Laser And Laser

Applicatins
Salma Al-Hussein
Ahmed Adel
Outline
• Introduction.
• Basic laser science.
• Types of laser light delivery.
• Emission modes.
• Laser&tissue interactions.
• Types of tissue interactions.
• Classification of lasers.
• Commonly used laser in dentistry.
• Laser applications in dentistry.
Introduction
• The word LASER is an acronym for Light Amplification
by Stimulated Emission of Radiation.
• A study of each of these words offers an understanding
of the basic principles of how a laser operates.
• Spontaneous emission occurs when atoms are excited
to a higher energy state, their electrons occupy excited
orbits, but spontaneously drop to a ground state orbit
with the concomitant release of a packet of energy called
a photon.
• Stimulated emission, however, occurs when atoms are
energized by heat, light or electric discharge.
Basic laser science
• Properties of LASER
Velocity: The speed of light in a vacuum = 2.99×1010
cm/sec.
Amplitude: The total height of the wave from peak to
peak.
Wave length: The distance between any two
corresponding points on the wave.
Frequency: A number of wave cycles per second.
Comparison between ordinary visible light and LASER Light
Basic Laser Components

1. Optical resonator / tube containing the

active medium and having two mirrors,
one fully reflective and the other one
partially trans-missive, which are located
at either end of the optical cavity.
2. Active medium(Lasing medium) solid,
liquid or gas.
3. Pumping mechanism which“pumps” the
atoms in the laser medium to higher
energy levels.
4. LASER delivery system
Advantages of Laser
1. Dry surgical field
2. better visualization.
3. Tissue surface sterilization.
4. Decreased swelling, edema
and scarring.
5. Decreased pain.
6. Faster healing.
7. Minimal mechanical
trauma.
Disadvantages of Laser

1. Relatively high in cost.

2. Operations of lasers require
specialized training.
3. No single wavelength will optimally
treat all dental disease.
4. There is inability to remove metallic
and cast-porcelain defective
restorations.
5. Harmful to eyes and skin.
Types of laser light delivery
1. Fiber optic delivery system:
Lasers in the visible (445 and 532 nm) and near
infrared (from 810 to 1,064 nm) range use optic
strands, by and large made of quartz, to convey
the laser vitality to the tissue, specifically or by
means of terminal hand piece, with straight and
precise tips
Disadvantage: gets worn with time

Why is Fiber optic important?

• Light weight
• Easy to approach
• Easy sterilization
• Tactile sensation
Types of laser light delivery
2. Hollow Fiber:
Er: YAG and CO 2 lasers utilize a hollow tube with
reflective internal walls which transmit laser energy along its
internal axis.
Disadvantage: loss of energy over time with lack of control
over variability of energy due to internal reflection.
Types of laser light delivery
3. Articulated arm delivery system:
This delivery system utilizes a progression
of verbalized mirrors (generally 7)
associated one to each other, prompting
transmission of vitality.
Disadvantage: requires a precise system for
alignment of mirrors.
Types of laser light delivery
• 4. Hand pieces
Emission modes
A) Continuous wave:
The beam transmitted at one power level continuously
as long device is active.

b) Pulsed laser mode

• 1) Gated pulse mode:
A periodic alteration of laser energy being on or off, similar to
blinking of an eye.
Mode achieved by an opening closing of the shutter in front of the
beam path.

• 2) Free running pulsed mode (Donat wave mode):

large peak energy of laser light are emitted for a short time
(microsecond) followed by along time when the laser is off.
Laser&tissue interactions
• The light energy from a laser
can have four different
interactions with the target
tissue, and these interactions
depend on the optical
properties of that tissue and
wave length used.
Laser&tissue interactions
Transmission

• Transmission of laser vitality

specifically through the tissue, with no
impact on an objective tissue.
• Water is generally straight forward to
Nd:YAG while tissue liquids promptly
retain carbon di-oxide
Laser&tissue interactions
Absorption

This impact is the typical alluring impact, and the measure of

vitality that is consumed by the tissue relies upon the tissue
qualities, for example, pigmentation and water content,
and on the laser wavelength and discharge mode.

