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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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Lasers and Its Role in Endodontics / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. For details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
www.indiandentalacademy.com FLOW CHART - INTRODUCTION - HISTORY - EXPLANATION OF TERM LASER - BASIC COMPONENT OF LASER - CLASSIFICATION OF LASER - LASER DELIVERY SYSTEM & EMISSION MODE - LASER EFFECT ON TISSUE - MEDICAL USES OF LASER - DENTAL USES OF LASER - ROLE OF LASER IN ENDODONTICS - LASER HAZARDS & CONTROL MEASURES
www.indiandentalacademy.com INTRODUCTION Most patients still associate the sound and vibration of the drill with pain. However, with the new advancements in this field, several options have become available to progressive dentists to allay fears and offer patients state of the art treatment. One such advancement is the advent of the laser technology presenting new vistas for dentists in fields of dentistry .
The unique characteristics of the laser are that it is monochromatic, coherent and collimated. This allows concentration of tremendous amount of energy to a small area. www.indiandentalacademy.com HISTORY The dental lasers of today have benefited from decades of laser research and have their basis in certain theories from the field of quantum mechanics formulated by Danish physicist Bhor.(1900)
Einsteins atomic theories on controlled radiation (1917) can be credited as the foundation for laser technology.
40 years later, American Physicist, Townes first amplified microwave frequencies by the stimulated emission process and the acronym MASER. (Microwave amplification by stimulated emission of radiation).
In 1958 they discussed extending the maser principle to the optical portion of the electromagnetic field hence. LASER (Light amplification by the stimulated emission of radiation). Albert Einstein www.indiandentalacademy.com L Light
www.indiandentalacademy.com LASER LIGHT IS MONOCHROMATIC REGULAR LIGHT IS POLYCHROMATIC www.indiandentalacademy.com COLLIMATION:
BEAM HAVING SPECIFIC SPATIAL BOUNDARIES Constant beam size
Constant shape. www.indiandentalacademy.com COHERENCY www.indiandentalacademy.com A- Amplification means that a very bright intense beam of light can be created. The laser may be activated by a few photons which then act to produce many more, and the initial light generated is computed to make a very bright compact beam.
www.indiandentalacademy.com S Stimulated : Means that the photons are amplified by stimulating an atom to releases more photons.
E-Emission refers to the giving off photons. The exited atom emits a photon by absorbing energy. www.indiandentalacademy.com The term stimulated emission of radiation is based on the quantum theory of physics first postulated by Bohr
www.indiandentalacademy.com R-Radiation mean giving or omitting photons. www.indiandentalacademy.com THE BASIC COMPONENTS OF LASER www.indiandentalacademy.com www.indiandentalacademy.com www.indiandentalacademy.com www.indiandentalacademy.com www.indiandentalacademy.com www.indiandentalacademy.com The wave energy of laser ranges between gamma rays to radio waves.
All the available dental laser devices have emission wave lengths of approximately 0.5 or 500 nm to 10.6 in 10,600 nm.
www.indiandentalacademy.com All dental lasers emit either a visible light beam or an invisible infra red light beam in the portions of non- ionizing spectrum called thermal radiation.
www.indiandentalacademy.com CLASSSIFICATION OF LASERS www.indiandentalacademy.com GAS LASERS Eg: CO 2 laser Argon laser
www.indiandentalacademy.com Solid state lasers
Eg: Nd:YAG Laser Ho:YAG Laser Er:YAG Laser DIODE Laser www.indiandentalacademy.com LASER DELIVERY SYSTEMS AND EMISSION MODES Delivery systems Flexible hollow wave guide or tube that has an interior mirror finish.
The laser energy as 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. www.indiandentalacademy.com The second delivery system is a glass fiberoptic cable.
It comes in various diameters and sizes ranging from 200- 1000m
The glass fiber is encased in a resilient sheath, it can be somewhat fragile and cannot be bent into a sharp angle.
It can be used in a contact or a non contact mode. www.indiandentalacademy.com EMISSION MODES Continuous wave:- beam emitted at one power level continuously as long devise is active.
Gated pulse mode:- periodic alteration of laser energy being on or off, similar to blinking of eye. Mode achieved by opening closing of shutter in front of beam path
Free running pulsed mode:- large peak energy of laser light are emitted for short time(microsecond) followed by long time when laser is off. www.indiandentalacademy.com Laser effects on tissue The light energy from a laser can have four different interactions with the target tissue, and these interactions depend on the optical properties of that tissue and wave length used. Reflection : laser beam become more divergent as distance from handpiece increases.
