LASERS IN PEDIATRIC

DENTISTRY

PRESENTED BY
DR. ASHWIN. D. BHAT
 Contents

• Introduction
• Mechanism
• Components of lasers
• Types of lasers
• Application of lasers in pediatric dentistry
• Conclusion
• References
 INTRODUCTION
• Dentistry has advanced a lot.

• Among various advances, one which have good scope

of improvement is the use of LASERS in dentistry.

• Recent advances in laser technology will bring

revolution in dentistry.

• Light Amplification by Stimulated Emission of

Radiation.
• Laser radiation is characterized by a low
divergence of the radiation beam and a
well-defined wavelength

• Most lasers intended for medical and

dental use operate in the red to infra-red
spectra of light
 History

• It was discovered by Shallow & Towns in 1958.

• First working laser, a synthetic ruby laser was built by

Theodore maiman of Hughes research laboratories in 1960.

•1964: The first report of laser application for the treatment

of dental caries was published by Goldman et al

•1990: Myers and Myers designed the first laser specifically

for general dentistry, the DLase 300 Nd:YAG laser.

•1997: FDA approved Er:YAG laser.

FUNDAMENTALS OF
LASERS
 LIGHT
Light is a form of electromagnetic energy that travels
in waves, at a constant velocity (186,000
miles/Sec).

The basic unit of this radiant energy is called a photon

or a particle of light.

A wave of photons can be defined by 2 basic

properties
• Amplitude – This is defined as the height
of the wave oscillation from the top of
the peak to the bottom.

• A measurement of the amount of energy

in the wave:
– larger the amplitude, greater the amount of
energy that can do useful work.
• Wave length: Distance between any two
corresponding points in the wave.

• Wavelength is the physical property that

determines the classification of electromagnetic
energy and lasers are named by their characteristic
wavelength and active medium.

• Wavelength is measured in meters.

– Micrometer (µm) = 10-6 meters or micron (µ)
– Nanometer (nm) = 10-9 meters
 Wavelength
Amplitude

Velocity

Frequency is the number of complete oscillations

of the wave per second.
AMPLIFICATION means that a very bright intense
beam of light can be created.

The light may be activated by a few photons, and

then many, more are generated.

The initial light is amplified to make a very bright

compact beam.
STIMULATED means that the photons are
amplified by stimulating an atom to release more
photons.

An atom can exist in an excited state, similar to a

bow when it is stretched. When the atom relaxes it
emits a photon.
EMISSION refers to the giving off of photons.
The excited atom emits a photon when another
photon comes by.

In 1917, Einstein described this process as

Stimulated Emission.
 RADIATION : It is a term for anything that is
radiated, or given off by an object.

For lasers, radiation refers to the PHOTONS which

are being emitted.
Electromagnetic spectrum and wavelengths of dental lasers
 Characteristics of Laser Light
• Spatial and temporal beam COHERENCY - Laser
light is in phase (same time and space)
• Monochromaticity - Laser light is all one
wavelength (the same color)
• Collimation - Laser light travels in a straight line.
 Incandescent vs. Laser Light

1. Many wavelengths 1. Monochromatic

2. Multidirectional 2. Directional

3. Incoherent 3. Coherent
Laser physics
 In the hypothetic energy diagram of an atom, an
electron whirls in an orbit surrounding a nucleus.

This electron ordinarily is in a low energy state, with

its domain in the ring most immediate to the
nucleus .
If a photon - a unit of energy strikes the atom, the
electron absorbs the energy and is transferred to a
more excited state which is less stable than the
resting or low – energy state.

The electron now occupies an orbital ring more distant

from the nucleus.
This process is called absorption.
Once an electron moves to a higher-energy orbit, it
eventually wants to return to the ground state.
When it does, it releases its energy as a photon -- a particle
of light

This phenomenon is termed spontaneous emission of

radiation.
When an atom in the excited state becomes irradiated with a
photon of light energy of the same wavelength and
frequency that was previously absorbed, as it returns to its
resting state, it will emit two photons of light energy of
the same direction in spatial and temporal phase.

