Laser in prosthodontics

Advances in technology are increasing and changing

the ways that the patient experience dental treatment.

One of the milestones in technological advancements

in dentistry is the use of lasers.

The term laser is the acronym for” Light Amplification

by Stimulated Emission of Radiation”

They provide more efficient , more comfortable and

more predictable outcomes of the patient.
 History
Theory of stimulated emission 1917-Einsteen

Laser principle 1958-

Townes&Schawlow
Ruby laser 1960-Maiman
Neodymium ion doped yttrium 1961-Johnson
aluminum garnet rod
Co2 laser 1964-Patel
First documented case in 1977-Shafir
OMFS using laser
First dental laser ND:YAG 1989-Terr Myers
Fundmentals of laser
 Components

1. Active component (lasing medium)

2. Pumping mechanism
3. Optical resonators
.Basic laser components
Classifications of laser
The main differentiating characterstics of laser is
wavelength which depends on the laser medium and
the excitation mode .
 Classification based on light spectrum

Not used in dentistry 100 nm - 400 nm UV Light

Most commonly used in dentistry 400 nm to 750 nm Visible light

( Argon & Diagnodent Lasers)

Most dental lasers are in this nm to 10000 nm 750 Infrared light

spectrum
The following four laser instruments emitt
visible light:
. Aragon laser :blue wave length of 488nm.
.Aragon laser: blue-green wavelength of 514nm
.frequency doubled laser ND:YAG also called
potassium titanyl phosphate(KTP) : green
wavelength of 530nm
.low level lasers red non surgical wavelength of 600
to 635 nm for photomodulation and 655nm for
caries detection
Other dental lasers emitt invisible laser light

These include photomodulation devices

.Diode lasers various wavelengths between 800 and
1064nm
.ND:YAG laser 1064nm
.Erbium ,chromium doped ytrium scandium gallium
garner (Er:Gr:Ysgg)2780nm
.Co2 laser :9300nm and 10,600nm
 Classification according to the materials used

solid liquid gas

Diodes Not so far in Argon

Nd:YAG, Er:YAG, clinical use Carbon dioxide
Er:Cr:YSGG, Ho :YAG
.Lasers are also classified as soft lasers and hard lasers
Delivery systems
Shorter wavelength instruments, such as Ar, diode,
and Nd:YAG lasers, have small, flexible fiber-optic
systems with bare glass fibers that deliver the laser
energy to the target tissue.
Because the Erbium and Co2 are absorped by water
which is a major component of coventional glass
fibers, these wavelengths cannot pass through these
fibers
Erbium and co2 laser devices are therefore constructed
with special fibers capable of transmitting these
wavelengths with semiflexible hollow waveguides or
articulator arms.
The Er family of dental lasers provides a cooling water
spray for hard tissue procedures that can be switched
off for soft tissue surgeries.
In the noncontact use the beam is aimed at the target
some distance away, with the loss of tactile sensation
the surgeon must pay attention to the tissue interaction
with the laser energy.
Emission mode
:There are two basic modes of wavelength emission for dental lasers
Continuous wave emission
• means that laser energy is
emitted continuously
produces constant tissue
interaction.
• CO2, Ar, and diode lasers
operate in this manner
Free-running pulse emission
• occurs with very short
bursts of laser energy
• KTP, Nd:YAG, Er:YAG, and
Er,Cr:YSGG devices operate
as free-running pulsed
lasers.
 Continuous wave emission Free-running pulse emission

•They are equipped with a • provides target tissue with

mechanical shutter with a time thermal relaxation time to
circuit to produce gated or cool
super-pulsed energy.

•To minimize some of the

undesirable residual thermal
damage.
 Regardless of the emission mode, all lasers produce a
thermal effect on target tissues, and the operator must
pay strict attention to the temperature of the surgical
site and ensure that the laser energy is correctly
controlled
Laser Effects on Tissue
Depending on the optical properties of the tissue, laser
may have four different interactions with the target
tissue.

