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Lasers deliver energy in the form of light. Depending on the intended
result, this energy travels at different wavelengths and is absorbed
by a "target." In dentistry, these targets can be enamel,
decay, gum tissue, or whitening enhancers. Each one absorbs a different
wavelength of light while reflecting other wavelengths. No measurable
effect is seen beyond the intended target site. Lasers are very
specific in regard to the wavelength produced. This means that there
must be a different laser for each type of procedure that you want
to complete. There is little or no sound associated with laser treatment,
a pleasant treat for the dental patient who has experienced the
whine of the dental drill. As technology advances, we hope to see
lasers which can be used for several related treatments combined
into one convenient machine.
There are currently four areas of dental care that are enjoying
the
benefits of laser technology:
Cavity removal can be accomplished with two currently available
(and
FDA approved) laser machines. Both have the ability to remove decay
within a
tooth, and prepare the surrounding enamel for bonded fillings. The
need for
anesthesia is greatly reduced or eliminated over the traditional
methods.
Laser energy dramatically reduces the bacteria found in dental decay,
and has
been demonstrated to enhance the tooth's ability to "heal"
in situations
where "deep cavities" had existed. There are, however,
several limitations
to laser decay removal including the inability to adequately remove
silver
fillings, onlays, and crowns.
Curing, or hardening bonding materials is another area where lasers
have become important. These lasers drastically reduce the time
it takes to
finish a filling, and create what some researchers have shown to
be a
stronger restoration.
Whitening teeth can be accomplished with special solutions that
are
applied to the tooth surface in the dental office and activated
by laser
energy. Color changes of several shades is possible in a very short
time.
When combined with at-home tray based whitening systems, dramatic
changes can be seen in even the most difficult cases.
Periodontal, or gum related care is the fourth area benefiting from
laser technology. Lasers are currently used for recontouring or
reshaping
gums (often described as "plastic surgery for the smile"),
removing extra or
diseased gum tissue associated with the use of certain medications
or
periodontal disease, and removing the bacteria in periodontal pockets
to
promote healing. Healing time and postoperative discomfort can be
significantly reduced over the traditional surgical methods.
Dental lasers have been shown to be safe and effective for treating
both children and adults. Very specific equipment and training are
required to incorporate this technology into the dental office,
and many dentists are becoming involved in providing laser care.
Research with the technology and design enhancements with the machines
themselves are proceeding at a staggering pace. We look to the future
with great excitement as the use of laser energy in dentistry expands
to include many more procedures.
Microabrasion: High technology Decay Removal
Another technique for removing decay while reducing the need for
anesthesia is called microabrasion. While there are a number of
different
machines available to dentists, they all work on the same principle,
and can
greatly enhance a patient's dental care experience.
Microabrasion is a procedure involving a fine stream of particles
aimed
at the decayed portion of a tooth. These particles are often silica,
aluminum oxide, or even baking soda based. They are propelled toward
the
tooth by air or bottled inert gasses through a handpiece, and remove
small
particles of decay as they strike the tooth's surface. These particles
are
then "vacuumed" away through the use of the suction system
as with the
traditional methods. A "rubber dam" technique is often
used when this system
is used, and involves using a thin latex sheet to isolate the tooth
from the
patient's lips and tongue. Microabrasion is also frequently used
to prepare
a surface for bonding or sealants.
While frequently described as creating a "dusty" taste,
many patients
enjoy the absence of sound associated with this technique. It is
virtually
silent as it removes areas of decay. There are, however, limitations
in its
use including the inability to remove any metallic restorations
like silver
fillings, onlays, or crowns.
Laser Q and A
Are Lasers new to dentistry ?
No. Lasers have been used in general dentistry for many years. Recent
advances in the technology have made it possible for lasers to be
used in individual dental offices. Some of the dental laser products
are similar or identical in design to those which have been successfully
used for more than 25 years in Operating Rooms of hospitals around
the world. In these Operating Rooms, lasers perform intricate and
sensitive surgical procedures in the fields of ophthalmology, neuro-surgery,
Ear/Nose/Throat (ENT) and dermatology.
Are Lasers safe?
Yes. In the hands of a qualified trained dentist, lasers are very
safe. As with any device used in the dental practice, the dentist
must undertake the appropriate training and there are several laser
dentistry courses and instructors dedicated to this cause. The primary
safety measure required during laser surgery is protective eyewear.
