LASER IN CONSERVATIVE

DENTISTRY & ENDODONTICS

A device which transforms light of

various frequencies into a chromatic
radiation in the visible,infrared &
ultraviolet regions with all the waves
in phase capable of mobilizing
immense heat & power when focused
in closed range.

HISTORY
1950 - Townes MASER (Microwave amplification by

stimulated emission of radiation)

1958 - Arthur Leonard Schawlow -working principles of

lasers

1960 - American physicist Theodore Maiman - the first

laser action using synthetic ruby

1961 - A helium-neon gas laser W.R.Benett

1964 - Subsurface demineralization ruby laser- stern &

sognnaes

1971 - Seal apical foramen CO2 laser- Weichman &

Johnson

L Light

Electromagnetic energy
Travels in waves
Constant velocity

POLYCHROMATIC

MONOCHROMATIC

ORDINARY LIGHT

LASER LIGHT

Spreads as it get farther

from light source

Moves straightforward
with almost no spreading at
all

Incoherent light

Coherent light (aligned

wavelength and phase)

Divided into seven colors Remains a single color.

when it goes through a
Thin beam
prism
Low energy density
High energy density

FEATURES OF LASER LIGHT

Collimation

Coherency

Monochromatic

Photons in a light beam have the same wavelength

- "MONOCHROMATIC- "all the same color".

COLLIMATION
Beam with
Constant shape
Constant size

COHERENCY
All the photons in a
monochromatic light
beam - synchronized

A- Amplification means that a very bright intense beam of

light can be created. The laser may be activated by a few
photons act then many more may be generated the initial light
is computed to make a very bright compact beam.

S Stimulated : Means that the photons are

amplified by stimulating an atom to release
more photons.

E-Emission refers to the giving off

photons. The exited atom emits a
photon when another atom comes by.

R-Radiation refers to light waves produced

by laser as a specific form of electromagnetic
energy.

Parts of laser system

Working Principle

High-voltage electricity causes the quartz

flash tube to emit an intense burst of light,
exciting some of the atoms to higher energy
levels.

Atoms emit particles of light called photons.

Photons from one atom stimulate emission
of photons from other atoms and the light
intensity is rapidly amplified.

Mirrors at each end reflect the photons back

and forth, continuing this process of
stimulated emission and amplification.

Laser light

Population inversion
A mechanism to add more and more atoms to the meta
unstable state.
Hold them long enough to store energy and allow the
production of great number of stimulated photons.

Classification
I- Gain medium
Solid state lasers
Gas lasers
Semiconductor lasers
Liquid laser/ Dye lasers

II-Operating mode
-Continuous wave
-Pulsed mode

Gas laser - Pumped by electrical discharge

He-Ne : 632.8 nm (cw)
Ar ion : 488, 514 nm (cw)
CO2 : 10.6 m (cw or pulsed)

CO2lasers- efficient, most powerful

continuous wave (CW) lasers.

Solid state laser

The highest power output.
Operated in a pulsed manner to generate a burst of light over
a short time.
Pumped by flash lamps or light from other lasers
Nd:YAG Laser
Ho:YAG Laser
Er:YAG Laser

Semiconductor laser
A semi conductors chip- works like an electrical diode.
Application in surgery and minimal application in
dentistry.

Dye laser
Chemical dyes
coumarin,
rhodamine,
fluorescein

Solvents
methanol
ethanol
ethylene glycol

Laser Tissue
Interaction
Absorption
Transmission
Reflection
Scattering

Absorption
Depends on tissue characteristics such as
pigmentation and water content, and laser
wavelength and emission mode
Water has varying degrees of absorption by
different wavelengths
CO2 Laser(10,600 nm) is well absorbed by water
and has the highest affinity for tooth structure

Transmission

The transmission of laser energy directly through

tissues with no effect on the target tissues
Depends on the wavelength of the lasers

Reflectio
n
The redirection of the beam off the surface having
no effect on target tissue
Caries detecting laser device
Can be dangerous because energy is directed to an
unintentional target