Can be dangerous www.indiandentalacademy.com Absorption
This effect is the usual desirable effect, and the amount of energy that is absorbed by the tissue depends on the tissue characteristics such as pigmentation and water content, and on the laser wavelength and emission mode.
Short wave lengths, from about 500-1000nm are absorbed readily in pigmented tissue.
Argon has high affinity for melanin and hemoglobin. .
Diode and Nd : YAG have a high affinity for melanin and less interaction with hemoglobin.
Longer wavelength are more interactive with water & hydroxyapatite Erbium , carbon di-oxide. www.indiandentalacademy.com 3. Transmission:
Transmission of laser energy directly through the tissue, with no effect on target tissue.
Water is relatively transparent to Nd:YAG whereas tissue fluids readily absorb carbon di-oxide.
4. Scattering
Scattering of the laser light causes weakening the energy and possibly producing no useful biologic effect.
May cause heat transfer to tissue adjacent to the surgical site and unwanted thermal damage can occur. www.indiandentalacademy.com www.indiandentalacademy.com Besides photothermal effects there are other effects that lasers have on selected tissue.
Photochemical effects that lasers create to stimulate chemical reactions, such as curing of composite resin.
They can also cause break in chemical bonds, such as in the process of photodyanamic therapy.
www.indiandentalacademy.com www.indiandentalacademy.com IN 1961 Goldman established the first laser medical laboratory at the university Of Cincinati, he is recognized as the first physician to use laser technology.
LEsparance was the first to report clinical use of an argon laser in1968 in opthalmology .
In 1972 Strong and Jako reported the first clinical use of Co 2
laser in otolaryngyology.
Keifhaber etal documented the first clinical use of Nd:YAG laser in1977 in Gastroenterology. History www.indiandentalacademy.com
Cardiovascular surgery Dermatology and plastic surgery Gastroenterology General and oncologic surgery Gynecology Neurosurgery Ophthalmology Orthopedic surgery Ornitholaryngology Podiatry Pulmonary medicine Thoracic surgery Urology Vascular surgery www.indiandentalacademy.com www.indiandentalacademy.com History In 1960, first working laser , PULSED RUBY LASER , built by Maiman of huges research lab.
During the 1970s and 1980s intraoral use of Co 2 laser was confined primarily to Specialists such as oral surgeons and some periodontists.
In 1990 Myer and Myers developed a pulsed Nd:YAG laser which was recognized as the first laser specifically fo general dentistry called the deLase 300
www.indiandentalacademy.com Intra oral soft tissue application Ablating, incising, excising, and coagulating Co 2 , Nd:YAG, Ho:YAG
Co 2 laser has been favorite instrument for oral surgeons bcos of its wave lengths ready absorption into water (soft tissue).
Nd:YAG is also used because of its excellent coagulation ability, flexible fibroptic delivery system, ease of use and precision. www.indiandentalacademy.com LASER ASSISTED UVULOPLASTY
Is a clinical application for the treatment of obstructive sleep apnea and snoring.
Kamami is credited as originator of tech.
CO 2 laser is used for this purpose. www.indiandentalacademy.com Treatment of pathologic conditions
Tuffin and Carruth were the first report on use of Co 2 laser in pathologic lesions.
Co 2 It is predominantly used.
Nd:YAG laser was also used to treat similar conditions.
Analgesia, pain relief, accelerated wound healing , fibroblast proliferation, enhanced neuron regeneration, bone formation and dentinal hypersensitive. www.indiandentalacademy.com Lasers used for endodontics
Laser type
Wave length (nm) Argon 488 515 CO 2 10,600 Nd:YAG 1064 Diode 800-980 Er:YAG 2.94 Er :YSGG 2.79 www.indiandentalacademy.com Argon Laser :- Active medium of argon gas &delivered fiber optically in continuous- wave &gated pulse modes. Laser has two emission wavelengths 488nm (blue) & 514nm (blue-green) 488nm wavelength needed to activate camphoroquinone. Used with other dental materials- light activated impression paste & light activated bleaching gel. 514nm wavelength peak absorption red pigment tissue containing hemoglobin, hemosiderin, melanin intract with laser Surgical laser with excellent hemostatic capabilities Poor absorption into enamel, dentine advantage when used for cutting & sculpting gingival tissues thus no damage to tooth structure Both wavelength used for caries detection orange-red color.
