1

Good morning
LASERS IN DENTISTRY

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 CONTENTS
• Introduction
• History of LASER
• Properties of LASER
• LASER design
• LASER emission modes
• Tissue interactions of LASER
• Biological effects of LASER
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• Types of LASER
 CONTENTS
• LASER used in dentistry
• Application of LASER in dentistry
• LASER hazards
• Advantages of LASER
• Disadvantages of LASER
• Public health significance
• Conclusion
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• Bibliography
 INTRODUCTION
‘LASER’ in an acronym for ‘Light Amplification by
Stimulated Emission of Radiation’.

LASER -The verb "to lase" means "to produce coherent

light“

A laser is a device that uses light energy to perform work.

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 DEFINITION

A laser is a device that emits light (electromagnetic

radiation) through a process of optical amplification
based on the stimulated emission of photons.

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 INTRODUCTION
The rules for dentistry were invented in the late 1800’s by
Dr. G.V.Black, the father of modern dentistry. Among the
foremost of his rules was the concept of “extension for
prevention”

With the advances in dentistry the concept has now

changed to “Minimal Invasive Dentistry”

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MINIMUM INVASIVE DENTISTRY
As defined by the World Congress of Minimally Invasive

Dentistry: ‘MID is respecting the health, function and

aesthetics of oral tissue by preventing disease from

occurring or intercepting its progress with minimal tissue

loss.’

{ Dental update Jan/Feb 2008}

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 PRINCIPLES OF MID
1. Remineralization of early lesions

2. Reduction in cariogenic bacteria

3. Minimum surgical intervention of cavitated lesions.

4. Repair rather than replacement of defective restorations.

5. Disease control

International dental journal 2000,50, 1-12.

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 STRATEGIES FOR MID
1. Early caries detection and risk assessment

2. Remineralization of demineralized enamel and dentine

3. Optimal caries preventive measures

4. Minimally invasive operative intervention

5. Repair rather than replacement of restoration

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 HISTORY
• Light has been used as a therapeutic agent for many
centuries.
• In ancient Greece, the sun was used in heliotherapy.
• The Chinease used the sunlight to treat Rickets, skin
cancer and psychoses.
• This use of light for treatment of various pathologies is
referred to as “Photo Therapy”.

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 HISTORY
• 1917: Einstein, A. - Concept and theory of stimulated
light emission

• 1951: Charles H Townes, Alexander Prokhorov,

Nikolai G Basov, Joseph Weber - The invention of the
MASER (Microwave Amplification of Stimulated
Emission of Radiation) at Columbia University, Lebedev
Laboratories, Moscow and University of Maryland.
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 HISTORY
• 1958: Schawlow, A.L. and Townes, C.H. - Proposed
the realization of masers for light and infrared at
Columbia University .
• 1960: Maiman, T.H. - Realization of first working
LASER based on Ruby at Hughes Research
Laboratories.
• The first medical application is reported by Goldman in
1962.
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 HISTORY
• After a long time of investigations and new
developments in laser technology first clinical
applications were performed by Choy and Ginsburg in
1983
• Dental researchers began investigating lasers’ potential
and Stern and Sognnaes reported in 1965 that a ruby
laser could vaporize enamel

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 HISTORY
• The first reported oral surgical application using a C02
laser occurred in 1977

• In January 1987, the first FDA clearance for a C02

laser used in oral surgery paved the way for the
acceptance and viability of using lasers in the oral
cavity in a clinical environment.

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 HISTORY
• In 1996, lasers application on hard tissue like the bone
or teeth of the mandible.
• In 1997, FDA approved the Erbium :YAG laser, the first
for use on dentin for the treatment of tooth decay.
• Over the years, laser has greatly reduced the
requirement for sutures or anesthesia
• As the laser is advancing it is also used to control
bleeding and minimize infection. 16/126
 APPLICATIONS OF LASER
IN DEFENCE
• Laser Range Finder
• Underwater Laser
• Laser Radar (Lidar)
• Communications
• Anti-Missile Defence System

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 APPLICATIONS OF LASER
CIVIL
• Laser Drilling
• Laser Cutting
• Metrology
• Holography

