JERUN JOSE

CONTENTS
 INTRODUCTION

 DISCOVERY OF LASERS

 LASER PHYSICS

 COMPONENTS OF LASER

 PROPERTIES OF LASER

 CLASSIFICATION OF LASERS

 LASER TISSUE INTERACTION AND BIOLOGICAL EFFECTS

 LASERS USED IN DENTISTRY

 USES OF LASERS IN ORTHODONTICS

 REFERENCE
 INTRODUCTION

Light has been used as a therapeutic agent for

many centuries.
Natural light was used for medical treatment
in ancient Egypt and Greece.
Later Roman and Arab physicians introduced
light therapy into general medical use
Light is a form of electromagnetic energy that exists as

a particle, and travels in waves, at a constant velocity

The basic unit of this radiant energy is called a photon
The wave of photons travels at the speed of light can be

defined by two basic properties

First is amplitude, which is defined the vertical height of

the wave oscillation from the zero axis to its peak.

The second property of a wave is wavelength, which is the

horizontal distance between any two corresponding points

on the wave.
This correlates to the amount of energy in the wave:

the larger the amplitude, the greater the amount of

energy that can do useful work
A joule is a unit of energy
As waves travel, they oscillate several times per

second, termed frequency.

 Frequency is inversely proportional to wavelength:
the shorter the wavelength, the higher the frequency
and vice versa.
The newer treatment procedures are conservative,

painless and are more reliable and they contribute

towards better esthetics.
The development of LASER (light amplification by the

stimulated emission of radiation) in dentistry has

allowed the dental professionals to provide comfort
and better treatment for the patient
A laser is a device that emits light (electromagnetic

radiation) through a process of optical amplification

based on the stimulated emission of photons
Discovery of laser
In 1704, Newton characterised light as a stream of
particles
The Young’s interference experiment in 1803 and the
discovery of the polarity of light convinced other
scientists of that time that light was emitted in the
form of waves
The concept of electromagnetic radiation, of which

‘light’ is an example, had been described in

mathematical form by Maxwell, in 1880
Maxwell’s electromagnetic (EM) theory explained light

as rapid vibrations of electromagnetic fields due to

the oscillation of charged particles
The spectrum is a
electromagnetic comparative
arrangement of electromagnetic energy (photonic
quanta) relative to wavelength, spanning ultra-short
gamma and X-radiation, through visible light, to ultra-
long micro- and radio-waves
Maxwell’s electromagnetic theory, the energy intensity

of electromagnetic emissions with a given frequency is

proportional to the square of this frequency
 At the turn of the 20th century, the black body
radiation phenomenon challenged the waveform light
theory
According to Planck,radiation such as light, is emitted,

transmitted and absorbed in discrete energy packets or

quanta, determined by the frequency of the radiation
and the value of Planck’s constant
In explaining the photoelectric effect, Einstein

assumed that a photon could penetrate matter, where

it would collide with an atom.
Since all atoms have electrons, an electron would be

ejected from the atom by the energy of the photon,

with great velocity.
Einstein explained about laser light in 1917 in his Zur

Theorie der Strahlung(Theory of Wavelength), that

when there exists the population inversion between
the upper and lower energy levels among the atom
systems, it was possible to realise amplified stimulated
radiation.
Stimulated electromagnetic radiation emission has the

same frequency (wavelength) and phase (coherence)

as the incident radiation
MASER
In 1953, Charles Townes, experimenting with microwaves,
produced a device whereby this radiation could be
amplified by passing it through ammonia gas
This was the first MASER (microwave amplification by the
stimulated emission of radiation) and was developed as an
aid to communication systems and time-keeping (the
‘atomic clock’)
 LASER
Theodore Maiman in 1960 invented the first laser at

the Hughes Air Craft Company,USA using a lasing

medium of ruby that was stimulated using high energy
fl ashes of intense light.
In 1964, Ralph Stern and Reidar Sognnaes used
the ruby laser to vaporise enamel and dentine.
 In 1969 Leon Goldman used the laser clinically
on enamel and dentine.
 Laser physics
Laser is a device that converts electrical or chemical
energy into light energy.
 In contrast to ordinary light that is emitted
spontaneously by excited atoms or molecules, the light
emitted by laser occurs when an atom or molecule
retains excess energy until it is stimulated to emit it
The radiation emitted by lasers including both visible
and invisible Iight is more generally termed as
electromagnetic radiation
The concept of stimulated emission of light was

first proposed in 1917 by Albert Einstein.

