LASERS IN

PROSTHODONTICS
LASERS IN
PROSTHODONTICS- A REVIEW
Zaara A et al, The journal of Prosthetic and Implant Dentistry 2019

Dr. Dr.
GOPIKA SALI
LITHIYA SUSAN
FINAL
1 YEAR PROSTGRADUATE
ST
YEAR PROSTGRADUATE
DEPT. OF PROSTHODONTICS
DEPT. OF PROSTHODONTICS
CONTENTS
INTRODUCTION
HISTORY
CLASSIFICATION
APPLICATION IN PROSTHODONTICS
LIMITATIONS
SAFETY MEASURES
CONCLUSION
 INTRODUCTION
Light is an integral part of our life.

The early 20th century saw one of the

greatest inventions in science & technology,
in that LASERS (Light Amplification by
Stimulated Emission of Radiation) went on
to became a gift to health sciences.
 A laser is an instrument that produces a
very narrow, intense beam of light energy
(electromagnetic radiation) through a
process called stimulated emission.
Albert Einstein in 1917
 Basic structure

Active Medium: It
Cooling System:  heat is an optical cavity
is generated consists
during of chemical
the production of laser energy. So
acompounds
cooling systemor substances, molecules
is used to lower at the centre.of the compartments.
the temperature
Control
PumpingPanel: Control
Mechanism: Optical panel iscavity
used is
to surrounded
control variable parameters
by pumping unitfor the
which
output
is eitherofan
thearc
laser.
light or a flash light for excitation, or it can be an
Delivery System: It
electromagnetic coilisora diode
systemunit.
through which laser reaches its targeted site.
Examples are articulated arm, a hand-piece, a flexible hollow wave guide
Optical Resonators: They
or a quartz fibre-optic. are usually a polished surfaces or two mirrors which
are aligned at each end of the optical cavity. The function of the optical
resonators are to perform amplification and collimation of the developing beam.
Application varies from
 television remote
 computer devices such as laser mouse,
presentations, CD ROMs, DVD ROMs,
Astronomy and communication application,
war machines, guns and tanks,
cutting and welding in metallurgy industries,
Robotics and even in toys.
Medical field
History

 Harold Maiman in 1960 at the Hughes

Research Laboratory in Malibu,
California.
 The application of laser to dental tissues
was reported by Stern, Sognnaes and
Goldman et al. in 1964.
Currently, common ones for dental use.
Neodymium-doped: Yittrium- Aluminium-Garnet
(Nd: YAG);1064nm, carbon dioxide (CO2); 9200-
10600nm and semiconductor diode lasers;830-
1064nm have already been approved by the
United States Food and Drug Administration for
soft tissue treatment in oral cavity.
The Erbium doped: Yttrium-Aluminium- Garnet
(Er: YAG); 2790-2940nm, laser was approved in
1997 for hard tissue treatment in dentistry.
CLASSIFICATION
I. According to the wavelength
(nanometers)
1. UV (ultraviolet) range – 140 to 400 nm
2. VS (visible spectrum) – 400 to 700 nm
3. IR (infrared) range – more than 700 nm

• Most lasers operate in one or more of

these wavelength regions.
II. Broad classification
1. Hard laser (for surgical work)
i. CO2 lasers (CO2 gas)
ii. Nd:YAG lasers (Yttrium-aluminium-garnet
crystals dotted with neodymium)
iii. Argon laser (Argon ions)
2. Soft laser (for biostimulation and analgesia)
i. He-Ne laser
ii. Diode lasers
III. According to the delivery system
i. Articulated arm (mirror type)
ii. Hollow waveguide
iii. Fiber optic cable

IV. According to the type of active

medium used : Gas, solid, semi-
conductor or dye lasers
V. According to type of lasing medium :
E.g. Erbium: Yttrium Aluminium Garnet
VI. According to pumping scheme
1. Optically pumped laser
2. Electrically pumped laser
VII. According to operation mode
1. Continuous wave lasers
2. Pulsed lasers
VIII. According to degree of hazard to skin
or eyes following inadvertent exposure
Class I- (< 39mw) : no threat
Class II- (< 1 mw) : longtime stare into light
without blinking
Class III - (<5OOmw) : direct exposure into
eyes
Class IV - (> 5OOmw) : direct exposure can
cause blindness
Laser applications in prosthodontics
I)COMPLETE DENTURES
i.Prototyping and CAD/CAM (Computer Aided
Design and Computer Aided Manufacturing)
technology
ii. Analysis of occlusion by CAD/CAM.
iii. Analysis of accuracy of impression by laser
scanner.
II) FIXED PARTIAL DENTURE:
i. Tissue management.
ii. Crown preparation