In some cases, when compared to traditional devices, dental lasers
can actually minimize the risk of damage to lateral tissue, based
on the precise and specific control over power output, time and
spot size. This concise control is unique to lasers, and in the
right hands, actually makes the laser a safer tool, hence the success
of medical lasers in the extremely sensitive areas of neurology
and ophthalmology. It is imperative to have this type of control
to minimize the risk of damaging healthy delicate tissues of the
tooth and gums.
Laser light is much more efficient that conventional light sources,
in that lasers produce an intense and narrow, concentrated beam
of light comprised of a single wavelength. In contrast, traditional
light sources encompass a continuum of light comprising the entire
spectrum including infrared (heat) and ultraviolet. As lasers are
capable of producing the exact wavelengths required, the same energy
can be delivered using a laser with lower power in a shorter period
of time, hence less heat and potential damage to surrounding tissue.
In certain procedures, when compared with electrocautery and high
speed curing lights, lasers can actually provide a safer environment
for the patient. Even though lasers are somewhat new to the general
dental practice, medical lasers were introduced in the 1960's and
the safety of medical lasers is substantiated by several years of
qualified research and many published reference papers. The FDA
has approved several different hard and soft laser dentistry applications,
including use on adults and children.
Will there be pain experienced in laser dentistry?
No. In most cases, pain is either eliminated entirely or significantly
reduced as a result of the lasers selective, precise control. With
laser dentistry, one of the fundamental advantages is the minimal
requirement for anesthetic. When performing many of the procedures,
the laser kills bacteria in the mouth, eliminates bleeding through
coagulation, and reduces pain, in many procedures to the degree
that no anesthetic is required. Lasers also promote faster healing
which minimizes the discomfort associated with the healing process.
What are some of the benefits of laser dentistry?
There are several. It's important to recognize that the technology
offers benefits to the patient as well as the dentist. Here are
some of the primary benefits;
Benefits for the Dentist Benefits for the Patient
- Practice growth and differentiation
- Precise incision, excision and ablation
- Quality of work;
- Increased bond strength
- Higher tensile strength
- Reduced micro-leakage
- Clean, clear operative field
- Reduced stress
- Cleaner procedure, no harmful plume
- Greater through-put (of patients)
- No arcing to metals
- Incremental Revenue (more referrals)
- Greater efficiency (more procedures/visit)
- Fiber delivery provides greater access
- Visibility in oral cavity (Argon)
- No vibration
- Minimal anesthetic requirement
- Higher profile
- Minimal or no bleeding
- Faster healing
- Reduced post-operative infection
- Minimal or no anesthesia
- Minimal pain, inconvenience, discomfort
- Less time in chair
- Precise wavelength minimizes probability of thermal damage to
surrounding healthy tissue.
- Less fear, anxiety, stress - No drill sound
- Conserves tooth structure
- Whitening - single visit procedure and no risk of absorption of
harmful chemicals by the gums
- No needles, no drill, no pain !
What types of procedures can be performed with a Laser?
There are a variety of different lasers approved for use in dentistry.
These lasers produce unique wavelengths, each of which are designed
to have specific reactions when contacting hard and soft dental
tissue. Some lasers can support multiple wavelengths within a single
unit, hence are capable of delivering the optimal wavelengths for
multiple procedures (i.e. - soft tissue management, curing and whitening
are all optimized at different wavelengths).
Some of the procedures which are performed by dental lasers include;
Caries Removal/Cavity Preparation - Class I-IV - 96% Anesthetic
Free
Laser Etching
Laser Whitening (approx.1hour)
Laser-assisted Soft Tissue Curettage
ENAP - Excisional New Attachment Procedure
Gingivectomy
Gingivoplasty
Aesthetic Contouring
Frenectomy
Ginigival Troughing - Eliminates Need to Pack Cord
Gingival Retraction
Implant Exposure
Sulcular Debridement
Root Planing
Biopsy
Aphthous Ulcers
Oral Lesion Therapy
Diagnosis - Trans-illumination for detection of caries micro-fractures
Caries Resistance
Bacteria Elimination and Delayed Re-population
Coagulation
Tissue Fusion - Replacing Sutures
Crown Lengthening
Laser Assisted Flap Surgery
Removal of Granulation Tissue
Papillectomy
Vestibuloplasty
Pulpotomy
Composite Curing
- Ceramic Onlay
- Ceramic Crown
- Ceramic Laminates/Veneers
- Posterior/Anterior Composites
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