He described three processes

1. Absorption

2. Spontaneous emission

3. Stimulated emission
Einstein considered the model of a basic atom to

describe the production of laser

An atom consists of centrally placed nucleus which

contains positively charged particles known as

protons, around which the negatively charged
particles, i.e. electrons are revolving.
When an atom is struck by a photon, there is
an energy transfer causing increase in energy of the
atom.
 This process is termed as absorption.
The photon then ceases to exist, and an

electron within the atom pumps to a higher

energy level.
 This atom is thus pumped up to an excited state
from the ground state

In the excited state, the atom is unstable and will soon

spontaneously decay back to the ground state,

releasing the stored energy in the form of an emitted
photon.
 This process is called spontaneous emission
If an atom in the excited state is struck by a photon
of identical energy as the photon to be emitted, the
emission could be stimulated to occur earlier than
would occur spontaneously.
 This stimulated interaction causes two photons
that are identical in frequency and wavelength to
leave the atom.
 This is a process of stimulated emission
If a collection of atoms includes, more that are

pumped into the excited state that remain in the

resting state, a population inversion exists.
This is necessary condition for lasing
Now, the spontaneous emission of a photon by one

atom will stimulate the release of a second photon in a

second atom, and these two photon will trigger the
release of two more photons.
 These four then yield eight, eight yield sixteen and
so on.
 In a small space at the speed of light, this photon
chain reaction produces a brief intense fl ash of
monochromatic and coherent light which is termed as
'laser'
 Components of laser
1. Active medium

2. Pumping mechanism

3. Optical resonator

4. Delivery system

5. Cooling system

6. Control panel
Active medium.
This material may be a solid, liquid or gas.

Lasing medium determines the wavelength of the

light emitted from the laser and the laser is named

after the medium.
The first dental laser used a crystal of

neodymium- doped yttrium aluminium garnet

(Nd:YAG) as its active medium.
The active medium is positioned within the laser

cavity, an Internally-polished tube, with mirrors co-

axially positioned at each end and surrounded by
the external energising input, or pumping
mechanism
2. Pumping mechanism
This represents a man-made source of primary energy

that excites the active medium.

This is usually a light source, either a flashlight or arc-

light, but can be a diode laser unit or a

electromagnetic coil
Energy from this primary source is absorbed by

the active medium, resulting in the production of

laser light.
This process is very inefficient, with only some 3-

10% of incident energy resulting in laser light, the

rest being converted to heat energy.
3. Optical resonator
Laser light produced by the stimulated active medium

is bounced back and forth through the axis of the laser

cavity, using two mirrors placed at either end, thus
amplifying the power.
The distal mirror is totally reflective and the proximal

mirror Is partly transmissive, so that at a given energy

density, laser light will escape to be transmitted to the
target tissue
4.Delivery system
Laser energy should be delivered to the surgical site by

various means that should be ergonomic and precise

Dependant upon the emitted wavelength, the delivery

system may be a quartz fibre-optic, a flexible hollow

waveguide, an articulated arm (incorporating mirrors),
or a hand-piece containing the laser unit (at present
only for low-powered lasers).
Shorter wavelength instruments, such as KTP, diode,

and Nd:YAG lasers, have small, flexible fiber‐optic

systems with bare glass fibers that deliver the laser
energy to the target tissue.
 Erbium and CO2 devices are constructed with more
rigid glass fibers, semi‐flexible hollow waveguides, or
articulated arms
All the invisible dental lasers are equipped with a

separate aiming beam, which can either be laser or

conventional light.
 The aiming beam is delivered co‐axially along the
fiber or waveguide and shows the operator the exact
spot where the laser energy will be focused.
Dental lasers can be used either in contact mode or

non contact mode

In contact mode, the fiber tip is placed in contact
with the tissue.
The charred tissue formed on the fiber tip or on the
tissue outline increases the absorption of laser energy
and resultant tissue effects
Char can be eliminated with a water spray and then

slightly more energy will be required to provide time

efficient results.
Advantage is that there is control feed back for the

operator
Non contact mode
Fiber tip is placed away from the target tissue.

The clinician operates with visual control with the aid

of an aiming beam or by observing the tissue effect

being created.
There are two basic modes of wavelength emission for

dental lasers, based on the excitation source.

1. Continuous mode

2. Pulsating mode
1.Continuous mode
Continuous wave emission means that laser energy is

emitted continuously— as long as the laser is

activated—and produces constant tissue interaction.
CO2 and diode lasers operate in this manner
These lasers are sometimes equipped with a

mechanical shutter with a time circuit or a digital

mechanism to produce gated or super‐pulsed energy.
 Pulse durations can range from tenths of a second to
several hundred microseconds.
2.pulsating mode
Free‐running pulse emission occurs with very short bursts

of laser energy due to a flashlamp pumping mechanism.

The usual pulse durations are in the low hundreds of

microseconds, and there is a relatively long interval

between pulses.
Nd:YAG, Er:YAG, and Er,Cr:YSGG devices operate as free‐

running pulsed lasers.

5. Cooling system
Heat is a by product of laser light
production
propagation.
 It increases with the power output of the laser and
hence, with heavy-duty tissue cutting lasers, the
cooling system represents the bulkiest component.
 Co-axial coolant systems may be air- or water-
assisted.
Erbium lasers employ a water spray for cooling
hard tissues
6.control panel
This allows variation in power output with time, above

that defined by the pumping mechanism frequency.

 Other facilities may allow wavelength change
(multi- laser instruments)
 PROPERTIES OF LASER LIGHT
There are several important properties of laser
light that distinguish it from the normal light
Monochromatism
Lasers emit light that is monochromatic or specifically

have a single wave length from UV to infrared. i.e.

lasers express one color.
Lasers of varying types emit an individual wave length

or specified wavelengths
This property is important for the high spectra power

density of the laser beam

Collimation or (Directionality)
The laser beam, as it exits from the laser device,
has very little divergence.
They do not diverge and travel parallel to each other.

