The Pilot Laser in Veterinary Dentistry

Advantages of LasersHow Lasers Work

Applications in Dentistry

Advantages

Advantages/Benefits of Laser Surgery Compared to Steel

Blade Surgery Superior ability to:

• Minimize Hemorrhage

• Minimize Collateral Damage

• Minimize Infection (sterilize surgical site)

• Minimize Pain

Thermal Trauma Should NEVER Happen

How Lasers Work

Hyperthermia:

• The tissue is elevated above normal temperature but not

destroyed

• The tissue whiten or blanch

• This phenomenon is useful because it will remove diseased

tissue but allow healthy tissue to remain intact

How Lasers Work

Coagulation:

• Irreversible damage to tissue

• Causes congealing of liquid into a semi-solid mass (clot)

• Clinician will see a bloodless surgical site contraction of the

vessel wall

How Lasers Work

Welding:

• Occurs when there is adherence of layers

• Due to collagen’s helical structure unfolding and intertwining

with adjacent segments

How Lasers Work

Vaporization:

• This is also called ablation

• There is a physical change of state; the solid and liquid

components turn into vapor in the form of smoke or steam

• Excision of tissue commences at this temperature

How lasers work

Carbonization:

• Tissue is dehydrated and then burned in the presence of air

• Carbon, as the end product, absorbs all wavelengths

• If laser energy continues to be applied, a heat sink will occur

and prevent normal tissue ablation

• The heat that is conducted can cause collateral thermal trauma

to a wide area

Periodontal Therapy

• An important use of laser technology is within the

periodontal pocket

• This has become a topic of much interest and is a

promising field in periodontal therapy

• Why would we want to use laser technology for

treatment of the periodontal pocket?

Periodontal Therapy

1) The FDA approved the Diode laser for sulcular debridement in 1988.

Due to the diode laser’s wavelength it is safe to use near dental hard

tissue where the CO2 would cause major thermal damage

2) The thin (400 micron = 0.4 mm) diode fiber less traumatic than

conventional instruments

3) Hot-tip fiber action is thought to:

A) Decreases inflammation (biostimulation effects)

B) Vaporize necrotic soft tissue (if can be maintained at hyperthermal

effect)

C) Reduce bacterial populations

… Result is reduced pocket depths over several weeks of healing

Periodontal Treatment

PROTOCOL:

For adjunctive

treatment of

scaling,

polishing, and

root planing:

• Pulse Mode

• Power 0.8-1.2 W

• 10-15

sec/pocket

Periodontal Therapy

Numerous human dental studies:

One of the first and many to follow:

Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J,

Sperr W. Treatment of periodontal pockets with a diode laser. Lasers

in Surgery and Medicine 1998;22:302-311.

Findings:

1) Reduction of pocket depth

2) Inhibition of bacteria

3) Preserves healthy tissues

Other Applications in Dentistry

Soft Tissue

On the bactericidal setting the diode laser can be a powerful tool during

wound management:

Important Notes

1) The important principle: light energy strikes the tissue for a

certain length of time, producing a thermal interaction.

2) The targeted tissue needs time to cool before the next pulse of

laser energy is emitted.

3) Of paramount importance to use the least amount of energy or

power to perform the treatment objective.

Advantages & Benefits

1) Bio-stimulate tissue

2) Sterilize surgery site

3) Never produce resistant microorganisms

4) Hemostasis

4) Surgical versatility (furcations and distal sites of molars)

5) Reduced intraoperative and postoperative pain/discomfort

Remember: Diode Lasers have FDA clearance for use in the periodontal

pocket

Periodontal Therapy

1) In the periodontal pocket, the root surface is contaminated with plaque

and calculus, as well as infiltration of bacteria into cementum

2) Complete removal of these harmful substances is essential for healing

3) Since the periodontium is composed of gingiva, periodontal ligament,

cementum, and alveolar bone, both soft and hard tissues are always

targeted when using lasers for the treatment of periodontal lesions

4) Due to the diode laser’s wavelength it is safe to use near dental hard

tissue were the CO2 would cause major thermal damage

Advantages

1) Hemostasis

2) Surgical versatility

3) Reduced intraoperative and postoperative pain/discomfort

4) Reduced need for sutures

5) Sterilization of surgery site

Clinical Applications

1) Gingivoplasty / Gingivectomy

2) Biopsy

3) Gingival troughing

4) Crown lengthening

5) Subgingival curettage

6) Operculectomy

7) Frenectomy

8) Open pocket elimination