LASER IN CONSERVATIVE
DENTISTRY & ENDODONTICS
A device which transforms light of
various frequencies into a chromatic
radiation in the visible,infrared &
ultraviolet regions with all the waves
in phase capable of mobilizing
immense heat & power when focused
in closed range.
HISTORY
1950 - Townes MASER (Microwave amplification by
stimulated emission of radiation)
1958 - Arthur Leonard Schawlow -working principles of
lasers
1960 - American physicist Theodore Maiman - the first
laser action using synthetic ruby
1961 - A helium-neon gas laser W.R.Benett
1964 - Subsurface demineralization ruby laser- stern &
sognnaes
1971 - Seal apical foramen CO2 laser- Weichman &
Johnson
L Light
Electromagnetic energy
Travels in waves
Constant velocity
POLYCHROMATIC
MONOCHROMATIC
ORDINARY LIGHT
LASER LIGHT
Spreads as it get farther
from light source
Moves straightforward
with almost no spreading at
all
Incoherent light
Coherent light (aligned
wavelength and phase)
Divided into seven colors Remains a single color.
when it goes through a
Thin beam
prism
Low energy density
High energy density
FEATURES OF LASER LIGHT
Collimation
Coherency
Monochromatic
Photons in a light beam have the same wavelength
- "MONOCHROMATIC- "all the same color".
COLLIMATION
Beam with
Constant shape
Constant size
COHERENCY
All the photons in a
monochromatic light
beam - synchronized
A- Amplification means that a very bright intense beam of
light can be created. The laser may be activated by a few
photons act then many more may be generated the initial light
is computed to make a very bright compact beam.
S Stimulated : Means that the photons are
amplified by stimulating an atom to release
more photons.
E-Emission refers to the giving off
photons. The exited atom emits a
photon when another atom comes by.
R-Radiation refers to light waves produced
by laser as a specific form of electromagnetic
energy.
Parts of laser system
Working Principle
High-voltage electricity causes the quartz
flash tube to emit an intense burst of light,
exciting some of the atoms to higher energy
levels.
Atoms emit particles of light called photons.
Photons from one atom stimulate emission
of photons from other atoms and the light
intensity is rapidly amplified.
Mirrors at each end reflect the photons back
and forth, continuing this process of
stimulated emission and amplification.
Laser light
Population inversion
A mechanism to add more and more atoms to the meta
unstable state.
Hold them long enough to store energy and allow the
production of great number of stimulated photons.
Classification
I- Gain medium
Solid state lasers
Gas lasers
Semiconductor lasers
Liquid laser/ Dye lasers
II-Operating mode
-Continuous wave
-Pulsed mode
Gas laser - Pumped by electrical discharge
He-Ne : 632.8 nm (cw)
Ar ion : 488, 514 nm (cw)
CO2 : 10.6 m (cw or pulsed)
CO2lasers- efficient, most powerful
continuous wave (CW) lasers.
Solid state laser
The highest power output.
Operated in a pulsed manner to generate a burst of light over
a short time.
Pumped by flash lamps or light from other lasers
Nd:YAG Laser
Ho:YAG Laser
Er:YAG Laser
Semiconductor laser
A semi conductors chip- works like an electrical diode.
Application in surgery and minimal application in
dentistry.