The beam which is emitted has constant size

and shape.
Most of the gas or solid-state laser emit laser beam

with a divergence angle of approximately a milli

radian.
 This explains why laser light is extraordinarily
hazardous.
By not diverging over distance, laser light maintains

brightness, so that it is still concentrated enough to be

dangerous.
 But this property is important for good transmission
through delivery system
Coherency
The laser light waves produced are physically
identical.
i.e. they have identical amplitude and frequency.
 There are two types of coherence of laser
light, longitudinal and transverse.
The longitudinal type of coherence represents time

coherence along the longitudinal beam, whereas

transverse coherence or spectral coherence refers to
coherence across the beam.
Coherence causes the collimation of a laser beam

over extremely large distances and allows the beam

to accept extremely fine focusing
 Any given laser beam can be focused only to a
diameter equal to the wavelength of the specific
laser
Brightness
This property arises from the parallelism or

collimation of the laser light as it moves through space

maintaining its concentration.
The high brightness factor translates to high

concentrations of energy when the laser is focused on

a small spot
The focusing of the brightness of the laser beam is

what the clinicians depends on to elevate the

temperature of tissues or to cut or to vaporize the
tissues
Difference between ordinary light
and laser light
 Classification of Lasers
1.BASED ON ACTIVE MEDIUM :
Solid state- Nd: YAG

 Liquid state-diode laser

 Gas state- CO2

2.DEPENDING ON WAVE LENGTH
Hard lasers- comes in infrared Spectrum (> 700
nm) Eg: CO2; Nd: YAG; Argon laser
Soft Lasers - Comes in UV (140-400nm) & visible

light (400-700) spectrum Eg: HeNe, diode laser

3.BASED ON SAFETY PROCEDURE
Class 1: safe under all conditions (fully enclosed system) -

Eg: Nd: YAG laser. Laser used in dental laboratory.

Class 2: Output is 1 mw- visible low power laser- Visible red

aiming beam of a surgical laser.

Class 3A: Visible laser above 1 milli watt- No
dental
examples
Class 3B: Upper continuous power output limit is 0.5 w-
Low power diode laser used for biostimulation. Direct
viewing is hazardous to the eye.

Class 4: Output excess of class 3B & are used for cutting &
drilling- All lasers used for oral surgery, whitening and
cavity preparation. Direct or indirect viewing is hazardous
to the eyes
 LASER- TISSUE INTERACTION AND
BIOLOGICAL EFFECTS
Once a laser beam is produced it is aimed at tissue
to perform a specific task.
 As the energy reaches the biological interface, one
of four interactions will occur
1. Absorption
2. Reflection

3. Transmission

4. Scattering
Absorption
Specific molecules in the tissue known as
chromophores absorb laser light energy
 The light energy is then converted into other forms
of
energy to perform work.
Main chromophores seen in oral tissues are hemoglobin,

melanin,pigmented proteins,hydroxyapatite,and water

Absorption is the most important interaction.

 Each wavelength has specific that

chromophores absorb their energy.
 Near infrared lasers like diodes and Nd:YAGs are
mostly absorbed by pigments such as hemoglobin and
melanin.
 Erbium and CO2 lasers are predominantly absorbed
by water
with erbium wavelengths also exhibiting some
hydroxyapatite absorption.
The shorter, near infrared wavelengths of diodes

and Nd:YAG lasers penetrate tissue more deeply

than the longer, mid infrared wavelengths of the
Erbium and CO2 lasers
Thermal relaxation
Thermal relaxation is the term applied to the ability to

control a progressively increasing heat loading of

target tissue.
Thermal relaxation rates are proportional to the area

of tissue exposed and inversely proportional to the

absorption coefficient of the tissue
Factors that influence absorption and
thermal relaxation are
1. Exposure time and Laser emission mode

Thermal relaxation will occur least with continuous

wave emission and maximally in free-running
pulsed delivery

2. Laser incident power (Joules per second)

3.Laser power density (Watts per square centimetre): for
any chosen level of incident power, the smaller the
beam diameter, the greater concentration of heat effects

4.Beam movement: relative to tissue site; rapid laser

beam movement will reduce heat build-up and aid
thermal relaxation
3. Endogenous coolant: blood flow.

4.Exogenous coolant: water, air, pre-cooling of tissue

6.Incident angle of laser beam

Maximum control of laser tissue interaction can be

achieved if the incident laser beam is perpendicular

to the tissue surface
Reducing the incident angle towards the refractive

angle of the tissue surface will increase the potential

for true light reflection with an associated reduction
in tissue change
Reflection
Density of the medium , or angle of incidence being less
than the refractive angle , results in total reflection of
the beam.
In true reflection ,the incident and emergence angles
will be the same .
If the medium interface is rough or non
homologous , some scatter may occur
Transmission
 In transmision beam enters the medium , but there
is no interaction between the incident beam and the
tissue.
The beam will emerge distally , unchanged or partially

refracted.
Scattering
 Once the laser energy enters the target tissue it
will scatter in various directions.
This phenomenon is usually not helpful, but can help

with certain wavelengths biostimulative properties.

