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Published: March 2011
Expiry: February 2014
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Lasers in Orthodontics
A Peer-Reviewed Publication
Written by Stephen Tracey DDS, MS
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Educational Objectives
The overall goal of this article is to provide the reader
with information on the use of lasers in orthodontics. On
completion of this course, the reader will be able to do the
following:
1. List and describe the development of lasers.
2. List and describe the scientic principles on which lasers
are based.
3. List and describe laser setup and troubleshooting in
practice.
4. List and describe periodontal considerations when using
a laser.
5. List and describe the procedures for which a diode laser
can be used in the orthodontic practice.
Abstract
Lasers were rst conceived of almost a century ago and
were introduced into dentistry in 1989. Several types of
dental lasers are now available, with the diode laser be-
ing of particular interest for the orthodontic clinician. It
is now possible to treat many soft tissue conditions that
present as challenges in orthodontics and can impact the
overall aesthetic outcome, and to treat these more easily.
Before using lasers, it is necessary to understand how they
work, the steps involved in setup, precautions that must be
taken (such as eye protection), and troubleshooting steps.
Periodontal considerations must also be known and under-
stood. Soft tissue procedures that can benet from use of a
diode laser include frenectomy, gingival recontouring, the
removal of hypertrophic tissue, and exposure of a partially
erupted tooth.
Introduction
Orthodontic clinicians have long been challenged by soft
tissue problems associated with treatment. Short clinical
crowns prevent ideal bracket placement and compromise
the effectiveness of aligner treatment, while delayed
eruption of teeth often results in excessive appointments
and extended treatment times. Other challenges include
excessive gingival display and uneven gingival margins
that can turn even the nicest treated case into one that falls
short aesthetically. With the introduction of lasers to the
profession in the last decade, these problems can now be
addressed.
Historical Background
In 1917, Albert Einstein laid the foundation for the in-
vention of the laser and its predecessor, the maser, when
he rst theorized that photoelectric amplication could
emit a single frequency, or stimulated emission. The term
“laser” is an acronym for light amplication by the stimu-
lated emission of radiation and was rst introduced to the
public in 1959 in a paper by Columbia University gradu-
ate student Gordon Gould. In 1960, American physicist
Theodore Maiman at the Hughes Research Laboratories
in Malibu, California, built the rst functioning laser.
Since that time, lasers have become nearly ubiquitous in
society. They are in computer printers and DVD players,
they record prices at the grocery store, they guide weap-
ons, and they measure distances between planets. The
rst surgical laser developed specically for dentistry, a
3 W Nd:YAG laser, was introduced in 1989, and in May
1997, the United States Food and Drug Administration
approved the Er:YAG laser for use on dental hard tissues
such as teeth and bones.
Scientific Concept
Light is a form of electromagnetic energy that can be
thought of as both a particle and a wave. The elementary
particle of light is called a photon and is typically described
as a tiny packet of energy that travels in waves at the speed
of light. A wave of photons can be dened by two basic
properties: amplitude and wavelength. Amplitude corre-
lates to the amount of energy each photon is excited to: the
larger the amplitude, the greater the energy. Wavelength
is dened as the horizontal distance between any two cor-
responding points on the wave. Ordinary light, such as
that produced by an incandescent lightbulb, is composed
of many wavelengths of light and is unfocused or incoher-
ent. Laser light is different from ordinary light in that it
is monochromatic and consists of a single wavelength of
light. In some cases, it is invisible to the human eye. Ad-
ditionally, each wave of laser light is coherent, or identical
in physical size, shape, and synchronicity. The monochro-
matic, coherent wave of light energy that is produced by a
laser is a unique source of focused electromagnetic energy
that is capable of useful work.
