GOOD MORNING

CONTENTS
Introduction History of Lasers Fundamentals of Lasers Light Amplification Stimulated Emission Emission Radiation Laser Delivery Systems & Emission Modes Components of Laser Laser Interaction With Biologic Tissues Laser Energy & Tissue Temperature

 Laser -Tissue Interactions

Types of Lasers

Common dental Lasers & their Major Clinical Uses

Application Of Lasers In Operative Dentistry Caries Detection By Laser Induced Flourescence Caries Removal Pit & Fissure Sealants Etching & Bonding Agents Curing Light Activated Resins Cavity Preparation

 Application Of Lasers In endodontics -Dentinal Hypersensitivity -Pulpal Diagnosis -Pulp Capping & Pulpotomy -Cleaning & Shaping of R.C. wall -Endodontic Surgery Advantages & Disadvantages of Lasers Lasers Safety in Dental Practice References Conclusion

L A S E R

Light Amplification by Stimulated Emission of Radiation

HISTORY
1900, Planck proposed that energy could be emitted or absorbed only in discrete chunks quanta

Early 1900 Quantum mechanics by Bohr

Einstein's atomic theory.

Einstein A : Zur Quanten Theorie der Stralung. Phys Zeit 18:121, 1917

 1950 Townes first amplified microwave frequencies.

WINNERS 1964 NOBEL PRIZE FOR PHYSICS

Townes

Basov

Prokhorov

 1960 Maiman developed first laser Pulsed Ruby laser(0.694 m)

 1961 Neodymium laser by Snitzer

October 1961: American Optical Co.s Elias Snitzer reports the first operation of a neodymium glass (Nd:glass) laser.

 1964 - Only 4 years later, the carbon dioxide laser was successfully shaped by Kumar Patel

1968 LEsperance was the first to report clinical use of an argon laser in ophthalmology.

1977 - Haber et al documented the first clinical use of

Nd: YAG laser in in gastro intestinal surgery.

1990 - the FDA cleared it for intraoral soft tissue surgery

PRINCIPLES OF LASER

LIGHT is a form of electromagnetic energy which travel in waves. :Velocity - Speed of Light

:Amplitude Height Of Wave Of Oscillation : Wave Length

AMPLIFICATION :

Duplication

The initial light is amplified to make a very bright compact beam.

Stimulation :

EMISSION refers to the giving off of photons. In 1917, Einstein described this process as Stimulated Emission.

RADIATION

Incandescent lamp

Chromatic Incoherent Non-directional

LASER

Monochromatic Collimated Coherent Directional

Laser Delivery Systems

Two delivery systems are used 1.Flexible hollow wave guide or tube 2. Glass Fiber Optic Cable Dental lasers can be used - Out Of Contact - In Contact

Delivery Device

fiber-optic cable and handpiece

CO2 laser with articulated arm

LASER EMISSION MODES

1.Continuous Wave : as long as the device is activated. 2.Gate Pulsed Mode: Periodic on and off 3.Free-Running Pulsed Mode/ True Pulsed: Large peak energies of light are emitted for a short time span.

ANATOMY OF LASER UNIT

Lasing/ Active Medium. Energy/ Pumping Source. Optical/ Resonating Chamber

 Lasing Medium: Can be solid , liquid or gas.

 Energy / Pumping Source

Pumping source can be Electrical, Chemical, Thermal. Optical Chamber fully reflecting mirror on one side, partly reflecting mirror at other side

LASER-TISSUE INTERACTION

Depending upon optical properties of tissue These 4 occur together in some degree relative to each other

REFLECTION

TISSUE
redirecting itself off of the surface, Dangerous..

ABSORPTION

TISSUE
Absorption ..most desired The shorter wavelengths ..

SCATTERING

TISSUE
weakening the intended energy. no useful biologic effect

TRANSMISSION

TISSUE
Directly through the tissue with no effect on the target tissue.

Laser Interaction With Biologic Tissues

Photo chemical Photo mechanical Photo thermal

PHOTOCHEMICAL
Subdivided into 3 types according to the clinical manifestation
Biostimulation Photodynamic Therapy (PDT) Tissue Fluorescence

PHOTOTHERMAL
Basis for most types of surgical laser applications. Subdivided into two types according to clinical manifestations:
Photoablation Photopyrolysis

Photomechanical
Photomechanical effects include photo disruption & photo dissociation.

Laser Energy & Tissue Temperature

Effect of laser energy on tissue depends on: Laser parameters like: Emission mode : Power density : Time of exposure

Tissue temperature oC 37 50 60 70

Observed Effect Hyperthermia Coagulation, Protein Denaturation Welding Vaporization, Ablation Carbonization

70 80 100 150 > 200

TYPES OF LASERS
Hard lasers: longer wavelength,which cut the
tissue by coagulation, vaporization & carbonization -Used for surgical soft tissue applications. Erbium lasers

Soft / Low level lasers: low energy wavelength

of less than 450nm .eg. CO2, Diode, Nd: YAG lasers

Laser Wavelengths Used In Dentistry

ARGON LASER
active medium is Its activated Has two modes 448 nm-blue in color -non contact mode Uses .. .

 The wavelengths can be used as an aid in CARIES DETECTION

illuminates ., the diseased, carious area appears as dark orange red color.

 Solid active medium. 800 nm for active medium containing aluminum 980 nm for active medium containing indium. Its activated Has two modes

Used in contact with soft tissue surgery or out of contact for deeper coagulation. Main advantage..

- First laser designed exclusively for dentistry - Solid active medium Yttrium & Aluminum, doped with Neodynium ions. - Emission wavelength of 1064 nm - Pumping mechanism is a Flash lamp Free-running pulsed mode - Flexible bare optic tips which USES:.