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 APPLICATIONS OF LASER
MEDICAL APPLICATIONS OF LASERS
• Cosmetic surgery (removing tattoos, scars, stretch
marks, sunspots, wrinkles, birthmarks, and hairs) Laser
types used in dermatology include ruby (694 nm),
alexandrite (755 nm), pulsed diode array (810 nm),
Nd:YAG (1064 nm), Ho:YAG (2090 nm), and Er:YAG
(2940 nm).
• Eye surgery and refractive surgery
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 APPLICATIONS OF LASER
• Soft tissue surgery: CO2, Er:YAG laser
• Laser scalpel (General surgery, gynecological, urology,
laparoscopic)
• Photobiomodulation (i.e. laser therapy)
• "No-Touch" removal of tumors, especially of the brain
and spinal cord.
• In dentistry for caries removal, endodontic/periodontic
procedures, tooth whitening, and oral surgery 20/126
 APPLICATIONS OF LASER
OTHER APPLICATIONS
• High-Speed Photography
• Seismography
• Laser Printing

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 MECHANISM OF ACTION OF
LASER
It depends on the concept of stimulated emission of light
by Albert Einstein(1917).

It depends on three processes:

1. Absorption

2. Spontaneous emission

3. Stimulated emission 22/126

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SPONTANEOUS EMISSION 24/126
STIMULATED EMISSION 25/126
AMPLIFICATION 26/126
PROPERTIES OF LASER

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 LASER DESIGN

• Lasing active medium.

• Energy or Pumping source.

• Optical chamber.

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 LASER DESIGN
Lasing medium

A material, capable of absorbing the energy produced by an

external extension source through the subatomic
configuration of its component molecules, atoms or ions
subsequently give off this excess energy as photons of
light.

Lasing medium can be solid / liquid / gas.

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 LASER DESIGN
Energy or pumping source

An energy source is used to excite or pump the atoms in

the lasing medium to their higher energy levels that are
necessary for production of laser radiation.
The pumping source can be electrical, chemical, thermal or
optical energy.

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 LASER DESIGN
Optical Chamber

The lasing medium is located within resonating chamber

which has cylindrical structure with a fully reflecting
mirror on one another. This arrangement allows for the
reflection of photons of light back and forth across the
chamber.

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LASER DEVICES

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 LASER EMISSION MODES
Continuous wave : Beam emitted at only one power level
for as long as device is operated by pressing the foot
switch.

Gated pulse Mode: Periodic attenuations of laser energy

being on and off similar to blinking light. The duration is
as small as a few mille sec

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 LASER EMISSION MODES
Free running pulsed mode: This is unique in that large
peak energies are emitted for an extremely short time span
(in microsecond) followed by long time of which laser is
off. It is computer controlled.

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TISSUE INTERACTIONS OF
LASERS

Source Reflect

Absorbed Scattered
Transmitted

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 TISSUE INTERACTIONS OF
LASERS
Reflection – The laser beam bounces off the surface with
no penetration or interaction at all. Reflection is usually an
undesired effect, but a useful example of reflection is found
when Erbium lasers reflect off titanium allowing for safe
trimming of gingiva around implant abutments.

Scattering – Once the laser energy enters the target tissue

it will scatter in various directions. This phenomenon is
usually not helpful, but can help with certain wavelengths
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biostimulative properties
 TISSUE INTERACTIONS OF
LASERS
Absorption – Specific molecules in the tissue known as
chromophores absorb the photons. The light energy is then
converted into other forms of energy to perform work.

Transmission – The laser energy can pass through

superficial tissues to interact with deeper areas. Retinal
surgery is an example; the laser passes through the lens to
treat the retina

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 BIOLOGICAL EFFECTS OF LASERS

• Fluorescence

• Photothermal

• Photodisruptive

• Photochemical/Photobiomodulation

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 BIOLOGICAL EFFECTS OF LASERS
Fluorescence happens when actively carious tooth
structure is exposed to the 655nm visible wavelength of the
Diagnodent diagnostic device. The amount of fluorescence
is related to the size of the lesion, and this information is
useful in diagnosing and managing early carious lesions.

Photothermal effects occur when the chromophores

absorb the laser energy and heat is generated.

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 Tissue temp Observed effect Tissue changes Application
in Centigrade
37-50 Hyperthermia Above normal temp Nil
60 - 70 Coagulation -Proteins - Remove diseased
denaturation granulation tissue
-Tissue whitens - Haemostasis by
or blanches contraction of vessel
wall
70-80 Welding collagen molecule Adherence of layer-
helical unfolding and stickiness
interwining with
adjacent segments
100-150 Vaporization Liquid - steam -Excision of soft
Ablation tissue commences
-Hard tissue:

>200 Carbonization Dehydrated and burn

in presence of air
--carbon
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 BIOLOGICAL EFFECTS OF LASERS
Photodisruptive effects (or photoacoustic)

Short-pulsed bursts of laser light with extremely high

power interact with water in the tissue and from the
handpiece causing rapid thermal expansion of the water
molecules. This causes a thermo-mechanical acoustic
shock wave that is capable of disrupting enamel and bony
matrices quite efficiently.

