Laser In Dentistry Revolution & Dreams

History of Lasers
The idea and concept of laser capability was first acknowledged in 1917. Albert Einstein first conceptualized the use of stimulated emission, which serves as the foundation of a laser.
Einstein

In the early to mid-1950s, Bell Labs Arthur L. Schawlow, and Charles H. Townes invented the MASER (microwave amplification by stimulated emission of radiation), by means of ammonia gas and microwave radiation.
Townes

Schawlow

The maser was invented prior to the optical laser, yet the technology is very comparable.

History of Lasers (cont.)

New laser technology slowed following the 1960s. The x-ray lasing action was developed in 1980. Finally, plasma lasing was created in 1993. However, despite the lull in creating new lasers the efficiency and effectiveness of lasing has improved drastically since its conception. Also, many new uses have been found for lasers during the last few decades.

Fundementals of Laser:
* Definition * Characteristics of laser light. * How laser light is named? *Advantages & Disadvantages of Laser . *Electromagnetic spectrum of laser light
*Laser requirements , delivery system and emission mode

*Definition:
Light Amplification by Stimulated Emitted Radiation

*Characteristics of laser light: Monochromatic Coherent Collimated.

Monochromatic
Coherent Collimated

Electromagnetic spectrum of laser :

*Melanin and Hemoglobin absorb Laser in the lower end of spectrum. *Middle of spectrum
absorbed in both water and Hydroxyapatite.

Laser spectrum
Laser Er:YAG Argon KTP:YAG Copper vapor FLPPD Long pulse Ruby, Q-switched Long pulse Q-switched Alexandrite Nd:YAG Q-switched YAG CO2 Wavelength (nm) 294 488/514 532 578 585 595-600 694 694 755 1064 1064 10600 Application Skin resurfacing Vascular lesions Vascular lesions Vascular lesions Vascular lesions Leg veins Tattoo removal Hair removal Tattoo removal Deep vascular Tattoo removal Cut/coag/resurf

*How laser light is named ?

According to the principal chemical elements involved in the resonating chamber
Ex : YAG Laser contains Ytrium, Aluminum and Garnet coating of crystal

*Laser requirements , delivery system and emission mode: 1- Articulated arm ( Flexible hollow waveguide or tube used with Laser of large wave length). 2- Glass fibro- optic cable (Used with Laser of shorter wave length).

Laser - tissue interaction:

* Reflection ( So, protection of patients & Dental personnel is mandeatory). *Absorption to perform its photothermal effect. *Transmission which explain Laser tissue selectivity. * Scattering which used as a concept in Photopolymerization of recent composite generation.

Laser emission modes

Continuous Uninterrupted beam Relatively constant power Pulsed/Superpulsed (microsec) Higher energy/shorter duration pulses Q-switched (nanosec) Extremely high energy/short pulse duration

Advantages of Laser Surgery

Haemostasis Accuracy Rapid healing Reduced inflammation Lack of scar tissue formation Low level of discomfort

Disadvantages of Laser Surgery

Technical difficulties Lack of precision in depth of cut Tissue not available for histopathology Hazardous Dispersal of viable virus particles in the plume

Mechanism of Tissue Damage

Boiling H2O in intra- and extra-cellular compartments Dehydration Carbonization

*Wound healing after Laser surgery

* Absence of normal cascade of acute inflammation & cytokine release. * Delayed epithelial migration. * Histologically: Neural seal of nerve endings. * Fewer myofibroblast at wound margin. So, less scar.

Before

After 2 Weeks

Laser Safety:

N.H.Z. (Nominial Hazard Zone) Self protective measures including : Eye shield . Face mask . Non flammable solution. Moistened draps & Oxygen mixture concentration less than 40%.

Surgical Uses of Lasers

Gastroenterology Respiratory Medicine Gynaecology Urology Dermatology Vascular surgery General Surgery Oral and Maxillofacial Surgery

Surgical Laser Technique:

1- Photocoagulation Techniques.
2- Incisional & Excisional techniques. 3-Ablation or Vaporization Techniques.

Carbon Dioxide Laser Therapy

Clinical application: 1- Laser curing. 2- Laser gum disease treatment. 3- Laser soft tissue application. 4-Laser tissue-whitening.(using carbamide peroxide35% &
betacarotene)

5- use of laser in root canal treatment. 6- Caries removal and cavity preparation.

Applications in dentistry Alternative to mechanical drills. Reduced thermal stress And micro cracks in enamel

Endoscopic & Microscopic Laser Surgery

1- Laser Arthroscopy& Arthroplasty of the TMJ. 2- Endoscopic Laser Lithotripsy of Salivary Gland Stones.

Maxillofacial Cosmotic & Dermatologic Laser Surgical procedures: Skin resurfacing , Vascular Lesion Treatment and Surgical Burn and scar revision.

Laser -- vascular lesions

*Telangiectasias: in order of preference/effectiveness Diode laser (variable-pulsed-width 532nm)-as effective as pulsed-dye without puerperal pulsed-dye laser (puerperal results) IPL Hemangiomas pulsed-dye laser (585nm wavelength) 2-10 treatments spaced 6-8 weeks apart Port-wine stains Pulsed-dye laser (585nm) 2-12 treatments spaced 6-8 weeks apart superficial lesions, red lesions, younger than 10, head and neck lesions respond better

Laser -- deep pigmented lesions

Deep lesions-deeper, therefore treated better with longer wavelength (goes deeper): can use ruby, alexandrite, and Nd:YAG

blue nevi:
1064 nm Nd:YAG laser

nevus of ota and ito:

Q-switched 1064nm Nd:YAG laser multiple treatments recurrence is unusual

Photodynamic Therapy (PDT)

An interaction between a drug and light energy that triggers a cold photochemical reaction that results in cell death The introduction of coherent laser light has allowed PDT to become a reality Illumination of the target can be achieved from the surface via fibres or lenses or with internal interstitial fibres

Photodynamic Therapy (PDT)

cytotoxic effect occurs as a result of the The release of free radical singlet oxygen Tissue oxygenation is therefore required Three photosensitizers are in common use Photofrin (dihaematoporphyrin) ALA (aminolaevulenic acid) mTHPC (meta tetrahydroxyl phenyl chlorin)

Photodynamic Therapy (PDT)

Method

Thank You