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1. Good
Morning
1

2. LASERS IN PERIODONTICS :
SESSION II
DR. SUMAN MUKHERJEE
MDS III YEAR
2

3. Contents : Session II
 Introduction
 Lasers in dentinal hypersensitivity
 Lasers in non surgical therapy
 Lasers in surgical therapy
 Lasers in implants
 Photodynamic therapy in laser
 Effects of lasers on periodontal therapy
 Conclusion
 References
3

4. Introduction
■ Lasers has emerged in recent years as a noninvasive therapeutic
modality for the treatment of various infections & conditions.
■ In periodontics, laser is beginning to emerge as one of the
important armamentarium for future generations. On day to day
basis, laser is being more & more preferred for minor procedures.
4

5. Lasers in dentinal hypersensitivity
■ Que et al. pointed out a prevalence of DH varying between 2%–8% and
74%.
■ In patients affected by periodontitis, DH prevalence was even higher
ranging between 60% and 98%, this condition may affect patients at
any age, and both genders are equally affected.
■ Laser therapy was first introduced as a potential method for treating
DH in the mid-1980s.
5

6. ■ Low-level laser therapy (LLLT) is a sensitizing method that shows promise.
This treatment induces alterations within the net of nerve transmission of
the dental pulp, instead of altering the exposed dentinal surface, as in most
other types of treatment.
■ LLLT has been used for DH since the 1980s. Studies using the gallium
aluminum arsenide (GaAlAs) laser showed DH reduction in the range of
60%–98%.
6

7. 7

8. Treatment of dentinal hypersensitivity by Lasers : A review
Kimura Y et al. JOCP 2000, 27 ; 715 - 721
To date 4 different types of laser have been used for hypersensitivity; to check
the effectiveness .
Low output lasers / low level lasers : He Ne laser, GaAlAr (diode) laser
Middle output laser : Nd YAG laser , CO2 laser
8

9. 9

10. 10

11. Combination of laser t/t with fluoride
■ There have been reports that NaF (Lin and Lan 1994) and SnF2 (Moritz et al
1996, 1998) effectiveness is enhanced when used with fluoride.
■ Combined use of GaAlAr laser (830 nm) with fluoride enhances the t/t
effectiveness by 20 % over laser t/t alone.
■ In an invitro study, most dentinal tubules orifices were occluded after t/t by Nd
YAG laser irradiation followed by topical NaF (Lan et al 1999)
11

12. Considerations regarding laser t/t of
dentinal hypersensitivity
■ Placebo effect : the cumulative effect of any therapy to provide gradual
improvement on every visit.
■ A strong placebo effect is seen in c/l trials of CDH.
■ Effect consist of a complex mixture of doctor patient r/l, with both parties
needing to believe that t/t is valuable and desiring to obtain relief of
symptoms.
■ Investigators reported of relief of pt’s without any t/t due to placebo effect
vary from 20 to 60 % in c/l trials. (West et al 1997)
12

13. Non surgical therapy
 primarily aimed at efficient removal of plaque, calculus &
reduction of bacterial load, inflammation
 Conventional therapy limitations:
• incomplete removal of calculus
• incomplete elimination of inflamed pocket lining.
• Lasers used : Diode lasers, ND:YAG, ER:YAG & CO2 lasers
13

14. 36. Buchanan SA, Robertson PB. Calculus removal by scaling and root planing with and without surgical
access. J Periodontol 1987;58: 159–163
38. Rabbani GM, Ash MM, Caffesse RG. The effecti veness of subgingival scaling and root planing in calculus
removal. J Periodontol 1981;52: 119–123.
39. Gellin RG, Miller MC, Javed T, Engle WO, Mishkin DJ. The effectiveness of the Titan-S sonic scaler versus
curettes in the removal of subgingival calculus. A human surgical evaluation. J Periodontol 1986;57: 672–
680.
40. Brayer WK, Mellonig JT, Dunlap RM, Marinak KW, Carson RE. Scaling and root planing effectiveness: the
effect of root surface access and operator experience. J Periodontol 1989;60: 67–72.
41. Clifford LR, Needleman IG, Chan YK. Comparison of periodontal pocket penetration by conventional
and microultrasonic inserts. J Clin Periodontol 1999:26: 124–130.
42. Carey HM, Daly CG. Subgingival debridement of root surfaces with a micro-brush: macroscopic and
ultrastructural assessment. J Clin Periodontol 2001;28: 820–827.
43. Kawanami M, Sugaya T, Kato S, Iinuma K, Tate T, Hannan MA, Kato H. Efficacy of an ultrasonic scaler with
a periodontal probe-type tip in deep periodontal pockets. Adv Dent Res 1988;2: 405–410.
45. Lee A, Heasman PA, Kelly PJ. An in vitro comparative study of a reciprocating scaler for root surface
debridement. J Dent 1996;24: 81–86
14

