Valuable clinical guide for soft tissue diode laser users with pre & post operative pics , useful , fully informative with tips helps my beloved coleagues to enjoy & profession the use of soft tissue dental laser #clinical_dental_laser #dental_laser #soft_tissue_laser

1. DENTAL
Diode
LASER
Clinical
Dr . Abdelrahman Mosaad

3. Laser Safety
Common safety practices include:
• 1)Eye Protection – The patient, clinical staff and any observers must
wear protective eyewear specific for the wavelength being used.
• 2) Plume Control – Laser procedures create a plume that may
contain hazardous chemicals and micro flora. Standard dental high-
speed evacuation properly used is adequate to control the plume.
• 3) Sharps – Scored laser tips of quartz fibers are considered sharps
and need to be disposed of as such.
• 4) Warning Signs and controlled area – Warning signs need to be in
a visible place and access to the operatory limited. Automatic door
lock , using special inst. , no reflecting surfaces ,,, etc.

4. 1)Eye Protection
 The patient, clinical staff and any observers
must wear protective eyewear specific for the
wavelength being used.
 How to choose it ? Design , VLT , OD
 Types of dental lasers ( classifications )
 Effect of different types of lasers on the eye
and skin

7. VLT :
- Visible Light Transmittance (VLT) of
the filter. VLT is the percentage of visible
light transmitted through a filter,
calculated against the spectral sensitivity of
the eye to daylight.
- The higher the better.
- VLTs below 20% should be used in well-
illuminated working environments.

8. OD
Optical Density (OD) is a measure of the
radiation permitted to pass through a filter and
it's determined by the filter

10. 2) Plume Control
 Laser procedures create a plume that may
contain hazardous chemicals and microflora.
 Standard dental high-speed evacuation
properly used is adequate to control the
plume.
 Ideal face masks should be used .

13. 3) Sharps
 Scored laser tips of quartz fibers are
considered sharps and need to be disposed
of as such.

15. 4) Warning Signs and
controlled area
 – Warning signs need to be in a visible place
and access to the operatory limited.
 Automatic door lock , red (operating ) warning
lamp , using special inst. , no reflecting
surfaces ,,, etc.

18. Soft tissue Laser
clinical Procedures
 Follow the safety measures
 Adjust the variables of the laser device
- power - fiber diameter - pulse mode
- pulse time
 Tissue condition may require changing
manufacturer pre-adjusted laser parameters
- e.g. fibrous rigid soft tissue may require
increasing power ,, young child ??

20.  Fiber optic : diameter , tip , …
 Contact vs non contact :
 Initiated vs non initiated : the laser tries to ablate the
pigmented region, creating a super focus of light energy
 Selective(vaporization) e.g. skin lesions , non-
selective (interstitial) e.g. large angioma , non-
selective (excision) e.g. sarcoma

26.  Test the accuracy of the laser beam and the
aiming beam before operating
 Most of manufacturers requires initiation of
the laser fiber optic before most of operation
 Initiation of the fiber optic is not required in :
- peri-implantitis – periodontitis
- aphthous ulcers

28.  During the operation always clean the tip of
the fiber optic
 Give a big concern to the tissue cooling
during laser application using air or wet
gauze , this will provide better healing and
prognosis
 Capture a pre&post -operative photo

32.  High parameter of soft tissue laser may
cause severe problems if applied to bare
bone
 High power Diode laser soft tissue
procedures requires anesthesia
 usually use adrenaline free anesthesia ,,
except ??

