Lasers in Dental Practice - part 1
Lasing is a new era of dentistry. When lasers are used for the correct clinical indications with correct technical parameters, in the hands of an appropriately educated and trained professional, they can be of great benefit for both the dentists and their patients. To enjoy laser dentistry to its fullest, it is necessary to gain a structured education from accurate and reliable sources, firstly with regards laser safety, then understand laser-tissue interactions and ultimately specific usage of the use of lasers in practice.
Depending on the medium used to generate the laser beam, different laser models delivery different wavelengths of laser energy. These different wavelengths have differing interactions with the various tissues to which they are applied, and therefore will offer varying degrees of effectiveness in clinical practice. For the most effective financial investment, dentists need to select equipment which operates with the wavelength(s) with the highest efficacy on the clinical application types they will most often undertake. This decision can only be made after they have a sound understanding of the interactions taking place in laser treatment.
Despite the fact that diode lasers have severe shortcomings in some areas of clinical practice, and can represent a serious risk for patients if used incorrectly, the price:performance ratio can suggest that they offer the best profitability.
Like all lasers, the most important step for prevention of hazards while enjoying the benefits of lasers, is to have the knowledge of the risks that diode lasers present and an understanding of how to minimise those risks.
Diode lasers operate in a continuous-wave mode, which leads to them having relatively low peak powers. The interaction of this kind of lasers with the tissue depends on the presence of haemoglobin or melanin in the tissue where the laser energy is absorbed. Penetration of the energy takes place when the tissue lacks these absorbents. When used correctly, both vaporization and coagulation of tissues is possible with diode lasers together with bio-modification and sterilisation effects.
Nd:YAG lasers have the similar indications to that of diode lasers.
Whilst both Diode and Nd:YAG lasers offers some benefit over the other; on balance Nd:YAG lasers can be more effective for as they are free running pulsed lasers, working with shorter pulses and high peak powers.
As the Er:YAG laser can be used in both hard- and soft- tissues, it has the widest range of indications. With Erbium lasers the energy is absorbed in water. At high power, the energy causes water to heat and vaporize very rapidly resulting in micro-explosions, which causes tissue particles on the surface to be expelled. It is very important to have a wide range of modifications of the parameters for this kind of laser device to give the dentist the opportunity to use it in different types of indications efficiently.
CO2 lasers are less frequently used in dentistry nowadays, as they can carbonize hard dental tissues in a very short time. They are fast, safe and successful when they are used away from hard tissues.
Depending on the requirements of the clinical indications, one laser can be used alone, in combination with another type of laser or in addition to conventional treatments. In oral surgery and restorative dentistry, they are used by themselves or with another wavelength to ablate\vaporize\coagulate tissues, whereas they are used to support the conventional treatment protocols in periodontal and endodontic treatments for cleaning/disinfection.
In part two of this five-part series, Dr Maden will discuss the use of Erbium lasers in hard-tissue dentistry.
About the Author:
Dr. Ilay Maden was born in 1980, in Istanbul. He studied dentistry (1998-2003) and did his Ph.D. studies for periodontology (2003-2009) in University of Istanbul. He has received his Master of Science degree for Lasers in Dentistry from Aachen University, Germany (2005-2007).
Dr. Ilay Maden is the co-director, lecturer and trainer of Seesaw Dental Education and representative of AALZ in the United Kingdom. He is also an Adjunct Faculty Member of Aachen Laser Research Center; AALZ, Aachen University, Germany, an expert lecturer for Laser and Health Academy and a training instructor for International Continuing Education Center for Dental Implants; IFZI – Germany. He has held a number of theoretical and hands-on courses and lectures on diode, Nd:YAG and Erbium lasers in dentistry in Turkey, Portugal, Croatia, UAE Norway, Taiwan, China, Sweden and United Kingdom. He has been a speaker in a number of international congresses regarding lasers in dentistry in Turkey, Croatia, UAE and Germany. In addition to being on the editorial board of ProDentalCPD and Journal of Laser and Health Academy, he is also a reviewer for Lasers in Medical Science; one of the leading international journals in the field of medical applications of lasers and light.
Dr. Ilay Maden is a member of Turkish Dental Association, European Federation of Periodontology, Turkish Periodontology Association, Turkish Association of Aesthetic Dentistry Academy and British Dental Association. He is the principle dentist in a private dental practice where he has been specialising in laser supported implantology and periodontal treatments since 2005.