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Authors: Dr. Subashani, Dr. Channesh Patel G S

Abstract:

Dentistry in high tech erais fortunate to have many technological innovations to enhance treatment,including intraoral video cameras, CAD-CAM units,RVGs and air abrasive units. However, no instrument is more representative of the term high tech, than laser. Dental procedures performed with the laser are so effective that they should set a new stand of care.

Laser is an acronym which stands for light amplification by simulated emission of radiation.1 In May 1960, Theodore Maimen at huges Aircraft Company made the first laser. He used ruby as a laser medium. Laser is a device that converts electrical or chemical energy to light energy.  Laser light moves straight forward and does not spread. It is a thin beam and remains as single colour. Laser light is a coherent light.  The components of typical laser are active medium, pumping mechanism, cooling system.2 Laser produces light that is distinguished from ordinary light by 2 properties 1) monochromatic 2) coherent. Based on wave length laser types are 1) soft laser 2) hard lasers. Soft lasers are low power lasers with a wave length around 632nm ex: He Ne,gallium arsenide laser. These are employed to reduce pain and promote healing ex: apthous ulcer. Lasers with well-known laser system for possible surgical system are called hard lasers. Ex co2, Nd: YAG, Argon, Er YAG. Co2 lasers has as wavelength of 10,600nm. This laser has an affinity for wet tissue regardless of tissue colour.3

Laser Tissue Interaction:

Each wavelength has a somewhat unique effect on dental structure.Tissue absorbs specific and particular laser energy.  Some lasers are only absorbed by blood and tissue pigments, while others are only absorbed by water as well as hard-tissue such as enamel, dentin and bone. The wave length can be categorized into 3 groups 1) soft tissue pigmentation,pathogens such as P.Gnigivalis ,inflammatory and vascularized tissue can be targeted with the use of- Diode and Nd:YAG laser.4  2)Carbon Dioxide lasers easily interact with free water molecules in soft tissue as well as vaporize the intracellular water of pathogens. 3) Erbium Laser( ErCr:YGG and Er: YAG )This lasers have excellent absorption both apatite crystals and water of soft and hard tissue and sometimes are called as tissue instruments. Depending on the optical properties of tissue the temperature will rise and various effects will occur. The inflammatory soft tissue present in the periodontal disease can be removed with temperature of 60 degrees c; haemostasis can be achieved within the same heat parameters. Laser excisional or incisional surgery can be accomplished at 100 degrees c where vaporization of intra and extracellular water causes ablation or removal of biologic tissue. Diode and Nd:YAG energy can penetrate a few millimetres into the tissue ,carbon dioxides radiation will travel about 0.5 mm, erbium wavelength are absorbed on the surface of the tissue with a depth of 5 microns. There are two basic emission modes of dental lasers continuous wave and free running pulsed. Continuous wave mode: Co2 and diode laser operate in this manner.

Free running pulsed mode: Nd:YAG, ErCrYSGG and Er :YAG devices operates as free running pulsed mode.

Lasers in complete denture prosthodontics:Prototyping and CAD/CAM technology 2)Analysis of accuracy of impression by laser scanner.5

Laser in Fixed prosthodontics: Oral environment at the operative site must be free of saliva and blood to manage the gingiva surrounding the teeth at certain procedures.

Soft tissue surrounding the abutment: lasers can be used during retraction and homeostasis of gingival tissue in preparation for an impression procedures.6 Argon lasers provide excellent haemostasis, efficient coagulation and vaporization of oral tissues as this type of laser energy has peak absorption in haemoglobin.

 

Modification of soft tissue around laminates:

The argon laser can be used for removal and reconturing of gingival tissue around the laminates.7

Crown lengthening: less complicated and maximum comfort procedures such as lasers can be used for crown lengthening procedures as they cut only at the tip and must be held parallel to the long axis of the tooth to remove bone immediately adjacent to cementum without damaging it.8

Bleaching:Laser bleaching is very much beneficial for patients who have sensitive teeth as it reduces the repeated use of peroxide gel. The laser beam is used to activate the peroxide gel .The procedures whitens the teeth up to 8-10 shades and generally completed in only one sitting.

Veneer removal:Er YAG &Er Cr YSGG type of lasers can be used to remove failed veneers.