1. Reflection
2.Transmission
3.Scattering
4.Absorption
The primary and beneficial goal of laser
energy is therefore
absorption of the laser light by the
.intended biological tissue
The principal laser-tissue interaction is
photothermal
Three primary photothermal laser-tissue interactions

Incision/excision

Ablation/vaporization

Hemostasis/coagulation
1. Laser beam in focus with a small spot size is used
for
incision/excision procedures

2. Laser beam with a wider spot size ablation

3. Laser beam out of focus will produce hemostasis/

coagulation
 Small spot size Large spot size

Deep effect on Superficial effect on tissue

tissue
.Laser excisional biopsy
Laser ablation of gingival
.hyperplasia
Laser coagulation of an aphthous ulcuer
Photochemical effects occur when the laser is used to
stimulate chemical reactions, such as the curing of
composite resin.

A laser can be used in a nonsurgical mode for

biostimulation for more rapid wound healing, pain relief.

The pulse of laser energy on hard dentinal tissues can

produce a shock wave, which is an example of the
photoacoustic effect of laser light. This process is often called
spallation.

Certain biologic pigments, when absorbing laser light of a

specific wavelength, can fluoresce, which can be used for
caries detection on occlusal surfaces of teeth.
Application of laser in prosthodontics
Removable prosethsis
 The successful construction of removable full and
partial dentures mainly depends on the preoperative
evaluation of the supporting hard and soft tissue
structures and their proper preparation.

 A comprehensive prosthodontic treatment plan may

need to incorporate surgery to maximize this support.
 Surgery of healthy tissues
may include

removal of a torus vestibuloplasty

removal of
contouring of
hyperplastic or
irregular ridge
redundant soft
anatomy
tissue

reduction of a
hard or soft tissue
tuberosity
Dental lasers can be successfully used for all of these
procedures because laser energy :

1. reduces bacteria at the surgical site

.coagulates blood vessels .2
3. minimizes scar formation.
4. reduces swelling and postoperative
pain.
5. facilitates the overall treatment of
prosthodontic patients.
 All dental wavelengths can perform soft tissue
surgeries, but the erbium (Er) family of lasers is the only
group of lasers indicated for treatment of osseous
.tissue
 Vestibuloplasty
maxilla (a) with both a buccal vestibuIe of inadequate depth and an anterior
frenum attached to the crest of th aIveolar ridge. and a mandible (b) with a
.buccal vestibule of inadquate depth
Immediate postoperative views of the maxilla (c) following the
frenectomy and vistibuloplasty and the mandible
.(d) following vistibuloplasty
Tuberosity reduction in the posterior maxilla
Any laser can be used to reduce soft tissue tuberosities. For hard
tissue tuberosity reduction, the Er family of lasers is necessary to
.ablate bone
 Removal of a mandibular torus

Large torus on the lingual aspect of An Er laser cuts the osseous protuberance
the left mandible
 Reflection of the soft tissue flap and hemostasis can be
accomplished using any wavelength. However, the osseous
.reduction can only be performed with Er family lasers

.Torus removal with a hemostat .Immediate postoperative view

Contouring of the maxillary denture base

Preoperative view showing a partially

edentulous maxilla immediately following
.extraction of the anterior dentition
Laser removal of the granulomatous and the
recontouring the soft tissue will create a better
.support base for the prosthesis
Although any dental laser will work, a wavelength with superior hemostatic ability (ie,
CO2, diode, or Nd:YAG) will ensure that blood clots formed in the coagulated extraction
.sockets will not be displaced and cause new bleeding
Chronically inflamed hyperplastic tissue
.Soft tissue laser ablation
on the mandibular ridge
Immediate postoperative view of the The l month postoperative view shows
.soft tissue denture base .complete healing
 Surgery may also be indicated to treat irritated or inflamed tissues
underneath or adjacent to a denture base, such as removal of an
.epulis or management of generalized denture stomatitis

Irritated epulis fissurata with the denture Immediate postoperative view of the affected
in place .area
Denture sore on the right mandibular ridge
 Treatment of undercut alveolar ridges

• Naturally occurring undercuts such those found

in the lower anterior alveolus or where a
prominent pre-maxilla is present.

• This causes soft tissue trauma, ulceration, and

pain when prosthesis is placed on such a ridge.

• Soft tissue surgery may be performed with any

of the soft tissue lasers. Osseous surgery may
be performed with the erbium family of lasers
Application of laser in Implant
dentistry
Why use laser technology in implant
dentistry?
The advantages of using lasers in implant dentistry are
the same as for any other soft tissue dental procedure.

