine and surgery and the Renaissance period which saw the expansion of procedures like cleft lip repairs. The 17th century saw the first textbook on oral surgery and the 19th century established oral surgery as a distinct field with leaders performing the first orthognathic surgery case and developing fixation techniques. Recent advances include minimally invasive endoscopy, improved imaging like CBCT, advancements in dental extractions using platelet-rich fibrin and atraumatic techniques, and applications of nanome
Lasers in oral and maxillofacial surgery Jeff Zacharia
This document discusses lasers used in oral and maxillofacial surgery. It begins with an introduction to lasers and their properties. It then covers the history of lasers, the components of a laser unit including the active medium and resonator cavity. It classifies lasers based on their active medium and wavelength and discusses their indications for soft and hard tissue procedures. Examples of surgical uses include cleft surgery, TMJ surgery, intraoral lesions, and implantology. Precautions for safe use and the selection of appropriate lasers are also outlined.
This document discusses the use of lasers in endodontics. It begins with a brief history of lasers, describing their development from Einstein's work in the early 1900s to their first use in dentistry in the 1970s. It then covers laser physics and components, different types of lasers including wavelengths used in dentistry, and laser tissue interactions. The main body discusses several clinical applications of lasers in endodontics such as pulp testing, pulp capping, pulpotomy, root canal disinfection and shaping, and endosurgery. Lasers can provide benefits like reduced need for anesthesia, hemostasis, and less collateral damage compared to other tools. Training is required and no single laser can perform all
This document discusses lasers used in periodontics. It provides an overview of laser physics, types of lasers including diode, CO2, Nd:YAG and erbium lasers, and their applications in soft tissue procedures and osseous surgery. The benefits of lasers include less pain, better hemostasis and wound healing compared to conventional methods. Safety protocols must be followed when using lasers to prevent eye and tissue damage. Lasers are becoming more widely used in dentistry due to their advantages over traditional techniques.
1) Lasers have various applications in periodontal and implant dentistry including calculus removal, soft tissue excision and ablation, root decontamination, biostimulation, and bacteria reduction.
2) Studies show lasers may provide benefits like less swelling and pain compared to conventional methods.
3) Different laser wavelengths penetrate tissues to varying depths depending on characteristics, and care must be taken to avoid overheating implants which could damage surfaces.
This document outlines the principles and techniques of biopsy for oral and maxillofacial lesions. It discusses the importance of a systematic approach including health history, lesion history, clinical and radiographic exams, and laboratory tests. Different types of biopsies are described such as incisional, excisional, needle, and intraosseous. Key principles of biopsy surgery are emphasized like anesthesia, hemostasis, specimen handling, and closure. The goal is to obtain an adequate tissue sample for accurate histopathologic evaluation while following principles of safe excisional surgery.
This document provides an overview of lasers in dentistry. It discusses the history and development of lasers, how lasers are designed and how laser light interacts with tissues. It describes common dental lasers like CO2 and argon lasers, and their applications. CO2 lasers are well absorbed in oral tissues and useful for soft tissue procedures. Argon lasers are absorbed by hemoglobin and melanin, making them good for coagulation. The document outlines the benefits of lasers for various dental procedures.
1. Lasers are used in oral and maxillofacial surgery for excising both benign and malignant lesions with advantages over conventional surgery like more tissue preservation, less blood loss, and optional for further treatment.
2. The CO2 laser is commonly used as its wavelength is absorbed by water, providing hemostasis while limiting thermal damage. It allows precise excision of soft tissue lesions.
3. Proper laser safety equipment and protocols must be followed to prevent injury to patients and operators from beam reflection and potential fires from surgical drapes and airway tubes near the operative site.
Skin grafts in oral and maxillofacial surgeryShibani Sarangi
Skin grafts can be either split-thickness or full-thickness. Split-thickness grafts contain some dermis while full-thickness grafts contain the full dermis and epidermis. The success of a skin graft depends on reestablishing blood flow to the grafted area either through connecting existing vessels or growing new vessels. Donor site selection is based on the type of graft needed and matching the color and characteristics of the recipient site while minimizing morbidity at the donor location.
This document provides an overview of the use of lasers in conservative dentistry. It discusses the history and development of lasers, classifications of lasers based on power output and wavelength, laser physics principles, and common types of lasers used such as Nd:YAG, Er:YAG, CO2, and diode lasers. Applications of lasers in conservative dentistry are described, including caries detection, cavity preparation, and restoration removal. Advantages include precision and control, while disadvantages include the high cost of laser systems.
This document discusses the use of lasers in dentistry. It begins with an introduction and history of lasers, then covers the fundamentals of laser operation and classification of lasers. The main uses of lasers in dentistry include soft tissue procedures like biopsy and surgery. Techniques for ablation, vaporization, and low level laser therapy are described. Benefits are reduced pain and bleeding, while risks include hazards to patients and staff if not used properly. Proper safety protocols and sterilization of laser equipment are emphasized.
This document provides an overview of lasers used in dentistry, including their history, mechanisms of action, applications, and safety measures. It discusses how lasers were first developed in the 1960s and introduced to dentistry in the 1990s. The main types of lasers used include CO2, Nd:YAG, Er:YAG, and KTP lasers. Lasers can be used for both hard and soft tissue procedures, such as caries removal, gingivectomies, and lesion removal, with advantages like reduced pain, bleeding, and recovery time compared to traditional techniques. Safety precautions must be followed when using lasers to protect patients and operators.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
Lasers have various applications in operative dentistry including cavity preparation, caries detection, bleaching, and composite resin polymerization. Different types of lasers such as Er:YAG, CO2, and diode lasers can be used to ablate dental hard tissues with little pulp damage. Lasers also increase the resistance of enamel and dentin to caries, aid in caries diagnosis, and accelerate tooth whitening. Their precision and ability to coagulate tissues make lasers beneficial for various dental procedures with advantages such reduced pain and scarring.
- Extraoral radiographs are used to examine large areas of the skull and jaws when intraoral films cannot be used. This document discusses various extraoral radiographic techniques including panoramic, skull, mandible, maxillary sinus, and temporomandibular joint views.
- Panoramic radiographs produce a single tomographic image of the facial structures and are commonly used. Skull views like lateral cephalograms evaluate facial growth while other views examine the skull vault or sinuses.
- Mandible views include lateral obliques of the body and ramus as well as posteroanterior projections. Maxillary sinus views use modifications of the Water's view.
- Temporomandibular
This document discusses the bisecting angle technique for intraoral radiography. It explains that the bisecting angle technique involves positioning the x-ray beam perpendicular to the long axis of the tooth by bisecting the angle between the tooth and the film. The document notes that proper horizontal and vertical angulation is needed to avoid issues like overlap or shortening/lengthening of teeth. It concludes with a thank you.
This document provides an overview of lasers used in dentistry. It discusses the fundamentals of laser operation including different types of lasers and their properties. Common lasers used in dentistry include CO2, Nd:YAG, erbium, and diode lasers which are used for both soft and hard tissue applications. Lasers offer advantages over traditional methods like reduced pain and bleeding, faster healing, and more precise tissue interaction. Safety measures must be followed when using lasers to avoid injury to patients and operators.
