Editorial
Volume 1 Issue 3 - 2017
Recent Scenario in Laser
Dr. Vishal Sahayata*
Department of Periodontology and Oral Implantology, Faculty of Dental Science, Dharmsinh Desai University, College Road, Nadiad, Gujarat, India
*Corresponding Author: Dr. Vishal Sahayata, Department of Periodontology and Oral Implantology, Faculty of Dental Science, Dharmsinh Desai University, College Road, Nadiad, Gujarat, India.
Received: June 26, 2017; Published: June 28, 2017
In last 100 years, dentistry has developed many cutting devices but still dental patients are afraid of noise and vibrations produce by the mechanical action of the air turbine or ultrasonic scalers. Laser is one of the most captivating and fascinating technologies in dental practice since Theodore Maiman in 1960 invented the ruby laser. Dentistry developed many photomechemical devices which are laser or ultrasound based. Waterlase system is a revolutionary dental device that uses laser energized water to cut or ablate soft and hard tissue. Periowave, a photodynamic disinfection system utilizes nontoxic dye (photosensitizer) in combination with low intensity lasers enabling singlet oxygen molecules to destroy bacteria [1].
Many different laser wavelengths have been used in oral and maxillofacial surgery, periodontal surgery and implant dentistry. Since there is excellent absorption of CO2 laser at wavele ngth of 10,600 nm in the water-based tissues, and at the same time penetrates only to a few microns of the target tissue’s surface, it is widely indicated in oral surgical procedures [2]. Diode laser is working on wave length of 819 and this energy level is absorbed by pigmentation of soft tissue and make it excellent haemostatic agent. It is used for soft tissue removal in contact mode giving tactile sensation. There is less traumatic bone cutting with the use of Erbium lasers resulting in less postoperative discomfort to the patients.
The management of patients with sleep apnea, TMJ derangements, dental implants, premalignant lesions, and post-traumatic facial scarring has improved significantly with the advent of laser surgery. Initial reports suggest that Laser Assisted New Attachment Procedure can be associated with cementum-mediated new connective tissue attachment and apparent periodontal regeneration of diseased root surface in humans.
Laser in endodontic therapy
The use of lasers as an aid in disinfection has been researched extensively in the last few years. The use of lasers in aiding root canal disinfection is more promising than in root canal preparation. For disinfection, laser energy can be used directly or can be combined with a photosensitive chemical that, when bound to microorganisms, may be activated by low-energy laser light to essentially kill the microorganism (Photodynamic Therapy (PDT). Another line of experiments suggests that the propagation of acoustic waves emanating from a pulsed-low energy laser may aid in distributing disinfecting solutions more effectively across the root canal system (Photon Induced Photoacoustic Streaming (PIPS)) [3]. The advantages of using laser, however, are balanced by several significant disadvantages. If the temperature is high enough, the bone surrounding the tooth may also be irreversibly injured, adversely affecting the entire area, which can result in ankylosis [4]. Moreover, cycles of melting and resolidification of radicular wall dentin apparently has no positive effect on clinical outcomes.
 Laser in oral implantology
The use of lasers in implant dentistry has been discussed extensively [5]. Many clinicians want to know if lasers can be used to treat peri‑implantitis, but it is difficult today to investigate this question using randomized clinical trials due to the lack of comparable test and control sites [6]. However, there are applications for lasers in implant dentistry, including for second stage surgery [7], removal of peri‑implant soft tissues, and decontamination of failing implants [8]. Serious concerns about the implant overheating followed by melting of the implant surface have been raised, along with concerns about a lack of reosseointegration following treatment of periimplantitis with lasers [9,10]. Recent systematic reviews have focused on the latter question and provided more information about how implants can restabilize following implant surface laser decontamination [11]. The main advantage of using CO2 laser irradiation on implant surfaces is that this wavelength does not pose the risk of overheating [12], unlike other wavelengths, such as that of diode, Nd:YAG, and Er:YAG lasers [13,14]. Recent systematic reviews have shown that there is limited information available about laser‑assisted decontamination of implant surfaces, with high heterogeneity of results and a low number of included studies. However, although information is limited about the clinical application of CO2 laser in the surgical treatment of periimplantitis, its use appears promising [15].
 Laser in periodontal therapy
Laser has definite advantages like less or no bleeding and pain during surgery. Lasers in periodontal therapy have been demonstrated to be beneficial for control of bacteremia [16], better removal of the pocket epithelium in the pockets [17,18] bacteria reduction [19-22], efficient subgingival calculus removal (using Er: YAG lasers) [23] and improvement of periodontal regeneration in animals and humans without damaging the surrounding bone and pulp tissues [24,25]. Use of low level laser irradiation to improve wound healing has been suggested but results to date are inconclusive. Further clinical trials and multicenter studies should be performed to improve the effects of laser treatment of periodontal and periimplant diseases and to develop standardized protocols so that lasers may be used in a predictable way in daily practice.