15. Subgingival calculus detection – unique
application for lasers
 Conventional methods : tactile sensation
 Recent : ER:YAG lasers with fluorescent feedback system for calculus
detection
Rationale :
 Difference of fluorescence emission properties of calculus and dental
hard tissues when subjected to irradiation with 655nm diode laser.
15

16. Treatment goal Technology Device name
Calculus detection only
 Fiberoptic endoscopy
 Spectra optical
technology
 Autofluoroscence
 Perioscopy
 Detectar
 Diagnodent
Combined calculus detection
& removal
Ultrasound laser &
autofluoroscence
Periscan
Keylaser 3
16

17. Author & yr Study design Objective Findings
Folwaczny M et al
2002
In vitro –
extracted teeth
assess efficacy of
fluorescence induced by 655
nm diode laser to detect
subgingival calculus
655 nm diode laser
effective for calculus
detection
Krause F et al 2003
Invitro –
histologic study
(in presence of
saline/ blood)
Efficacy for calculus
detection
Laser fluorescence
value co-relate
strongly with calculus
presence
Scharwz F et al
2003
In- vivo & vitro.
Er YAG with diode
655nm combined
Compare the new system
with SRP for calculus
removal efficacy
Selective removal of
subgingival calculus
Sculean A et al
2004
Er YAG + diode vs
SRP
Improvement of c/l
parameters
Similar results with
both systems
Tung OH et al 2008 Detection through the gingiva - based on autofluoroscnece – Ti sapphire
lasers
17

18. Author &
year
Laser Study design Observation
period
Findings
Cobb et al
1992
Nd YAG Exp (Laser, laser +
SRP, SRP + LASER),
controls
(untreated)
Immediately after
t/t
Low effectiveness of calculus
removal
Decrease in no. of bacteria
Scharwz et al
2003
Diode
Exp (lasers),
Control (SRP)
Immediately after
t/t
Not effective for calculus
removal.
Thermal damages to root
surface
Scharwz et al
2001
Er YAG
Lasers (no
controls)
Immediately after
t/t
Smooth root surface
morphology.
Effective calculus removal
No thermal damage
Scharwz et al
2003
Er YAG with
fluorescent
calculus
detection
system
Exp (lasers)
Control (SRP +
hand scaling)
Immediately after
t/t
Selective subgingival calculus
removal
No thermal damage
Less cementum removal.
18

19. Root surface alterations
Diode laser
 Dry or saline moistened root surfaces -
no detectable alterations.
 Blood coated specimens – charring
(Kreisler M et al 2002)
Nd YAG laser
 Morlock BJ et al 1992: surface pitting,
craters, melting, carbonization of root
surface.
 Spencer et al 1992,1996 : decrease in
protein/ mineral ratio, production of protein
by products.
 Trylovich DJ eta l 1992: Nd YAG treated root
surface - not favorable for fibroblast
attachment
 Thomas D et al 1994 : lasers followed by SRP
– restores the biocompatibility of root
surface
19

