LASERS IN PROSTHODONTICS

CONTENTS

• Fundamentals of Laser
• Classifications of Laser
• Delivery System
• Laser Effects on Tissue
• Lasers used in Dentistry
• Laser Applications in Dentistry
• Laser Application in Prosthodontics
- Fixed prosthodontics
- Removable prosthodontics
- Implants and Periimplantitis
• Recent advances in Laser
• References

❖ FUNDAMENTALS OF LASER

HISTORY

● The dental lasers of today have their basis in the quantum theory of
mechanics initially formulated during the early 1900s by Danish physicist
Bohr.
● However, Einstein’s article on the stimulated emission of radiant energy
in 1917 is acknowledged as the conceptual basis for amplified Light.
● The word LASER “Light Amplification by Stimulated Emission of
Radiation” was used for the first timeby an American Physicist, Gordon
Gould in 1957.
● The invention of the first LASER device was by Theodre Maiman, in
1960 which used a solid ruby as an active medium, at 649nm wavelength
which was energized or ‘pumped’ by an electrical source.
● Dr. Leon Goldman in 1965 first experimented the effect of ruby laser on
enamel and dentin
● Studies by Patel and Johnson in the 1970s and 1980s turned to other
devices such as CO2 and Nd: YAG (Neodymium Yttrium Aluminium
Garnet), which was thought to have better interaction with dental hard
tissues
● In May 1990, the FDA cleared for intraoral soft tissue surgery a pulsed
Nd: YAG laser. Developed by Myers and Myers, it was recognized as the
first laser designed specifically for general dentistry called the dLase
300, it was manufactured by Sunrise technologies California. Other
noteworthy firsts in FDA dental laser marketing clearances include the
Curing of composite materials (1991), Tooth whitening(1995), Sulcular
debridement(1997), Caries removal and cavity preparation(1997),
Removal of coronal pulp(1998), Selective ablation of enamel caries
● Other laser wavelengths made available for use in dental practice-
Argon, Ho:YAG and Er:YAG
● Donald. J. Coluzzi has made valuable contributions to literature on the
current concepts in Clinical Laser Dentistry, DCNA 2004, Laser
Applications 2007
● The word LASER is an acronym for light amplification by the stimulated
emission of radiation
 I. Laser light
● The light wave produced by a laser is a specific form of electromagnetic
energy that behaves as a particle and a wave. The basic unit of energy is
called a photon.
● The wave of photons produced by a laser can be defined by 3
measurements, namely,
a) Velocity i.e. speed of light
b) Amplitude (intensity in the wave) - this is the total height of the wave
oscillation from the top of the peak to the bottom of the vertical axis.
Larger the amplitude greater is the performable work
c) Wavelength - this is the distance between any two corresponding points
on the wave on the horizontal axis

Characteristics of Laser Light

i. Monochromacity - laser light is one specific colour/ single
wavelength unlike ordinary white light which is a sum of many
colours of the visible spectrum.
ii. Collimation - refers to the beam having specific spatial
boundaries which ensures a constant size and shape of the beam
emitted from the laser cavity.
iii. Coherency - means that the light waves produced in the
instrument are all in phase with one another and have identical
wave shapes, i.e. all the peaks and valleys are equivalent.
iv. Efficiency - at very low average power levels lasers can produce
the required energy to perform their specific function, e.g. 2 watts
of Nd: YAG laser light provides the thermal energy to precisely
incise a gingival papilla
 II. Amplification
Amplification is part of a process that occurs inside the laser. Identifying the
components of a laser instrument is useful in understanding how light is
produced.
COMPONENTS OF LASER

Active medium that can be a solid, liquid or gas. This lasing medium is what
determines the wave length of the light emitted from the laser and the
laser is named after the medium.
Eg: Gaseous active medium lasers in dentistry – Argon and CO2
Pumping mechanism /External power source – Either a flash lamp strobe
device or an electrical coil which excites or 'pumps' the atoms in the laser
medium to higher energy levels.
Optical resonators /optical cavity that consists of two mirrors, one fully
reflective and the other partially transmissive, which are located at either
end of the optical cavity allowing light of sufficient energy to exit the
optical cavity thus amplifying the power
Cooling system -Co-axial coolant systems may be air- or water-assisted.
Focusing lenses