There are five important types of biological effects
that can occur once the laser photons enter the
tissue:
They are

1. fluorescence
2. photothermal

3. photodisruptive

4. photochemical

5. photobiomodulation
Fluorescence
 The amount of fluorescence is related to the size of
the lesion, and this information is useful in
diagnosing and managing early carious lesions.
Photothermal effects occur when the chromophores

absorb the laser energy and heat is generated.

 This heat is used to perform work such as
incising tissue or coagulating blood.
Photothermal interactions predominate when most

soft tissue procedures are performed with dental

lasers.
 Heat is generated during these procedures and great
care must be taken to avoid thermal damage to the
tissue
Photodisruptive or photoacoustic
Hard tissues are removed through a process known as

photodisruptive ablation.
 Short-pulsed bursts of laser light with extremely
high power interact with water in the tissue and from
the handpiece causing rapid thermal expansion of the
water molecules
This causes a thermo-mechanical acoustic shock wave

that is capable of disrupting enamel and bony matrices

quite efficiently.
 The pulsed Erbium laser ablation mechanism of
biological tissues is still not completely understood but
erbium lasers’ high ablation efficiency seems to result
from these micro- explosions of overheated tissue water in
which their laser energy is predominantly absorbed.
Thus tooth and bone are not vaporized but pulverized

instead through the photomechanical ablation

process.
 This shock wave creates the distinct popping sound
heard during erbium laser use.
Photochemical reactions occur when photon energy

causes a chemical reaction.

 These reactions are implicated in some of
the beneficial effects found in biostimulation
Photobiomodulation or Biostimulation refers to

lasers ability to speed healing, increase circulation,

reduce edema, and minimize pain.
 Many studies have exhibited effects such as
increased collagen synthesis, fibroblast proliferation,
increased osteogenesis, enhanced leukocyte
phagocytosis
The exact mechanism of these effects is not clear, but

it is theorized they occur mostly through

photochemical and photobiological interactions
within the cellular matrix and mitochondria.
Biostimulation is used dentally to reduce postoperative

discomfort and to treat recurrent herpes and aphthous

stomatitis
When a laser heats oral tissues, certain reversible
or irreversible changes can occur
1. Hyperthermia – below 50 degrees C
2. Coagulation and Protein Denaturation –
60+ degrees C
3. Vaporization – 100+degrees C
4. Carbonization - 200+ degrees C
Irreversible effects such as denaturation and
carbonization result in thermal damage that causes
inflammation, pain, and edema.
Immediate post operative view of an
excisional procedure using a diode
laser.
Immediate post operative views of excisional procedures
using Erbium and Carbon Dioxide lasers.
 Jerun jose
2nd
year
pg
Department of orthodontics
CONTENTS
LASER EFFECTS ON DENTAL HARD AND SOFT TISSUES

LASERS USED IN DENTISTRY

USES OF LASERS IN ORTHODONTICS

LASER SAFETY IN DENTAL PRACTICE

CONCLUSION

REFERENCE
Laser Effects on Dental Hard
Tissues
Thermal Effect
Here thermal vaporization of tissue by absorbing

infrared laser light occur

The laser energy is converted into thermal energy or

heat which destroys the tissues.

The laser beam couples to the tissue surface, and this

absorption leads to a heating with denaturation at

about 45°C to 60°C.
Above 60°C coagulation and necrosis can be

observed accompanied by a desiccation of the tissue.

At 100°C the water inside the tissue vaporizes
Carbonization and later pyrolysis with vaporization of
the bulky tissue terminate the thermal laser tissue
interaction.
The laser light will be absorbed and converted to

thermal energy by stimulating the lattice vibrations of

the tissue molecules.
This leads to a heating of the surrounding tissues to

a boiling of water followed by carbonization and

tissue removal
Damage to the adjacent tissue is manifested by
massive
zones of carbonization, necrosis and cracks.
Mechanical Effect
High energetic and short pulsed laser light can lead to
a
fast heating of the dental tissues in a very small area.
The energy dissipates explosively in a volume

expansion that may be accompanied by fast shock

waves
These waves can lead to very high pressures so

that adjacent tissue will be destroyed or damaged.

To avoid micro cracks in dental tissues, the maximum laser

energy density of all laser systems must be kept below a

certain threshold.
Chemical Effect
The basis of the photochemical effect is the absorption
of laser light without any thermal effect which leads to
an alteration in the chemical and physical properties of
the irradiated tissues

Normal enamel Lased enamel

Thermomechanical Effect
Due to the good absorption of laser in water as well as in

hydroxyapatite, the laser radiation leads to fast heating

of water inside.
 In the mineralized matrix there is an explosive
volume expansion
In dentin, no cracks are seen, but more thermal

damage like carbonization and necrosis are found.

 In enamel, cracks are always found
Morphological analysis of Er:YAG laser treated enamel

Enamel. 100 mj. 10 Hz.

Enamel. 100 mj. 10 Hz.
With water cooling.
With water
 Honey-comb cooling.
Honey-comb
appearance can be seen
appearance
but not throughout the can be seen on the
surface
surface due to non- similar to acid
etching.
homogenous application
Enamel. 100 mj. 10 Hz. Enamel. 250 mj. 10 Hz.
With water cooling. With water cooling.
Higher magnification
Serrated surface with
of the surface
honey-comb
No signs of
appearance.
thermal damage.
Honey-comb
Enamel. 500 mj. 10 Hz. Enamel. 600 mj. 10 Hz.