Lasers convert electrical or chemical energy into light energy. There are several types of dental lasers including CO2 lasers (wavelength 10.6 μm) used for soft tissue procedures. Nd:YAG lasers (wavelength 1.06 μm) are similar to CO2 lasers but can penetrate deeper, risking collateral damage. Er:YAG lasers (wavelength 2.94 μm) are used for caries removal and cavity preparation while protecting the pulp due to low penetration. Argon lasers (wavelength 457-502 nm) are used for resin curing, bleaching, and soft tissue procedures. The wavelength determines tissue absorption and penetration depth, affecting the thermal effects on tissues.
Radiation safety and protection for dental radiographyNitin Sharma
1) Licensed dentists must maintain radiation exposures as low as reasonably achievable and understand the health risks of radiation.
2) Dental radiographic equipment must be registered and follow safety protocols to protect patients and staff, such as using protective gear and collimation.
3) Dentists are responsible for quality assurance programs to ensure proper functioning and calibration of dental X-ray machines and processing of films. Guidelines help prescribe radiographs appropriately.
This document discusses common errors that can cause faulty radiographs. Good radiographs require optimum density, contrast, and minimal distortion. Errors can occur in operating the x-ray machine, exposure techniques, or film processing. Underexposure is caused by too short exposure time or low kVp, while overexposure results from excessive time or high kVp. Technique errors include improper positioning, cuts, blurring, and distortions. Processing errors involve contaminated chemicals, improper development or fixing, expired film, dust, and improper drying. Specific errors can also occur with panoramic radiographs like ghost images or incorrect Frankfort plane positioning.
This document summarizes the effects of radiation therapy on oral tissues. Radiation is commonly used to treat oral cancers. It is delivered in small daily doses over 6-7 weeks for a total of 60-70 Gy. This causes damage to oral mucosa, taste buds, salivary glands, teeth, bone, and muscles. Oral mucositis is a common side effect, along with loss of taste, xerostomia, and rampant dental caries due to changes in saliva. Teeth may have arrested development. Long term risks include osteoradionecrosis and trismus. Management involves oral hygiene, pain control, fluoride application, and sometimes surgery.
Cryotherapy and its implications in Oral surgeryShibani Sarangi
Cryosurgery involves applying low temperatures to living tissues in a controlled manner to induce irreversible damage. It has been used for over 100 years to treat skin lesions. The document discusses the history, indications, contraindications, cryogens, and mechanisms of cryosurgery. It describes open systems using liquid nitrogen spray and closed systems using cryoprobes. Cryosurgery can treat premalignant and benign oral lesions using 1-2 minute freeze/thaw cycles and is an effective minimally invasive treatment option in oral and maxillofacial surgery.
The evolution of oral and maxillofacial surgery began in ancient Egypt and Greece with early treatments involving bandages soaked in honey and egg white for mandibular fractures and tooth extractions using loosening agents. Significant developments occurred during the Middle Ages with the separation of medicine and surgery and the Renaissance period which saw the expansion of procedures like cleft lip repairs. The 17th century saw the first textbook on oral surgery and the 19th century established oral surgery as a distinct field with leaders performing the first orthognathic surgery case and developing fixation techniques. Recent advances include minimally invasive endoscopy, improved imaging like CBCT, advancements in dental extractions using platelet-rich fibrin and atraumatic techniques, and applications of nanome
Lasers in oral and maxillofacial surgery Jeff Zacharia
This document discusses lasers used in oral and maxillofacial surgery. It begins with an introduction to lasers and their properties. It then covers the history of lasers, the components of a laser unit including the active medium and resonator cavity. It classifies lasers based on their active medium and wavelength and discusses their indications for soft and hard tissue procedures. Examples of surgical uses include cleft surgery, TMJ surgery, intraoral lesions, and implantology. Precautions for safe use and the selection of appropriate lasers are also outlined.
This document discusses the use of lasers in endodontics. It begins with a brief history of lasers, describing their development from Einstein's work in the early 1900s to their first use in dentistry in the 1970s. It then covers laser physics and components, different types of lasers including wavelengths used in dentistry, and laser tissue interactions. The main body discusses several clinical applications of lasers in endodontics such as pulp testing, pulp capping, pulpotomy, root canal disinfection and shaping, and endosurgery. Lasers can provide benefits like reduced need for anesthesia, hemostasis, and less collateral damage compared to other tools. Training is required and no single laser can perform all
This document discusses lasers used in periodontics. It provides an overview of laser physics, types of lasers including diode, CO2, Nd:YAG and erbium lasers, and their applications in soft tissue procedures and osseous surgery. The benefits of lasers include less pain, better hemostasis and wound healing compared to conventional methods. Safety protocols must be followed when using lasers to prevent eye and tissue damage. Lasers are becoming more widely used in dentistry due to their advantages over traditional techniques.
1) Lasers have various applications in periodontal and implant dentistry including calculus removal, soft tissue excision and ablation, root decontamination, biostimulation, and bacteria reduction.
2) Studies show lasers may provide benefits like less swelling and pain compared to conventional methods.
3) Different laser wavelengths penetrate tissues to varying depths depending on characteristics, and care must be taken to avoid overheating implants which could damage surfaces.
explained with Limited matter moreover I have included all the images. if you go through a standard textbook and referred to this PPT it will help you so much I hope It helps you
The document discusses lasers used in dentistry. It begins with an introduction to lasers and their history in dentistry. Key topics covered include the mechanism of action of lasers, common dental laser therapies, and safety measures when using lasers. Examples are provided of how different types of lasers like CO2, Nd:YAG, and diode lasers are used for both soft tissue and hard tissue procedures in dentistry.
This document provides an overview of lasers used in oral medicine. It discusses the history and mechanism of laser tissue interaction. Common lasers used include CO2, Nd:YAG, Er:YAG, and diode lasers. Applications include treatment of oral lesions, pain management, salivary gland diseases, biopsy, caries detection and removal, calculus removal, and bleaching. Lasers offer advantages over traditional techniques such as less bleeding, less pain, and faster healing.
This document discusses lasers used in endodontics. It begins with the history and development of lasers, then classifies dental lasers based on their wavelength and penetrating power. Common lasers used in endodontics are described, including argon, KTP, diode, erbium YAG, erbium chromium, and CO2 lasers. The interaction of laser light with tissue is explained in terms of reflection, absorption, diffusion, and transmission. Laser effects in endodontics include photothermal, photochemical, and photomechanical-acoustic effects. Parameters that influence laser endodontics are discussed, such as continuous wave mode and the importance of chopping or gating emission.
Lasers have many uses in ophthalmology, both therapeutic and diagnostic. Therapeutically, lasers are used to treat retinal disorders like diabetic retinopathy, macular edema and retinal detachments. They are also used in procedures like laser iridotomy and trabeculoplasty to treat glaucoma. Diagnostically, lasers are used in optical coherence tomography and scanning laser ophthalmoscopy to image the retina. Different types of lasers like argon, Nd:YAG and excimer interact with tissue in various ways such as coagulation, vaporization or ablation, depending on the wavelength and power. While lasers are generally safe, potential complications include pain, elevated pressure, retinal damage and
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.
This document provides an overview of dental calculus and lasers. It discusses the history and development of lasers from Einstein's work in 1917 to current diode lasers. It describes laser physics including stimulated emission and classifications based on gain medium, tissue application, and mode of action. Safety hazards of lasers like ocular injury, tissue damage, fires, and respiratory issues are covered. In conclusion, lasers may become preferred for non-surgical and surgical periodontal therapy in the future.