Dye laser
Chemical dyes
coumarin,
rhodamine,
fluorescein
Solvents
methanol
ethanol
ethylene glycol
Laser Tissue
Interaction
Absorption
Transmission
Reflection
Scattering
Absorption
Depends on tissue characteristics such as
pigmentation and water content, and laser
wavelength and emission mode
Water has varying degrees of absorption by
different wavelengths
CO2 Laser(10,600 nm) is well absorbed by water
and has the highest affinity for tooth structure
Transmission
The transmission of laser energy directly through
tissues with no effect on the target tissues
Depends on the wavelength of the lasers
Reflectio
n
The redirection of the beam off the surface having
no effect on target tissue
Caries detecting laser device
Can be dangerous because energy is directed to an
unintentional target
Scatterin
g
Weakening of the intended energy
Cause unwanted damage by heat transfer to the
adjacent tissues
Effect of Lasers on target tissues
Principle effect of laser is
Photo thermal
37-50o
Hyperthermia
60-70o
Coagulation
70-80o
Welding
100-150o Ablation
>200o
Carbonization
Hyperthermia
Occurs when the tissue is elevated above
normal temperature but is not destroyed
Coagulation
At 60oC, proteins begin to denature
without vaporisation
Surgical removal of granulomatous tissue
Welding
Soft tissue edges can be welded
together with a uniform heating to
70 80oC
Ablation
When elevated to temperatures of 100oC,
vaporization of water occurs
A resultant jet of steam expands and then
explodes the surrounding matter into small
particles
Carbonization
Tissue is dehyrated and then burned in the
presence of air
Carbon is formed as a product which
absorbs all the wavelengths
Method of delivery
Free beam laser/Non contact laser
Contact laser
Interstitial
Laser Delivery systems
Flexible
Hollow
waveguide or
tube that has an
interior mirror
finish
Has to be used in
a non contact
fashion
Glass
Fibre
optic Cable
Smaller in
diameter
Can be used in
contact or non
contact mode
EMISSION MODES
Continuous wave
Gated pulse mode
Pulsed mode
Free running pulsed mode
Continuous wave mode : Beam emitted
at one power level for as long as the
operator depresses the foot switch
Gated Pulse mode : Periodic alterations
of the laser energy
True Pulsed mode : Large peak energies
are emitted for a short time span
followed by relatively long time in which
the laser is of
LASER WAVELENGTHS USED IN DENTISTRY
ARGON LASER(Cure star,Accu cure)
488nm,514nm
Activate camphoroquinone
Absorption in tissues containing hb
Hemostatic capability
Not well absorbed in dental hard tissue or water
Indication periodontal disease
-- caries detection
Diode laser
800nm 980nm
Highly absorbed by pigmented tissue
Poorly absorbed by tooth structure
Bactericidal (root canal)
Nd:YAG (pulsemaster,Periolase)
1064nm
Cutting & coagulating dental soft tissue
Slightly absorbed by tooth structure
Pigmented surface caries can be vapourised
without removing healthy enamel
Pulpal analgesia
Bactericidal
Holomium:YAG
2100nm
Absorbed
by water
can ablate hard calcified tissue
Er , Cr:YSGG-2780nm
Er:YAG-2940nm
Highest absorption water
High affinity for hydroxyapatite
Indication
Caries removal
Tooth preparation
Modify enamel surface for increased
adhesion
Root canal therapy
Removal of non-metallic restoration
CO2 laser(LX-20,Novapulse)
10600nm
High
affinity for hydroxyapatite
Well Absorbed by water
Cutting & coagulating dental soft
tissue
Laser in conservative
dentistry
Caries detection
Quantitative light induced fluorescence
655nm
Fluorescent light is measured
Intensity-size & depth of lesion
5-25 initial lesion in enamel
25-35 - initial lesion in dentin
>35
advanced dentin caries
Caries prevention
Laser irradiation
Modifies Ca:P ratio
Formation of more stable & less acid
soluble compounds
Hard tissue ablation
o
o
o
o
o
CO2 laser
Nd:YAG
Er,Cr:YSGG laser
