diode lasers an essential tool - university at … documents...diode lasers: an essential tool...

DIODE LASERS: AN ESSENTIAL TOOL

ROBERT J. YETTO, DDSROBERT J. YETTO, DDSCLINICAL ASSISTANT PROFESSORCLINICAL ASSISTANT PROFESSOR

SUNY/BUFFALO SDMSUNY/BUFFALO SDMJANUARY 26, 2013JANUARY 26, 2013

DIODE LASERS: AN ESSENTIAL TOOL

BEAUTY IS IN THE DETAILSBEAUTY IS IN THE DETAILS

DIODE LASERDIODE LASER

THE ESSENTIAL TECHNOLOGIES I THE ESSENTIAL TECHNOLOGIES I WOULD NOT PRACTICE WITHOUT:WOULD NOT PRACTICE WITHOUT:LOW TECHLOW TECHRUBBER DAMRUBBER DAMLOUPES (MAGNIFICATION)LOUPES (MAGNIFICATION)


THE ESSENTIAL TECHNOLOGIES I THE ESSENTIAL TECHNOLOGIES I WOULD NOT PRACTICE WITHOUT:WOULD NOT PRACTICE WITHOUT:MID TECHMID TECHCLINICAL CAMERA (DSLR)CLINICAL CAMERA (DSLR)INTRAORAL CAMERAINTRAORAL CAMERA


THE ESSENTIAL TECHNOLOGIES I THE ESSENTIAL TECHNOLOGIES I WOULD NOT PRACTICE WITHOUT:WOULD NOT PRACTICE WITHOUT:HIGH TECHHIGH TECHDIGITAL RADIOGRAPHYDIGITAL RADIOGRAPHYVIRTUAL IMPRESSIONINGVIRTUAL IMPRESSIONINGDIODE LASERDIODE LASER


The diode laser is a portable instrument The diode laser is a portable instrument intended for ablating, incising, excising intended for ablating, incising, excising and coagulating intraoral soft tissue, and coagulating intraoral soft tissue, including the marginal and interdental including the marginal and interdental gingiva .gingiva .


A flexible fiber is used to transmit the A flexible fiber is used to transmit the laser energy to the surgical site . laser energy to the surgical site . It works best on soft tissues and can It works best on soft tissues and can cut very precisely with little or no cut very precisely with little or no collateral damage depending on thecollateral damage depending on thesettings used during the surgery.settings used during the surgery.


The diode laser many times can be usedThe diode laser many times can be usedwithout anesthesia, doing very precisewithout anesthesia, doing very preciseanterior aesthetic surgery without anterior aesthetic surgery without causing bleeding or discomfort. causing bleeding or discomfort.

It is the best laser for this purpose .It is the best laser for this purpose .

DIODE LASERDIODE LASERWHAT IS A DIODE LASER?WHAT IS A DIODE LASER?

SemiSemi--conductor conductor pp--nn junction made in a junction made in a GaAlAsGaAlAs crystal (crystal (ieie., a diode) ., a diode) Contact Si fiber optic delivery (initiated)Contact Si fiber optic delivery (initiated)800 800 -- 1064 nanometer wavelengths1064 nanometer wavelengths6 6 -- 10 Watt maximum average power10 Watt maximum average powerContinuous wave or gated CW (pulsed)Continuous wave or gated CW (pulsed)0.8 0.8 -- 20 ms pulse duration20 ms pulse duration


Fiber initiation: When used in a tissue Fiber initiation: When used in a tissue contacting procedure, the Si fiber tip is contacting procedure, the Si fiber tip is carbonized to focus the laser energy at carbonized to focus the laser energy at the tip. This is accomplished by the tip. This is accomplished by activating the tip while touching a dark activating the tip while touching a dark surface, such as the black/blue side of surface, such as the black/blue side of a piece of articulating paper.a piece of articulating paper.


