lasers in endodontics and conservative dentistry
DESCRIPTION
LASERS IN ENDODONTICS AND CONSERVATIVE DENTISTRYTRANSCRIPT
An acronym for Light Amplification by
the Stimulated Emission of Radiation..
A device that creates a uniform and
coherent light that is very different from
an ordinary light bulb.
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Also can be described as a device for
generating a high-intensity, ostensibly
parallel beam of monochromatic(single
wavelength) electromagnetic radiation.
Laser light can be focused down to a
tiny spot as small as a single wavelength.
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The possibility of stimulated emission
predicted by Einstein-1917..
Based on work of Gordon in 1955 & Schawlow n Townes in 1958, MAIMAN
created the 1st operatinal laser in 1960, a
ruby laser emitting a brillant red beam of
light..
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photo of the development of the helium-
neon laser taken at AT&T's Bell
Laboratories in 1964.
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Basic components..
An ACTIVE LASING MEDIUM :-
- cn be a solid, liquid or gas
Enclosed within a LASER CAVITY
bounded by two perfectly parallel
reflectors(mirrors)
PUMP SOURCE – high energy radiation
pumped into the active medium
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POPULATION INVERSION :-
condition when energyfrom pump
source is absorbed by active medium
until the majority of atoms, ions or
molecules are raised to their upper
energy state..
And this condition is NECESSARY to
generate laser light..
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TWO PARALLEL REFLECTORS – situated at end of laser cavity act to constarin light along n within the axis of cavity..
So light is repeatedly bounced b/w the reflectors
One of the mirrors is only partially reflective, enabling some of the light to escape the cavity as a beam of laser light..
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Working of laser
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Working of laser
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Processing of matter without contact.
High working speed
Outstanding precision
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Soft, quiet, vibration-free operation
As fast as the high-speed turbine
CO2 laser cuts and coagulates soft tissue without bleeding
No risk of cross-infection
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Sterilization of operating field
Fewer cracks than with turbine
Multiple quadrant dentistry
No need for etching
Pulsing minimizes charring and thermal necrosis
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Lasers are still in the pioneering stage, but
there are many current uses..
There are three types of Dental lasers:
Surgical Laser (soft tissue)
Curing Laser
Tooth Laser (hard tissue)
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This laser replaces traditional surgery for many gum and soft tissue dental applications and is gentler than traditional surgical procedures.
This laser used for : Improve treatment
results for gum disease
Contour gums for smile enhancement
Surgically correct oral abnormalities
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Surgically assist in arresting herpes lesions
and canker sores
Assist in biopsies
Treat infant tongue/frenum problems which
can hinder proper chewing/sucking
Treat child/adult frenum problems which
can cause speech impediments, gum
disease, and teeth to grow apart rather
than together
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This laser spectrum light source is used for rapid teeth whitening and placing all tooth-colored restorations (fillings) and repair procedures.
Bonds created by this advanced instrument result in dentistry that is twice as strong !
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The light source increases gradually during
the curing process to create the best bond
available in dentistry today.
Appointment length is also reduced
because it is 500% more powerful than
standard equipment.
Less than 1% of dental offices nationwide
have this instrument, making it one of the
newest tools in dentistry..
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TOOTH LASER (hard tissue) Third type of laser is used to remove cavities. But since this laser cannot be used on existing metal fillings, we use micro dentistry..
MICRO DENTISTRY one of the greatest advancements in the field of dentistry.
offers the ultimate flexibility and capability. It is also the most tooth conservative dentistry available.
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About 50% of cavities are candidates for this technique and there is no drilling, no needle, no extra fee, and no pain!
And because this process is so efficient, it reduces appointment length.
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Desensitize exposed root surfaces
Diagnosis of non-cavitated caries
To arrest demineralization and promote
remineralization of enamel.
Debond ceramic orthodontic brackets.
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The DIAGNOdent can find cavities that
other dental instruments can miss.
The device is designed as an adjunct to a
traditional oral examination in the
detection of occlusal decay. Teeth that are
suspicious for caries are ideal candidates
for survey with the device
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Key Benefits:
A laser examination tool for the early
detection of caries.
Even very small lesions can be detected
at the earliest stages.
Over 90% accurate!
Earlier treatment - Better outcomes
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Diagnodent is a pen-like probe that sends a safe, painless laser beam into the tooth. A numeric display & alarm signals when there are signs of hidden decay.
