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Introduction
death ray, the ultimate weapon of destruction, something you would only
find in a science fiction story. Then lasers were developed and actually
used, among other places, in light shows. The beam sparkled, it showed
pure, vibrant and intense colors. Today the laser is used in the scanners at
the grocery store, in compact disc players, and as a pointer for lecturer and
above all in medical and dental field. The image of the laser has changed
With dentistry in the high tech era, we are fortunate to have many
Dental procedures performed today with the laser are so effective that they
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History of Lasers
flash lamp which produced deep red visible light at two wavelength.
Zeil, “Zur Quantern Theorie der Strahlung”, was the first discussion of
stimulated emission.
• In 1954 Townes and Gordon built the first microwave laser or better
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• One of the first reports of laser light interacting with tissue was from
This was the first continuous laser and used helium – neon.
• In 1964, the Nobel Prize for the development of the laser was
by Snitzer.
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• The use of low-power lasers has recently become known as “Low
1. Coherence
↓
i.e. it is coherent
2. Monochromatic
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Other Terminologies
When lasers first appeared as clinical tools, they were divided into
2 groups
Related to their observed
Hard Soft interaction with the tissue
Produces immediate Appeared to cause no visible change in
observable effects on the the tissue at the time of lasing
tissues irradiated
These terms are generally falling from use and it is probably better
Laser Physics
light energy.
radiation emitted by lasers including both visible and invisible light is more
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generally termed as electromagnetic radiation. The concept of stimulated
1. Absorption
2. Spontaneous emission
3. Stimulated emission.
absorption. The photon then ceases to exist, and an electron within the
spontaneously decay back to the ground state, releasing the stored energy
emission.
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If an atom in the excited state is struck by a photon of identical
causes two photons that are identical in frequency and wavelength to leave
Laser Design
A. Lasing Medium
- As a rule, the lasing medium gives its name to the laser e.g.
Nd :YAG (solid)
Semi-conductor lasers
B. Energy Source
that protons of laser light are emitted. The energy for this maybe provided
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by an electric discharge, high powered xenon-flash lamps or even another
laser.
laser and ensure that when the light does emerge from the laser, it
Several years ago a hand held laser meant holding a larger, several hundred
pound laser usually the size of a desk, above a patient. Although the idea
1. Articulated arms
simple but elegant devices. Mirrors are placed at 45o angles to tubes
carrying the laser light. The tubes can rotate about the normal axis of the
delivery of the laser light. This is typically used with CO2 laser. The arm
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does have some disadvantages that include the arm counter weight and the
2. Optical Fiber
used with near infrared and visible lasers. The light is trapped in the glass
and propagates down through the fiber in a process called total internal
reflection.
Advantages of optical fiber is that they provide easy access and transmit
high intensities of light with almost no loss but have two disadvantages.
Disadvantages
(1) The beam is no longer collimated and coherent when emitted from the
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Mode of Delivery of Laser
Once the laser is produced, its output power may be delivered in the
following modes.
shutter that “chops” the beam into trains of short pulses. The speed of
high peak power laser with a short pulse duration, typically between
second that permits the laser output to appear almost continuous during
use.
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corresponding increase in peak power, that is much higher than in
6. Ultra pulsed: This mode produces an output pulse of high peak power
that is maintained for a longer time and delivers more energy in each
pulse than in the superpulsed mode. The duration of the ultra pulse is
slightly less.
7. Q-scotched: Even shorter and more intense pulse can be obtained with
Focusing
mode.
A focussed mode is when the laser beam hits the tissue at its focal
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used. This mode can also be referred as cutting mode. Eg. While
performing biopsies.
moved away from the total plane. This beam size that hits the tissue has a
papillary hyperplasias.
tissue whereas in the non-contact, the handpiece is placed away from the
target tissue.
In contact mode, the fiber tip is placed in contact with the tissue.
The charred tissue formed on the fiber tip or on the tissue outline and
increases the absorption of laser energy and resultant tissue effects. Char
can be eliminated with a water spray and then slightly more energy will be
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Non contact mode: Fiber tip is placed away from the target tissue. In the
non contact mode the clinician operates with visual control with the aid of
Dental Lasers
Those work in
both
Laser Types
I. Based on wavelength.
1. Soft lasers
2. Hard lasers
Lasers can be classified according to the state of the active medium i.e.,
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III. Based on the potential danger posed to the exposed skin and to the
unaccomodated eye.
I. Based on wavelength:
Soft Lasers: Soft lasers are lower power lasers; with a wave length around
Apthous ulcers.
Hard lasers: Lasers with well known laser systems for possible surgical
application are called as hard lasers. Eg: CO2, Nd: YAG, Argon, Er:YAG etc.