III. STIMULATED EMISSION

• Introduced In 1990 – By Max Planck
 • Based on quantum theory of physics
• Incident light energy, absorbed by a target atom, will result in an electron
moving to a higher energy shell. This unstable state will result in the
emission of photonic energy relative to the stable energy state of the
target, with excess energy being produced as heat. This process is called
‘spontaneous emission’.
• Albert Einstein theorized further that if an already energized atom is
bombarded with a second photon, this will result in the emission of two
coherent photons of identical wavelength, a phenomenon he termed
‘stimulated emission’.
• This energy is emitted or radiated as two identical photons, traveling as a
coherent wave
• These photons are then able to energize more atoms, which emit
additional identical photons stimulating more surrounding atoms

IV. RADIATION
• Refers to the light waves produced by the laser as a specific form of
electromagnetic energy ranging from gamma rays to radio waves
• Emission wavelength of dental lasers – 500-10,600 nm
• They are within the visible or invisible infrared non-ionizing portion of
electromagnetic spectrum
Ionizing
• Short wavelengths below 300nm
• Higher frequency (smaller wavelength) radiation has large photon
momentum which penetrate biological tissue and produce charged
atoms

Non-ionizing
• Wavelength larger than 300nm
 • Less photon energy and cause excitation and heating of tissue with
which they interact

LASER PHYSICS

• Atoms in the exited state spontaneously emit photons of light which

bounce back and forth between the two mirrors in the laser tube.
• As they bounce within the laser tube, they strike other atoms, stimulating
more spontaneous emissions
• Photon of energy of the same wave length and frequency escape through
the transmissive mirror as the laser beam.
• The energy that leaves the tube is extremely intense, highly directional,
collimated, and monochromatic
• If a lens is placed in front of the laser beam, an extremely small intense
beam of energy is produced which has the ability to vaporize, coagulate
and cut. This lens concentrates the emitted energy and allows for focusing
to a small spot size.

CLASSIFICATION OF LASERS
The main differentiating characteristics of laser is wavelength which depends on
the laser medium and the excitation mode.
1. Based on light spectrum
● UV Light (100 nm - 400 nm)- Not used in dentistry
● Visible light (400 nm to 750 nm)- Most commonly used in
dentistry (Argon & Diagnodent Lasers)
● Infrared light (750 nm to 10000 nm)- Most dental lasers are in this
Spectrum
2. According to the materials used
● Gas – Argon, Carbon dioxide
● Liquid - Not so far in clinical use
● Solid – Diodes, Nd:YAG, Er:YAG, Er:Cr:YSGG, Ho :YAG
3. Based as application
● Soft tissue laser eg: Argon, Co2, diode; Nd: YAG.
● Hard tissue laser eg: Er: YAG
● Resin curing laser eg: Argon.
4. Based on Level of energy emission
● Soft lasers (low level energy): A thermal low energy lasers emitted at
wave length, which are supposed to stimulate cellular activity.
eg: He-Neon; Ga-Arsenide.
Stimulate circulation and cellular activity (tissue regeneration and
enhancement of healing
● Hard lasers (High level energy): Thermal lasers emitted at
wavelength in the visible infra red and U.V range.
eg: Er:YAG laser ; Nd: YAG laser.
Surgical procedures to cut, coagulate, vaporize, composite
polymerization and for welding purposes.
LASER DELIVERY SYSTEMS
Currently, two delivery systems are used (for surgical lasers):
A flexible hollow waveguide/tube attached to a handpiece (non-contact mode)
or an accesory tip of saphire or hollow metal (contact mode) connected to
the end of the waveguide.
Er and CO2 laser (as they are absorbed by water, cannot pass through glass
fibre)
A glass fiber optic cable attached to a handpiece (non-contact mode) or a
sapphire or quartz tip (contact mode). Most of the times it is used in
contact mode.
Lasers with shorter emission wavelengths- argon, diode, and Nd:YAG can be
designed with small flexible glass fibers.

