LASERS IN ENDODONTICS

AND CONSERVATIVE
DENTISTRY
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 LASER
• An acronym for Light Amplification by
the Stimulated Emission of Radiation..

• A device that creates a uniform and

coherent light that is very different from
an ordinary light bulb.

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• Also can be described as a device for
generating a high-intensity, ostensibly
parallel beam of monochromatic(single
wavelength) electromagnetic radiation.

• Laser light can be focused down to a

tiny spot as small as a single
wavelength.
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 A bit of history
• The possibility of stimulated emission
predicted by Einstein-1917..

• Based on work of Gordon in 1955 &

Schawlow n Townes in 1958, MAIMAN
created the 1st operatinal laser in 1960,
a ruby laser emitting a brillant red beam
of light..
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• photo of the development of the helium-neon
laser taken at AT&T's Bell Laboratories in
1964.
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 THE LASER
• Basic components..
• An ACTIVE LASING MEDIUM :-
- cn be a solid, liquid or gas
• Enclosed within a LASER CAVITY
bounded by two perfectly parallel
reflectors(mirrors)
• PUMP SOURCE – high energy
radiation pumped into the active
medium rxdentistry.net
• POPULATION INVERSION :-
condition when energyfrom pump
source is absorbed by active
medium until the majority of atoms, ions
or molecules are raised to their upper
energy state..

• And this condition is NECESSARY to

generate laser light..

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• TWO PARALLEL REFLECTORS –
situated at end of laser cavity act to
constarin light along n within the axis of
cavity..
• So light is repeatedly bounced b/w the
reflectors
• One of the mirrors is only partially
reflective, enabling some of the light to
escape the cavity as a beam of laser
light.. rxdentistry.net
• Working of laser

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• Working of laser

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 Advantages of lasers in
general

• Processing of matter without contact.

• High working speed

• Outstanding precision

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 Benefits

• Soft, quiet, vibration-free operation

• As fast as the high-speed turbine

• CO2 laser cuts and coagulates soft tissue

without bleeding

• No risk of cross-infection

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• Sterilization of operating field

• Fewer cracks than with turbine

• Multiple quadrant dentistry

• No need for etching

• Pulsing minimizes charring and thermal

necrosis
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 LASER DENTISTRY
Lasers are still in the pioneering stage,
but there are many current uses..

There are three types of Dental lasers:

• Surgical Laser (soft tissue)
• Curing Laser
• Tooth Laser (hard tissue)
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 SURGICAL LASER (soft tissue)

This laser replaces

traditional surgery for
many gum and soft
tissue dental
applications and is
gentler than traditional
surgical procedures.
This laser used for :
• Improve treatment
results for gum disease
• Contour gums for smile
enhancement
• Surgically correct oral
abnormalities

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• Surgically assist in arresting herpes lesions
and canker sores
• Assist in biopsies
• Treat infant tongue/frenum problems which
can hinder proper chewing/sucking
• Treat child/adult frenum problems which can
cause speech impediments, gum disease,
and teeth to grow apart rather than together

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CURING LASER
• This laser spectrum
light source is used for
rapid teeth whitening
and placing all tooth-
colored restorations
(fillings) and repair
procedures.
• Bonds created by this
advanced instrument
result in dentistry that is
twice as strong !

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• The light source increases gradually during
the curing process to create the best bond
available in dentistry today.
• Appointment length is also reduced because
it is 500% more powerful than standard
equipment.
• Less than 1% of dental offices nationwide
have this instrument, making it one of the
newest tools in dentistry..
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• TOOTH LASER (hard tissue)
Third type of laser is used to remove
cavities. But since this laser cannot be
used on existing metal fillings, we use
micro dentistry..

• MICRO DENTISTRY
one of the greatest advancements in the
field of dentistry.
• offers the ultimate flexibility and
capability. It is also the most tooth
conservative dentistry available.
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• About 50% of
cavities are
candidates for this
technique and there
is no drilling, no
needle, no extra fee,
and no pain!
• And because this
process is so
efficient, it reduces
appointment length.
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 Hard tissue applications
• Desensitize exposed root surfaces

• Diagnosis of non-cavitated caries

• To arrest demineralization and promote

remineralization of enamel.

• Debond ceramic orthodontic brackets.

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DIAGNOdent Caries Detector 
 
• The DIAGNOdent can find cavities that
other dental instruments can miss.

• The device is designed as an adjunct to a

traditional oral examination in the detection of
occlusal decay. Teeth that are suspicious for
caries are ideal candidates for survey with the
device
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 Key Benefits:
• A laser examination tool for the early
detection of caries.
• Even very small lesions can be
detected at the earliest stages.
• Over 90% accurate!
• Earlier treatment - Better outcomes
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• Diagnodent is a pen-like
probe that sends a safe,
painless laser beam
into the tooth. A numeric
display & alarm signals
when there are signs of
hidden decay.
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rxdentistry.net
• These pictures show how the Diagnodent
finds cavities that other
dental instruments can miss.

