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LASER IN PERIODONTICS

Dr. Saswati Sarmah

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INTRODUCTION

 LASERs were first introduced into the field of dentistry with the perception of
overcoming few of the drawbacks set by conventional methods of dental
procedures.

 Ever since its first inception for dental application in the early 1960's,
significant strides have been made in the last couple of decades.

 At present, wide arrays of clinical procedures are carried out using LASERs.

 A remarkable paradigm shift is occurring in the field of dentistry with a

technology breakthrough that gives dentists the capability to perform a wide
range of hard and soft tissue procedures with which improved patient outcomes,
minimal trauma and reduced postoperative complications are achieved.
LASERs can be applied to diverse areas in the field of dental research

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 HISTORY
1917, Albert Einstein

1954, Charles Townes & Arthur Schawlow built

the MASER using ammonia and microwave
energy

LASER is an acronym for ‘Light Amplification

by the Stimulated Emission of Radiation’ given by
public Columbia University graduate student,
Gordon Gould 1959.

Theodore Maiman 1960, Ruby LASER

The first application of a LASER to dental tissue

was reported by Goldman et al. and Stern and
Sognnaes in 1963

Lasers in Periodontics: A Review of the Literature Charles M. Cobb, J Periodontol April 2006 4
COMPONENTS

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 PROPERTIES
LASER light energy has following characteristics :

a) Energy emitted is a light of one color (Monochromatic) thus of a single

wavelength.
b) Photons can be Collimated into an intensely focused energy beam which
interacts with the target tissue.
c) Each wavelength is identical in physical size and shape (Coherent).

Dental Lasers -A Review Dr. Vishakha S. Patil, Dr. Rohini Mali, Dr. Priya Lele, International Journal of 6
Scientific and Research Publications, Volume 3, Issue 8, August 2013
 LASER TISSUE INTERACTION
Depending on the optical properties of the tissue, the light energy from a laser may
have four different interactions with the target tissues.
1. Reflection
2. Absorption
3. Transmission
4. Scattering

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MODE OF EMISSION

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CLASSIFICATION OF LASER

(periodontology 2000, 2009)

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 APPLICATIONS IN DENTISTRY

 B. iopsy. Tori reduction.

Surgery (major & minor) Soft tissue modification around

laminates.
Apicoectomy.
Impacted teeth exposure for
Teeth preparation. orthodontic movement.

Epulis fissuratum. Caries removal.

Residual ridge modification. Root canal disinfection.

Bleaching. Bacterial reduction

Impaction. Crown contouring

Pontic site preparation  Crown lengthening

A Contemporary Apprise on LASERS and its Applications in DentistryChaitanya Pendyala1, International Journal of
Oral Health and Medical Research JULY-AUGUST 2017 ,VOL 4 ,ISSUE 2 47 10
 CLINICAL APPLICATIONS IN PERIODONTICS

Initial non-surgical pocket Osseous recontouring.

therapy.
Crown lengthening.
Frenectomy/ Frenotomy
Surgery- implants.
Gingivectomy/ Gingivoplasty
Peri-implantitis.
Soft tissue grafting.
Operculectomy.
De-pigmentation.
Removal of granulation
Desensitization tissue.

A Contemporary Apprise on LASERS and its Applications in DentistryChaitanya Pendyala1,

International Journal of Oral Health and Medical Research JULY-AUGUST 2017 ,VOL 4
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,ISSUE 2 47
Application Of Lasers In Periodontal Therapy: A Review Of Literature With Proposed Classification, dr. Rao naman
Rajeshkumar and Dr. Chandramani B. MoreInternational Journal of Current Research Vol. 8, Issue, 09, pp.38985-38994,
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September, 2016
 ADVANTAGES OF LASER
 Relatively bloodless surgical and post-surgical course

 The ability to coagulate, vaporize, or cut tissue

 Sterilization of wound tissue

 Minimal swelling and scarring

 No requirement of sutures

 Little mechanical trauma

 Reduced surgical time

 inDecreased
Lasers post-surgical
periodontics Sugumari Elavarasu, pain
Devisree Naveen, and Arthiie Thangavelu, J Pharm Bioallied Sci. 2012 Aug;
4(Suppl 2): S260–S263.
 High patient acceptance
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DISADVANTAGES OF LASER

 Destruction in the bottom of pocket may occur if the laser fibre is not placed
short of the bottom of the pocket.

 In periodontal pockets excessive ablation of root surface and gingival tissue

may occur if the proper criteria is not followed.

