Clinical applications of CO2

laser
DR ASHOK MATHEW
 Properties of CO2 Laser

• - Wavelengths : 9600 ,10600 nm

(far infrared). - Active medium:
Gas.
• - Affinity : H2O
• - Delivery system: Articulated
arm.
• Non contact mode
• - Mode of emission : CW, Pulsed
and Super pulsed.
• At the beginning it was used for “melting” , but
today it is used for soft tissues surgery
• - When focalized it gives an efficient, precise and
narrow incision.
• - Great capacity for coagulation.
• - Good antibacterial, antifungal and antiviral
activity.
• - Very safe (greatly absorbed: poor penetration in
the depth).
 Advantages
• Reduced swelling

• Improved coagulation

• Reduced pain

• Decreased scarring

• Little or no need of suturing

• Little or no chance of mechanical trauma

• High patient acceptance

• As it operates in non contact mode, one of the

greatest advantage is its outstanding ability to
easily negotiate curves and folds in the oral
cavity
 Disadvantages of CO2 laser
• CO2 laser require local anesthesia.

• Co2 laser gets absorbed by the fiber optic cable so can’t

be used in inaccessible areas for procedures like for
throat procedures.

• It can’t penetrate more than 0.1-0.3mm and hence can’t

be used in lesions extending beyond this range.
 Consultations and assessments:
• The practitioner should take into consideration the
personal history and complaints of the patient.
• Clinical examination and complementary
(RX,MRI,Bleeding level,etc) should be completed
prior to surgery.
• Biopsy is mandatory before any ablation of oral
disease, tumors…
Various modes and clinical
outcomes
• Pre-cautions during surgery: It is necessary to
protect the eyes of the practitioners , nurses,
assistants and patient with adapted glasses.
• For patients considered risky cases ( hemophilia,
diabetic, heart disease…), it is highly recommended
that the wound be sutured at the end of laser
surgery.
 Precautions in post-operative period:
• Clinical Protocol : A similar procedure to that used in
conventional surgeries is respected for oral laser
surgeries.
• Prescribe an oral disinfecting solution for a maximum 10
days to avoid the risk of secondary infections of the
wound.
• The decision about which antibiotics and analgesics to
prescribe depends on the kind and nature of the disease,
topography, and the size of the ablated tissues. This
decision is left to the practitioners discretion.
 CLINICAL APPLICATIONS
• Used in :
• Biopsies
• Tongue lesions
• White lesions
• Vesicullobullous lesions
• Pre malgant lesions
• Apthous ulcers
• Herpetic lesions
• Coagulation of bleeding ares
 Vestibular deepening
• In case of advanced or severe resorption (atrophy) of
alveolar processes and the body of the bone crest,
vestibular lengthening should be helpful.
• In this case: Nd:YAG,Nd:YAP ,Diode and KTP lasers are
difficult to use because those wavelengths are too much
absorbed in the depth of the target tissues & difficult to
manage post-operatively.
• Vestibular deepening (Increase of the crest length) CO2 ,
Er:YAG and Er,Cr;YSGG lasers provide a simple and secure
method. The sutures and grafts are not needed.
Vestibular deepening
• Removal of granulation tissue
• Exposure of implants
• Frenectomy
• Crown lengthening, distal wedge and tuberosity reduction
• Hypersensitivity
• Gingivectomy and gingivoplasty
• Pre prosthetic surgery
• Malignant lesions
• Gingival troughing haemorrhagic disorders
EXCISION BIOPSY
 Proceedure
• With a focused mode , incision is made in the biopsy area.
• Power setting will be in the range of 6-12 W
• It follows the predefined surgical outline and by means of
a tissue pick up.
• A border of outline is raised and the lesion is undermined
with traction and counter traction.
• Sutures are not required
Biopsies
 Precautions to be taken
• If there is any area of collateral damage is there, it will
affect the accuracy of the histological examination
results.
• The tissue damage is inversely proportional to the water
content of the tissue.
• The higher the water content, the lesser the tissue
damage.
• The pathologist must be informed that it is laser excised
tissue.
 WHITE LESIONS, VESICULLOBULLOUS LESIONS,
PRE MALIGNANT LESIONS

