1. Lasers in Orthodontics
Dr. Nabil Al-Zubair

2. Several decades ago: the laser was a DEATH RAY
the ultimate weapon of
destruction
something you would
only find in a science
fiction story

3. Today the 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

4. ‫أوائل حروف الكلمات‬
Light
‫االسم المختصر‬
Acronym
Amplification by
for
Stimulated
Emission of
)‫(تضخٌم الضوء بانبعاث اإلشعاع المحفز‬ Radiation
“is a mechanism for emitting light within the electromagnetic
radiation spectrum, via the process of stimulated emission”.

5. ‫براعة فرٌدة‬ ‫وإمكانات هائلة‬
The Unique Versatility and Vast Potential of Dental Lasers
‫ٌتٌح إجراءات عدٌدة تعزز من نجاح العالج‬
ALLOWS many procedures
that enhance
overall treatment success
Thus, lasers have
become an
indispensable ‫ال غنى عنه‬
clinical tool in an
orthodontist’s
‫عتاد‬ armamentarium

6. History of Lasers
begins similarly to much of
modern physics, with Einstein

7. History of Lasers
in 1964
The Nobel Prize
awarded to
Townes, Basor and Prokhovov
for the development of the laser

8. History of Lasers
Food and Drug Administration
in 1964
The Nobel Prize
awarded to
Townes, Basor and Prokhovov
for the development of the laser

10. Light is a form of electromagnetic energy = particle and a wave
Ordinary light (lightbulb) Laser light
monochromatic ‫أحادي اللون‬
composed of many wavelengths consists of a single wavelength
unfocused or incoherent Coherent ‫متماسكة‬
(identical in physical size, shape,
and synchronicity)

11. Properties of LASERS
1. Coherent: all waves are in certain phase relationship to each
other both in space and time
2. Mono- chromatic: all waves are of same frequency and wavelength
3. Collimated: all the emitted waves are PARALLEL and the beam
divergence is very low
4. Excellent When a calcified tissue for eg. dentin is exposed to
concentration of the laser of high energy density, the beam is
energy: concentrated at a particular point without
damaging the adjacent tissues even though a lot of
temperature is produced ie 800-900oC
5. Zero entropy
Entropy= ‫أدق وصف لإلنتروبً أنها مقٌاس لعدم االنتظام‬

12. Typical Laser Oscillator
energy SOURCE
A laser is composed of three principal parts:
High reflecting rear mirror
Partially reflecting output coupler
optical cavity or RESONATOR
LASING MEDIUM ‫مادة تولٌد اللٌزر‬
- Gas (CO2)
- Liquid (dye)
- Solid (Ho: YAG)
- Semiconductor (diode)
Determine
The WAVELENGTH and other properties of the laser

13. In the case of dental lasers:
Hollow Waveguide
the laser light is delivered from the laser to the target tissue via:
a fiber-optic cable, hollow waveguide, or articulated arm
Articulated Arm

14. Laser Classification & Types

15. Classification
laser devices are classified according to:
their Potential To Cause Biological Damage, as follows:
Class 1 Safe under all reasonably laser pointers and
anticipated conditions of use supermarket UPC
scanners
Class 2 - Emits light in the visible laser printers and CD,
light spectrum DVD, and BD players
- It is presumed that the and readers
human blink reflex will be
sufficient to prevent
damaging exposure,
although prolonged
viewing may be dangerous

16. Class 3 - Produces light of such intensity that direct viewing Dental Argon Curing
of the beam can potentially cause serious harm. Light
- requires special training and eye protection
Class 4 - Produce high-powered light that is hazardous to Nearly all medical and
view at all times. dental lasers fall into
- Exposure to the eye or skin by both direct and this category
scattered laser beams of this intensity, even those
produced by reflection from diffusing surfaces,
must be avoided at all times

17. LASERS TYPES

18. LASERS TYPES
I. Based on wavelength
With a wave length around 632mm
1. Soft Soft lasers are lower power lasers. Eg: He
lasers Ne, Gallium arsenide laser
These are employed to relieve pain and
promote healing eg. In Apthous ulcers
Lasers with well known laser systems for
2.Hard
possible surgical application are called as
lasers
hard lasers. Eg: CO2, Nd: YAG, Argon,
Er:YAG etc.