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 How it works....

• The Diagnodent device measures laser fluorescence

within the tooth structure.
• As the incident laser light is propagated into the site,
two-way hand-piece optics allows the unit to
simultaneously quantify the reflected laser light
energy.
• At the specific wavelength that the device operates
(655 nm), clean healthy tooth structure exhibits little
or no fluorescence, resulting in very low scale
readings on the display.
• Carious tooth structure exhibits fluorescence,
proportionate to the degree of caries, resulting in
elevated scale readings
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on the display
• Roughen tooth surfaces ,in lieu of acid
etching in preparation for bonding procedure

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• Treatment of dentin hypersensitivity..
• In bleaching
• Adhesion of pit & fissure sealant
• Most obvious application – controlled removal
of dental enamel, dentin, bone or cementum.

• Replacement of dental drill is a real possibility

for the future.
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 Soft tissue aplications
• 1968 – use of carbon dioxide laser – in
oral and maxillofacial surgery –
Goldman et all.
• Restricted mostly to incising and
excising masses from the mucosa and
gingiva in oral cavity.
• Vaporize exces tissue as in
gingivoplasty, gingivectomyy and
labial /lingual frenectomy.
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• Remove or reduce hyperplastic tissue.
• Remove and control hemorraging of
vascular lesions such as hemangiomas.
• In endodontics

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 Characteristics of surgical
lasers
SPECTRA
LASER WAVEL MODE TYPICA
TYPE ENGTH L L MAX
REGION
POWER
CO2 10,600nm Mid- CW& 100w
infrared Gated CW
&superp
ulsed
Holmiu 2,100 Near Pulsed 15Wavg
m nm infrared .
Nd:YAG 1,064 Near CW & 100W
nm rxdentistry.net
infrared pulsed CW
Diode 800- Near CW >50W
890nm infrared
KTP/KD 532nm visible Pulsed 25Wavg
P .
Argon 488/514 Visible CW 20W
nm
Excimer 190nm Ultaviole Pulsed 550mJ
ArF-XeCl t
Erbium: 308nm Ultraviol Pulsed 250mJ
YAG(Er: et
YAG) rxdentistry.net
 Carbon dioxide Laser
• Co2 gas as lasig /active medium
• Delivery system – uses an articulated
arm (a series of hollow tubes connected
together through a series of six to eight
articulating mirrors).
• USED-
cutting & vaporising tissue in open
proceures or in procedures where rigid
endoscopyis acceptable..
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 Cavity preparation
• Efect of ruby laser radiation on enamel
– Goldman, Stern & Sognnaes, 1964
• Carbondioxide laser – Lobene et all
1968
• Nd:YAG laser – Yamamoto & Ooya
1974
• Argon laser – Goodman & Kaufmann
1977
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• In removal of enamel n dentin – thermal side
effect occoured..
• Superpulsed carbon dioxide laser – removal
of dentin without thermal side effect possible.
• Transversal stimulation or carbon dioxide
TEA (the Alexandrit laser with double
frequency) – most efficent carb.dioxide laser
for dental hard tissue ablation.

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• Clinical perespactive of lasers
increased by introduction of Er:YAG,
Er, Er:YSGG lasers
• have advatages of
- reduced thermal effects
- creating precise contour of
the section zone.
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• Also in meantime new lasers
-Nd:YAG
-excimer
-holmium
-argon
-diode

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 Speed of preparation
• In thermomechanical , micro-abrasion
like explosion – much less energy is
needed.
• If soft tissue is softened by caries,the
laser ablation rate increases…
• Rough surfaces produced by laser
ablation provide good retension

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• Dentin surfaces r less rough aftr
ablation and hence less problamatic.
• High bond n shear strength can be
achieved with simple defocused
radiation..
• For conditioning less time is needed
than when etching conventionaly..

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• Drying the surface with laser is very
quick , efficent and gentle.
• Erbium laser has bactricidal abilities.
• Bcz high surface temperature can be
achieved for a short time by subalative
irradiation..
• Irridation of caries by a sequence of
laser pulses leads to consecuetive
dessication and sterlization.
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• The Er:YAG laser can be used to
disinfect cavity prep , in case of residual
bacteria contaminating, otherwise intact
enamel or dentin, or in fissures prior to
sealing.

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 Dentin hypersensitivity
• Best results obtained whn affected areas
exposed to co2 , Nd:YAG, Er:YAG, Diode
laser radiation
• Colojoara et al showed that dentin
hypersensitivity can be reduced without any
damages to pulp vitality by using co2 laser..
• They also showed that when using co2 laser ,
in parallel direction with dentin tubules, the
desensiting effect ws obvious aftr three
exposures. rxdentistry.net
 Dental material curing
• The first materials introduced in 1970’s
(photopolymerised composites) wr
cured by ultraviolet light..
• Power et al showed that an argon laser
requires shorter curing times & th
ematerials dentin bond strength was
stronger whn compared with laser.

