Patients

This section is intended to provide the public with a comprehensive overview of laser dentistry.

Dr. Mark Schlesinger is a board-certified periodontist and founder of the NY Laser Institute. He maintains a private practice in Manhattan.

Lasers: An Introduction

Medical surgeons began using lasers in the 1970′s to complement, and in some instances, to replace a scalpel. The first laser intended for dentistry was developed in the late 1980′s. As technological advances have improved lasers, an increasing number of patients and dentists are choosing laser dentistry as a preferred method of treatment. A laser dentist receives special training to operate laser equipment, however, laser dentistry is not a recognized specialty of the American Dental Association.

Lasers are not magic wands, but modern tools that help dental professionals perform a variety of dental procedures. A dentist should not use a laser for advanced procedures that he/ she would otherwise not perform by conventional means due to lack of training and skill.

If you are considering laser dental treatment, here is what you might expect during a visit to your laser dentist:

Patients are required to wear protective eyewear during laser dental treatment. Unlike the high-pitched noise heard from a typical dental drill, lasers may be silent or make a continuous popping sound, similar to that of a popcorn maker. Some lasers emit a gentle spray of water or air. Depending upon the type of treatment, the laser may be used alone or in conjunction with conventional tools.

Surgical procedures that can benefit from laser-assistance include, but are not limited to, periodontal treatment, extractions, dental implants and cosmetic procedures. Generally, the requirement for local anesthesia is less for surgical procedures performed with a laser. Laser assisted dental surgery usually results in reduced bleeding and swelling, and better post-operative recovery, as compared to surgery by conventional means. Studies have shown that lasers can reduce pain, swelling, and the formation of bacteria that can occur during dental procedures. A laser cuts more precisely than a scalpel, and can sterilize surface tissues when used to create gum flaps. In addition, sutures are frequently unnecessary after laser dental surgery.

As compared to a dental drill, lasers that are designed to remove tooth decay often do so more efficiently and with less or no anesthetic. A root canal can also be performed with laser-assistance. Other lasers have been developed to whiten teeth, detect cavities and for the hardening of tooth colored fillings.

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Types of Lasers Used in Dentistry

Several varieties of lasers are used in dentistry. Each laser is very different. Large laser units are robust and provide a much greater range of treatment options than smaller, table-top or handheld lasers.

Four (4) main families of dental lasers exist.

  1. Diode Lasers
  2. CO2 (carbon dioxide) Lasers
  3. Nd:YAG Laser or “Periolase”
  4. Erbium Lasers (“Waterlase” or Er:YAG)
  • How Lasers Work
      Lasers emit a specific wavelength of light. The energy in the light interacts with the body to produce a desired result. For example, when the pinpoint laser light from an Erbium laser contacts a tooth, it will accurately vaporize the tooth structure. Different types of lasers utilize different chemicals or crystals to create a unique wavelength of light with specific properties.While all dental lasers are designed for soft tissue (gums) procedures, only the Erbium lasers are FDA-approved for safely cutting hard tissue (teeth and bone). Diode lasers emit a low level energy that has been shown to accelerate healing, but these results have not been clearly validated in studies.
    1. Minimally Invasive

      2. Laser energy is delivered with pinpoint precision, thereby minimizing the need for surgical flap access during periodontal, oral surgical or implant related procedures. Erbium lasers can selectively eliminate diseased tooth structure from a cavity while keeping the healthy tooth intact.

    2. Blades and Scalpels May Be Obsolete

      3. The CO2 and Erbium lasers are effective in making precise incisions. Unlike a scalpel incision, these lasers vaporize tissue with minimal cellular damage, greatly reducing the inflammatory response. The Er:YAG and Waterlase generate much less heat than other types of lasers, decreasing the likelihood of damage to healthy tissue. In some instances, however, heat may be desirable, such as during the removal of pathological tissues in the mouth and for controlling bleeding. The diode, CO2 and Nd:YAG lasers emit heat energy that can be regulated by the dentist and is capable of penetrating deep into tissues when necessary for treatment.

    3. Reduction in Pain and Need for Injections (Anesthetic)

      4. The correct application of laser energy can desensitize nerve endings, thus allowing many procedures to be performed without anesthetic.
      Also, the preciseness inherent in lasers results in less trauma to the treated site. Since Erbium lasers produce less heat than the diode, CO2 and Nd:YAG lasers, they can assist in many more procedures that require less anesthetic.

    4. Minimal Bleeding

      5. Laser energy can be manipulated to cause blood coagulation on contact. Coagulation means the clotting of blood. This feature improves the dentist’s visibility and is one of the reasons laser surgical procedures are characterized as minimally invasive. It is possible, therefore, to eliminate the need for patients to discontinue taking, prior to surgery, Aspirin, Coumadin, Plavix and other blood thinning medications, all critical to preventing a heart attack or stroke. The diode, CO2 and Nd:YAG lasers are very effective at blood coagulation.