EMISSION MODE
The principle behind any laser emission mode is that the light energy strikes the
tissue for a certain length of time producing a thermal interaction. The
dental laser device can emit light energy in three different modalities,
namely:
● Continuous wave mode – the beam is emitted at only one power level
for as long as the operator depresses the foot switch. Here the
operator must cease the laser emission manually so that thermal
relaxation of the tissue may occur.
Eg: CO2, Ar, Diode
● Gated pulse mode – there are periodic alternations of the laser energy.
This mode is achieved by the opening and closing of a mechanical
shutter in front of the beam path of a continuous wave emission.
● Free-running pulsed mode – (“true-pulsed”) This emission is unique
in that large peak energies of laser light are emitted for a short time
span (microseconds) followed by a relatively long time in which the
laser is off.
Eg :KTP, Nd:YAG, Er:YAG and Er, Cr:YSGG

LASER TISSUE INTERACTION

Depending on the optical properties of the tissue, laser light can have
four different interactions with the target tissue, i.e.

1.Absorption – The absorption of the laser energy by the intended

tissue is the first and most desired interaction. The amount of energy
absorbed by the tissue depends on tissue characteristics:
pigmentation and water content.

2. Transmission - Laser energy passes directly through the tissue with

no effect on the target tissue and is highly dependent on the
wavelength of laser light. Water is relatively transparent to the shorter
wavelengths (argon, diode and Nd:YAG lasers)whereas tissue fluids
readily absorb the longer wavelengths (erbium family and CO2) at the
outer surface

3. Reflection- Refers to the beam redirecting itself off of the surface,

having no effect on the target tissue. For example, a caries detecting
device used the reflected light to measure the degree of sound tooth
structure

4. Scattering- Refers to the laser beam in different directions. This

phenomenon is useful in facilitating the curing of composite resin or
in covering a broad area
LASER ENERGY AND TISSUE TEMPERATURE

• The principle effect of laser energy is photothermal, i.e. the conversion of

light energy into heat.

• The rate of temperature rise plays an important role in this effect and is
dependent on several factors such as

1. Cooling of the surgical site

2. Ability of the surrounding tissues to dissipate heat

3. Various laser parameters such as emission mode, power density and the
time of exposure

Tissue temperature Observed effect

(⁰C)

37-50 Hyperthermia

60-70 Coagulation, protein

 denaturation

70-80 Welding

100-150 Vaporization, ablation

> 200 Carbonization

PHOTOTHERMAL LASER -TISSUE INTERACTIONS

● Incision/excision
● Ablation/vaporization
● Haemostasis/coagulation

Effect of contact vs non-contact modes on the ‘spot size’ of the laser

beam

The ‘spot size’ of the beam, relative to the target tissue, will determine the
concentration of laser energy – fluence and power density – being delivered
over an area. It follows therefore, that during any laser tissue interaction the
concentration of energy being delivered to a target site can be modified and
controlled by moving the handpiece back and forth
 LASER WAVE LENGTHS USED FOR DENTISTRY

ARGON

● This laser has 2 emission wavelengths, and both are visible to the
human eye - 488nm (blue in colour) and 514 nm (blue – green).
● The 488 nm emission is exactly the wavelength needed to activate
camphoroquinone, the most commonly used photo initiator that causes
polymerization of the resin in light cured composite restorative
materials

CO2 LASER

• Wavelength – 10,600 nm.

• Well absorbed by water, second only to Er series of lasers

• Rapid soft tissue remover and has a shallow depth of tissue penetration,
which is important when treating mucosal lesions. • Especially useful for
cutting dense fibrous tissue.

• Highest absorption in hydroxy apatite; about 1000 times greater than the Er
series of lasers.

Nd:YAG

• Emission wavelength is 1064 nm.

• Highly absorbed by pigmented tissue and is about 10,000 times more

absorbed by water than an argon laser.

• Common clinical applications are for cutting and coagulation of dental soft
tissues with good haemostatic capability
• Nd: YAG laser energy is absorbed slightly by dental hard tissue; but there
is little interaction with sound tooth structure, allowing tissue surgery
adjacent to the tooth to be safe and precise.

DIODE

• Wave length range from 800-980nm

• All the diode wavelengths are very well absorbed by pigmented tissue,
although haemostasis is not quite as rapid as with the argon laser.