34.  The excisional biopsy should be done in
suspected malignancies
 Usually follow manufacturer instructions
regarding the parameters and safety ,
however you have the full control during
operation
 Always keep full records for each patient
including the parameters , time of operation
and tissue condition

37. 1- low level laser therapy
2- surgery
3- endo
4- perio
5- bleaching

38. 1- low level laser therapy
 Known also as cold laser
 Low laser parameters are used to produce
photochemical effect
 Biostimulation hand piece is used

40.  This includes :
- pain relief
- teeth hypersensitivity
- TMJ pain
- biostimulation
- - aphthous ulcers
- herpes

41. pain relief :
 could be used before anesthesia needle
puncture for painless anesthesia
- 0.3 W , C.W mode for 1 minute or till initial
numbness
- fiber optic may be used for seconds instead
higher parameters non-contact ( 1W , C.W ,
non-contact )

43. teeth hypersensitivity :
- LLLT reverses the polarity of dentinal tubules
providing immediate pain relief
- 0.3 W , C.W mode for 1 minute or till initial
numbness
- fiber optic may be used for seconds instead
higher parameters non-contact ( 1W , C.W ,
non-contact )

45. TMJ pain :
- adjunctive to other treatment modalities
- biostimulation hand piece is used
- 0.5 W , C.W , 3 minutes day after day or
two applications per week

47. biostimulation :
- improves the biological health and action of
tissue cells
- used in :
- recovery after surgeries
- -implantation
- - orthodontics
- 0.5 W , C.W , 3-5 minutes

49. - 0.5 W , C.W , 3-5 minutes
- e.g. day after day for 2 weeks after implant
placement
- what are the limitations ??

51. aphthous ulcers :
- immediate relief of pain , very effective
- use a newly cleaved non initiated fiber tip
- 1-1.5 W , C.W
- 5 mm away from the lesion , circular
motion from outside edges toward the
center of the lesion

53. - 30-60 seconds , the session ends always
by achieving a milky appearance of the
lesion , never exceed 2 minutes
- repeat after 3 days if the lesion still exist

55. - herpes :
- reduce the symptoms and relief the pain
- decrease healing period which is 10-14
days
- non-initiated fiber for small lesions and
biostimulation hand piece for larger ones
- treated areas will be less to reappear

56. - 1-1.5 W , C.W ,,, 2-3W pulsed ( 50% duty
cycle )
- 5 mm away from the lesion , circular
motion from outside edges toward the
center of the lesion
- 30-60 seconds per session

58. surgery
 High laser parameters are used to
produce photo-thermal cutting effect

59. This includes :
- hemostasis
- soft tissue surgeries ( frenectomy ,
gingivectomy , implant uncovery ,
troughing , crown lengthening , cyst
removal )
- abscess surgeries
- angioma and bloody lesions
- premalignancy and malignancy

60. - Hemostasis :
- use non initiated fiber tip
- 1W , C.W , non contact 2 mm away from
bleeding , 30 seconds , painting motion
- repeat again if the bleeding persists
- maximum 90 seconds

63. - soft tissue surgeries :
- ( frenectomy , gingivectomy , implant
uncovery , troughing , crown lengthening ,
cyst removal )
- Anatomy of peridontium ???

65. Gingivectomy :
- use 400 fiber , pulsed or C.W
- if C.W 2-2.5 W used , move quickly and
always cool the tissue during operation
- pulsed mode will provide more tissue cooling
but the cutting efficiency will decreased so
mush and the operation time will increased
so mush as well

66. - if C.W mode is used  always move the
fiber as quickly as you can , to avoid over
heating of the tissue
- direct the fiber to cut with an angle toward
the incisal or occlusal surface , this will
provide better cutting and tissue recession
will be also avoided

67. - avoid lasing the roots or the bone
- always keep 1 mm away from the depth of
the pocket
- consider the anatomy of the peridontium
while performing gingivectomy
- use wet gauze to cool the tissue , that will
give better healing

68. Fiber incisaly directed = better cutting + better healing

69. Fiber optic directed apically may cause ging. recession

70. Small fiber optic , fiber directed apically , non-harmonious
cutting = worse non-harmonious healing + gingival recession

71. - Crown lengthening :
- usually be 1.5 mm above the bone level
- laser parameters and instructions as provided
previously in gingivectomy i.e. C.W 2-2.5 W

74. - frenectomy :
- buccal frena , tongue tie ( lingual frena )
- 400 initiated fiber is used , C.W 2-2.5 W