Figure 1. Typical laser oscillator
Excitation source
(such as a solid-state semi-conductor)
High
reecting
rear mirror
Lasing
medium
(such as an AlGaAs rod)
Partially
reecting
output coupler
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A laser is composed of three principal parts: an energy
source, an active lasing medium, and an optical cavity or reso-
nator (Figure 1). In order for amplication to occur, energy is
supplied to the laser system by a pumping mechanism such as
a ashlamp strobe device, an electrical current, or an electrical
coil. This energy is pumped into an active medium contained
within an optical resonator, producing a spontaneous emis-
sion of photons. Subsequently, amplication by stimulated
emission takes place as the photons are reected back and
forth through the medium by the highly reective surfaces
of the optical resonator before they exit the cavity via the
output coupler. In the case of dental lasers, the laser light is
delivered from the laser to the target tissue via a ber-optic
cable, hollow waveguide, or articulated arm. The wavelength
and other properties of the laser are determined primarily by
the composition of the active medium, which can be a gas, a
crystal, or a solid-state semiconductor (Figure 2).
A laser is composed of three principal parts:
an energy source, an active lasing medium, and
an optical cavity or resonator.
Laser Classification
It is generally recognized that lasers of all but the lowest
powers can be potentially dangerous, particularly to human
eyesight. Consequently, laser devices are classied according
to their potential to cause biological damage, as follows:
Class 1. A Class 1 laser is safe under all reasonably antici-
pated conditions of use. Examples include laser pointers and
supermarket UPC scanners.
Class 2. A Class 2 laser emits light in the visible light
spectrum. It is presumed that the human blink reex will be
sufcient to prevent damaging exposure, although prolonged
viewing may be dangerous. Consequently they are typically
self-contained such as in laser printers and CD, DVD, and
BD players and readers.
Class 3. A Class 3 laser produces light of such intensity
that direct viewing of the beam can potentially cause serious
harm. Consequently, use of a Class 3 laser requires special
training and eye protection. One example of a Class 3 laser
would be a dental argon curing light.
Class 4. Class 4 lasers produce high-powered light that is
hazardous to view at all times. Exposure to the eye or skin by
both direct and scattered laser beams of this intensity, even
those produced by reection from diffusing surfaces, must be
avoided at all times. Nearly all medical and dental lasers fall
into this category.
Lasers in Dentistry
Since the development of the rst laser by Maiman in 1960,
dental interest in lasers has been high and research has been
continuing into ways to improve dental treatment through
laser application. Argon curing lasers have been around since
the 1980s, diagnostic lasers have been used since the late
1990s to assist in detecting caries, and 3-D laser scanners have
been used for many years to translate physical plaster models
into virtual e-models. In this article, we will be focusing our
attention on the use of dental lasers for surgical applications
involving soft tissues.
Laser Effects on Tissue
The light energy produced by a laser can have four different
interactions with a target tissue (Figure 3). The rst effect is
reection, which involves redirection of the beam off the sur-
face of the tissue, with no effect on the target tissue. The sec-
ond effect is transmission of the laser energy directly through
the tissue, again with no effect on the target tissue. The third
effect is a scattering of the laser energy, resulting in a weaken-
ing of the intended energy and possible undesirable transfer
Electromagnetic spectrum
Invisible ionizing radiation Visible Invisible thermal radiation
X-Rays UltraViolet Near infrared Mid infrared Far infrared
200nm 2000nm 3000nm
Alexandrite (2x)
377nm
Nd:YAG
1064nm
Argon
488nm
Argon
514nm
HeNe
632nm
AlGaAs
810nm
InGaAs
980nm
Ho:YAG
2120nm
Er,Cr:YSGG
2790nm
Er:YAG
2940nm
CO
2
10.6 μm
9.6 μm
9.3 μm
400-700nm
Figure 2. Wavelengths of dental lasers
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of heat to adjacent nontarget tissue. The fourth effect is ab-
sorption of the laser energy by the target tissue. While there is
always a mixture of all four interactions taking place simulta-
neously any time laser energy is directed at a target tissue, it is
the interaction of absorption that is of primary interest. When
laser light is absorbed, the temperature of the target tissue is
elevated, resulting in a number of photothermal effects based
upon the water content of the tissue. When a temperature of
100 degrees C is reached, vaporization of the water within
the tissue occurs. Since soft tissue is composed of a very
high percentage of water, ablation of soft tissue commences
at this temperature. At temperatures below 100 degrees but
above approximately 60 degrees, proteins begin to denature
without vaporization of the underlying tissue. Conversely,
at temperatures above 200 degrees, tissue is dehydrated and
then burned, an undesirable effect called carbonization.