• Poorly absorbed by tooth structure so that soft tissue surgery can be

performed safely in close proximity to enamel, dentine and cementum.

• An excellent soft tissue surgical laser indicated for cutting and coagulating
gingiva & mucosa, and for soft tissue curettage, or sulcular debridement.

ER, CR: YSGG AND ER: YAG

Er, Cr:YSGG (2790 nm) has an active medium of a solid crystal of yttrium
– scandium-gallium-garnet that is doped with erbium and chromium.

Er:YAG (2940 nm) has an active medium of a solid crystal of yttrium-Al-

Garnet that is doped with erbium.

• They have the highest absorption in water of any dental wave length and
have a high affinity for hydroxyapatite

• These lasers are ideal for caries removal and tooth preparation when used
with a water spray. The health enamel surface can be modified for increased
adhesion of restorative materials by exposing it to the laser energy.

• Both lasers can ablate soft tissue readily because of its water content, but
the haemostatic ability is limited. Advantage of this laser for restorative
 dentistry is that a carious lesion in close proximity to the gingiva can be
treated, and the soft tissue recontoured with the same instrumentation Lasers
and Prosthetic Dentistry

LASER APPLICATIONS IN DENTISTRY

❖ Diagnosis
▪ Detection of pulp vitality
▪ Doppler flowmetry
▪ Laser fluorescence- Detection of caries, bacteria and dysplastic
changes in the diagnosis of cancer
❖ Hard tissue applications
▪ Caries removal and cavity preparation
▪ Re-contouring of bone (crown lengthening)
▪ Endodontic (root canal preparation, sterilization and Apicectomy)
▪ Laser etching
▪ Caries resistance
❖ Soft tissue applications

▪ Laser-assisted soft tissue curettage and peri-apical surgery

▪ Bacterial decontamination

▪ Gingivectomy and Gingivoplasty

▪ Gingival retraction for impressions

▪ Implant exposure

▪ Biopsy incision and excision

▪ Treatment of aphthous ulcers and Oral lesion therapy

▪ Coagulation / Hemostasis
 ▪ Tissue fusion - replacing sutures

▪ Laser-assisted flap surgery

▪ Removal of granulation tissue

▪ Pulp capping, Pulpotomy and pulpectomy

▪ Operculectomy and Vestibuloplasty

▪ Incisions and draining of abscesses

▪ Removal of hyperplastic tissues and Fibroma

❖ Laser-induced analgesia

❖ Laser activation

▪ Restorations (composite resin)

▪ Bleaching agents
❖ Other

▪ Removal of root canal filling material and fractured instrument

▪ Softening gutta-percha

▪ Removal of moisture/drying of canal

➢ ADVANTAGES

Laser instruments provide

• Excellent surgical precision

• Hemostasis

• Tissue healing
 (Janda P et al. Lasers Surg Med 2003; 33: 93-101)

FIXED PROSTHETICS

(Dent Clin N Am 48(2004)771-794)

1) Crown lengthening.

▪ Gingival re-contouring may be performed with all dental laser

wavelengths
▪ Insufficient clinical crown length
▪ Caries at gingival margin
▪ Endodontic perforations near alveolar crest.
▪ Unaesthetic gingival architecture.
▪ Cosmetic enhancement.

2) Osseous crown lengthening.

All dental lasers may be used for soft tissue procedures, but only the
erbium (Er) family of lasers is effective in removing and recontouring
bone.

3) Soft tissue management around abutments:

Gingival retraction for impressions:

• Diode and neodynium – doped yitrium aluminium garnet (Nd:YAG)

• Longer wave length of Er and CO2

4) Troughing.

A trough is created around a tooth before impression making using Nd:

YAG laser. This can entirely replace the need for retraction cord, electro
cautery, and the use of haemostatic agents.

5) Formation of ovate pontic sites.

 Er: YAG LASER 2940nm, 50mJ, 30 Hz with water spray

• Two most common causes of unsuitable pontic site:

• Insufficient compression of alveolar plates after an extraction

• Non-replacement of a fractured alveolar plate.