75. - in lingual frena always take care of
vascular beds at the floor of the mouth
and at the inferior border of the tongue ,
so a hemostat may be used to protect these
parts and cut safely

76. - for maxillary and mandibular buccal frena ,
always :
- place tension on frenum by retract the lip
or cheek
- cut perpendicular to the frenum and
extend the cutting tell removing all
attachments
- healing by secondary intension

77. Fiber directed perpendicular to frenum

79. Fiber is directed toward dangerous area !!

80. - troughing :
- for better impressions and better abutment
finishing
- 400 initiated fiber , 1.5 W , C.W
- rest the fiber against the tooth , apply
very light pressure and start laser within
the sulcus in a rapid movement all around
the tooth

83. - implant uncovery :
- 400 initiated fiber optic , 2.5 W , C.W
- inspect using probe then start lasing
reproducing good gingival contour and good
emergence profile
- avoid back reflections from the implants

85. - benign oral lesions :
- mucocele , ranula & pyogenic
granuloma are the most common treated
oral benign lesions
- mucocele is a minor salivary gland lesion ,
most frequent in lower lip and cheek

86. - ranula mucous extravasation cyst of
sublingual gland due to trauma or duct
obstruction
- pyogenic granuloma common in
pregnant women and young childs

87. - for mucocele do an incision
around the lesion , using ( 400 initiated
fiber optic , 2W , C.W ) ,, then grasp the
lesion and remove it carefully
- usually complete healing period 45 days
by secondary intension

90. - ranula :
- treated by marsupilization if the lesion is
very large , 2 W , initiated or non-initiated
400 fiber optic , C.W
- always take care of vascular beds at the
floor of the mouth and at the inferior border of
the tongue

92. - pyogenic granuloma :
- 400 initiated fiber optic , 2W , C.W
- anesthesia , then grasp the granuloma and
cut all around with no remnants remained
- use fiber optic 1W , C.W , non-contact for 1
minute to gain full homeostasis

95. - abscess surgeries :
- determine the status of the lesion and select
the point of entry to the lesion , which is
usually the most coronal part of the
parulis (fistula)
- give anesthesia then activate the laser 1W
C.W , initiated fiber, to establish a drainage
path , use saline and high volume suction
to drain the abscess

96. - repeat until you reach the base of the
lesion and the drainage is completed
- after the drainage is completed cleave
the fiber and don't initiate it , re-enter the
fistula with activating laser 2W , pulsed (200
micro sec off , 200 micro sec on ) , this will
flood the area with energy and reduce the
number of pathogens
- prescribe antibiotics if needed

99. - bloody lesions :
- consider the status of the lesion and its
extent
- consider the medical status of the
patient , i.e. blood disorders , kidney
transplantation … etc
- consider the type of anesthesia that
suits the treatment of the , i.e. adrenalin
or adrenalin free anesthesia

100. - hemangioma usually occurs in maxilla at
the first year of life
- venous , arterial , aneurismal ,
arteriovenous and cystic aneurisms usually
occurs in mandible (why?)
- angioma could be established any where
by different factors

101. - small lesions could be treated by complete
removal and vaporization (3 - 4.5 W , C.W ,
initiated )
- large and very large lesions could be treated
interstitially for many sessions until reaching
the desired result and may requires guided
DSA ( digital subtraction angiography )
anhydrous ethanol injection

105.  - venous lake ( angio edema ) due to
trauma which is blood surrounded by
epithelium could be treated interstitially
for many sessions

106. - regarding the interstitial use of
laser :
- inter the lesion from an intact normal
point tell reaching the lesion
- usually palpate while activating laser
to detect any very high raise of temperature

107. - interstitial session ends by blenching of
the area and changing in color
- direct the fiber optic tip to the point you
want the lesion to be treated toward it