Increased Reduced
visibilty due to swelling and
hemostasis infection

Minimal damage
to the
Reduced pain
surrounding
tissue
 Impressions for restorative procedures can
be taken immediately after second-stage surgery
because the surgical field will be clean and dry.
 The erbium (Er) family of lasers, with its capacity for
osseous ablation, can be used in osteotomy preparation
and for removal of diseased osseous tissue around
".areas of inflammation
Although Nd:YAG has been a particularly popular
wavelength to use for soft tissue second-stage surgery,
several investigators contend that it is contraindicated
to use with implants.

Due to
1. the transmission of heat to the bone from the heated
implant surface.
2. the potential for pitting and melting, and the porosity
of the implant surface.
whereas the diode, Er family, and carbon dioxide (C02)
lasers can be used .

Because they are reflected away from metal surfaces,

they interact only minimally with the implant.
 Peri-implantitis case

Radiographic view showing radiolucency between

.Preoperative swelling around implants .implants
CO2 laser makes incision in Er:YAG ablates granulation months posoperative 2
soft tissue for drainage tissue
 Periimplantitis

Inflamed hyperplastic tissue Immediate postoperative view

.surrounding implant abutments .following laser ablation

Excellent soft tissue tone. contour, and health

.are restored 6 months after laser treatment
 Implant Uncovering Surgery
Immediate postoperative view of the
implant site. The soft tissue hat covered
diode laser at a maxillary central incisor implant
site at the beginning of implant uncovering
the implant has been ablated. The surgical
field is clean and dry and requires no
.sutures
CO2 laser removing soft tissue during Immediate postoperative view showing
.second-stage implant surgery three uncovered Implants
 Implant Placement

.Partially edentulous posterior maxilla The Er:YAG laser begins soft tissue
.preparation

After soft tissue ablation is completed

.the surgical site is ready for pilot holes
The Er:YAG laser begins osseous pr Implant placement with
.eparation .supragingival healing caps

Three months postoperative view of implants

Implant problem solving
Soft tissue growth over an implant
One of the most interesting uses of lasers in implant
dentistry is the possibility of salvaging ailing
implants
by decontaminating their surfaces with laser energy.

Diode, ER:YAG, CO2 lasers can be used for this

purpose

Nd:YAG wavelength did not sterilize dental

implants. In addition,melting, loss of porosity, and
other surface alterations.
In some clinical sitiuations using laser may be the best
choice

A patient with potential bleeding problems could be

treated with a laser to provide essentially bloodless
surgery in the bone. This practice could be particularly
useful in the placement of mini-implants
 Sinus lift procedure

• The procedure can be done by making the

lateral osteotomy with a decreased incidence
of sinus membrane perforation.

• The yttrium-scandium-gallium-garnet (YSGG)

laser is the optimal choice for not cutting the
sinus membrane
 Bone grafts done with lasers have been
demonstrated to decrease the amount of
bone necrosis from the donor site and the
osteotomy cuts are narrower, resulting in
less postoperative pain and edema
The impact laser use have on the prostheses that are manufactured
for
implant restoration

One of the hallmarks of the osseointegration

technique is a passive fit of the prosthesis on
the implants.
one of the ways to obtain a true passive fit is by
the elimination of the casting technique.
The expansion and contraction during casting
can lead to a nonpassive fit of the implant
prosthesis when placed onto multiple implants
To that end, the proposed
laser welding of
titanium components
has been advocated and
used with some
mixed success.
 One of the issues was the learning curve for the
technicians and that as familiarity with the procedure
increased, success rates improved
 LASER APPLICATION IN DENTAL LABORATORY
• Laser holographic imaging is a well established method
for storing topographic information, such as crown
preparations, occlusal tables, and facial forms for maxillofacial
prosethsis.

• Holography is the science of recording the reflected light

waves from an object onto a hologram and subsequently
reconstructing the stored image of the object in the space
where the original object had been. The terms holo, meaning
complete, and gram, meaning message, give rise to the
hologram or complete message.

• The three-dimensional aspect of the hologram image is

unique.
Ultraviolet (helium-cadmium) laser-initated polymerization of
liquid resin in a chamber, to create surgical templates for
implant surgery and major reconstructive oral surgery
Laser scanning of casts can be linked to computerized milling
equipment for fabrication of restorations from porcelain and
other materials
 Safety regulations

. •
Using high volume plum evacuaton
system

wearing wavelength-specific
,protective eyewear

Restricting access to the laser surgery area,

minimizing reflective surfaces and normal protocol
for infection control