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Lasers In Oral Medicine

Lasers in oral medicine

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Lasers In Oral Medicine

  1. 1. DEPARTMENT OF ORAL MEDICINE LASERS IN ORAL MEDICINE Submitted by, shiji margaret bds -crri
  2. 2. contents  Definition  History of laser development  Types of lasers in dentistry  Characteristics of laser light  Features of laser  Treatment using lasers in oral medicine  Conclusion  References
  3. 3. DEFINITION LASER (Light amplification by stimulated emission of radiation) is a device which can operate in the infrared , visible or ultraviolet region of the spectrum and which amplifies electromagnetic waves by stimulated emission of radiation.
  4. 4. HISTORY OF LASER DEVELOPMENT 1916 Albert Einstein: Theory of spontaneous emission of radiation 1960 Theodore Maiman :Ruby laser 1964 Stern ,Sognnaes ,and Gold man :Laser in dentistry 1971 Weichman and Johnson :laser in endodontics 1979 Adrian and Gross Argon laser sterilization of dental instrument 1985 Shoji et al :laser aided pulpotomy
  5. 5. 1986 Zakariasen et al :starilization of root canal 1988 Miserendino Apicectomy with CO2 laser 1990 Potts and Petrou :laser aided photo polymerization of camphoroquinone activated resins 1993 Paghdiwala :Er:YAG laser for root resection and retrograde cavity preparation 1994 Morita:Nd:YAG laser in endodontics 1998 Mazeki et al :Root canal shaping with Er:YAG laser
  6. 6. Type Active medium Dental applications Excimer lasers Argon fluoride Xenon chloride Hard tissue ablation, dental calculus removal Gas lasers Argon Helium-neon Carbon dioxide Curing of composite material, tooth whitening, intraoral soft tissue surgery, sulcular debridement. Analgesia, treatment of dentin hypersensitivity, aphthous ulcere treatment. Intraoral soft tissue and soft tissue surgery, aphthous ulcer treatment, removal of gingival melanin pigmentation, treatment of dentin hypersensitivity, analgesia. Types of lasers in dentistry
  7. 7. Diode lasers Indium-gallium-arsenide-phosphorous Gallium-aluminium-arsenide Gallium-arsenide Caries and calculus detection Intraoral general and implant soft tissue surgery, sulcular debridement, analgesia, pulpotomy, root canal disinfection, aphthous ulcer treatment, removal of gingival melanin pigmentation. Solid state lasers Erbium group Caries removal and cavity preparation, sulcular debridement, scaling and root surface, osseous surgery, root canal treatment.
  8. 8. CHARACTERISTICS OF LASERS Laser light has three unique characteristics, that make it different than "ordinary" light. It is: •Monochromatic •Directional •Coherent
  9. 9. •Monochromatic means that it consists of one single color or wavelength. Even through some lasers can generate more than one wavelength, the light is extremely pure and consists of a very narrow spectral range. •Directional means that the beam is well collimated (very parallel) and travels over long distances with very little spread. •Coherent means that all the individual waves of light are moving precisely together through time and space, i.e. they are in phase.
  10. 10. FEATURES OF LASER •Laser light is highly directional and travels in a narrow beam,the sides of which stay almost parallel. •Laser produces coherent light,that is it has only one frequency •Laser light is of a single color. •Laser light is powerful with very high intensity.
  11. 11. TREATMENT USING LASERS IN ORAL MEDICINE APHTHOUS ULCER  One of the most debilitating oral lesions are recurrent aphthous ulcer. Dental lasers can immediately relieve aphthous ulcer lesion.  Treatment of the lesions is usually performed at low power settings in a defocused mode.
  12. 12.  When treating apthous ulcers,the treated area has to include the entire lesion as well as 3 to 5 mm lateral to the erythematous halo marking this lesions border. If a small area of healthy tissue around the lesion is not treated along with the entire lesion,the ulcer will recur.  Apthous ulcer is treated using erbium laser.