• Diode and Nd : YAG has a high fondness for

melanin and less communication with hemoglobin.
• Longer wavelength is more intelligent with water
and hydroxyapatite – Erbium, carbon dioxide laser.
• Short wave lengths, from around 500-1000nm are
consumed promptly in pigmented tissue.
Laser & tissue interactions
Diffusion or Scattering

• Scattering of the laser light

causes debilitating the vitality
and conceivably delivering no
helpful biologic impact.
Laser & tissue interactions
• Reflection

• Laser beam becomes more

divergent as the distance from
hand-piece increases.
• Can be dangerous
Types of tissue interactions
1. Photochemical

• Effects that lasers make to arouse chemical

reactions, such as curing of the composite resin.
• They can also origin a breakdown in chemical bonds,
such as in the process of photodynamic therapy
Types of tissue interactions
2. Photo-thermal
• occur when the chromo-phores absorb the
laser energy and heat is generated.

N.B chromo-phore is the tissue

component that absorbs the laser energy
and converts it into thermal energy.
Types of tissue interactions
3. Photo ablation

• When a laser is absorbed, it elevates the

temperature and produces photochemical
effects depending on the water content of the
tissues.
• When a temperature of 100°C is extended,
vaporization of the water within the tissue
occurs, a process called Ablation.
• Removal of tissue by vaporization and
super heating of tissue fluids, coagulation,
and hemostasis.
Types of tissue interactions
• [Link]-bio-modulation:

• The process whereby laser energy is used

to stimulate positive clinical outcomes
such as pain relief and improved healing.
Types of tissue interactions
• [Link](or
photoacoustic):
• Short-pulsed bursts of laser light with
extremely high power interact with water
in the tissue and from the hand piece
causing rapid thermal expansion of the
water molecules.

• This causes a thermo-mechanical

acoustic shock wave that is capable of
disrupting enamel and bony matrices quite
efficiently.
Types of tissue interactions
6. Tissue fluorescence

happens when actively carious tooth

structure is exposed to the 655nm visible
wavelength of the Diagnodent
diagnostic device.
The amount of fluorescence is related
to the size of the lesion, and this
information is useful in diagnosing and
managing early carious lesions.
Used as a diagnostic method to detect
the light reactive substance in tissue.
Types of tissue interactions
7. Vaporization & Carbonization
• At temperatures below 100°C, but above
almost 60°C, proteins begin to denature,
without vaporization of the underlying tissue.
• On the other hand, at temperatures above
200°C, the tissue is dehydrated and then
burned, resulting in an undesirable effect
called Carbonization.
Classification of lasers
Based on active medium

I. Gas lasers : an electric current is discharged through

a gas to produce coherent light.
e.g. Helium-Neon laser.

II. Solid lasers: medium is a solidus material.

e.g. neodymium, chromium, erbium or
ytterbium.

III. Liquid lasers: it uses a liquid crystal as the resonator

cavity, allowing selection of emission wavelength
and polarization from the active laser medium.
The lasing medium is usually a dye doped into
the liquid crystal.
Classification of lasers
• Based on their power supply:

• High-power lasers:
when used in medicine, they destroy or
cut tissue.
• Mid power lasers:
Are in great demand for a variety of
applications including plastic and polymer
processing, spectroscopy, non-invasive
medical diagnosis and laser scalpel.
• Low power lasers :
other names include soft laser, cold laser,
bio-stimulation laser, therapeutic laser, and l
aser acupuncture. Low-power lasers are claimed
to stimulate tissues and to encourage the
Classification of lasers
• Based on their clinical use
• Diagnosis
` e.g. Laser fluorescence, Laser Doppler
Flow-metry
• Non-surgical treatment
a- Laser activation of bleaching agent.
b- Laser activation of light curing
materials.
• Surgical treatment
a- Soft tissue.
b- Hard tissue.
c- Combined.
Classification of lasers
Based on wavelength
1. Excimer 195-350nm
2. Alexandrite 337nm
3. Argon 455-515nm
4. He-Ne 637nm
5. Diode 655-980nm
6. Nd:YAG 1064nm
7. Ho:YAG 2100nm
8. Er,Cr: YSGG 2780nm
9. Er:YSGG 2790nm
[Link]:YAG 2940nm
11.CO2 10600nm
Commonly used laser in dentistry
Commonly used laser in dentistry
• Carbon dioxide Lasers : Gas Lasers