This presentation gives a brief introduction to the characteristics of laser devices.
Absorption, tissue penetration and physiological mechanisms of laser irradiation are discussed.
The biological effects of low power laser light are reviewed in the areas of collagen metabolism, wound healing, inflammation and pain control. Contraindications, precautions and side effects of low power laser irradiation are discussed.
Lasers have many applications in operative dentistry including caries detection, cavity preparation, prevention of dental caries, bleaching, and photopolymerization of composite resin. Different types of lasers like Er:YAG, CO2, and diode lasers can be used safely for hard and soft tissue procedures with benefits like minimal damage, hemostasis, reduced post-operative pain and inflammation, and sterilization of wounds. While lasers provide advantages, training is required for their safe use and they can be costly to obtain.
Light is an integral part of our life. 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 early 20th century saw one of the greatest inventions in science & technology, in that LASERS which later went on to became a gift to health sciences. Albert Einstein is usually credited for the development of the laser theory. He was the first one to coin the term “Stimulated Emission” in his publication “Zur Quantentheorie der Strahlung”, published in 1917 in the “Physikalische Zeitschrift”
Lasers are devices that produce beams of coherent and very high intensity light. The word LASER is an acronym for “Light Amplification by Stimulated\Emission of Radiation”. A crystal or gas is excited to emit light photons of a characteristic wavelength that are amplified and filtered to make a coherent light beam. The effect of the laser depends upon the power of the beam and the extent to which the beam absorbed. Several types of lasers are available based on the wavelengths. These range from long wavelengths (infrared), to visible wavelengths, to short wavelengths (ultraviolet), to special ultraviolet lasers called excimers. Lasers are used nowadays in many areas in the field of dentistry It is of the most captivating technologies in dental practice. Even though, introduced as an alternative to the traditional halogen curing light, laser now has become the instrument of choice, in many dental applications. Its advancements in the field of dentistry are playing a major role in patient care and well being.
This document provides an overview of lasers used in operative dentistry. It discusses the history of lasers, components of lasers, types of lasers classified by wavelength and material used. Applications of lasers include caries detection using methods like quantitative laser fluorescence and DIAGNOdent, caries removal and cavity preparation, caries prevention, and restoration removal. Common lasers used are CO2, Nd:YAG, argon, and Er:YAG lasers. Hazards and safety precautions of lasers are also mentioned.
Laser science is principally concerned with quantum electronics, laser construction, optical cavity design, the physics of producing a population inversion in laser media, and the temporal evolution of the light field in the laser. It is also concerned with the physics of laser beam propagation, particularly the physics of Gaussian beams, with laser applications, and with associated fields such as non-linear optics and quantum optics.
Lasers and its role in endodontics/certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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1. LASERS IN ORAL AND MAXILLOFACIAL SURGERY
PRESENTED BY – MAHIMA SHANKER
DEPT. OF ORAL AND MAXILLOFACIAL
SURGERY
2. CONTENTS
• INTRODUCTION OF LASERS IN ORAL AND MAXILLOFACIAL SURGERY
• INITIAL USE IN ORAL AND MAXILLOFACIAL SURGERY
• CHARACTERISTICS OF LASER LIGHT
• CLASSIFICATION OF LASERS
• TISSUE INTERACTION
• TYPES OF LASERS
• ADVANTAGES AND DISADVANTAGES
• LASER SAFETY IN SURGERY AND ANESTHESIA
• PATIENT SELECTION
• APPLICATIONS
• SURGICAL LASERTECHNIQUE
• APPLIED ASPECTS
• RECENTADVANCES
• COMPLICATIONS
3. INTRODUCTION OF LASERS IN ORAL AND MAXILLOFACIAL SURGERY
• Light Amplification by Stimulated Emission of Radiation
• Efficacy of lasers as soft tissue incising agents first studied byYamamoto et al. in 1972 using ruby lasers
• Development of CO2 laser and its tissue ablating properties - increased interest in application of lasers to surgery
• Use of lasers led to reduced local hemorrhage, provided a clean surgical field to operate
• Designed specifically for use in dentistry - dLase 300 Nd:YAG laser, introduced in United States - Dr.Terry D. Myers and
Dr.William D. Myers on May 3, 1990
• Introduction of the laser in dentistry - credited to Goldman L - extensively studied effects on soft, hard tissues, staunch
advocate of use in routine dental practice
Kale LN, Garde JB, Garde SS, Gupta P. Evolution and applications of lasers in oral and maxillofacial surgery. J Dent Allied Sci 2017;6:28-31.
4. INITIAL USE IN ORAL AND MAXILLOFACIAL SURGERY
• First reported use of lasers specific to Oral and Maxillofacial surgery - Strong et al. - CO2 lasers - excision of
premalignant and malignant lesions, other surgical procedures
• Kaplan et al. - removal of oral cancers - 1974
• Ackermann - Nd:YAG lasers - hemophiliacs - various oral surgical conditions - 1984
• Apfelberg - Argon laser - vascular lesions - 1987
• Alternative to scalpel, development of treatment modalities like laser skin resurfacing - could not be performed by
existing means
6. CLASSIFICATION OF LASERS
SOFT LASERSAND HARD LASERS
• Current soft lasers in clinical use - Helium-neon (He-N) at 632.8 nm (red, visible),Gallium- arsenide (Ga-As) at 830 nm
(infrared, invisible)
• Hard lasers - Argon lasers (Ar) at 488 to 514 nm, Carbon-dioxide lasers (CO2) at 10.6 micrometer, Neodymium-doped
yttrium aluminum garnet, (Nd:YAG) at 1.064 micrometer, Holmium yttrium-aluminum-garnet (Ho:YAG) at 2:1.micro-
meter, Erbium, chromium yttrium-slenium-gallium-garnet ( Er,Cr:YSGG) at 2.78 micro-meter, Neodymiumm yttrium -
aluminum - perovskite(Nd:YAP) at 1,340 nm
MODE OF APPLICATION
Parthiban J, Sargunar B, Prakash CA, Anandh B. Usefullness of Laser in Oral and Maxillofacial Surgery. Biomedical & Pharmacology Journal. 2015 Oct 1;8(SpecialOct):271.
7. ON BASIS OF STATE OF GAIN MEDIUM
• Solid state (Eg - Nd:YAG, Er:YAG, Er,Cr:YAG)
• Gas (Eg - HeNe, Argon,CO2)
• Excimer (Eg.ArF, KrCl)
• Diode (Eg - GaAIAs)
ONTHE BASIS OF OSCILLATION MODE
• Continuous wave (Eg - CO2, Diodes)
• Pulsed wave (Eg - Nd:YAG, Er:YAG)
ONTHE BASIS OF OUTPUT ENERGY
• Low output, soft or therapeutic (Eg - Low output diodes)
• High output, hard or surgical (Eg - CO2,Nd:YAG,Er:YAG)
Parthiban J, Sargunar B, Prakash CA, Anandh B. Usefullness of Laser in Oral and Maxillofacial Surgery. Biomedical & Pharmacology Journal. 2015 Oct 1;8(SpecialOct):271.
