A major revolution that has occurred in dentistry with a technology breakthrough that gives dentists the capability to perform a wide range of hard-and-soft tissue procedures with improved patient outcomes, less trauma and in most cases, with less need for injections. This new technology greatly expands the scope of procedures a dentist can offer their patients. Its of course the Laser Dentistry!
What are lasers?
Laser is an acronym, which stands for Light Amplification by Stimulated Emission of Radiation. Several decades ago, the laser was a death ray, the ultimate weapon of destruction, something you would only find in a fiction story. Then lasers were developed and actually used, among other places, in light shows. The beam showed pure, vibrant and intense colors. Nowadays, laser is used in the scanners at the grocery store, in compact disc players, and as a pointer for lecturer and above all in medical and dental field. The impact of the laser has changed considerably over the past several years.
With dentistry in the high tech era, we are fortunate to have many technological innovations to improve treatment. . However, no instrument is more representative of the term highly technical than, the laser. Dental procedures performed today with the laser are so effective that they should set a new standard of care.
Laser – tissue interaction
Laser interacts with the target tissue in four ways which depends on the optical properties of that tissue: Absorption, transmission, reflection, scattering of the laser light.
Lasers used in Dentistry:
This laser has an active medium of ionized argon gas, energized by a high current electrical discharge, and the laser light is delivered by a fiber-optic in continuous wave and gated pulsed modes. There are two emission argon laser wavelengths used in dentistry: 488 nm (blue) and 514 nm (blue green). Both these wavelengths are poorly absorbed in the enamel and dentin which is beneficial during cutting and sculpting gingival tissues as there is minimal interaction with the dental hard tissue. Both these wavelengths are used as an aid for caries detection.
The diode laser is manufactured from solid semiconductor crystals made from a combination of aluminum, indium ,gallium or arsenic. These wavelengths penetrate deep into the tissue and highly attenuated by the pigmented tissue. These lasers are excellent soft tissue surgical lasers. So, surgery can be performed safely as these wavelengths are poorly absorbed by the hard tissues of the tooth.
Nd:YAG has a solid active medium, which is a garnet crystal combined with rare earth elements yttrium and aluminum, doped with neodymium ions. The dental wavelength of 1064 nm is indicated for various soft-tissue procedures such as cutting of gingival and sulcular debridement.
The Er-Cr: YSGG Laser:
This laser is widely indicated in restorative and etching procedures. During cavity preparation, the laser provides rough surfaces for bonding without causing any significant crack in the dental hard tissue.
The CO2 laser is water or air cooled gas discharge, containing a gaseous mixture with CO2 molecules, that helps in producing a beam of infrared light. The light energy, whose wavelength is 10,600 nm, well absorbed by water and is delivered through a hollow tube-like waveguide in continuous or gated pulsed mode. The laser wavelength can easily assists in cutting and coagulation of soft tissue, thus providing a clear operating field.
How are lasers used for pain management in Dentistry?
Low-power lasers inhibit the release of pain mediators from injured tissues. In other words, they decrease concentration of chemical agents such as histamine, acetylcholine, serotonin, H+ and K+, all of which are pain mediators. Low-power lasers inhibit concentration of a pain mediator.
Uses of lasers on hard tissues
Lasers for Caries Detection:
When the laser irradiates the tooth, the light is absorbed by both organic and inorganic substances in the dental tissues, as well as by metabolites such as bacterial porphyrins. These porphyrins showed some fluorescence after excitation by red light. Since bacteria are present in the carious lesions, carious tissue exhibits more fluorescence as compared to the healthy tissue which distinguish between the carious and sound tooth structure.
Lasers for Caries Removal and Cavity Preparation:
Lasers are proven to be safe and effective in caries removal and cavity preparation in pediatric and adults patients without significant damage to tooth structure or patient discomfort. This device also aid in removal of defective composite restoration and ablate the distal carious lesion.
Lasers Used for Calculus removal:
Laser is used for calculus removal as the bacterial porphyrins in dental calculus give a strong fluorescence signal, which can be used to control lasers used for scaling.
Laser Assisted Bleaching:
The objective of laser bleaching is to achieve the ultimate power bleaching process using the most efficient energy source while reducing any adverse effects.
The management of patients with sleep apnea, TMJ derangements, dental implants, premalignant lesions, and post-traumatic facial scarring has improved significantly with the advent of laser surgery.
Laser assisted curettage significantly improves outcomes in mild to moderate periodontitis. The treatment is not invasive and comfortable to the patients..
Laser Assisted Incisional and Excisional Biopsy:
These procedures are accomplished at 100°C. The lasers are placed in cutting or focused mode, held perpendicular to the tissue and follow the surgical outline. When laser light interact with the soft tissue, there is vaporization of intra and extracellular water content resulting in ablation or removal of biological tissue.
A lot more….
In addition, there are specific soft tissue indications for the clinical use of lasers, including gingival depigmentation, gingivectomy/gingivoplasty, operculectomy, sulcus debridement, pre-impression sulcular retraction, laser assisted new attachment procedures, removal of granulation tissue. Pulp capping, pulpotomy and pulpectomy, incisions and draining of abscesses, removal of hyperplastic tissues, frenectomy, vestibuloplasty, and treatment of herpetic and recurrent aphthous ulcers. Other excisional procedures that can be easily performed using lasers.
Lasers in Pediatric Dentistry:
Lasers can provide treatment without the need for needles and high-speed handpieces causing less intra and postoperative discomfort to the children. Furthermore, there is less need for behavioral management therapies in case of lasers assisted therapy. During laser treatment, hemostasis can be achieved without the need of sutures in many patients.
The use of laser technology has been widely used in dentistry. When used efficaciously and ethically, lasers have been an essential tool in many dental treatments.