• The lesions which can be treated include

• lichen planus [erosive type],
• benign mucous membrane pempigoid
• sub lingual keratosis,
• hyper keratotic growths
 Laser peel
• LASER POWER 3-4 W
• DEFOCUSED MODE
• TISSUE BLISTER----allowing the clinician to
laser peel the lesion away.
LICHEN PLANUS
BLISTERING OF TISSUE
PEELING OF TISSUE
12 WEEKS AFTER LASING
• Most of the patients are symptom free and
lesions don’t recur for months to years.
• If the symptoms recur , the process is benign
and the lesions can be retreated.
 APTHOUS ULCERS
• MECHANISM OF ACTION IS UNKNOWN
• The laser is set to a lowest 1-2 W setting
• The laser is set to a defocused mode
where the minimal energy is delivered to
the site and the beam is brought to
near to the ulcer until the patient begins
to feel the discomfort or heat.

• At this point using a circular motion

The ulcer is lased from its centre to
just beyond the erythematous halo.
 HERPETIC LESIONS
• The lesions are treated very effectively with
lasers and the patient experiences the symptom
relief.
• But the virus can be transmitted in laser
plume.
• It should be used with caution.
 COAGULATION
• Once the laser coagulation can be
achieved the chance of secondary
bleeding is very less.

• For getting effective coagulation the

active bleeding should be stopped for
some time using pressure pack or other
means

• The co2 laser is applied in defocused

mode in very low power setting 3-4 W
until a char layer is formed.
EXPOSURE OF IMPLANTS
• The CO2 laser is applied to uncover
the healing cup.
• This is accomplished with a defocused
mode , a circular motion and the power
setting is 3-6 W
• .This method is called cookie cutter
approach.
• There is minimum discomfort associated
with this as there is no sutures and flap
procedure associated with it.
EXPOSED HEALING CUP
. REMOVAL OF GRANULATION
TISSUE
• The wavelength can be used to
remove granulation tissue in
periodontal surgeries or
• for degranulating any wound
present.
• Caution should be taken not to
damage the osseous structures and
root surfaces.
LESION AFTER HEALING
• . In the lingual frenectomy, the tip of the
tongue is grasped and the tension is applied.
• From the greatest concavity of the frenum,
moving posteriorly, the frenum is simply
vaporized.
• POWER: 4-5W
• Advantages
• Operative time is 35 sec to 2-3 mts
• Pain free post operative recovery

• Sutures are not needed

 CROWN LENGTHENING
• Laser can be used effectively for crown
lengthening [cause -due to soft tissue growth or
due to passive eruption ]
• power settings used are 3-6 W
CROWN LENGTHENING
• To protect the under lying tooth structure a no
7 wax spatula is used in the sulcus.
• As the lasing continues, the spatula is moved in
conjunction with laser.
• Moreover this is inaccessible area and difficult
for suturing.
• The laser allows the operator to vaporize the
tissue. The power setting used is 4-7 W, used
in focused or defocused mode.
 HYPERSENSITIVITY
• Hypersensitivity to cold is completely avoided by
sealing the dentinal tubules.
• The beam is used in defocused mode power
setting is 1-2 w
• Some operators use fluoride gel over the
surface before lasing.
 Gingivectomy
• Tooth protection is needed and periosteal
elevator or no7 spatula can be used
• Power setting used is 4-10 W.
• Near the tooth margins the beam is used in
focused mode to precisely contour margins,.
• Away from the gingival margin the beam is
used in defocused mode to ablate the tissue.
 Malignant lesions
• No bleeding or minimal bleeding
• less post operative pain
• 1cm clear margin is removed
• power setting is 4-10 W
• Seeding and metastasis is minimized as blood
vessels and lymphatics are sealed
Hemorrhagic disorders
• These disorders include hemophilia,
• Sturge Weber syndrome
• Idiopathic thrombocytopenic
purpura.
• They loose minimal amounts of
blood because of coagulative
effects of lasers when applied
 PERI-IMPLANTITIS
• After elevation of a mucoperiosteal flap, removal
of granulation tissue with plastic curettes,
decontamination with a CO2 laser.
• Continuous mode, power levels of 2–4 W, with a
non-contact mode.
• Augmentation with bone grafting material, use of
an absorbable membrane (GBR), and flap closure,
we found good healing and new bone formation.
Diode vs CO2 LASER
 THANK U
DR ASHOK MATHEW