8. TISSUE INTERACTION
• Absorption - Specific molecules in the tissue
(chromophores) absorb photons - light energy converted
into other forms of energy, perform work
• Reflection - Laser beam bounces off surface, no
penetration/ interaction - usually undesired effect, useful
example - Erbium lasers reflect off titanium allowing for
safe trimming of gingiva around implant abutments
• Transmission - Laser energy passes through superficial
tissues - interact with deeper areas - Eg : Retinal surgery,
laser passes through lens to treat retina - deeper
penetration seen Nd:YAG, diode lasers
• Scattering - Once laser energy enters target tissue -
scatter in various directions - usually not helpful, help with
certain wavelengths biostimulative properties
Guttenberg SA, Emery 3rd RW. Laser physics and tissue interaction. Oral and maxillofacial surgery clinics of North America. 2004 May;16(2):143-7.
9. Chromophores in the skin
Are selectively laser energy absorbing target molecules in skin
Endogenous chromophores
• Melanin - UV -1200nm
• Haemoglobin - UV, blue (400 nm), green (541 nm),Yellow (577nm)
• Collagen -Visible and near infra-red spectra
• Water - in the mid and far infrared regions
Exogenous chromophores - such as tattoo ink
10. FIVE INTERACTION MECHANISMS ASSOCIATEDWITHTHE USE OF LASERS IN BIOMEDICINE
Optical effect - fluorescence spectroscopy for cancer screening, optical coherence tomography (OCT) for high-resolution
imaging
Photomechanical effect (photoacustic) - laser lithotripsy, removal of tattoos, certain pigmented lesions
Photochemical effect - photodynamic therapy (PDT), chemical reaction stimulation, composite resin polymerization
Photothermal effect - laser resurfacing, treatment of vascular lesions, laser hair removal
Photobiostimulative and photobiomodulative effect - low level laser therapy (LLLT), laser acupuncture, collagen
remodeling for aged skin, anti-inflammatory treatments, blue light therapy for acne treatments, accelerated wound
healing
Pandurić DG, Bago I, Zore IF, Sušić M, Katanec D, MilenovićA, Boras VV. Application of diode laser in oral and maxillofacial surgery. In A textbook of advanced oral and
maxillofacial surgery 2013 Jun 26. IntechOpen.
11. Parthiban J, Sargunar B, Prakash CA, Anandh B. Usefullness of Laser in Oral and
Maxillofacial Surgery. Biomedical & Pharmacology Journal. 2015 Oct
1;8(SpecialOct):271.
12. CARBON DIOXIDE LASER
• Developed by Patel, 1964
• Wavelength - 10600 nm
• Medium - mixture of CO2 ,nitrogen, helium
• Uses an articulated arm to deliver beam
• Uses - for excision and ablation of superficial lesions, skin resurfacing
• Most commonly used laser in oral cavity -
1. The chromophore that absorbs the CO2 wavelength is water
2. Shallow depth of penetration 0.2mm
3. Little scatter ,reflection, transmission
ARGON LASER
• Developed by Bridges, 1964, Hughes aircraft research laboratories
• Delivers green blue light beam with wavelength - 488-514nm
• Delivered with fibre optic cable, hand piece
• Argon beam - highly absorbed by hemoglobin, excellent hemostatic laser
• Used to excise gingival soft tissue lesions, treatment of vascular hemangiomas
13. Nd:YAG LASER
• Developed by Guesic, 1964
• Wavelength - 1064 nm
• Neodymium yttrium aluminium garnet
• Delivered by fibre optic cable
• Used with specially designed sapphire or ceramic tips, used as contact laser scalpel or ablation tool, excellent
hemostasis and cutting abilities
• Uses - treatment of vascular lesions, intraoral and extraoral pigmented lesions, openTMJ arthroplasty, malignant lesion
excision
KTP LASER
• Modified version of Nd:YAG laser
• Wavelength - 532nm
• Absorption is similar to argon laser
• Used in treatment of vascular and pigmented lesions, tattoo removal, blepharoplasty, endoscopic procedures
14. Ho:YAG LASER
• Holmium yttrium aluminium garnet
• Wavelength - 2140 nm
• Aiming beam with fibre optic cable used for delivery
• Used in both contact, noncontact mode
• Well absorbed by synovium and joint surface
• Extensively used in endoscopic orthopaedic surgery
• Used inTMJ for lysis of adhesions and sculpting of fibrocartilaginous disk tissue
Er:YAG LASER
• ErbiumYAG laser for facial resurfacing, incision, ablation of soft tissues
• Wavelength - 2940nm
• Advantage - ability to remove superficial skin layers more precisely than CO2 laser
• Allows reorganization of collagen with less total energy
15. ADVANTAGESOF LASER SURGERY
Lasers have stood test of time, in spite of criticism, they are widely used because
• Lasers incise tissue more efficiently than a scalpel - provide the added advantages of sterilization of field of operation,
decrease mechanical trauma by contact-free incision, minimizes postoperative swelling, scarring
• Effectively coagulates blood vessels in the field - maintaining a bloodless field
• Increased precision, accuracy in surgical procedures due to its ablative properties, effective control on the depth of
penetration of laser beam
• Histologically - wound shows less wound contracture, scarring due to reduced myofibroblasts
• Better healing as compared to scalpel wounds
• Reduced need for sutures
Kale LN, Garde JB, Garde SS, Gupta P. Evolution and applications of lasers in oral and maxillofacial surgery. Journal of Dental and Allied Sciences. 2017 Jan 1;6(1):28.
16.
17. DISADVANTAGESOF LASERS
Although lasers have multiple advantages over a scalpel, carries a few disadvantages
• Speed of healing may be delayed
• Incidence of increased pain 4 -7 days postoperatively
• Laser plume generated during procedure may be harmful to persons in operating room
• Scattered and reflected laser beams pose a massive health hazard to operator, assistants, patients
• High cost, operator training
Kale LN, Garde JB, Garde SS, Gupta P. Evolution and applications of lasers in oral and maxillofacial surgery. Journal of Dental and Allied Sciences. 2017 Jan 1;6(1):28.
18. LASER SAFETY IN SURGERYANDANESTHESIA
Field preparation
• Alcohol to be avoided
• If not - alcohol should vaporize completely before draping
• Protection of patient’s throat, oral tissues from accidental beam impact
• Hair near field can ignite - kept moist
• Use wet gauze packs, towels to avoid reflection from shiny metal surfaces
• Adequate high speed evacuation used to capture laser plume - biohazard
Specular reflection
• Surgical beam tested for alignment prior each use of machine
• No instruments passed across intended path of laser
Anesthetic agents
• Inflammable agents - ether, cyclopropane - absolutely contraindicated in
laser surgeries
• Instead - halothane, enflurane, isoflurane, sevoflurane
• Surgery along the airway - oxygen <40%
Care should be taken to ensure
complete coverage of the face and area
around the surgical site with wet towels
A warning sign should be placed on
the operating room door to prevent
personnel from inadvertently
entering during laser surgery
19. Eye
• Use glasses for eye protection (patient, operator,
assistants)
• Retinal damage - even if eyes closed it can penetrate eye
lids
• Normal saline is used to lubricate eye, petroleum based is
avoided
Metallic goggles are used during laser procedures on surface skin
Endotracheal tubes
Nonmetallic
• Red rubber, silicon, (PVC - not recommended)
• Tubes wrapped with metallic foil - mucosal injury (wrapped with metallic tape of copper,
silver)
• Silver anode sheet that has spongy water-absorbent material outside, adhesive inside
• Ceramic coated endotracheal tube
Metallic
• Cuffed metallic tubes
• Water injected in to cuff to inflate
Patel A. Anesthesia for Laser Airway Surgery. InBenumof and Hagberg's Airway Management 2013 Jan 1 (pp. 824-858).WB Saunders.