• Advantages
1. Have high affinity for water, rapid soft tissue
removal.
2. Rapid hemostasis with shallow penetration.
3. Generally used in surgical procedures both major and
minor.
4. Improves mechanical retention of sealant
5. Sealing of nerve endings.
6. Sutures are rarely needed.
7. In leukoplakia and dysplasia.
8. Helps in healing of aphthus ulcers.
Commonly used laser in dentistry
• Carbon dioxide Lasers
• Disadvantages
1. Have the highest absorbance of any laser.
2. Large size, high cost.
3. Greater hard tissue destruction.
4. Wound healing can be delayed for a few
days.
5. CO2 treated tissue will have a black/brown
appearance, which is caused by a carbon
residue that easily rinses off within the first
few days after the procedure.
Commonly used laser in dentistry
• Neodymium- Yttrium
Aluminum Garnet Laser (Nd:
YAG) :
• Solid state Lasers
• This form of laser commonly delivers
continuous waves but can also be
configured to operate in a special
pulsed mode.
Commonly used laser in dentistry
• Neodymium- Yttrium Aluminum Garnet
Laser (Nd: YAG) :

• Advantages
1. Highly absorbed by pigmented tissues.
2. They also have the ability to stimulate
fibrin formation with longer pulse duration
setting, this phenomenon is utilized to:
-Biologically seal treated pockets and act as a
scaffold for reattachment.
-Form clots in extraction sites which c an
help prevent alveolitis and enhance
osteogenesis.

[Link] for cutting and coagulating dental soft

tissues.
[Link] hemostasis.
Commonly used laser in dentistry
• Neodymium- Yttrium Aluminum
Garnet Laser (Nd: YAG) :

• Advantages
6. It can be used for multiple soft tissue
procedures such as gingivectomy, frenectomy,
impression troughing, and biopsy.
Offering good hemostasis during soft-tissue
procedures, which facilitates a clear operating
field.

7. Photo-bio-modulation procedures.

8. Remove incipient enamel caries, although

not as efficiently as the Er:YAG, or
Er:Cr:YSGG, lasers.
Commonly used laser in dentistry
Disadvantages:
1. It has the greatest depth of penetration of all the
available dental surgical laser systems.
This means that tissues under the surface are exposed to laser
energy risking unwanted damage, especially in the underlying
bone or the dental pulp.
It can cause pulpal hypersensitivity or even complete damage.