With water Without water

cooling. cooling.
Interprismatic matrix
has  Layered enamel
been removed.
surface due to
some melting points due
to dehydration of enamel
repeated shots at the
same during laser
Enamel. 750 mj. 10 Hz. Enamel. 800 mj. 5 Hz
Without water Without water
cooling. cooling.
Melted and resolidified
enamel.
This texture is highly
acid resistant.
Enamel. 1000 mj. 10 Hz. Enamel. 1000 mj. 10 Hz.
Without water Without water cooling.
cooling. Overdestructed and
Rose-bud like
layered surface as a result
appearance.
over destruction of of excessively heated

enamel with high energy enamel.

intensity.
 Enamel lost its integrity
Effects on dentin

Dentin. 250 mj. 10 Hz. Dentin. 250 mj. 10 Hz.

With water cooling. Without water
 Partially open cooling.
Swollen dentin orifices
dentinal tubules with
crater formations
Dentin. 500 mj. 5 Hz. With Dentin. 500 mj. 10 Hz.

water cooling. Without water

Dehydartion resulted in cooling.
Pop-corn like
appearance.
cracking Thermal destruction

of dentin
Ablation Threshold of Er:YAG and Er:YSGG Laser
Radiation in Enamel and dentin
Laser Effect on Dental
Pulp
Vital dental pulp is acutely sensitive to thermal change
The pulp tissue response to lasers is evaluated in three
forms
Histologic analysis

Radiographic analysis

Laser Doppler fl ow meter measurement

Use of a continuous wave apparatus has been shown

to generate significant thermal tissue damage in the

oral cavity
 Pulpal tissue cannot survive in an environment of
elevated temperatures for long periods when tooth
structure is irradiated with lasers
Rise of 6°C results in irreversible
pulpitis
Rise of 11°C results in necrosis of pulp
Pulsing which has been used during soft tissue laser

ablation has an effective mechanism for reducing

the extent of collateral tissue damage
The use of a combination of air and water spray before,

during or immediately after laser irradiation to enamel

and dentin may be a more effective method for
temperature control and reduction of heat transfer to the
pulp
 Air-water cooling is used with laser systems such as
CO2, holmium and erbium.
This can provide adequate heat protection to the pulp

equivalent to that of the common dental drill

Uncontrolled laser irradiation of oral structures can

cause pulpal inflammation with any type of laser

The undesirable side effects of laser vary primarily with

power and energy density and secondarily with the type

of laser used
If pulp temperature is raised beyond 5°C level, the

odontoblastic layer may not be present.

Odontoblastic alignment may be disrupted,
displaying
vertical and layering type of structure.
The threshold response for pulp reaction appears to lie

at energy density less than 60 J/cm

LASERS USED IN DENTISTRY
The dental lasers in common use today are

Erbium, Neodynium, Diode, and CO2.

Each type of laser has specific biological effects
and
procedures associated with them.
Erbium Lasers

Erbium lasers are built with two different crystals, the

Er:YAG (Erbium yttrium aluminum garnet crystal)

and Er,Cr:YSGG (Erbium chromium sensitized
yttrium scandium gallium garnet crystal).
They do have different wavelengths, Er:YAG has 2940

nm and Er,Cr:YSGG has 2780 nm.

 There is a significant water absorption difference
between
these two wavelengths.
 Er:YAG wavelength is at the peak of water absorption in
the infrared spectrum whereas the Er,Cr:YSGG exhibits less
absorption
The Er,Cr:YSGG has also been shown to have

significantly deeper thermal penetration in tooth

structure
The erbium lasers are hard and soft tissue capable

Their primary chromophore is water, but hydroxyapatite

absorption occurs to a lesser degree

Photothermal interactions predominate in soft tissue

procedures and photodisruptive in hard tissue procedures.

Thermal relaxation is excellent and very little collateral

thermal damage occurs in tissues

Bone cutting with erbium lasers results in minimal

thermal and mechanical trauma to adjacent tissues.

Atraumatic effect and excellent healing response

Very short laser pulses of 50 to 100 microseconds

are typically used for hard tissue procedures.

SOFT TISSUE LASER
 The main parameters that differ from hard tissue uses
are much longer pulse durations (300-1000 microseconds)
and less or no water spray.
There will be thermal relaxation and minimal

heat penetration into underlying tissues

Nd:YAG Lasers
Nd:YAG lasers were the first types of true pulsed lasers
to
be marketed exclusively for dental use in 1990.
They are a near infrared wavelength of 1064 nm.

 This wavelength is absorbed by pigment in the

tissue, primarily hemoglobin and melanin
Photothermal interaction predominates and the laser

energy here can penetrate deeply into tissues.

Contact and noncontact mode are both utilized
depending
on the procedure being performed.
Nd:YAG also have excellent biostimulative properties.

 Nd:YAG lasers have the unique capacity to stimulate

fibrin formation.
This effect is maximized when the pulse duration is set

at 650 microseconds
These lasers are primarily used for periodontal
treatments.
 Their proclivity for pigmented tissue allows for
effective debridement and disinfection of periodontal
pockets.
Bacterial decontamination in tissues treated with Nd:YAG

laser energy also contributes to resolution of periodontal

infection
Nd:YAG lasers can also be used for multiple soft tissue

procedures such as gingivectomy, frenectomy, impression

troughing and biopsy
Diode Lasers
Diode lasers are becoming quite popular due to

their compact size and relatively affordable pricing.

