Dental laser

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A dental laser is a type of laser designed specifically for use in oral surgery or dentistry.

Contents

In the United States, the use of lasers on the gums was first approved by the Food and Drug Administration in the early 1990s, and use on hard tissue like teeth or the bone of the mandible gained approval in 1996. [1] Several variants of dental lasers are in use with different wavelengths and these mean they are better suited for different applications.

Soft tissue lasers

Diode lasers wavelengths in the 810–1,100 nm range are poorly absorbed by the soft tissues [3] [4] [5] [6] [7] such as the gingivae, and cannot be used for soft tissue cutting or ablation. [4] [5] [7] [8] Instead, the distal end of diode's glass fiber is charred (by burned ink or by burned corkwood, etc.) and the char is heated by the 810-1,100 nm laser beam, which in turn heats up the glass fiber's tip. [6] [8] The soft tissue is cut, on contact, by the hot charred glass tip and not by the laser beam itself. This is used for variety of oral surgery procedures such as gingivectomy, frenectomy, treatment of pericoronitis, and exposure of superficially impacted teeth. [9] This method was primarily used by the Michigan school of dentistry . [6] [8]

Similarly Nd:YAG lasers are used for soft tissue surgeries in the oral cavity, such as gingivectomy, periodontal sulcular debridement, LANAP, frenectomy, biopsy, and coagulation of graft donor sites. The Nd:YAG laser wavelength are partially absorbed by pigment in the tissue such as hemoglobin and melanin. [10] These lasers are often used for debridement and disinfection of periodontal pockets. Their coagulative ability to form fibrin allows them to seal treated pockets.

The CO2 laser remains the best surgical laser for the soft tissue where both cutting and hemostasis is achieved photo-thermally (radiantly). [3] [6] [7] [8]

Soft and hard tissue lasers

Erbium lasers are both hard and soft tissue capable. [11] They can be used for a host of dental procedures, and allow for more procedures to be done without local anaesthesia. Erbium lasers can be used for hard tissue procedures like bone cutting and create minimal thermal and mechanical trauma to adjacent tissues. These hard tissue procedures show an excellent healing response. [12] Soft tissue applications with erbium lasers feature less hemostasis and coagulation abilities relative to the CO2 lasers. Er,Cr:YSGG laser was found to be effective in gum de-pigmentation. [13] The new CO2 laser operating at 9,300 nm features strong absorption in both soft and hard tissue and is the newest alternative to erbium lasers. [14] The 9,300 nm laser ablates hard tissue in excess of 5,000 °C, which often results in extremely bright thermal radiation. [15]

Dental caries removal

In September 2016, the Cochrane collaboration published a systematic review of the current evidence comparing the use of lasers for caries removal, in both deciduous and adult teeth, with the standard dental drill. [16] The authors reviewed nine trials published between 1998 and 2014, with 662 participants in total. These included three different types of laser: Er:YAG; Er,Cr:YSGG; and Nd:YAG. Overall, the quality of the evidence available was found to be low, and the authors were unable to recommend one method of caries removal over the other. There was no evidence of a difference between the marginal integrity or durability of the restorations placed. However, there was some evidence that the laser produced less pain and required less anesthesia than the drill. The authors concluded that more research is required.

Cost of lasers

Use of the dental laser remains limited, with cost and effectiveness being the primary barriers. The cost of a dental laser ranges from $4,000 to $130,000, where a pneumatic dental drill costs between $200 and $500. Hard tissue lasers are incapable of performing some routine operations in the treatment of cavities. [17]

Benefits of lasers

Dental lasers are not without their benefits, though, as the use of a laser can decrease morbidity after surgery, and reduces the need for anesthetics. Because of the cauterisation of tissue there will be little bleeding following soft tissue procedures, and some of the risks of alternative electrosurgery procedures are avoided. Additionally, the use of dental lasers is associated with less vibration and a more favorable noise profile when compared to pneumatic dental drills. [18]

History

Kumar Patel made the first CO2 laser in 1964, in the same year the Nd:YAG Laser was invented at Bell Labs. [19]

See also

Related Research Articles

<span class="mw-page-title-main">Erbium</span> Chemical element with atomic number 68 (Er)

Erbium is a chemical element; it has symbol Er and atomic number 68. A silvery-white solid metal when artificially isolated, natural erbium is always found in chemical combination with other elements. It is a lanthanide, a rare-earth element, originally found in the gadolinite mine in Ytterby, Sweden, which is the source of the element's name.