Indications for use :Indications for use :AphthousAphthous ulcersulcersExcisionalExcisional and and incisionalincisional biopsiesbiopsiesFrenectomyFrenectomy / / frenotomyfrenotomyGingival incisions and excisionsGingival incisions and excisionsGingivectomy / gingivoplastyGingivectomy / gingivoplastyHemostaticHemostatic assistanceassistance

DIODE LASERDIODE LASERIndications for use :Indications for use :

Incising and draining of abscessesIncising and draining of abscessesOperculectomyOperculectomyOral Oral papillectomypapillectomyReduction of drugReduction of drug--induced gingival induced gingival hypertrophyhypertrophyRemoval of Removal of fibromasfibromasSoft tissue crown lengtheningSoft tissue crown lengthening

DIODE LASERDIODE LASERIndications for use :Indications for use :

Sulcular debridement (removal of Sulcular debridement (removal of diseased or inflamed soft tissue in the diseased or inflamed soft tissue in the periodontal pocket) to improve clinical periodontal pocket) to improve clinical indices including gingival index, indices including gingival index, gingival bleeding index, probe depth, gingival bleeding index, probe depth, attachment loss and tooth mobilityattachment loss and tooth mobilityTissue retraction for impression or Tissue retraction for impression or preparationpreparationVestibuloplastyVestibuloplasty


DiolaseDiolase stst

Odyssey 2.4g 5WOdyssey 2.4g 5W


ZAP DIODE LASERZAP DIODE LASER


Odyssey Navigator Odyssey Navigator 3W3W


NV NV MicrolaserMicrolaser DIODE LASERDIODE LASER


Indications for use :Indications for use :AphthousAphthous ulcersulcers



Do not initiate the tip, as the energy must penetrate the lesion. Start5-8mm away and advance towards the lesion, keeping 2-3mm away, while “painting” the entire surface of the area (no contact with tissue).



Energy increases from 0.6 watt CW (1.2 watts pulsed) to 0.7 watt CW (1.4 watts pulsed) to 0.8 watt CW (1.6 watts pulsed) for 30-45 seconds each. Rest phase is 15-20 seconds between each pass.



Ferreira et al and Schindl and Neumann demonstrated that low- level laser therapy (LLLT) has shown promising clinical results as a long lasting suppression therapy.Patients were symptom free for 17 months following initial treatment.

One of the most common uses of the One of the most common uses of the diode laser is for gingivoplasty in diode laser is for gingivoplasty in esthetic cases. Provided biologic width esthetic cases. Provided biologic width is not violated, free marginal gingiva is not violated, free marginal gingiva can be sculpted to balance and can be sculpted to balance and harmonize the tooth height and width harmonize the tooth height and width ratio, as well as to provide proper ratio, as well as to provide proper placement of the gingival zenith.placement of the gingival zenith.


Introduction to Smile DesignIntroduction to Smile Design

Gingival Architecture


A second common use is for the A second common use is for the development of ovate pontic sites for development of ovate pontic sites for fixed bridges. This may or may not be fixed bridges. This may or may not be in conjunction with other tissue in conjunction with other tissue mouldingmoulding procedures such as guided procedures such as guided tissue regeneration or socket tissue regeneration or socket preservation grafts, supported by preservation grafts, supported by properly contoured properly contoured provisionalsprovisionals..


A diode laser is indispensable in cases A diode laser is indispensable in cases involving the noninvolving the non--orthodontic closure orthodontic closure of large diastemas. In order to provide of large diastemas. In order to provide proper emergence profiles and correct proper emergence profiles and correct orientation of line angles, restorative orientation of line angles, restorative materials must extend materials must extend subgingivallysubgingivally and lingually, depending on how large and lingually, depending on how large a diastema is being treated.a diastema is being treated.

Many clinicians use the diode laser toMany clinicians use the diode laser toretract soft tissue in preparation forretract soft tissue in preparation forimpressioning. Although the laser is impressioning. Although the laser is an excellent choice for an excellent choice for hemostasishemostasisand/or coagulation, I personally and/or coagulation, I personally do not use it for tissue retraction.do not use it for tissue retraction.