20. Root surface alterations
CO2 lasers
• Spencer P , Cobb CM et al 1996 :
 Carbonized layer on root surface.
 Cyanamide, cyanate ions detected on
carbonized layers – FTIS method
• Gopin BW et al 1997 : char layer
inhibits the periodontal soft tissue
attachment
• CO2 laser contraindicated for root
surface treatment in focused mode.
Erbium lasers
• Aoki et al 2000 : Er YAG with coolant
 Micro irregular surface
 No thermal effects such as cracking,
fissuring
• Sasaki KM et al 2002 : no major chemical
or compositional change on root
cementum or dentin
• Biocompatibility of root surface: micro-
irregularity offers better attachment to
fibroblasts (Scharwz F et al 2003)
20

21. Bacterial reduction
 The only 2 soft tissue wavelengths currently meet the criterion of having a delivery
system able to deliver laser energy efficiently & effectively to periodontal pockets
for NSPT are : Nd YAG and diode
 Well abs. by melanin & Hb & other chromophores present in periodontally
diseased tissues. The laser energy is transmitted through water and poorly
absorbed in HA.
21

22. ■ Both of these wavelengths have been shown to be extremely effective
against periodontal pathogens in-vivo & in-vitro (Moritz 1998, Pinhero J
1997)
■ These investigators concluded that the diode laser revealed a bactericidal
effect, helped reduce inflammation, supported healing of the periodontal
pockets through the elimination of bacteria.
22

23. Detoxification studies : basic studies
Author & year Lasers Findings
Misra V et al 1999 CO 2 Smear layer removal
Crepsi et al 2002 CO 2 Root surface decontamination. Favorable for cell
attachment
White JM et al
1991
ND YAG Decontamination of irradiated dentin
Fukuda M et al
1994
ND YAG Inactivation of endotoxin of periodontally
diseased root surface
Ando Y et al 1996 ER YAG High bactericidal activity at low energy settings
Yamaguchi et al
1997
ER YAG Removes LPS diffused into root surface
23

24. Low Level Lasers
Therapy
Biostimulation
24

25. ■ 1903 : N.R. Finesen, the father of modern phototherapy, first described low
level UV in t/t of lupus vulgaris.
■ The use of LLLT first initiated in medicine for invitro experiments to determine
the effects on cell cultures & increase blood circulation within regenerating
tissues.
■ Generally smaller, less expensive lasers which operate in the 1-500 milliwatt
range are used. The therapy performed with such lasers is called “LLLT” or
“therapeutic lasers therapy”.
■ The suitable therapeutic energy range is indicated in 1 – 10 joules per point.
25

26. ■ All commercially avl LLT are variants of Ga, Al, Ar which emit in the near
infrared spectrum.
 He – Ne laser
 Ga, Al, Ar diode laser
 Ga - Ar laser
 Argon laser
 Defocused Nd YAG laser
 Defocused CO2 laser
26

27. Biostimulation effects of LLLT
 Reduction of discomfort & pain (Kreisler MB et al 2004)
 Promotion of wound healing (Qadri T et al 2005)
 Bone regeneration (Merli LA et al 2005)
 Suppression of inflammatory process (Qadri T et al 2005)
 Activation of gingival & pdl fibroblasts (Kreisler M et al 2003), growth factor
release (Saygun T et al 2007)
 Alteration of gene expression of inflammatory cytokines (Safavi SM et al 2007)
 Photo biostimulation (Garcia et al 2012)
27

28. Laser Assisted New Attachment Procedure
■ LANAP
■ Gold & Villardi 1994, safe application of Nd YAG laser for removal of pocket
epithelium lining without carbonization of the underlying connective tissue.
■ Approved by FDA for use: true regeneration.
■ Yukna et al 2007 – case series – histologic study – new cementum with new
connective tissue attachment on previously diseased root surface.
28

29. 29
1st pass – laser troughing
2nd pass – laser long pass
C E F G HA B D

30. Author & year Laser
used
Study design Observation
period
Findings
Ben Hatit et al
1996 Nd YAG
RCT
SRP + Laser vs SRP
Immediately after 2,6
and 10 weeks
Significantly reduce post
therapy levels of bacteria
following adjunctive laser
Liu et al 1999
Nd YAG
RCT Split mouth study
Laser, laser + SRP (6 wk ltr)
SRP + laser (6 wk ltr)
12 weeks Less effectiveness of laser t/t
in reducing IL-1 ß as compared
to SRP
Miyazaki et al 2003
Nd YAG
RCT
Lasers vs Ultrasonic
1, 4, 12 wks Similar results b/t lasers & US
reduction of P. gingivalis & IL 1
beta levels
Noguchi et al 2005
Nd YAG
Lasers, lasers + local
minocycline, laser +
povidine iodine
1, 3 months Greater reduction of bacteria
on laser + minocycline treated
sites
30