Since soft tissue is composed of a very high
percentage of water, ablation of soft tissue com-
mences at 100 degrees C
Figure 3. The interactions of laser light
Absorption
Scatter
Transmission
(Refraction)
Reection
Absorption requires an absorber of light, termed a chro-
mophore. Chromophores have a certain afnity to specic
wavelengths of light: the higher the afnity, the greater the
absorption of energy. The primary chromophores in intraoral
soft tissue are melanin, hemoglobin, and water. Different
laser wavelengths have different absorption coefcients with
respect to these primary tissue components, making laser
selection procedure-dependent (Figure 4).
Laser Selection for Orthodontic Applications
Many laser systems are available today, each with its own
set of benets and drawbacks. The most common lasers
used in dentistry today are the CO2 laser, the Nd:YAG la-
ser, the erbium lasers (Er:YAG and Er,Cr:YSGG), and the
diode laser. Each produces a different wavelength of light
and is generically named for the active medium contained
within the device. Since no single laser wavelength can be
used to optimally treat all dental diseases, there is no one
perfect dental laser. However, the needs of the orthodontic
clinician are unique, and selection of the most appropriate
laser for orthodontic applications is ideally determined by
examining four important factors: procedure specicity,
ease of operation, portability, and cost. CO2 and Nd:YAG
are not ideally suited for orthodontic applications and are
hampered by their large size and high cost. Erbium lasers
are extremely popular in dentistry today and hold the sin-
gular distinction of being able to perform both hard and soft
tissue procedures. However, it is the diode laser that seems
most ideal for incorporation into the orthodontic specialty
practice.
With regard to procedure specicity, the diode laser’s
sole purpose is soft tissue surgery. It safely removes tissue
without risk to adjacent tooth structure and provides excel-
lent hemostasis. As to ease of operation, most practitioners
prefer the diode laser’s dry-eld operation and the proprio-
ceptive feedback provided by the light contact of the ber
tip with target tissue during ablation. Portability, or being
able to easily move a laser from chair to chair or even of-
ce to ofce, is an especially important feature to consider
when selecting a laser for the typical orthodontic practice.
Wavelength (microns)
Melanin
Hb
Soft Tissue Lasers
Hydroxy
apatite
UV
ionizing
H
2
O
IR
thermal
Argon
.48 - .51
Diode
.81 - .98
Nd:YAG
1.06
Er:YAG
2.94
CO
2
9.6 - 10.6
105
104
103
102
101
1
10-1
10-2
10-3
10-4
Absorption Coecient (1/cm)
0.1 1.0 10.0
Figure 4. Tissue and their net absorption
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Diode lasers are the most portable of all dental lasers, with
the smallest diode laser being similar in size to an electric
toothbrush and weighing in at a scant 1.9 ounces. In terms
of affordability, the cost of a diode laser is a mere fraction of
the cost of other dental lasers, with quality diode lasers avail-
able for under $5,000. With this in mind, most orthodontic
clinicians interested in purchasing a dental laser would be
best served by a diode laser due to its soft tissue specicity,
simple operation, small size, and relatively low cost.
