DEPARTMENT OF PEDIATRIC DENTISTRY

ASERS IN PEDIATRIC DENTISTRY

CONTENTS
Introduction

Components of lasers

Types of lasers

Application of lasers in pediatric dentistry

Summary
INTRODUCTION
Dentistry has advanced a lot.

Among various advances, one which have good

scope of improvement is the use of lasers in
dentistry.

Recent advances in laser technology will bring

revolution in dentistry.

Laser is an acronym for light amplification by

stimulated emission of radiation.
DISCOVERY OF LASERS:
It was discovered by shallow & towns in 1958.

First working laser was built by mailman of

Hughes research laboratories in 1960.

ISTORY OF LASERS IN DENTISTRY:

Vain used a ruby laser & reported extensive deep
destruction of carious tissue along with
melting of dentin.

Paghdiwala[U.S.A] in 1988,first time tested the

ability of Er:yag laser on dental hard tissue.

In 1997,er:yag laser was cleared for marketing by

Food & drug administration of U.S.A.
COMPONENTS OF
LASER
There are 3 main parts of laser delivery system.

(1).LASING OR ACTIVE MEDIUM

•It is the material which is capable of absorbing

the energy produced by the external source
Through subatomic configuration of it’s
component molecules & subsequently giving the
Excess energy as photons of light.

•It can be solid, liquid or gas.

(2).ENERGY OR PUMPING SOURCE

•It is used to excite or pump the atoms in

Lasing medium to their higher energy levels
That are essential for laser production.

•It can be electrical,thermal,chemical or

Optical.

(3).OPTICAL OR RESONATING CHAMBER

•The lasing medium is located within the

Optical chamber.

•It is a cylindrical structure with fully

Reflecting mirror on one side & partially
reflecting mirror on other side--parallel
to each other.
•This arrangement allows reflection of photons
Of light, back & across the chamber.

•It will result in production of intense photo

resonance within the medium.
TYPES OF LASERS
2 categories of lasers are used in medicine & dentistry
(1).HARD LESARS
- Longer wavelength

- Cuts the tissue by coagulation, vaporization &

carbonization.

- Used for surgical soft tissue applications

(2).SOFT LASERS OR LOW LEVEL LASERS

- Low energy wavelengths

- They are believed to stimulate circulation
& Cellular activity & causes various effects
Such as anti-inflammatory,vascular,muscle
Rlexant,analgesia & tissue healing.

There are many types of lasers used in

dentistry, depending upon their active medium

(1).CARBONDIOXIDE LASER
- WAVELENGTH: 10.6um
- USES: SOFT TISSUES , DENTIN
DESENSITIZATION
(2).ARGON LASERS
- WAVELENGTH: 488,514.5um
- USES: CURING , SOFT TISSUE DESENSITIZATION
(3).Nd:YAG [NEODYMIUM:YTTRIUM-ALLUMINIUM
GARNET] LASER
- WAVELENGTH: 1.064um
- USES: SOFT TISSUE , DESENSITIZATION , ANALGESIA
TOOTHWHITENING , PERIODONTICS,
ENDODONTICS

(4).KTP[POTASIUM-TITANYL PHOSPHATE] LASER

(5).HELIUM-NEON[He-Ne]

(6).RUBY LASER

(7).EXCIMER LASER
(8).HOLMIUM[Ho]:YAG LASER

(9).ERBIUM[Er]:YAG LASER
- WAVELENGTH: 2.94um
- USES: HARD TISSUE

(10).ERBIUM-CHROMIUM[Er-Cr]:YSGG LASER
- WAVELENGTH: 2.79um
- USES: HARD TISSUE

(11).DIODE
- WAVELENGTH: 800-830um
- USES:SOFT TISSUE , PERIODONTICS
LASER UNITS
LASER UNITS

LASER TIPS
LASERS IN PEDIATRIC
DENTISTRY

DIAGNOSIS OF DENTAL CARIES

(A).INFRARED LASER FLUORESCENCE

[DIAGNODENT]

- Diagnodent is an instrument, recently designed to

facilitate the detection of dental caries.

- Used for detection of caries on occlusal & smooth

surface.
•MECHANISM OF ACTION

Diode laser light source & fiber optic cable

It transmits light to hand held probe with fiber

optic eye on tip

Light is absorbed & induces infrared fluorescence

by organic or inorganic materials

Emitted fluorescence is collected at probe tip

transmitted through ascending fibers,
processed & presented on display window as
an integer between 0 to 99.

If fluorescence is higher than 20,it reflects

carious tooth substance.
•Instrument is also capable of detecting
advanced carious lesions.