    5. Stitches Often Not Needed

      6. The precise nature of laser treatment, particularly as it pertains to periodontal therapy, means that sutures are often not necessary.

    6. Disinfection

      7. All dental lasers are disinfectants, meaning they kill bacteria and microorganisms on contact, and disrupt bacterial biofilms. The ability of a laser to disinfect is especially important with respect to periodontal therapy, where eliminating harmful bacteria is critical to successful treatment. Sterilization of a site improves the body’s healing response. Additionally, some lasers have special probes that assist in the removal of bacteria and toxins during root canal treatment.

    7. Accelerated Healing and Recovery

      8. Treatment with a laser leads to quicker healing and less post-operative discomfort. Some evidence also indicates that laser energy from diode lasers and the residual energy from other lasers enhances cellular healing. This is known as Low Level Laser Therapy (LLLT) or “Biostimulation”.

    8. Relief of Anxiety

      9. Millions of Americans suffer from some level of dental anxiety and phobia. Due to the gentle nature of dental laser therapy, patients are much less fearful in the dental chair.

    9. Great for Kids

      10. Soft tissue surgery, either a frenectomy or gingivectomy, is sometimes required prior to or during orthodontic treatment (i.e. braces or Invisalign). These patients are generally children. These procedures can often be performed quickly and painlessly with a laser, and with minimal post-operative problems.

    10. High Patient Satisfaction

      11. Patients are more comfortable proceeding with a surgical procedure that is minimally invasive. Additionally, patients are happier after laser dental surgery than dental surgery by conventional means.

    • The diode laser can kill pathogenic bacteria below the gums and can assist in removing diseased tissue below the gumline, but has limited effectiveness in deeper gum pockets due to limited visibility. Since the diode generates heat, it can damage healthy tissue if it remains in one spot for too long.
    • The CO2 laser is more powerful than a diode laser, therefore, additional care must be taken to avoid charring of healthy tissue. Studies show that the thermal effect created by the CO2 laser can melt away healthy tooth structure or bone.
    • The Nd:YAG (LANAP) is extremely effective in killing bacteria and removing diseased, inflamed tissue. In some cases, however, it is recommended to incorporate regenerative therapy involving the placement of special materials that will bio-engineer and restore new bone and ligament tissue that was destroyed by the gum disease process. The problem that arises is that the Nd:YAG laser creates a fibrin blood clot in the gum pocket that prevents the use of regenerative materials, thereby limiting the ability to achieve the best outcome.
    • The Erbium lasers, like the Nd:YAG laser, will kill bacteria and remove diseased and inflamed tissue, but unlike the Nd:YAG, can also be used in conjunction with regenerative materials to provide more comprehensive treatment. The Erbium laser may be slightly slower than the Nd:YAG laser at removing diseased tissue and sterilizing a pocket, but it is safer on the teeth and root surfaces.
    • PERIODONTICS: cleanings, deep gum treatment, gum grafts, cosmetic reshaping of the gums
    • ENDODONTICS: root canal detoxification, apicoectomy
    • ORTHODONTICS: frenectomies and gingivectomies
    • ORAL SURGERY: extractions, biopsies, grafts, removal of benign or malignant pathologic growths
    • ORAL MEDICINE: biopsies, treatment of canker sores, cold sores, and other pathologic conditions
    • IMPLANT DENTISTRY: surgical access, sinus augmentation, bone grafts
    • GENERAL DENTISTRY: cavity preparations for fillings, treatment for tooth sensitivity, and minor trimming of the gums
LASER CLINICAL USE PRECAUTIONS
Diode Removal of soft tissue, gingivectomy, frenectomy, excision of soft tissue pathology, hemostasis, gum treatment and pocket disinfection. Excellent for minor, localized surgical procedures. Controls bleeding well. This is probably the most common laser. Because it runs on low wattage, small, relatively inexpensive handheld models are available.It’s uses are limited. May damage jawbone and tooth roots during gum treatment. In some states, dental hygienists can legally operate a diode laser.
CO2 Removal of soft tissue, gingivectomy, frenectomy, excision of soft tissue pathology (benign and malignant), hemostasis. Can be used as an adjunct to gum treatment.This laser is excels at making clean, quick incisions of soft tissue. This is an uncommon laser and it is large, typically with a swinging arm that operates the laser.This laser generates heat and can char underlying healthy tissue. Sometimes, however, the thermal coagulating effect is helpful as a surgical dressing. It’s uses are also limited.
Nd:YAG / Periolase Removal of soft tissue, gingivectomy, frenectomy, excision of soft tissue pathology, hemostasis, gum treatment.The Periolase is marketed mainly for periodontal treatment and the LANAP procedure. Dentists report very good results for periodontal treatment but there are important limitations. Tissue penetration from this laser can cause underlying thermal damage below the surface. It’s uses may also be limited.
Erbium Removal of soft tissue, gingivectomy, frenectomy, excision of soft and hard tissue pathology, gum treatment. Erbium lasers are the only ones FDA-cleared for hard tissue procedures, including cavitiy preparation and bone surgery. These lasers generate the least amount of harmful heat.Many procedures can be performed without anesthetic. This is probably the most versatile of all the dental lasers. Adequate water spray must be used when cutting hard tissues. There is minimal heat damage when used at appropriate power settings. Unlike the Nd:YAG, regenerative procedures can be performed in conjunction with Erbium laser therapy for enhanced results.

