Lasers in Dentistry

Overview:

Laser dentistry is an ideal option for many dental procedures, especially when it has to be less invasive. Many medical professionals and dentists use a laser to make alterations to the tissue at a minimal level. But, the sad truth is that many people might have never heard the term laser dentistry unless they have experienced it. Lasers can be used in dentistry for many procedures, such as removing tissue that is overgrown, whitening the teeth, and reshaping the gingiva. Laser dentistry is very good for kids who are afraid and anxious about dental treatments.

What is Laser?

The laser is a device that is used for the emission of light by processing an amplification. This laser is based on the emission of light that gets stimulated by electromagnetic radiation. The full form for LASER is Light Amplification by Stimulated Emission of Radiation. Currently, laser technology is influencing our life in many ways. Its advancements in dentistry and medicine play a vital role in patient well-being and care.

History of Laser in Dentistry:

In 1965, Goldman experimented on a patient who had a vital tooth for laser surgery. The results of the experiment showed that the patient did not experience any pain. Also, the patient had only mild and superficial damage to the crown structure. Ruby lasers were given much importance earlier. When it was found that ruby lasers required a lot of energy for hard tissues of teeth, their usage was reduced. Another disadvantage of the ruby laser is that it caused thermal damage to the pulp. In 1964, Nd: YAG laser was identified. But, till 1990, this laser was not used in dentistry. Carbon dioxide laser is considered as the first and the foremost laser that had applications in dentistry. It was useful for treating problems in both hard and soft tissues. In 1971, Weichman and Johnson tried using lasers for endodontics. Their attempts were unsuccessful in sealing the apical foramen. In 1977, the FDA approved Er: YAG for its usage in cavity preparation. It was commercially released in Germany.

Classification of Laser:

1. Based on safety concerns, the lasers are classified into the following types:

• Class 1: Inherently safe.

• Class 2: The eye is being protected by blink reflex.

• Class 3: Viewing the lasers directly is considered hazardous.

• Class 4: The laser is very harmful because it has a power that is more than 0.5 watt (W). Most of the lasers that are used for medical and dental purposes come under the fourth category. Therefore, it is essential for doctors and patients to stay safe.

2. On the basis of the laser medium, the lasers are classified into four types, they are:

• Gas laser.

• Solid-state laser.

• Semiconductor laser.

• Liquid laser.

3. On the basis of the components used, the lasers are classified into different types, as mentioned in the below table:

In dentistry, both ultraviolet light and infrared light are used. The application of lasers in dentistry is varying vastly. The usage of lasers depends on the following factors:

• The wavelength of light.

• Time of exposure.

• The density of the energy.

• The output of power.

• Nature of the tissue.

What Are the Applications of Lasers in Dentistry?

The wide range of applications of laser in dentistry are:

1. Diagnosis:

• Doppler flowmetry.

• Detection of pulp vitality.

• Laser fluorescence- detection of caries, dysplastic changes, and bacteria in the diagnosis of cancer.

• Low-level laser therapy (LLLT).

2. Hard Tissue Applications:

• Re-contouring of bone (crown lengthening).

• Caries removal and cavity preparation.

• Endodontics (sterilization, root canal preparation, and apicectomy).

• Caries resistance.

• Laser etching.

3. Soft Tissue Applications:

• Bacterial decontamination.

• Laser-assisted soft tissue curettage and peri-apical surgery.

• Gingival retraction for impressions.

• Gingivectomy and gingivoplasty.

• Implant exposure.

• Aesthetic contouring, frenectomy.

• Treatment of oral lesion therapy and aphthous ulcers.

• Biopsy incision and excision.

• Replacing sutures.

• Coagulation.

• Removal of granulation tissue.

• Laser-assisted flap surgery.

• Operculectomy and vestibulopathy.

• Pulp capping, pulpotomy, and pulpectomy.

• Removal of hyperplastic tissues and Fibroma.

• Incisions and drainage of abscesses.

4. Laser-induced analgesia.

5. Laser activation.

• Bleaching agents.

• Restorations (composite resin).

6. Other:

• Softening gutta-percha.

• Removal of fractured instruments and root canal filling material.

• Removal of moisture or drying of the canal.

What Are the Benefits of Using Lasers in Dentistry?

• Bleeding will be minimal while treating soft tissues, as the laser promotes blood clotting.

• There is potentially a reduced need for sutures with soft tissue lasers.

• The risk for bacterial infections is lower because the laser sterilizes the area.

• With some procedures, anesthesia is unnecessary.

• The methods may involve less damage to the surrounding tissues.

• Wounds can heal faster, and tissue can regenerate.

What Are the Disadvantages of Lasers in Dentistry?

• Hard lasers can sometimes injure or damage tooth pulp.

• Lasers can not be used on teeth that already have certain types of filling, such as metal amalgam.

• Drills are still occasionally needed to complete fillings, including shaping, adjusting the bite, and polishing it.

• Some laser procedures still require anesthesia.

• There is a risk of gum injury.

• Specific procedures cannot be done with laser treatment, depending on the preexisting surrounding tissue or components involving the tooth or gums.

• It is not an economical procedure.

What Is Photodynamic Therapy?

Photodynamic therapy has a beneficial application in dentistry. It is also known as photoradiation therapy. It is used by many periodontists and endodontics. This method focuses on the activation of a photoactive dye or photosensitizer. This activation occurs at a particular wavelength of the laser. This will be made successful only in the presence of oxygen. A transformation of energy from the photosensitizer that is activated will be required to form toxic oxygen components. These components include free radicals and singlet oxygen. This property is used for the destruction of cancerous and non-cancerous oral lesions. Photodynamic therapy has shown positive effects on patients diagnosed with leukoplakia, lichen planus, cancerous of the head and neck. To ensure long-term safety during the treatment process, it is necessary to remove the mutagenic and genotoxic effects of this therapy. To prevent opportunistic infections, the usage of selective photosensitizer is recommended.

What Are the Safety Measures to Be Followed While Using Lasers?

Though lasers are very helpful, they cannot be used carelessly. There are specific tips and tricks to be followed. They are:

• The clinical setup should have a signboard showing the warning of lasers.

• The use of protective equipment such as goggles and aprons for restricting the laser is essential. Both the dentist and the patient should follow this.

• The laser should be stored and used according to the instructions recommended by the manufacturer.

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