Energy dissipationshock wave-cavitation
Water molecule-super heated,explode &
ablate tooth str.& caries
Caries-100-200mj(10sec)
Enamel-200-250mj(15sec)
Dentin-150-200mj(10sec)
Restoration removal
Composite resin
GIC
LIMITATION
Gold
Cast Restoration
Ceramic
Laser etching
Er:YAG
Micro-explosion-microscopic
irregularities-adhesion
Acc. to studies-bond strength of
composite to laser etched enamel
-low
Laser curing
Argon laser-488nm
Class II composite restorations 250-350mw(10-12sec)
Laser Bleaching
Argon -488nm
CO2
GaAlAs diode-980nm
250mw(10sec)
Decontamination of cavities
Photo activated disinfection
Tolonium chloride-low level visible red light-635nmsinglet oxygen-bacterial cell wall rupture
Dentinal Hypersensitivity
Low output laser
GaAlAs- 780nm,830nm,900nm-30mW(0.5-3min)
He-Ne- 632nm-6mW(1-3min)
-sealing of dentinal tubules
High output laser
Nd: YAG- 1,064nm
CO2- 10,600nm
-pulpal analgesia
LASER IN
ENDODONTICS
Diagnosis of pulp
Laser doppler flowmetry
Ga Al As- 780nm
He-Ne-632nm
Changes in RBC flux in pulp tissue
Pulp vitality test (heat)
Alternate to hot gutta-percha
Pulsed Nd: YAG
Diagnosis of pulpitis
Normal pulp: Pulsed Nd: YAG laser at
2W & 20pps at 10mm from the surfacepain within 20-30secs
Acute pulpitis : Pain arise immediately
after laser appln. & continuous for more
than 30 secs
Laser - indirect plup capping
Indications
Deep cavity
Hyper sensitive cavity
Pulsed Nd: YAG laser
2W,20pps,1sec
Air spray cooling
CO2 laser
Low wavelength
short period
Laser - direct pulp capping
Indications
Pulp exposure 2mm or less
No pulp infection
Pulsed Nd: YAG
Argon
Irradiation of 1 or 2W
irrigating with NaOCl & Diode
3% H2O2 for more than 5
Er: YAG
mins
Pulpotomy
CO2 laser at 1 to4W
Along with irrigation
3%H2O2 & 5.25%NaOCl
Access cavity preparation &
Root canal orifice enlargement
Er,Cr:YAG laser to cut enamel &dentin at 5W and
6Hz
Root canal preparation
Indication
Straight or slightly curved canal
Nd: YAG, Er: YAG laser at 2W&
8Hz,Er,Cr:YSGG,CO2
Hand instrumentation before laser irradiation
Tip inserted into the canal 1-2 mm short of the WL
-RC Lase side firing spiral tip(Er:YAG)
Removal of pulp remnants
Pulsed
Nd:YAG laser
2W,20pps for 1 sec,5 sec interval for
three to four times
Sterilization and disinfection of root canal
Pulsed Nd: YAG laser at 2W,20pps for 5sec
Thin fibre optic delivery system
To enhance the effect
- 38%silver ammonium solution
- 5.25% NaOCl, 14% EDTA
Apicoectomy & Root end preparation
Er: YAG
CO2 laser
Bloodless surgical field
Doesnt improve healing process
Takes more time
Other applications
o
Removal of calcified attached denticles-pulsed dye
laser-504nm
To sterilize dental instruments
Ar,CO2,Nd:YAG laser
Argon -1W for 2mins
Removal of g.p & broken files in retreatment
Nd:YAG laser
LASER
HAZARDS
Laser hazards are basically categorized into a
categories according to ANSI or OHSA standards
Class
I
IIa
IIb
IIIa
IIIb
IV
Description
Low powered lasers that are safe to view
Low powered visible lasers that are
hazardous when viewed for longer
than 1000sec
Low powered visible lasers that are
hazardous when viewed for longer
than 0.25sec
Medium powered lasers that are
normally not hazardous if viewed for
less than 0.25sec without magnifying
optics
Medium powered lasers (0.5w) that
can be hazardous viewed directly
High powered lasers (>0.5w) that
produce ocular, skin, and fire hazards.
In dentistry - Class IV.
Occular injury
Retinal, corneal burns
Electric hazard
Shock,
Fire and explosion
Tissue damage
Cell Destruction
Mutagenic changes
Respiratory hazard
Chemicals
Conclusion
Laser equipment represents one of the
most captivating technologies in
dentistry. Although laser cannot fully
replace all the conventional techniques
of dentistry, the progress is obvious and
the laser is expected to become an
essential component in conservative
dentistry & endodontics
THANK YOU