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• Variables that control the depth &extent
of cure include
- time of exposure
- composite material
- wavelength
- intensity of light
- particle size of filler
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• Current reserches report that used at
the power of 250 +/- 50 mW for 10sec
per increment ,
• the argon laser provides good curing of
light activated restorative material in
shorter period of time with equal or
better physical properties than the
conventional halogen curing light..
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 LASER TEETH WHITENING
( bleaching)

•           With today's technology, laser teeth whitening

through the use of the Diode Laser is the quickest
and most dramatic way to brighten your smile if
porcelain laminates are not an option.
•           All tooth whitening procedures use hydrogen
peroxide or carbamide peroxide to bleach out stains
on your tooth enamel, but this is where the similarity
ends when comparing standard bleaching
procedures such as whitening performed with a light
cure to laser whitening.

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• Laser whitening is superior to all other whitening
techniques since
•           1.laser whitening products contain the highest
concentration of peroxide
          2.the laser provides the highest light intensity
available
          3.the procedure is done in the office at
chairside
•           thus allowing us to concentrate in those areas
of your mouth where the type and location of
discoloration is worse. Laser technology allows us to
whiten your teeth with amazing results in just one
hour! rxdentistry.net
 Whitening techniques will vary with
every individual depending on:

1.the type of stain on your teeth

2.where the stain is located

3.the amount of time the whitening gel is used

4.the peroxide concentration in the whitening gel

5.the intensity of the light activating the whitening gel

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Bleaching
• In Laser-Assisted Tooth
Whitening, the laser
enhances the effect of
bleaching agents for faster,
more comfortable and more
effective results.

• By stimulating the bleaching

gel to react faster, the
bleaching agent (mainly
peroxide) spends less time
on the tooth.

• This leads to increased

comfort levels, a reduction in
reaction from gums both
during and after treatment,
rxdentistry.net and improved results over
non-laser treatments
 Hazards of lasers
• Types of hazards

Ocular hazards
# injury to eye – direct emission or by
reflection from mirror like surface.
# irreversible retinal burns- by
conversion of incident radiation to heat
energy.
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 Tissue damage
* damage to skin & other non-target
tissue result from thermal interaction of
energy with tissue proteins
* temperature elevations can produce
denaturation of cellular enzymes
&structural proteins which interrupt
basic metabolic processes

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 3. Environmental hazards
• Are referred to as non-beam hazards

• Capable of producing smoke , toxic

gases and chemicals.

• Laser plume – composed of vaporised

water (steam), carbon particles, cellular
products..
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• The greatest producers of smoke are
co2, erbium lasers followed by Nd:YAG
Lasers..

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 Mechanical efects
• High energetic & short pulsed laser light
lead to a fast heating of dental tissue.
• Energy dissipates explosively in vol of
expansion – accompanied by fast
shockwaves..
• The shockwaves lead to high pressure
–destroy or damage adjacent tissue.

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 Effects on dental pulp
• Characteristically pulp tissue cannot
survive environment of elevated temp
for protracted periods when tooth
structure is irridated with lasers.
• Use of combination of air and water
spray before during or immediately after
laser irridation may be more effective..

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 4. Combustion hazards
• Flammable solids , liquids, gases used
within the surgical setting can be easily
ignited if exposed to laser beam..

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 5. Electrical hazards
• Can be in form of
- electric shock
- fire
- explosion

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 Thremal effects of laser
irradation
• Temperature < 60 celcius
~ tissue hyperthermia
~ enzymatic changes
~ edema
• Temperature > 60 celcius
~ protein denaturation

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• Temperature < 100 celcius
! Tissue dehydration
! Blanching of tissue
• Temperature > 100 celcius
! Super heating
! Tissue ablation&shrinkage

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 Fire & electrical control
measures
• Operatory must be dry
• Control panel & its electrical power unit
should be protected from any kind of
splashing..

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 Control of air borne
contamination
• Can cause charring
• Coagulation of blood elements

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 Procedural control
• Highly reflective instruments & those
with mirror surfaces should be avoided.
• Tooth protection is needed, whenever ,
the beam is directed at angles other
than parallel to the tooth surface.
• A no.7 wax spatula can be inserted into
gingival sulcus to serve as an effective
shield for teeth
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• If anesthesia is required in place of
standard PVC tubes , rubber or silastic
tubes should be used.
• For further protection tube should be
wraped with an aluminium tape.

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EYE PROTECTION

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rxdentistry.net
LASER PLUME
• The plume from a
laser ablation
deposition:
A Nd:YAG laser hits
ZnTe

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 • The 514nm line of
the cw laser, a few
100 mW, going
through a prism. Do
not try this at home!

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 A CASE STUDY
• Figure 1A—
Maxillary left first
permanent molar
with occlusal
enamel hypoplasia

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 • Figure 1B—
Waterlase MD. used
to remove (ablation).

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• Completed cavity
preparation after
using Waterlase MD

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• Completed
restoration with
resinomer

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Thanx !

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