 A specialized semiconductor that produces
monochromatic light when stimulated electrically is
common to all diode lasers
A simple laser pointer is an example of a diode laser.

Diode lasers can be used in both contact and non-

contact mode and can function with continuous wave or

gated pulse modes
They are not capable of free running pulsed mode.

Diode lasers are invisible near infrared wavelengths

and current machines range from 805 – 1064 nm.

One exception is the Diagnodent caries diagnostic
laser
which uses a visible red wavelength of 655 nm
Diode lasers are used for soft tissue only.

The chromophores are pigments such as hemoglobin

and melanin.
 Photothermal interactions predominate
They are quite effective for gingivectomy, biopsy,,

and frenectomy, photobiomodulation

CO2 Lasers
The CO2 laser is a gas-active medium laser

Incorporates a sealed tube containing a gaseous

mixture with CO2 molecules pumped via electrical
discharge current.
 The light energy, whose wavelength is 10,600 nm, is
placed at the end of the mid-infrared invisible nonionizing
portion of the spectrum, and it is delivered through a
hollow tube-like waveguide in continuous or gated pulsed
mode
This wavelength is well absorbed by water, second only to

the erbium family.

It can easily cut and coagulate soft tissue, and it has

a shallow depth of penetration into tissue, which is

important when treating mucosal lesions,.
 In addition, it is useful in vapourizing dense fibrous
tissue.
There is rapid tissue interaction
The CO2 laser cannot be delivered in a conventional

optic fiber.
The laser energy is conducted through the waveguide

and is focused onto the surgical site in a noncontact

fashion
The loss of tactile sensation could pose a disadvantage

for the surgeon, but the tissue ablation can be precise

with careful technique.
Large lesions can be treated using a simple back and

forth motion
The noncontact mode thus has an advantage when treating

movable oral structures, such as the tongue and fl oor of

the mouth.
This wavelength has the highest absorption in

hydroxyapatite of any dental laser, about 1000 times greater

than erbium
Therefore, tooth structure adjacent to a soft-tissue

surgical site must be shielded from the incident laser

beam
usually a metal instrument placed in the sulcus

provides the protection

 A portable hand-held CO2 laser system

The continuous wave emission and delivery system

technology of CO2 devices limit hard-tissue applications

because carbonization and crazing of tooth structure can
occur due to the long pulse duration and low peak
powers
Uses of Lasers in orthodontics
1.Laser etching

2.Bonding

3.Debonding of ceramic brackets

4.Bracket mesh designing

5.Efficacy of low level laser therapy in

reducing orthodontic post adjustment pain

6.Lasers in holography

7.Laser spectroscopy

8.3D laser scanning

9.Laser microwelding

10.Effect of laser for demineralisation

resistence
11.Soft tissue lasers

12.Mangement of impacted teeth

13.Laser orthopedics

14.Effect of low level laser in accelerated tooth movement

Laser Etching in Orthodontics

 Argon laser

 Krypton flouride excimer

laser
Principle
Splits the bond of organic and inorganic substances on
the surface.
Explosive vapourization of water modifies the

smooth surface of enamel

Due to the extremely short pulse length of some

nanoseconds and sudden removal,there is no efficient

heat conductance through the hard substance
so no harmful increase in the temperature of the pulp.

Etched enamel by Er;YAG laser Etched by Malic

Bonding
Argon laser is commonly used as light curing
adhesives.
The procedure for light curing is almost same

as conventional light curing

The enamel surface was etched with 37% phosphoric

acid for 15 seconds

The surface was treated with Megabond

Adhesive precoated brackets were placed on enamel

surface

Mark Kurchak,Bernadette Desantos,John Powers,David Turner JCO 1997

Laser tip was held 0.5mm from the bracket and the

light curing wand was kept touching the bracket.

No enamel damage caused by argon lasers at energy

levels
of 1.6 to 6 watts
Result
• The study demonstrates that 10 seconds of curing with

argon laser produces bond strength comparable to those

achieved with 20 to 40 seconds of curing with a
conventional high intensity light.

• The time savings involved in bonding a full arch is

significant with the help of Laser.

Laser Debonding of Ceramic Orthodontic
brackets
Laser light has been shown to degrade resins by

thermal softening or photo ablation.

• Both polycrystalline alumina and single crystal alumina

(saphire) ceramic orthodontic brackets were bonded to

the labial surface of lower deciduous teeth with regular
acid etch technique.

Robert M Tocchio,Peter T Williams,Franz J Mayer,Kenneth G

Standing) AJO 1993
• The brackets were debonded by irradiating the labial

surfaces of the brackets with laser light at

wavelengths of,1060nm.

• Debonding times were measured and the surfaces created

by debonding were examined with both light and scanning

electron microscopy to determine the extent of bracket
and enamel damage
Results
• No enamel, bracket damage in any sample.

• The debonding of polycrystalline brackets is caused by

thermal softening of the bonding resin resulting from

heating of the bracket.