Another popular use for the diode laser Another popular use for the diode laser is the debridement of periodontal is the debridement of periodontal pockets for the purpose of regainingpockets for the purpose of regainingattachment. This procedure is knownattachment. This procedure is knownas as LANAPLANAP ((LLaser aser AAssisted ssisted NNewewAAttachment ttachment PProcedure).rocedure).


DIODE LASERDIODE LASERWhat are the steps involved in the LANAP Procedure?What are the steps involved in the LANAP Procedure?

A. Perio Probe indicates excessive pocket depth. A. Perio Probe indicates excessive pocket depth.

B. Laser light kills bacteria and diseased tissue. (Dotted line B. Laser light kills bacteria and diseased tissue. (Dotted line shows gum shows gum tissue cut away with traditional surgery.) tissue cut away with traditional surgery.)

C. Ultrasonic C. Ultrasonic scalerscaler and hand instruments are used to remove root calculus. and hand instruments are used to remove root calculus.

D. Laser finishes cleaning and sterilizing pocket which aids in D. Laser finishes cleaning and sterilizing pocket which aids in sealing the sealing the pocket closed so new microorganisms cannot enter pocket closed so new microorganisms cannot enter

E. Reattachment of connective tissue to the clean root surface, E. Reattachment of connective tissue to the clean root surface, with a stable with a stable fibrin clot and gingival crest to create fibrin clot and gingival crest to create ““a closed systema closed system””

F. Bite trauma is adjusted F. Bite trauma is adjusted

G. New attachment is regenerated. New bond and new ligament is fG. New attachment is regenerated. New bond and new ligament is formed ormed and healing occurs.and healing occurs.

DIODE LASERDIODE LASERStepStep--byby--step guidelines for laser assisted step guidelines for laser assisted

gingivoplasty:gingivoplasty:1.1. Observe symmetry of gingiva Observe symmetry of gingiva ––

contour, height of contour (Zenith), contour, height of contour (Zenith), papilla form, marginal tissue papilla form, marginal tissue thicknessthickness

2.2. Probe sulcus to attachment Probe sulcus to attachment –– you you must respect biologic width must respect biologic width (2.07 mm?)(2.07 mm?)

3.3. Mark proposed changes on dry tissue Mark proposed changes on dry tissue with black sharpie marker (remove with black sharpie marker (remove with alcohol as needed)with alcohol as needed)

Introduction to Smile DesignIntroduction to Smile Design

DIODE LASERDIODE LASER4.4. Be aware that with the diode laser, the Be aware that with the diode laser, the

tissue will heal at the level you create tissue will heal at the level you create (compare to cutting tissue with (compare to cutting tissue with electrosurgeryelectrosurgery or cold steel)or cold steel)

5.5. Begin at low power setting (1.2W), increase Begin at low power setting (1.2W), increase only if tip drags through tissue (increase in only if tip drags through tissue (increase in small increments only)small increments only)

6.6. Do not leave tip in one place (i.e., constant Do not leave tip in one place (i.e., constant movement through tissue)movement through tissue)


One of the most requested procedures One of the most requested procedures (other than whitening and porcelain (other than whitening and porcelain veneers) is the soveneers) is the so--called called ““laser gum laser gum lift.lift.”” However, many of these cases are However, many of these cases are actually bony issues (vertical maxillary actually bony issues (vertical maxillary excess). They cannot be accomplished excess). They cannot be accomplished by the diode laser alone and require by the diode laser alone and require surgical intervention.surgical intervention.


For those cases where sufficient excess For those cases where sufficient excess gingival tissue exists, the diode laser is gingival tissue exists, the diode laser is a quick, painless and predictable a quick, painless and predictable means of tissue recontouring. Even means of tissue recontouring. Even some cases of VME may be improved some cases of VME may be improved via soft tissue recontouring, but only if via soft tissue recontouring, but only if sufficient excess tissue exists that can sufficient excess tissue exists that can be modified while still respecting be modified while still respecting biologic width. biologic width.


How your dentistry (and a diode laser) How your dentistry (and a diode laser) can change livescan change lives

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