LASERS IN

PERIODONTICS
By: Dr.Shima Hassan
What is??
■ Laser is an acronym for “Light Amplification by Stimulated
Emission of Radiation.” Lasers function by stimulating the
emission of light energy from a given medium in a collimated,
focused monochromatic ray of light. The energy beam reacts with
a target tissue by being absorbed, reflected, or scattered
depending on wavelength and absorption characteristics . Some
lasers (e.g., Nd:YAG lasers) may be transmitted through surface
tissues to interact with deeper tissues.
■ When the laser is well absorbed, the energy explodes the target
tissue cells and extracellular matrix in a process called ablation.
The efficiency of ablation is related to the wavelength and the
affinity of the laser beam for the target tissue.
■ Laser beams may also be reflected or bounced off the target (e.g.,
reflected off a metal surface) without interaction. This is typically
an undesirable
■ Lasers are commonly used in many fields of medicine to treat a
variety of problems.
■ The technologic perspective of laser therapy gives patients the
perception that they are getting state-of-the-art treatment. Despite the
fact that dental applications were investigated with the earliest lasers,
they did not offer much benefit over conventional therapies and the
interest in lasers for dentistry faded until the 1990s.
■ Recently, with the evolution of laser devices, there has been increased
interest in applying lasers to dentistry and, in particular, to periodontal
and implant procedures. There is a perception that laser technology
can enhance conventional periodontal and implant surgical therapies.
Potential advantages of laser therapy include improved access,
minimally invasive surgery, wound detoxification, enhanced healing,
and greater patient acceptance.
■ However, these perceived advantages need to be evaluated and
validated in well designed controlled clinical studies.
Laser Applications in Periodontics

■ Currently, lasers are used in periodontal therapy for

■ (1) aesthetic surgical procedures such as gingivectomy,
osseous crown lengthening, and depigmentation;
■ (2) nonsurgical therapy
■ (3) decontamination and antimicrobial therapy
■ (4) biomodulation
■It is important for clinicians to recognize not
only the type of tissue (e.g., hard vs. soft
tissue) but also the quality of target tissue
makeup when applying laser therapy. For
example, the varying percentages of
mineralized structures, blood vessels, and
fluid found in cortical bone versus cancellous
bone will result in the laser energy beam
encountering differing fluctuations in
absorption and scattering, regardless of the
wavelength.
Aesthetic and Pre-Prosthetic Surgical
Applications
■ Several types of laser wavelengths have been used for soft tissue
surgical procedures.
■ Appropriate use of lasers for procedures such as frenectomy,
gingivectomy/gingivoplasty, reshaping of drug-induced gingival
overgrowth, exposure of short crowns associated with altered
passive/delayed eruption, and management of excess mucosal
tissue such as pericoronitis situations distal of mandibular second
molars have been well documented.
■ Some of the positive aspects of laser therapy are good visibility
during the surgical procedure as a result of coagulation,
hemostasis, and minimal tissue damage
 Nonsurgical Periodontal Therapy
■ One of the more prevalent applications of lasers in periodontics is the
nonsurgical treatment of moderate to advanced chronic periodontitis.
■ Lasers have been used as a monotherapy or as an adjunct to scaling and root
planing.
■ The purported benefits of lasers for nonsurgical periodontal therapy include
subgingival curettage, minimally invasive access for scaling and root planning,
and calculus removal, as well as detoxification and killing of subgingival
periodontal pathogens.
■ In the clinical situation, periodontal pathogenic bacteria exist within a protective
biofilm in a periodontal pocket.
■ Consequently, it is difficult for conventional periodontal therapies to completely
eliminate them.
■ Laser therapy is proposed to improve access to areas that are difficult for
instruments to reach and to facilitate killing bacteria. Indeed, lasers with various
wavelengths have been shown to effectively kill periodontal pathogens.
 ■ 1. Do the in vivo studies demonstrate a
reduction in pathogenic bacteria as compared
with conventional therapy (e.g., scaling and
root planing [SRP])?
When assessing the ■ 2. Are positive microbial changes sustained, or
do the periodontal pathogens return and
effectiveness of any recolonize the sites?
particular laser type used ■ 3. Are there any differences in clinical
parameters following laser-assisted versus
for nonsurgical conventional therapy SRP? When evaluating
nonsurgical periodontal therapy, gain in clinical
periodontal therapy, attachment level (CAL) represents the gold
standard. Pocket depth (PD) and levels of
several questions need to subgingival microbes are important because
they correlate with changes in CAL.
be considered
■ 4. Are there changes in root surface condition
based on in vitro or in vivo studies?
Complications and Risks of Laser
Therapy
■ The primary disadvantage of laser therapy is the potential for
unintended tissue damage, as lasers can easily generate
excessive temperatures.
■ The exposure of bone to temperatures =47°C (116.6°F) can induce
cellular damage and osseous resorption. Extreme temperature
levels of =60°C (140°F) result in tissue necrosis.
■ Overexposure of laser energy has been the basis for complications,
reports of tissue damage, and destruction of the periodontium.
■ New, inexperienced operators as well as more seasoned, “cutting-
edge” clinicians may encounter disastrous results from their initial
treatments
■ To avoid these negative outcomes, knowledge of the laser
mechanics and technique is essential to minimize tissue damage.
PHOTODYNAMIC
THERAPY
Photodynamic Therapy
■ Photodynamic therapy (PDT) involves the use of a
photosensitizer (photoactive dye) that is activated by exposure
to a specific wavelength of light in the presence of oxygen. The
activated photosensitizer transitions to an excited state and
subsequently reacts with oxygen to create singlet oxygen and
free radicals, which are damaging to proteins, lipids, nucleic
acids, and other vital elements causing destruction of the target
tissues.
■ In the case of biofilm and periodontal pathogens, antimicrobial
photodynamic therapy (aPDT) may appear to offer a magic bullet
effect of target killing bacteria. PDT may be an effective means
of disrupting the biofilm.
■ Antimicrobial photodynamic therapy uses a photosensitizer
(nontoxic dye), which specifically targets microorganisms and is
activated by low-level laser light.
■ The introduction of a photosensitizer can greatly increase the
bactericidal ability of a laser.
Low-Level Laser Therapy
■ The use of low-level laser therapy (LLLT) for photobiomodulation is
prevalent in medicine.
■ The term low-level laser therapy refers to the therapeutic
application of light to tissues with the goal of reducing pain or
stimulating healing.
■ It is referred to as “low level” because the density of light energy is
low compared with other lasers
■ Although LLLT is widely used in medicine, it continues to be
controversial because the biologic mechanism(s) are not
understood and the parameters of use (i.e., wavelength, power,
pulse, and timing or exposure duration) are not defined.