This is the stimulated emission of radiation

 COMPONENTS OF LASER
There are 3 main parts of laser delivery system.

1. LASING OR ACTIVE MEDIUM

•It is the material which is capable of absorbing the

energy produced by the external source through
subatomic configuration of it’s component
molecules & subsequently giving the excess energy
as photons of light.

•It can be solid, liquid or gas.

LASER COMPONENTS
 2. ENERGY OR PUMPING SOURCE

•It is used to excite or pump the atoms in lasing

medium to their higher energy levels that are
essential for laser production.

•It can be electrical, thermal, chemical or

Optical.
3. OPTICAL OR RESONATING CHAMBER

•The lasing medium is located within the

Optical chamber.

•It is a cylindrical structure with fully

Reflecting mirror on one side & partially
reflecting mirror on other side—parallel to
each other.
•This arrangement allows reflection of photons
Of light, back & across the chamber.

•It will result in production of intense photo

resonance within the medium.
 TYPES OF LASERS
• 2 categories of lasers are used in medicine & dentistry

(1)HARD LASERS
- Longer wavelength
- Cuts the tissue by coagulation, vaporization &
carbonization.
- Used for surgical soft tissue applications

(2)SOFT LASERS OR LOW LEVEL LASERS

- Low energy wavelengths
 They are believed to stimulate circulation & Cellular
activity & causes various effects such as anti-
inflammatory, vascular, muscle relaxant, analgesia &
tissue healing.

•There are many types of lasers used in

dentistry, depending upon their active medium

(1)CARBONDIOXIDE LASER
- WAVELENGTH: 10.6um
- USES: Soft tissues , dentin desensitization
(2)ARGON LASERS
- WAVELENGTH: 488,514.5um
- USES: Curing , soft tissue desensitization
(3)Nd:YAG [NEODYMIUM:YTTRIUM-ALLUMINIUM
GARNET] LASER
- WAVELENGTH: 1.064um
- USES: Soft Tissue , Desensitization , Analgesia
Toothwhitening , Periodontics,
Endodontics

(4)KTP[POTASIUM-TITANYL PHOSPHATE] LASER

(5)HELIUM-NEON[He-Ne]

(6)RUBY LASER

(7)EXCIMER LASER
(8)HOLMIUM[Ho]:YAG LASER

(9)ERBIUM[Er]:YAG LASER
- WAVELENGTH: 2.94um
- USES: Hard tissue

(10)ERBIUM-CHROMIUM[Er-Cr]:YSGG LASER
- WAVELENGTH: 2.79um
- USES: Hard tissue

(11)DIODE
- WAVELENGTH: 800-830um
- USES:Soft Tissue , Periodontics
LASER UNITS
LASER UNITS

LASER TIPS
 LASER DELIVERY SYSTEMS
The coherent, collimated beam of laser light must
be able to be delivered to the target tissue in a
manner that is ergonomic and precise.

Two delivery systems are used in dental lasers.

1. Flexible hollow wave-guide or tube that has an

interior mirror finish.
The laser energy is reflected along this
tube and exits through a hand piece at the
surgical end, with the beam striking the tissue in
a non contact fashion (ie, without directly
touching the tissue)
• Second delivery system is a glass fiber optic
cable.

• The cable is pliant and comes in various

diameters, with sizes ranging from 200 to 1000µ.

• The glass fiber, although encased in a resilient

sheath, can be fragile and cannot be bent into
sharp angle. It fits snugly into a hand piece with
the bare end protruding or, in some cases, with
an attached glass like tip.

• This fiber system can be used in contact or non-

contact mode, mostly contact mode.
Laser Delivery Systems

Fiberoptic cable Articulated arm

 PRECAUTIONS IN CLINICAL USE OF LASERS

Caution before and during irradiation

• Use of glasses for eye protection (patient, operator and
assistants)
• Precautions for inadvertent irradiation and reflection from
shiny metal surfaces
• Protection of patients throat and oral tissues outside the
target site
• Accurate foot pedal control
• Adequate high speed evacuation to capture the laser
plume
 Laser hazard classification according to ANSI &
OSHA standards.

