LASERS IN PROSTHODONTICS

2. LASERS IN PROSTHODONTICS
Dr .SHARI.S.R
FIRST YR MDS
DEPARTMENT OF
PROSTHODONTICS

3. CONTENTS
1.INTRODUCTION
2.HISTORY
3.LASER LIGHT VS ORDINARY LIGHT
4.COMPONENTS OF LASER.
5.LASER INTERACTION
6.CLASSIFICATION OF LASER
7.EMISSION MODE
8.COMMON INTRAORAL LASERS
9.DELIVERY SYSTEMS
10.APPLICATIONS OF LASER IN PROSTHODONTICS
11.LASERS IN LABORATORIES
12.ADVANTAGES AND DISADVANTAGES
13.LASER SAFETY
14.REVIEW OF LITERATURE
15.CONCLUSION
16.REFERENCES

4. INTRODUCTION
• One of the milestones in technological advancements in
dentistry is the use of lasers.
• The term laser is the acronym for” Light Amplification by
Stimulated Emission of Radiation”
• They provide more efficient , more comfortable and more
predictable outcomes of the patient.
• Term coined by GORDON GOULD ,1957

5. HISTORY

6. Why Lasers In Prosthodontics
• Prosthodontics takes all concepts of dentistry and integrates
effective comprehensive treatment planning.
Fearful patients
Patients with complex medical histories
Patient allergic to anesthetics

8. FUNDAMENTALS OF LASER

10. Spontaneous vs stimulated
emission

12. COMPONENTS OF LASER
1.LASER MEDIUM
2.PUMPING MECHANISM
3.OPTICAL RESONATORS

14. ELECTROMAGNETIC SPECTRUM

15. CLASSIFICATION

16. BASED ON LIGHT SPECTRUM

17. MATERIAL USED

18. TISSUES IT IS USED
SOFT TISSUE
LASERS
DIODE
CO2
ND: YAG
HARD TISSUE
LASERS
ER- YAG
ER -CR-
YSGG

19. DELIVERY SYSTEM
Ar, diode, and Nd:YAG lasers, have small, flexible fiber-optic
systems with bare glass fibers that deliver the laser energy to
the target tissue .

20. Erbium and co2 laser devices are constructed with special
fibers capable of transmitting these wavelengths with
semiflexible hollow waveguides or articulated arms.

21. EMISSION MODE
• means that laser energy is emitted
continuously produces constant tissue
interaction
• CO2, Ar, and diode lasers
Continuous
wave
emission
• very short bursts of laser energy
• Nd:YAG, Er:YAG
Free-running
pulse
emission

22. COMMON INTRA ORAL LASERS
1. DIODE (805-1064 nm)
2. CO2(10600 nm)
3. ERBIUM (2780-2940 nm)
4. ND –YAG(1064 nm)
5. ARGON LASERS(470 nm)

23. ARGON LASER
• Delivered -continuous/pulse emission
• Two wavelengths used in dentistry: 488 nm and 514 nm
• 488 nm -curing composite restorative materials, light
activation of whitening gels and in caries detection
• 514 nm wavelength is used for oral soft tissue surgeries
,highly vascularized lesions, such as hemangiomas
• Peak absorbance in tissues containing hemoglobin,
hemosiderin, and melanin

24. DIODE LASER
• Solid state semiconductor laser which uses a
combination of gallium, arsenide, aluminum, and
indium.
• Wavelengths used in dentistry -800-980 nm
• Poorly absorbed in water, highly absorbed in
hemoglobin and other pigments.(melanin)
• Excellent for soft tissue procedures ,do not interact with
dental hard tissues.
• Used for biostimulation of osteoblasts around implants.

25. Nd –YAG LASER
Wavelength of 1064 nm.
Uses
• Hemorrhagic soft tissues
• Periodontal procedures(LANAP)
• Bleaching
• Welding of titanium components of prostheses

26. Er LASERS
• Very well absorbed by all biological tissues that
contain water molecules & hydroxyl ions
• Ideal for use in soft tissue procedures as well as
hard tissue procedures
Uses
• Caries removal
• Cavity preparation
• Tooth preparation,
• Osteotomy
• Implant site preparation.

27. CO2 LASER
• 10,600 nm.
• Well absorbed by water
• Easy cutting, coagulability and shallow depth of penetration into tissues
• Strong hemostatic and bactericidal effects
• Minimal depth of penetration, reducing lateral thermal damage CO2 laser that
can safely treat tissue around implants for periimplantitis.
Disadvantages
• Large size
• High cost
• Hard tissue destructive interactions

28. Laser energy and tissue temperature
• OBSERVED EFFECTS
• NORMAL BODY
TEMPERATURE
• COAGULATION AND
DENATURATION OF PROTEINS
• VAPORIZATION OF
INTRACELLULAR AND EXTRA
CELLULAR WATER
• TISSUE TEMPERATURE
• 37◦C
• >60◦C
• 100◦C

29. HEALING
• HEALING UN EVENTFUL,NO DRESSING/SUTURING IS NEEDED
• HEALING IS BY SECONDARY INTENTION
• BACTERIAL CONTAMINATON IS LESS
• REDUCED SCARRING
• EARLY HEALING