•Readings are influenced by several variables

like,
- Dehydration of lesion
- Presence of plaque
- Presence of various types of stains in
occlusal surface.

•This instrument is very good at indicating the

Presence of deeper lesions in enamel or dentin
But unable to indicate the depth of the lesion
In dentine.
(B).LASER INDUCED FLUORESCENCE

- Kutsch in 1992,illuminated carious & non carious

tissue with argon laser along with dark field
photography.

- He reported that while illuminating, carious

Has clinical appearance of dark,fiery,orange-
Red colour.
(C).QUANTITATIVE LASER FLUORESCENCE

- A hardware & software system was developed in

Netherlands & Sweden.

- It collects images of the lesions based on excitation at

488um with argon laser.

(D).OPTICAL COHERENCE TOMOGRAPHY

- It is an imaging technique, capable of producing two

dimensional or three dimensional images of subsurface
tissue.
CAVITY PREPARATION WITH LASER

- NUMBER OF STUDIES HAVE BEEN PERFORMED FOR

THE USE OF Er:yag LASER FOR CAVITY PREPARATION.

- Results of studies says that little or no noticeable

pulp reaction is produced while preparing the cavity
with Er:yag laser.

- It is safe & can be used foe cavity preparation

CAVITY PREPARATION
WITH LASERS
CARIES PREPARATION
 PREVENTION OF DENTAL CARIES WITH
LASERS
- Laser can be used for prevention of dental caries.
-
Different types of lasers increases the resistance to
dental caries by reducing the rate of demineralization of
substance of enamel & dentin.

- Argon laser alters the surface characteristics of enamel

to make it caries resistant.
- It also facilitates the uptake of fluoride by tooth.
-
The lased enamel shows formation of micro spaces
within the enamel which would impart
Increased caries resistance by trapping ions
Formed during acid demineralization.
• MECHANISM OF ACTION
Carbonate is lost from carbonated appetite mineral of
tooth during laser irradiation

Pulsed co2 laser irradiation interacts with the

Phosphate group in dental materials

It gets preferentially absorbed & transformed

Efficiently to heat

Carbonated hydroxyapetite in the surface & in the

Immediate subsurface of enamel is heated at temp.
Greater than 400`c

Carbonate is decomposed, leaving behind the a

Hydroxyapetite like mineral that is less soluble
BLEACHING WITH LASERS

- Power bleaching is the term used for accelerated

In-office tooth whitening procedures, using laser or
Xenon plasma arc-curing light.

(A). ARGON LASER

- A true laser light is delivered to chemical agent.

- The action is to stimulate crystals in the chemical.

- No thermal effect, so less dehydration of enamel.

- The treatment time is 10sec. Per application per tooth

Is the advantage for clinician & patient.
(B). DIODE LASER

- A true laser light produced from a solid state

Source.

- It is ultra fast, taking 3to5 sec. To activate

Bleaching agent.

- This type of lasers produce no heat.

 DIAGNOSIS OF PULP VITALITY WITH
LASER

- Laser Doppler flowmetery is used for diagnosis of

Pulp vitality.

- It uses laser bimb of known wavelength.

Moving RBC causes the frequency of laser beam
To be Doppler shifted & some of the light to be back
scattered out of the tooth.

- It is a complicated procedure.

- Equipment is very expensive for avg.

Dental clinics.
- It is accurate & can be used in patient, who can
Not communicate effectively or whose response
Is not reliable (young patient).

- As this procedure does not produce any noxious

Stimuli as EPT,apprehensive or depressed patient
May accept it more readily.
PULPOTOMY IN PRIMERY TOOTH WITH
LASERS
- Eliot et al compared use of co2 laser with
formocresol in caries free primary cuspid.

- They found significant difference between the

Teeth which are treated with formocresol or
laser.

- They said that on the basis of symptomatic

clinical & histological findings, the co2 lasers
Appear to compare favorably to formocresol
Treatment.

- Onthe basis of studies,co2 laser should be

Considered as viable alternative to other method
that shows possible toxic side effect.
 PULPECTOMY IN PRIMERY TOOTH WITH
LASERS

- Lasers that can cut enamel or dentin with fine

optical fibers has been developed, making it
possible to remove pulp & straight or slightly
Curved canals.

- Er:yag laser, at 8hz & 2w is used to prepare the

root canals
.
- Laser tip must slide gently from apical portion
To coronal portion while pressing the laser tip
To root canal wall under water spray.
PULPECTOMY WITH LASERS
 IRRIGATION,STERILLIZATION OR
DISINFECTION OF INFECTED ROOT
CANALS WITH LASER
- Nd:yag LASER & Er:yag laser are recommended for
this treatment.