CO2 Lasers
The CO2 laser first developed by Patel et al in 1964 is a gas laser and
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CO2 lasers have an affinity for wet tissues regardless of tissue color.
not be removed.
They are highly absorbed in oral mucosa, which is more than 90%
in a non-contact mode.
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• Of all the lasers for oral use, CO2 is the fastest in removing
tissue.
Nd: YAG Laser: Here crystal of Ytrium – aluminum – garnet are doped
no reflection.
recommended.
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enhances the effect of the Nd:YAG laser, and it is not necessary
wavelength.
dental material.
Uses:
- Soft tissue removal
- Haemostasis
- Coagulation
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Argon Lasers
unaffected by H2O.
• Argon lasers work both in the contact and non contact mode
• Like, Nd: YAG lasers, at low powers argon lasers suffer from
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• Argon lasers also have the ability to cure composite resin, a
This is the 1st Laser to be cleared by the FDA on May 7, 1997 for
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hydroxyapatite, which particularly accounts for its efficiency in
• Er: YAG can also be used for bone ablation and has
surgery and abrasion of large benign lesions of the oral mucosa and
skin.
crystal
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• A He-Ne laser is used as an aiming light
• Like Nd: YAG, can be used in both the contact and non-
• Ho: YAG laser has an affinity for white tissue and has ability
Scattered
Absorbed
Transmitted
absorbed or transmitted.
Reflection: Reflected light bounces off the tissue surface and is directed
outward.
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It also limits the amount of energy that enters the tissue.
Transmission: Light can also travel beyond a given tissue boundary. This
is known as transmission.
penetration depth.
E.g. CO2, Nd-YAG and Argon have similar co-agulation depths but
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Naturally, the temperature and tissue effects are greatest near the
of 2nm / above and therefore these penetrate little in soft tissues, the
Hard tissues
Many researchers felt that lasers were obvious replacement for the
dental drill, as
• Lasers are ‘non-contact’ and their use produces much less vibration
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• They are much quieter than drills, usually producing only a muted
• They can also be used to seal tissues at the periphery of the cut.
operative hypersensitivity.
1. Thermal effects:
of tissue by absorbing laser light i.e. the laser energy is converted into
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↓
Which can absorbed the incoming laser beam, allowing less energy
to reach the surface. This hot plasma, can then quickly conduct heat to the
tissues surfaces and causes ablation and severe heating which can lead to
tissue damage.
Flowing water down the fiber and onto the tissue has been used in
High energetic and short pulsed laser light can lead to a fast heating
of the dental tissues in a very small area. The energy dissipates explosively
Histologic Results:
When continuous wave and pulsed CO2 lasers were used, structural
1. Microcracks.
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2. Zones of necrosis and carbonization are unavoidable. Because of
drying effects
enamel and dentin and finally heats the pulp. In dentin, at the laser impact,
pulse are used. But the appearance and the extent of the side effects are not
predictable.
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D. Excimer Lasers
decrease.
stroma and viable epithelial root sheath can be retained following laser
pulp temperatures are raised beyond the 5°C level, research has shown that
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Lasers find numerous applications in restorative dentistry and
root canals.
1. Prevention of carries:
enamel.
• Stern concluded that energy levels below 250 J/cm² did not
permanently alter the pulp but necrosis could occur when energy
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• Another study, laser dentin closed resembled e.g. because of
sealing pits and fissures. The CO2 and Nd:YAG lasers can remove
attached to enamel using the laser. Power densities used are low and
incipient caries.
CO2 lasers:
Florin has shown that a continuous wave CO2 laser homogenesizes the
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Argon:
caries attack.
using lasers is used for this purpose. The lesion appears as a distinct
dark red area easily differentiated from the rest of the sound tooth
radiography.
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Cavity preparation:
The use of lasers for cavity preparation has been under scrutiny for
20yrs as many investigators found that pulpal necrosis would occur with
use of lasers.
The search for laser that can be used to cut hard tissues begun in
1964 by Dr. Leo Goldman who used laser on his brother Bernard’s teeth.
The subsequent search included many laser wavelengths such as CO2 but
as Ho: YAG, ArF, Nd:YLF and Er: YAG have been investigated.
ability to cut or ablate dental hard tissues effectively and efficiently. The
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• It has generally been assumed that if pulpal
drill.
than 3°C.
efficiency of ablation.
treatment technique.
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The laser absorbed by enamel causes the enamel surface to be
region of the visible spectrum with broad peak activity in the 480nm
Advantages:
• Improved adhesion
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• Reduced microleakage
approximately 40sec.
cavity preparation.
