Applications of Lasers in Dentistry: A Overview
Prof (Dr.) Bashir A Mir
Dept. of Oral and Maxillofacial Medical procedures,
Govt. Dental University, Sgr.
Dr. Ajaz A Shah
Associate Professor and Head,
Dept. of Oral and Maxillofacial Medical procedures,
Govt. Dental University, Sgr.
Dr. Suhail Latoo
Office of Oral Pathology and Microbiology,
Govt. Dental University, Sgr
Dr. Altaf H Malik
Dept. of Oral and Maxillofacial Medical procedures,
Govt. Dental University, Sgr
Lasers were being launched into the field of scientific dentistry with the hope of conquering some of the drawbacks posed by the common procedures of dental techniques. Given that its very first experiment for dental software in the nineteen sixties, the use of laser has greater swiftly in the past couple of a long time. At present, broad versions of techniques are carried out making use of lasers. The aim of this evaluate is to describe the software of lasers in dental tricky tissue techniques. Lasers are located to be helpful in cavity preparing, caries removal, restoration removal, etching, and procedure of dentinal sensitivity, caries prevention and bleaching. Dependent on progress in adhesive dentistry and the propagation of minimum amount intervention concepts, lasers may possibly revolutionize cavity style and preparing.
Critical terms: laser, dental tricky tissue, adhesive dentistry
The use of lasers in dentistry has greater around the past number of years. The very first laser was launched into the fields of medicine and dentistry for the duration of the nineteen sixties (Goldman et al., 1964). Given that then, this science has progressed swiftly. For the reason that of their several benefits, lasers are indicated for a broad selection of techniques (Frentzen and Koort, 1990 Aoki et al., 1994 Pelagalli et al., 1997 Walsh, 2003). Typical procedures of cavity preparing with low- and substantial-pace handpieces involve sounds, awkward vibrations and anxiety for clients. Whilst agony may possibly be decreased by regional anaesthesia, worry of the needle and of sounds and vibration of mechanical preparing remains brings about of soreness. These cons have led to a search for new strategies as possible solutions for dental tricky tissue removal. The aim of this evaluate is to describe the software of lasers in dental tricky tissue techniques.
The very first experiment with lasers in dentistry was documented in a study about the outcomes of a pulsed ruby laser on human caries (Goldman et al, 1964). The outcomes of that study confirmed that the outcomes assorted from tiny 2-mm deep holes to comprehensive disappearance of the carious tissue, with some whitening of the surrounding rim of enamel, indicating intensive destruction of carious regions along with crater formation and melting of dentine. Even more get the job done in the 1970’s concentrated on the outcomes of neodymium (Nd) and carbon dioxide (CO2) lasers on dental tricky tissues. Early researches located that CO2 lasers developed cracking and disruption of enamel rods, incineration of dentinal tubule contents, extreme reduction of tooth structure, carbonisation and fissuring and greater mineralization prompted by the removal of natural and organic contents (Gimbel, 2000). It was also documented that the use of the CO2 laser was unfavourable due to the fact of the reduction of the odontoblastic layer (Wigdor et al., 1993).
As a result, it was concluded that, except if warmth-connected structural adjustments and destruction to dentinal tissues could be decreased, laser technological know-how could not swap the common dental drill. Even more developments in laser technological know-how however, have identified suitable biologic interactions. For example, the Er: YAG laser was tested for its capacity to ablate (or vapourise) dental tricky tissues (Gimbel, 2000). Enamel and dentine cavities were being correctly well prepared making use of the Er: YAG laser. Given that then, this laser has been made use of for caries removal and cavity preparing, gentle tissue small surgical procedures and scaling (Aoki and Watanabe et al., 1998).