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 BIOLOGICAL EFFECTS OF LASERS
Photobiomodulation or Biostimulation
• Lasers ability to speed healing, increase circulation,
reduce edema, and minimize pain.
• Many studies have exhibited effects such as increased
collagen synthesis, fibroblast proliferation, increased
osteogenesis, enhanced leukocyte phagocytosis, and the
like with various wavelengths.
• It is theorized they occur mostly through interactions
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within the cellular matrix and mitochondria
 TYPES OF LASERS
I. Based on wavelength

1. Soft lasers
Soft lasers are low power lasers with a wave length
around 632nm.

Example. He-Ne, Diode.

2. Hard lasers

Lasers used for surgical application

Example: CO2, Nd: YAG, Argon, Er:YAG . 45/126

 TYPES OF LASERS
II. Based on the lasing medium

Lasers can be classified according to the state of the

active medium.

1. Solid Example: Nd:YAG, Diode

2. Liquid Example: Dye

3. Gas Example: CO2, Argon, Er:YAG

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 LASERS USED IN DENTISTRY
• Argon

• Diode

• Neodymium YAG

• Holmium: YAG

• The Erbium Family

• CO2 47/126
 LASERS USED IN DENTISTRY
Other Advances

• KTP Lasers
• Flash Lamp pumped pulsed Dye Laser
• Copper Vapor Laser

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 ARGON LASER
Argon is laser with an active medium of argon gas that is
energized by a high current electrical discharge.

It is fiber optically delivered in continuous wave and gated

pulsed modes and is the only available surgical laser device
whose light is radiated in the visible spectrum

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 ARGON LASER

488 nm, which is blue in color

to activate camphoroquinone

polymerization of the resin in

composite restorative materials.
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 DIODE LASER
It is a solid active medium laser, manufactured from
(Gallium arsenide)

Semi conductor crystals using combination of aluminum or

indium, gallium, and arsenic.

800 nm for active 980 nm for active

medium containing medium
aluminum containing indium
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 DIODE LASER

• All of diode wavelength are highly absorbed by pigmented

tissue they are deeply penetrating.
• These are relatively poorly absorbed by tooth structure so
that soft tissue surgery can be safely performed in close
proximity to enamel, dentin and cementum.
• It can be used for Apthous ulcers, gingival troughing,
esthetic contouring of gingiva, and frenectomy procedures.

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 NEODYMIUM YAG
• It operates at a wavelength of 106 nm in a high inter

pulsed wave form.

• It was developed by Creusic and co workers in 1964.

• It emits light in near infrared area of spectrum.

• It uses a fiber optic cable to divert the light to a hand

piece and lens to produce free beam of laser light 53/126

 NEODYMIUM YAG

• Common clinical applications are for cutting and

coagulating of dental soft tissues and debridement.

• If offers good hemostasis during soft tissue procedures

which facilitates a clear operating filed more over it has

flexible delivery system 54/126

 NEODYMIUM YAG

• Greatest disadvantage is collateral damage that occurs

due to its depth of penetration.

• Wound healing in soft tissue can be delayed for a few

days or more when the Nd: YAG laser is used.

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 HOLMIUM: YAG LASER
• It operates at a wavelength of 2100 nm and uses a

pulsed waveform.

• It is absorbed by water 100 times greater than Nd: YAG

• At high peak powers can abrade hard, calcified tissue.

• An aiming device is used, as the light produced is

invisible. 56/126
 THE ERBIUM FAMILY
There are 2 distinct wavelengths that use erbium:

(1) Erbium: YSGG (2780nm) with solid crystal of yttrium

scandium gallium garnet doped with erbium and chromium

(2) Erbium : YAG (2940nm) has crystal of yttrium

aluminum garnet doped with erbium

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 THE ERBIUM FAMILY
1) It is used for caries removal, cavity preparation in both
enamel and dentin and in preparation of root canals.

2) It is also used for facial resurfacing, incision, ablation

of soft tissue. Its advantage lies in its ability to remove
superficial skin layers even more precisely than co2
laser with less adjacent tissue damage.