Scatterin
g
Weakening of the intended energy
Cause unwanted damage by heat transfer to the
adjacent tissues

Effect of Lasers on target tissues

Principle effect of laser is

Photo thermal

37-50o
Hyperthermia
60-70o
Coagulation
70-80o
Welding
100-150o Ablation
>200o
Carbonization

Hyperthermia
Occurs when the tissue is elevated above
normal temperature but is not destroyed

Coagulation
At 60oC, proteins begin to denature
without vaporisation

Surgical removal of granulomatous tissue

Welding
Soft tissue edges can be welded
together with a uniform heating to
70 80oC

Ablation
When elevated to temperatures of 100oC,
vaporization of water occurs
A resultant jet of steam expands and then
explodes the surrounding matter into small
particles

Carbonization

Tissue is dehyrated and then burned in the

presence of air

Carbon is formed as a product which

absorbs all the wavelengths

Method of delivery
Free beam laser/Non contact laser
Contact laser
Interstitial

Laser Delivery systems

Flexible

Hollow
waveguide or
tube that has an
interior mirror
finish

Has to be used in
a non contact
fashion

Glass

Fibre
optic Cable

Smaller in
diameter

Can be used in
contact or non
contact mode

EMISSION MODES
Continuous wave

Gated pulse mode

Pulsed mode
Free running pulsed mode

Continuous wave mode : Beam emitted

at one power level for as long as the
operator depresses the foot switch
Gated Pulse mode : Periodic alterations
of the laser energy
True Pulsed mode : Large peak energies
are emitted for a short time span
followed by relatively long time in which
the laser is of

LASER WAVELENGTHS USED IN DENTISTRY

ARGON LASER(Cure star,Accu cure)

488nm,514nm
Activate camphoroquinone
Absorption in tissues containing hb
Hemostatic capability
Not well absorbed in dental hard tissue or water
Indication periodontal disease
-- caries detection

Diode laser
800nm 980nm
Highly absorbed by pigmented tissue
Poorly absorbed by tooth structure
Bactericidal (root canal)

Nd:YAG (pulsemaster,Periolase)
1064nm
Cutting & coagulating dental soft tissue
Slightly absorbed by tooth structure
Pigmented surface caries can be vapourised
without removing healthy enamel
Pulpal analgesia
Bactericidal

Holomium:YAG
2100nm
Absorbed

by water
can ablate hard calcified tissue

Er , Cr:YSGG-2780nm

Er:YAG-2940nm

Highest absorption water

High affinity for hydroxyapatite
Indication
Caries removal
Tooth preparation
Modify enamel surface for increased
adhesion
Root canal therapy
Removal of non-metallic restoration

CO2 laser(LX-20,Novapulse)
10600nm
High

affinity for hydroxyapatite

Well Absorbed by water
Cutting & coagulating dental soft
tissue

Laser in conservative
dentistry

Caries detection
Quantitative light induced fluorescence
655nm
Fluorescent light is measured
Intensity-size & depth of lesion
5-25 initial lesion in enamel
25-35 - initial lesion in dentin
>35

advanced dentin caries

Caries prevention
Laser irradiation
Modifies Ca:P ratio

Formation of more stable & less acid

soluble compounds

Hard tissue ablation

o
o
o
o
o

CO2 laser
Nd:YAG
Er,Cr:YSGG laser
Energy dissipationshock wave-cavitation
Water molecule-super heated,explode &
ablate tooth str.& caries

Caries-100-200mj(10sec)
Enamel-200-250mj(15sec)
Dentin-150-200mj(10sec)

Restoration removal
Composite resin
GIC
LIMITATION
Gold
Cast Restoration
Ceramic

Laser etching
Er:YAG
Micro-explosion-microscopic
irregularities-adhesion
Acc. to studies-bond strength of
composite to laser etched enamel
-low

Laser curing
Argon laser-488nm
Class II composite restorations 250-350mw(10-12sec)

Laser Bleaching
Argon -488nm
CO2
GaAlAs diode-980nm

250mw(10sec)

