Lecture 5 Laser in Operative Dentistry

lec.4 (2nd term) Dr.
Abdulkareem Al-Mezouri 2019
Laser in operative dentistry

Laser is a device which produces beams of very high intensity light.
The word laser is for Light Amplification by Stimulated Emission of
Radiation
Laser basics:
Dental lasers are named depending based on the active medium that is
stimulated. The active medium can be:
 a gas (e.g. argon, carbon dioxide),
 a liquid (dyes) or
 a solid state crystal rod e.g. Neodymium yttrium aluminum
garnet (Nd:YAG), Erbium yttrium aluminum garnet (Er: YAG) or
 a semiconductor ( diode lasers).
The active mediums contain atoms whose electrons may be excited to
a metastable energy level by an energy source. The active medium may be
excited by excitation mechanisms that pump energy into the active medium
by one or more of three basic methods;
 optical (e.g. xenon flash lamps, other lasers),
 electrical (e.g. gas discharge tubes, electric current in
semi-conductors) or
 chemical.
Laser light is unique in that:
 it is monochromatic (light at one specific wavelength),
 Directional (Low divergence) and
 coherent (all waves are in a certain phase relationship to each
other).
lec.4 (2nd term) Dr. Abdulkareem Al-Mezouri 2019
These highly directional and monochromatic laser lights can be

delivered on to target tissue as:
 a continuous wave,
 Gated-pulse mode or
 free running pulse mode.
Types of lasers used in dentistry:
The most common laser types used in dentistry are the following:
1. Argon laser: Operates at wavelength of 457 to 502 nm, using apulsed or

continuous waveform. Argon laser is used for caries detection, curing of
composite, teeth whitening and in minor surgery.
2. Helium-neon (He-Ne) laser: Operates at wavelength of 632.8 nm, used for

pulp vitality test.
3. Diode laser: Operates at wavelengths of 810, 840, 904, 940 nm, using
apulsed or continuous waveform. Diode laser used in oral surgery,
endodontic treatment, soft tissue procedures, and teeth bleaching.
4. Neodymium: Yttrium, Aluminium, Granet (ND: YAG) laser: Operates at
wavelength of 1.064 μm, in high intensity pulsed waveform. It is used in
tissue retraction, endodontics and oral surgery.
5. Carbon dioxide (CO2) laser: Operates at wavelengths of 9.6, 10.6 μm. CO2
can be operated in interrupted waveform or continuous waveform. CO 2 laser
is used in oral soft tissue surgery, dentin hypersensitivity, and teeth
bleaching.
6. Erbium:Yttrium, Aluminium,Granet (Er:YAG) laser: Operates at

wavelength of 2.94 μm and in a pulsed waveform. It is used for caries
removal and cavity preparation, modification of enamel and dentin surfaces,
intraoral general and implant soft tissue surgery, sulcular debridement
(subgingival curettage in periodontitis), scaling of root surfaces, treatment of
dentin hypersensitivity, analgesia, pulpotomy, root canal treatment and
disinfection, and aphthous ulcer treatment.
7. Erbium,Cromium: Yttrium, Scandium, Gallium and Garnet (Er,Cr:
YSGG) laser: Operates at wavelength of 2.78 μm and in a pulsed waveform.
Same dental applications as Er:YAG laser.
Laser application in operative dentistry:
Use of Laser in detection of caries:
Laser fluorescence systems for detection of dental caries originally

employed visible blue light from the argon laser, relying on the lack of
fluorescence from carious enamel and dentine to demonstrate the presence
of the lesion.
Subsequent development of the technique allowed visible red laser
light from a semiconductor diode laser to be used to elicit fluorescence from
bacterial deposits.
For detection of dental caries in pits and fissures, laser fluorescence
offers greater sensitivity than conventional visual and tactile methods. The
technique is also well suited to smooth surface lesions on cervical surfaces
of teeth and to recognition of caries beneath clear fissure sealants. Detection
of proximal lesions is technically more difficult, and in this setting, argon
laser-induced fluorescence offers a valuable adjunct to conventional

methods. The differential water content of early fissure caries and sound
occlusal enamel has also led to the development of methods using the carbon
dioxide laser to reveal such lesions and to modify the fissure system to
increase resistance to future carious attack. Moreover, the use of dyes in
conjunction with laser fluorescence holds promise for using the method for
delineating cavitated from non-cavitated lesions in sites of poor clinical
access, such as approximal surfaces.
Cavity preparation
The Er: YAG laser was tested for preparing dental hard tissues for the
first time in 1988. It was successfully used to prepare holes in enamel and
dentine with low ‘fluences’ (energy (mJ)/unit area (cm2)). Even without
water-cooling, the prepared cavities showed no cracks and low or no
charring while the mean temperature rise of the pulp cavity was about 4.3°C.
it was concluded that dentine and enamel removal was very effective with
no risk to the pulp and the ablation rates in enamel were stated to be in the
range of 20-50 μm/pulse, and in dentine they were reported to be as high at
lower fluences.
Clinically, cavity preparation in enamel results in ablation craters with a
white chalky appearance on the surface of the crater. In dentine, cavity
margins are sharp and dentinal tubules remain open without a smear layer.
Caries removal:
Carious material contains a higher water content compared with
surrounding healthy dental hard tissues. Consequently, the ablation
efficiency of caries is greater than for healthy tissues. There is a possible