The Er: YAG laser was tested for planning dental tricky tissues for the very first time in 1988. It was correctly made use of to put together holes in enamel and dentine with low ‘fluences’ (electricity (mJ)/device region (cm2)). Even devoid of water-cooling (Burkes et al., 1992), the well prepared cavities confirmed no cracks and low or no charring even though the necessarily mean temperature rise of the pulp cavity was about four.3°C (Rechmann et al., 1998). In 1989, it was demonstrated that the Er: YAG laser developed cavities in enamel and dentine devoid of key adverse facet outcomes. The ablation efficiency was about one particular purchase of magnitude lessen than for gentle tissue. It was then concluded that dentine and enamel removal was extremely helpful with no hazard to the pulp (Armengol, 2000 Cavalcanti, 2003) and the ablation premiums in enamel were being stated to be in the array of twenty-fifty µm/pulse, and in dentine they were being documented to be as substantial at lessen fluences.
Clinically, cavity preparing in enamel outcomes in ablation craters with a white chalky look on the area of the crater (Tokonabe et al., 1999). In dentine, cavity margins are sharp and dentinal tubules continue to be open devoid of a smear layer. In a scientific study done to examine the efficiency and protection of the Er: YAG laser for caries removal and cavity preparing in dentine and enamel (Cozean et al, 1997), Class I, II, III, IV and V cavities were being well prepared for amalgam and composite restorations. It was located that the Er: YAG laser was equivalent to the air rotor in its capacity to make cavity preparations in enamel and dentine and remove caries. However, the flooring of the preparing was not as sleek as that achieved with the substantial-pace drill.
Carious materials incorporates a bigger water information as opposed with surrounding healthier dental tricky tissues. Consequently, the ablation efficiency of caries is greater than for healthier tissues. There is a achievable selectivity in the removal of carious materials making use of the Er: YAG laser due to the fact of the unique electricity need to ablate carious and audio tissues leaving all those healthier tissues minimally afflicted. However, Rechmann et al. (1998) located that selective ablation of carious dentine is tough with the Er: YAG laser. The ablation thresholds of healthier dentine and carious dentine are unique. The ablation threshold of healthier dentine is two moments bigger than the corresponding threshold of carious dentine.
As a result, extremely tiny fluences (electricity (Joules) / region (cm2)) of the Er: YAG laser electricity are required to selectively ablate carious dentine. This low fluence will consequence in low efficiency of the ablation approach (Shigetani, 2002). In one more in vitro study investigating the usefulness of caries removal by Er: YAG laser, it was located that the Er: YAG laser ablated carious dentine correctly with negligible thermal destruction to the surrounding intact dentine (Aoki and Ishikawa et al., 1998). The laser taken out contaminated and softened carious dentine to the same degree as the bur procedure. In addition, a lessen degree of vibration was observed with the Er: YAG laser procedure. However, the study did not handle the problem of selective removal of carious tissue and even further reports of caries removal making use of lasers are indicated.
The Er: YAG laser is capable of getting rid of cement, composite resin and glass ionomer (Dostalova et al., 1998 Gimbel, 2000). The efficiency of ablation is similar to that of enamel and dentine. Lasers really should not be made use of to ablate amalgam restorations however, due to the fact of possible release of mercury vapour. The Er: YAG laser is incapable of getting rid of gold crowns, solid restorations and ceramic elements due to the fact of the low absorption of these elements and reflection of the laser light (Keller et al., 1998). These limitations emphasize the require for satisfactory operator education in the use of lasers.
Laser etching has been evaluated as an alternate to acid etching of enamel and dentine. The Er: YAG laser provides micro-explosions for the duration of tricky tissue ablation that consequence in microscopic and macroscopic irregularities. These micro-irregularities make the enamel area micro-retentive and may possibly provide a system of adhesion devoid of acid-etching. However, it has been revealed that adhesion to dental tricky tissues following Er: YAG laser etching is inferior to that received following common acid etching (Martinez-Insua et al., 2000). These authors attributed the weaker bond power of the composite to laser-etched enamel and dentine to the presence of subsurface fissuring following laser radiation. This fissuring is not observed in common etched surfaces. The subsurface fissuring contributed to the substantial prevalence of cohesive tooth fractures in bonding of the two laser-etched enamel and dentine.
A similar summary was drawn from a study that as opposed shear bond power (SBS) of composite resin to dentine surfaces adhering to unique treatment plans (Ceballos et al., 2001). These authors documented that acid etched specimens achieved the maximum SBS values, even though laser procedure confirmed the cheapest SBS outcomes. These results recommend that intensive fissuring prompted by laser procedure and the consequent weak bonding power may possibly outweigh the putative benefits of laser etching.