<span class="mw-page-title-main">Laser diode</span> Semiconductor laser

A laser diode is a semiconductor device similar to a light-emitting diode in which a diode pumped directly with electrical current can create lasing conditions at the diode's junction.

<span class="mw-page-title-main">Nd:YAG laser</span> Crystal used as a lasing medium for solid-state lasers

Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12) is a crystal that is used as a lasing medium for solid-state lasers. The dopant, neodymium in the +3 oxidation state, Nd(III), typically replaces a small fraction (1%) of the yttrium ions in the host crystal structure of the yttrium aluminum garnet (YAG), since the two ions are of similar size. It is the neodymium ion which provides the lasing activity in the crystal, in the same fashion as red chromium ion in ruby lasers.

<span class="mw-page-title-main">Carbon-dioxide laser</span> Form of gas laser

The carbon-dioxide laser (CO2 laser) was one of the earliest gas lasers to be developed. It was invented by Kumar Patel of Bell Labs in 1964 and is still one of the most useful types of laser. Carbon-dioxide lasers are the highest-power continuous-wave lasers that are currently available. They are also quite efficient: the ratio of output power to pump power can be as large as 20%. The CO2 laser produces a beam of infrared light with the principal wavelength bands centering on 9.6 and 10.6 micrometers (μm).

<span class="mw-page-title-main">Yttrium aluminium garnet</span> Synthetic crystalline material of the garnet group

Yttrium aluminium garnet (YAG, Y3Al5O12) is a synthetic crystalline material of the garnet group. It is a cubic yttrium aluminium oxide phase, with other examples being YAlO3 (YAP) in a hexagonal or an orthorhombic, perovskite-like form, and the monoclinic Y4Al2O9 (YAM).

<span class="mw-page-title-main">Laser ablation</span> Process that removes material from an object by heating it with a laser

Laser ablation or photoablation is the process of removing material from a solid surface by irradiating it with a laser beam. At low laser flux, the material is heated by the absorbed laser energy and evaporates or sublimates. At high laser flux, the material is typically converted to a plasma. Usually, laser ablation refers to removing material with a pulsed laser, but it is possible to ablate material with a continuous wave laser beam if the laser intensity is high enough. While relatively long laser pulses can heat and thermally alter or damage the processed material, ultrashort laser pulses cause only minimal material damage during processing due to the ultrashort light-matter interaction and are therefore also suitable for micromaterial processing. Excimer lasers of deep ultra-violet light are mainly used in photoablation; the wavelength of laser used in photoablation is approximately 200 nm.

<span class="mw-page-title-main">Er:YAG laser</span>

An Er:YAG laser (erbium-doped yttrium aluminium garnet laser, erbium YAG laser) is a solid-state laser whose active laser medium is erbium-doped yttrium aluminium garnet (Er:Y3Al5O12). Er:YAG lasers typically emit light with a wavelength of 2940 nm, which is infrared light.

Epulis fissuratum is a benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture. More simply, epulis fissuratum is where excess folds of firm tissue form inside the mouth, as a result of rubbing on the edge of dentures that do not fit well. It is a harmless condition and does not represent oral cancer. Treatment is by simple surgical removal of the lesion, and also by adjustment of the denture or provision of a new denture.

Laser surgery is a type of surgery that uses a laser to cut tissue.