III) REMOVABLE PARTIAL DENTURE:

i. Laser welding.
IV) IMPLANT DENTISTRY:
i. Soft tissue surgery.
ii. Implant surface debridement.
iii. Implant surface treatment.
V)MAXILLOFACIAl PROSTHODONTICS
i. Sintering with CAD/CAM technology.
COMPLETE DENTURE PROSTHODONTICS:

PROTOTYPING AND CAD/CAM

TECHNOLOGY:
The term rapid prototyping (RP) refers to a
class of technologies that can automatically
construct physical models from Computer-
Aided Design (CAD) data.
These “three dimensional printers” allow
designers to quickly create tangible prototypes
of their designs, rather than just two-
dimensional pictures.
Rapid prototyping is an additive process,
combining layers of paper, wax, or plastic
to create a solid object.
Creates complicated internal features that
cannot be manufactured by other means.
In contrast, most machining processes
(milling, drilling, grinding, etc.) are
“subtractive”processes that remove
material from a solid block.
combination of the CAD/CAM and LRF
(Laser Rapid Forming) methods for
forming the titanium plate of a complete
denture.
The denture plate will be built layer-by-
layer, on the LRF system. After the
traditional finishing techniques, this
denture plate will be acceptable for use in
patients.
 STUDY OF COMPLETE DENTURE OCCLUSION
BY THREE-DIMENSIONAL TECHNIQUE

The scanning laser three-dimensional (3D)

digitizer can delineate x, y, and z coordinates
from a specimen without actually contacting
the surface.
The digitizer automatically tracks and
coordinates with precision and stores data
as the number of points on a surface with
a resolution of 130 mm at 100 mm.
These exacting features suggest that the
laser digitizer might accurately and
reliably measure the dimensions of dental
impression materials while avoiding
subjective errors.
scanning process in a minute and
software analysis follows
The software superimposes the two
objects
This finds an optimal fit between the two
surfaces and in effect acts as a reference
area.
the difference of the two surfaces is
calculated as the shortest distance of each
point on one object surface from a second
object surface, within a range of 0.5 mm.
Fixed Partial Denture:

I) SOFT TISSUE MANAGEMENT

 With the help of the lasers soft tissue crown
lengthening can be done without raising a
flap.
 By its thermal effect the laser seals vascular
and lymphatic vessels at the same time it
vaporize the excess gingival tissue.
 Since no flap was required for this surgery,
sutures were not necessary and the wound
healed by secondary intention.
Advantages
No bleeding
Tissue surface sterilization, reduction in
bacteremia.
Decreased swelling, edema
Decreased pain, and in some cases no
need of anesthesia
Faster healing response and increased
patient acceptance.
Less chair-side time.
Crown preparation
Crown preparation with lasers is a
debated topic still.
There are no conclusive studies yet
showed the use of lasers for crown
preparation purposes.
But still some commercial companies say
that they can be used.
Er, Cr: YSGG laser is used most
commonly now. It uses hydrokinetic
technology (laser-energized water to cut
or ablate soft and hard tissue)
No anesthesia
Patient comfort
saving time and anesthetic use by the
patient.
Accurate and faster
Disadvantage is training required
The so-called ultra-short pulse laser (USPL)
has picosecond and femtosecond pulse widths.
These laser pulses, which are amplified with
energies of up to millijoules and are focused
on the material’s surface, allow thin layers to
be ablated with a high accuracy and
reproducibility, which can result in much less
collateral damage to the adjacent tissues
compared to using other thermal, chemical, or
mechanical processes

(Rode A. V. et al. Precision ablation of dental enamel using a

subpicosecond pulsed laser. Aust. Dent. J. 48, 233–239 (2003).)
In a preliminary study by Yuan F,
The results for the preparation efficiency
showed that the maximum preparation
efficiency and best preparation quality were
achieved at an energy density of 4.42 J/m2 and
scanning rate of 1,900 mm/s using USP
Lasers.