2. Diminished localization of the energy on the tissue’s

surface makes vaporization of soft tissue with the Nd:YAG
laser slower than with the better-absorbed laser wavelengths,
such as those produced by the CO2laser.
Commonly used laser in dentistry
Argon lasers:
• Argon is laser with an active
medium of argon gas that is
energized by a high-current
electrical discharge.
Commonly used laser in dentistry
• Argon lasers:
1. Yield high intensity visible blue light.
2. Curing of dental restorations.
3. It also changes the surface chemistry of
both enamel and root surfaces dentine,
which reduces the probability of
recurrent caries.
4. Removes extrinsic and intrinsic stains.
5. Bleaching of teeth.
6. Acute inflammatory periodontal disease.
7. Highly vascularized lesions, it achieves
rapid hemostasis.
8. Cutting and sculpting of gingival tissues.
Commonly used laser in dentistry
Diode lasers:
• Diode is a solid active medium laser,
manufactured from semiconductor
crystals using some combination of
aluminum or indium, gallium, and
arsenic.
• The continuous wave emission mode of
the diode laser can cause a rapid
temperature rise in the target tissue.
• The clinician should use air and
sometimes water to cool the surgical
site and to continue to move the fiber
around the treatment area.
Commonly used laser in dentistry
Diode lasers:
Advantages:
1. It is an excellent soft tissue surgical
laser and is indicated for cutting and
coagulating gingiva and mucosa, as well
as, sulcular debridement.
2. Within certain low-energy ranges, the
diode laser can stimulate the
proliferation of fibroblasts.
3. Bactericidal capabilities and can be used
for adjunctive periodontal procedures.
4. Teeth whitening.
5. Photo-bio-modulation properties .
6. Engrossed primarily by tissue pigment
(melanin) and hemoglobin.
Commonly used laser in dentistry
• Diode lasers:
Disadvantages
1. Poorly absorbed by the hydroxyapatite and water
present in the enamel
Commonly used laser in dentistry
Erbium Laser: Solid state Lasers

Advantages
Erbium wavelengths have a high affinity
for hydroxyapatite and the highest
absorption of water.
Used for both soft and hard tissues

Disadvantages
• High cost.
• Marginally prolonged treatment
time but better results.
Commonly used laser in dentistry
Erbium: Chromium: Yttrium Scandium
Gallium Garnet Laser (Er:Cr:YSGG)
1. Etches enamel surface.
2. Removal smear layer.

Erbium: Yttrium Aluminium Garnet Laser

(Er:YAG)
3. Remove caries in enamel and dentin.
4. Removes dislodged GIC and Composite.
5. Desensitize the hypersensitivity dentine.
Commonly used laser in dentistry
• Soft tissue applications
1-Periodontal procedures, Erbium
lasers can also be used to safely scale
root surfaces during periodontal
procedures which has the added
benefit of root surface
decontamination.
2- Gingival contouring.
3- Biopsies.
4- Frenectomies.
5- Pre-prosthetic procedures.
Laser
applicatio
n in
dentistry
• SOFT TISSUE APPLICATION
• HARD TISSUE APPLICATION
• MISCELLANEOUS APPLICATIONS
Wound healing

• At low doses (e.g., 2 J/cm2), laser

application stimulates proliferation,
while at high doses (e.g. 16 J/cm2) it
is suppressive. It affects fibroblast
maturation and locomotion, and this
in turn may contribute to the higher
tensile strengths reported for healed
wounds.
• Low-level laser treatment
(LLLT) of gingival fibroblasts
in the culture has been
shown to induce
transformation in
myofibroblasts (useful in
wound contraction) as early
as 24 hours after laser
treatment.
• The positive effects of LLLT
on the healing of lesions of
recurrent aphthous
stomatitis in humans have
also been recorded
Photoactivated dye disinfection
using lasers

• Low power laser energy is useful for

photochemical activation of oxygen-
releasing dyes, causing membrane and
DNA damage to the microorganisms.
• The photoactivated dye (PAD)
technique can be undertaken with a
system using low power (100
milliwatts) visible red semiconductor
diode lasers
• Photoactivated dye can be
applied effectively for killing
Gram-positive bacteria (including
Methicillin-
resistant Staphylococcus
aureus (MRSA)), Gram-negative
bacteria, fungi, and viruses.
• The major clinical applications of
PAD include disinfection of root
canals, periodontal pockets,
deep carious lesions, and sites of
peri-implantitis.
Photodynamic therapy for
malignancies
• Photodynamic therapy (PDT), which has been employed
in the treatment of malignancies of the oral mucosa,
particularly multi-focal squamous cell carcinoma, acts
on the same principle of PAD, and generates reactive
oxygen species, which in turn, directly damages the
cells and the associated blood vascular network,
triggering both necrosis and apoptosis.