Treatment of dentinal hypersensitivity
Dentinal hypersensitivity is one particular of the most typical problems in dental scientific exercise. Numerous procedure modalities these kinds of as the software of concentrated fluoride to seal the uncovered dentinal tubules have been tested to handle the problem. However, the success charge can be enormously enhanced by the ongoing evaluation of lasers in tricky tissue applications. A comparison of the desensitising outcomes of an Er: YAG laser with all those of a common desensitising system on cervically uncovered hypersensitive dentine (Schwarz et al., 2002) confirmed that desensitising of hypersensitive dentine with an Er: YAG laser is helpful, and the servicing of a beneficial consequence is extra prolonged than with other agents.
Many reports examined the likelihood of making use of laser to protect against caries (Hossain et al., 2000 Apel et al., 2003). It is thought that laser irradiation of dental tricky tissues modifies the calcium to phosphate ratio, lessens the carbonate to phosphorous ratio, and potential customers to the formation of extra stable and considerably less acid soluble compounds, cutting down susceptibility to acid assault and caries. Laboratory reports have indicated that enamel surfaces uncovered to laser irradiation are extra acid resistant than non-laser addressed surfaces (Watanabe et al., 2001 Arimoto et al., 2001).
The degree of protection towards caries progression presented by the one particular-time original laser procedure was documented to be similar to every day fluoride procedure by a fluoride dentifrice (Featherstone, 2000). The threshold pH for enamel dissolution was reportedly reduced from five.five to four.8 and the tricky tooth structure was four moments extra resistance to acid dissolution. However, the genuine system of acid resistance by laser irradiation is continue to unclear and reports, specifically in vivo, to exam all those statements are required.
The aim of laser bleaching is to achieve an helpful electricity bleaching approach making use of the most economical electricity supply, even though averting any adverse outcomes (Solar, 2000). Electricity bleaching has its origin in the use of substantial-intensity light to raise the temperature of hydrogen peroxide, accelerating the chemical approach of bleaching. The Food and drug administration accepted expectations for tooth whitening has cleared a few dental laser wavelengths: argon, CO2 and the most latest 980-nm GaAIAs diode. There are no reports at present about the use of the Er: YAG laser in bleaching strategies. The wavelength of the Er: YAG laser may possibly be unsuitable for the techniques, but it is a even further region that could be explored.
The Er: YAG laser has been located to have applications in regions these kinds of as cavity preparing, removal of caries and restorations, and etching of enamel. However, the benefits as perfectly as limitations of the Er: YAG laser treatment plans have not however been absolutely documented. There look to be windows of chance for the Er: YAG laser in a array of dental applications. Lasers may possibly revolutionise cavity style and preparing based mostly on progress in adhesive dentistry.
Aoki A, Ando Y, Watanabe H and Ishikawa I (1994). In vitro reports on laser scaling of sub-gingival calculus with an erbium: YAG laser. J Periodontal, sixty five: 1097 – 1106
Aoki A, Ishikawa I, Yamada T, Otsuki M, Watanabe H, Tagami J, Ando Y and Yamamoto H (1998). Comparison amongst Er: YAG laser and common system for root caries procedure in nitro. J Dent Res, 6: 1404-1414.
Aoki A, Watanabe H and Ishikawa I (1998). Er: YAG scientific expertise in Japan: evaluate of scientific investigations. SPIE, 3248: forty-45.
Apel C, Schafer C and Gutknecht N (2003). Demineralization of Er: YAG and Er,Cr: YSGG Laser-Prepared Enamel Cavities in vitro. Caries Res, 37: 34-37.
Arimoto N, Suzaki A, Katada H and Senda A (2001). Acid Resistance in Lased Dentine. 6th Intercontinental Congress on Lasers in Dentistry, 61-62.
Armengol V, Jean A and Marion D (2000). Temperature rise for the duration of Er: YAG and Nd: YAP laser ablation of dentine. J Endodon, 26(3): 138 –
Burkes EJ, Hoke J, Gomes E and Wolbarsht M (1992). Moist as opposed to dry enamel ablation by Er: YAG laser. J Prosthet Dent, 67: 847-851.
