DEPARTMENT OF ORAL MEDICINE

LASERS IN ORAL MEDICINE

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shiji margaret

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contents

Definition History of laser development Types of lasers in dentistry Characteristics of laser light Features of laser Treatment using lasers in oral medicine Conclusion References

DEFINITION

LASER (Light amplification by stimulated emission of radiation) is a device which can operate in the infrared , visible or ultraviolet region of the spectrum and which amplifies electromagnetic waves by stimulated emission of radiation.

HISTORY OF LASER DEVELOPMENT1916 Albert Einstein: Theory of spontaneous

emission of radiation

1960 Theodore Maiman :Ruby laser

1964 Stern ,Sognnaes ,and Gold man :Laser in

dentistry

1971 Weichman and Johnson :laser in

endodontics

1979 Adrian and Gross Argon laser sterilization

of dental instrument

1985 Shoji et al :laser aided pulpotomy

1986 Zakariasen et al :starilization of root canal

1988 Miserendino Apicectomy with CO2 laser

1990 Potts and Petrou :laser aided photo

polymerization of camphoroquinone activated

resins

1993 Paghdiwala :Er:YAG laser for root resection

and retrograde cavity preparation

1994 Morita:Nd:YAG laser in endodontics

1998 Mazeki et al :Root canal shaping with

Er:YAG laser

Type Active medium Dental applications

Excimer lasers Argon fluoride

Xenon chloride

Hard tissue ablation, dental

calculus removal

Gas lasers Argon

Helium-neon

Carbon dioxide

Curing of composite

material, tooth whitening,

intraoral soft tissue surgery,

sulcular debridement.

Analgesia, treatment of

dentin hypersensitivity,

aphthous ulcere treatment.

Intraoral soft tissue and soft

tissue surgery, aphthous

ulcer treatment, removal of

gingival melanin

pigmentation, treatment of

dentin hypersensitivity,

analgesia.

Types of lasers in dentistry

Diode lasers Indium-gallium-arsenide-

phosphorous

Gallium-aluminium-

arsenide

Gallium-arsenide

Caries and calculus

detection

Intraoral general and

implant soft tissue surgery,

sulcular debridement,

analgesia, pulpotomy, root

canal disinfection, aphthous

ulcer treatment, removal of

gingival melanin

pigmentation.

Solid state lasers Erbium group Caries removal and cavity

preparation, sulcular

debridement, scaling and

root surface, osseous

surgery, root canal

treatment.

CHARACTERISTICS OF

LASERSLaser light has three unique

characteristics, that make it different

than "ordinary" light. It is:

•Monochromatic

•Directional

•Coherent

•Monochromatic means that it consists of one

single color or wavelength. Even through some

lasers can generate more than one wavelength,

the light is extremely pure and consists of a

very narrow spectral range.

•Directional means that the beam is well

collimated (very parallel) and travels over long

distances with very little spread.

•Coherent means that all the individual waves

of light are moving precisely together through

time and space, i.e. they are in phase.

FEATURES OF LASER

•Laser light is highly directional and

travels in a narrow beam,the sides of

which stay almost parallel.

•Laser produces coherent light,that is it has

only one frequency

•Laser light is of a single color.

•Laser light is powerful with very high

intensity.

TREATMENT USING LASERS IN ORAL

MEDICINE

APHTHOUS ULCER

One of the most debilitating oral lesions are

recurrent aphthous ulcer. Dental lasers can

immediately relieve aphthous ulcer lesion.

Treatment of the lesions is usually performed at low

power settings in a defocused mode.

When treating apthous ulcers,the treated area

has to include the entire lesion as well as 3 to

5 mm lateral to the erythematous halo marking

this lesions border. If a small area of healthy

tissue around the lesion is not treated along

with the entire lesion,the ulcer will recur.

Apthous ulcer is treated using erbium laser.

Before treatment

After treatment

HERPES LABIALIS

•Treating herpes labialis involves passing the laser tip

slowly over the entire portion of the lip that is infected, just

short of observing the white change in tissue color.

•This usually involves treating the treating the entire one

half of the lip involved.

•This process takes 1 to 2minutes usually without

anesthesia.

•The healing time of aphthous ulcers can be shortened and

the immediate pain reduced by administering 4to 6 J over

the lesion.

PERICORONITIS [OPERCULITIS]

•Pericoronal inflammation or infection of the

gingiva surrounding the crown of the tooth

during the eruption of molars may cause patient

discomfort. This tissue can be removed with any

wavelength of laser.

•The advantage of using erbium laser is that only

topical anaesthetic may be required.

The potential disadvantage is less

hemostasis post operatively and the slight

risk of ablating hard tissue once the soft

tissue has been removed.

HEMANGIOMA

Hemangiomas are benign proliferations of blood

vessels that resemble normal vessels.

Half of the hemangiomas occur in the head and neck

area,especially the tongue,buccal mucosa and the

lips.

After infiltration of local anaesthesia,the laser was

used in a defocused mode.Ablation of the lesion

should begin at the surface of the mucosa at the

peripheral margin working towards the

epicenter.This ensures complete removal at

the widest dimension.

•Charring of the tissues in a vascular lesion

is more prevalent because of the absorptive

properties of hemoglobin.

•Complete healing is achieved within 2 to

6 weeks.

Before treatment

After treatment

PERIPHERAL ODONTOGENIC FIBROMA

This is a painless,firm soft tissue mass with an intact

mucosa,emerging directly from the gingival sulcus.

This is found most commonly in the premolar or the canine region and

most often in females.the size is usually less than 2 cm.

After local anaesthesia is administered by infiltration,an excision

biopsy procedure aws performed using the laser in a focused

mode,parallel to the facial surface into the sulcus,while reflecting the

mass away from the tooth.