• this activates the host immune response, and promotes

anti-tumor immunity through the activation of
macrophages and T lymphocytes
Aesthetic gingival re-contouring and crown lengthening

• With the advent of the diode laser,

many clinicians are choosing to
include optimization of gingival
aesthetics as part of the
comprehensive orthodontic
treatment

• ,whereas, conventional
gingivectomy is associated with
pain, discomfort, and bleeding.
Exposure of unerupted
and partially erupted
teeth

• An impacted or partially
erupted tooth can be
exposed for bonding by
conservative tissue removal,
allowing for reasonable
positioning of a bracket or
button It has the advantage
of no bleeding, and an
attachment can be placed
immediately, and moreover,
it is not painful at all.
Removal of inflamed, hypertrophic tissue, and
miscellaneous tissue removal

• Isolated areas of transient tissue

hypertrophy can easily be excised
with the diode laser without specialist
referral . The diode laser is also very
useful for a number of isolated
applications, such as, removing
tissue that has overgrown mini-
screws, springs
Frenectomies

• A high or prominent labial frenum when

indicated, laser assisted frenectomy is a
simple procedure that is best performed
after the diastema is closed as much as
possible.

• Ankylosglossia can lead to problems with

deglutition, speech, malocclusion, and
potential periodontal problems.
• SOFT TISSUE APPLICATION
• HARD TISSUE APPLICATION
• MISCELLANEOUS APPLICATIONS
Photochemica
l effects

• The argon laser produces

high intensity visible blue
light (488 nm), which is
able to initiate
photopolymerization of
light-cured dental
restorative materials,
which use
camphoroquinone as the
photoinitiator.
Laser
fluorescence

• Enamel demineralization
with white spot formation
on the buccal surfaces of
the teeth is a relatively
common side effect from
orthodontic treatment
with fixed appliances.
• There is evidence,
however, which suggests
that such small areas of
superficial enamel
demineralization may re-
mineralize.
Cavity preparation, caries, and restorative removal

• Various studies depict the use of Er: YAG, since

1988, for removing caries in the enamel and
dentine by ablation, without the detrimental
effect of rise in temperature on the pulp,even
without water-cooling, with low ‘fluences’ laser
(LLLT), similar to air-rotor devices, except that
the floor of the cavity is not as smooth.

• The Er: YAG laser is capable of removing

cement, composite resin, and glass ionomer.
Etching

• Laser etching has been evaluated as an

alternative to acid etching of enamel and
dentine. Enamel and dentine surfaces
etched with (Er, Cr: YSGG) lasers show
micro-irregularities and no smear layer.

• Adhesion to dental hard tissues after Er:

YAG laser etching is inferior to that
obtained after conventional acid etching
Treatment of
dentinal • Dentinal hypersensitivity is one of the most common
complaints in clinical dental practice. Comparison of the
hypersensitivit desensitizing effects of an Er: YAG laser with those of a
conventional desensitizing system on cervically exposed
y hypersensitive dentine
Diagnostic application
3-D Laser scanner
for e-model
preparation

• The laser scanner can be

used as a soft tissue
scanner and is a valuable
tool for its ease of
application and creation of
3D images of oral dental
structures. There is no
need of cast preparation
as e-models are prepared
from scanned
impressions.
• SOFT TISSUE APPLICATION
• HARD TISSUE APPLICATION
• MISCELLANEOUS APPLICATIONS
Analgesic effect of
the laser

• There have been claims that

successful analgesia
following oral surgery can be
achieved with all major LLLT
wavelengths from 632 nm to
904 nm.
• Local CO2 laser irradiation
will reduce the pain
associated with orthodontic
force application, without
interfering with tooth
movement.
Nerve repair and regeneration

• The direct application of this technique to

dentistry has yielded positive results in
promoting the regeneration of inferior dental
nerve (IDN) tissue, damaged during surgical
procedures.
Post surgical
pain

• A single episode of LLLT

(irradiance 0.9-2.7 J) is
100% effective for apical
periodontitis following
root canal treatment and
post-extraction pain.
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