 LASER may cause thermal injury to root surface, gingival tissue, pulp and bone
tissue .

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 A STRONG

HOUSE
APPLICATION OF LASER IN PERIODONTAL
NEEDS A
TREATMENT
STRONG

FOUNDATION

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NON SURGICAL PERIODONTAL THERAPY

 LASERs have a direct deleterious effect on bacteria .

 Incorporating LASERs into conventional therapy helps accomplish treatment

objectives.

 Deposits and biofilms are more thoroughly removed and that a more
biocompatible surface is created for reattachment with use of erbium LASERs
than conventional method .( Aoki et al)

 Co2 LASER has been shown to increase adherence of fibroblasts to root

surface.

 In LASER assisted phase1 therapy the diseased biofilm infested tissue of the
periodontal pockets are debrided.

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SULCULAR DEBRIDEMENT WITH LASER DELIVERY

Calibrating laser fibre length Laser fibre in periodontal pocket

Immediate post operative

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SULCULAR DEBRIDEMENT WITH CO2 LASER

Marginal dehydration of gingival tissue Tip of co2 laser in periodontal pocket

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Reduction of periodontal probing depth after 6 month

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 LASER-INDUCED ROOT SURFACE
MODIFICATIONS
 LASERs like CO2, Nd:YAG, Er:YAG, and, to a lesser extent, the diodes have
been used majorly for surface modifications of dentin and cementum.

 Majorly wavelengths have to be taken in to consideration for using LASERs

over the root surface to avoid the damage to root and effects to pulp.

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Extraoral root planing using an Er: YAG LASER (with sapphire tip) provides complete
calculus removal, a smooth, undamaged root surface, and removal of the cementum

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 DENTINAL HYPERSENSITIVITY

 LASER therapy was first introduced as a potential method for treating dentinal
hypersensitivity in 1985

 LASER treatment reduces sensitivity by coagulation of protein without altering

the surface of the dentin .

 Pashley suggests that it may occur through coagulation and protein precipitation
of the plasma in the dentinal fluid or by alteration of the nerve fiber activity.

 The study by McCarthy et al. indicates that the reduction in DH could be the
result of alteration of the root dentinal surface, physically occluding the dentinal
tubules.

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LASER IN DENTINAL HYPERSENITIVITY

Assessment Application
of hypersensitivty
of LASER
with VAS scoring

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 LASERS IN SURGICAL PERIODONTICS
ADVANTAGES OF LASER OVER CONVENTIONAL

Minimal collateral effects result in decreased tissue damage

Patient comfort can be enhanced

Hemostasis and coagulation typically readily achieved

Some procedures can be performed with topical anaesthesia only

The concept of minimally invasive dentistry can be achieved

LASERs are safe if the operators adheres to protocol

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 GINGIVECTOMY/GINGIVOPLASTY

 Time honoured procedure for removal of gingiva.

 The indications ranges from access to esthetics.

 Can be used when suprabony pockets are present and access to osseous
structure is not necessarily important.

 Resecting gingiva with laser enhances access because of increased visualization

resulting from sealing of capillaries and lymphatics during laser irradiation.
(principal and practice of LASER dentistry, Robert A Convissar)

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GIGIVECTOMY WITH LASER

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LASER gingivectomy performed to gain access for restoration prognosis

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GUMMY SMILE CORRECTION

 Beautification of smiles is becoming an everyday requirement in dental

practice. Apart from teeth, gingiva also plays an important role in smile
Beauty is
esthetics.
power..
smile is its
 Excessive
sword.. visualization of gingiva is a common complaint among patients
seeking esthetic treatment.

 A wide variety of procedures are available for correction of excessive gum

display based on the cause of the condition.

 Soft tissue diode LASER contouring of gingiva is a common procedure that can
be undertaken in a routine dental setting with excellent patient satisfaction and
minimal post-operative sequale

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(a) Preoperative smile, (b) Diode LASER contouring, (c) 2 week postoperative gingival contour,
(d) One month post operative smile.

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 GINGIVAL DEPIGMENTATION
 Gingival hyperpigmentation can be defined as a darker gingival color beyond what
is normally expected.Pigmentation is contributed by-products of the physiological
process such as melanin, melanoid, carotene, oxyhemoglobin, reduced
hemoglobin, bilirubin and iron and/or pathological diseases, and conditions

 Most commonly used LASERs for gingival depigmentation are carbon dioxide
(CO2, 10,600 nm) lasers, neodymium: Yttrium, aluminum, and garnet (Nd: YAG,
1,064 nm) and diode (980 nm) lasers.