Table 1. Characteristics of diode lasers
Sole purpose is soft tissue removal
No risk of damage to adjacent tooth structure
Excellent hemostasis
Dry-field operation
Light contact of the fiber tip with tissue
Proprioceptive feedback
Portability
The Diode Laser
The active medium of the diode laser is a solid-state semi-
conductor, made of aluminum, gallium, arsenide, and oc-
casionally indium, that produces laser wavelengths ranging
from approximately 810 nm to 980 nm. These wavelengths
fall at the beginning of the near-infrared electromagnetic
spectrum and are invisible to the human eye. Diode lasers
deliver laser energy from the laser to the working area ber-
optically, either by ber-optic cable or disposable ber-
optic tip, ordinarily in light contact with the target tissue
for ablating procedures. All diode wavelengths are absorbed
primarily by tissue pigment (melanin) and hemoglobin.
Conversely, they are poorly absorbed by the hydroxyapatite
and water present in enamel. Consequently, diode lasers are
excellent soft tissue surgical lasers and indicated for incis-
ing, excising, and coagulating gingiva and mucosa. Due to
the fact that diode laser wavelengths are poorly absorbed by
tooth structure and metal, ablation procedures can safely be
performed in close proximity to enamel, orthodontic appli-
ances, and temporary anchorage devices.
Diode Laser Setup and Troubleshooting
Laser Safety
While most dental lasers are relatively simple to use, certain
precautions should be taken to ensure their safe and effec-
tive operation. Of extreme importance is the use of protec-
tive eyewear by anyone in the vicinity of the laser while it
is in use. This includes the doctor, chairside assistants,
the patient, and any observers such as family or friends
(Figure 5). It is critical that all protective eyewear worn is
wavelength-specic (Figure 6). Most surgical lasers produce
a wavelength of light that is outside the visible portion of
the electromagnetic spectrum. Consequently, sunglasses
or safety glasses designed for use with visible dental curing
lights are ineffective at protecting the eye from potentially
irreversible damage as a result of exposure to dental laser
light. Additionally, accidental exposure of nontarget tissue
can be prevented by limiting access to the surgical environ-
ment, minimizing reective surfaces, and ensuring that the
laser is in good working order with all manufactured safe-
guards in place. To prevent possible exposure to infectious
pathogens, high-volume suction should be used to evacuate
any vapor plume created during tissue ablation, and normal
infection protocols should be followed. Each ofce should
have a designated staff member act as Laser Safety Ofcer to
supervise the proper use of the laser, coordinate staff train-
ing, oversee the use of protective eyewear, and be familiar
with pertinent regulations.
The use of protective eyewear by anyone in
the vicinity of the laser while it is in use is of
extreme importance.
Figure 5. Protective eyewear worn by all in the operatory
Figure 6. Wavelength specific protective eyewear
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Table 2. Requirements and recommendations for laser safety
Use of protective eyewear by anyone in the vicinity of the laser
Limit access to the surgical environment
Minimize reflective surfaces
Ensure that the laser is in good working order
Ensure all manufacturer safeguards are in place
Use of high-volume suction
Follow normal infection control protocols
Designated staff member as Laser Saftey Officer
Staff training
Fiber Preparation
The diode laser transmits laser light from the laser to the
target tissue via a ber-optic cable or disposable ber-optic
tip. In the case of a ber-optic cable, a 400-micron optical
ber is recommended, as smaller diameter bers tend to be
more friable and breakable. Prior to use, a sufcient por-
tion of protective outer cladding must be removed with an
appropriately sized stripping device in order to expose the
inner glass ber (Figure 7). The amount of outer cladding
removed is determined by the length of the handpiece sup-
plied with the laser, such that any exposed ber is complete-
ly contained within the handpiece. The ber is then inserted
into the handpiece, and a disposable plastic tip is tted over
the ber tip and placed on the end of the handpiece, leav-
ing approximately 3 mm of ber exposed (Figure 8). Before
each patient use, 2-3 mm is cut off the end of the ber with
ceramic scissors or a cleaving stone in order to avoid cross-
contamination (Figure 9). The ber tip is then “initiated”
by placing some form of pigment on the end of the ber in
order to create a hyper-focus of usable laser energy at the tip.