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These pictures show how the Diagnodent
finds cavities that other
dental instruments can miss.
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The Diagnodent device measures laser fluorescence within the tooth structure.
As the incident laser light is propagated into the site, two-way hand-piece optics allows the unit to simultaneously quantify the reflected laser light energy.
At the specific wavelength that the device operates (655 nm), clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display.
Carious tooth structure exhibits fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display
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Roughen tooth surfaces ,in lieu of acid
etching in preparation for bonding
procedure
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Treatment of dentin hypersensitivity..
In bleaching
Adhesion of pit & fissure sealant
Most obvious application – controlled
removal of dental enamel, dentin, bone or
cementum.
Replacement of dental drill is a real
possibility for the future. dr. Blagoja Lazovski 31
1968 – use of carbon dioxide laser – in oral and maxillofacial surgery – Goldman et all.
Restricted mostly to incising and excising masses from the mucosa and gingiva in oral cavity.
Vaporize exces tissue as in gingivoplasty, gingivectomyy and labial /lingual frenectomy.
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Remove or reduce hyperplastic tissue.
Remove and control hemorraging of
vascular lesions such as hemangiomas.
In endodontics
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LASER
TYPE
WAVEL
ENGTH
SPECTRAL
REGION MODE TYPICAL
MAX
POWER
CO2 10,600nm Mid-infrared
CW& Gated &superpulsed
100w CW
Holmium
2,100 nm
Near infrared
Pulsed 15Wavg.
Nd:YAG 1,064 nm
Near infrared
CW & pulsed
100W CW
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Diode 800-890nm
Near infrared
CW >50W
KTP/KDP
532nm visible Pulsed 25Wavg.
Argon 488/514nm
Visible CW 20W
Excimer ArF-XeCl
190nm Ultaviolet
Pulsed 550mJ
Erbium:YAG(Er:YAG)
308nm Ultraviolet
Pulsed 250mJ
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Co2 gas as lasig /active medium
Delivery system – uses an articulated arm (a
series of hollow tubes connected together
through a series of six to eight articulating
mirrors).
USED-
cutting & vaporising tissue in open
proceures or in procedures where rigid endoscopyis acceptable..
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Efect of ruby laser radiation on enamel –
Goldman, Stern & Sognnaes, 1964
Carbondioxide laser – Lobene et all 1968
Nd:YAG laser – Yamamoto & Ooya 1974
Argon laser – Goodman & Kaufmann
1977
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In removal of enamel n dentin – thermal
side effect occoured..
Superpulsed carbon dioxide laser – removal
of dentin without thermal side effect
possible.
Transversal stimulation or carbon dioxide
TEA (the Alexandrit laser with double
frequency) – most efficent carb.dioxide
laser for dental hard tissue ablation.
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Clinical perespactive of lasers increased
by introduction of Er:YAG, Er, Er:YSGG
lasers
have advatages of
- reduced thermal effects
- creating precise contour of
the section zone.
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Also in meantime new lasers
-Nd:YAG
-excimer
-holmium
-argon
-diode
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In thermomechanical , micro-abrasion
like explosion – much less energy is
needed.
If soft tissue is softened by caries,the laser
ablation rate increases…
Rough surfaces produced by laser
ablation provide good retension
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Dentin surfaces r less rough aftr ablation
and hence less problamatic.
High bond n shear strength can be
achieved with simple defocused
radiation..
For conditioning less time is needed than
when etching conventionaly..
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Drying the surface with laser is very quick , efficent and gentle.
Erbium laser has bactricidal abilities.
Bcz high surface temperature can be achieved for a short time by subalative irradiation..
Irridation of caries by a sequence of laser pulses leads to consecuetive dessication and sterlization.
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The Er:YAG laser can be used to disinfect
cavity prep , in case of residual bacteria
contaminating, otherwise intact enamel
or dentin, or in fissures prior to sealing.
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Best results obtained whn affected areas
exposed to co2 , Nd:YAG, Er:YAG, Diode
laser radiation
Colojoara et al showed that dentin
hypersensitivity can be reduced without
any damages to pulp vitality by using co2
laser..
They also showed that when using co2 laser
, in parallel direction with dentin tubules, the
desensiting effect ws obvious aftr three
exposures. dr. Blagoja Lazovski 45
The first materials introduced in 1970’s
(photopolymerised composites) wr
cured by ultraviolet light..
