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Lasers In dentistryDept. of Oral and Maxillofacial Surgery

By,DINESHWARRAN RAJENDRAN (CRI)

Guided by, DR. R.KANNAN, MDSProfessor of Oral and Maxillofacial Surgery

TopicsIntroductionHistoryMechanism of ActionApplication of Lasers in DentistryAdvantages and Disadvantages of LasersSafety MeasuresExamples of Dental Laser TherapiesVideo PresentationsConclusion

IntroductionDefinition:LASER

A device that emitslightthrough a process ofoptical amplificationbased on thestimulated emissionof electromagnetic radiation

Features: Spatially coherent, which means that eitherthe light is emitted in a narrow, low divergence beam.

Many uses of lasers in daily life includes : In consumer devices such asDVD players,laser printers, andbarcode scannersIn medicine forlaser surgeryand various skin treatmentsIn industry for cutting andweldingmaterialsIn military andlaw enforcementdevices for marking targets andmeasuring rangeand speed

In Dentistry,

Laser dentistry A precise and effective way to performmany dental procedures. The potential for laser dentistry to improve dental procedures rests by allowing for treatment of a highly specific area of focus without damaging surrounding tissues.

History

Dental Lasers

1993: Nd:YAG Laser.

1994: CO2 Laser.

1996: Laser welder.

1998 : Er:YAG Laser.

Mechanism of ActionLaser PhysicsDesign of Laser MediumTissue- Laser Interaction

Laser Physics

Design of Laser Medium

Components of a typical laser:1. Gain medium2. Laser pumping energy3. High reflector4.Output coupler5. Laser beam

Tissue-Laser InteractionLaser light can have four different interactions with the target tissue,depending on the optical properties of that tissue :

Different Laser-Tissue Interactions

Using the principle of selective photothermolysis, these laser target different chromophores in the skin, which selectively absorb the laser or light energy as heat and yield the desired response.

Different Temperature Effects

Applications of Lasers in DentistryThe rapid development of laser technology has seen its introduction into various fields of dentistry.

Types of Lasers Used in Dentistry

Carbon Dioxide LaserMode : vaporisation, cutting (>100C)Specification : 10.6 micron wavelength

Used effectively in treating patients with oral lesions with blood dyscrasias.Oral indication: a. Excision of pre-malignant lesions b. Excision/biopsy c. Hemiglossectomy d. Adhesive microvascular/macro neuralDisadvantages :-Cornea at risk-Haemostasis may not be adequate on very vascular area (posterior tongue)

ND-YAG Laser (Neodymium doped- Yttrium Aluminium Garnet)Mode: coagulation (>60c), central vaporisationSpecification : 1.06 micron wavelength

Can be combined with CO2 (combo laser) or KTPOral indications: a. Coagulation of very vascular lesions or near major blood vessel b. Excision in vascular areas such as posterior tongue d. Gingivectomy e. Frenectomy Disadvantages: - Retina at risk - Penetration could cause inadvertent spread - Oedema more than CO2 laser

KTP Laser (Potassium Titanyl Phosphate)Modality : cutting with moderate coagulation Specification : 0.53 micron wavelength

Can be combined with Nd-YAG laserOral indications a. Excision in vascular areas, eg. Tonsillectomy Disadvantage - Retina at risk

Comparison of The Lasers

Advantages and Disadvantages of Lasers

Advantages:

Less pain in some instances (reducing the need for anesthesia) Reduce anxiety in patients uncomfortable with the use of the dental drill. Minimize bleeding (high-energy beam photocoagulation) and swelling. Reduce bacterial infections (sterilizes the area being worked on)Preserve more healthy tooth during cavity treatment.

Disadvantages:

Lasers cant be used on teeth with fillings that are already in place.Lasers can't be used in many commonly performed dental procedures. Eg. lasers can't be used to fill cavities located between teeth, cavities around old fillings, and large cavities.Traditional drills may still be needed to shape the filling, adjust the bite, and polish the filling even when a laser is used. Do not eliminate the need for anesthesia. More expensive since the cost of the laser is much higher.

Safety MeasuresDental lasers generally fall into Class 4

Precautions:Safety goggle (should be worn by patient and operator)Lock the door during the treatmentNever look directly into the laser beamNever point the laser hand-piece at any person except at the treated areaNever use the laser in the presence of flammable anaestheticsNever step on or abruptly bend the fibre optic cableNever move the laser machine during operation

Examples of Dental Laser Therapies

Leukoplakia

Gingivectomy

Operculectomy

Pyogenic Granuloma Excision

Frenectomy

Video Presentation

ConclusionTraditional SurgeryLaser Surgery SubjectYes No or mildAnesthesiaYes depends on operating zoneNo or minimalBleedingSedation dependedSlight irritationPainTime consumingLess timeTimeYes in invasive proceduresNo needSuturingLess expensiveExpensive CostMore Minimal Postoperative complications

Traditional SurgeryLaser Surgery SubjectSlowerRapid Healing Traumatic excisionDehydration and carbonizationMethod of pathology eliminationSlight worse Better Dentist comfortMore convenientComplicated Procedure Less More Team workSame Same Experience

Thank You.