Cuffed metal tube
20. Airway Laser Hazards
• High energy of laser, its potential for combustion - can cause an airway
fire when surgical field is near to airway
• When laser strikes unprotected external surface of a tracheal tube
during laser airway surgery, surface starts to disintegrate, can catch fire
• If fire is not recognized, laser continues to be applied - hole in tracheal
tube, expose the burning surface to oxidant-rich gas within anesthesia
system
• At this stage - explosive blowtorch-like fire may occur, rapidly spread in
distal, proximal manner
• Any airway fire - life-threatening complication, but blowtorch fire is
especially feared
• An open basin of sterile water with an irrigating syringe should be
available in case fire develops
An airway fire results when a laser strikes
the polyvinyl chloride endotracheal tube
21. PATIENT SELECTION
• Take History to find out -Immunocompromised status, especially diabetes, isotretinoin use
• Active local or systemic infections especially recurring herpes simplex infection (Acyclovir or valacyclovir given 1 day
prior to, 5–14 days post treatment)
• Tendency of keloid scarring
• Personal or family history of vitiligo
• Prophylactic antibiotics, antivirals for ablative procedure
• To minimize post laser hyperpigmentation -2 weeks before, 8 weeks after laser - 2% Hydrocortisone, 4%
Hyroxyquinone
• Anesthesia -Topical anesthetic ointment for 1 hour, for ablative procedures - nerve blocks
Absolute
• Active bacterial, viral or fungal infections
• Unrealistic expectations
• Uncooperative patients
• Malignancy
Relative
• Immunocompromised - Diabetes, HIV, Hepatitis B, HepatitisC
• Oral isotretinoin
• History of keloid
• Patients taking gold salts are at the risk of chrysiasis (gold
related skin discoloration)
Contraindications
22. APPLICATIONS
• Hemostasis
• Malformations
• Pre-prosthetic surgeries
• Pre-cancerous lesions
• Cysts
• Benign tumors
• Scar corrections
• Gingivectomy, frenectomy
• Removal of granulation tissue
• Removal of melanin pigmentation, tattoos
• Subgingival debridement and curettage
• Osseous re-contouring, implant surgery
• Maintenance of implants
• Low Level LaserTherapy
Use of Laser for soft tissue surgery
Exposure of impacted teeth
23. SURGICAL LASERTECHNIQUE
• Photocoagulation technique
• Incisional and excisional technique
• Ablation or vaporization technique
• Contact laser technique
PHOTOCOAGULATIONTECHNIQUE
• CO2 laser - used to coagulate vessels smaller than 500 um in diameter
• Laser - used in defocused mode to a spot size of approximately 2mm with power density
less than 5W
• CO2 laser is absorbed readily by water, area must be relatively dry for effective
coagulation of vessels
• Increasing exposure time heats tissue to critical temperature needed for haemostasis
• As haemoglobin is a major chromophore - blood components directly lased, surrounding
vessel damaged by collateral heat after being coagulated
• Crisscross or circumferential pattern, defocused mode
24. INCISIONALAND EXCISIONALTECHNIQUE
• Carbon dioxide laser - light scalpel
• Near bloodless field - excellent visualization of specimen during surgical removal
• Point to be considered during biopsy - lateral zone of thermal necrosis
• Zone of necrosis - generally less than 500um when using carbon dioxide, contact Nd:YAG laser
• Topical, local, general anaesthesia administered as procedure indicates
• Area dried to increase accuracy of absorption of energy
• To outline specimen - single or slow repeating pulse mode, mark area of incision
• A row of dots can be used to outline the specimen with desired margin
• Power density adjusted, incision made to desired depth
• Advancing handpiece into incision keeps spot size, distance constant
• Hemostasis is achieved
• Gentle tension on specimen with a forceps on lesion as it is surgically removed
• Lesions can be left open
• Specimen should be handled in usual manner, pathologist informed use of laser
Outlining of planned incision in a low power
intermittent
mode allows for greater control with incision
placement
25. ABLATION ORVAPORIZATIONTECHNIQUE
• One of the greatest advantages of laser is its ability to ablate or vaporize lesions layer by layer
• It is useful in removing discrete benign lesions, eradicating multiple, diffuse lesions of oral cavity
• An anaesthetic plan implemented as type of procedure indicated
• 5 to 10 W of power on carbon dioxide laser is adequate for efficient and controlled ablation of a lesion layer by layer
• Lesion outlined
• Crisscrossing patterns of horizontal, vertical, oblique lines can be used when clearing wound of char between passes
CONTACT LASERTECHNIQUE
• Contact laser has several advantages over traditional
beam
• Nd:YAG & Ho:YAG LASERS are commonly used
contact lasers
• The specially designed tips of contact lasers allow for
transmission of laser energy to tissue directly from tip
surface
• Effect of laser is concentrated to just around tip
surface
• There is less tissue penetration, less collateral tissue
damage
• Helpful in lysis of adhesions withinTMJ
26. WOUND HEALING AFTER LASER SURGERY
Hendrick DA, Meyers A. Wound healing after laser surgery. Otolaryngol Clin North Am. 1995 Oct;28(5):969-86. PMID: 8559583.
• Laser tissue interaction involves many cellular and subcellular events
• There is vaporization of intra cellular fluid that helps disintegrate cell structure almost instantaneously, the subcellular structures
often vaporize
• This likely occurs without normal cascade of cytokines seen in acute inflammation
• Slower healing due to delayed epithelial migration, decreased scar formation
• Nerve endings are histologically sealed which causes decreased post operative pain
• Finding of fewer myofibroblasts at wound edges after laser surgery has been postulated as the reason for lessened scarring
27. Laser hemostasis
• In modern societies - increasing number of older patients, who take anticoagulant drugs
• Over the past years - lasers hemostatic properties have been established
• Due to deeper penetration in soft tissues - Nd:YAG and diode laser - effective
• To reduce thermal effect - pulsed lasers are used
• Once it is ensured that the surgical field is dry and saliva-free - laser is directed over tissues in defocused mode till the bleeding is
arrested
• Optical characteristics of blood result in scattering and dispersion of laser light - reducing the adverse effects on bony tissue
• The cause of this effect is not coagulation of blood - rather the contraction of vascular wall collagen
• The contraction results in constriction of vessels and hemostasis
• Very useful for removal of vascular lesions in the oral and maxillofacial region
APPLIEDASPECTS
28. Vascular lesions
• Chromophore - Oxy-haemoglobin
• Absorption wavelengths - 418, 542, 577 nm
• Laser of Choice: FPPDL or CO2 - wavelength -
585, 590, 595, 680 nm
• Fluence - 5-14 J/cm2
• Spot Size - 2-10 mm
• Density - Less than 10%
• Pulse Duration - 1.5-40 milliseconds
• Delay between pulses - 10-500 milliseconds
Apfelberg DB, Maser MR, Lash H &White DN (1985) Benefits of the CO2 laser in oral hemangioma excision. Plastic and Reconstruc-tive Surgery 75, 46-50.
29. Genovese WJ, dos Santos MT, Faloppa F & de Souza Merli LA (2010) the use of surgical diode laser in oral hemangioma: a case re-port. Photomedicine and Laser Surgery 28,147-51.