Power et al showed that an argon laser
requires shorter curing times & th
ematerials dentin bond strength was
stronger whn compared with laser.
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Variables that control the depth &extent
of cure include
- time of exposure
- composite material
- wavelength
- intensity of light
- particle size of filler
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Current reserches report that used at the
power of 250 +/- 50 mW for 10sec per
increment ,
the argon laser provides good curing of
light activated restorative material in
shorter period of time with equal or
better physical properties than the
conventional halogen curing light..
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With today's technology, laser teeth whitening through the use of the Diode Laser is the quickest and most dramatic way to brighten your smile if porcelain laminates are not an option.
All tooth whitening procedures use hydrogen peroxide or carbamide peroxide to bleach out stains on your tooth enamel, but this is where the similarity ends when comparing standard bleaching procedures such as whitening performed with a light cure to laser whitening.
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Laser whitening is superior to all other whitening techniques since
1.laser whitening products contain the highest concentration of peroxide 2.the laser provides the highest light intensity available 3.the procedure is done in the office at chairside
thus allowing us to concentrate in those areas of your mouth where the type and location of discoloration is worse. Laser technology allows us to whiten your teeth with amazing results in just one hour!
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1.the type of stain on your teeth
2.where the stain is located
3.the amount of time the whitening gel is used
4.the peroxide concentration in the whitening gel
5.the intensity of the light activating the whitening gel
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In Laser-Assisted Tooth
Whitening, the laser enhances the effect of bleaching agents for faster, more comfortable and more effective results.
By stimulating the bleaching gel to react faster, the bleaching agent (mainly peroxide) spends less time on the tooth.
This leads to increased comfort levels, a reduction in reaction from gums both during and after treatment, and improved results over non-
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Types of hazards
Ocular hazards
# injury to eye – direct emission or by reflection from mirror like surface.
# irreversible retinal burns- by conversion of incident radiation to heat energy.
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* damage to skin & other non-target tissue
result from thermal interaction of energy
with tissue proteins
* temperature elevations can produce
denaturation of cellular enzymes
&structural proteins which interrupt basic
metabolic processes
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Are referred to as non-beam hazards
Capable of producing smoke , toxic
gases and chemicals.
Laser plume – composed of vaporised
water (steam), carbon particles, cellular
products..
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The greatest producers of smoke are
co2, erbium lasers followed by Nd:YAG
Lasers..
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High energetic & short pulsed laser light
lead to a fast heating of dental tissue.
Energy dissipates explosively in vol of
expansion – accompanied by fast
shockwaves..
The shockwaves lead to high pressure –
destroy or damage adjacent tissue.
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Characteristically pulp tissue cannot
survive environment of elevated temp
for protracted periods when tooth
structure is irridated with lasers.
Use of combination of air and water
spray before during or immediately after
laser irridation may be more effective..
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Flammable solids , liquids, gases used
within the surgical setting can be easily
ignited if exposed to laser beam..
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Can be in form of
- electric shock
- fire
- explosion
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Temperature < 60 celcius
~ tissue hyperthermia
~ enzymatic changes
~ edema
Temperature > 60 celcius
~ protein denaturation
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Temperature < 100 celcius
! Tissue dehydration
! Blanching of tissue
Temperature > 100 celcius
! Super heating
! Tissue ablation&shrinkage
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Operatory must be dry
Control panel & its electrical power unit
should be protected from any kind of
splashing..
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Can cause charring
Coagulation of blood elements
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Highly reflective instruments & those with
mirror surfaces should be avoided.
Tooth protection is needed, whenever ,
the beam is directed at angles other
than parallel to the tooth surface.
A no.7 wax spatula can be inserted into
gingival sulcus to serve as an effective
shield for teeth
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If anesthesia is required in place of
standard PVC tubes , rubber or silastic
tubes should be used.
For further protection tube should be
wraped with an aluminium tape.
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The plume from a
laser ablation
deposition:
A Nd:YAG laser
hits ZnTe
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The 514nm line of
the cw laser, a
few 100 mW,
going through a
prism. Do not try
this at home!
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Figure 1A—
Maxillary left first
permanent molar
with occlusal
enamel
hypoplasia
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Figure 1B—Waterlase MD.
used to remove
(ablation).
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Completed cavity
preparation after
using Waterlase
MD
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Completed
restoration with
resinomer
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Thank You