31. Author & yr Lasers
used
Study design Obs . Period Findings
Moritz et al
1997
Diode SRP + Laser
SRP
1, 2 weeks High bacterial reduction in SRP
+ Laser as compared to SRP
sites alone
Moritz et al
1997
Diode SRP + Laser
SRP + H202 rinse
6 months Higher reduction in bacterial,
BOP, PD in SRP + Laser
Kresiler et al
2005
Diode SRP split mouth
SRP + Laser
SRP alone
3 months Greater reduction of PD and
attachment gain in Laser
adjunct sites
Miyazaki et al
2003
CO2 RCT, Laser vs US 1, 4, 12 wks No decrease of Pg and IL 1 in
laser sites, but significant
decrease in US sites
31

32. Author and
yr
Lasers
used
Study design Obs. period findings
Watanabe et
al 1996
Er YAG Case series – Lasers
only
4 wks Safe & effective calculus
removal
Schwarz et al
2001
Er YAG Split mouth design,
RCT (Laser + SRP)
6 months c/l outcome similar to SRP
Sculean et. al.
2004
Er YAG RCT, split mouth (laser
vs US)
6 months c/l outcome similar to US
Tomasi et al
2006
Er YAG RCT, split mouth (laser
vs US)
6 months 1 month following therapy,
laser t/t sites better c/l
outcomes, no difference in
microbiological levels
32

33. Surgical pocket therapy using lasers
■ Lasers used : CO2 and Erbium family
■ use of laser for:
 Calculus removal
 Osseous surgery
 Detoxification of root surface & bone
 Granulation tissue removal
Advantages of Laser: Better access in furcation areas, Hemostasis, Less post-op
discomfort and faster healing.
33

34. Author & yr Laser
used
Animal
model
Study objective Findings
Nelson et al 1989 Er YAG Rabbit Immediate tissue
characteristics
Found useful as a bone cutting tool
Lewandrowski et al
1996
Er YAG Rat Cutting efficacy and tissue
characteristics
Comparable thermal damage as
mechanical cut bone. Normal
fracture healing.
Friesen et al 1999 CO2, Nd
YAG
Rat Tissue characteristics Residual carbonized tissue &
thermal necrosis
Sasaki et al 2002 CO2 and Er
YAG
Rat Tissue characteristics Er YAG: tissue removal, no charring.
Two distinct layers. CO2 charring &
no tissue removal.
Stubinger et al 2007 Er YAG human depth control of laser Laser couldn’t offer precise depth
control in prep osteotomies.
34

35. Author & yr Laser used Study design Observation
period
Findings
Centty et al
1997
CO2 laser RCT, split mouth
OFD+ laser vs OFD
alone
Biopsy during
surgery
Laser eliminated significantly
more sulcular epithelium than
conventional surgery
Schwarz et al
2003
Er YAG (for root
conditioning)
RCT + Split mouth,
(OFD + Laser + EMD)
VS (OFD + EMD +
EDTA)
6 months NS difference by using laser for
root conditioning
Sculean et al
2004
Er YAG (granulation
tissue removal)
RCT + split mouth
(OFD + Laser vs OFD
alone)
6 months NS difference between two
groups in c/l outcomes
Gaspire et al
2007
Er YAG (bone
defect irradiation)
RCT, split mouth
Mod Widman Flap +
laser vs MWF
5 years Laser application greater gain in
attachment & pocket depth
reduction
35