Argon Laser :- www.indiandentalacademy.com CO 2 Laser
Uses hollow wave guide delivery system
Has gas active medium, delivered in continuous &gated pulse mode . Wavelength - 10,600nm
Effective in pain reduction & dentin hypersensitivity
It is used as an adjunct to mechanical root instrumentation The CO2 lasers ability to act as bactericidal
It is found effective in removing masses of tissue
www.indiandentalacademy.com Nd:YAG laser has solid active medium, crystal of Y-A-G doped with Nd
useful adjunct in reducing gingival inflammation and providing analgesic effects. www.indiandentalacademy.com Different laser systems used in dentistry www.indiandentalacademy.com ROLE OF LASERS IN ENDODONTICS www.indiandentalacademy.com VITAL AND NON VITAL DIAGNOSIS OF DENTAL PULP BY LASER
Use of Laser Doppler Flowmetry EPT uses electric current to stimulate A nerve fibre within pulp. Intact nerve fibre does not mean pulp is vital. Teeth that have experienced recent trauma or are in position of the jaw that has undergone orthognathic surgery. Laser doppler flowmetry uses specific wave length. HeNe and Diode laser at a lower power of 1 or 2 mW are used in laser doppler flowmetry. Wave length of HeNe laser 632.8mm Diode laser 780 to 820mm
www.indiandentalacademy.com Prevent reflecting from surrounding gingiva used under rubber dam. Advantages Allow painless diagnosis - Vital and non vital diagnosis of immature or traumatized teeth. - Patient sensitive to tooth pain.
www.indiandentalacademy.com Dentinal Hypersensitivity It is a short, sharp pain from exposed dentin. Erosion, abrasion, attrition, gingival recession are risk factors. Management of Dentinal hypersensitivity involves therapies that reduces flow of dentinal fluid. www.indiandentalacademy.com Blocking dentinal fluid flow decreases DH. This is obtained by application of Oxalate salt, isobutyl cynoacrylate, fluoride releasing resin, varnish, potassium containing dentifrices, fluoride containing medicaments and agent with 10% strontium chloride.
www.indiandentalacademy.com Laser induced reduction in dentinal hypersensitivity 2 mechanism.
1. Direct effect of laser on electric activity of nerve fibre within pulp. 2. Modification of tibular structure of dentin by sealing dentinal tubule.
The laser is used for treatment in 2 groups - Low output power laser (HeNe, diode) - Middle output for laser (Nd:YAG, Co 2 ) www.indiandentalacademy.com DIFFERENTIAL DIAGNOSIS OF PULPITIS BY LASER STIMULATION
Normal pulp and Acute Pulpitis Normal pulp stimulated by Nd: YAG laser at 2W and 20pps at distance 10mm - pain produced within 20-30 sec and disappear a couple of seconds after stimulation is stopped. However, in case of acute pulpitis pain is induced immediately after application and continues for 30sec after stopping the stimulation. www.indiandentalacademy.com Acute Serous Pulpitis and Acute Suppurative Pulpitis Obtained by combining the electric current resistance of caries and pain induced by laser stimulation. If electric current resistance is greater than 15.1m and patient experience continuous pain for more than 30 sec acute serous pulpitis. If electric current resistance is less than 15 m and pain continuous for more than 30 sec Acute suppurative pulpitis. www.indiandentalacademy.com Because of advantage of control of haemorrhage and sterilisation - DPC Diameter of pulpal exposure must be 2mm or less and there must be no infection in pulp. CO 2 laser can be used for this purpose TREATMENT BY LASER FOR DIRECT PULP CAPPING www.indiandentalacademy.com Laser irradiation performed at 1 or 2W after irrigating alternatively with 8% sodium hypoclhorite & 3% H 2 O 2 for 5 min. Ca (OH) 2 paste must be used to dress the exposure site. After which the cavity is tightly sealed with cement e.g carboxylate cement. High success rate because ability to control haemorrhage, disinfection, sterilization, carbonization and stimulation on dentinal pulp cells. Others Nd:YAG, argon, diode, Er : YAG.
www.indiandentalacademy.com Closure of dentinal tubule and sedative effect on pulpitis. Indication Deep cavities, hypersensitive cavities & cavities requiring sedative treatment Pulsed Nd:YAG laser + air spray used at 2W and 20 pps for 1 sec. CO 2 can be used for IPC at low energy for 1sec. Treatment by Laser for Indirect Pulp Capping www.indiandentalacademy.com ACCESS CAVITY PREPARATION AND ENLARGEMENT OF ROOT CANAL ORIFICE BY LASER Access cavity preparation has been performed - Air turbine And Enlargement of canal orifice Gates Glidden drill. Er:YAG and Er, Cr : YSGG laser, which ablate enamel and dentin can replace air turbine. www.indiandentalacademy.com Indications Vital extripation of infected root canal - Gates glidden cannot be inserted because of difficulty in opening mouth. - Difficulty to find root canal orifices.