Diascopic maneuver Delimitation of the surgical area with laser Fiber passing parallel to the mucous membrane
30. Patient after 3 months
Application of low-level laser irradiation in exudates
Application of low-level laser irradiation after the
removal of the roof of the lesion
31. Venous malformation Port-wine stain
Telangiectasia
(A) Before and (B) after picture of a patient with nevus
of Ota treated with the Q-switched ruby laser
32. Premalignant lesions of the oral mucosa
• Malignant transformation of pre-malignancies such as oral leukoplakia, oral lichen planus occurs in up to 28% of these lesions
• Surgery of these lesions is mostly performed conventionally, but using laser for the removal of the pre-malignancies has been proven
very effective being associated with recurrence rates of less then 20%
• It allows precise excision together with some of the underlying connective tissue
• The heat generated reaches the deeper-lying cells and renders very low recurrence rates
• A delay in healing caused by thermal laser energy is an hindrance for the patient
• As an alternative to the scalpel - CO2 laser has been used for more then 25 years
• Recent studies - very low recurrence rates were observed with the Nd:YAG and diode lasers when treating above mentioned lesions -
probably due deep penetration of the light through the tissue
Pandurić DG, Bago I, Zore IF, Sušić M, Katanec D, MilenovićA, Boras VV. Application of diode laser in oral and maxillofacial surgery. In A textbook of advanced oral and
maxillofacial surgery 2013 Jun 26. IntechOpen.
33. Leukoplakia of tongue
• No prophylactic antibiotics administered
• Dorsal tongue lesion vaporized with true rapid super-pulsedCO2 laser, 46 PPS, average power of 20W, spot size of 2.0 mm, fluence of approximately 435
mJ/pulse width, peak pulse power of 500W, pulse width of approximately 4.2 ms, and an interpulse distance of 19 ms
• Two rasters applied with target tissue being wiped free of debris between applications
• Almost no char, no bleed, removed with same laser at 30W average power using the handpiece in focus at 0.3 mm spots for incision, defocused to control
bleeding
• Wound sutured closed
• Estimated blood loss for resection 15 mL
• Reepithelization of surface of the tongue 100% complete at 27 days
• Hyperkeratosis present immediately after healing complete
1. Leukoplakia affecting majority of surface area of dorsal tongue
2. First, horizontal, raster used to remove surface epithelium. HeNe aiming spot of
approximately 2.0-mm diameter. Rastering half completed.
3. Debris removed by wiping with gauze.Yellow color in central portion where vaporization was
done especially in center area.
4. Surface re-epithelized at 3 weeks. Mature mucosa shown at 9 weeks.
1
2
3
4
34. Benign oral lesions
• For soft tissue surgery several wavelengths including Er:YAG, CO2, Nd:YAG and diode lasers - investigated over past years
• Excision of benign lesions - fibroma, papilloma, mucocele, gingival lesions, benign salivary glands lesions, salivary stones, epulis
fissuratum, tongue lesions, hyperplastic tissue excisions
• Removal of these lesions using lasers is minimally invasive, can make the surgery less extensive, may reduce the need for general
anesthesia or in-patient hospital care, resulting in the lowered overall costs
35. Fibroma
• Commonly appear on buccal mucosae, inner surface of the lip, lateral surfaces of the tongue
• Presumably their origin is from trauma, particularly lip or cheek biting
• May result as the final involution form of a pyogenic granuloma
36. Excision of mucocele using diode laser in lower lip
Swelling in the left labial
mucosal region
Application of laser -
parameters, 940 nm and 1.5W,
continuous mode, 400 microns
Photograph showing
immediate postoperative day
Photograph showing
postoperative view: Day 45
Ramkumar S, Ramkumar L, Malathi N, Suganya R. Excision of mucocele using diode laser in lower
lip. Case reports in dentistry. 2016 Dec 21;2016.
37. Selected malignant lesions
• Selected patients with oral squamous cell carcinoma - lasers play role in excision of lesion
• Thermal laser energy supposed to be of value in cancer surgery - thermal laser energy may seal arteries, veins, lymphatic vessels
• Advantages of laser surgery seem to be more attributable to technical handling during surgery than to oncologic parameters
Fluorescence spectroscopy and photodynamic therapy (PDT)
• Laser-induced fluorescence (LIF) spectroscopy - non-invasive technique that has been used in various fields to differentiate tissues -
important tool for cancer diagnostics
• Differentiation of benign and malignant tissues using this method is possible with a sensitivity above 80%
• PDT can optimize conventional surgery in cases of squamous cell carcinoma using a new photosensitizer meta
• tetrahydroxyphenylchlorine (m-THPC)
• Intraoperative fluorescence-guided resection followed by PDT seem to be highly promising in improving the radicality of tumor
resection combined with a conventional therapeutic approach
38. Miyaguchi, M., & Sakai, S.-I. (1994). The Contact Nd-YAG Laser for Oral and Oropharyngeal Malignant Tumors. Auris Nasus Larynx, 21(4), 226–231. doi:10.1016/s0385-8146(12)80085-x
Singh GB, Tiwari M, Shukla HS, Pandey M. Nd:YAG laser therapy of carcinoma lip (stage I squamous cell carcinoma): a retrospective evaluation. Indian J Otolaryngol Head Neck Surg. 2009
Sep;61(3):179-84. doi: 10.1007/s12070-009-0062-0. Epub 2009 Sep 27. PMID: 23120631; PMCID: PMC3449982.
• Carried out as outpatient procedure under local anesthesia
• The power of the Nd:YAG laser set between 30–50 watts, duration of pulse at one second, pulsed mode
• The lesion fully coagulated with the laser - followed by surface cooling of lesion for maximum absorption of heat in lesion Entire lesion
coagulated in a punctate manner at 8 mm of interval for 1–2 seconds each
• The fulgurated site left to granulate, undergo healing by secondary intention
• In post-laserization period - patients prescribed analgesics (ibugesic + paracetamol combination for 5 days), mouthwash only
• Patients encouraged to take normal meals after the procedure
• The overall 5-year survival rate - 88.14% , the 3-year SR was 100% - 46pts - 1yr recall
40. Laser osteotomy
• Experimental laser osteotomies were performed in vitro and in vivo with use of different wavelengths including excimer lasers,
Er:YAG, CO2 and Ho:YAG lasers
• The laser light emitted by Er:YAG and CO2 lasers are well absorbed by water
• The wavelength of the Er:YAG laser, also well absorbed by hydroxyapatite, CO2 laser is highly absorbed by collagen
• These wavelengths seem to play an increasingly important role in OMF surgery
• Light microscopy, histologic sections and SEM revealed no charring, very thin basophilic zone next to cut surface, while cutting the
trabecular structures resulted in coagulation zone’
Dental implantology
• May be useful in pre-implant treatments when mucogingival surgery is required
• Most important indication of laser treatment in implantology - peri-implant soft tissues, decontamination of the implant surfaces in
order to treat peri-implant bony defects, rehabilitate failing implants
• Not all laser systems available in dentistry are of value in this regard
• Nd:YAG laser can change the implant surfaces, cause melting of implant microdesign
• Better results - CO2 laser - modify the implant surface, temperature changes are clinically acceptable, bacteria reduction significant
Clinical use of the diode laser - not able to change the implant surface, excellent properties for incision, excision, coagulation of soft
tissues
• RECENTLY - PDT with toluidine blue plus diode laser light - treatment of peri-implant diseases
• Lasers have been used for implant site preparation
• Laser irradiation has a biostimulating effect on osteoblasts - promoting the osseointegration process of dental implant, healing of
bony defect after augmentation procedures
41. • Er:YAG laser used with a spot size of 0.9 mm at a distance of about 10 mm from the bone surface
• The laser settings used for bone cutting - pulse energy of 1,000 mJ, pulse duration of 300 s and a frequency of 12 Hz (energy density
157 J/cm 2)
• Pulse profiles are nearly square shaped, approximately constant power within the pulses, water spray level was 40–50 ml/min
Stübinger, S., Ghanaati, S., Saldamli, B., Kirkpatrick, C. J., & Sader, R. (2009). Er:YAG Laser Osteotomy: Preliminary Clinical and Histological Results of a NewTechnique for
Contact-Free Bone Surgery. European Surgical Research, 42(3), 150–156. doi:10.1159/000197216
Clinical situation after laser
osteotomy of a bone graft in
the chin region.The
circumferential gap of the
bone block is shown. Note the
characteristic craggy and
clean surface structure after
laser osteotomy without any
signs of bony particles and
debris.
