ACTA SCIENTIFIC DENTAL SCIENCES (ISSN: 2581-4893)

Volume 3 Issue 12 December 2019

Review Article

Lasers in Fixed Prosthodontics

El khourani Wadie1* and Pr Amal El yamani2

1
Resident in Prosthodontics Department, Mohamed V University, Faculty of Dental Medicine of Rabat
2
Associate Professor, Head of the Department of Prosthodontics Mohamed V University, Faculty of Dental Medicine of Rabat
*Corresponding Author: El khourani Wadie, Resident in Prosthodontics Department, Mohamed V University, Faculty of Dental Medicine
of Rabat.
Received: October 15, 2019; Published: November 21, 2019

DOI: 10.31080/ASDS.2019.03.0707

Abstract
Among the most significant events in the evolution of modern prosthodontics is the introduction of lasers. A laser (acronym for
light amplification by stimulated emission of radiation) is a device that produces radiation which is spatially and temporally coher-
ent.
In fixed prostheses, lasers find their indications in the management of soft and hard tissues, they are characterized by their preci-
sion, their speed as well as the positive response of the tissues treated by this technique in comparison with other surgical techniques.

This work will describe the different types of lasers, their uses in fixed prosthodontics, their indications and their interactions
with the tissues concerned.
Keywords: Lasers; Prosthodontics

Introduction studies.40 years later, the American physicist Charles Townes

One of the most significant events in the evolution of modern developed Einstein's theory thanks to the principle of amplifying
fixed prosthodontics is the introduction of lasers. A laser (acronym microwave frequencies by stimulated emission who takes the
for light amplification by stimulated emission of radiation) is a acronym maser [3].
device that produces radiation that is spatially and temporally
The appearance of the first functional laser was in 1967, the
coherent [1].
ruby laser signed by T. Maiman, in 1961, Snitzer introduced the
Currently the laser has become an integral part of a complete neodymium laser.
treatment plan. Since its first application in 1960 in the field of In 1962, the first medical laser was developed in the laboratories
dentistry, its current use has replaced several technical and surgical of the University of Cincinnati following the work of Goldman, who
steps [2]. is the first doctor to have used the laser in the medical field.

The purpose of this work is to synthesize the fundamental Keifhabes., et al. were the first to use the Nd: yttrium-aluminum-
principles of lasers and their applications in the various fields of garnet (YAG) laser.
fixed prosthodontics.
In 1988 Francis l'Esperance was the first to use the argon laser
Invention of the laser
in ophthalmology [4].
The theory presented by Einstein in 1917 on stimulated
emissions can be considered as the founding element of laser In 1990 the first dental laser was released.

Citation: El khourani Wadie and Pr Amal El yamani. “Lasers in Fixed Prosthodontics”. Acta Scientific Dental Sciences 3.12 (2019): 99-103.
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Laser classification Neodymium laser

The different laser systems used in prosthodontics can be Neodymium laser Yttrium Aluminium Garnet: Nd: YAG has
classified into several categories according to their wavelengths: a solid active environment, which is a garnet crystal combined
with rare earth elements (yttrium and aluminium), doped with
Laser erbium
neodymium ions.
The erbium laser family has two wavelengths, the YSGG laser
(yttrium scandium gallium garnet, 2780 nm) and the ER laser, YAG The wavelength Nd: YAG is strongly absorbed by the pigmented
(yttrium aluminium garnet 2940 nm). tissue, making it a very useful surgical instrument for cutting and
coagulating soft tissues with good hemostasis. The available dental
The ER laser, YSGG, has a solid crystal of yttrium scandium
models have an emission wavelength of 1064 nm, which is located
gallium garnet doped with erbium and chromium. The ER laser,
in the invisible part of the near infrared of the electromagnetic
YAG, has a solid crystal of erbium-doped yttrium aluminum garnet
spectrum. In addition to its surgical applications, Nd: YAG is also
[5].
indicated for the non-surgical debridement of periodontal disease.
The wavelengths of erbium have a high affinity for Laser diode
hydroxyapatite, as well as a remarkable water absorption capacity
The diode laser is a solid-state semiconductor laser that uses
compared to other lasers, which implies that erbium’s are the
a combination of gallium, arsenide, aluminum and indium. The
lasers of choice for dental hard tissue treatments [6] and soft tissue
wavelengths used in dentistry are between 800 and 980 nm and are
procedures (high presence of H2O in soft tissues) [7].
poorly absorbed in water, unlike hemoglobin and other pigments
CO2 laser where they are highly absorbed. This laser is excellent for soft
The CO2 laser has an active gaseous environment who is pumped tissue interventions because it does not interact with dental and
through the electrical discharge current. The wavelength of these bone hard tissue. diode lasers are also used as adjuvant therapy for
lasers is 10,600 nm. the bio-stimulation of osteoblasts around implants [11].