One of the most effective ways to deposit pigment on the tip
is to lightly tap the end of the ber onto a sheet of articulat-
ing lm while the laser is activated (Figure 10). In the case
of a disposable ber-optic tip, it is not necessary to strip or
cleave the ber; however, tip initiation is still required.
Figure 7. Stripping of the protective outer cladding
Figure 8. Placement of a disposable plastic tip
Figure 9. Removal of terminal 3 mm to avoid cross-contamination
Figure 10. Depositing pigment on the tip
Basic Power Settings
To prevent collateral thermal damage to adjacent tissue, the
Academy of Laser Dentistry recommends using the least
amount of power that can effectively accomplish a desired
procedure. For most soft tissue ablation procedures, a set-
ting of 1 to 1.2 watts will result in excellent tissue removal
with minimal thermal degeneration of adjacent tissue.
Areas of denser tissue, such as the palate and the brous
tissue distal to the lower second molars, may require set-
tings closer to 1.4 watts, while frenectomy procedures often
require settings as high as 1.6 watts. In addition to adjusting
power settings, it is also necessary to choose between op-
erating the laser in either continuous wave mode or pulsed
mode. Although some practitioners have advocated using
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pulsed mode to potentially reduce patient discomfort and
minimize adjacent tissue damage, in actual practice there
seems to be little benet to this strategy when ablating tissue
with a diode laser. In contrast to the free-running pulsed/
high-peaked power light produced by Nd:YAG and erbium
lasers, diode lasers produce a continuous wave of laser light
that can be “pulsed” only through the use of a mechanical
gate that opens and closes to disrupt the ow of light. Con-
sequently, when a diode laser is operated in pulsed mode,
the power produced per unit of time, i.e., watts, is cut in
half, rendering the laser ineffective unless power settings
are doubled. Since there seems to be no real advantage to
operating a diode laser in pulsed mode, it is generally recom-
mended that most ablation procedures be performed using
continuous wave mode.
To prevent collateral thermal damage to
adjacent tissue, the Academy of Laser Dentistry
recommends using the least amount of power that
can effectively accomplish a desired procedure.
Laser Troubleshooting
Diode lasers have proven to be remarkably reliable and
virtually trouble-free. However, on occasion, practitioners
will encounter cases when tissue ablation seems decient, in
spite of adequate power settings. To ascertain the problem,
rst ensure that all power switches and key locks have been
placed in the ON position. Second, conrm that the ber-
optic tip has been initiated properly, as an uninitiated tip
will fail to focus enough energy at the end of the ber to ad-
equately ablate tissue. Third, check to see if the ber-optic
cable has been inadvertently fractured. Poor ber manage-
ment can result in a hidden break anywhere along the length
of the ber if it is stepped on or rolled over with a chair. And
fourth, if the laser is being operated in pulsed mode, be sure
that power settings normally used in continuous wave mode
have been doubled in order to compensate for the reduction
in power per unit of time.
Periodontal Considerations
When used judiciously and in the hands of a properly
trained practitioner, the diode laser is a safe and effective
tool. However, violation of basic periodontal principles can
result in less than desirable results. Respect for maintenance
of biologic width is important. Typically, biologic width as
measured from the free gingival margin to the crestal bone
is considered to be approximately 3 mm, consisting of, on
average, 1 mm of junctional epithelium and 1 mm of con-
nective tissue attachment combined with a gingival sulcus
of approximately 1 mm (Figure 11). Should this biologic
width be violated with excessive removal of gingival tissue
along with placement of a restoration within that zone, unin-
tended negative consequences may result, including chronic
inammation of the gingiva and unpredictable bone loss.
Fortunately, orthodontic laser procedures rarely involve
placement of restorations after tissue removal. It must be
noted, however, that in the absence of a restoration, excised
marginal tissue may grow back as biologic width returns to
its natural state. Consequently, cases requiring a signicant
amount of tissue removal are best referred to a periodontal
specialist for surgical crown lengthening. Another contrain-
dication for soft tissue removal with the laser is exposure of
unerupted teeth in unattached, non-keratinized gingiva, as
this may result in a loss of attached gingiva once the tooth is
brought into the arch form.