Harvested bone graft after
loosening with chisels
from the chin region.The
bone graft is without any
signs of carbonization,
there is no charred tissue.
Clinical situation after fixation of
the bone graft with 2 titanium
screws in the left upper jaw.The
bone graft was necessary
because of the massive loss of
bone volume prior to dental
implant placement. After a
healing period of 3 months, the
implant can be placed into the
augmented region.
Typical intraoperative situation
during laser ablation of bone.The
red pilot beam and the additional
water spray are clearly visible. In
this case, the alveolar crest is
flattened by laser osteotomy after
multiple tooth extractions in the
left upper jaw.
42. Kurtzman GM, DICOI D. Diode Laser for Implant Uncovery and SoftTissue Modification.
• Diode laser set at 0.8 watts and increased slowly to 2.5 watts in continuous mode until the fibrous tissue overlaying the implant cover screws cut
• An initiated tip placed at center of the depression from pontics of provisional bridge in soft tissue above implants cover screw, moved in an increasing
circular motion moving outward until entire cover screw was exposed
• The diode cuts desired soft tissue, coagulate bleeding from cut edges
• Cover screws removed from both implants -Open tray implant impression abutments placed into the implants, seating verified radiographically
• Healing abutments placed into the implants
Buccal view of the anterior maxilla
demonstrating preservation of the
papilla due to the provisional bridge
Diode laser removing soft
tissue to uncover the implants
cover screws
Uncovery of the implants
and healing screw removal
Healing abutments placed
into the implants
43. Frenectomy
• Accomplished using incision and/or ablation
• Either CW mode at 3 to 5W with a 0.2-mmspot size for incision, a pulsed mode at 20 W, 50 to 60pps, and 2.0-mm spot for ablation size can be
used
• Topical anesthetic is usually adequate, infiltration technique maybe preferred
• Upper lip everted, the frenum stretched taut, short (3-5 mm), vertical incision made through mucosa of mid portion of frenum
• Horizontal releasing incisions - developed through mucosa on both sides of frenum, extend to periosteum - diamond-shaped wound developed - lip-
mucosal attachment is released
• Fibrous band between central incisors vaporized
• Saline with hydrogen peroxide rinses prescribed, No dressing is necessary
• Wound develops fibrinous coagulum in 24 hours, re-epithelialization occurs in 5 weeks
• Contact Nd:YAG , fine scalpel tip at 8 to 12W CW may be used, same surgical technique
44. Exposure of impacted teeth
• Easily accomplished using local anesthesia, loop cautery
• Less swelling, less postoperative pain, less chance of thermal injury to the exposed tooth if free beam CO2 or contact Nd:YAG
laser used
• CO2 laser used at PD of approximately 10,000 W/cm2 at 50 PPS, 10W average output power and 0.3mm spot size - incise around
impacted crown of tooth
• Mucosal flap is elevated, Crown of impacted tooth exposed, absence of bleeding
• Mucosa well healed at 3weeks
• Bonded bracket - start tooth movement
• Nd.YAG laser in contact mode using a short scalpel tip at 5 to 10W average output power - excise the gingival cuff
• Rapid identification of the crown permits the operator to avoid inadvertently damaging - excessive heating from the scalpel tip
45. Temporomandibular joint laser-assisted surgery
• Arthroscopic surgery - treatment of choice for internal derangements ofTMJ using Er:YAG, CO2 and Ho:YAG lasers
• Using this technique procedures such as discectomy, discoplasty, synovectomy, hemostasis, posterior attachment contraction,
eminectomy - performed on an out-patient basis through two incisions less than 2mm each
Esthetic and plastic indications
• Lasers used for more 25 years in cosmetic surgery
• Superficial vascular, pigmented lesions - most commonly treated with use of argon laser
• Nd:YAG laser - treatment of deep vascular lesions and tumors
• CO2 laser indicated for vaporization of exophytic lesions
• More common procedures performed with laser is cosmetic skin resurfacing by removing surface layer of epidermis, superficial
papillary dermis, conctracting dermal collagen, allowing skin to re-epithelialize in more uniform manner
• Advantage of laser surgery in cases of esthetic and plastic surgery - based on hemostasis, decreased scarring, decreased postoperative
disability
46. Boyden DK. A brief overview of noninvasive lasers in cosmetic
maxillofacial surgery. Oral and Maxillofacial Surgery Clinics.
2004 May 1;16(2):231-7.
47. TATTOO REMOVAL
Guttenberg SA, Emery 3rd RW. Laser dermatopathology. Oral and maxillofacial surgery
clinics of North America. 2004 May;16(2):189-95.
Ho SG, Goh CL. Laser tattoo removal: a clinical update. Journal of cutaneous and aesthetic
surgery. 2015 Jan;8(1):9.
Showing good resolution of dark blue tattoo
using the QS Nd:YAG laser after 5 treatments.
Noticed textural changes and mild post
inflammatory hyperpigmentation and
silhouette of old tattoo
48. Recent Advances
• Waterlasesystem - revolutionary dental device that uses laser energized water to cut or ablate soft and hard tissue
• Periowave - photodynamic disinfection system utilizes nontoxic dye (photo sensitizer) in combination with low intensity lasers
enabling singlet oxygen molecules to destroy bacteria
• Photodynamic therapy (PTD) - currently being evaluated for the treatment of head and neck, skin, intraabdominal, other types of
cancers
• Carbon dioxide laser, other lasers - used in the micro anastomosis of nerve and vascular tissue with some success
• Excimer laser - useful tool in the treatment of vitiligo - achieving excellent results in a few months rather than months to years
• Non-ablative skin rejuvenation - laser to improve the appearance without injuring the surface of the skin
Nd :YAG (1320 nm)
Diode (1450 nm)
Er-glass laser (experimental)
• Confocal laser scanning microscopy (CLSM) - diagnosis and marginal Clearance without biopsy
• Optical coherence tomography (OCT) - new noninvasive imaging technique
• Photobiomodulation therapy - high potential treatment modality for COVID-19
49. Brandon MS, Strauss RA. Complications of CO2 laser procedures in oral and maxillofacial surgery. Oral and Maxillofacial Surgery Clinics. 2004 May 1;16(2):289-99.