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 THE ERBIUM FAMILY
4. It is antimicrobial when used within root canals and on
root surfaces.

5. Same instrument can be used for soft and hard tissue

treatment at the same time.
6. Few studies demonstrated that tissue retraction for
uncovering implants is safe with these wavelength
because of minimal heat transferred during procedure.

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 CO2 LASER
It was developed by Patel in 1964. The CO2 laser is a gas
active medium laser that incorporates a sealed tube
containing a gaseous mixture with CO2 molecules

1) It has been used for excision and ablation of various

types of superficial lesions and for skin resurfacing

2) It offers excellent Hemostasis, often giving a clear field

of view. Post operative pain is minimal
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 CO2 LASER
3) Its disadvantage lies with the fact that wound healing is
delayed and there is lack of tactile feed back. Co2 treated
tissue will have black / brown appearance which slowly
fades with time.

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 KTP LASERS
• It is a modified version of Nd: YAG laser: addition of

frequently doubling crystal operates at 532 nm.

• It uses fiber optic cable with a hand piece.

• It is similar to argon laser in absorption characteristics

• It is used in the treatment of vascular and pigmented

lesions, tattoo removal and blepharoplasty. 62/126

 FLASH LAMP PUMPED PULSED
DYE LASER
This produces yellow visible light in 400 – 1000nm range
and is commonly used at 510, 577, 585nm. It is determined
by dye chosen.

The desired wavelength can be used for specific tissue to

be removed, offering great flexibility

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 FLASH LAMP PUMPED PULSED
DYE LASER
• 510 nm- melanin can be targeted and various benign
melanin containing tissues can be ablated
• 585nm: targets oxy-hemoglobin with in vascular
abnormities.
• Thus it is used in treatment of cancer, ablation of
salivary gland, kidney stones and scar revision.

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 COPPER VAPOR LASER
• Works at wavelengths of 511-578 nm.
• Thus is similar to both KTP and Argon lasers.
• Its medium is heated copper which produces copper
gas. It is delivered by fiber optic cable in pulsed mode.
• It is effective in treatment of port wine stains or large
superficial telangiectasias, lentigines, ephelides,
lentiginous nevi and tattoos.

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 APPLICATIONS OF LASER
• Laser assisted caries diagnosis and management

• Restorative and Pediatric dentistry

• Surgical applications of dental lasers

• Periodontics – gingivectomy, crown lengthening,

periodontitis treatment

• Oral surgery 66/126

 Laser Assisted Caries Diagnosis
and Management
• The Diagnodent caries detection laser is a portable,
battery powered diode laser.
• Its 655 nm visible wavelength causes active caries to
fluoresce.
• The amount of fluorescence is measurable and is
correlated to the size and direction of the lesion.

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 Laser Assisted Caries Diagnosis
and Management
• The laser gives a reading of zero to 99
• General guideline is that occlusal lesions above 30
likely need restoration and those from ten to 30 are
potentially reversible.
• The Diagnodent’s primary indication is for detecting
class I, class V, and incisal caries.
• It can also be useful when paired with transillumination
for detecting permanent class III and primary class 2
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lesions.
 Restorative Dentistry
• Er:YAG and Er,Cr:YSGG machines are multi tissue
lasers that are FDA approved for cutting tooth, bone and
soft tissue.
• Their extremely short pulses and high peak power allow
for efficient enamel and dentin photoacoustic ablation.
• Erbium lasers can prepare all classes of restorations.
• Many restorations can be accomplished without local
anesthesia. 69/126
 Restorative Dentistry
• Sterilization and Disinfection of root canals.

Pulsed Nd : YAG and Co2 lasers are recommended

at 1-2 w under air cooling.
• Removing of # Instruments, Temporary cavity sealing
materials, Sealing materials in root canals:
• Nd: YAG, Er: YAG can be used to remove temporary
cavity materials made of ZnO2 and gutta percha.

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 Paediatric dentistry

• Application of lasers before Fluorides in Children: This

ensures better bonding of fluorides into the laser treated
tooth hydroxy appetite crystals.
• Pulpotomy and Pulpectomy procedures.

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 Advantages
• Precise ablation allows for minimally invasive
preparations
• Smear layer removal
• Disinfection of preparations
• Eliminates the noise, heat, and vibration of high speed
rotary instrumentation
• Reduced need for local anesthesia
• Selective caries removal due to carious dentin’s higher
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water content and softer consistency
 Surgical Applications of Dental
Lasers
• The primary chromophores for diode and Nd:YAG lasers
are pigments such as hemoglobin and melanin.
• The erbium and CO2 lasers are mostly absorbed by water.
• All these lasers use photothermal effects to incise tissue
whereby photons absorbed are converted to heat energy in
order to do work.