(Yuan F, Wang Y, Zhang Y, Sun Y, Wang D, Lyu P. An automatic

tooth preparation technique: A preliminary study. Sci Rep.
2016;6:25281. Published 2016 Apr 29.)
Removable partial dentures
LASER WELDING:
The removable partial dentures defect can
be repaired by the use of pulsed laser with
relative low average out power.
This is known as a precise and rapid
joining method, but its success depends
on the control of many parameters.
Eg: For Co-Cr alloy frameworks:
Adequate combination of
pulse energy (6-14 J),
pulse duration (10-20ms) and
peak power (600- 900 W) depending on
the working stage improves the success of
the welding procedure.
IMPLANT DENTISTRY
FOR STERILIZATION OF SOCKET:
In immediate implant dentistry after
extraction of tooth,sockets can be
sterilized immediately without inducing
pain and any infection.
IN CASE OF PERI- IMPLANTITIS:
Since the laser does not transmit
damaging heat, it can be utilized to
vaporize any granulation tissue as well as
clean the implant surface in
periimplantitis cases.
It eliminates acute stage of periimplantitis
TO DEBRIDE THE IMPLANT SURFACE:
Miller Robert has shown that treatment of the
contaminated implant surface by mechanical and
chemotherapeutic means has met with mixed
success.
laser system operating at 2780 nm and using an
ablative hydrokinetic process offer efficient
decontamination and debridement.
Er: Cr: YSGG laser is highly efficient ,while
demonstrating no effects on the titanium substrate.
 peer-reviewed papers suggest that
CO2 laser-assisted peri-implantitis
treatment causes no thermal damage to
implant surfaces, creates a far greater
amount of reestablished bone to implant
contact than non-laser assisted
conventional peri-implantitis
treatment and therefore can be utilized for
implant sterilization 
(Deppe H., Horch H.H., Henke J, et al. Peri-implant care of ailing
implants with the carbon dioxide laser. Int J Oral Maxillofac Implants.
2001; 16:659-667.)
IN MAXILLOFACIAL PROSTHESIS
The use of selective laser sintering
technology is an alternative approach for
fabricating a wax pattern of maxillofacial
prosthesis.
This new approach can generate directly
by prototyping and reduce labor-intensive
laboratory procedures.
The SLS (Selective Laser Sintering) is a
method of computer aided designing
using mainly the laser.
models are generated directly from 3-D
computer data then converted to STL
files,
which are then sliced in to thin layers
(typically about 0.1 mm/0.004 inches)
using the associated computer software.
The laser sintering machine produces the
models on a removable platform by applying
incremental layers of the pattern material.
For each layer, the machine lays down a film
of powdered material with an accurate
required thickness, again a fresh film of
powder is laid down, and the next layer is
melted with exposure to the laser source.
This process continues, layer by layer, until
the pattern is completed
Advantages
Manufacturer time is reduced.
More precision can be achieved.
LIMITATIONS OF LASERS

 It requires additional training and

education for various clinical applications
and types of lasers.
 High cost required to purchase
equipment, implement technology and
invest in required education.
 More than one laser may be needed since
different wave lengths are required for
various procedures.
Laser Hazard and its Safety Measures