References
  1. Walsh LJ. “The current status of laser applications in dentistry”. Australian Dental Journal 48.3 (2003):146-155.
  2. Coluzzi DJ. “Fundamentals of dental lasers: Science and instruments”. Dental Clinics of North America 48.4 (2004): 751-770.
  3. Kishen A. “Advanced therapeutic options for endodontic biofilms”. Endodontic Topics 22.1 (2010):  99-123.
  4. Bahcall J., et al. “Preliminary investigation of the histological effects of laser endodontic treatment on the periradicular tissues in dogs”. Journal of Endodontics 18.21 (1992):  47-51.
  5. Romanos GE., et al. “Laser wavelengths and oral implantology”. Lasers in Medical Science 24.6 (2009): 961-970.
  6. Romanos GE and Weitz D. “Therapy of peri-implant diseases. Where is the evidence?” Journal of Evidence Based Dental Practice 12.3 (2012): 204-208.
  7. Arnabat-Dominguez J., et al.  “Erbium: YAG laser application in the second phase of implant surgery: A pilot study in 20 patients”. The International Journal of Oral & Maxillofacial Implants 18.1 (2003): 104-112.
  8. Romanos GE., et al. “Peri-implant diseases: A review of treatment interventions”. Dental Clinics of North America 59.1 (2015): 157-178.
  9. Block CM., et al. “Effects of the Nd: YAG dental laser on plasma-sprayed and hydroxyapatite-coated titanium dental implants: Surface alteration and attempted sterilization”. The International Journal of Oral & Maxillofacial Implants 7.4 (1992): 441-449.
  10. Romanos GE., et al. “Effects of diode and Nd: YAG laser irradiation on titanium discs: A scanning electron microscope examination”. Journal of Periodontology 71.5 (2000): 810-815.
  11. Javed F., et al. “Re-stability of dental implants following treatment of peri-implantitis”. Interventional Medicine & Applied Science 5.3 (2013): 116-121.
  12. Oyster DK., et al. “CO2 lasers and temperature changes of titanium implants”. Journal of Periodontology 66.12 (1995): 1017-1024.
  13. Geminiani A., et al. “Temperature increase during CO2 and Er: YAG irradiation on implant surfaces”. Implant Dentistry 20.5 (2011): 379-382.
  14.  Geminiani A., et al. “Temperature change during non-contact diode laser irradiation of implant surfaces”. Lasers in Medical Science 27.2 (2012): 339-342.
  15. Kotsakis GA., et al. “Systematic review and meta-analysis of the effect of various laser wavelengths in the treatment of peri-implantitis”. Journal of Periodontology 85.9 (2014): 1203-1213.
  16. Pinero J. “Nd: YAG-assisted periodontal curettage to prevent bacteria before cardiovascular surgery”. Dentistry Today 17.3 (1998): 84-87.
  17. Gold SI and Vilardi MA. “Pulsed laser beam effects on gingiva”. Journal of Clinical Periodontology 21.6 (1994): 391-396.
  18. Romanos GE. “Clinical applications of the Nd: YAG laser in oral soft tissue surgery and periodontology”. Journal of Clinical Laser Medicine & Surgery 12.2 (1994): 103-108.
  19. Ben Hatit Y., et al. “The effects of a pulsed Nd: YAG laser on subgingival bacterial flora and on cementum: An in vivo study”. Journal of Clinical Laser Medicine & Surgery 14.3 (1996): 137-143.
  20. Moritz A., et al. “Treatment of periodontal pockets with a diode laser”. Lasers in Surgery and Medicine 22.5 (1998): 302-311.
  21. Schwarz F., et al. “Periodontal treatment with an Er: YAG laser compared to scaling and root planning. A controlled clinical study”. Journal of Periodontology 72.3 (2001): 361-367.
  22. Yaneva B., et al. “Bactericidal effects of using a fiber-less Er: YAG laser system for treatment of moderate chronic periodontitis: Preliminary results”. Quintessence International 45.6 (2014): 489-97.
  23. Eberhard J., et al. “Efficacy of subgingival calculus removal with Er: YAG laser compared to mechanical debridement: An in situ study”. Journal of Clinical Periodontology 30.6 (2003): 511-518.
  24. Israel M., et al. “Use of the carbon dioxide laser in retarding epithelial migration: A pilot histological human study utilizing case reports”. Journal of Periodontology 66.3 (1995): 197-204.
  25. Mizutani K., et al. “Periodontal tissue healing following flap surgery using an Er: YAG laser in dogs”. Lasers in Surgery and Medicine 38.4 (2006): 314-324.
Citation: Dr. Vishal Sahayata. “Recent Scenario in Laser”. Oral Health and Dentistry 1.3 (2017): 150-152.
Copyright: © 2017 Dr. Vishal Sahayata. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.