Diode lasers

DR ASOK MATHEW
Diode laser – characterstics
• Diodes are available in
635,670,810,830,980nm
wavelengths.
• As its wavelength is poorly
absorbed by hard dental tissue,
diode laser is safe and well
indicated for soft oral tissue
surgeries in regions near the dental
structures for cutting, vaporization,
curettage, blood coagulation and
haemostasis in the oral region.
Clinical pearls
• Continuous wave mode is used for surgical procedures and pulsed
mode in frenectomy, pulpotomy and periodontal procedures and as
canal disinfectants.
• CW mode can ablate tissue faster heat and buildup heat resulting in
collateral damage of the target tissue and adjacent tissue.
• This heat buildup can be reduced by moving the laser beam faster.
Power settings /fiber used
• The smaller diameter fiber will deliver the increased power density;
this allows the decreased power setting.
• The rule of thumb followed while using diode lasers is to achieve the
same rate of work from either larger or smaller diameter of fiber.
• In small diameter fiber, decreased power setting is used and
conversely an increased power setting in large diameter fiber.
GENERAL PROPERTIES
• It is having a solid active medium of semiconductors and uses the
combination of Aluminum, Gallium and Arsenide to change electrical
energy in to light energy.
• The available wavelengths for dental use range from 800nm to 980
nm, in the infra red invisible non ionizing spectrum.
Characteristics of Diode laser
• Compact and portable in design and are relatively inexpensive surgical units, with
efficient and reliable benefits for use in soft tissue oral surgical procedures.
• Diode lasers can be used in continuous-wave or gated-pulse modes, in contact or out
of contact with tissue.
• The 980-nm diode laser has significantly higher absorption in water, which makes it
cut more optically than thermally, with an optical penetration of less than 300
microns (µm).
• Romanos and Nentwig found that the 980 nm diode laser produced a more precise
incision margin compared with other laser wavelengths.
• In addition to various soft tissue oral surgical procedures, 980-nm diode lasers have
become as popular as CO2 lasers in the treatment of periimplantitis because they
offer a bactericidal effect without causing implant surface alterations.
Gen properties
• Here we use contact mode either in continuous or gated pulsed mode..
• All of these are highly absorbed by pigmented tissue although the
hemostasis is not as rapid as argon laser.
• They are poorly absorbed by the dental hard tissues so the soft tissue
surgery can be performed very safely.
• The diode laser is an excellent tool in cutting and coagulating gingiva and
mucosa.
• It can be used for soft tissue curettage and sulcular debridement
• The chief advantage of this laser is its small size and is the lowest
priced among the lasers.
Lasing medium
• What is a p-n junction diode?
• A p-n junction diode is a semiconductor device that allows the
flow of current in only one direction.
• The p-n junction diode is made of two types of semiconductor
materials namely p-type and n-type semiconductor.
• The p-type semiconductor  is joined with the n-type
semiconductor to form a p-n junction .
• The device that results from the joining of a p-type and n-type
semiconductor is called a p-n junction diode.
Mechanism of Diode laser
Mechanism of Diode laser
• The p-n junction diode allows electric current in forward bias condition
whereas it blocks electric current in reverse bias condition.

• If the positive terminal of the battery is connected to the p-type

semiconductor and the negative terminal of the battery is connected to
the n-type semiconductor, the diode is said to be forward biased.

• When forward bias voltage is applied to the diode, free electrons start
moving from the negative terminal of the battery to the positive
terminal of the battery.
Mechanism of Diode laser
• When a forward bias voltage is applied to the diode, free
electrons start moving from the negative terminal of the battery
to the positive terminal of the battery similarly holes start
moving from the positive terminal of the battery to the negative
terminal of the battery.

• Because of these flow of charge carriers (free

electrons and holes ), electric current is generated in the p-n
junction diode.
Mechanism of Diode laser
Mechanism of Diode laser
• In ordinary p-n junction diodes, the electrons moving from n-
type to p-type will recombines with the holes in the p-type
semiconductor or junction.
• Similarly, the holes moving from p-type to n-type will
recombines with the electrons in the n-type semiconductor or
junction.
Mechanism of Diode laser
• We know that the energy level of free electrons in the conduction
band is high as compared to the holes in the valence band.