 LASERs exhibit enhanced hemostatic activity, good visibility at the surgical site
and fewer post-operative complications such as pain, bleeding, edema, infection,
and impaired wound healing

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GINGIVAL DEPIGMENTATION WITH LASER

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 FRENECTOMY / FRENOTOMY

 Frenectomy procedures with laser are predictably successful so long as the

following steps are incorporated-

1. Creation of a periosteal fenestration at the base of the frenectomy to prevent

reattachment of fibres.
2. Removal of all impeding muscle fibres.

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FRENECTOMY WITH LASER

The upper anterior labial frenum is extended to the

palatal inter-incisal area causing dental discrepancies.

The final rhomboidal laser cut

Post operative did not require
view
sutures
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LINGUAL FRENECTOMY

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ENHANCING MUCOGINGIVAL ATTACHMENT

Preoperative view showing

Intraoperative decreased
view width of attached
using laser
gingiva and gingival recession in tooth 31, 41
Postoperative view - 45 days after vestibuloplasty

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MUCOGINGIVAL RECONTOURING

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CROWN LENGTHENING WITH LASER

 Crown Lengthening indicate procedures designed to increase extension of

surpagingival tooth structure for restorative or aesthetic purposes

 The laser-assisted soft-tissue crown-lengthening procedure is a valuable

treatment that can establish a healthier and more esthetic appearance regardless
of what terminology is used to describe the procedure.

 With the proper use of most dental surgical lasers, it can be accomplished with
relative ease and with minimal discomfort to the patient and less stress to the
clinician with an extremely predictable outcome.

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 CROWN LENGTHENING WITH LASER

The surgical plan was mapped to measure the planned correction in the
cervico-incisal direction to ensure esthetic width-to-length ratios were
followed

With the surgical guide in place, the proposed gingival margin was
Following
transferred to the patient’s tissues by using the Er:YAGlaser-mediated
laser at low power gingivectomy,
A periodontalPreoperative
probe was anterior
used toview showing
measure bone sounding
theexcessive display revealed thetissue
of gingival osseous crest at
asymmetrythe
and toothdirection
planned correction in the cervico-incisal whennewly
smilingpositioned gingival margin.
to ensure the esthetic width-to-length aspect was Osseous resection was therefore required to
followed. create space for the biologic width

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GINGIVAL DE-EPITHELIZATION

 The rationale for laser de-epithelialization stems from the attempts to block the
down-growth of epithelium into the healing periodontal wound after surgery
and prevent formation of a long junctional epithelial attachment.

 The use of a CO2 laser to de-epithelialize the gingival flaps is an attempt to

exclude this cell type from the healing wound and has been used with and
without the benefit of GTR membranes.

Laser de-epithelialization for enhanced guided tissue regeneration. A paradigm shift?

Rossmann JA1, Israel M. Dent Clin North Am. 2000 Oct;44(4):793-809.

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(a) Preoperative clinical condition; (b) clinical condition after laser-assisted
scaling and root planing in conjunction with a de-epithelialization of the oral
and sulcular epithelium for pocket reduction using an Nd: YAG laser; (c) stable
long-term clinical condition (5 years postoperative)

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Surgical procedure: (a) Incision. (b) Flap elevation. (c) Laser de-epithelialization. (d)
Incision in the donor site. (e) Harvesting of graft. (f) Final position of flap
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Preoperative view Postoperative view

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LASER EXCISION OF LOCALISED LESION

 Lasers have obvious benefits for all the patients without administering
anesthetic shots and that means less time spent in the dental chair.

 Procedures are performed more conservatively, with less trauma for patients.

 Laser applications also enable the patient to enjoy a more relaxed dental
experience, reducing or diminishing their fears, and resulting excellent post-
operation experience for patients.

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LASER EXCISION IMMEDIATE POST OP
3MONTHS POST OP

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 LASER-ASSISTED NEW ATTACHMENT
PROCEDURE

 laser-assisted new attachment procedure (LANAP) could initiate regeneration

of the affected periodontal tissues in human beings, and new connective tissue
attachment mediated by cementum could be seen

 Patients needing standard periodontal treatment with pocket depth (PD) ≥4 mm

are indicated for LANAP [Katuri KK, Clinical effectiveness of laser assisted
new attachment procedure as an adjunct to nonsurgical periodontal treatment: a
randomized clinical study. J Int Oral Health. 2015;7(11):57–62]

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 PHOTOYNAMIC THERAPY
 Photodynamic therapy (PDT) has emerged in recent years as a noninvasive
therapeutic modality for the treatment of various infections by bacteria, fungi,
and viruses.