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 Surgical Applications of Dental
Lasers
• Er:YAG and Er,Cr:YSGG lasers are also capable of
cutting bone and have FDA clearance for osseous use.
Multiple studies have shown erbium irradiated bone
shows minimal thermal damage, necrosis, or
inflammation.
• Erbium and CO2 lasers have been shown to effectively
decontaminate implant surface without damaging
titanium and are useful in treating peri-implantitis
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 Surgical Applications of Dental
Lasers
Diode and Nd:YAG lasers exhibit much deeper tissue
penetration and thermal effects than the erbium lasers and
the potential for tissue damage is greater

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 Periodontal treatment
• Diodes, Er:YAG, Nd:YAG, and CO2 devices from
various manufacturers have received FDA clearance for
sulcular debridement.

• The Nd:YAG wavelength is also bactericidal,

biostimulative, and has the ability to stimulate fibrin
formation with the proper parameters.

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 Periodontal treatment
• Erbium lasers have been shown to be effective at
scaling and root planning, effective pocket
decontamination, and can replace scalpels when
incisions are needed.
• Crown lengthening: Lasers can be efficaciously used
for crown lengthening related to excessive soft tissue of
due to passive eruption problem

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 Oral Surgery
CO2 lasers have been popular in oral surgery due to their
precise incisions and excellent hemostasis.
Erbium lasers are capable of cutting bone in a less traumatic
fashion and can be quite useful for the following procedures:
• Surgical Extractions with less traumatic flaps and bone
removal
• Alveoplasty
• Incision and Drainage
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 Oral Surgery
• Operculectomies
• Treatment of peri-implantitis
• Pre-Prosthetic
 Ridge preparation/hyperplasic tissue reduction

 Frenectomies

 Tuberosity reductions

 Vestibuloplasty

 Tori Removal 79/126

 Oral Surgery
• Nd:YAG and diodes have biostimulative properties that
can be used to promote healing, osteogenesis, and post-
operative comfort.
• Nd:YAG lasers can also form fibrin rapidly in an
extraction site creating a quick and more durable clot
• Treatment of bisphosphonate induce osteonecrosis

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 Oral Surgery
Biopsies: Effective in both incision and Excisional
biopsies. Using a focused mode for all the lasers, an
incision is made in the area to be biopsied. No sutures are
required and wound heals by secondary intention.

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 Oral surgery
Distal Wedge and Tuberosity Reduction

For soft tissue distal wedge and tuberosity reduction

procedures, lasers offer many advantages.

Using lasers, allows the operator simplify to vaporize or

cut away the tissue as needed until the desired result is
achieved.

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 CLINICAL USES OF LASERS
Removal of Granulation Tissue: All lasers can be used to
remove granulation tissue either for periodontal “clean out”
or for degranulating any wound site present.

In certain areas with circumferential defects, intrabony

defects, 3 wall defects, lasers can be useful aid in helping
degranulate completely the area or in partial deregulation.

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 CLINICAL USES OF LASERS
Coagulation: Lasers are excellent in controlling the
bleeding, for coagulation of bleeding areas, coagulation of
soft tissue graft donor sites.

For active bleeding sites, Argon, Nd: YAG, AG and Ho:

YAG is the lasers of choice in that order.

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 CLINICAL USES OF LASERS
Malignant Lesions:
• Malignancies can be removed easily by dental lasers.
• They offer the advantages of minimal bleeding,
swelling and less post surgical pain, especially
considering the large areas of tissue often removed.
• Potential advantage relates to lasers ability to seal blood
vessels and lymphatics

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 CARIES PREVENTION USING
LASER LIGHT
The U.S. food and drug administration approved in 1997 the
use of Er : YAG laser for caries removal and cavity
preparation in teeth. This was the first approval in the U.S.
for laser use on dental hard tissues
An in vivo study was conducted by Stern et al, in 1969 with
a ruby laser (λ = 693.4 nm) and energy density of 10 to 15
J/cm² has demonstrated that heating the enamel surface
with a laser, increased the enamel resistance to
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demineralization.
Stern R, Renger HL, Howell FV. Laser effect on vital dental pulps. Br Dent J.1969;127(1):26-8.
An in vitro study was conducted by Yamamoto et al in
1974 on extracted human teeth using Nd: YAG laser ( λ =
1,064nm) with an energy density of 10 to 20 joules/cm2
showed resistance to demineralization - fusion of enamel
prisms on high energy levels.