General complications of laser surgery of the head and neck
• Postoperative infection
• Contact dermatitis
• Postoperative pain
• Promotion of malignant transformation by laser energy
• Airway fire
• Ocular injuries
• Injury to staff
Cutaneous fungal infection after
laser cosmetic skin resurfacing
Squamous cell carcinoma arising in an area
of tissue previously ablated with laser
Application of stainless steel eye
shields for periocular procedures
50. Complications unique to extraoral laser surgery of the head and neck
• Hyperpigmentation
• Hypopigmentation
• Erythema
• Hypertrophic scarring
• Milia and acne outbreaks
• Ectropion
Acne outbreak following laser skin
resurfacing
Prolonged erythema
associated with poor
hygiene following laser
skin resurfacing
Poor postoperative
hygiene contributing to
long term complications
Cutaneous
hypopigmentation
after laser cosmetic
skin resurfacing
Cutaneous
hyperpigmentation after
laser cosmetic skin
resurfacing
51. Complications unique to intraoral laser procedures
• Moderately severe or severe postoperative pain - tends to peak at postoperative day 1 or 2 and frequently does not subside for 7 to 9
days. Narcotic analgesia is often required.
• Postoperative edema - airway disturbances
• Blood vessels too large to be effectively constricted are cut - bleeding may occur
• Pitting of the enamel
• Pulpal tissues in teeth can undergo irreversible damage with sufficient increases in temperature
• Laser surgery can be associated with a range of complications
• Many procedures now routinely performed with lasers have significantly lower rates of complications than comparable
• procedures performed with the scalpel (Example - frenectomies, treatment of hemangiomas)
• Some procedures are unique to laser surgery, would not be possible without their use (Example - laser resurfacing, ablation of large
mucosal lesions)
• These benefits have resulted in increasing use, expanding scope of lasers in oral and maxillofacial surgery
• With a thorough understanding of possible complications, clinicians can minimize occurrence through proper patient selection,
preoperative preparation, appropriate technique, vigilant postoperative care
52. • Measurement of temperature, ask possible symptoms of patients
• Bed sheets, head rest covers disposable, must be replaced for every treatment
• Bathrobes, gowns used during laser hair removal procedures – disposable, dumped into biohazards bags
• Hand washing practice implemented before, after every treatment, eye, nose, mouth hand contact should be avoided
• Patients - disinfect hands with 60% to 70% isopropyl alcohol, provide verbal consents, wear surgical masks
• Working surfaces sanitized with hospital-grade disinfectant between every treatment
• Gloves, dry high-filtration media masks must be worn by handling physicians and nurses
• Adequate eye protection considering that exposed mucous membranes, unprotected eyes can increase risk of SARS-CoV2
transmission
• Machine body can be covered with disposable sheet/cling film for each procedure with the exhaust fan area open
• Eye shields and connected straps as well as lens optics should be cleaned with 70% ethyl alcohol
• Avoid laser gel contamination between patients by using disposable cups for each patient
• Disinfect the entire laser hand piece between patients
• Proper fitting high-filtration masks to be used by the surgical team during procedures
• A smoke evacuator should be used while doing laser procedures that generate plume (Example - viral warts, epidermal nevi, laser
ablation, laser hair reduction)
• Maintain good general ventilation in the clinic to dilute any contaminants that skipped in the air
Insights into laser safety considerations during COVID19 pandemic
Elsaie ML, Nada HA. Insights into laser safety considerations during COVID 19 pandemic. DermatologicTherapy. 2020 Sep;33(5):e13777.
53. REFERENCES
• Fonseca, oral and maxillofacial surgery, vol. 1
• Lasers in maxillofacial surgery - Clayman, Lewis
• Kale LN, Garde JB, Garde SS, Gupta P. Evolution and applications of lasers in oral and maxillofacial surgery. J Dent Allied Sci 2017;6:28-31.
• Parthiban J, Sargunar B, Prakash CA, Anandh B. Usefullness of Laser in Oral and Maxillofacial Surgery. Biomedical & Pharmacology Journal. 2015 Oct 1;8(SpecialOct):271.
• GuttenbergSA, Emery 3rd RW. Laser physics and tissue interaction.Oral and maxillofacial surgery clinics of NorthAmerica. 2004 May;16(2):143-7.
• Pandurić DG, Bago I, Zore IF, Sušić M, Katanec D, Milenović A, BorasVV.Application of diode laser in oral and maxillofacial surgery. In A textbook of advanced oral and maxillofacial
surgery 2013 Jun 26. IntechOpen.
• Patel A.Anesthesia for Laser Airway Surgery. InBenumof and Hagberg'sAirway Management 2013 Jan 1 (pp. 824-858).WB Saunders.
• Hendrick DA, MeyersA.Wound healing after laser surgery. OtolaryngolClin NorthAm. 1995 Oct;28(5):969-86. PMID: 8559583.
• Apfelberg DB, Maser MR, Lash H &White DN (1985) Benefits of the CO2 laser in oral hemangioma excision. Plastic and Reconstruc-tive Surgery 75, 46-50.
• Genovese WJ, dos Santos MT, Faloppa F & de Souza Merli LA (2010) the use of surgical diode laser in oral hemangioma: a case re-port. Photomedicine and Laser Surgery 28,147-51.
• Ramkumar S, Ramkumar L, Malathi N, Suganya R. Excision of mucocele using diode laser in lower lip. Case reports in dentistry. 2016 Dec 21;2016.
• Miyaguchi, M., & Sakai, S.-I. (1994).The Contact Nd-YAG Laser for Oral and Oropharyngeal MalignantTumors. Auris Nasus Larynx, 21(4), 226–231. doi:10.1016/s0385-8146(12)80085-
x
• Singh GB,Tiwari M, Shukla HS, Pandey M. Nd:YAG laser therapy of carcinoma lip (stage I squamous cell carcinoma): a retrospective evaluation. Indian J Otolaryngol Head Neck Surg.
2009 Sep;61(3):179-84. doi: 10.1007/s12070-009-0062-0. Epub 2009 Sep 27. PMID: 23120631; PMCID: PMC3449982.
• Stübinger, S., Ghanaati, S., Saldamli, B., Kirkpatrick,C. J., & Sader, R. (2009). Er:YAG Laser Osteotomy: PreliminaryClinical and Histological Results of a NewTechnique for Contact-
Free Bone Surgery. European Surgical Research, 42(3), 150–156. doi:10.1159/000197216
• Kurtzman GM, DICOI D. Diode Laser for Implant Uncovery and SoftTissue Modification.
• Boyden DK.A brief overview of noninvasive lasers in cosmetic maxillofacial surgery. Oral and Maxillofacial SurgeryClinics. 2004 May 1;16(2):231-7.
• GuttenbergSA, Emery 3rd RW. Laser dermatopathology.Oral and maxillofacial surgery clinics of NorthAmerica. 2004 May;16(2):189-95.
• Ho SG, Goh CL. Laser tattoo removal: a clinical update. Journal of cutaneous and aesthetic surgery. 2015 Jan;8(1):9.
• Brandon MS, Strauss RA. Complications of CO2 laser procedures in oral and maxillofacial surgery.Oral and Maxillofacial Surgery Clinics. 2004 May 1;16(2):289-99.
• Elsaie ML, Nada HA. Insights into laser safety considerations duringCOVID 19 pandemic. DermatologicTherapy. 2020 Sep;33(5):e13777.