• The hot bracket then slides off the tooth

• Ideal debonding time – 0.5 seconds shows no pulp

reaction,

• No enamel tear outs and catastrophic bracket

failures were
observed.

• Lasers used are Nd:YAG laser and carbon

dioxide laser.
Newer Bracket Systems
Newer brackets with laser reinforced structured bases

enable the force to be applied even closer to the crown.

The base of brackets guarantees an excellent bond

during the entire treatment period

Laser markings help in easy identification of brackets.

Compared with conventional markings,laser markings

cannot be abraded and does not contain harmful

colouring agents
Accelerated Tooth movement
Method of increasing tooth movement are ,Injection of

1. Prostaglandins

2. Active form of vitamin D3

3. Osteocalcin

4. Relaxin
Side effects are local pain and discomfort
Electric stimulation ,corticotomy and resonance vibration

Requires complex apparatus

Low level laser therapy(LLLT)
Fujita et al. (2008) and Yamaguchi et al. (2007) reported

that LLLT stimulated the velocity of tooth movement

via RANK and c-Fms gene expressions in vitro
This was confirmed by Yamaguchi et al. (2010)

which showed that LLLT accelerates the process of

bone remodeling by stimulating MMP-9, cathepsin
K, and integrin subunits.
Study conducted by Gauri Doshi-Mehta and

Wasundhara in 2012 at Nagpur showed 56%increase in

rate of tooth movement in first 3 months and later 30%

Gauri Doshi,Wasundhara,AJODO 2012

Reducing orthodontic post adjustment pain

Methods

1. TENS

2. Low level laser therapy

3. Vibratory stimulation
Low level laser therapy
LLLT has been shown to produce analgesic effects

Here the energy output is low enough so as not to cause

a rise in the temperature of the treated tissue above

36.5 degrees centigrade
Biostimulatory effects of LLLT have been attributed to its

anti inflammatory and neuronal effects.

Harris proposed that LLLT has benign stimulatory

influence on depressed neurons and lymphocytes
• Stabilization of membrane potential and release of

neuro transmitters.

• Laser unit used was Galium diode laser

Laser Holography
Hans Rydin and Bielkhagen(1982) developed a new method

for comparing the tooth positions on the dental casts at

different stages.
Holograms of the casts were prepared using Helium Neon

laser
Burstone C.J.,T.W.Every and R.J.Pryputneiwiz (1982)based

on pulsed laser hologram inferometry studied the

dynamics of incisor extrusion
Procedure
The output from the laser is split into two parts by

beam splitter.

One part was expanded by a beam expander and is used

to illuminate the object.

The scattered wave from the object is called object wave.

The second part was expanded by a beam

expander,reflected by a mirror and a wave called reference

wave is formed which forms the hologram
Laser
spectroscopy
 Used in the field of dentistry for the purpose of
analyzing the surface structures of dental materials
Used for evaluating the surface roughness of orthodontic

wires, brackets, comparison of materials, surface

changes of orthodontic materials
3D LASER SCANNING
Obtains 3D surfaces by gathering measurements made

by smoothly sweeping a handheld laser scanning wand

over an object
Similar to spray painting
The object's image instantly appears on computer screen

Finished scan is processed to combine any

overlapping sweeps
 Significantly reducing the time to develop surface
models
The scanner works by casting a fan of laser light over

the object, while the camera on the wand views the

laser to record a cross-sectional profile of the object.
 The software is used to determine the position
and orientation of the wand enabling the computer
to reconstruct the full three-dimensional surface of
the object.
LASER MICRO WELDING
Laser welding produces deep
penetration welds with minimum heat
effective zones.
Laser welding has the advantage of welding

dissimilar metals while producing very low

heat
The process is a non-contact one that directs laser

outputs of 2-10 kW into a very small area

The laser beam makes a 'keyhole and the liquid

steel solidifies behind the traversing beam, leaving

a very narrow weld and heat affected zone
The weld is approximately 1 mm wide and the

surrounding material is not distorted

Because the weld bead is small, there is usually no need
for
finishing or re-working and this reduces costs.
ORTHOPHASE
R
 Orthophaser Unit is bigger than the conventional
spot welder
It provides highly superior result
Almost all metals including the most recent and
popular titanium can be welded.
 The unit consists of working microscope with
integrated eye protections, flexible hand piece with a
locking mechanism for the hand piece and a compact
control with preprogrammed parameters
The gas used in this is Argon
EFFECT OF LASERS FOR DEMINERLIZATION
RESISTANCE
Exposure of enamel to laser irradiation
imparts some degree of protection
against demineralization under acid attack
Using quantitative microradiography, argon laser

irradiation of enamel reduces the amount of

demineralization by 30- 50%.
Fox et al found that, in addition to decreasing

enamel demineralization and loss of tooth structure,

laser treatment can reduce the threshold pH at
which dissolution occurs by about a factor of five.
10 sec lased 5 sec lased enamel Control group
enamel
In sound enamel, calcium, phosphorus and fluoride ions

diffuse into the acid solutions and are released into the
oral environment
With lased enamel, the microspaces created by laser

irradiation,trap the released ions and act as sites for

mineral reprecipitation within the enamel
structure.
Lloyd Noel, Joe Rebellato, Rose D. SheatsAngle Orthod 2003;73:249–258
Thus, lased enamel has an increased affinity for

calcium, phosphate and fluoride ions

This will prevent demineralization
SOFT TISSUE
LASERS
Soft tissue laser is an effective tool to help manage
treatment and enhance our aesthetic outcomes
The soft-tissue laser can significantly reduce
treatment time by creating access for brackets/bands,
improving bracket placement by improving tooth
proportionality, and helping manage
oral hygiene through removal of
Gingival aesthetics can be enhanced through shaping

and contouring the gingival tissue during

treatment
MANAGEMENT OF IMPACTED TEETH
Commonly, cuspids are the last teeth bonded due to

slow eruption, delayed passive eruption, or impaction.