Class Description
• I • Low powered that are safe

• Low powered visible lasers that

are hazardous only when
• II a viewed directly for longer than
1,000 sec.
•
• II b • Low powered visible lasers that
are hazardous when viewed for
longer than 0.25 sec.
• III • A Medium-powered lasers or
systems that are normally not
hazardous , if viewed for less
than 0.25 sec. without
magnifying optics.

• Medium powered laser (0.5W

• III b maxim) that can be
hazardous if viewed directly

•
• High powered lasers (>0.5W)
• IV that produce ocular , skin &
fire hazardous.
APPLICATION OF LASERS IN PEDIATRIC DENTISTRY

DIAGNOSIS OF DENTAL CARIES

(A)INFRARED LASER FLUORESCENCE

[DIAGNODENT]

- Diagnodent is an instrument, recently designed to facilitate

the detection of dental caries.

- Used for detection of caries on occlusal & smooth surface.

 MECHANISM OF ACTION

Diode laser light source & fiber optic cable

It transmits light to hand held probe with fiber optic eye on tip

Light is absorbed & induces infrared fluorescence by organic or inorganic

materials

Emitted fluorescence is collected at probe tip transmitted through ascending

fibers, processed & presented on display window as an integer between 0- 99.

If fluorescence is higher than 20,it reflects carious tooth substance.

•Instrument is also capable of detecting advanced
carious lesions.

•Readings are influenced by several variables like,

- Dehydration of lesion
- Presence of plaque
- Presence of various types of stains in
occlusal surface.

* This instrument is very good at indicating the

presence of deeper lesions in enamel or dentin but
unable to indicate the depth of the lesion in dentine.
(B)LASER INDUCED FLUORESCENCE

- Kutsch in 1992,illuminated carious & non carious tissue with

argon laser along with dark field photography.

- He reported that while illuminating, carious has clinical

appearance of dark,fiery,orange-red colour.
(C)QUANTITATIVE LASER FLUORESCENCE

- A hardware & software system was developed in

Netherlands & Sweden.

- It collects images of the lesions based on excitation at

488um with argon laser.

(D)OPTICAL COHERENCE TOMOGRAPHY

- It is an imaging technique, capable of producing two

dimensional or three dimensional images of subsurface
tissue.
 CAVITY PREPARATION WITH LASER

- Number of studies have been performed for the use

of Er:YAG laser for cavity preparation.

- Results of studies says that little or no noticeable

pulp reaction is produced while preparing the cavity
with Er:yag laser.

- It is safe & can be used for cavity

preparation
CAVITY PREPARATION
WITH LASERS
CARIES PREPARATION
 PREVENTION OF DENTAL CARIES WITH LASERS

•Laser can be used for prevention of dental caries.

•Different types of lasers increases the resistance to

dental caries by reducing the rate of demineralization
of substance of enamel & dentin.

•Argon laser alters the surface characteristics of

enamel to make it caries resistant.
•It also facilitates the uptake of fluoride by
tooth.

•The lased enamel shows formation of micro

spaces within the enamel which would impart
increased caries resistance by trapping ions
formed during acid demineralization.
 MECHANISM OF ACTION
Carbonate is lost from carbonated appetite mineral of tooth during laser
irradiation

Pulsed co2 laser irradiation interacts with the phosphate group in dental
materials

It gets preferentially absorbed & transformed efficiently to heat

Carbonated hydroxyapetite in the surface & in the immediate subsurface of

enamel is heated at temp. Greater than 400`c

Carbonate is decomposed, leaving behind the a hydroxyapetite like mineral

that is less soluble
• BLEACHING WITH LASERS

- Power bleaching is the term used for accelerated in-office

tooth whitening procedures, using laser or Xenon plasma arc-
curing light.

(A). ARGON LASER

- A true laser light is delivered to chemical agent.

- The action is to stimulate crystals in the chemical.