When used judiciously and in the hands of a
properly trained practitioner, the diode laser is a
safe and effective tool; respect for maintenance
of biologic width is important.
Anesthesia
In most cases, adequate soft tissue anesthesia required for
laser-assisted tissue removal is obtained via application of a
compounded topical anesthetic gel such as Profound PET
(prilocaine 10%, lidocaine 10%, tetracaine 4%, and phenyl-
ephrine 2%). The combination of the various local anesthet-
ics along with the vasoconstrictor phenylephrine produces
profound anesthesia in a relatively short amount of time.
After the target tissue is dried, topical anesthetic gel is ap-
plied to the area and left in place for approximately three to
four minutes (Figure 12). Prolonged exposure beyond the
recommended time may result in mild tissue sloughing as
a result of the vasoconstrictive properties of the phenyleph-
rine. Occasionally, in areas of thicker, denser tissue, as seen
on the palate and on the distal of an erupting lower second
molar, injection of local anesthetic solution may be required
to obtain sufcient anesthesia. Once the target tissue has
been sufciently anesthetized, a periodontal probe is used
to measure sulcus depth and biologic width on the teeth to
be recontoured in order to determine how much tissue can
be safely removed.
Figure 11. Biologic width
Histologic
Connective tissue
attachment
Junctional
epithelium
Sulcus 0.69 mm
0.97 mm
1.07mm
Clinical
Biologic zone
2.0 - 2.5 mm
Intracrevicular margin
location 0.5 -1.0 mm
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Figure 12. Application of topical anesthetic gel
Surgical Procedure
The operator activates the laser with a foot pedal and gently
moves the tip of the ber across the target tissue in a light-
contact mode. Tissue is removed with the ber tip held at vari-
ous angles to provide ideal tissue contours (Figure 13). Careful
attention must be paid to the interaction of the laser energy
with the target tissue. Leaving the ber tip in one spot too long
will result in carbonization and unnecessary collateral damage,
while moving the tip too quickly will result in an insufcient
absorption of energy to produce ablation. During the proce-
dure, it is imperative that high-volume aspiration is used to
evacuate vapor plume and objectionable odors at the site of ab-
lation. Once satisfactory tissue removal has been achieved, any
remnants of slightly carbonized tissue remaining at the surgical
margins are removed with light pressure using a micro-appli-
cator brush soaked in 3% hydrogen peroxide solution (Figure
14). Postoperatively, patients are advised to keep the area clean
and plaque-free with gentle brushing, avoid foods and liquids
that may cause pain or irritation to the sensitive tissue while it is
healing, and to use over-the-counter analgesics as needed.
Careful attention must be paid to the interaction
of the laser energy with the target tissue - leaving
the fiber tip in one spot too long will result in
carbonization and unnecessary collateral damage.
Figure 13. Contouring of gingival tissue
Figure 14. Removal of slightly carbonized tissue
Clinical Applications
Specic procedures include aesthetic gingival recontour-
ing, soft tissue crown lengthening, exposure of soft-tissue-
impacted teeth, removal of inamed and hypertrophic tissue,
and frenectomies. Incorporating the use of lasers into my
orthodontic practice has been extremely rewarding on
many levels. Being able to place brackets more accurately
and sooner in treatment has signicantly reduced treatment
times, and patients really appreciate how much better their
smiles look.
Aesthetic Gingival Recontouring
Gingival aesthetics play a vital role in the appearance of a
nished orthodontic case. Excessive gingival display, uneven
gingival contours, and disproportionate crown heights and
widths signicantly diminish the aesthetic value of even the
most perfectly aligned teeth.
