Lasers in dentistry./ dental education in india

LASERS in DENTISTRY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

INTRODUCTION
L A S E R – light amplification of stimulated emission
of radiation, is a form of electromagnetic energy in
which photons are generated from a medium by
stimulating the medium from external energy source.
Emergence : 1960
First use in clinics : 1980
Today available in different wavelengths.

ADVANTAGES
Excellent visibility.
Reduced operating time.
Reduced post operative sequelae.
Negotiates curves and folds in oral cavity.
Vaporize, coagulate or cut tissue.
Pain is reduced 90% of the time.
Portable and less expensive newer models
Patient’s high acceptance.

HISTORY
 Early 1900 – Quantum mechanics by Bohr
Einstein's atomic theory.
 1950 – Townes first amplified microwave
frequencies.
 1960 – Maiman developed first laser or Maser.
 1960 – Pulsed Ruby laser(0.694 µm).
 1961 – Neodymium laser by Snitzer.
HAD DENTAL RESEARCHERS FOCUSSED ON Nd. LASER SOONER,
LASER DENTISTRY MAY HAVE PROGRESSED TO ITS PRESENT
STATUS 10 YRS EARLIER
.

LASER PHYSICS
L ight A mplified by S timulated E mission of R adiation.
LASER light is Monochromatic and finely focused.
Collimation and Coherency makes it unique.
Collimation: constant beam size and shape.
Coherency: waves with identical amplitude and
identical frequency.

An Atom at excited state releases photon.
QUANTUM THEORYQUANTUM THEORY

EINSTEIN’S THEORY
An energized atom can absorb additional energy
to release 2 identical coherent photons, these
photons energizes more atoms and releases more
photons resulting in amplification of light energy.

Dental lasers have emission wavelengths of
500µm – 10,600µm.
All dental lasers emit either visible light beam or an
invisible infra red light beam.
Dental lasers are named after the chemical elements/ compounds
that compose the medium.
- Gas :- argon / co2
- Solid crystal rod :- Al, Arsenide,
Garnet, Yttrium,
-Added elements :- Cr, Nd, Ho, Erbium.

ANATOMY OF LASER UNIT
 LASER CHAMBER IS CALLED – “CAVITY”.
 M1- PARTIALLY REFLECTIVE MIRROR.
 M2 - TOTALLY REFLECTIVE MIRROR.
 EXTERNAL SOURCE OF ENERGY IS CALLED PUMPING.

LASER DELIVERY SYSTEM
FLEXIBLE HOLLOW WAVE GUIDE TUBE
It has interior mirror finish.
Laser energy reflected along this tube strikes the tissue in non contact
fashion.
GLASS FIBER OPTIC CABLE
Glass fiber is encased in a resilient sheath.
Cannot be bent into sharp angle.
fiber fits snugly into hand piece protruding at the tip or sometimes with
attached glass tip.
Used in contact fashion.

EMISSION MODE
1. CONTINUOS WAVE MODE.
Beam is emitted at one power level
continuously as the foot switch is
pressed.
2. GATED PULSE MODE.
Periodic on and off by the
mechanical shutter in front of a
continuous wave laser at a duration
of few milli seconds.
3. FREE RUNNING PULSE MODE.
High energy of laser light is emitted
for a few micro seconds followed by a
relative long time gap.
This is computer controlled.

PRINCIPLE OF EMISSION
Light energy strikes tissue for a certain length
of time producing thermal interaction, then a
time gap for the tissue to cool before the next
pulse of laser energy is emitted.

LASERS USED IN DENTISTRY
LASERLASER λλ LASERLASER λλ
ArgonArgon 488-514 nm488-514 nm Nd:YAPNd:YAP 1.34 µm1.34 µm
DiodeDiode 600-908 nm600-908 nm Ho:YAGHo:YAG 2.12 µm2.12 µm
He-NeHe-Ne 632 nm632 nm Er:YSGGEr:YSGG 2.79 µm2.79 µm
RubyRuby 694.3 nm694.3 nm Er:YAGEr:YAG 2.94 µm2.94 µm
Nd:YLFNd:YLF 1.053 µm1.053 µm COCO22
9.3,10.6 µm9.3,10.6 µm
Nd:YAGNd:YAG 1.064 µm1.064 µm XeFXeF 0.351 µm0.351 µm

Application of Lasers in Dentistry:
Application Possible Laser Types
Basic research
Laser tissue interaction
Technical development of applications
of lasers in dentistry
All types
All types
Measurement and diagnosis
Holography
Laser Doppler flowmetry
Spectroscopy (caries diagnosis)
He Ne, diodes
He Ne, diodes
Various types

