LASER IN

CONSERVATIVE
DENTISTRY
-NH-
Light Amplification by Stimulated Emission
of Radiation (Lasers)

The main benefits for laser applications are

patient comfort, pain relief and better
results for specific applications. Major
concerns for using dental lasers frequently
are high cost, need for specialized training
and sensitivity of the technique, thereby
compromising its usefulness particularly in
developing countries.
The use of laser in medicine presents a
special interest, due to the spectacular
progresses recorded in the treatment of
various conditions. With no intention to
cover all the fields of use of laser
technology, we will enumerate a few
more common: ophthalmology, E.N.T.,
gastroenterology, obstetrics-
gynecology, dermatology, general
surgery, plastic surgery, neurosurgery,
cardiovascular surgery, pediatrics,
urology, orthopedics, oncology,
rheumatology, dentistry, etc.
 Basic When a laser interacts with oral tissues, there are four
possible outcomes: transmission, reflection, scatter

Principles
and/or absorption
Advantages • It is painless, bloodless that results in
clean surgical field and fine incision with
precision.
• The risk of infection is reduced as a more
sterilized environment is created, as laser
kills microorganisms.
• No post-operative discomfort, minimal
pain and swelling, generally doesn't
require medication.
•Superior and faster healing, offers better patient compliance
•Reduced operator chair time
•Minimal invasive cavity preparation
•Bactericidal effect
•Haemostatic effect
•Increase in the success of direct and indirect pulp capping procedures
•Increased depth of penetration; makes it possible
•to cure thicker increments of composite resin.
Disadvantages • Relatively high cost.
• Requires specialized training for the
clinician.
• Modification of clinical technique is required.
• Harmful to eyes and skin of both clinician
and patients if exposed adversely.
• No single wavelength of laser will optimally
treat all dental diseases
• Lasers don't completely eliminate the need
for anesthesia.
 Diagnostic laser devices such as DIAGNOdent and
DIAGNO- cam have been introduced.
Applications for DIAGNOdent is the most widely used laser-
Caries fluorescence caries detection device. It uses a
red laser (wavelength ∼688 nm) based on the
Detection principle that healthy (nonpathological
mineralized) and carious enamel and dentin
tooth tissues have different fluorescent
properties that are detected by the device.
DIAGNOdent use alone increases the
chances of ‘false positives’, hence it is
highly recommended that it should be
used along with radiography for a more
accurate caries diagnosis. However, the
latest technologies such as quantitative
light-induced fluorescence and
VistaProof have claimed to be more
efficient in detecting early and incipient
carious lesions.
Soft Tissue Applications
 Soft Tissue • The soft tissue applications have
been restricted mostly to incising and
Applications excising masses from the mucosa and
gingiva in the oral cavity.

• CO2 laser may have the unique

characteristic of being able to remove
a thin layer of epithelium cleanly,
unlike anything now available in
dentistry.
Hard Tissue Applications
 Cavity Since 1987, the clinical perspective of laser
use on hard dental tissues has grown by
Preparations introducing the Er:YAG, Er,Cr:YSGG
lasers,45-58 which have the advantage of
reducing thermal effects, and of creating a
precise contour of the section zone.

Preliminary clinical trials suggest that erbium

lasers are as efficient as conventional rotary
instruments in removing carious tooth
structure. However, erbium lasers can cause
pulpal necrosis due to thermal damage and
require a copious amount of water spray
during ablation. 
Ultra-short pulsed lasers (USPLs) have
been shown to precisely cut hard
materials including tooth enamel and
dentin with less temperature rise than
conventional lasers.