The output of certain lasers are vulnerable to

human body and its exposure can cause injury to
the eye and skin.
Controlling the hazards depends on the limited
access to the room and equipments, proper use
of personal protective devices, monitoring the
system, testing and operations of the laser and
its delivery systems, correct applications, and
vigilance on the part of each laser team member
(Gounder R, Gounder S. Laser Science and its Applications in
Prosthetic Rehabilitation. J Lasers Med Sci. 2016;7(4):209-213.)
Gounder R, Gounder S. Laser Science and its Applications in
Prosthetic Rehabilitation. J Lasers Med Sci. 2016;7(4):209-213.
Dental lasers belong to category IV which is the
most hazardous of all the lasers. According to
Miserendino et al. (1995), the types of hazards
that can be encountered within the clinical
practice of dentistry are grouped as follows:
 i. Ocular injury
ii. Tissue damage
iii. Respiratory hazards
iv. Fire and explosion
v. Electrical shock.
Lasers are also used….
Preprosthetic surgery
Fibroma: any of the soft tissue lasers which
allows the tissue to re-epithelialize.
Carbonization was easily removed using a
cotton swab soaked with a Lotagen® (36%
dihydroxy dimethyl diphenylmethane-
disulfonic acid) solution to ensure a rapid
and better quality of healing.
Vesitbuloplasty: Vestibuloplasty is chosen when
prosthetic stability is poor due to mandibular or
maxillary crest atrophy and a small vestibule
length.
CO2 laser technology provides a simple and secure
method.
The sutures and grafts are not needed.
Removable denture must be immediately and
temporarily relined with soft acrylic. Patients
should wear the denture for 3 to 4 weeks after
surgery.
Frenectomy: The presence of high labial
frenulum
A thin layer of a minimum of 1 mm of soft
tissues should be kept to cover the maxillary
bone up to the end of the vestibule.
The insertion of the frenulum at the level of
the lip should also be removed.
Sutures were made only on the lip’s side of
the frenulum.
Epulis fissuratum: Epulis is the overgrowth
of the mucosa in CD wearing patients,
caused by the chronic irritation of the tissue.
The most commonly used techniques for the
excision of the lesion are soft tissue lasers,
surgical or electrical scalpel.
Denture stomatitis:
chronic candidal infection associated with
60% to 65% of denture wearers.
Laser beam not only helps in ablation of
superficial candida contaminated epithelial
surface, but also prevents inflammation of
adjacent normal mucosa.
Postoperative prescription of antibiotics or
non-steroidal anti-inflammatory drugs not
needed
 Lasers helps in adequate pain relief due to
neuron sealing effect.
Trough formation: Trough is created around
the tooth structure before impression
procedure.
Which eliminates the need of retraction cord
placement, electrocautery, and hemostatic
agents.
The laser provides efficient, predictable, no
or minimal bleeding during the impression
procedure, thus minimises the post-operative
pain and chair time.
Laser phototherapy: Low-level laser
therapy (LLLT) such as AsGaAl (gallium
aluminum arsenide) 660 nm laser is used
in the gingival sulcus, gingival tissue
surrounding the crown preparation to
promote soft tissue bio-modulation; so
that no inflammation signals should be
present in the gingival tissue before the
final luting procedure.
Dentinal decontamination: High-level laser
therapy (HLLT) is used as a last step before
the final cementation of crown due to their
better penetration into dentinal tissues and
microbial inhibition properties.
Second stage implant uncovering:
CO2 laser and almost all types of lasers are
used to remove overlying soft tissue.
Immediate impression can be taken after
second stage surgery due to minimal blood
contamination and tissue shrinkage.

( Romanos G. Current concepts in the use of lasers in periodontal and

implant dentistry. J Indian Soc Periodontol. 2015;19(5):490–4.)
Veneer removal: The laser energy transmits
through the ceramic glass and is absorbed by
the water molecules present in the adhesive.
De-bonding occurs at the silane – resin
interface. The technique takes approx. Two
seconds to 2 minutes for ceramic
restorations, based on the thickness of the
ceramic restoration.
Bleaching: In-office bleaching treatments are
commonly done by Ar and diode lasers.
KTP laser and H2O2 gel combination (Smart Bleach
gel [SBI]) is currently the only laser bleaching
system with photothermal, photochemical and
photocatalytic activity.
Laser tooth whitening is to achieve the ultimate
bleaching power while avoiding any adverse
effects.
( Roeland JG. The use of KTP laser, an added value for tooth
bleaching. The Journal of Oral Laser Applications. 2009;9(4):219–
226.)
Conclusion
The laser technology has been widely used
in dentistry on both hard and soft tissues in
various treatment modalities. However,
lasers have got their own limitations
specifically being technique sensitive.
This article has not greatly explained about
the mechanism of action of lasers, about
safety measures while using and missed
some uses of lasers in prosthodontics.
References
 Zaara A; Lasers in prosthodontics – a review , The journal
of Prosthetic and Implant Dentistry; 2019; 3(1).
 Gounder R, Gounder S. Laser Science and its Applications
in Prosthetic Rehabilitation. J Lasers Med Sci.
2016;7(4):209-213.
 Rode A. V. et al. Precision ablation of dental enamel using
a subpicosecond pulsed laser. Aust. Dent. J. 48, 233–239
(2003).
 Yuan F, Wang Y, Zhang Y, Sun Y, Wang D, Lyu P. An
automatic tooth preparation technique: A preliminary
study. Sci Rep.2016;6:25281.
 Deppe H., Horch H.H., Henke J, et al. Peri-implant care of
ailing implants with the carbon dioxide laser. Int J Oral
Maxillofac Implants.2001; 16:659-667
 Gounder R, Gounder S. Laser Science and its Applications in
Prosthetic Rehabilitation. J Lasers Med Sci. 2016;7(4):209-
213.
  Romanos G. Current concepts in the use of lasers in
periodontal and implant dentistry. J Indian Soc
Periodontol. 2015;19(5):490–4.
 Roeland JG. The use of KTP laser, an added value for tooth
bleaching. The Journal of Oral Laser
Applications. 2009;9(4):219–226.)