 This will take long treatment time.

 It is a functional issue if the cuspids cannot be

bracketed ideally
Archwire bends are required if the bracket cannot be

placed ideally, resulting in increased chair time and

difficulty in finishing treatment.
The posterior occlusion is often hindered by

delayed passive eruption of the second premolars

The diode laser can be used to assist the clinician in

avoiding these situations by going directly to

attachment, bracket, or band placement
LASER-ORTHOPEDICS
Lasers can be applied to manipulation facial growth

Study by Mostafa Abathi and Maryam in rabbits showed

irradiation TMJ by LLL during mandibular

advancement increases bone formation in condylar
region

Abathi etal.Head and face medicine 2012

They irradiated TMJ by 630 nm KIO3 laser for 3 weeks

Found that increase in bone formation in condylar

region, while no increase in cartilage thickness and

fibrous tissue
Laser Safety in Dental Practice

Tissue hazards
Laser induced damage to the skin and other non target

tissue can result from thermal interaction of radiant

energy with tissue proteins
Temperature elevations of 21 degrees centigrade above the

normal body temperature can produce cell destruction

by denaturation of cellular enzymes and structural
• Histologically thermal coagulation necrosis is
produced.
Char layer is formed

 char layer is a strong absorbent of different wavelengths

of laser light and the extent of collateral damage increases
with this layer.
Mechanical removal of char layer is essential
Environmental hazards
• Potential inhalation of airborne hazardous materials that

may be released as a result of laser therapy.

• Some lasers contain inert gases (argon, krypton or

xenon) mixed with toxic gases such as fluorine or

hydrogen chloride as the active medium
• Inhalation of toxic material in the form of aerosols has

been found potentially damaging to the respiratory

system.

• Standard surgical masks and surgical smoke evacuation

equipment is used in the theatre

Greatest producers of smoke – carbon dioxide and Nd:YAG

laser
Combustion Hazards
• Flammable solids,liquids and gases used within the

surgical setting can be easily ignited if exposed to the

laser beam.

• The use of fl ame resistant materials and other

precautions therefore is recommended

Electrical hazards
• Electrical hazards of lasers can be grouped as electrical

shock hazards,electric fire hazards or explosion

hazards.

• Insulated circuitry,shielding,grounding and housing of

high voltage electrical components provide protection

under most circumstances from electrical injury
Personal Protective Equipment

Eye protection
lasers can cause occular damage by either direct viewing

or reflection of the beam.

Adequate eye protection must be worn by the operator

as well as the patient.

They are available in the form of safety goggles or

screening devices.
Laser protective eyewear filters are specified according

to their optical density which takes into account the

wavelength,power and diameter of the beam
Laser filtration
masks
Prevents air borne
contamination
Foot pedal control switch with protective
hood
Prevents accidental depression by surgical
staff.
conclusion
With technology and science reaching new heights it is

needless to say that lasers would soon become a

necessity in every field of science .
Orthodontics has also been captured into this magical

spell of laser which would enable us to reach new

goals
 REFERENCES
1. Lasers in DentistryFrom Fundamentals
toClinical Procedures By:Dr. Donald J. Coluzzi
2. Basic Laser Principles , MELLESGRIOT
3. The Use of Lasers in Dentistry A Clinical
Reference Guide for the Diode 810 nm & Er:Yag
4. Introduction history of lasers,laser
production,s.parker
,practice 1
5.Introduction history of lasers,laser
production,s.parker ,practice 2

6.Versatality of an 810 nm Diode laser in dentistry; An over

view.Samo piranat,Journal of laser and health
academy.vol.2007

7. Lloyd Noel, DMD, MSa; Joe Rebellato, DDSb; Rose D.

Sheats, DMD, MPHcAngle Orthod 2003;73:249–258
8.Hu Longa; Ujjwal Pyakurela; Yan Wangb; Lina Liaoa; Yang
Zhoua; Wenli LaicAngle Orthodontist, Vol 83, No 1, 2013

9.Elaut j,Weharbein Eur journal of orthodontics 26(2004)

10.C. Apel, J. Meister1,, R.S. Ioana Lasers Med Sci 2002,

17:246–252
11.David M. Sarver and Mark YanoskyAm J Orthod
Dentofacial Orthop 2005;127:262-4
12. Jasmina Primoz; Giuseppe Perinettib,Angle
Orthodontist,
Vol 82, No 4, 2012

13.Y. Mahesh Kumara; N.S. RavindranbAngle Orthodontist,

Vol 79, No 2, 2009