30. Depending on the optical properties of the
tissue, laser may have four different
interactions with the target tissue
Transmission Reflection
Scattering Absorption
EFFECT ON
TISSUES

31. The primary and beneficial goal of laser energy
is absorption of the laser light.
The principal laser-tissue interaction is
photothermal

32. Primary Photothermal Laser-tissue Interactions
Incision
OR
• excision
Ablation
OR
• vaporization
Hemostasis
OR
• coagulation

33. Incision
excision
• Laser beam in focus with a small spot size
ablation
• Laser beam with a wider spot size
hemostas
is/
coagulati
on
•. Laser beam out of focus

34. Small spot size Large spot size
Deep effect on tissues Superficial effect on tissues

36. REMOVABLE PROSTHESIS
The successful construction of removable full and partial
dentures mainly depends on the preoperative evaluation
of the supporting hard and soft tissue structures and their
proper preparation.
Lasers are best suited for pre-prosthetic surgeries.

37. Tuberosity
reduction
Torus
reduction
Residual ridge
modification
Soft
tissue
lesions

38. TUBEROSITY REDUCTION
• The most common reason for enlarged Tuberosity is usually a soft
tissue hyperplasia
• It affects stability of prosthesis
• Surplus soft tissue should be excised using soft tissue lasers
Clinical applications of lasers during removable prosthetic reconstruction
Gabi Kesler, DMD,J THE DENTAL CLINICS

39. Tuberosity reduction.
A, Preoperative photograph of enlarged
soft tissue tuberosity.
B, Tuberosity reduction performed using a
simple ablation technique, with no incision
or sutures.
C, Postoperative view of surgical site
at 17 days.

40. TORUS REDUCTION
• Tori and exostoses are formed mainly of compact bone.
• They may cause ulceration of oral mucosa.
• They may also interfere with lingual bars or flanges of
mandibular prostheses.
• Soft tissue lasers may be use to expose the exostoses and
Erbium lasers may be use for the osseous reduction.

43. SOFT TISSUE LESIONS
&VESTIBULOPLASTY
• Epulis fissurata, denture stomatitis
• Excised with any of the soft tissue lasers and the tissue
allowed to re epithelialize.

44. A, Preoperative view of maxillary ridge epulis fissuratum. B, Epulis
excision with a CO2 laser in continuous-wave mode. Note residual muscle
on the periosteum. The laser is used to incise the muscle attachments,
which subsequently migrate vertically. As the muscle is being dissected
superiorly, tension is applied to the lip. C, Supraperiosteal dissection and
vestibuloplasty completed. Note clean periosteum. D, Postoperative
appearance at 10 days, with excellent vestibular depth and
reepithelialization

45. RESIDUAL RIDGE MODIFICATION
• For proper retention, stability and support for the prosthesis,
residual ridge modification is done with lasers, in pre
prosthetic preparation phase for • Under cuts • Flabby tissue

46. In FIXED PROSTHESIS

47. GINGIVAL TROUGHING
• The deflection of the marginal gingiva away from a tooth
• A trough is created around a tooth before impression
making using Nd:YAG laser.
• This can entirely replace the need for retraction cord,
electro cautery, and the use of haemostatic agents.
• Gingival troughing with the diode laser exposes finish
lines

48. SOFT TISSUE MANAGEMENT
AROUND ABUTMENTS
• ARGON laser provide excellent Hemostasis
and Coagulation
• Gingival Retraction for making impression
during a crown and bridge procedure becomes
easy

49. CROWN LENGHTNING INDICATIONS..
Insufficient clinical crown length ,Caries at gingival margin
Endodontic perforations near alveolar crest
Unaesthetic gingival architecture

50. FORMATION OF OVATE PONTIC SITES
Unsuitable pontic site DUE TO:
1. Insufficient compression of alveolar plates after an
extraction
2. Non replacement of a fractured alveolar plate.
• Unsuitable pontic site results in unesthetic and non self
cleansing pontic design.
• For favorable pontic design laser re-contouring of soft and

52. MODIFICATION OF SOFT TISSUE
AROUND LAMINATES
The removal and re-contouring of gingival tissues around
laminates can be easily accomplished with the Argon laser

53. BLEACHING:
Diode lasers are used to bleach teeth without causing
much tooth sensitivity and modification of the
complexion of the tooth.
REMOVAL OF VENEER
The laser energy passes through porcelain glass and is
occupied by the water molecules present in the adhesive.
Debonding takes place at the junction of the silane and
the resin without causing any trauma to the underlying
tooth.

