Lasers

What does LASER stand for?

Light Amplification by Stimulated Emission of Radiation developed in the 1960's

Summary on the role of Lasers

Additional in vivo research is necessary to fully understand the role of lasers in the nonsurgical treatment of periodontitis.

What are the two types of Erbium lasers?

Er:YAG and ErCr:YSGG

ADA position on Laser root planning

Erbium lasers such as Er:YAG has been shown in vitro testing upon the removal of calculus and to retract endotoxins. Additional studies need to confirm these results.

When did AAP release its statement on the efficacy on lasers for non-surgical periodontal therapy?

2010 but was updated in 2018.

Nd:YAG

First laser approved by the FDA for gingival sulcular debridement.

Defined under the ADHA seal of acceptance, which 5 states allows RDH to use lasers for soft tissue curettage or periodontal therapy?

Arizona, California, Colorado, Idaho and Nevada.

ADA position on Laser wound healing

Council considers the application of laser energy purely for the purpose of improved wound healing to be controversial and not well supported by clinical studies.

CO2 laser

Created in 1985, only used on soft tissue, it is the most effective laser to control bleeding (hemostasis).

Diode laser

Energy source is a semiconductor embedded in a crystal

Defined under the ADHA seal of acceptance, which 11 states DO NOT ALLOW RDH to use lasers for soft tissue curettage or periodontal therapy?

Illinois, Alabama, Arkansas, Florida, Georgia, Iowa, Ohio, Pennsylvania, Texas Utah, and West Virginia.

When and what was the first soft tissue laser?

In 1985, CO2 Laser by an oral surgeon named Pick used for gingivectomies

Argon laser

Low-powered energy laser best suited for curing composite resins.

What is exactly a Laser?

It is a powerful beam that can produce intense heat when focused at close range. It concentrates high energies into an intense, narrow beam of non divergent, monochromatic electromagnetic radiation of 1 wavelength.

ADA position on lasers against the reduction of bacteria level

Lasers, as a group, have inconsistently demonstrated the ability to reduce microorganisms within a periodontal pocket. However, limited new data suggest that clinical outcomes may be enhanced by the adjunctive use (following root debridement) of a bactericidal irritant activated by a cold laser.

Nd:YAG

May be effective in the reduction of bacteria (LBR) in diseased pockets and it creates excellent hemostasis, similar to the diode laser. It's claim is to regenerate the attachment apparatus of the teeth: Periodontal ligament, cementum and alveolar bone.

Erbium

Most noteworthy for sulcular debridement, decay removal, and treatment of oral lesions through ablation. Both have been successfully used for calculus removal, hemostasis and pocket depth reduction.

Which lasers are attracted to hemoglobin and pigment?

Nd:YAG and Diode laser

Which are lasers contraindicated for calculus removal?

Nd:YAG and Diode laser. This is due to the amount of heat build up that results when a dark deposit is located in the pocket.

What is Diode laser often referred to as?

Soft tissue laser

ADA position of lasers against sulcular debridement (curettage)

There is little convincing clinical evidence that adjunctive laser curettage produces a result superior to adjunctive mechanical or chemical curettage, or even scaling and root planning.

Before the 1980s what were lasers mainly used for?

They were used for oral surgery.

Tissue cauterize technique with soft tissue laser

Used as a Probe-sweep technique inserted into the sulcus and used to curettage the tissue. Anesthetic has to be distributed before this procedure and requires multiple appointments by reducing the probe depth by 1mm at each appointment. High speed suction has to be used for smoke

LBR procedure technique with soft tissue laser

Used as a waterpik technique inserted into the sulcus to lower the bacterial count for 4-6 weeks. Can be used before or after debridement. The patient doesn't have to be numb and it causes no pain.

Erbium

Used to perform cavity preparation and their use may reduce the need for anesthesia during treatment

Diode laser

Which Laser is specified for the use of tissue curettage for cauterization by an RDH?

Erbium

Which laser can be used by RDH before sealant preparation for disinfection of the tooth?

CO2 laser

Which laser is easily absorbed in hydroxyapatite and water which can damage hard and soft tissues if not carefully placed or used?

CO2 laser

Which laser is favored by its skills with tissues upon biopsy, frenectomy and gingivectomy procedures?

CO2 laser

Which laser is the most expensive laser?

Argon laser

Works well for labial and oral lesions such as HSV-1 with large vascular components

Erbium

because of its high wavelengths, it easily cuts into structures and also has the ability to anesthetize a tooth, blocking sensory innervations

What can happen if lasers are used incorrectly?

if used incorrectly, could have an adverse effect on the patients health and safety.

Diode laser

is designed to reduce the amount of bacteria in a diseased pocket, as well as remove inflammatory products. Offers moderate necrosis of cell layers in the target zone as well as excellent hemostasis control in tissues.

Erbium

the energy of this laser is absorbed in hard tissues and water at very low depth. (high energy)

Diode laser

uses of this laser include treating peri-implantitis, frenectomies and crown lengthening.