Cavalcanti BN, Lage-Marques JL and Rode SM (2003). Pulpal temperature increases with Er: YAG laser and substantial-pace handpieces. J Prosthet Dent, ninety: 447-451.
Ceballos L, Osorio R, Toledano M and Marshall GW (2001). Microleakage of composite restorations following acid or Er: YAG laser cavity procedure. Dental Products, 17: 340-346.
Cozean C, Arcoria CJ, Pelagalli J and Powell GL (1997). Dentistry for the twenty first century? Erbium: YAG laser for tooth. J Am Dent Assoc, 128: 10801087.
Dostalova T, Jelinkova H, Kucerova H, Krejsa O, Hamal K, Kubelka J and Prochazka S (1998). Noncontact Er: YAG Laser Ablation: Scientific Evaluation. J Clin Laser Med Surg, 16(five): 273
Featherstone JDB (2000). Caries detection and prevention with laser electricity. Dental Clinics of North The usa, forty four(four): 955-969.
Frentzen M and Koort HJ (1990). Lasers in dentistry: new prospects with advancing laser technological know-how? Int Dent J, forty: 323 – 332
Gimbel CB (2000). Challenging tissue laser techniques. Dental Clinics of North The usa, forty four(four): 931-953.
Goldman L, Hornby P, Meyer R and Goldman B (1964). Impression of the laser on dental caries. Mother nature, 203: 417.
Hossain M, Nakamura Y, Kimura Y, Yamada Y, Ito M and Matsumoto K (2000). Caries-Preventive Influence of Er: YAG Laser Irradiation with or devoid of H2o Mist. J Clin Laser Med Surg, 18(2): 61-sixty five.
Keller U, Hibst R, Geurtsen W, Schilke R, Heidemann D, Klaiber B and Raab WHM (1998). Erbium: YAG laser software in caries treatment. Evaluation of affected individual perception and acceptance. J Dent, 26: 649-656.
Martinez-Insua A, Dominguez LS, Rivera FG and Santana-Penin UA (2000). Variances in bonding to acid-etched or Er: YAG – laser – addressed enamel and dentine surfaces. J Prosthet Dent, 84: 280-288.
Pelagalli J, Gimbel CB, Hansen RT, Swett A and Winn II DW (1997). Investigational Study of the Use of Er: YAG Laser Compared to Dental Drill for Caries Removing and Cavity Preparation – Section I. J Clin Laser Med Surg, fifteen(3): 109 – 115.
Rechmann P, Goldin DS and Hennig T (1998). Er: YAG lasers in dentistry: an overview. SPIE, 3248: 0277-0286.
Schwarz F, Arweiler N, Georg T and Reich E (2002). Desensitising outcomes of an Er: YAG laser on hypersensitive dentine, a managed, future scientific study. J Clin Periodontol, 29: 211-215.
Shigetani Y, Okamoto A, Abu-Bakr N and Iwaku M (2002. A study of cavity preparing by Er: YAG laser – observation of tricky tooth structure by laser scanning microscope and examination of the time vital to remove caries. Dent Mater J, 21(1): twenty – 31.
Solar G (2000). The part of lasers in beauty dentistry. Dental Clinics of North The usa, forty four(four): 831-850.
Tokonabe H, Kouji R, Watanabe H, Nakamura Y and Matsumoto K (1999). Morphological adjustments of human tooth with Er: YAG laser irradiation. J Clin Laser Med Surg, 17(1): 7-12.
Watanabe H, Yamamoto H, Kawamura M, Okagamv Y, Kataoka K and Ishikawa I (2001). Acid Resistance of the Human Teeth Enamel Irradiated by Er: YAG Laser. 6th Intercontinental Congress on Lasers in Dentistry, 68-sixty nine.
Walsh LJ (2003). The current status of laser applications in dentistry. Aust Dent J, 48(3): 146
Wigdor H, Abt E, Ashrafi S and Walsh Jr JT (1993). The impact of lasers on dental tricky tissues. J Am Dent Assoc, 124: sixty five-70.