Bleaching:
bleaching gel.
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ii) Both Argon and CO2 are used. CO2 is employed with another
beam is reflected.
Lasers in endodontics
utilized a light beam from a He-Ne laser emitting at 032.8nm, which when
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illuminated area was frequency shifted in this way. This light was detected
and processed to produce a signal that was a function of the red cell flux.
• Non laser light (576nm) has also been used for the detection of
pulpal perfusion.
2. Dentinal hypersensitivity:
To date, most of the therapies for this, have failed to satisfy one or
painless on application
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easily carried out
rapid in action
but some authors report that lasers may now provide reliable and
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The lasers used for the treatment of dental hypersensitivity are divided into
two groups:
unknown, but it is thought that the mechanism for each laser is different.
tissue.
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Note: It is necessary to consider the severity of dentinal hypersensitivity
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• No laser damage was found in tissues, with the presence of
Smith et al (1997).
dentinal surface.
• Nd:YAG within fiber / fiber optic laser was used to seal the
(Weichman 1972).
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• Since absorption of Nd:YAG laser irradiation is enhanced by
HO:YAG
Note: The removal of smear layer and debris is possible however, it is hard
to clean all the walls, because the laser is emitted straight ahead, making it
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• There appears to exist a potential for spreading bacterial
contamination from the root canal to the patient and the dental
team via the smoke produced by the laser, which can cause
protect against spreading infections when using lasers in the root canal
(McKinley 1994).
achieved.
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• The results indicate than an Argon laser coupled to an optical
compaction.
• Argon, CO2 and Nd:YAG lasers have been used to soften gutta-
percha and results (Anic 1995) indicate that the Argon laser can
Note: It is hard to irradiate root canal walls; as after laser irradiation, walls
are rough and uneven. Therefore it is necessary to improve the fibre tip and
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• To minimize the rise in tissue temperature within the target and
beneficial.
after laser irradiation and root canal filling revealed that post-
9. Apicoectomy:
Because of the high heat energy generated by the use of laser, better
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• If a laser is used for the surgery, a blood less surgical field
With other lasers like CO2 and Nd:YAG did not improve the healing
process.
Note: It take more time to perform with lasers when compared to more
conventional methods.
that the working time with the Er:YAG laser is significantly less
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10. Other applications for endodontic treatment
only an awareness of the potential risks and hazards related to how lasers
are used, but also a recognition of existing standards of care and a thorough
Class IIa - Low powered visible lasers that are hazardous only when
viewed directly for longer than 1000 sec.
Class IIb - Low powered visible lasers that are hazardous when viewed
for longer than 0.25 sec.
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Class IIIa - Medium powered lasers or systems that are normally not
hazardous if viewed for less than 0.25 sec without
magnifying optics.
Class IIIb - Medium powered lasers (0.5w max) that can be hazardous if
viewed directly.
Class IV - High powered lasers (>0.5W) that produce ocular, skin and
fire hazards.
1. Ocular injury
2. Tissue damage
3. Respiratory hazards
5. Electrical shock
1. Ocular Injury:
- Direct emission
- Reflection
Potential injury to the eye can occur either by direct emission from
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to sclera, cornea, retina and aqueous humor and also as cataract formation.
recommended.
2. Tissue Hazards:
Laser induced damage to skin and other non target tissues can result
from the (1) thermal interaction of radiant energy with tissue proteins.
proteins. (2) Tissue damage can also occur due to cumulative effects of
been questioned.
3. Respiratory:
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surgical application of lasers. Toxic gases and chemical used in lasers are
vaporized due to the rapid heating of the liquid component in the tissue. In
and relatively intact tissue elements are violently projected into the area,
what is commonly called the ‘laser plume’. Standard surgical masks are
able to filter out particles down to 5µ m in size. Particle from laser plume
Flammable solids, liquids and gases used within the clinical setting
can be easily ignited if exposed to the laser beam. The use of flame-
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Solids Liquids Gases
Clothing Ethanol Oxygen
5. Electrical Hazards:
Engineering controls:
Protective housing
Interlocks
Beam enclosures
Shutters
Service panels
Equipment tables
Warning systems
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Key switch
Administrative controls:
Output limitations
Medical surveillance
Eye wear
Clothing
Special controls:
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Conclusion
for many clinical conditions that dentists treat on daily basis. But laser has
never been the “magic wand” that many people have hoped for. It has got
its own limitations. However, the futures of dental laser is bright with some
dentists with the ability to care for patients with improved techniques.
References
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CONTENTS
INTRODUCTION
HISTORY OF LASERS
TYPES OF LASER
CONSERVATIVE
ENDODONTIC
LASER HAZARDS
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