Laser lithotripsy is a surgical procedure to remove stones from urinary tract, i.e., kidney, ureter, bladder, or urethra.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

<span class="mw-page-title-main">Frenectomy</span> Surgical removal of a frenulum

A frenectomy is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far. It can refer to frenula in several places on the human body. It is related to frenuloplasty, a surgical alteration in a frenulum. Done mostly for orthodontic purposes, a frenectomy is either performed inside the middle of the upper lip, which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy is a very common dental procedure that is performed on infants, children, and adults. A similar procedure frenulotomy is where a tight frenulum may be relieved by making an incision in the tight tissue.

A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

Laser-assisted new attachment procedure (LANAP) is a surgical therapy for the treatment of periodontitis, intended to work through regeneration rather than resection. This therapy and the laser used to perform it have been in use since 1994. It was developed by Robert H. Gregg II and Delwin McCarthy.

Photorejuvenation is a skin treatment that uses lasers, intense pulsed light, or photodynamic therapy to treat skin conditions and remove effects of photoaging such as wrinkles, spots, and textures. The process induces controlled wounds to the skin. This prompts the skin to heal itself, by creating new cells. This process—to a certain extent—removes the signs of photoaging. The technique was invented by Thomas L Roberts, III using CO2 lasers in the 1990s. Observed complications have included scarring, hyperpigmentation, acne, and herpes.

A dopant is a small amount of a substance added to a material to alter its physical properties, such as electrical or optical properties. The amount of dopant is typically very low compared to the material being doped.

<span class="mw-page-title-main">Laser medicine</span>

Laser medicine is the use of lasers in medical diagnosis, treatments, or therapies, such as laser photodynamic therapy, photorejuvenation, and laser surgery.

Laser gingivectomy is a dental procedure that recontours or scalpels the gingival tissue to improve long term dental health or aesthetics. Compared to conventional scalpel surgery, soft-tissue dental lasers, such as laser diode, Nd:YAG laser, Er:YAG laser, Er,Cr:YSGG laser, and CO2 lasers, can perform this procedure, offering a precise, stable, bloodless, often less painful, and accelerated healing experience. However, the laser diode gained more popularity due to its versatility, less interaction with hard tissue, ease of use, and the less expensive set up.

Cyclodestruction or cycloablation is a surgical procedure done in management of glaucoma. Cyclodestruction reduces intraocular pressure (IOP) of the eye by decreasing production of aqueous humor by the destruction of ciliary body. Until the development of safer and less destructive techniques like micropulse diode cyclophotocoagulation and endocyclophotocoagulation, cyclodestructive surgeries were mainly done in refractory glaucoma, or advanced glaucomatous eyes with poor visual prognosis.