As a rule, aesthetic gingival recontouring is most benecial
in the upper arch from cuspid to cuspid. Ideally, the gingival
margins of the upper anterior teeth are positioned at or very
near the inferior border of the upper lip in full smile. Display
of gingival tissue in excess of 2 mm is generally considered to
be undesirable. Additionally, the perception of tooth length
and width is often inuenced by the position, contour, and
bulk of the marginal gingiva framing the crowns of the teeth,
with uneven gingival contours causing some teeth to appear
Figure 15. Gingival form
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too short and others to appear too long. The gingival margins
of the upper central incisors and upper cuspids should be ap-
proximately level with each other and slightly superior to the
gingival margins of the upper lateral incisors. The gingival
zeniths of the upper central incisors and cuspids should fall
slightly distal to their long axis centers, the gingival zeniths of
the upper lateral incisors should typically coincide with their
long axis centers, and gingival symmetry should exist from
one side to the other (Figures 15, 16).
Figure 16a. Pre-treatment
Figure 16b. Gingivae immediately post-treatment
Figure 16c. Gingival symmetry following healing
Exposure of Unerupted and Partially
Erupted Teeth
Lengthy orthodontic treatment times are often the result of
delayed eruption of teeth or compromised bracket position-
ing due to gingival interference. Using the diode laser, both
unerupted and partially erupted teeth can be exposed for
bonding, and tissue interfering with ideal bracket placement
can be removed. Unerupted teeth to be exposed are located
by radiographic examination, visualization, and palpation.
After the patient is anesthetized, it is possible to determine if
bone is covering the crown of the tooth by using an explorer
to puncture the overlying soft tissue and score the underlying
hard tissue with a back-and-forth motion. Enamel will feel
very hard and smooth, while bone will seem more porous
and rough. When exposing an unerupted tooth for bonding,
tissue removal should take place solely in attached gingiva,
excising only enough to allow for reasonable positioning of a
bracket or button (Figure 17).
Using the laser in unattached, non-keratinized
gingiva to expose unerupted teeth must be avoided
as this may result in a loss of attached gingiva once
the tooth is brought into the arch form.
Figure 17a. Partially erupted tooth
Figure 17b. Removal of tissue to suciently expose the tooth for a bracket
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Figure 17c. Brackets, elastics and archwire in position
Removal of Inflamed and Hypertrophic Tissue
Treatment and maintenance of moderate to severe gingival
hypertrophy and inammation during orthodontic treatment
is best handled by a periodontal specialist. However, isolated
areas of transient tissue hypertrophy can easily be removed
with the diode laser (Figure 18). In addition to excision of
inamed tissue, the laser also contributes to gingival health
by sterilization of the area adjacent to the ablated tissue.
Figure 18a. Pre-treatment tissue
Figure 18b. Post-removal of distal tissue
Isolated areas of transient tissue hypertrophy can
easily be removed with the diode laser.
Frenectomies
A high or thick labial frenum is often of concern when the
attachment causes a midline diastema or exerts a traumatic
force on the marginal gingiva. Frenectomies performed with
a laser permit painless excision of frena, without bleeding, su-
tures, surgical packing, or special postoperative care (Figure
19). Typical power settings for performing frenectomies with
a diode laser are 1.4 to 1.6 watts in continuous wave mode.
Figure 19a. Pre-treatment showing frenum
Figure 19b. Immediately following laser removal of frenum
Figure 19c. Healed tissue
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A laser permits painless excision of frena, without
bleeding, sutures, surgical packing, or special
postoperative care.
Miscellaneous Tissue Removal
The diode laser is also very useful for a number of isolated
applications such as removing tissue that has overgrown
orthodontic appliances as well as replacing the need for a
tissue punch when placing miniscrews in unattached gingiva
(Figure 20).
