LASERS IN ENDODONTICS AND CONSERVATIVE DENTISTRY

 An acronym for Light Amplification by
the Stimulated Emission of Radiation..

 A device that creates a uniform and
coherent light that is very different from
an ordinary light bulb.

dr. Blagoja Lazovski 2

 Also can be described as a device for
generating a high-intensity, ostensibly
parallel beam of monochromatic(single
wavelength) electromagnetic radiation.

 Laser light can be focused down to a
tiny spot as small as a single wavelength.


 The possibility of stimulated emission
predicted by Einstein-1917..

 Based on work of Gordon in 1955 &
Schawlow n Townes in 1958, MAIMAN
created the 1st operatinal laser in 1960, a
ruby laser emitting a brillant red beam of
light..


 photo of the development of the helium-
neon laser taken at AT&T's Bell
Laboratories in 1964.


 Basic components..
 An ACTIVE LASING MEDIUM :-
- cn be a solid, liquid or gas
 Enclosed within a LASER CAVITY
bounded by two perfectly parallel
reflectors(mirrors)
 PUMP SOURCE – high energy radiation
pumped into the active medium


 POPULATION INVERSION :-
condition when energyfrom pump
source is absorbed by active medium
until the majority of atoms, ions or
molecules are raised to their upper
energy state..

 And this condition is NECESSARY to
generate laser light..


 TWO PARALLEL REFLECTORS – situated at
end of laser cavity act to constarin light
along n within the axis of cavity..
 So light is repeatedly bounced b/w the
reflectors
 One of the mirrors is only partially
reflective, enabling some of the light to
escape the cavity as a beam of laser
light..


 Working of laser


 Processing of matter without contact.

 High working speed

 Outstanding precision


 Soft, quiet, vibration-free operation

 As fast as the high-speed turbine

 CO2 laser cuts and coagulates soft tissue
without bleeding

 No risk of cross-infection


 Sterilization of operating field

 Fewer cracks than with turbine

 Multiple quadrant dentistry

 No need for etching

 Pulsing minimizes charring and thermal
necrosis

Lasers are still in the pioneering stage, but
there are many current uses..

There are three types of Dental lasers:
 Surgical Laser (soft tissue)
 Curing Laser
 Tooth Laser (hard tissue)


This laser replaces
traditional surgery for
many gum and soft
tissue dental
applications and is
gentler than
traditional surgical
procedures.
This laser used for :
 Improve treatment
results for gum
disease
 Contour gums for
smile enhancement
 Surgically correct
oral abnormalities


 Surgically assist in arresting herpes lesions
and canker sores
 Assist in biopsies
 Treat infant tongue/frenum problems which
can hinder proper chewing/sucking
 Treat child/adult frenum problems which
can cause speech impediments, gum
disease, and teeth to grow apart rather
than together


 This laser spectrum
light source is used
for rapid teeth
whitening and
placing all tooth-
colored restorations
(fillings) and repair
procedures.
 Bonds created by
this advanced
instrument result in
dentistry that is twice
as strong !


 The light source increases gradually during
the curing process to create the best bond
available in dentistry today.
 Appointment length is also reduced
because it is 500% more powerful than
standard equipment.
 Less than 1% of dental offices nationwide
have this instrument, making it one of the
newest tools in dentistry..


 TOOTH LASER (hard tissue)
Third type of laser is used to remove
cavities. But since this laser cannot be
used on existing metal fillings, we use
micro dentistry..

 MICRO DENTISTRY
one of the greatest advancements in
the field of dentistry.
 offers the ultimate flexibility and
capability. It is also the most tooth
conservative dentistry available.


 About 50% of
cavities are
candidates for this
technique and
there is no drilling,
no needle, no extra
fee, and no pain!
 And because this
process is so
efficient, it reduces
appointment
length.


 Desensitize exposed root surfaces

 Diagnosis of non-cavitated caries

 To arrest demineralization and promote
remineralization of enamel.

 Debond ceramic orthodontic brackets.

 The DIAGNOdent can find cavities that
other dental instruments can miss.

 The device is designed as an adjunct to a
traditional oral examination in the
detection of occlusal decay. Teeth that are
suspicious for caries are ideal candidates
for survey with the device


Key Benefits:
 A laser examination tool for the early
detection of caries.
 Even very small lesions can be detected
at the earliest stages.
 Over 90% accurate!
 Earlier treatment - Better outcomes


 Diagnodent is a pen-
like probe that sends
a safe, painless laser
beam into the tooth.
A numeric display &
alarm signals when
there are signs of
hidden decay.