36. Gingivectomy
■ Laser offers increased operator control & minimal damage in the removal of
gingival tissue for restorative purpose & gingival hyperplasia.
■ Pick RM et al presented 12 cases of phenytoin hyperplasia removed
surgically by the CO2 lasers & hence suggested that in the future the laser
may offer an alternative or an advancement to current procedures now used
in dentistry.
Pick RM, Pecaro BC & Silberman CJ (1985) the laser gingivectomy : the use of CO2 laser for the
removal of phenytoin hyperplasia. Jop 56, 492-6
36

37. Crown lengthening
■ Lasers have been used for clinical crown lengthening without flap
reflecting for both esthetic & prosthetic reasons.
■ Cobb CM et al only support such application in non controlled case
reports.
Cobb CM (2006). Lasers in periodontics: a review of the literature. Jop 77, 545 - 64
37

38. Frenectomy
■ According to Kafas P et al. 2009, diode laser frenectomy maybe performed
without infiltrated anesthesia with the optimum healing post surgically.
Tissue pigmentation reduction
■ Recently, laser has been used widely & is even preferred over scalpel
technique procedure for depigmentation.
38

39. Implant therapy- management of peri implantitis
■ Peri-implantitis management options:
■ Conventional – plastic curette & antibiotics
■ Newer option – Laser
■ Rationale :
• Disinfection & decontamination of implant surface
• Granulation tissue removal
• laser used : Diode, Erbium, CO2,
• Laser not used : Nd YAG
39

40. Authors & year Lasers used Study
design
Objective Findings
Schwarz et al
2006
Er YAG c/l & h/l Pocket
debridement &
decontamination
c/l improvement at the end
of 6 mnths of therapy
similar to conventional
therapy
Deppe et al
2001
CO2 invivo decontamination Safe for debridement of
bone defect around
implants
Schwarz et al
2006
Er YAG invivo Granulation tissue
removal
Laser btr than plastic
instruments & antibiotics/
ultrasonic scalers
40

41. Photo dynamic therapy
■ Main objective: to eliminate deposits of bacteria
■ Conventional methods incomplete because of :
 Anatomic complexity of root
 Deep periodontal pockets
41

42. Photodynamic reaction
 Principle
■ Only the first excited state with the
energy of 94 kJ/mol (22 kcal/mol)
above the ground state is important
and the second excited state does
not react.
42

43.  Mechanism of action : PDT involves three components: light, a
photosensitizer, and oxygen.
 When a photosensitizer is administered to the patient and irradiated with a
suitable wavelength, it goes to an excited state from its ground state. This
excited state can then decay back to its ground state or form the higher
energy triplet state.
 The triplet state photosensitizer can react with biomolecules in two different
pathways - type I and II
43

44. ■ Type I: It involves electron/hydrogen transfer directly from the
photosensitizer, producing ions, or electron/hydrogen removal from a
substrate molecule to form free radicals.
■ These radicals react rapidly with oxygen, resulting in the production of
highly reactive oxygen species (superoxide, hydroxyl radicals, and hydrogen
peroxide).
44

45. ■ Type II: In type II reaction, the triplet state photosensitizer reacts with oxygen
to produce an electronically excited and highly reactive state of oxygen, known
as singlet oxygen ( 1 O2 ) which can interact with a large number of biological
substrates inducing oxidative damage on the cell membrane and cell wall.
■ Microorganisms that are killed by singlet oxygen include viruses, bacteria, and
fungi. Singlet oxygen has a short lifetime in biological systems and a very short
radius of action (0.02 mm).
■ Hence, the reaction takes place within a limited space, leading to a localized
response; thus making it ideal for application to localized sites without affecting
distant cells or organs. Thus, the type II reaction is accepted as the major
pathway in microbial cell damage.
45

46. ■ The effectiveness of cellular targeting of the photosensitizer is also affected by
heterogenous perfusion, vascular permeability, and interstitial pressure of the
tumor (Chen B et al., 2005; Solban et al., 2006).
■ PDT produces cytotoxic effects through photodamage to subcellular organelles
and molecules. Mitochondria, lysosomes, cell membranes, and nuclei of tumor
cells are considered potential targets, along with the tumor vasculature.
■ During light exposure, sensitizers that localize in mitochondria may induce
apoptosis, while sensitizers localized in lysosomes and cell membranes may
cause necrosis (Castano et al., 2005).
46