References

  1. ↑ Lewis, Ph.D., Ricki (January 1995). "Lasers in Dentistry". FDA Consumer Magazine. Archived from the original on 2007-07-13. Retrieved 2007-07-21.
  2. ↑ Winter, Richard B. (June 2017). "Practical Laser Applications in General Practice". Dentistry Today. 36 (6): 78, 80, 82–83. ISSN   8750-2186. PMID   29231673 . Retrieved 2019-12-16.
  3. 1 2 Wright, V. Cecil; Fisher, John C. (1993-01-01). "Qualitative and quantitative tissue effects of light from important surgical lasers". Laser Surgery in Gynecology: A Clinical Guide. Saunders. pp.  58–81. ISBN   9780721640075.
  4. 1 2 Vogel, Alfred; Venugopalan, Vasan (2003-02-12). "Mechanisms of Pulsed Laser Ablation of Biological Tissues". Chemical Reviews. 103 (2): 577–644. doi:10.1021/cr010379n. PMID   12580643.
  5. 1 2 Willems, Peter W.A.; Vandertop, W. Peter; Verdaasdonk, Rudolf M.; van Swol, Christiaan F.P.; Jansen, Gerard H. (2001-04-01). "Contact laser-assisted neuroendoscopy can be performed safely by using pretreated 'black' fibre tips: Experimental data". Lasers in Surgery and Medicine. 28 (4): 324–329. doi:10.1002/lsm.1057. ISSN   1096-9101. PMID   11344512.
  6. 1 2 3 4 Romanos, G. "Diode Laser Soft-Tissue Surgery: Advancements Aimed at Consistent Cutting, Improved Clinical Outcomes". cced.cdeworld.com. Retrieved 2016-04-05.
  7. 1 2 3 Shapshay, S. M.; Fisher, JC (1987-06-16). "Basic laser physics and interaction of laser light with soft tissue". Endoscopic Laser Surgery Handbook. CRC Press. pp. 1–130. ISBN   9780824777111.
  8. 1 2 3 4 Levine, Robert; Vitruk, Peter (2015-09-01). "Laser-Assisted Operculectomy". Compendium of Continuing Education in Dentistry. 36 (8): 561–567, quiz 568. ISSN   2158-1797. PMID   26355439.
  9. ↑ Borzabadi-Farahani, A. (2022). "A Scoping Review of the Efficacy of Diode Lasers Used for Minimally Invasive Exposure of Impacted Teeth or Teeth with Delayed Eruption". Photonics. 9 (4). doi: 10.3390/photonics9040265 .
  10. ↑ dentalcare.com (June 2012), Lasers in Dentistry: Minimally Invasive Instruments for the Modern Practice (PDF), dentalcare.com Continuing Education, archived from the original (PDF) on 2014-02-01, retrieved 2014-01-25
  11. ↑ Technology 4 Medicine (January 2014), Erbium and Nd:YAG Lasers, Laser Dental Boynton{{citation}}: CS1 maint: numeric names: authors list (link)
  12. ↑ Sasaki, Katia M.; Aoki, Akira; Ichinose, Shizuko; Yoshino, Toshiaki; Yamada, Sachiko; Ishikawa, Isao (June 2002). "Scanning electron microscopy and Fourier transformed infrared spectroscopy analysis of bone removal using Er:YAG and CO2 lasers". Journal of Periodontology. 73 (6): 643–652. doi:10.1902/jop.2002.73.6.643. ISSN   0022-3492. PMID   12083538.
  13. ↑ Seker, Basak Kusakci (2018). "Treatment of gingival melanin hyperpigmentation with Er,Cr:YSGG laser: Short-term follow-up of patient". Journal of Cosmetic and Laser Therapy. 20 (3): 148–151. doi:10.1080/14764172.2017.1288256. PMID   28166448.
  14. ↑ Fantarella, David; Kotlow, L (2014). "The 9.3-µm CO2 Dental Laser: Technical Development and Early Clinical Experiences" (PDF). J Laser Dent. 22 (1): 10–27. Archived from the original (PDF) on 2015-02-05. Retrieved 2016-04-05.
  15. ↑ "Laser Surgery Basics - American Laser Study Club". American Laser Study Club. Retrieved 2018-05-04.
  16. ↑ Montedori, Alessandro; Abraha, Iosief; Orso, Massimiliano; D'Errico, Potito Giuseppe; Pagano, Stefano; Lombardo, Guido (2016-09-26). "Cochrane Database of Systematic Reviews". Cochrane Database of Systematic Reviews. 9: CD010229. doi:10.1002/14651858.cd010229.pub2. PMC   6457657 . PMID   27666123.
  17. ↑ Gordon, Jerry. "How Cavities and Fillings Work". HowStuffWorks.com. Retrieved 2007-07-21.
  18. ↑ Takamori, Kazunori; Furukawa, Hirohiko; Morikawa, Yoshikatsu; Katayama, Tadashi; Watanabe, Shigeru (2003). "Basic study on vibrations during tooth preparations caused by high-speed drilling and Er:YAG laser irradiation". Lasers in Surgery and Medicine. 32 (1). Wiley: 25–31. doi:10.1002/lsm.10140. ISSN   0196-8092.
  19. ↑ "A brief history of lasers" (PDF). Archived from the original (PDF) on 2014-06-11. Retrieved 2014-06-16.
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