Yamamoto H et al. Potential of ytrium-aluminium-garnet laser 87/126

in caries prevention. J Oral Pathol.1974;38:7-15
An invitro study was conducted by Hossain MM et al in
2002 to investigate the caries-preventive effect of CO2
laser irradiation with or without sodium fluoride (NaF)
solution at human dental enamel and dentin.

It was concluded that CO2 laser irradiation with NaF

solution has more caries-preventive effect than CO2 laser

irradiation at the enamel and dentin surfaces
Hossain M et al .Caries-preventive effect of Er:YAG laser irradiation with or without water mist. J Clin Laser Med Surg.
88/126
2000;18(2):61-5
 A review was conducted by Rodrigues et al in 2004 to know
the effect of CO2 laser in inhibiting caries and also to discuss
the effects of CO2 laser in combination with fluoride.

It was concluded that irradiation of tooth by specific

wavelengths 9.3, 9.6 μm and 10.6μm of CO2 laser alters the
hydroxyapatite crystals by converting to insoluble
orthohydroxyapatite crystals thus reducing the acid reactivity of
the mineral. 89/126
Rodrigues et al. Carbon dioxide laser in dental caries prevention. Journal of Dentistry. 2004;32(7):531-40
In the early 1980’s, Feather stone et al proposed that the
appropriate lasers for caries prevention would be those that
overlapped with the major absorption bands of the tissues.
• There are specific sets of the irradiation conditions for
laser lights that interact most efficiently and effectively
with dental hard tissues.
• Efficient conversion of light to heat as the laser light is
absorbed results in increased resistance of tooth mineral
90/126
to dissolution by acid.
Fried et al have reported -a CO2 laser removes carious
tissue efficiently and can inhibit caries progression.

Harazaki and his group also showed the effectiveness of

the Nd:YAG laser plus fluoride on the prevention and
reduction of white-spot lesions associated ortho­dontic
bands.

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Lasers in Preventing Pit and fissure caries
A study was conducted by Bahar A et al in 1994 to examine the
effects of Nd:YAG laser irradiation on the acid resistance of human
dental enamel of pits and fissures, the cleaning of the pit and
fissure contents and fluoride uptake into deep pits and fissures.

It was concluded that the pit and fissure enamel treated with laser
irradiation obtained an acid resistance 30% higher than that of the
unlased controls.
Bahar A, Tagomori S. The Effect of Normal Pulsed Nd-YAG Laser Irradiation on Pits and Fissures 92/126
in
Human Teeth. caries research.1994;28(6):460-7.
Koukichi Motsumoto

Using Er:YAG Laser Class I and class II cavities can be

prepared in minutes

Laser treatment of hard tissues. Journal of oral lasers 2004

93/126
 Laser Hazard Class according to ANSI and
OSHA Standards
LowLaser
powered
Pointers
lasers that are safe to view
I
Low powered visible lasers that are hazardous only
II when viewed directly for longer than 1,000 sec (Radiant
LASER RADIATION-
AVOID DIRECT EYE EXPOSURE

power not above 1mw)

ND:YAG 532nm
5 milliwatts max/CW
CLASS IIIa Laser Product

Low powered visible lasers that are hazardous when

LASER RADIATION-

IIIA viewed for longer than .25sec (most pen like pointing
AVOID DIRECT EXPOSURE TO BEAM

2w ND:YAG Wavelength: 532 nm

lasers belong to this class) Output Power 80 mW

CLASS IIIb Laser Product

Laser Radiation
VISIBLE LASER RADIATION-
Do Not Stare Into Beam
AVOID EYE OR SKIN EXPOSURE TO
DIRECT OR SCATTERED RADIATION

Moderate powered lasers (.5 w max) that are hazardous

2w Nd:YAG

Output1
Helium
Wavelength: 532 nmNeon Laser
milliwatt
Power 20 W max/cw

IIIB when viewed directly

CLASS IV Laser Product
CLASS II LASER PRODUCT

High powered lasers (>500 mw) that produce ocular,

94/126
IV skin and fire hazards.
 LASER HAZARDS
• Ocular hazards

• Tissue damage

• Respiratory depression

• Fire and explosion

• Electrical Shock

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 LASER HAZARDS
1) Ocular Injury

Causes: - Direct emission

- Reflection

Damage can manifested as injury to sclera, cornea, retina

and aqueous humor and also as cataract formation.