 It involves the use of low power lasers with appropriate wavelength to kill
microorganisms treated with a photosensitizer drug.

 The use of contemporary PDT was first reported by the Danish physician, Niels
Finsen.

 PDT is based on the principle that a photoactivable substance (the

photosensitizer) binds to the target cell and can be activated by light of a
suitable wavelength. During this process, free radicals are formed (among them
singlet oxygen), which then produce an effect that is toxic to the cell

Scope of photodynamic therapy in periodontics, Vivek Kumar , indian journal of dental

research,2015,26, 439-442
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Application of the phenothiazine chloride dye following subgingival SRP

Application of the low level laser light into the pocket

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 REGENERATIVE LASER PERIODONTAL
THERAPY

 The use of laser to deepithelize the gingival flaps is an attempt to exclude

epithelial cells from the healing wound
 This approach is used with or without GTR.

Laser wound margin shows thermal necrosis and impedes epithelial migration

Decrease in wound contraction compared with scalpel

The thin layer of denatured collagen on the wound surface acts as impermeable
dressing

Reduced inflammation in the laser induced wound

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LASER BIOMODIFICATION OF PERIODONTAL POCKET

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POST OPERATIVE VIEW

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SURFACE BIOMODIFICATION IN LASER TREATMENT OF
FURCATION

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 LASERS IN IMPLANT

 There are many therapeutic role of laser in improving the presurgical , surgical
and postsurgical and prosthetic phase of implant dentistry.

 From surgical placement to prosthetic delivery to treating infected periimplant

tissues lasers have been proved to be beneficial in many ways.

 A promising method for decontaminating implant surfaces involves the use of

laser energy.

 Unlike mechanical decontamination methods, which can not fully adapt to the
irregularities on the surface of an implant, lasers can irradiate the whole surface,
reaching areas that are too small to receive mechanical instrumentation

Laser Therapy: The Future Of Peri-implantitis Management? Nicholas Peters,braz J

Periodontol - March 2012 - Volume 22 - Issue 01

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FRENECTOMY AND MIDCRESTAL INCISION

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ALTERATION OF UNEVEN SOFT TISSUE AROUND IMPLANT

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DECONTAMINATION OF SURGICAL SITE

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PERI-IMPLANTITIS

(a) Swelling and bleeding on probing around the left

posterior implant. (b) Peri-implant bone loss involving
more
Surgicalthan 50% (a)
treatment: of Erbium-doped
the implant yttrium
length.aluminium
Nonsurgical
garnet
scaling
(Er:YAG)andlaser
debridement of failing implant. (a)
debridement/decontamination. (b)Ultrasonic
Synthetic
Teflonsubstitute.
bone tip used for mechanical
Six-month reevaluation.scaling and implant
(a) Reduced swelling
around the left posterior implant. (b) Peri-implant bone
debridement.b)Er:YAG)laserdebridement/decontaminatin
regeneration.
of the subgingival implant surface. 58
 CONCLUSION

 LASERs are captivating technology and one of the best inventions of the
twentieth century. The application of LASERs in Periodontology will definitely
alter the clinical practice with numerous uses in the nonsurgical as well as
surgical aspects of therapy.

 Although lasers cannot replace all the conventional procedures , it's use enables
some procedures to be performed differently than the conventional procedure
and its development in the field continues to expand further enabling greater
patient care.

 Lasers are a “new and different scalpel” (optical knife, light scalpel)

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REFERENCES

 Dr. Vishakha S. Patil, Dr. Rohini Mali, Dr. Priya Lele , Dental Lasers-a review,
International Journal of Scientific and Research Publications, Volume 3, Issue
8, August 2013
 Chaitanya Pendyala , Rahul VC Tiwari , Heena Dixit , Vaishak Augustine , A
Contemporary Apprise on LASERS and its Applications in Dentistry,
International Journal of Oral Health and Medical Research, vol 4, issue 2 july-
august 2017
 Sachit Anand Arora, Shivjot Chhina, Johnn Kazimm , Anjali Goel, Shivesh
Mishra, Clinical Crown Lengthening Using Soft Tissue Diode Laser: A Case
Series , International Journal of Oral Health and Medical Research, vol 2 | issue
5 january-february 2016 |

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