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Benefits of Lasers in Dentistry

The benefits will vary depending upon the procedure, the type of laser being utilized and the dentists’ level of experience and training.

Procedures That Can Be Performed With a Laser

All dental lasers are designed for use on oral soft-tissues, including the gums, tongue, the inside of the cheek and lips. Only Erbium lasers can also effectively be used on oral hard-tissues, specifically the teeth and the jawbone.

A laser manufacturer’s website or a laser dentist’s website usually lists the various procedures that can be performed with their laser equipment. This sort of information can be misleading because every type of laser can be used to some degree in practically all soft-tissue dental procedures, however, each laser functions differently and cannot produce the same results.

For example: The diode, CO2, Nd:YAG and Erbium lasers can all technically provide gum treatment, however, to what extent is the real question.

The example described above demonstrates that the appropriateness of a particular laser depends upon the extent of treatment required by the patient’s condition. An individual suffering from mild gum disease or an individual receiving routine care from a dental hygienist could be treated effectively with the assistance of a diode laser. An individual with moderate or advanced gum disease would respond better to treatment with an Nd:YAG/ LANAP or Erbium laser. The Erbium lasers appear to be the most effective in treating advanced gum disease.

Virtually all dental procedures can benefit from lasers, taking into account the type of laser being used for treatment and the dental professional’s level of training and experience. Below is a list of procedures that dentists are performing successfully with laser assistance:

Cold Lasers – Low Level Laser Therapy (LLLT) / Biostimulation

Diode laser energy, as well as residual energy from the other dental lasers, is thought to penetrate deeper into tissues with no heating effect or damage. The energy is directed deep into the targeted area, stimulating the body’s cells, which convert the energy into chemical energy to promote natural healing.

Cold lasers are often compared to “acupuncture with a laser beam.” In most LLLT treatments, the laser beam is used to stimulate the body’s acupoints or damaged area in an attempt to increase the blood supply. Further studies are necessary to validate these claims.

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What You Should Know Before Proceeding With Laser Therapy

Laser dentistry is a revolutionary way of administering dental care but patients should be educated before proceeding with laser dental treatment. The majority of dentists and dental specialists are uninformed about laser dentistry and its benefits. Unfortunately, this lack of awareness among the dental community makes it exceedingly difficult for patients to evaluate laser dentistry as an option.

PERIODONTAL CARE: Since millions of Americans suffer from gum disease, marketing for laser dentistry has focused primarily on laser gum therapy. The use of lasers to treat gum disease can be very appealing to patients, especially those suffering from dental phobia or anxiety.

Gum disease must be diagnosed properly and the extent of disease must be determined in order for a dentist or periodontist to devise an effective treatment plan. A dentist or periodontist should advise a patient of all options, including conventional treatment, the possible extraction of badly diseased teeth, the use of regeneration and bone grafting where appropriate, and referral to a specialist, especially in advanced cases. If a patient decides to undergo laser gum treatment, it is important for the patient to understand the capabilities and limitations of the specific laser system being utilized for treatment.

DENTAL FILLINGS: When Erbium lasers were first introduced, they were intended to offer a viable alternative to traditional dental drills for cavity preparations. In reality, the lasers cut teeth very slowly, making them impractical. Recently, the Erbium lasers have improved with the advancement in laser technology. Today, the Waterlase MD Turbo and Er:YAG lasers offer the ability to cut teeth at almost the same speed as conventional drills. These newer lasers offer a legitimate and minimally invasive alternative to conventional drills with appealing benefits, like less need for anesthetic and the ability to more precisely remove decay.

ROOT CANALS: Some laser systems have specially designed thin and flexible probes that assist in root canal treatment. This method of treatment appears to be very effective, but whether it is superior to traditional root canal treatment is still unknown.

FDA APPROVAL: Laser manufacturers often publicize the fact that a particular procedure has “received FDA clearance or approval” in an attempt to gain marketing leverage against a competitor. FDA approval simply means that a procedure has met certain criteria for safety, but it should not be misinterpreted as an approval of it’s effectiveness or that the same procedure cannot be safely performed by other methods that have not received FDA approval.

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