• Therefore, the free electrons will release their extra energy (non-
radiative energy) while recombining with the holes.
Spontaneous Emission
Mechanism of Diode laser
• For the construction of laser diodes, gallium arsenide is chosen over silicon.
• In silicon diodes, the energy is released during recombination. However, this release of
energy is not in the form of light.
• In gallium arsenide diodes, the release of energy is in the form of light or photons.
Therefore, gallium arsenide is used for the construction of laser diodes.
• N-type semiconductor
• Adding a small percentage of foreign atoms into the intrinsic semiconductor produces
an n-type or p-type semiconductor.
• If pentavalent impurities are added to the intrinsic or pure semiconductor, an n-type
semiconductor is produced.
• In n-type semiconductors, free electrons are the majority charge carriers whereas holes
are the minority charge carriers. Therefore, free electrons carry most of the electric
current in n-type semiconductors.
• P-type semiconductor
• If trivalent impurities are added to the pure semiconductor, a p-type
semiconductor is produced.
• In p-type semiconductors, holes are the majority charge carriers
whereas free electrons are the minority charge carriers. Therefore,
holes carry most of the electric current in p-type semiconductors.
• Main steps required for producing a coherent beam of light in laser
diodes
• The main steps required for producing a coherent beam of light in
lasers diodes are: light absorption, spontaneous emission, and
stimulated emission.
Mechanism of Diode laser
• In laser diodes, electrical energy or DC voltage is used as the
external energy source.
• When the DC voltage or electrical energy supplies enough
energy to the valence electrons or valence band electrons, they
break bonding with the parent atom and jumps into the higher
energy level (conduction band).
• The electrons in the conduction band are known as free
electrons.
Mechanism of Diode laser
• When the valence electron leaves the valence shell, an empty space is created at
the point from which electron left.
• This empty space in the valence shell is called a hole.
• Thus, both free electrons and holes are generated as a pair because of the
absorption of energy from the external DC source.
• Spontaneous emission
• Spontaneous emission is the process of emitting light or photons naturally while
electrons falling to the lower energy state.
• In laser diodes, the valence band electrons or valence electrons are in the lower
energy state.
• Therefore, the holes generated after the valence electrons left are also in the
lower energy state.
Mechanism of Diode laser
• Stimulated emission
• Stimulated emission is the process by which excited electrons or free
electrons are stimulated to fall into the lower energy state by releasing
energy in the form of light. The stimulated emission is an artificial process.
• In stimulated emission, the excited electrons or free electrons need not
wait for the completion of their lifetime.
• Before the completion of their lifetime, the incident or external photons
will force the free electrons to recombine with the holes.
• In stimulated emission, each incident photon will generate two photons.
Advantages of laser diodes- General

1.Simple construction
2.Lightweight
3.Very cheap
4.Small size
5.Highly reliable compared to other types of lasers.
6.Longer operating life
7.High efficiency
8.Mirrors are not required in the semiconductor lasers.
9.Low power consumption
Advantages –Clinical
• The laser cut is more precise than that of a scalpel.
• The cut is more visible initially because the laser seals off blood and lymphatic vessels,
leaving a clear dry field.
• The laser sterilizes as it cuts, reducing the risk of blood-borne transmission of disease.
• Minimal postoperative pain and swelling.
• Less postoperative infection because the wound is sealed with a biological dressing
during surgery.
• Less damage occurs to adjacent tissues.
• Minimum anesthesia is required.
• These qualities result in a shorter operative time, faster postoperative recuperation
and a better compliance of infant patients.
Disadvantages of laser diodes