Due to its cutting capacity, coagulating power and short tissue Application of the laser in fixed prosthodontics
penetration depth, CO2 lasers are indicated for the treatment of Coronary elongation
mucosal lesions and the vaporization of dense fibrous tissues [8]. Lasers offer the operator precision, comfort and control of the
Argon laser surgical procedure that are far superior to other surgical techniques.
The argon laser system uses argon as the active environment. Lasers allow the incision lines to be finely drawn and the desired
Argon lasers have two wavelengths used in dentistry: 488 nm gingival contour to be formed. All other coronary elongation
(blue) and 514 nm (blue-green) in the visible light spectrum. The methods have disadvantages in the surgical approach, the healing
488 nm wavelength is used for photopolymerization of composite time is longer, the position of the gingival margin after healing is
restorative materials, activation of bleaching gels and detection of random and the postoperative outcomes are uncomfortable and
dental cavities [9]. painful for the patient. In electrosurgery, the electric scalpel emits
significant heat that can cause pulp and bone necrosis [12].
The advantages of using the argon photopolymerization system
are the improved physical properties of composite resins as well as Er: YAG lasers have a high potential for bone ablation due to the
reducing time for curing compared to the ordinary blue light. mineralized matrix of bone that contains water and hydroxyapatite
(very high absorption rate) [13].
The 514 nm wavelength is used for soft tissue surgeries such
as acute inflammatory periodontal disease and highly vascularized Any technique used for coronary elongation in the anterior area
lesions, such as hemangiomas due to its maximum absorption into should ensure that an optimal esthetic result is obtained, hence the
tissues containing hemoglobin, hemosiderin and melanin [10]. interest of using lasers.

Citation: El khourani Wadie and Pr Amal El yamani. “Lasers in Fixed Prosthodontics”. Acta Scientific Dental Sciences 3.12 (2019): 99-103.
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The laser coronal elongation is indicated in: Formation of oval pontic sites

• The presence of subgingival cavities. Dental avulsion causes alveolar resorption of edentulous sites.
After the healing is complete, a bone ridge covered with a flat fibro-
• Coronary fracture that extends apically below the mar-
mucosa will form.
ginal gumline.
• Endodontic perforation close to the alveolar rim. This architecture is considered inappropriate for plural
• Insufficiency of the coronary lenght. restoration, especially in the anterior maxillary areas, as it leads
• Difficult positioning of the finishing line at a distance to an unaesthetic design of the pontic elements associated with
from the biological space. phonation and hygiene problems.

• Disordered gingival architecture. For a good design of the pontic sites, the use of lasers can be
Soft tissue management around the abutments indicated for soft tissue and bone remodeling. Soft tissue surgery

The energy supplied by the argon laser has a peak absorption in can be performed with argon and CO2 lasers and bone surgery can

hemoglobin, thus ensuring excellent hemostasis and well-regulated be performed with the Erbium laser family.

vaporization of oral tissues. These characteristics are beneficial for Removal of ceramic veneers
the retraction and hemostasis of gingival tissue around peripheral The use of lasers when removing veneers allows the practitioner
preparations before an impression is taken. to avoid cutting out the bonded elements, it also improves the
patient's comfort and reduces the time in chair-side.
The argon laser used for gingival eviction must have a 300 um
fiber, a power setting of 1.0 W and a continuous wave emission [14]. The energy emitted by the laser passes through the ceramic
while remaining unchanged, then absorbed by the water molecules
present in the bonding agent.