19. LASERS TYPES excimer ='excited dimer'
‫ ومثار أي دٌمر مثار‬dimer ‫أختصار كلمتً دٌمر‬
II. Base don the type of active / lasing medium used ”‫والدٌمر ٌعنً "ثنائً الوحدات‬
193 nm 1. ArF excimer
248 nm 2. KrF excimer ‫لٌزر إكسٌمر‬
308 nm 3. XeCl excimer
351- 528 nm 4. Argon ion
(KTiOPO4) 5. KTP Potassium titanyl phosphate
694.3 nm 6. Ruby ‫ٌاقوت‬
1064 nm 7. Nd: YAG (neodymium-doped yttrium aluminum garnet
8. HO: YAG
9. YSGG
10. Er: YAG Erbium-doped yttrium aluminium garnet
11. CO2

20. Laser Interaction with Biologic Tissues

21. LASER can have four different interactions with a target tissue
،‫انتقال لطاقة اللٌزر مباشرة من خالل األنسجة‬
- weakening of energy ‫بدون أي تأثٌر على النسٌج المستهدف‬
‫نثر‬
Laser Effects on Tissue
‫انتقال‬
- Possible undesirable transfer of
heat to adjacent nontarget tissue
‫انعكاس‬
‫امتصاص‬
‫إعادة توجٌه الشعاع قبالة سطح‬
‫األنسجة، بدون أي تأثٌر على النسٌج‬
the interaction that is of primary interest ‫المستهدف‬

22. Absorption requires:
an absorber of light, termed a chromophore ‫حامل اللون‬
The primary chromophores in intraoral soft tissue are:
- Melanin
- Hemoglobin
- Water

23. LASER EFFECTS
1. Thermal effects:
2. Mechanical effects:
3. Chemical effects:

24. 1. Thermal effects:
The best known laser effect in dentistry is the thermal vaporization of tissue
by absorbing laser light i.e. the laser energy is converted into thermal energy
or heat that destroys the tissues
Tissue Temperature (° C ) Observed effect
Denaturation occurs ‫تمسخ‬
45° – 60° →
Coagulation and necrosis
>60° →
Water inside tissue Vaporizes
100° C →
Carbonization and later Phyrolysis with
300° C →
Vaporization of bulky tissues

25. Laser Selection for Orthodontic Applications

26. Selection of the most appropriate laser for orthodontic applications is
ideally determined by examining Four Important Factors:
- Procedure Specificity
‫ - سهولة التشغٌل‬Ease of Operation
‫ - القابلٌة للنقل‬Portability
- Cost

27. Many laser systems are available today ‫اختٌار اللٌزر لتطبٌقات تقوٌم األسنان‬
each with its own set of benefits and drawbacks
The most common lasers used in dentistry today are the :
- CO2 laser
- Nd:YAG laser
- Erbium lasers (Er:YAG and
Er,Cr:YSGG) - Each produces:- a different WAVELENGTH of light
- Diode laser - Generically named for the Active Medium
contained within the device

28. CO2 and Nd:YAG lasers
- Not Ideally suited for orthodontic applications
Hampered by:
their
- large size
- HIGH COST

29. ‫اإلربٌوم‬
Erbium lasers ً‫أحد عناصر الالنثٌنٌدات الفلزٌة األرضٌة النادرة ولونه فض‬
- extremely Popular in Dentistry today and
- hold the singular distinction of being:
Able to Perform both
Hard and Soft Tissue Procedures
Coast= 15000 $

30. seems most IDEAL for incorporation into the
‫لٌزر اشباه الموصالت‬ Diode laser
orthodontic specialty practice
A laser diode is a laser where the active medium is a semiconductor
similar to that found in a light-emitting diode

31. The Diode Laser
a The Active Medium A Solid-state Semiconductor, made of:
Aluminum, Gallium, Arsenide, and Occasionally Indium
aWavelengths 810 nm to 980 nm
Fall at The Beginning of the Near-infrared Electromagnetic
Spectrum and are Invisible to the Human Eye

32. The Diode Laser
Deliver laser energy - Fiber-optic cable or
a FIBEROPTICALLY, either by: - Disposable fiberoptic tip
a Absorbed Primarily by: Tissue Pigment (Melanin) and Hemoglobin
Poorly Absorbed by: Ablation Procedures Can Safely be Performed
a Tooth Structure and Metal in Close Proximity to:
- Enamel, Orthodontic Appliances, and
- Temporary Anchorage Devices
a Excellent soft tissue indicated for :incising, excising, and
surgical lasers coagulating gingiva and mucosa

33. Laser Safety
Protective Eyewear
Protection of Nontarget Tissue
Protection of infection

34. While most dental lasers are relatively simple to use
Certain Precautions should be taken to ensure
their safe and effective operation

35. Only authorized persons who have received training in the proper operation
of the laser equipment shall work with such equipment
Laser HAZARDS may be listed as follows:
• Optical
• Nontarget oral tissue
• Skin
• Chemical
• Fire
• Other collective hazards

36. • Of extreme importance is the use of:
Protective Eyewear
by ANYONE in the vicinity of the laser while it is
in use: ‫قُرب‬
- the doctor,
- chairside assistants,
- the patient, and
- any observers such as family or friends