Decontamination of cavities
Photo activated disinfection
Tolonium chloride-low level visible red light-635nmsinglet oxygen-bacterial cell wall rupture

Dentinal Hypersensitivity
Low output laser
GaAlAs- 780nm,830nm,900nm-30mW(0.5-3min)
He-Ne- 632nm-6mW(1-3min)
-sealing of dentinal tubules

High output laser

Nd: YAG- 1,064nm
CO2- 10,600nm
-pulpal analgesia

LASER IN
ENDODONTICS

Diagnosis of pulp
Laser doppler flowmetry

Ga Al As- 780nm
He-Ne-632nm

Changes in RBC flux in pulp tissue

Pulp vitality test (heat)

Alternate to hot gutta-percha
Pulsed Nd: YAG

Diagnosis of pulpitis
Normal pulp: Pulsed Nd: YAG laser at
2W & 20pps at 10mm from the surfacepain within 20-30secs

Acute pulpitis : Pain arise immediately

after laser appln. & continuous for more
than 30 secs

Laser - indirect plup capping

Indications
Deep cavity
Hyper sensitive cavity

Pulsed Nd: YAG laser

2W,20pps,1sec
Air spray cooling

CO2 laser
Low wavelength
short period

Laser - direct pulp capping

Indications
Pulp exposure 2mm or less
No pulp infection
Pulsed Nd: YAG
Argon
Irradiation of 1 or 2W
irrigating with NaOCl & Diode
3% H2O2 for more than 5
Er: YAG
mins

Pulpotomy
CO2 laser at 1 to4W

Along with irrigation

3%H2O2 & 5.25%NaOCl

Access cavity preparation &

Root canal orifice enlargement

Er,Cr:YAG laser to cut enamel &dentin at 5W and

6Hz

Root canal preparation

Indication
Straight or slightly curved canal
Nd: YAG, Er: YAG laser at 2W&
8Hz,Er,Cr:YSGG,CO2
Hand instrumentation before laser irradiation
Tip inserted into the canal 1-2 mm short of the WL
-RC Lase side firing spiral tip(Er:YAG)

Removal of pulp remnants

Pulsed

Nd:YAG laser

2W,20pps for 1 sec,5 sec interval for

three to four times

Sterilization and disinfection of root canal

Pulsed Nd: YAG laser at 2W,20pps for 5sec
Thin fibre optic delivery system
To enhance the effect
- 38%silver ammonium solution
- 5.25% NaOCl, 14% EDTA

Apicoectomy & Root end preparation

Er: YAG
CO2 laser

Bloodless surgical field

Doesnt improve healing process
Takes more time

 Other applications
o

Removal of calcified attached denticles-pulsed dye

laser-504nm
To sterilize dental instruments
Ar,CO2,Nd:YAG laser
Argon -1W for 2mins
Removal of g.p & broken files in retreatment
Nd:YAG laser

LASER
HAZARDS

Laser hazards are basically categorized into a

categories according to ANSI or OHSA standards
Class
I
IIa
IIb
IIIa

IIIb
IV

Description

Low powered lasers that are safe to view

Low powered visible lasers that are
hazardous when viewed for longer
than 1000sec
Low powered visible lasers that are
hazardous when viewed for longer
than 0.25sec
Medium powered lasers that are
normally not hazardous if viewed for
less than 0.25sec without magnifying
optics
Medium powered lasers (0.5w) that
can be hazardous viewed directly
High powered lasers (>0.5w) that
produce ocular, skin, and fire hazards.

In dentistry - Class IV.

Occular injury
Retinal, corneal burns

Electric hazard
Shock,
Fire and explosion

Tissue damage
Cell Destruction
Mutagenic changes

Respiratory hazard
Chemicals

Conclusion
Laser equipment represents one of the
most captivating technologies in
dentistry. Although laser cannot fully
replace all the conventional techniques
of dentistry, the progress is obvious and
the laser is expected to become an
essential component in conservative
dentistry & endodontics

THANK YOU