47. Light Sources
■ PDT requires a source of light that activates the photosensitizer by exposure to
low-power visible light at a specific wavelength. Human tissue transmits red
light efficiently, and the longer activation wavelength of the photosensitizer
results in deeper light penetration.
■ Consequently, most photosensitizers are activated by red light between 630 and
700 nm, corresponding to a light penetration depth from 0.5 cm (at 630 nm) to
1.5 cm (at ~ 700 nm) (Salva, 2002; Kübler, 2005). This limits the depth of
necrosis and/or apoptosis and defines the therapeutic effect
47

48. The total light dose, the dose rates, and the depth of destruction vary with
each tissue treated and with each photosensitizer (Grant et al., 1997; Biel,
2002; Allison et al., 2005, 2006)
48

49. ■ In the past, photosensitizer activation was achieved via a variety of light
sources, such as argon-pumped dye lasers, potassium titanyl phosphate (KTP)-
or neodymium:yttrium aluminum garnet (Nd/YAG)-pumped dye lasers, and
gold vapor or copper vapor-pumped dye lasers.
■ All these laser systems are complex and expensive.
■ At present, diode laser systems that are easy to handle, portable, and cost-
effective are used predominantly (Kübler, 2005). For treatment of larger areas,
non-coherent light sources, such as tungsten filament, quartz halogen, xenon
arc, metal halide, and phosphor-coated sodium lamps, are in use.
49

50. ■ Recently, non-laser light sources, such as light-emitting diodes (LED), have also
been applied in PDT (Allison et al., 2004c; Juzeniene et al., 2004; Pieslinger et
al., 2006; Steiner, 2006).
■ These light sources are much less expensive and are small, lightweight, and
highly flexible.
50

51. Photosensitizers
 Thousands of natural and synthetic photoactive compounds have
photosensitizing potential.
 They include degradation products of chlorophyll, polyacetylenes,
thiophenes, quinones (cercosporin), anthraquinones (fagopyrin, hypericin),
and 9- methoxypsoralen (Ebermann et al., 1996).
 An ideal photosensitizer should be non-toxic, and should display local
toxicity only after activation by illumination. The majority of the sensitizers
used clinically belong to dyes, the porphyrinchlorin platform, and
furocoumarins
51

52. 52

53. Photosensitizers used in the
different clinical applications of
photodynamic therapy (PDT) and
photodynamic antimicrobial
chemotherapy (PACT).
53

54. Side-effects
 The major side-effect after the use of intravenous photosensitizers is
photosensitivity. photosensitizer can be activated by daylight, causing first-
or second-degree burns.
 Usually, PDT treatment by itself is not painful, but several hours after PDT,
most patients suffer from severe pain. Pain medications should be given after
or prior to the laser treatment. Patients treated by topically applied ALA (5-
aminolevulinic acid) report burning sensations during illumination.
54

55. ■ PDT can cause burns, swelling, pain, and scarring in nearby healthy tissues.
Other side-effects of PDT are related to the area that is treated. They can
include coughing, trouble swallowing, stomach pain, painful breathing, or
shortness of breath; these side-effects are usually temporary.
■ All other potential side-effects, such as allergic reaction, change of liver
parameters, etc., occur infrequently and are specific for each
photosensitizer and each patient (Vrouenraets et al., 2003; Kübler, 2005).
55

56. Photodynamic
Antimicrobial
Chemotherapy
Studies on Plaque
Biofilms in vitro
56

57. 57

58.  Allison et al. have described PDT as the therapy that “is truly the
marriage of a drug and a light,” and as a result, only interdisciplinary
research approaches can overcome all the difficulties and challenges of
PDT.
58

59. Effects of Lasers on Periodontal Therapy (Summarize)
■ Pain relief
• Laser therapy blocks the pain signals transmitted from injured parts of the
body to the brain. This decreases nerve sensitivity and significantly reduces
the perception of pain.
• Increases the production and release of endorphins and enkephalins
which are natural pain-relieving chemicals within our bodies.
59