108. - premalignancy and
malignancy excision :
- fibroma , leukoplakia , keratosis , lipoma ,
sarcoma … etc
- excise with very high power C.W 2-2.5 W
and safety margin to avoid recurrence
- usually do biopsy for the excised lesion

110. - Biopsy technique :
- drop view drops of TBO dye to the lesion , wash
with 1% acetic acid , drop view drops of TBO ,
wash with water , then do the biopsy at the most
dysplastic area ( the darkest area )

111. - remove the cause before doing the laser
excision
- CO2 laser is the best for such excisions
10 W , focus , pulsed or C.W ,or, diode max
power , C.W , initiated fiber

112. lichen planus :
- immune disease that regress with
maximum 2 years
- laser is used mainly to treat erosive
lichen in conjugation with antihistaminics or
corticosteroids
- laser treatment is to decrease the pain
and decrease the recurrence rate

113. - treated as the aptha , 1-2 W , C.W , non-
contact , cress cross motion till blenching and
coagulation of the lesion

115. Endodontics
1) pulpotomy ( pediatric ) :
- Ablate the pulp till pulp chamber is
reached
- 2W , Pulsed 50% , or, C.W non-contact ,
initiated 200 fiber optic
- some studies show success rate 100% in
laser pulpotomy !!

116. 2) canal sterilization :
- to sterile the canal after regular endo filing
before the opturation , this will improve the
success rate
- 1.5 W , C.W , non-initiated , with TBO or
without
- start 1mm away from the apex then go
coronaly in spiral motion

118. Periodontics
1 ) PDT :
- TBO or MB is used as a photosensitizer then
LLLT laser is activated to start a PDT action
- improves the periodontal ligament
health and kill most of resistant pathogens
- 400 fiber optic for accessibility

119. - the used photosensitizer(Ps) is applied to
the pocket and left for 60 seconds then the
residual Ps is washed away , start laser
activation (0.7 W , C.W , non initiated for 20
seconds , then repeat for another 20 sec )

121. 2) pocket sterilization :
- after perfect scaling and root planning
(SRP)
- kills most of pathogens and improve the
healing and the new attachments of the
periodontal tissue
- start 1mm away from the pocket depth ,
2 W C.W or 2.5 W pulsed 50% to preserve the
pulp intact , non-initiated 400 fiber optic

122. - may called LANAP ( Laser Assisted
New Attachment Procedure )

125. 3 ) peri-implantitis :
- remove any gross granulation tissue
attached to the bone or the implant threads
- use 400 fiber optic , 1-1.5W C.W or
2Wpulsed 50% , non initiated to debride
around the implant and remove any remaining
granulation tissue

126. - bone graft and resorbable membrane may
be used to complete the treatment procedure
- laser may be used to decontaminate the
implant surface , but take care of reflected beam
- LLLT may be done ( 0.5 W , C.W ) for 2
minutes day after day for 10 days period to
improve the repair mechanism

128. 4 ) depigmentation :
- the best way and the less invasive to gain
normal pink gingival color
- give anesthesia , use 400 initiated fiber
optic , 3W pulsed 50% or 1.5W C.W , swap
over the dark gingiva tell dark part is
removed and the color of gingiva become
brownish

129. - give post operative instructions
- healthy normal pink gingival color will
be reached within 14 days

130. End of laser depigmentation session

132. Bleaching
- the best and the less invasive way to bleach the
teeth
- tooth by tooth (1W bio stimulation hand piece )
or quadrant by quadrant (7W bleaching hand piece )
- 45 seconds ( session for tooth or quadrant )
- do another sessions to get the best result
- never exceed three sessions
- stop the laser if the patient feel sensitivity,

136. Fiber sterelization
 Prepare a sterilizing and disinfecting
solution of a CaviCide™ equivalent and
submerge approximately 12 inches (30
cm) of the fiber’s distal end into the solution
for 5 minutes.
 For high-level of disinfecting, immerse the
fiber end for 30 minutes at 68°F (20°C).
 N.B. the hand piece and the fiber are come
non-sterilized from the manufacturer

138. Marketing