Prevention: The use of carbonized and non-reflective

instruments has been recommended.

96/126
 LASER HAZARDS
2) Tissue Hazards

Temperature elevation of 21°C above normal body

temp (37°C) can produce cell destruction by denaturation
of cellular enzymes and structural proteins.

Has the potential for mutagenic changes, possibly by

the direct alteration of cellular DNA through breaking of
molecular bond. 97/126
 LASER HAZARDS
3) Respiratory Hazards

Causes:
The potential inhalation of airborne bio-hazardous
materials that may be released as a result of the surgical
application of lasers.

laser plume – an airborne contaminant produced as

smoke during ablation.

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 LASER HAZARDS
Prevention:

Standard surgical masks are able to filter out

particles down to 5µm in size

For laser plume, as the particle size is as small as

0.3µm evacuation is always indicated with a “Smoke
Evacuator”.

99/126
 LASER HAZARDS
4) Fire and Explosion

Causes: Inflammable solids, liquids and gases used

within the clinical setting can be easily ignited if exposed
to the laser beam.

Prevention: The use of flame- resistant materials and

other precautions therefore is recommended.

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 LASER HAZARDS
Electrical Hazards

These can be

- electrical shock hazards

- electrical fire or explosion hazards

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 ADVANTAGES OF LASERS
• Minimal damage to surrounding tissues.
• Exerts Haemostatic effects by sealing blood vessels
• Reduction of post operative inflammation and edema
due to seating of lymphatics.
• Reduced post operative pain, scarring resulting in little
induration or restriction in movements of soft tissue
intra orally.

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 ADVANTAGES OF LASERS
• Dressing or suturing is not required for wound closing
• Operating time is reduced.
• Sterilization of wound due to reduction in amount of
microorganism
• Excellent wound healing
• Minimal instrumentation.

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 DISADVANTAGES OF LASERS
• Injury to patient or operator by direct beam of reflected
light causing retinal burn.
• Irreversible pulpal damage
• G.A is required for patient undergoing extensive laser
treatment in mouth
• Post operative infection by Herpes, Candidiasis.

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 DISADVANTAGES OF LASERS

• Loss of tactile feed back.

• Bone devitalisation

• High cost

• Special training required for operation

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 PUBLIC HEALTH SIGNIFICANCE
Laser dentistry the so called “painless dentistry” is emerging in
a drastic manner.

Conventional treatment poses patient to apprehension, fear,

anxiety due to invasive procedures.

The treatment with laser not only reduces the fear of pain but
also treats the condition by preventing damage to the
surrounding structures and it is non-invasive in nature 106/126
 PUBLIC HEALTH SIGNIFICANCE
In a country like India, the treatment costs should be bore in
mind before implementing the lasers on community basis.

Further studies are recommended in the areas of dental caries

and periodontal disease prevention.

If those studies prove that the lasers are effective in preventing

dental caries and periodontal disease, then lobbying of the policy
makers should be done to subsidize the cost of laser treatment.
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 CONCLUSION
Thus, as we enter the next millennium we see that dentistry
has advanced by leaps and bounds. Among the various
advances, the one which has good scope of improvement is
the lasers in Dentistry.

Laser application in dentistry allowed patients to enjoy a

better and improved oral health.

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 CONCLUSION
When used efficaciously and ethically, lasers are an
exceptional modality of treatment for many conditions
that dentists treat on daily basis

It has got its own limitations. Recent advances in laser

technology and research into its potential have set the stage
for a revolution in dental practice.

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Ethical issues are divided into major groups:

(1) media, marketing, and advertising;

(2) economic outcomes

(3) user training

(4) the user-patient/client relationship

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 LASER CENTRES IN INDIA
• Raja Ramanna Centre for Advanced Technology, Indore
(RRCAT)
• Laser Science & Technology Centre, Delhi (LASTEC)
• Indian Institute of Technology, Kanpur
• Instruments Research and Development Establishment (IRDE)
• Centre of Excellence in Lasers & Optoelectronic Sciences
(CELOS)
• Indian Institute of Technology, Delhi
• Indian Institute of Technology, Guwahati 111/126
 LASER CENTRES IN INDIA
• Indian Institute of Technology, Kharagpur
• Indian Institute of Technology Madras, Chennai
• Indian Institute of Technology, Mumbai
• Raman Research Institute, Bangalore
• Tata Institute of Fundamental Research (TIFR)
• International School of Photonics, Cochin University of
Technology, Cochin
• University of Pune, Pune 112/126
 LASER CENTRES IN INDIA
• University of Kerala, Thiruvananthapuram
• Physical research Laboratory, Ahmedabad
• Institute of Plasma Research, GandhiNagar, Gujrat
• Shri G.S. Institute of Technology & Science, Indore
• Devi Ahilya Vishwavidyalaya, Indore