37. It is CRITICAL that all Protective Eyewear worn is Wavelength-Specific
Consequently,
- Sunglasses or
- Safety glasses designed for use with
visible dental curing lights are:
- INEFFECTIVE at protecting the eye from
potentially irreversible damage as a result of
exposure to dental laser light

38. Accidental Exposure of Nontarget Tissue Can be Prevented by:
Limiting access to the surgical Attention is Required to focus the beam onto the target
environment tissue and avoid accidently damaging adjacent tissues
Minimizing reflective surfaces - Glass mirrors should not be used because they absorb
heat from the laser energy and may shatter.
- Stainless steel or Rhodium mirrors may be used
safely, providing measures are taken to minimize
possible unwanted reflection
- Dull, Nonreflective, or matte-finished instruments
should be employed
- Surfaces that minimize specular reflections, including
exposed watches and jewelry
Ensuring that the laser is in good working order with all manufactured safeguards in place
Parallel monitoring of the adjacent tissues by all dental staff present at the time of
treatment is to be ensured

39. To prevent possible exposure to infectious pathogens:
- High-volume suction should be used to
evacuate any vapor plume created during
tissue ablation, and
- Normal infection protocols should be
followed

40. CONTROL MEASURES
Requirements and recommendations for laser safety
- Use of protective eyewear by anyone in the vicinity of the laser
- Limit access to the surgical environment
- Minimize reflective surfaces
- Ensure that the laser is in good working order
- Ensure all manufacturer safeguards are in place
- Use of high-volume suction
- Follow normal infection control protocols
- Designated staff member as Laser Safety Officer
- Staff training

41. Diode Laser Setup
Fiber Preparation Basic Power Settings

42. Fiber Preparation
The diode laser transmits laser light from the laser to the target tissue via
or
a fiber-optic cable
disposable fiber-optic tip
400-micron
‫سهل التفتٌت‬
ْ َ
a 400-micron optical fiber is recommended,
as smaller diameter fibers tend to be more
In the case of a fiber-optic cable
friable and breakable

43. Fiber Preparation ‫ٌجب إزالة جزء كاف من الكسوة الخارجٌة الواقٌة‬
Prior to use
- A sufficient portion of protective
outer cladding must be removed
with:
an appropriately sized Stripping Device
in order to expose the inner glass fiber
The amount of outer cladding removed is determined by:
- the LENGTH of the HANDPIECE
supplied with the laser,
such that any exposed fiber is
completely contained within the
handpiece

44. Then
- The fiber is inserted into the handpiece, and
- a disposable plastic tip is fitted over the fiber
tip and placed on the end of the handpiece,
leaving approximately 3 mm of fiber exposed
Before each patient use:
- 2-3 mm is cut off the end of the fiber with
ceramic scissors or a cleaving stone in order
to avoid cross-contamination

45. The fiber tip is then “INITIATED” by placing some form of
PIGMENT on the end of the fiber in order to create a hyper-focus
of usable laser energy at the tip
One of the most effective ways
to deposit pigment on the tip is:
to lightly tap the end of the fiber onto a sheet
of articulating film while the laser is activated
uninitiated tip will fail to focus enough energy
at the end of the fiber to adequately ablate
tissue

46. Basic Power Settings

47. the Academy of Laser Dentistry recommends:
using the Least Amount of Power
To prevent collateral thermal damage to adjacent tissue:
Power Settings Procedure
1.2 watts For most soft tissue ablation Result in excellent tissue
removal with minimal
procedures° →
thermal degeneration of
1.4 watts Areas of denser tissue, such as adjacent tissue
the palate and the fibrous tissue
distal to the lower second molars
1.6 watts Frenectomy

48. Surgical Procedure
Anesthesia

49. Adequate soft tissue anesthesia required for laser-assisted tissue removal
Anesthesia
Application of a compounded Topical Anesthetic Gel such as: In most cases
Profound PET (prilocaine 10%, lidocaine 10%,
tetracaine 4%, and
phenylephrine 2%)
3 – 4 minutes
Produces profound
anesthesia in a relatively
Denser Tissue short amount of time
- Distal of an erupting lower second molar
injection of local anesthetic solution
- Palate

50. Surgical Procedure
The operator activates the laser with a foot pedal and gently moves the
tip of the fiber across the target tissue in a lightcontact mode

51. Surgical Procedure
- Careful attention must be paid
to the interaction of the laser
energy with the target tissue
Leaving the fiber tip in one spot too long will result in:
- CARBONIZATION and
- unnecessary collateral damage,
While moving the tip too quickly will result in:
- an insufficient absorption of energy to produce ablation

52. Surgical Procedure
During the procedure,
it is imperative that high-volume aspiration is used to:
- Evacuate vapor plume and objectionable odors at the
site of ablation
Once satisfactory tissue removal has been
achieved:
- any remnants of slightly carbonized
tissue remaining at the surgical
margins are removed with light
pressure using a micro-applicator
brush soaked in
3% hydrogen peroxide solution