ERBIUM FAMILY OF LASERS

Two erbium lasers which are used are:

-Erbium, Chromium: YSGG (2780 nm)

- Erbium: YAG (2940 nm)

Free running pulsed mode. Main disadvantage. costly, fragile less flexible cutting soft tissue, tooth structure & bone.

CO2 Laser
Gas active medium -Wavelength is 10,600 nm -Delivery system is by hollow tube -Has two modes
--Uses

a. Diagnosis Of Dental Caries

- Argon laser . illuminate teeth - Kavo Diagnodent- chair

Caries removal
-Goldman etal & Taylor etal studies confirmed-

-T.O.Myers & W.O.Myers - Pulsed Nd:YAG laserremoved organic & inorganic.

-fine spray cooling -exchangeable exit window -mountable on laser tube coupling -freely rotatable 360
Laser hand piece 2060 for caries therapy & surgery

Polymerisation Of Composite Resins

- Argon .. - Power output set at 250 to 440 mw

- Pulse parameters- single pulse for 10 sec-2mm increments

Lasers in Etching/ Bonding

-Argon ,CO2, Nd: YAG & Excimer lasersetching enamel & dentin -Laser Etching: Process of continuous vaporization & micro explosions -Cooper et al CO2 laser energy- evaluated shear strength & results shown that 300 time increase in bond strength.

Bleaching
- Argon, Nd: YAG & CO2 most commonly used. - Photo thermal interaction.. - Heat..oxidation of peroxide contained in the substance. 830 to 980 nm .30 sec..

ANALGESIA
Certain wavelengths of laser energy may . depolarisation of C & A fibres of nerves

Pulsed Nd:YAG has commanded the most attention in this aspect.

PULP DIAGNOSIS
Laser Doppler Flowmetry- - Helium-Neon & Diode lasers at low power of 1-2mW - Moving blood cells .. Reflected light is

PULP CAPPING & PULPOTOMY

- Moritz et al CO2 laser Direct pulp capping by forming..

sealing dentinal tubules . Nd:YAG & CO2 lasers.

(Deep dentinal cavities )

CLEANING & SHAPING OF ROOT CANAL

Laser systems for R.C. preparation can be by :Thin optical fiber Nd: YAG, Er,Cr: YSGG, Argon & Diode :Hollow tube CO2 & Er:YAG Used following

Limitations :

SIDE FIRING SPIRAL TIP

- Designed to fit the shape & volume of canals prepared by , NiTi rotary instruments. - Emits Er: YAG laser- laterally

- Tip is sealed

ENDODONTIC SURGERY
-Weichman & Johnson 1st used lasers in Endodontics attempted to seal the apical foramen.

ADVANTAGES

DISADVANTAGES

LASERACTIVATED IRRIGATION WITHIN ROOT CANALS: CLEANING EFFICACY AND FLOW VISUALIZATION
IEJ, 42, 1077-1083, 2009

ADVANTAGES & DISADVANTAGES

anxiety or fear of drill.

noise from drill.

Needle free or no anesthesia dentistry. Restorative dentistry without numbness or fat lip. Desensitization of teeth. chair side time for many procedures

 Faster & more comfortable healing

bleeding & discomfort

Precision in procedures need for sutures invasive procedures Sterile cavity prep with stronger fillings.

DISADVANTAGES
- Retinal burn if no protection.

- Prolonged exposure to pulp causes irreversible pulp damage.

- High cost. - Specially trained personnel required.

- Chances of explosion.
- Aerosol contamination- respiratory hazards.

PHOTO-ACTIVATED DISINFECTION ?

PAD is a simple method of disinfection easily controlled by the dentist to eliminate bacteria rapidly.

 How Does PAD Work ?

There are 2 principal components: PAD solution:

saveDent laser unit :

PAD an ideal final step in the preparation of the canal for restoration.

WATERLASE
WATERLASE:
Excitation of Water Molecules

O H
Expansion

Laser + Water Spray

Photo-acoustic

Effective Tissue Cutting

WATERLASE Dentistry uses a patented technology combining YSGG laser energy and a spray of water, a process called HydroPhotonics

PRINCIPLE Pain by

serotonin level

Stimulates fibroblasts and osteoblasts Reduces Swelling and hyper sensitivity Increases Healing of soft tissue and bone

Wavelength Laser 905 nm Infrared 875 nm Red 660 nm

Advantages
Replaces Drill No Heat No Vibration No Numbness Sterilizes Tooth Maximizes Bonding

INTERESTING FACTS
There is a new laser that can detect cancer and diabetes called the breathalyzer. The worlds most powerful laser can have the power of a hydrogen bomb! That is amazing! Scientists are working on a laser to draw lightning strikes away from airports and power plants. Cold lasers are used for acupuncture instead of needles. Lasers are used in military applications both as weapons and for guidance systems for weapons. Future applications may include very powerful lasers that can down planes and missiles

 Lasers in Dentistry Leo Miserendino , Robert Pick JADA Vol.124, February 1993. Dental Update March 1996 Review.

Lasers in Endodontics, IEJ, 33, 2000.

Journal of Endodontics 1995 21, 4704. Journal of Endodontics (1996) 22, 6627.

Endodontics and Dental Traumatology (1998) 14, 758.

Lasers in the Life Sciences (1988) 2, 3951. Laser effects on dental hard tissues. Advanced Dental Research 1, 216.

Conclusion
For those of us who fear of going through the agony and torture of the painful, scary and noisy drill..,,

..there is a ray of hope..

THANK YOU