 These pictures show how the Diagnodent
finds cavities that other
dental instruments can miss.


 The Diagnodent device measures laser
fluorescence within the tooth structure.
 As the incident laser light is propagated into the
site, two-way hand-piece optics allows the unit to
simultaneously quantify the reflected laser light
energy.
 At the specific wavelength that the device
operates (655 nm), clean healthy tooth structure
exhibits little or no fluorescence, resulting in very
low scale readings on the display.
 Carious tooth structure exhibits fluorescence,
proportionate to the degree of caries, resulting in
elevated scale readings on the display

 Roughen tooth surfaces ,in lieu of acid
etching in preparation for bonding
procedure


 Treatment of dentin hypersensitivity..
 In bleaching
 Adhesion of pit & fissure sealant
 Most obvious application – controlled
removal of dental enamel, dentin, bone or
cementum.

 Replacement of dental drill is a real
possibility for the future.

 1968 – use of carbon dioxide laser – in
oral and maxillofacial surgery – Goldman
et all.
 Restricted mostly to incising and excising
masses from the mucosa and gingiva in
oral cavity.
 Vaporize exces tissue as in gingivoplasty,
gingivectomyy and labial /lingual
frenectomy.


 Remove or reduce hyperplastic tissue.
 Remove and control hemorraging of
vascular lesions such as hemangiomas.
 In endodontics


LASER WAVEL SPECTRAL MODE TYPICAL
TYPE ENGTH REGION MAX
POWER
CO2 10,600nm Mid- CW& 100w
infrared Gated CW
&superp
ulsed
Holmiu 2,100 Near Pulsed 15Wavg.
m nm infrared
Nd:YAG 1,064 Near CW & 100W
dr. Blagoja Lazovski
nm infrared pulsed CW 34

Diode 800- Near CW >50W
890nm infrared
KTP/KD 532nm visible Pulsed 25Wavg.
P
Argon 488/514 Visible CW 20W
nm
Excimer 190nm Ultaviole Pulsed 550mJ
ArF-XeCl t
Erbium: 308nm Ultraviol Pulsed 250mJ
YAG(Er: et
YAG)

 Co2 gas as lasig /active medium
 Delivery system – uses an articulated arm (a
series of hollow tubes connected together
through a series of six to eight articulating
mirrors).
 USED-

cutting & vaporising tissue in open
proceures or in procedures where rigid
endoscopyis acceptable..

 Efect of ruby laser radiation on enamel –
Goldman, Stern & Sognnaes, 1964
 Carbondioxide laser – Lobene et all 1968
 Nd:YAG laser – Yamamoto & Ooya 1974
 Argon laser – Goodman & Kaufmann
1977


 In removal of enamel n dentin – thermal
side effect occoured..
 Superpulsed carbon dioxide laser – removal
of dentin without thermal side effect
possible.
 Transversal stimulation or carbon dioxide
TEA (the Alexandrit laser with double
frequency) – most efficent carb.dioxide
laser for dental hard tissue ablation.


 Clinical perespactive of lasers increased
by introduction of Er:YAG, Er, Er:YSGG
lasers
 have advatages of
- reduced thermal effects
- creating precise contour of
the section zone.


 Also in meantime new lasers
-Nd:YAG
-excimer
-holmium
-argon
-diode


 In thermomechanical , micro-abrasion
like explosion – much less energy is
needed.
 If soft tissue is softened by caries,the laser
ablation rate increases…
 Rough surfaces produced by laser
ablation provide good retension


 Dentin surfaces r less rough aftr ablation
and hence less problamatic.
 High bond n shear strength can be
achieved with simple defocused
radiation..
 For conditioning less time is needed than
when etching conventionaly..


 Drying the surface with laser is very quick
, efficent and gentle.
 Erbium laser has bactricidal abilities.
 Bcz high surface temperature can be
achieved for a short time by subalative
irradiation..
 Irridation of caries by a sequence of laser
pulses leads to consecuetive dessication
and sterlization.


 The Er:YAG laser can be used to disinfect
cavity prep , in case of residual bacteria
contaminating, otherwise intact enamel
or dentin, or in fissures prior to sealing.


 Best results obtained whn affected areas
exposed to co2 , Nd:YAG, Er:YAG, Diode
laser radiation
 Colojoara et al showed that dentin
hypersensitivity can be reduced without
any damages to pulp vitality by using co2
laser..
 They also showed that when using co2 laser
, in parallel direction with dentin tubules, the
desensiting effect ws obvious aftr three
exposures. 45

 The first materials introduced in 1970’s
(photopolymerised composites) wr
cured by ultraviolet light..
 Power et al showed that an argon laser
requires shorter curing times & th
ematerials dentin bond strength was
stronger whn compared with laser.