  13. 13. Before treatment After treatment
  14. 14. HERPES LABIALIS •Treating herpes labialis involves passing the laser tip slowly over the entire portion of the lip that is infected, just short of observing the white change in tissue color. •This usually involves treating the treating the entire one half of the lip involved. •This process takes 1 to 2minutes usually without anesthesia. •The healing time of aphthous ulcers can be shortened and the immediate pain reduced by administering 4to 6 J over the lesion.
  15. 15. PERICORONITIS [OPERCULITIS] •Pericoronal inflammation or infection of the gingiva surrounding the crown of the tooth during the eruption of molars may cause patient discomfort. This tissue can be removed with any wavelength of laser. •The advantage of using erbium laser is that only topical anaesthetic may be required. The potential disadvantage is less hemostasis post operatively and the slight risk of ablating hard tissue once the soft tissue has been removed.
  16. 16. HEMANGIOMA  Hemangiomas are benign proliferations of blood vessels that resemble normal vessels.  Half of the hemangiomas occur in the head and neck area,especially the tongue,buccal mucosa and the lips. After infiltration of local anaesthesia,the laser was used in a defocused mode.Ablation of the lesion should begin at the surface of the mucosa at the
  17. 17. peripheral margin working towards the epicenter.This ensures complete removal at the widest dimension. •Charring of the tissues in a vascular lesion is more prevalent because of the absorptive properties of hemoglobin. •Complete healing is achieved within 2 to 6 weeks.
  18. 18. Before treatment After treatment
  19. 19. PERIPHERAL ODONTOGENIC FIBROMA  This is a painless,firm soft tissue mass with an intact mucosa,emerging directly from the gingival sulcus.  This is found most commonly in the premolar or the canine region and most often in females.the size is usually less than 2 cm.  After local anaesthesia is administered by infiltration,an excision biopsy procedure aws performed using the laser in a focused mode,parallel to the facial surface into the sulcus,while reflecting the mass away from the tooth.
  20. 20.  Proximity of the mass to the tooth increases the potential for injury to the tooth.  Sculpting of irregular tissue,intrasulcular ablation and hemostasis are accomplishrd by defocusing energy.  Intrasulcular ablation of the remnants of the periodontal membrane, minimizes the potential recurrence and improves the cosmetic outcome.
  21. 21. Before treatment After treatment
  22. 22. MUCOCELE  Mucoceles are often observed after experiencing a traumatic injury that severs the minor salivary ducts,forcing extravasated mucin into the mucosa and eliciting an inflammatory reaction that causes localized fibrosis.  It is most usually found in the lower lip and is usually 1 cm or less.  Local anaesthesia is administered by infiltration and the CO2 laser is used in a defocused mode.  When ablating the lesion it begins at the peripheral margin of the mucosa towards the epicenter.
  23. 23. •Once the epicenter has reached,applying finger pressure on the lesion causes the enlarged fibrotic minor salivary gland to protrude,allowing complete vapourization of the damaged glandular tissue. •Further ablation is performed by working from the epicenter towards the periphery. •The wound is then left to granulate.
  24. 24. Immediate post-operative Before treatment view 1 week post operative view
  25. 25. TONGUE LIPOMA  Lipomas are proliferations of mature fat cells that arise in the submucosa usually seen in adults of age 40 to 60.  They typically arise in the buccal vestibules and mucosa,floor of the mouth,and tongue.  It an asymptomatic,slow growing mass,non tender,soft,doughy mass 1 cm in diameter,with healthy overlying tissues.  Local anaesthesia was administered by infiltration at the periphery and deep margins.
  26. 26.  A curvilinear “trapdoor” incision was made using a CO2 laser and is used to dissect along the perimeter of the mass in all directions completes the excision biopsy.  The exposed cavity was irrigated with a sterile saline solution and hemostasis was achieved by defocusing the laser.  The tongue flap was approximated and primarily closed with chromic gut interrupted sutures.