Formation of ovate Pontic site: The use of ovate pontic receptor site is of great value when trying to create a natural maxillary anterior fixed bridge.9

Removable prosthodontics: The key to successful removable prosthesis is the preoperative planning of the surrounding oral structures. The hard and soft tissue must be evaluated for pre prosthetic surgery. The resultant surgery should provide the patient with ridges and mucosa covering free of disease and of a quality and quantity sufficient to provide stability and retention.so that the appliance may function as close to ideal as possible. The preprosthetic surgeries that can be performed with lasers are soft tissue tuberosity reduction,10 removal of buccal, labial, lingual frenum, treatment of hyperplasia of oral mucosa, removal of fibroma, papilloma or soft tissue gingiva.

Laser use in implantology: surgical lasers can be used in a variety of ways with regard to implantology ranging from placement, second stage recovery, gingival management, treatment of perimplantitis.11 Laser can be used to control bleeding in patients who has bleeding problems and can be used for placement of mini implants. Er YAG lasers, co2 lasers, diode lasers because of bactericidal effect can be used for implant placement. Lasers can be used for debridement of implant surface, effectively decontaminate the surface, reduce the bacterial count and improve success rate of ailing implant.

Lasers in maxillofacial rehabilitation: The three dimensional acquisition of optical data of the extra oral defects, Planning the shape , position of the prostheses and SLS can be performed with lasers.12 Lasers can totally eliminate the need for conventional techniques and associated disadvantages like deformation of soft tissue and discomfort to patient. Lasers also overcome the drawbacks of 3-dimensional computed topography and magnetic resonance imaging.

Laser application in the dental laboratory: Laser can be used for scanning of models for orthodontics, scanning of crown preparation for CAD-CAM welding titanium component of the prosthesis,Laser pointer surveyor, laser titanium sintering, ablation of titanium surfacesand CAD model fabrication of splints.13

Laser welding is an alternative method to conventional torch technique to join dental casting alloy.Laser welding has been increasingly used because there is no need for investment and soldering alloy,decreased working time,lasers are easy to operate,little damage is caused to the denture resin from pinpoint heat. Improved bond strength was resulted by using lasers for surface treatment of titanium casting for ceramic bonding when compared to acid etching technique.

Advantages of using laser:Precise and self-sterilizing because the tissues are vaporized, blood less as the blood vessel with a diameter less than the width of the laser beam will be vaporized and heat sealed, pain free because the nerves that are transacted are also heat sealed by the laser beam,lymphatic’s are also sealed during the laser procedures so postoperative swelling appear to be minimal,14 laser wounds contract less because of fewer myofibrioblast and the major advantage ability to perform soft tissue adjustment on the same day that the preliminary and final impression are made on the same day of appliance placement.15

Disadvantage:

Laser wounds have less tensile strength than scalpel wounds although after 3 weeks the strength are similar, laser beam is focused and if the arm slips it can potentially injure tissues that might be inadvertently contacted by laser beam. Laser hazards can be grouped as ocular injury, respiratory hazard, fire and explosion, tissue damage and electrical shock.

Conclusion:

The knowledge and ideas of pioneers in laser are being developed and expanded into clinical practice that can enhance the quality of dental care and make patient comfortable .Through the continued development of laser technology, new application and education we look into new era of dentistry.

References:
  1. Diederik S. Wiersma. The physics and applicationsof random lasers. Nature physics. 2008; 4:359-367
  2. Lasers in dentistry.chhattisgarh journal of heal science jan 2014;2(1):1-13.
  3. Dortbudk O, Hass R, Mallath –PokornyG.Biostimulation of bone marrow cells with a diode soft laser. Clin oral implant res 2000;11:540-55
  4. Parker S. Surgical laser use in implantology and endodontics. Br Dent J 2007;202:377-86.
  5. Lasers in prosthodontics –A Review .J EvolMedDentSci, 2012 ;1(4): 624-633
  6. Punia V, Lath V, Khandelwal M, Punia SK, Lakhyani R. The current status of laser application in Prosthodontics. Natl J Integr Res Med 2012;3:170-5.
  7. liJyothy JR, Satapathy SK, Annapurra PD. Lasers in prosthetic dentistry. Indian J Appl Res 2013;3:369-70.
  8. Nagaraj KR. Use of lasers in prosthodontics: A review. Int J Clin Dent 2012;5:91-112.
  9. Bertrand C, Le Petitcorps Y, Albingre L, Dupuis V. The laser welding technique applied to the non precious dental alloys procedure and results. Br Dent J 2001;190:255-7.
  10. Punia V, Lath V, Khandelwal M, Punia SK, Lakhyani R. The current status of laser application in Prosthodontics. Natl J Integr Res Med 2012;3:170-5.

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