Dental laser

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

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’ tip.[6][8] The soft tissue is cut, on contact, by the hot charred glass tip and not by the laser beam this 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.[9] 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.[10] They can be used for a host of dental procedures, and allow for more procedures to be done without local anesthesia. 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.[11] 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.[12] 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.[13] The 9,300 nm laser ablates hard tissue in excess of 5,000 °C, which often results in extremely bright thermal radiation.[14]

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.[15] Nine trials were reviewed, 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 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 anaesthesia 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.[16]

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 cauterization of tissue there will be little bleeding following soft tissue procedures, and some of the risks of alternative electrosurgery procedures are avoided.

History

Kumar Patel made the first CO2 laser in 1964, in the same year the Nd:YAG Laser was invented at Bell Labs.[17]

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See also

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. 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. 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. 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. Romanos, G. "Diode Laser Soft-Tissue Surgery: Advancements Aimed at Consistent Cutting, Improved Clinical Outcomes". cced.cdeworld.com. Retrieved 2016-04-05.
  7. 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. Levine, Robert; Vitruk, Peter (2015-09-01). "Laser-Assisted Operculectomy". Compendium of Continuing Education in Dentistry (Jamesburg, N.J.: 1995). 36 (8): 561–567, quiz 568. ISSN 2158-1797. PMID 26355439.
  9. 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
  10. Technology 4 Medicine (January 2014), Erbium and Nd:YAG Lasers, Laser Dental Boynton
  11. 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.
  12. 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.
  13. 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.
  14. "Laser Surgery Basics - American Laser Study Club". American Laser Study Club. Retrieved 2018-05-04.
  15. 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.
  16. Gordon, Jerry. "How Cavities and Fillings Work". HowStuffWorks.com. Retrieved 2007-07-21.
  17. "A brief history of lasers" (PDF). Archived from the original (PDF) on 2014-06-11. Retrieved 2014-06-16.
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