An Introduction to Laser Dentistry

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Diode Laser

Today was our first laser dentistry rotation. The dean of our dental clinic is the former president of the American Association of Laser Dentistry (AALD). Also, several of our faculty members are really into lasers. Because there is a strong culture of laser dentistry at our school, we are all laser certified by the end of our second year. Our laser rotation today was part of the laser certification training that every Midwestern dental student goes through.

First, just a bit about rotations here at MWU-AZ. During our second year, our SIM clinic benches form into groups of 12 students. These groups go through various rotations throughout the year for hands-on training in endodontics, periodontics, orthodontics, bonding, implant dentistry, community service, prosthodontics, clinical rotations, and of course, lasers.

Our group today was broken down further into groups of 3-4 students for the laser rotation. We each got a chance to work with two different diode lasers, a Thor LLLT laser, a CO2 laser, and an erbium, chromium:yttrium-scandium-gallium-garnet laser. Yes, I copy / pasted that one.

Low-Level Light Therapy

Thor LaserLow-Level Laser Therapy, or LLLT for short, is laser therapy that penetrates tissue and initiates tissue repair and anti-inflammatory effects. According to numerous studies, light energy from the laser frees nitric oxide (NO) from cytochrome C inside cellular mitochondria, allowing oxygen to bind and initiate oxidative phosphorylation.

There are numerous studies on LLLT and it seems to provide real and beneficial treatment for people in pain, especially when it is used as an adjuvant to other treatment modalities. For more information about LLLT, take a look at the following study on the Use of Low Level Laser Therapy for Musculoskeletal Pain.

Thor Laser ConsoleIn the world of dentistry, practitioners use LLLT to treat oral mucositis following chemotherapy and radiation treatment for cancer. Our school is working with the Mayo Clinic just down the road to treat patients experiencing this otherwise debilitating complication of cancer therapy.

LLLT can also be used to alleviate orthodontic pain associated with braces and aligners, or to treat muscular pain from jaw clenching and para-functional habits. Veterinarians were some of the the earliest adopters of LLLT and they still probably use it more widely than any other health profession. Some physicians are beginning to use LLLT for treatment of pain and to increase healing in orthopedic patients, burn trauma patients, and other maladies.

Thor LaserThere is some research that indicates LLLT may improve nerve regeneration in peripheral tissues. Given the fact that LLLT has no real side effects and very few contraindications, it seems to be an excellent low-risk treatment modality in the modern dental practice.

Diode Lasers

Diode Laser Cow JawModern laser dentistry makes use of both hard and soft-tissue lasers. The diode lasers were used today operate at 810 nm or 980 nm. We started with a Sirona diode laser and ended with a newer but less powerful Ultradent diode laser. Both lasers can be used for gingivectomies, frenectomies, flaps, gingival troughing, cautery, and even photobiomodulation (LLLT).

Sirona Diode LaserThe Sirona was easy to use and had a nice user interface. It made an obnoxious ringing sound whenever the laser was active, hopefully users can change the sound. The laser features 14 pre-programmed user profiles, so each user in a dental office can have their own configuration.

UltraDent Diode LaserEveryone in my group preferred the Ultradent diode laser for its futuristic user interface and the pleasant beeping it makes when the laser is in operation. Beyond those reasons though, it seemed to cut more precisely and consistently than the Sirona laser did too.

Diode LaserOne of the things I love about this school is the fact that we have exposure to so much technology. Dentists use the equipment that they are trained on. If you take a CE course that teaches you Sirona, then you will buy Sirona. Our school provides multiple diode lasers so that we can experiment and get a feel for which one we might want to buy ourselves one day.

Hard Tissue Lasers

CO2 lasers are often used in surgical cases for both hard and soft-tissue cutting. The CO2 laser we used today is a soft-tissue only 10,600 nm laser. To cute bone, we would need a 9,250 nm CO2 laser.

CO2 LaserThese machines are big and expensive ($70,000), but they cut well, they don’t make a lot of noise, and they are accurate. My good friend and classmate Ben actually made a little gift for me in the side of a tomato.

Ben's GiftYou can see that these lasers allow for a high level of precision!

Finally, we used an erbium, chromium:yttrium-scandium-gallium-garnet laser for hard-tissue cutting. Like working with a bur, it took some time to get a feel for how the laser was cutting into the tissue. Also, cutting through gingival tissue is obviously very different from cutting into bone. Unlike a bur though, there is no tactile feedback from a laser. You have to watch for certain visual cues to know what tissue you are cutting and how deeply.

Erbium, chromium:yttrium-scandium-gallium-garnet laserLaser Dentistry is the Future

I don’t think lasers will replace traditional handpieces and hand instruments any time soon, but I believe they will steadily occupy more marketshare as time goes on. Being able to cut into tissues without blood is too big a perk for most dentists to ignore. Add to that the versatility of the lasers, and the comparatively small doses of anesthetic needed and lasers are a no-brainer.

Obviously, lasers have their limitations. Most laser dentists still do crown preps with a bur and handpiece. The future is bright for laser dentistry, and I’m happy to be on the cutting edge of this amazing new field!

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