The Case for Erbium in Periodontics
There are many different wavelengths to choose from, depending on the clinical needs. I want to begin by explaining why Erbium lasers seems to be ideally suited for comprehensive periodontal treatment.
We have all seen the chart showing the absorption coefficient of different wavelengths in water.
This is important for us to understand since water is a main component of dental tissues. The CO2 laser is absorbed very well in water, but there is a tendency to see charring and thermal effects in soft tissue, as well as melting of hard tissues. This does not make it very friendly for periodontal therapy where cementum and roots are involved, although a newer pulsed CO2 laser does improve on this problem.
Diode and Nd:YAG penetrate deep into tissue and may cause unseen thermal effects. Currently, they seem to be positive as adjuncts in periodontal therapy, as long as laser energy applied to the roots is kept minimal and controlled.
Erbium lasers have an excellent ablative potential in soft tissues, do not penetrate deep, and do not show the same thermal damage as the other wavelengths. They seem to be ideally suited for comprehensive soft tissue periodontal treatment, as well as calculus removal and root treatment.
There are 2 different Erbium lasers: Er:YAG and Er, Cr:YSGG. Both have a very similar absorption spectrum. There are few studies that compare their physical properties. As one study shows, it is difficult to analyze different systems because of the different manufacturer parameters.
For all intents and purposes, and to facilitate a meaningful discussion, going forward we will assume that all Erbium laser studies are reasonably interchangeable. Literature reviews will follow very soon.