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DEPARTMENT OF ORAL MEDICINE
LASERS IN ORAL MEDICINE
History of laser development
Types of lasers in dentistry
Characteristics of laser light
Features of laser
Treatment using lasers in oral medicine
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
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
1971 Weichman and Johnson :laser in
1979 Adrian and Gross Argon laser sterilization
of dental instrument
1985 Shoji et al :laser aided pulpotomy
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
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
Type Active medium Dental applications
Excimer lasers Argon fluoride
Hard tissue ablation, dental
Gas lasers Argon
Curing of composite
material, tooth whitening,
intraoral soft tissue surgery,
Analgesia, treatment of
aphthous ulcere treatment.
Intraoral soft tissue and soft
tissue surgery, aphthous
ulcer treatment, removal of
pigmentation, treatment of
Types of lasers in dentistry
Diode lasers Indium-gallium-arsenide-phosphorous
Caries and calculus
Intraoral general and
implant soft tissue surgery,
analgesia, pulpotomy, root
canal disinfection, aphthous
ulcer treatment, removal of
Solid state lasers Erbium group Caries removal and cavity
debridement, scaling and
root surface, osseous
surgery, root canal
Laser light has three unique
characteristics, that make it different
than "ordinary" light. It is:
•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.
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
TREATMENT USING LASERS IN ORAL
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.
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.
•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
•The healing time of aphthous ulcers can be shortened and
the immediate pain reduced by administering 4to 6 J over
•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.
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
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
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
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.
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
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
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.
•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.
Before treatment view
1 week post
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
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
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
The tongue flap was approximated and primarily closed
with chromic gut interrupted sutures.
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.
HERPES SIMPLEX VIRUS
•Patients with a herpes simplex virus type 1 can also be treated
•If it is treated during the initial prodromal stage,the healing
will take only a few days or may even disappear within few
•Large blisters can be opened with surgical lasers,eg:
CO2,erbium to empty the fluid.
•In acute stages of HSV1 infection repeated irradiations is
•Laser light enables the cell to resist viral attack for a longer
period, presumably providing time for the immune system to
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
Laser treatment of pre-malignant lesions is through excision or
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.
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.
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
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
Laser surgery is much more precise and can be more easily
manipulated in the narrow joint space.
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.
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.
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