The detachment is made at the junction of the silane and the

resin, the underlying tooth does not suffer any trauma during this
operation [15].
Root canal etching during Direct fiber-reinforced composit
restoration
Adhesion is an essential element for the success of Direct fiber-
reinforced composite restoration. it is generally impossible to
create a bonding surface without the presence of smear layer. This
Figure 1: Technical tray for laser gingival eviction containing structure contains hydroxyapatite, destroyed collagen fibers and
a diode laser, protective glasses for practitioner and patient and other elements that can alter the quality of the adhesion.
examination tray.
Er: YAG lasers cause thermomechanical ablation by micro-
explosions. This type of laser evaporates water and organic
components. The pressure interval during this process increases
by causing micro-explosions in the inorganic structures leading to
the opening of the dentine tubules [16].

The resulting irregularity improves the adhesive properties of

the dentine surface, ensuring then a better bonding.

Lasers in implantology
Dental lasers also find their indications in implantology, from
the preparation of the implant site before placement, to the bio-
stimulation of peri-implant tissues after osteointegration of the
Figure 2: Gingival evacuation by laser diode around the
implant and finally as a therapy for peri-impactites.
prepared stump of the 45 before the impression is taken, the fiber
is placed in the sulcus in contact with the tissue. With a sweep- One of the advantages of using lasers in implantology is the
ing motion, the fiber is moved around the tooth under a spray of ease of intervention on peri-implant soft tissues, particularly in
water spray associated with a suction. the 2nd surgical stage due to its hemostatic effect and the minimal

Citation: El khourani Wadie and Pr Amal El yamani. “Lasers in Fixed Prosthodontics”. Acta Scientific Dental Sciences 3.12 (2019): 99-103.
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retraction of peri-implant soft tissues after laser surgery, which 4. S Kaura., et al. “Lasers in prosthodontics”. The Saint’s Interna-
ensures that tissue margins remain at the same level after healing tional Dental Journal 1 (2015) 11.
as they are immediately after surgery [17].
5. G van As. “Erbium lasers in dentistry”. Dental Clinics of North
America 48 (2004): 1017-1059.
Preparation of the implant site: Lasers can be used for the
placement of mini-implants, especially in patients with bleeding 6. T Harashima., et al. “Morphological comparative study on ab-
problems, in order to perform bone surgery without blood lation of dental hard tissues at cavity preparation by Er: YAG
diffusion. and Er, Cr: YSGG lasers”. Photomedicine and Laser Therapy 23
(2005): 52-55.
Treatment of peri-implantitis: Diode lasers, CO2 lasers and
Er: YAG lasers have been used for the treatment of peri-implant 7. I Ishikawa., et al. “Clinical application of erbium: YAG laser in
periodontology”. Journal of the International Academy of Peri-
diseases, due to their bactericidal effect and their technical
odontology 10 (2008): 22-30.
simplicity.
8. M Pogrel., et al. “Structural changes in dental enamel induced
Debridement of the abutment-implant interface with lasers can
by high energy continuous wave carbon dioxide laser”. Lasers
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and improve the success rate of contaminated implant Schwarz., et
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Nd: YAG and Ho: YAG lasers are not suitable for the treatment of
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Conclusion
540-545.
The use of different types of lasers in prosthodontics has
made it possible to redefine the principles of soft and hard tissue 12. S Parker. “The use of lasers in fixed prosthodontics”. Dental
management around dental and implant abutments, offering the Clinics of North America 48 (2004): 971-998.

practitioner the possibility of performing Multiple procedures in 13. JR Jyothy., et al. “Lasers in prosthetic dentistry”. Indian Journal
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However, the dentist's responsibility requires him to choose the 14. V Punia., et al. “The current status of laser applications in”.
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15. U Iseri., et al. “Effect of Er:YAG laser on debonding strength
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Volume 3 Issue 12 December 2019

© All rights are reserved by El khourani Wadie and
Pr Amal El yamani.

Citation: El khourani Wadie and Pr Amal El yamani. “Lasers in Fixed Prosthodontics”. Acta Scientific Dental Sciences 3.12 (2019): 99-103.