- No thermal effect, so less dehydration of enamel.

- The treatment time is 10sec. Per application per tooth is the

advantage for clinician & patient.
(B). DIODE LASER

- A true laser light produced from a solid state Source.

- It is ultra fast, taking 3to5 sec. To activate Bleaching

agent.

- This type of lasers produce no heat.

 DIAGNOSIS OF PULP VITALITY WITH LASER

- Laser Doppler flowmetery is used for diagnosis of Pulp vitality.

- It uses laser beam of known wavelength.

Moving RBC causes the frequency of laser beam to be

Doppler shifted & some of the light to be back scattered out
of the tooth.

- It is a complicated procedure.

- Equipment is very expensive for avg. dental clinics.

- It is accurate & can be used in patient, who can not
communicate effectively or whose response is not
reliable (young patient).

- As this procedure does not produce any noxious

stimuli as EPT, apprehensive or depressed patient m
ay accept it more readily.
 PULPOTOMY IN PRIMERY TOOTH
WITH LASERS
• Eliot et al compared use of co2 laser with
formocresol in caries free primary cuspid.

•They found significant difference between the

teeth which are treated with formocresol or laser.

-
• They said that on the basis of symptomatic
clinical & histological findings, the co2 lasers
appear to compare favorably to formocresol
treatment.

• On the basis of studies,co2 laser should be

considered as viable alternative to other
method that shows possible toxic side effect.
 PULPECTOMY IN PRIMERY TOOTH WITH LASERS

- Lasers that can cut enamel or dentin with fine optical fibers
has been developed, making it possible to remove pulp &
straight or slightly curved canals.

- Er:YAG laser, at 8hz & 2w is used to prepare the root canals

- Laser tip must slide gently from apical portion to coronal

portion while pressing the laser tip to root canal wall under
water spray.
PULPECTOMY WITH LASERS
IRRIGATION,STERILLIZATION OR DISINFECTION OF
INFECTED ROOT CANALS WITH LASER

- Nd:yag LASER & Er:yag laser are recommended for

this treatment.

- Irradiation is carried out y using lasers with 5.25%

Nacl & 14% EDTA.
PREVENTION OF MICROLEAKAGE OF RETROGRADE
ROOT CANAL FILLING WITH LASERS

- Micro leakage in retrograde root canal filling

causes failure of apicectomies.

- Closer of exposed end dentinal tubules on cut

surface at root end can be done with Nd:YAG &
CO2 lasers in combination with 38% silver ammonium
solution.
 LASERS FOR DIRECT/INDIRECT PULP CAPPING

- Uses of lasers with respect can control hemorrhage

& do sterilization so it can be used for pulp capping
either direct or indirect.

- For this purpose,

~ Laser irradiation is performed at 1 to 2w after

irradiating alternatively with 8% sodium hypochlorite &
3% hydrogen peroxide for more than 5 min.

~ Calcium hydroxide paste is used to dress the

exposed pulp after laser treatment.
 • DENTIN DESENSITIZATION WITH
LASER

- Mechanism of action includes;

Narrowing or occlusion of dentinal tubules &

nerve analgesia through depression of nerve

transmission.
 ANALGESIA

- It’s mechanism is not well understood yet.

- Some suggests that;

Certain wavelength of laser may interfere with

sodium pump mechanism, change cell membrane
permeability & alters temporarily, the endings of
sensory nerves & blocks depolarization of c & a
fibers of nerves.

- Nd:YAG laser is used most for this purpose.

 PREVENTION OF TOOTH FRACTURE BY
LASERS

- Pulp less teeth have tendency to fracture so to

prevent this;

~ Teeth are to be lased with pulsed Nd:YAG or CO2

lasers along with 38% silver ammonium
solution.

~ After this treatment, teeth become more resistant

to fracture.
 PHOTOPOLYMERIZATION OF COMPOSITE
RESIN WITH LASER

- Argon lasers are used for this purpose.