Proximity of the mass to the tooth increases

the potential for injury to the tooth.

Sculpting of irregular tissue,intrasulcular

ablation and hemostasis are accomplishrd

by defocusing energy.

Intrasulcular ablation of the remnants of the

periodontal membrane, minimizes the

potential recurrence and improves the

cosmetic outcome.

Before treatment

After treatment

MUCOCELE

Mucoceles are often observed after experiencing a traumatic injury

that severs the minor salivary ducts,forcing extravasated mucin into

the mucosa and eliciting an inflammatory reaction that causes

localized fibrosis.

It is most usually found in the lower lip and is usually 1 cm or less.

Local anaesthesia is administered by infiltration and the CO2 laser is

used in a defocused mode.

When ablating the lesion it begins at the peripheral margin of the

mucosa towards the epicenter.

•Once the epicenter has reached,applying

finger pressure on the lesion causes the

enlarged fibrotic minor salivary gland to

protrude,allowing complete vapourization

of the damaged glandular tissue.

•Further ablation is performed by working

from the epicenter towards the periphery.

•The wound is then left to granulate.

Immediate post-operative

viewBefore treatment

1 week post

operative view

TONGUE LIPOMA

Lipomas are proliferations of mature fat cells that arise in the

submucosa usually seen in adults of age 40 to 60.

They typically arise in the buccal vestibules and mucosa,floor of the

mouth,and tongue.

It an asymptomatic,slow growing mass,non tender,soft,doughy mass 1

cm in diameter,with healthy overlying tissues.

Local anaesthesia was administered by infiltration at the periphery and

deep margins.

A curvilinear “trapdoor” incision was made using a CO2

laser and is used to dissect along the perimeter of the mass

in all directions completes the excision biopsy.

The exposed cavity was irrigated with a sterile saline

solution and hemostasis was achieved by defocusing the

laser.

The tongue flap was approximated and primarily closed

with chromic gut interrupted sutures.

Before treatment

After treatment

HYPERPLASTIC GINGIVAL TISSUE

When the final result of orthodontic positioning of the

front teeth results in gingival hypertrophy,or orthodontic

therapy itself causes gingival hypertrophy from poor oral

hygiene,the laser can be a useful tool to increase crown

length and give the patient a more esthetic smile.

Patients who have drug induced hyperplastic tissue,as from

phenytoin administration,as well as organ transplant

recipients taking cyclosporine,can also have their tissue

reduced and reshaped with lasers.

Before treatment

After treatment

HERPES SIMPLEX VIRUS•Patients with a herpes simplex virus type 1 can also be treated

using lasers.

•If it is treated during the initial prodromal stage,the healing

will take only a few days or may even disappear within few

hours.

•Large blisters can be opened with surgical lasers,eg:

CO2,erbium to empty the fluid.

•In acute stages of HSV1 infection repeated irradiations is

necessary.

•Laser light enables the cell to resist viral attack for a longer

period, presumably providing time for the immune system to

react.

LEUKOPLAKIA

The advantages of using a laser to treat leukoplakia include better

control of bleeding,less surgical time,more precise tissue removal,less

morbidity and complications and excellent healing with virtually no

scarring.

Laser treatment of pre-malignant lesions is through excision or

ablation.

The depth of the cut being deep to the lesion itself,usually 4 to 9 mm.

The affected tissue is elevated at one end and undermined with laser

acting as a cutting tool.

The laser is defocused and tissue removed in the

multiple side by side U pattern.

With the blood less surgical field, produced by the

laser, visual confirmation of complete removal is

much easier than with scalpel surgery.

The area is then left to re-epithelialize by secondary

intention, avoiding sutures and the possible

distortion and scarring.

Before treatment

After treatment

VERRUCOUS CARCINOM

It is a slow growing non metastatizing form of

squamous cell carcinoma that is most frequently

found in the mouth.

It is usually a white cauliflower like lesion that is

seen in elderly patients

Heavy use of snuff,tobacco and cigarettes maybe

the primary factor.

The CO2 laser has proved to be an effective means

of treating verrucous carcinoma by total excision in

cutting mode.

Before treatment

After treatment

TEMPOROMANDIBULAR JOINT SURGERY

Artroscopic surgery of the TMJ has been a successful mode of

surgery.Eliminating the need for physical contact with the diseased

tissue the trauma to surrounding synovial tissue and articular cartilage.

Laser use can also provide rapid coagulation with minimal thermal

damage allowing better visualization of the surgical field and

decreased hemarthrosis.

Laser surgery is much more precise and can be more easily

manipulated in the narrow joint space.

The Ho:YAG laser is minimally absorbed by water and

therefore transmits its energy directly to the desired tissue.

Arthroscopic procedures are typically performed under

general anaesthesia with naso tracheal intubation.

Procedures such as diskectomy ,diskoplasty, synovectomy,

hemostasis, posterior attachment contraction,anterior release

and debridement of fibrous ankylosis can be performed.

CONCLUSION

Current laser research focuses on Optical Coherance

Tomography in dental diagnosis (OCT) in dental

diagnosis,new dental applications for the alexandrite laser,and

photo activated disinfection in daily practice.

Carbon dioxide lasers, has shown to be effective in many

fields of dentistry,with advantages such as less

bleeding,selective removal of tissue,short operating time and

reduced post operative pain.

Future studies will show the feasibility of using these new

technologies as everyday tools in many clinical applications.

REFERENCES

1.Robert A. Convissar, Principles And Practice Of

Laser Dentistry,edition 2011.

2.Grossman’s Endodontic Practice,12th edition.

3. Carranza’s Clinical periodontology, 10th edition