• Unsuitable pontic site results in unesthetic and non self cleansing pontic
design.

• For favourable pontic design laser re-contouring of soft and bony tissue
may be needed

6) Modification of soft tissue around laminates

The removal and re-contouring of gingival tissues around laminates can

be easily accomplished with the Argon laser.

7) Contouring edentulous sites for fixed partial dentures (Walsh L et al. Aust
Dent J 2003; 48: 146-155)

• Edentulous site often needs to be reshaped to provide aesthetic emergence

profile for restorations

• Both soft tissue and alveolar crest can be contoured with laser
instruments

• Any laser can be used to reshape soft tissue but only Er lasers can be used
to recontour the underlying osseous structure

REMOVABLE PROSTHETICS

(Dent Clin N Am 48(2004)771-794)

• Tuberosity Reduction
• Torus Reduction

• Soft tissue modification

• Epulis fissurata

• Denture Stomatitis

• Residual ridge modification

Lasers used in removable prosthodontics

• Treatment of inflamed soft tissue- Nd-YAG

• Soft tissue denture base modification – Nd-YAG laser- Shorter

wavelength

• Torus reduction- Er Lasers

• Reduction of residual ridge and maxillary tuberosity- Er Lasers- Longer

wavelength

(Atlas of laser applications in dentistry, Donald J Coluzzi, Robert A.

Convissar)

IMPLANTOLOGY

▪ Second stage uncovering.

▪ Implant site preparation.

▪ Peri-implantitis.

The advantages of using lasers in implant dentistry are the same as for
any other soft tissue dental procedure.

● Increased visibility due to Hemostasis

● Reduced swelling and infection
 ● Reduced pain
● Minimal damage to the surrounding tissue
❖ SECOND STAGE UNCOVERING

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 and to uncover osseo integrated
implants"

Advantages over conventional surgery

• Little blood contamination (haemostatic effects)

• Minimal tissue shrinkage

• Eliminate trauma to the tissues during flap reflection

• Impressions can be obtained at the same appointment

• Although Nd: YAG has been a particularly used for soft tissue second-
stage surgery, it is contraindicated to use with implants. Due to the
transmission of heat to the bone from the heated implant surface. And 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 for this because they are reflected away from metal surfaces and
they interact only minimally with the 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
❖ PERI-IMPLANTITIS

• Lasers can be used to salvage ailing implants by decontaminating their

surfaces with laser energy.

• Lasers can also be used to remove inflamed granulation tissue around an

already osseointegrated implant.

• Diode, CO2 & Er: YAG 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 can result.

❖ 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

 RECENT ADVANCES IN LASERS

❖ MAXILLOFACIAL PROSTHETICS

(Optic letters vol.24, issue 5 pg 291-293; 1999)

• Laser holographic imaging is a well-established method for storing

topographic information, such as crown preparations, occlusal tables, and
facial forms for maxillofacial prostheses.

• 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.

• Lasers aid in creating a realistic prosthesis that can provide an illusion of

normal appearance.

❖ LASER WELDING

An alternative method to join dental casting alloys such as broken clasp

Advantages over Conventional Soldering:

• No need for investment and soldering alloy

• Working time is decreased

• Easy to operate

• Minimal heat damage to denture base resin

❖ LASER INITIATED POLYMERISATION

Ultraviolet (helium-cadmium) laser-initiated polymerization of liquid

resin in a chamber, to create surgical templates for implant surgery and
major reconstructive oral surgery.

❖ LASER SCANNING OF CASTS

Laser scanning of casts can be linked to computerized milling equipment
for fabrication of restorations from porcelain and other materials.