55. CROWN FRACTURES AT THE GINGIVAL
MARGINS
Er: YAG or Er, Cr: YSGG lasers can be moved out to permit
correct exposure of the fracture margin

56. IN IMPLANTOLOGY

57. Second stage uncovering
Implant site preparation
Peri-implantitis.

58. SECOND STAGE UNCOVERING
Following the placement of implant and its Osseo integration,
Er:YAG laser can be used to uncover implants
ADVANTAGES OVER CONVENTIONAL SURGERY
• Little blood contamination (haemostatic effects)
• Minimal tissue shrinkage
• Eliminate trauma to the tissues during flap reflection
• Impressions can be obtained at the same appointment

60. IMPLANT SITE PREPARTION
• Lasers can be used for the placement of mini implants
especially in patients with potential bleeding problems, to
provide essentially bloodless surgery in the bone

63. PERI-IMPLANTITIS
• Lasers can be used to repair ailing implants by
decontaminating their surfaces with laser energy.
• Lasers can also be used to remove inflamed granulation
tissue around an already osseointegrated implant.
• Diode, CO2 & Er:YAG lasers can be used for this purpose.

68. LASER HOLOGRAPHIC IMAGING
• Laser holographic imaging is a well established method for
storing topographic information, such as crown
preparations, occlusal tables, and facial forms.
• Helium neon laser used

69. LASER SCANNER
valuable tool for its ease of application and creation of 3D
images of oral dental structures

71. Ultraviolet (helium-cadmium) laser-initated polymerization
of liquid resin in a chamber, to create surgical templates for
implant surgery and major reconstructive oral surgery

72. LASER WELDING
• An attractive alternative method to join dental casting
alloys such as broken clasp
• Advantages
• No need for investment and soldering alloy
• Working time is decreased
• Minimal heat damage to denture base resin

73. ADVANTAGES DISAVANTAGES
Bloodless ,painless, precise
cutting
Less chair time, reduce anxiety
High cost, require training
Less discomfort, less post op
swelling, has antibiotic property,
conservative tooth prep, minimal
scarring
Modification of clinical tech
Warfarin pt, Inability to remove metallic
restoration, air embolism

74. LASER SAFETY

75. LASER CLASSIFICATION
• Based on the potential of beam to cause potential biologic
damage to the eyes or skin……………put forward by ANSI.
• 4 classes are there. Higher the class……………
• Class-1;Normally they don’t pose health hazard
• Class-2;Emit only visible light with low power out put. Usually
not hazardous because of human blinking and aversion
reactions.
• Class-2M.Hazardous when viewed for > ¼ of sec-----------------
-------ordinary blinking reflex

76. • Class3 a- They can emit any wavelength. When viewed
momentarily, it will not harm the unprotected eye…..has caution
label on them.
• Class3 b-They are hazardous if viewed . With them eye
protection is must. They don’t pose reflective & fire hazard.
• Class4- Hazardous for direct view. They also pose reflective , fire
& skin hazards. They also produce hazardous airborne
contaminants

77. LASER SAFETY METHODS
1. Protective eye ware
2. Avoid reflecting surfaces
3. Use wet cloth in op area
4. Non combustible LA(alcohol based)
5. Warning signs

78. REVIEW OF LITERATURE
CLINICAL ULTRAFAST LASER SURGERY:
RECENT ADVANCES AND FUTURE DIRECTIONS
• Ieee journal of selected topics in quantum electronics, vol. 20, no.
2, march/april 2014
• ultrafast lasers are capable of ablating biological material
with up to sub-cellular precision and can create confined, largely
nonthermal cuts inside bulk tissue.

79. A LASER POINTER SURVEYOR TO DETECT AN UNDERCUT IN
FIXED PARTIAL DENTURE PREPARATION
Heeje Lee, DDS,a and Joseph S. So, DMDb
Louisiana State University School of Dentistry, New Orlean
JPD
Laser pointer attached to the surveyor to detect the undercut
Extraorally. One of the physical properties of the laser is
collimation, and the straight laser beam makes it possible to
survey the intaglio surface of the impression.

80. CONCLUSION
Lasers are an exceptional modality of treatment for many
clinical conditions ,but never been the magic wand, it has got
its own limitations. However, the future of dental laser is
bright with some of the newest ongoing researches.

81. REFERENCES
• Lasers in Prosthodontics - An Overview Part 1:
Fundamentals of Dental Lasers Journal of Indian
Prosthodontic Society (March 2010) 10:13–26
• IOSR Journal of Dental and Medical Sciences (July.
2015), Dental Lasers – A Prosthodontic
Perspective!!! Dr. GursahibaSahni
• Coluzzi D J.Fundamentals of dental lasers.science
and instruments.Dent clin north Am 2004;48:751-70
• Nagaraj K R.Use of lasers in prosthodontics:A
Review.Int J Clin Dent 2012;5:91-112

82. REFERENCES (CONT.)
• Punia V,Latha V,Khandelwal M,Punia S K,Lakhyani R.The
current status of laser application in prosthodontics.Natl J
Integr Res Med 2012;3:170-5
• Convissar RA .The biologic rationale for the use of lasers in
dentistry .Dent Clin North Am.2004;48:771-94,v
 Pediatric laser dentistry;A users guide-giovanniand Margolis
 Laser applications in oral and maxillofacial surgery-catone alling
 Lasers in clinical dentistry-dental clinics of north america
 Principles and practice of laser dentistry-robert .a.convissar

83. THANK YOU