selectivity in the removal of carious material using the Er: YAG laser
because of the different energy requirement to ablate carious and sound
tissues leaving those healthy tissues minimally affected. The ablation
threshold of healthy dentine is two times higher than the corresponding
threshold of carious dentine. Therefore, very small fluences (energy
(Joules) / area (cm2)) of the Er: YAG laser energy are required to selectively
ablate carious dentine. The laser removed infected and softened carious
dentine to the same degree as the bur treatment. In addition, a lower degree
of vibration was noted with the Er: YAG laser treatment.
Restoration removal:
The Er: YAG laser is capable of removing cement, composite resin
and glass ionomer. The efficiency of ablation is comparable to that of
enamel and dentine. Lasers should not be used to ablate amalgam
restorations however, because of potential release of mercury vapor. The
Er:YAG laser is incapable of removing gold crowns, cast restorations and
ceramic materials because of the low absorption of these materials and
reflection of the laser light.
Etching:
Laser etching has been evaluated as an alternative to acid etching of
enamel and dentine. The Er: YAG laser produces micro-explosions during
hard tissue ablation that result in microscopic and macroscopic irregularities.
These microirregularities make the enamel surface microretentive and may
offer a mechanism of adhesion without acid-etching. However, it has been
shown that adhesion to dental hard tissues after Er: YAG laser etching is
inferior to that obtained after conventional acid etching. These authors
attributed the weaker bond strength of the composite to laser-etched enamel
and dentine to the presence of subsurface fissuring after laser radiation. This
fissuring is not seen in conventional etched surfaces. The subsurface
fissuring contributed to the high prevalence of cohesive tooth fractures in
bonding of both laser-etched enamel and dentine.
The use of Laser in curing of resin restoration:

The argon laser produces high intensity visible blue light (488nm)
which is able to initiate photopolymerization of light-cured dental restorative
materials which use camphoroquinone as the photoinitiator. The temperature
increase at the level of the dental pulp is much less with argon laser curing
than when conventional quartz tungsten halogen lamp units are used.
Argon laser radiation is also able to alter the surface chemistry of both
enamel and root surface dentine which reduces the probability of recurrent
caries. This clinical benefit is added to the reduced curing time and
improved depth of cure achieved with the argon laser.
Treatment of dentinal hypersensitivity:

Dentinal hypersensitivity is one of the most common complaints in
dental clinical practice. Various treatment modalities such as the application
of concentrated fluoride to seal the exposed dentinal tubules have been
tested to treat the condition. However, the success rate can be greatly
improved by the ongoing evaluation of lasers in hard tissue applications. A
comparison of the desensitizing effects of an Er: YAG laser with those of a
conventional desensitizing system on cervically exposed hypersensitive

dentine showed that desensitizing of hypersensitive dentine with an Er:
YAG laser is effective, and the maintenance of a positive result is more
prolonged than with other agents.
Caries prevention:
Several studies examined the possibility of using laser to prevent
caries. It is believed that laser irradiation of dental hard tissues modifies the
calcium to phosphate ratio, reduces the carbonate to phosphorous ratio, and
leads to the formation of more stable and less acid soluble compounds,
reducing susceptibility to acid attack and caries. Laboratory studies have
indicated that enamel surfaces exposed to laser irradiation are more acid
resistant than non-laser treated surfaces.
Bleaching:
The objective of laser bleaching is to achieve an effective power
bleaching process using the most efficient energy source, while avoiding any
adverse effects. Power bleaching has its origin in the use of high-intensity
light to raise the temperature of hydrogen peroxide, accelerating the
chemical process of bleaching.
The FDA approved standards for tooth whitening has cleared three dental
laser wavelengths:
 argon,
 CO2 and
 the most recent 980-nm gallium aluminum arsenide (GaAIAs) diode.

Lecture 5 Laser in Operative Dentistry

Uploaded by

Copyright:

Available Formats

Lecture 5 Laser in Operative Dentistry

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Lecture 5 Laser in Operative Dentistry

Uploaded by

Copyright:

Available Formats

lec.4 (2nd term) Dr.

Abdulkareem Al-Mezouri 2019

Laser in operative dentistry

These highly directional and monochromatic laser lights can be

Types of lasers used in dentistry:

1. Argon laser: Operates at wavelength of 457 to 502 nm, using apulsed or

2. Helium-neon (He-Ne) laser: Operates at wavelength of 632.8 nm, used for

6. Erbium:Yttrium, Aluminium,Granet (Er:YAG) laser: Operates at

Laser application in operative dentistry:

Use of Laser in detection of caries:

Laser fluorescence systems for detection of dental caries originally

laser-induced fluorescence offers a valuable adjunct to conventional

efficiency of caries is greater than for healthy tissues. There is a possible

The use of Laser in curing of resin restoration:

Treatment of dentinal hypersensitivity:

conventional desensitizing system on cervically exposed hypersensitive

You might also like