Access cavity and orifice enlargement is carried out at 5W and 6Hz under water spray. www.indiandentalacademy.com CLEANING & SHAPING OF ROOT CANAL BY LASER Optical fiber of laser can cut enamel &dentin making possible to remove pulp tissue & prepare root canal wall Er:YAG laser at 8hz & 2w can be used Laser tip must slide gently from apical portion to coronal portion laser irradiation performed in combination with usual root canal preparation shown that smear layer removed completely & dentinal tubules opened.
www.indiandentalacademy.com One limitation with use of laser laser is emitted .straight ahead,making it almost impossible to irradiate the lateral canal walls Stabholz, et al reported development of a new tip that can be used with Er:YAG laser system This is called as RC Lase side firing tip The beam of laser delivered through hollow tube, tip of tube sealed at its far end thus preventing the transmission of irradiation through apical foramen. Thus laser is delivered laterally to the walls of canal through spiral slit located along the tip. www.indiandentalacademy.com LASERS FOR REMOVING PULP REMNANTS & DEBRIS AT APICAL FORAMEN pulsed Nd:YAG , Er:YAG recommended A power of 2 5 w for 1 sec is recommed Carried out in combination with 5.25% sodium hypochlorite or 14% EDTA Laser produces cavitation effect similar to ultrasonic Indication - straight , slightly curved canal ,wide root canal www.indiandentalacademy.com STERLIZATION OR DISINFECTION OF INFECTED ROOT CANAL laser is effect tool in killing micro organism Nd:YAG in combination with 38% silver ammonium sol. At 2W & 20 pps for 5 sec are recommed. Silver ammonium sol has been used as iontrophoresis of infected root canal To prevent leakage of 38% silver ammonium sol into periapical tissue , a cotton pellet is placed in apical 1/3 rd
of root canal If no symptom obturate root canal otherwise calcium hydroxide intracanal dressing given www.indiandentalacademy.com
LASER CAN ALSO BE USED FOR APICOECTOMY , RETROGRADE ENDODONTIC APICAL CAVITY PREPARATION, & PERIAPICAL CURETAGE www.indiandentalacademy.com www.indiandentalacademy.com Laser hazards are basically categorized into a categories according to ANSI or OSHA standards Class
Description
I
Low powered lasers that are safe to oral
II
Low powered visible lasers that are hazardous when viewed for larger than 0.25sec
III
Low powered visible lasers that are hazardous when viewed for larger than 1000sec
IIIa
Medium powered lasers that are normally not hazardous if craves for less than 0.25sec without magnifying optics
IIIb
Medium powered lasers (0.5w) that can be hazardous viewed directly
IV
High powered lasers (>0.5w) that produce ocular, skin, and fire hazards.
www.indiandentalacademy.com The lasers generally used for surgical procedures in dentistry fall under class IV.
The types of hazards that may be encountered within clinical practice of dentistry may be grouped as follows. 1. Occular injury 2. Tissue damage 3. Respiratory hazards 4. Fire and explosion 5. Electrical shock
www.indiandentalacademy.com LASER HAZARD CONTROL MEASURES USE OF PROTECTIVE WEAR THE SMALL FLEXIBLE FIBEROPTIC , HANDPIECES OR Tip MUST BE STEAM STERLIZED IN STERLIZING POUCHES. USE OF SCREEN & CURTAINS SHOULD BE PROMOTED USE OF PROPER CLOTHING USE OF ANTI-FIRE EXPLOSIVE THEIR SHOULD BE PROPER TRANING EDUCATION FOR USE OF LASER www.indiandentalacademy.com C0NCLUSION The last 20 years have witnessed many new developments in dental technologies, and the next 20 years promise to be even richer in technologic advancements. Lasers will be in the forefront of that growth. www.indiandentalacademy.com REFRENCES - THE DENTAL CLINICS OF NORTH AMERICA VOL-44; NO-4;OCT 2000 - TEXT BOOK OF ENDODONTIC JOHN I INGLE 5 TH Edi. - www.HOW STUFF WORKS LASERS - CLEANING AND SHAPING OF ROOT CANALWITH Nd:YAG LASER:A COMPARATIVE STUDY. J.O.E 18;123-127;1992. - EFFECT OF LASER TREAT ON ROOT CANAL OF HUMAN TEETH. DENTAL TRAUMATOLOGY 13;139- 145;1997. - THE DENTAL CLINIC OF NORTH AMERICA - VOL-48;NO-8;2004