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 COURSES ON LASERS
Indian Institute of Technology, Kanpur

M. Tech in Laser Technology

Indian Institute of Technology, Kharagpur

M. Tech in Fiber Optics and Lightwave engineering

Indian Institute of Technology, Delhi

M. Tech in Applied Optics

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M. Tech in Opto-electronics and Optical Communication
 COURSES ON LASERS
University of Pune, Pune

M. Tech. in Laser And Laser applications

M. Tech. in Lasers & Electro-Optics

International School of Photonics at Cochin University of

Science & Technology, Cochin

M. Tech in Opto-Electronics and Laser Technology

M. Phil in Photonics 115/126

 COURSES ON LASERS
University of Calcutta
M. Tech in Optics & Opto-electronics

Centre of Excellence in Lasers and Opto-Electronic Sciences

(CELOS), Cochin
M. Sc (Photonics) - 5 Year Integrated course in Photonics

University of Kerala, Thiruvananthapuram

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M. Tech in Opto-electronics
 COURSES ON LASERS
College of Engineering, Anna University, Chennai

M. Tech-Laser and Electro Optical Engg

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 COMPANIES MANUFACTURING
LASER
Aarvam Medical System, Pondicherry

Advanced Laser Systems Ltd., Faridabad (Haryana)

Advanced Photonics Pvt. Ltd., Mumbai

Alpha Nippon Innovatives Limited, Ahmedabad

Amagic HolographicsIndia Pvt Ltd, Nasik

Anatech Instruments, Mumbai

Ask Hydro Hi-Tech Systems (P) Ltd, Delh

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 COMPANIES MANUFACTURING
LASER
IPG Photonics (India) Pvt. Ltd., Bangalore

Jain Lasertech Pvt. Ltd, Mumbai

Jingcheng India, Delhi

Joy Industries, Bangalore

Kirti Lasers, Maharashtra

Krishna Engineers, Surat

Kuwer Industries Limited, Noida (U.P.)

Lancer Laser Tech Pvt. Ltd., GandhiNagar, Gujrat

Laser Lab India, Delhi

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Laser Science, Mumbai
 BIBLIOGRAPHY
Apel C, Meister J , Gotz H, Duschner H, Gutknecht N. Structural
Changes in Human Dental Enamel after Subablative Erbium Laser
Irradiation and Its Potential Use for Caries Prevention. Caries Res.
2005;39:65-70.
Bahar A, Tagomori S. The Effect of Normal Pulsed Nd-YAG Laser
Irradiation on Pits and Fissures in Human Teeth. caries
research.1994;28(6):460-7.
Donald et al. Lasers in clinical dentistry.The Dental clinics of North
America.2004;48(4).
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 BIBLIOGRAPHY
Hossain MM et al. Acquired acid resistance of
enamel and dentin by CO2 laser irradiation with
sodium fluoride solution. J Clin Laser Med Surg.
2002;20(2):77-82.

Hossain M et al .Caries-preventive effect of

Er:YAG laser irradiation with or without water
mist. J Clin Laser Med Surg. 2000;18(2):61-5.
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 BIBLIOGRAPHY
www.scribd.com. Lasers in dentistry. Accessed on
03/01/2015

Vahl J. Electron microscopical and X-ray crystallographic

investigations of teeth exposed to laser rays. Caries Res.
1968;28:10-8.

Yamamoto H et al. Potential of ytrium-aluminium-garnet

laser in caries prevention. J Oral Pathol.1974;38:7-15.

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 BIBLIOGRAPHY
Rodrigues et al. Carbon dioxide laser in dental caries
prevention. Journal of Dentistry. 2004;32(7):531-40.

Tandheelkd N T . The use of lasers for the prevention of

dental caries.2002;109(5):162-7
Todea CDM. Laser applications in conservative dentistry.

TMJ 2004;54(4):392-405.

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THANK YOU

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