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What is laser
(Light Amplification by Stimulated Emission of Radiation) is
light with specific properties that can perform
Light is a type of energy that travels in a
wave as a particle, called a photon.
Photon waves have three properties. One is amplitude,
(vertical measure of the height of the wave = the energy of
the wave), the second is length of the wave (the color of
the light) and the third is the velocity (speed of light).
Laser light is very specific with a stable wave height, a
single wave length with one color and a focused beam with
concentrated energy giving heat that can cut or disinfect
tissue (unlike light bulbs that have variability of
amplitude and wavelength, scatter light in many directions
and don’t cut or disinfect).
Laser light (and bulb light) is a type of electromagnetic
Laser is NOT ionizing radiation like X-ray, which can cause
risk of mutations in DNA.
Lasers in dentistry
There are several types of
lasers with different wavelengths and absorption
capabilities that interact with different tissue types.
wave lasers (Diode and Nd:YAG) have an affinity
(selective absorption) for tissue pigments
hemoglobin, melanin) and are used for soft tissue surgery
and blood clotting. The laser works on pigment and will not
harm surrounding bone or tooth at the settings used for soft
tissue. Since diseased soft tissue has a higher hemoglobin
content and melanin from the bacteria, the laser light is
absorbed by the diseased tissue without affecting the
healthy tissue. These lasers have a beam wavelength in the
infrared spectrum. They ablate by photo thermal or heat
Nd:YAG - Wavelength: 1064
nm, Pulse width: 100 – 120 µs, Energy per pulse: 15 Watt,
Frequency: 10 - 100 Hz (5Hz steps), Delivery System: 200µ
and 300µ fibers, Cooling Integrated: air & water cooling
Diode laser: Wavelength:
810 / 940 / 980 nm
wave lasers (Er:YAG, Er:Cr:YAG) have an affinity for
water, can recognize the
decayed part of the tooth
because of differences in water content between solid and
decayed tooth structure, and are used for teeth and bone.
Hard tissue lasers can remove decay but
can not remove old silver filling material because the heat
of the laser would vaporize the mercury in the fillings.
Removing composite filling material can be very difficult
The laser emits light
energy either in continuous or pulsed states. Most dental
lasers involve pulsed
energy release. The
pulse (burst of light) delivers the laser’s heat energy
pulse has a duration of
a few ten thousandths of a second) and allows the tissue
time to cool before
pulse. The heat is not retained
by the tooth or soft tissue. This heat energy pulse works by
either boiling away
water within and between the cells, or by causing micro
expansion of hard tissue, resulting in a tiny explosion
(pops) that removes the unwanted tissue. When using the
continuous wave operation, it can trigger nerve response so
local anesthesia may be needed.
The dentist must always
take care to use the proper laser at the proper settings for
each individual therapy, just like all other dental tools.
It is important for everyone in the room to use special
safety glasses while the laser is being used in order to
prevent eye damage.
Laser is precise and
specific for certain tissue types. When used correctly,
it does not effect the surroundings.
can kill bacteria in the area being worked on
(periodontal, surgical, endodontic).
Laser can reduce
periodontal infection by killing the periodontal
bacteria causing the disease.
When performed correctly
and together with optimal daily oral hygiene, this can aid
in the process of stabilizing the periodontal condition.
It does not reduce all pocket depths to a
long term optimal healthy condition.
with or without laser may be the optimal treatment.
Laser can remove diseased
soft tissue lining (curettage) in the periodontal pocket
and attempt to "seal" it at the same time (like heat can seal the end
of a rope). Local anesthesia is recommended for the
optimal removal of calculus with ultrasonic instruments at the same
time of laser usage.
NdYag laser does not remove calculus, but it may make it
porous and therefore easier to remove. Curettage can be done
with handinstruments alone. Laser has access to
Laser can be an
alternative to gum surgery when indicated: e.g. maintaining gum height esthetically
on front teeth or when surgery is denied by the patient
or not an advantageous option (disease, medications,
Laser advantages are: no
scalpel cutting, no stitching, in mild cases no anesthesia,
removal only of the diseased tissue without removing any
of the healthy tissue, maintaining the height of the
tissue around the front teeth, less inflammation response,
less bleeding, less pain, less swelling, less
postoperative discomfort, assisting in healing and
achieving a healthy periodontal condition.
promotes healing and reduces duration of canker sores
and herpes outbreaks.
Laser for soft tissue
gives no vibration and no unpleasant noises.
Minor oral surgery like
eliminating tongue and lip ties, uncovering implants,
soft tissue crown lengthening, preventing bleeding when
taking impressions for crowns, or removing cysts and tumors can all
be performed by a laser with minimal trauma and bleeding
to the area. Most surgeries can be accomplished with a
very small local anesthesia.
Laser therapy is safe for
patients with health concerns such as diabetes, HIV,
hemophilia, or those taking medications such as Coumadin
Why is laser often painless?
works precisely with heat energy that vaporizes specific
diseased tissue and with very little effect on surrounding
tissue nerves. This happens so fast, and occurs through
repeated pulses with long enough rest time between the
pulses that there is no cumulative (addition of previous
pulses) effect and does not trigger a nerve response (pain).
The surface tissue is sealed.
This procedure reduces the stimulation of the mediators of
inflammation causing less inflammation at the surgical site
and therefore less pain and more rapid healing than
traditional surgical techniques.
However, there is a
variation among patient’s reaction and dental procedures in
the timing of pulses.
Laser Certification of Dentists
Hoffmeyer is currently in the process of taking a certified
postgraduate educational program
leading to a Diploma
and Masters Degree in Lasers offered by the International
Society for Oral Laser Applications.
This is an organization
dedicated to providing education about lasers and testing
dentists to insure that standards of care are met. The group
is composed of researchers, academic professionals and
Laser certification is voluntary at
this time, but Dr. Hoffmeyer believes that it is important to
obtain a high quality of
Dr. Hoffmeyer is not commercially or economically involved with any
but she has received assistance to be able to persue her
She would like to thank the representatives from Deka Laser Europe
(www.dekalasers.com) and BioLase Europe
(www.biolase.com) for donating their
time, equipment and helpfulness in laser hands-on and
Limitations and opinions of
in the dental research and practice community have been met
with controversial opinions, due to the fact that research
results are varying.
Since laser equipment and settings change constantly, it is
nearly imposible to compare research results and end up with
one single answer as to the efficacy of lasers in
Dr. Hoffmeyer has an open mind to the topic and is doing her
best to keep
herself up to date at international conferences and with
publications so she can give you her best advise.
Lasers have their limitations and can not replace other dental
tools. NdYag laser alone does not remove calculus. ErYag
laser may remove calculus, but should be used with causion.
Not all patients are candidates for laser therapy, in
which case a traditional surgical approach should be used to
create the desired results.
When indicated, laser
can be an aid
to provide you as a patient with dental care that can be effective
in killing bacteria, being comfortable and helps you overcome your fear of
pain or surgery.
Optimal daily oral hygiene is your number one asset
and must not be neglected.
Dr. Hoffmeyer, as a
periodontal specialist, will advise you how to have your
periodontal disease treated and maintained healthy in the
least discomforting and most efficient and cost
gallery of treatment options
A tooth that is non-symptomatic with a hole to the
The tooth is desinfected and the bleeding stopped
with laser before filling.
This is a attept to avoid root canal treatment.