  27. 27. Before treatment After treatment
  28. 28. HYPERPLASTIC GINGIVAL TISSUE  When the final result of orthodontic positioning of the front teeth results in gingival hypertrophy,or orthodontic therapy itself causes gingival hypertrophy from poor oral hygiene,the laser can be a useful tool to increase crown length and give the patient a more esthetic smile.  Patients who have drug induced hyperplastic tissue,as from phenytoin administration,as well as organ transplant recipients taking cyclosporine,can also have their tissue reduced and reshaped with lasers.
  29. 29. Before treatment After treatment
  30. 30. HERPES SIMPLEX VIRUS •Patients with a herpes simplex virus type 1 can also be treated using lasers. •If it is treated during the initial prodromal stage,the healing will take only a few days or may even disappear within few hours. •Large blisters can be opened with surgical lasers,eg: CO2,erbium to empty the fluid. •In acute stages of HSV1 infection repeated irradiations is necessary. •Laser light enables the cell to resist viral attack for a longer period, presumably providing time for the immune system to react.
  31. 31. LEUKOPLAKIA  The advantages of using a laser to treat leukoplakia include better control of bleeding,less surgical time,more precise tissue removal,less morbidity and complications and excellent healing with virtually no scarring.  Laser treatment of pre-malignant lesions is through excision or ablation.  The depth of the cut being deep to the lesion itself,usually 4 to 9 mm.  The affected tissue is elevated at one end and undermined with laser acting as a cutting tool.
  32. 32.  The laser is defocused and tissue removed in the multiple side by side U pattern.  With the blood less surgical field, produced by the laser, visual confirmation of complete removal is much easier than with scalpel surgery.  The area is then left to re-epithelialize by secondary intention, avoiding sutures and the possible distortion and scarring.
  33. 33. Before treatment After treatment
  34. 34. VERRUCOUS CARCINOM  It is a slow growing non metastatizing form of squamous cell carcinoma that is most frequently found in the mouth. It is usually a white cauliflower like lesion that is seen in elderly patients Heavy use of snuff,tobacco and cigarettes maybe the primary factor. The CO2 laser has proved to be an effective means of treating verrucous carcinoma by total excision in cutting mode.
  35. 35. Before treatment After treatment
  36. 36. TEMPOROMANDIBULAR JOINT SURGERY  Artroscopic surgery of the TMJ has been a successful mode of surgery.Eliminating the need for physical contact with the diseased tissue the trauma to surrounding synovial tissue and articular cartilage.  Laser use can also provide rapid coagulation with minimal thermal damage allowing better visualization of the surgical field and decreased hemarthrosis.  Laser surgery is much more precise and can be more easily manipulated in the narrow joint space.
  37. 37.  The Ho:YAG laser is minimally absorbed by water and therefore transmits its energy directly to the desired tissue.  Arthroscopic procedures are typically performed under general anaesthesia with naso tracheal intubation.  Procedures such as diskectomy ,diskoplasty, synovectomy, hemostasis, posterior attachment contraction,anterior release and debridement of fibrous ankylosis can be performed.
  38. 38. CONCLUSION Current laser research focuses on Optical Coherance Tomography in dental diagnosis (OCT) in dental diagnosis,new dental applications for the alexandrite laser,and photo activated disinfection in daily practice. Carbon dioxide lasers, has shown to be effective in many fields of dentistry,with advantages such as less bleeding,selective removal of tissue,short operating time and reduced post operative pain. Future studies will show the feasibility of using these new technologies as everyday tools in many clinical applications.
  39. 39. REFERENCES 1.Robert A. Convissar, Principles And Practice Of Laser Dentistry,edition 2011. 2.Grossman’s Endodontic Practice,12th edition. 3. Carranza’s Clinical periodontology, 10th edition