- Irradiation is carried out y using lasers with 5.25%

Nacl & 14% EDTA.
 PREVENTION OF MICROLEAKAGE OF
RETROGRADE ROOT CANAL FILLING WITH
LASERS
- Micro leakage in retrograde root canal filling
causes failure of apicectomies.
- Closer of exposed end dentinal tubules on cut
surface at root end can be done with Nd:yag & co2
Lasers in combination with 38% silver ammonium
Solution.
LASERS FOR DIRECT/INDIRECT PULP
CAPPING

- Uses of lasers with respect can control

Hemorrhage & do sterilization so it can be used
for pulp capping either direct or indirect.
- For this purpose,

~ Laser irradiation is performed at 1 to 2w after

Irradiating alternatively with 8% sodium
hypochlorite & 3% hydrogen peroxide for more
Then 5 min.

~ Calcium hydroxide paste is used to dress the

exposed pulp after laser treatment.

• DENTIN DESENSITIZATION WITH LASER

- Mechanism of action includes;

Narrowing or occlusion of dentinal tubules &
nerve analgesia through depression of nerve
Transmission.
ANALGESIA

- It’s mechanism is not well understood yet.

- Some suggests that;

Certain wavelength of laser may interfere with sodium

pump mechanism, change cell membrane permeability
& alters temporarily, the endings of sensory nerves &
blocks depolarization of c & a fibers of nerves.

- Nd:yag laser is used most for this purpose.

PREVENTION OF TOOTH FRACTURE BY
LASERS

- Pulp less teeth have tendency to fracture so to

Prevent this;

~ Teeth are to be lased with pulsed Nd:yag or co2

Lasers along with 38% silver ammonium
solution.

~ After this treatment, teeth become more resistant

to fracture.
PHOTOPOLYMERIZATION OF COMPOSITE
RESIN WITH LASER

- ARGON LASERS ARE USED FOR THIS PURPOSE.

- FOR POLYMERIZATION OF CAMPHORQUINONE

ACTIVATED COMPOSITE RESIN,THE ARGON LASER
INCREASES;

~ THE DEPTH OF CURE

~ THE DIAMETRIC TENSILE STRENGTH
~ ADHESIVE BOND STRENGTH
~ DEGREE OF POLYMERIZATION OF
MATERIELS.
REDUCES;
~ Acid solubility of surrounding enamel
Decreases the time of activation
Significantly.
LASERS IN SOFT TISSUE SURGERY

- Lasers can be used for soft tissue incision & for

controlled destruction of oral pathogens.

- A Pfizer model o-c surgical laser, used as source

Laser beam in soft tissue.
SURGERY WITH LASER
 As the research on use of laser in dentistry is
giving bright results, lasers are getting more &
ADVANTAGES OF
more famous among dentists.

LASERS
(1).Minimal damage to surrounding tissues.

(2).Haemostatic effect-by sealing blood vessels.

(3).Reduction of postoperative inflammation &

edema.

(4).Little postoperative scarring.

(5).Reduction in postoperative pain sensation
Since nerve endings are blocked.

(6).Dressing & suturing is not required for

Wound closer.

(7).Opereting time is reduced.

(8).Sterilization of wound due to reduction in

In amount of microorg. Exposed to laser
Irradiation.
(10).Excellent wound healing.

(11).Laser exposure to tooth enamel causes

reduction in caries activity.
DISADVANTAGES
OF LASERS
(1).Laser beam could injure the patient or operator
By direct beam or reflected light, causing retinal
Burn.

(2).G.A. Is usually required for the patients

Undergoing laser surgery.

(3).Cumbustion hazards.
(4).Removal of soft tissue overlying the bone can
Damage the underlying bone.

(5).It available only at big hospital & treatment is

very expensive.

(6).Specially trained person is needed.

SUMMARY
Positive results of the research on use of lasers in
dentistry have captured the attention of dentists &
researchers to it.
Lasers can perform certain procedure very effectively.
Like,
- Soft tissue management & analgesia.
- Desensitization.
- Endodontic uses.
- Caries detection, removal & prevention.
- Curing of composite resin.
But the ideal laser system which can perform hard
tissue procedure effectively without causing pulpal
damage, still does not exists.
Laser equipments are not manufactured largely &
they are also very expensive.
However;
Future aspect of lasers in dentistry shows many
interesting trends & possibilities but long
development period is ahead.
REFERENCES
COMPREHENSIVE PEDIATRIC DENTISTRY
-- NIKHIL MARWAH
PATHWAYS OF THE PULP
-- COHEN , BURNS