60. ■ Inflammation reduction
• Laser therapy causes the smaller arteries and lymph vessels of the body to
increase in size – a mechanism called vasodilatation.
• This increased vasodilatation more effectively allows the following:
• Inflammation, swelling, and edema to be cleared away from injury sites.
• Promotes lymphatic drainage which also aids in this vital healing process.
 Accelerated tissue repair and cell growth
• Photons of light emitted by therapeutic lasers penetrate deeply into the tissues
of the body to stimulate the production centers of individual cells.
60

61. Wound healing
 Improved blood flow
 Laser therapy significantly increases the formation of new capillaries (tiny blood vessels)
within damaged tissues.
 Reduced formation of scar tissue
• Laser therapy reduces the formation of scar tissue (fibrous tissue) following tissue damage
related to cuts, burns, and surgery.
• Laser therapy is able to reduce this formation by speeding up the healing process,
improving the blood flow to the injured area, and more effectively carrying away waste
products.
• Faster healing always leads to less scar tissue formation.
Raffetto N. Lasers for initial periodontal therapy. Dent Clin N Am 2004;48:923-36.
61

62. Conclusion
 The application of lasers has been recognized as an adjunctive or alternative
approach in soft tissue surgeries.
 Laser t/t have been shown to be superior to conventional mechanical
approaches with easy ablation, decontamination and hemostasis, as well as
less surgical and postop pain in soft tissue management.
62

63. References
 Jha A, Gupta V, Adinarayan R. LANAP, periodontics and beyond: a review. J Lasers Med Sci.
2018;9(2):76- 81. doi:10.15171/jlms.2018.16.
 Dr. Rao Naman Rajeshkumar and Dr. Chandramani B. More proposed classification” IJOCR
8,09, 38985-38994
 ARCHANA V. Calculus detection : where we stand now ? Journal of Medicine and Life
Volume 7, Special Issue 2, 2014
 Prabhuji Munivenkatappa Lakshmaiah et al. NOVEL SYSTEMS FOR CALCULUS DETECTION
AND REMOVAL- A REVIEW .
 Konopka & Goslinski. Photodynamic Therapy in Dentistry. J Dent Res 86(8) 2007.
 Kumar V, Sinha J, Verma N, Nayan K, Saimbi CS, Tripathi AK. Scope of photodynamic
therapy in periodontics. Indian J Dent Res 2015;26:439-42
63

64.  Charles M Cobb. Lasers in Periodontics: A Review of the Literature. J Periodontol
2006;77:545-564.
 Elavarasu S, Naveen D, Thangavelu A. Lasers in periodontics. J Pharm Bioall Sci
2012;4:260-3.
 Offenbacher S. Periodontal diseases: Pathogenesis. Ann Periodontol 1996;1:821-
78.
 Raffetto N. Lasers for initial periodontal therapy. Dent Clin N Am 2004;48:923-36.
 Piccione PJ. Dental laser safety. Dent Clin North Am 2004;48:795-807.
 Powell GL, Morton TH, Whisenant BK. Argon laser oral safety parameters for
teeth. Lasers Surg Med 1993;13:548-52.
 Walsh LJ. The current status of laser applications in dentistry. Aust Dent J
2003;48:146-55.
64

65. Diode laser – initiation
■ Diode laser fibers are "initiated" by burning articulating paper on the tip. This
initiation causes the light energy to be absorbed by the burnt material on the
tip, effectively making it a hot piece of quartz. The laser energy cuts indirectly
by heating up the fiber optic tip. Diose lasers do not have enough peak
power to efficiently cut tissue on their own without initiation.
■ If one defines "laser dentistry" as light interacting with tissue, then diode
procedures are not laser dentistry ones.
■ Biolase : Pre initiated tips
65

66. Laser fumes : Gases
 Poly cyclic aromatic hydrocarbons
 Hydrogen cyanide & benzene
 Heavy metals
 Formaldehyde & synthetic fibers
 Acute Health attack to long term asthma or nervous system damage
66

67. Which laser has maximum penetration
67