53. Clinical Applications

54. Clinical Applications in ORTHODONTICS
Specific procedures include :

55. Exposure of Unerupted and Partially Erupted Teeth

56. Exposure of Unerupted and Partially Erupted Teeth
Lengthy orthodontic treatment times are often the result of:
- Delayed eruption of teeth
- compromised Bracket Positioning due to gingival
interference

57. Exposure of Unerupted and Partially Erupted Teeth
Using the diode laser
both unerupted and partially erupted teeth
can be :
- exposed for bonding, and
- tissue interfering with ideal bracket
placement can be removed

58. Canine exposure
Canine exposure in labial sulcus
Canine exposure on palatal aspect

59. Canine exposure in labial sulcus
Labially erupting canines are: Common Malocclusion
Conventional exposure
with scalpel based method leads to:
- Extensive bleeding and
- the field of operation requires special hydrophilic
moisture insensitive primers to bond orthodontic
attachments

60. The use of a 810 nm diode laser ensures:
- Easy exposure with Minimal Bleeding and
- least patient discomfort
The Clear Bloodless Field ensures
Fast Predictable Bonding
Enabling fast correction of malocclusion

61. Canine exposure on palatal aspect
Palatally impacted canines are Difficult Situation requiring:
- surgical raising of
an extensive
MUCOPERIOSTEAL FLAP
- Sutures at the end and
- an extensive postoperative
discomfort and swelling

62. Diode laser allows:
- exposure without any extensive flap
and
- generally no sutures are required
after the procedure
- The patient experiences minimal pain or discomfort
- In addition, a Bloodless Field
ensures instant bonding of
orthodontic attachment

63. Frenectomies

64. A high or thick labial frenum is often of concern
when the attachment:
- Causes a midline diastema or
- Exerts a traumatic force on the marginal
gingiva
Laser permit :
PAINLESS excision of frena, without
- Bleeding,
- Sutures,
- Surgical packing, or
- Special postoperative care
Typical power settings:
1.4 to 1.6 watts in continuous wave mode

65. Frenectomy for midline diastema correction
It is an accepted Contemporary View that:
- Midline Diastema first should be Corrected with orthodontics and THEN
- Frenectomy so that
Scarring that results after conventional scalpel
based frenectomy doesn’t interfere with tooth
movement

66. With a diode laser:
Frenectomy can be done
or
BEFORE complete closure AFTER
Healing of laser wound doesn’t involve any scarring

67. Miscellaneous Tissue Removal

68. Removal of Odontome
in maxillary anterior region preventing eruption of permanent incisor

70. Replacing the need for aTissue Punch when placing MINISCREWS in unattached gingiva

71. Aesthetic Gingival Recontouring

72. Orthodontic fixed appliances good oral hygiene maintenance
In many cases we notice Gingival Hyperplasia

73. The gingival margins of the upper central incisors
and upper cuspids should be:
- approximately level with each other and
- slightly superior to the gingival margins of the
upper lateral incisors
With: Uneven Gingival Contours causing some
teeth to:
appear too short and others to appear too long

74. Such enlargement
further impedes good hygiene and is commonly associated with bleeding

75. Gingival aesthetics play
A VITAL ROLE in the appearance of a finished orthodontic case
- Excessive gingival display - significantly diminish the
- Uneven gingival contours, and aesthetic value of even the
- Disproportionate crown heights and widths most perfectly aligned
teeth

76. Diode laser can be used effectively in such situations
Gingivoplasty

77. Removal of Inflamed and Hypertrophic Tissue

78. assisted salvaging of orthodontic microimplant
‫إنقاذ‬ inflammation of tissue around the implant
A diode laser was used at 0.5 W to:
- decontaminate and allow healing of tissue around microimplant
The implant survived and served its orthodontic purpose

79. Laser-assisted circumferential supracrestalmfibrotomy/ LACSF/ pericision
Control of Tooth Rotation correction in orthodontics from relapse is always a challenge
Permanent lingual bonded retention is essential
It is also suggested to do
Circumferential Supracrestal Fibrotomy
Allow
Elastic Fibres to reorganize favorably without
causing relapse of correction
Conventional scalpel-assisted CSF
- associated with bleeding and
- requires infiltration anaesthesia.

80. A diode laser can also be used as Low Level Therapy
during Orthodontic Tooth Movement
especially during
a situation where
Heavy Orthopedic Forces
are applied as in
Rapid Maxillary Expansion

81. Finally
‫ضرورة دراج اللٌزر فً الممارسة الروتٌنٌة لتقوٌم‬
‫األسنان‬
The incorporation of lasers in routine orthodontic
practice is the order of the day
The practices that embrace this technology will surely flourish
‫الممارسات التً تبنً هذه التكنولوجٌا ســــــــوف تزدهر بالتأكٌد‬