Oral and Maxillofacial Surgery
Cutting and Coagulation
Photodynamic therapy
CO2, Nd: YAG, Ar, dye
Dye, Au-Cu vapour
Conservative dentistry
Preventive dentistry (fissure sealing)
Caries treatment
Composite resin light Curing
Tooth surface conditioning
CO2, Nd:YAG, ruby
CO2, Nd:YAG, Er: YAG, Excimer
Ar, dye, HeCd
Excimer, CO2, Nd:YAG, Er:YAG
Endodontics
Root canal treatment
Apicoectomy
Nd: YAG, CO2, Excimer
CO2, Nd:YAG

Periodontics
Laser sealing of affected root surfaces
Excision of gingival soft tissues
CO2, excimer
CO2
Analgesic effect and bio-stimulation
Stimulation of wound healing
Low power laser radiation with analgesic
Effects
He Ne, diodes
Nd: YAG

Application of Lasers in
Prosthodontics
Removable Prosthetic reconstruction
1.Treatment of unsuitable alveolar ridges
2.Surgical treatment of unsupported soft tissues
3.Enlarged tuberosity
4.Surgical treatment of tori & exostoses.
5.Soft tissue lesions

Prosthodontics
Fixed Partial dentures
1.Remove excess or intrusive tissue relative tissue relative to
restorative margins.
2.To enhance esthetics of a pontic space.
3.To establish increased clinical crown length.
4.Laser gingival retraction

Prosthodontics
Dental Implantology
1.Welding of titanium framework on multiple implants
2.Salvaging ailing implants by decontaminating their surface
with laser energy.

Other applications:
Laser processing of dental materials
Welding of dental alloys
Cobalt – chrome – molybdinum
Nickel – chrome – aluminum
Silver Palladium
Titanium alloys
Welding of ceramic materials
Still under investigation

LASER SAFETY IN DENTAL PRACTICE
A Responsibility that is shared by a Dentist,
Educator, Manufacturer and scientist, each having
a role from design and development to practical
application.
Given the proper training and appropriate
precautions, lasers may be used safely for the
mutual benefit of both the patient and the dentist.

CDRH – Center for Devices and Radiological
Health.
ANSI – American National Standards Institute.
OSHA – Occupational Safety and Health
Administration.

LASER HAZARD CLASSIFICATION
– ANSI & OSHA
CLASSCLASS DESCRIPTIONDESCRIPTION
II Low poweredLow powered lasers that are safe to view.lasers that are safe to view.
IIaIIa Low powered visibleLow powered visible lasers that are hazardous when viewedlasers that are hazardous when viewed
directly for longer than 1.000 sec.directly for longer than 1.000 sec.
IIII Low powered visibleLow powered visible lasers that are hazardous when viewedlasers that are hazardous when viewed
for longer than 0.25 secfor longer than 0.25 sec
IIIaIIIa Medium powered laserMedium powered laser or systems that are non hazardous ifor systems that are non hazardous if
viewed for less than 0.25 sec with out magnifying optics.viewed for less than 0.25 sec with out magnifying optics.
IIIbIIIb Medium poweredMedium powered lasers (lasers (0.5 w0.5 w) are hazardous if viewed) are hazardous if viewed
directly.directly.
IVIV High poweredHigh powered laserslasers(>0.5 w)(>0.5 w) produce ocular,skin and fireproduce ocular,skin and fire
hazards.hazards.

According to CDRH and ANSI system of classification CLASS
IV are Potentially Hazardous from either direct or diffuse
reflection.
They emit power greater than 5 w.
HAZARDS ENCOUNTERED IN CLINICAL PRACTICE
1. OCCULAR INJURY.
2. TISSUE DAMAGE.
3. RESPIRATORY HAZARDS.
4. COMBUSTION & ELECTRICAL HAZARDS.

LASER SAFETY OFFICER (L.S.O.)
Identifies and assess the Hazard .
Determines the potential hazard zone.
Establishes standard operating procedures.
Approves use of protective equipment.
Ensures safety of all persons within the operating
field.

SAFETY RECOMMENDATIONS
All class IV Dental lasers are potentially hazardous.
Manufacturer safety precautions must be followed.
Fire and electric hazards can be avoided by
• Dry floor.
• Soaking surgical drapes and gauze in sterile saline.
• Avoid flammable liquids and gases.
Personal protective equipment.
• Safety goggles
• Mouth masks
• High vacuum evacuation
• Re-circulatory air filter system
• Proper ventilation

CONCLUSION
WITH THE NEED FOR,
▪ Fiber optic delivery system.
▪ Multitude wavelengths and pulse widths.
▪ Economical devices.
LASER TODAY OFFERS DENTIST NOT ONLY A
WINDOW BUT A DOOR INTO THIS HI-TECH,
REWARDING AND POTENTIALLY
PROFITABLE ARENA.

For more details please visit
www.indiandentalacademy.comwww.indiandentalacademy.com

Lasers in dentistry./ dental education in india

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