A, Buccal caries in upper-left bicuspid. B, Cavity prepared

using Er:YAG laser (2940 nm) and water spray (350 mJ/pulse,
10 Hz). Topical anesthetic applied. C,Completed acid-etched
composite restoration placed, before polishing.
 Dentin There are numerous studies in the
medical literature regarding the use of
Hypersensitivity laser therapy in dentin hypersensitivity
treatment. The best results have been
obtained when the affected areas were
exposed to CO2, Nd:YAG, Er:YAG and
diode laser irradiation.
 Composite Another use of light in dentistry began
with the advent of photopolymerized
Resin Curing dental composite materials. The first
materials introduced in the late 1970s
were cured with a light in the
ultraviolet wavelengths.
The variables that control the depth
and extent of cure include time of
exposure, composite material,
wavelength and intensity of the light,
and particle size of the filler.
• The use of a more powerful laser may have
cured the material faster and deeper. Since
the physical properties of the composites
post-laser irradiation were not determined,
no judgement can be made regarding
improved results with the laser.
• Current researches71 reported that, used at
powers of 250 ±50 mW for 10 s per increment,
the argon laser provides good curing of light-
activated restorative materials in a shorter
period of time with equal or better physical
properties than the conventional halogen
curing light.
Endodontics
• Uses of Lasers In Endodontics :
• Pulp diagnosis
• Pulp capping and pulpotomy
Cleaning and shaping of the root canal
system
• Endodontic surgery
Pulp Capping Advantages of lasers
• Bloodless field
and
• Sterilization of the treated wound
Pulpotomy • Hemostasis
• Improved restoration (scarring) of the
dentin tissue through the formation of
secondary dentin
Direct pulp capping:
 Moritz et al used Co2 laser for direct pulp capping
 The energy level of 1 W at 0.1 second exposure time
with 1 second pulse intervals was applied to the
exposed pulp
 Teeth were check for vitality after 6 and 12 months
and 89.4% of the teeth retained their vitality
 According to Paschoud and Holz, 1988 laser
treatment causes direct stimulation of dentin
formation
 Jukic et al used Co2 and Nd:YAG lasers on exposed
pulp tissue and reported that a dentinal bridge was
formed
• Indirect pulp capping:
• Nd: YAG and CO2 lasers are used
• Shoji et al used Co2 lasers in different WL and
reported that no damage was detected in the
radicular pulp.
• Charring, coagulation necrosis and
degeneration of odontoblastic layer occurred,
with no pulp damage resulting in secondary
dentin formation
• Irradiated by lasers such as CO2,Nd:YAG and
Excime
• A closer look reveals that the melted material
resembles glazed interconnected droplets
• Pulpotomy
• Shoji et al 1985 performed the first
laser pulpotomy using CO2 laser in
dogs. Wound healing of their radiated
pulp seemed to be better than that of
controls.
• Wildar- Smith et al 1997 and Dang et al
1998 found CO2 laser pulpotomy to be
very successful even in teeth with large
exposure sites, subjected to bacterial
contamination for several days.
Cleaning & Shaping Of Root Canal System:
• The potential bactericidal effect of laser
irradiation can be used effectively for
additional cleaning of the root canal system
following biomechanical instrumentation.
Various laser systems emit energy that can be
delivered into the root canal system by a
Thin optical fiber Nd: YAG, Er, Cr: YSGG, Ar,
Diode Hollow Tube, CO2 and Er:YAG
• It has been demonstrated in many studies that
the laser radiation has the ability to remove
debris and smear layer from the root canals
also has the potential to kill the
microorganisms
Laser Assisted Obturation:
• Rationale in using lasers for obturation is
that the irradiation can be used as a heat
source for softening the GP
• Conditioning of the dentin walls canal so
be done
Advantages:
 Good hemostasis
 Improved visualization of surgical site
 Sterilization operative field
 Reduced permeability of root surface
dentin
 Reduction in post operative pain
 Reduced risk of contamination of surgical
site by eliminating use of air turbines
Constraints:
 Time Consuming
 Increase temperature
 Cause irreversible pulpal damage
 Needs precise execution
 Increased cost of treatment
Bleaching • Conventionally, there are many
methods to remove external stains,
including micro- or macroabrasion
and hydrogen peroxide bleaching. In
certain cases, prolonged
accumulation of these substances
causes the extrinsic stains to be
‘internalized' into the outer layer of
the dental enamel, which could cause
difficulties in bleaching treatment
 The heat energy produced from laser
application is utilized to remove stains
with ease.
A recent study by Schoenly et al. tested
the feasibility of using a near-UV laser
(60-ns pulse rate) to remove
internalized extrinsic stains on enamel.
The laser was able to remove the
Photochemical and photothermal
bleaching are used for the removal of stains, leaving a smooth enamel su In
intrinsic stains. addition, any affected underlying
Argon KTP diode CO2 lasers enamel is ablated using this technique.
(515, 532, 810-980 and 10,600 nm)
are used for tooth bleaching applications
surface.
Laser Hazard • Ocular Hazard
• Tissue Damage
• Respiratory Hazard
• Combustion Hazard
• Electrical Hazzard

Laser Hazard • Engineering Controls

Control Measure • Personal Protective Equipment
• Procedural Control
Dafter Putaka

Todea, C.D.M. 2004. Laser Application in Conservative Dentistry.TMJ2004,Vol.54,No.4

Amudhalaksmi, K., dkk. 2016. Lasers in Conservative Dentistry and Endodontics-A Review. IOSR-JDMS.
Vol 15. PP 125-130

Najeeb, S. dkk. Applications of Light Amplification by Stimulated Emission of Radiation (Lasers) for Restorative
Dentistry.Karger Medical Principles and Practice. 2016. Vol. 25. no 3.