1.Not suitable for the applications where high powers are

required.
2.Semiconductor lasers are highly dependent on temperature.
Diode laser clinical applications
Diagnodent – Caries Diagnosis
• Caries Detection and diagnosis The DIAGNOdent unit contains a laser
diode (655nm, modulated, 1 mW peak power) as the excitation light
source, and a photo diode combined with a band pass filter
(transmission > 680 nm) as the detector.
• DIAGNOdent showed higher sensitivity and accuracy as compared
with other conventional methods for detection of enamel caries,
whereas for detection of dentinal caries, even though the sensitivity
was high, accuracy of the DIAGNOdent device was similar to other
conventional caries diagnostic methods
LAFT Therapy – Laser applied fluoride therapy.
• Diode with reduced wavelength 810-980 nm has highest co efficient
of thermal absorption of hemoglobin with minimal interactions with
hydroxyapatite and water.
• This property of diode makes it suitable for use in LAFT therapy
without affecting the tooth structure.
• Loosely bound calcium fluoride and firmly bound fluoride was
evaluated in LAFT using diode laser at 2 W and 5 s exposure time.
Disinfection of periodontal pockets.
• Diodes of 810-980 nm are used in the disinfection of periodontal
pockets and in Photoactivated dye disinfection of pockets diodes of
635,670 830 nm are used.
• The wavelengths of diode lasers are well absorbed by the pigmented
anaerobic microorganisms (Prevotella intermedia and Porphyromonas
gingivalis).
• The laser photonic energy penetrates diseased epithelium and
granulation tissue leading to coagulative changes due to increase in
temperature of microorganism and reduce their colony forming
activity
Disinfection of the canals
• Diode lasers in root canal therapy are used for disinfecting the canals
and as pulpotomy medicaments.
• In deep dentinal caries, diode (810 nm) at 1.5 W , 10ms on and 10 ms
off for 10-15 s defocuses at 4-5 mm used as decontamination of
dentinal wall and 0.5 -1W in CW for 5-10s defocused at 10mm in
continuous mode for dentin melting.
• Diode laser optic fibres are inserted within the canals, 3 mm short of
apex and withdrawn gradually approximately at one minute of lasing
time per canal.
Disinfection of the canals.
• Diodes as canal disinfectant and combination of Diodes with 2%
chlorhexidine solution showed the highest antimicrobial efficacy
against Enterococcus faecalis .
• These findings are suggestive that 810 nm Diodes laser can be an
effective tool for cleaning and disinfecting the root canal system when
used alone or in combination as canal irrigants at 2.5 power setting
and 5 s exposure time with cycle repeated 4 times.
Irradiation of root canal
Pulpotomy
• In pulpotomy procedure the pulp amputation is done using 810 nm
diodes at 2 W in CW for 10 -15 s until charred layer appears.
Clinical cases – Root canal therapy with adjuvant laser
therapy.
• A 62-year-old female patient presented with a periapical lesion on tooth 34.
After conventional endodontic treatment with the rotatory file system and
irrigation with 2.5% sodium hypochlorite, the tooth was cleaned with EDTA
and washed with sterile water solution.
• The root canal was filled with 1 M (3%) hydrogen peroxide for 1 minute and
with 60 μM methylene blue for another 1 minute.
• The root canal system was irradiated with a 40-mW diode laser emitting at
660 nm coupled with a 300-μm optical fiber (Twin laser MMOptics, São
Carlos, Brazil).
• Helicoidal movements were performed during the 4 minute irradiation (total
energy 9.6 J) to assure the entire root canal wall was irradiated.
FRENECTOMY
• Treatment with a diode laser was proposed for a 29-year-old female patient in
good general health but with an abnormal inferior labial frenum that was causing
retraction of the gingival margin.
• The frenectomy performed in an infant patient using a diode laser with a
wavelength of 980 nm, operated at a power of 3.0 watt in continuous wave mode
with a 320- micron quartz optical fibre proved to be a successful method and
advocated the use of diode laser as a comparably simple and safe procedure
without the need for general anaesthesia.
• The frenum mucosa was removed, as well as the deeper tissue comprising
connective fiber and muscle fiber. Local anesthetic was given prior to surgery.
• No sutures were required and healing with re- epithelization was complete 3
weeks after treatment.
Frenectomy
Post operative healing – 3 weeks
LLLT ( Low level laser therapy)
• LLLT or bio stimulation has three main effects on tissue: analgesics, bio
stimulation and anti-inflammatory.
• Laser induces hyperpolarization of the nerve membrane and increases
metabolism of acetylcholine, resulting in reduced stimulation and perception
of pain. LLLT therapy increases the production of ATP as well as overall activity
of cell thereby promoting bio-stimulation.
• LLLT modifies blood flow and induces angiogenesis.
• In addition, modification of lymph drainage reduces inflammation.
• LLLT has the following indications in pediatric dentistry: tooth eruption, tooth
pain, TMJ pain, treatment of aphthous , traumatic and herpetic lesions, and
accerlating orthodontic movement.
LLLT ( LOW LEVEL LASER THERAPY)
• A 48-year-old female patient reported orofacial pain upon waking and during mouth
opening for 3 months. After history recording and physical examination, bilateral
capsulitis and bilateral myositis of the masseter muscle was diagnosed, possibly caused
by parafunctional habits.
• She received information about TMD evolution and counseling for habit and behavioral
changes. While waiting for an interocclusal splint to be manufactured, she was treated
with LLLT.
• The patient underwent three sessions of LLLT per week for during 2 weeks with an
infrared diode low power laser (AsGaAl, 808 nm, spot size 0.028 cm2), 100 J/cm2, 2.8 J
per point, 28 seconds, 100 mW, punctual, continuous mode, perpendicular to the plane
of application.
• The points irradiated were selected according to the areas referred to as painful during
the TMD exam
POINTS FOR APPLICATION
PYOGENIC GRANULOMA
• Removal of the lesion was performed under local infiltrative
anesthesia using a diode laser in continuous mode in a contact
technique with a power setting of 2 W.
Haemostasis
• The diode laser (810–820 nm) is also absorbed by pigment in the soft
tissues, making it an excellent hemostatic tool; it can also be used to
remove soft tissue, reducing the amount of deep thermal damage.
NOTE THE HEMOSTASIS ….
Sialolithiasis
• Diode laser of 2-2.5 W in CW with a 320 microfiber is used for
removal of sialolithiasis.
Orthodontic applications
• Gingival hyperplasia can manifest during orthodontic treatment as a
result of poor oral hygiene: gingivectomy may be necessary to expose
the brackets covered by overgrown gingiva.
• Gingivoplasty may be necessary to remodel the gingival contour and
improve the smile line at the conclusion of orthodontic therapy.
• Gingivectomy is carried out using diode laser (810nm) at 1.5W CW
and gingivoplasty is carried out at low power and angulated.
• Operculectomy, exposure of unerupted teeth can be effectively done
using diode laser without affecting the erupting tooth.
Thank you ..