 Variables that control the depth &extent
of cure include
- time of exposure
- composite material
- wavelength
- intensity of light
- particle size of filler


 Current reserches report that used at the
power of 250 +/- 50 mW for 10sec per
increment ,
 the argon laser provides good curing of
light activated restorative material in
shorter period of time with equal or
better physical properties than the
conventional halogen curing light..


 With today's technology, laser teeth
whitening through the use of the Diode Laser is the
quickest and most dramatic way to brighten your
smile if porcelain laminates are not an option.
 All tooth whitening procedures use hydrogen
peroxide or carbamide peroxide to bleach out
stains on your tooth enamel, but this is where the
similarity ends when comparing standard
bleaching procedures such as whitening
performed with a light cure to laser whitening.


 Laser whitening is superior to all other whitening
techniques since
 1.laser whitening products contain the
highest concentration of peroxide
2.the laser provides the highest light intensity
available
3.the procedure is done in the office at
chairside
 thus allowing us to concentrate in those
areas of your mouth where the type and location
of discoloration is worse. Laser technology allows us
to whiten your teeth with amazing results in just one
hour!

1.the type of stain on your teeth

2.where the stain is located

3.the amount of time the whitening gel is used

4.the peroxide concentration in the whitening gel

5.the intensity of the light activating the whitening gel


 In Laser-Assisted Tooth
Whitening, the laser
enhances the effect of
bleaching agents for
faster, more comfortable
and more effective
results.

 By stimulating the
bleaching gel to react
faster, the bleaching
agent (mainly peroxide)
spends less time on the
tooth.

 This leads to increased
comfort levels, a
reduction in reaction from
52
gums both during and

 Types of hazards

Ocular hazards
# injury to eye – direct emission or by
reflection from mirror like surface.
# irreversible retinal burns- by conversion
of incident radiation to heat energy.


* damage to skin & other non-target tissue
result from thermal interaction of energy
with tissue proteins
* temperature elevations can produce
denaturation of cellular enzymes
&structural proteins which interrupt basic
metabolic processes


 Are referred to as non-beam hazards

 Capable of producing smoke , toxic
gases and chemicals.

 Laser plume – composed of vaporised
water (steam), carbon particles, cellular
products..


 The greatest producers of smoke are
co2, erbium lasers followed by Nd:YAG
Lasers..


 High energetic & short pulsed laser light
lead to a fast heating of dental tissue.
 Energy dissipates explosively in vol of
expansion – accompanied by fast
shockwaves..
 The shockwaves lead to high pressure –
destroy or damage adjacent tissue.


 Characteristically pulp tissue cannot
survive environment of elevated temp
for protracted periods when tooth
structure is irridated with lasers.
 Use of combination of air and water
spray before during or immediately after
laser irridation may be more effective..


 Flammable solids , liquids, gases used
within the surgical setting can be easily
ignited if exposed to laser beam..


 Can be in form of
- electric shock
- fire
- explosion


 Temperature < 60 celcius
~ tissue hyperthermia
~ enzymatic changes
~ edema
 Temperature > 60 celcius
~ protein denaturation


 Temperature < 100 celcius
! Tissue dehydration
! Blanching of tissue
 Temperature > 100 celcius
! Super heating
! Tissue ablation&shrinkage


 Operatory must be dry
 Control panel & its electrical power unit
should be protected from any kind of
splashing..


 Can cause charring
 Coagulation of blood elements


 Highly reflective instruments & those with
mirror surfaces should be avoided.
 Tooth protection is needed, whenever ,
the beam is directed at angles other
than parallel to the tooth surface.
 A no.7 wax spatula can be inserted into
gingival sulcus to serve as an effective
shield for teeth


 If anesthesia is required in place of
standard PVC tubes , rubber or silastic
tubes should be used.
 For further protection tube should be
wraped with an aluminium tape.


 The plume from a
laser ablation
deposition:
A Nd:YAG laser
hits ZnTe


 The 514nm line of
the cw laser, a
few 100 mW,
going through a
prism. Do not try
this at home!


 Figure 1A—
Maxillary left first
permanent molar
with occlusal
enamel
hypoplasia


 Figure 1B—
Waterlase MD.
used to remove
(ablation).


 Completed cavity
preparation after
using Waterlase
MD


 Completed
restoration with
resinomer


Thank You 


LASERS IN ENDODONTICS AND CONSERVATIVE DENTISTRY

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