❖ PHOTOBIOMODULATION (LLLT)

• Low level laser therapy or cold laser therapy

• Application of Red and near infra red light with a wave length between
600-1000nm and power from 5 to 500 milliwatts, over injuries or lesions
to improve wound or soft tissue healing
• Helps to reduce inflammation and oedema

• Used for treatment of both acute and chronic pain. (Induces analgesia )

• promote healing in range of musculoskeletal disorders

Basic Effects of LLLT

• Bio-stimulative

• Regenerative

• Analgesic

• Anti inflammatory

Applications of LLLT in Dentistry

• Xerostomia

• Burning mouth syndrome

• Mucositis

• Paraesthesia

• Post operatively to reduce pain and oedema in implant patients

• Temporomandibular joint disorders

• Post operative management of impacted third molars

Mechanism of Action of wound healing

• LLLT produces rearrangement of cytoskeleton ie, differentiation of

fibroblast to myofibroblast, so contraction occur during wound healing –
it accelerates the process of wound healing

• Ultimately enhances healing and stability of wound

 Anti inflammatory action of LLLT

(Dr Tiina I Karu Science of low power laser therapy -1998, Textbook of
lasers in medicine and dentistry )

• LLLT exerts its vasoactive effect by action on mast cells

• LLLT causes degranulation of mast cells

• Release pro inflammatory cells

• TNF- Enhances endothelial leukocyte adhesion ,Chymase- Alters

basement membrane and facilitates entry of leukocyte into tissue

• Thus controls leukocyte trafficking in cell and Increases anti

inflammatory and phagocytic actions at sites of inflammation

Analgesic effects

• Increases Pain Threshold

• Inhibits Nociceptive signals arising from peripheral nerves and reduces

its firing frequency

• Due to the increasing of endogenous endorphins (Beta Endorphin) and

decreasing the activity of C- fibers and bradykinin

The Results may be,

• Increased cell proliferation and migration ( particularly by fibroblasts)

• Modulation in the levels of cytokines, growth factors, and inflammatory

mediators

• Influence on the activity of second messengers (Cyclic adenosine

monophosphate , Ca 2+, nitric oxide)

• Increased tissue oxygenation

 • Increased healing of chronic wounds and improvements in injuries and
carpel tunnel syndrome, pain reduction and impact on nerve injury

❖ OTHER USES OF LASER

• Diagnostic laser for caries and calculus detection.

• Composite curing laser.

• Optical impression like CAD/CAM- Co2 lasers

• Teeth bleaching.

CONCLUSION
• Lasers - alternative to conventional surgical systems

• Lasers are a “new and different scalpel” (optical knife, light scalpel)

REFERENCES

1. Donald J Coluzzi. Lasers in clinical dentistry. DCNA 2004

2. Donald J Coluzzi. Atlas of laser applications in dentistry.2007

3. Aruna M. Bhat. Lasers in Prosthodontics - An Overview Part 1:

Fundamentals of Dental Lasers. Journal of Indian Prosthodontic Society
(March 2010) 10:13–26

4. Myers TD (1991) Lasers in dentistry: Their application in clinical

practice. J Am Dent Assoc 122:46–50

5. Coluzzi DJ (2000) An overview of laser wavelengths used in dentistry.

Dent Clin N Am 44:753–765
6. Coluzzi DJ (2004) Fundamentals of dental lasers: science and
instruments. Dent Clin N Am 48:751–770

7. Mercer C (1996) Lasers in dentistry: a review. Part I. Dental Update

23:74–80

8. Parker S (2007) Introduction, history of lasers and laser light production.

BDJ 202:21–31

9. Parker S (2007) Laser-tissue interaction. BDJ 202:73–81

10. Ravish Malhotra. Laser Applications in Prosthodontics: A Review

International Journal of Enhanced Research in Medicines & Dental Care,
ISSN: 2349-1590 Vol. 3 Issue 7, July -2016

11.Introduction, history of lasers and laser light production; S. parker.

British dental journal volume 202 no. 1 jan 13 2007 1-9

12.Kesler G Clinical applications of lasers during removable prosthetic

reconstruction. Dent Clinic North Am 2004: 48:963-969

13.Bareli. Er: YAG laser in oral soft tissue surgery . J Oral Laser Appli
2001; 24

14.Priya Nachrani Rajeev Umesh Vivek. Laser in rosthodontics –review

.NJDSR number 2, vol 1, jan 2014

15. Laser and it’s Application in Prosthetic Dentistry . Shaista Durrani .Int J
Dent Med Res | MAR- APR 2015 | VOL 1 | ISSUE 6

16.Adams TC , Pang PK. Lasers in asthetic dentistry. Dent Clinc North Am

2004:48