- For polymerization of camphorquinone activated

composite resin, the argon laser increases;

~ The depth of cure

~ The diametric tensile strength
~ Adhesive bond strength
~ Degree of polymerization of materials.
REDUCES;
~ Acid solubility of surrounding enamel decreases the time
of activation significantly.
 • LASERS IN SOFT TISSUE SURGERY

- Lasers can be used for soft tissue incision & for controlled
destruction of oral pathogens.

- A Pfizer model o-c surgical laser, used as source Laser beam

in soft tissue.
SURGERY WITH LASER
 Other uses
To help in healing tissues

Control in gag reflex

Pretratment of surgical sites

Lingual frenectomy

Treatment of herpes lesions

Biopsies

Recurrent aphthous ulcers

Gingival contouring

In cases of bleeding disorders

Venous like lesions

 ADVANTAGES OF LASERS

(1).Minimal damage to surrounding tissues.

(2).Haemostatic effect-by sealing blood vessels.

(3).Reduction of postoperative inflammation & edema.

(4).Little postoperative scarring.

(5).Reduction in postoperative pain sensation since nerve endings are
blocked.

(6).Dressing & suturing is not required for wound closer.

(7).Operating time is reduced.

(8).Sterilization of wound due to reduction in amount of microorg.

Exposed to laser irradiation.

(9).Excellent wound healing.

(10).Laser exposure to tooth enamel causes reduction in caries activity.

 DISADVANTAGES OF LASERS

1).Laser beam could injure the patient or operator by direct beam or reflected
light, causing retinal burn.

(2).G.A. Is usually required for the patients undergoing laser surgery.

(3).Cumbustion hazards.

(4).Removal of soft tissue overlying the bone can damage the underlying
bone.

(5).It available only at big hospital & treatment is very expensive.

(6).Specially trained person is needed.

 HAZARDS
o OCULAR HAZARDS
o Can cause retinal damage & cataracts either by direct exposure or
by reflection from a mirror like surface.(Dental instruments).
o Always use protective eyewear.

o TISSUE HAZARDS
o Temperature elevations of 21º C above body temp.(37ºc) can
produce cell destruction by denaturation of cellular enzymes and
structural proteins.

• ELECTRICAL HAZARDS
– Can be grouped as
shock hazards
electric fire hazards
explosion hazards
• RESPIRATORY HAZARDS

• After soft tissue vaporization by lasers a variety of chemicals are

released ( formaldehyde, cyanates, benzene ,methane, acetone).

• These when inhaled –damage to the respiratory system.

*appropriate ventilation, evacuation, use of suction etc.

• COMBUSTION HAZARDS

• In the presence of inflammable materials lasers may pose

significant hazards.
(Resins, plastics, acetone, waxes, anesthetics etc.)
 Conclusion
Positive results of the research on use of lasers in dentistry have
captured the attention of dentists & researchers to it.

Lasers can perform certain procedure very effectively. Like,

- Soft tissue management & analgesia.

- Desensitization.
- Endodontic uses.
- Caries detection, removal & prevention.
- Curing of composite resin.

But the ideal laser system which can perform hard tissue procedure
effectively without causing pulpal damage, still does not exists.
 Laser equipments are not manufactured largely & they are
also very expensive.

However;
Future aspect of lasers in dentistry shows many interesting
trends & possibilities but long development period is ahead.

As the research on use of laser in dentistry is giving

bright results, lasers are getting more & more famous
among dentists.
 REFERENCES
Lasers in dentistry. DCNA2004

Lasers in pediatric dentistry. DCNA2004

Pediatric laser dentistry : A clinical guide. Giovanni Olivi

Lasers in dentistry. A review. Archives of Orofacial

Sciences 2006; 1: 1-4

• Principles and Practice of LASER DENTISTRY-Robert A.

Convissar
 Lasers in pediatric dentistry a review. J of laser
appliacations 2005

Comprehensive pediatric dentistry-- Nikhil marwah

Pathways of the pulp-- Cohen , burns

• Lawrence Kotlow. Lasers and Soft Tissue Treatments for

the Pediatric Dental Patient.