Figure 20a. Laser tissue removal at site for miniscrew
Figure 20b. Site following laser tissue removal
Figure 20c. Miniscrew and appliance
Summary
The use of lasers in orthodontics, and in particular diode la-
sers, has made it possible for orthodontic clinicians to more
easily and ably address the challenges faced on a daily basis
in orthodontic practice. With nearly a decade of experience
using lasers, I can not imagine practicing without them.
When used properly, lasers are effective and safe for soft
tissue procedures and contribute to aesthetic outcomes for
orthodontic patients.
References
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Clin North Am. 2004;48(4):833-60.
Al-Melh MA, Andersson L. Reducing pain from palatal
needle stick by topical anesthetics: a comparative study
between two lidocaine/prilocaine substances. J Clin
Dent. 2008;19:43-7.
Baumgaertel S. Compound topical anesthetics in
orthodontics: putting the facts into perspective. Am J
Orthod Dentofacial Orthop. 2009;133:556-7.
Bornstein ES, Camargo PM, Melnick PR, Camargo LM:
Clinical crown lengthening in the esthetic zone. J Calif
Dent Assoc. 2007; 35(7):487-98.
Carroll L, Humphreys TR. Laser-tissue interactions. Clin
Dermatol. 2006;24(1):2-7.
Castro GL, Gallas M, Nunez IR, et al. The use of lasers in
periodontal therapy. Gen Dent. 2008;56(7):612-6.
Coluzzi DJ. An overview of lasers in dentistry. Alpha
Omegan. 2008;101(3):125-6.
Coluzzi DJ. An overview of lasers in dentistry cont. Alpha
Omegan. 2008;101(4):179-80.
Coluzzi DJ. Fundamentals of dental lasers: science and
instruments. Dent Clin North Am. 2004;48(4)751-70.
Coluzzi DJ. Lasers in dentistry. Compend Contin Educ
Dent. 2005;26(6A Suppl):429-35.
Coluzzi DJ, Convissar RA. Atlas of laser applications in
dentistry, Chicago, 2007, Quintessence.
Coluzzi DJ, Convissar RA. Lasers in clinical dentistry. Dent
Clin North Am 2004;48(4):11-3.
Coluzzi DJ, Goldstein AJ. Lasers in dentistry. An overview.
Dent Today. 2004;23(4):120-7.
Convissar RA, Goldstein EE. An overview of lasers in
dentistry. Gen Dent. 2003;51(5):436-40.
Fornaini C, Rocca JP, Bertrand MF, et al. Nd:YAG and
diode lasers in the surgical management of soft tissues
related to orthodontic treatment. Photomed Laser Surg.
2007;25(5):381-92.
Gontijo I, Navarro RS, Haypek P, et al. The applications of
diode and Er:YAG lasers in labial frenectomy in infant
patients. J Dent Child 2005;72(1):10-5.
Graham JW. Profound, needle-free anesthesia in
orthodontics. J Clin Orthod. 2006;40:723-4.
Gross AJ, Hermann TR. History of lasers. World J Urol.
2007;25(3):217-20.
12 www.ineedce.com
Hilgers JJ, Tracey SG. Clinical uses of diode lasers in
orthodontics. J Clin Orthod. 2004;38:266-73.
Kravitz ND, Kusnoto B. Soft-tissue lasers in orthodontics:
an overview. Am J Orthod Dentofacial Orthop.
2008;133:S110-4.
Lee EA. Laser-assisted gingival tissue procedures in esthetic
dentistry. Pract Proced Aesthet Dent. 2006;18(9):suppl
2-6.
Lomke MA. Clinical applications of dental lasers. Gen
Dent. 2009;57(1):47-59.
Magid KS, Strauss RA. Laser use for esthetic soft tissue
modication. Dent Clin North Am. 2007;51(2):525-45.
Maiman TH. Stimulated optical radiation in ruby lasers.
Nature. 1960;187:493.
Moritz A. Oral laser application, Chicago, 2006,
Quintessence.
Myers TD, Sulewski JG. Evaluating dental lasers: what
the clinician should know. Dent Clin North Am.
2004;48(4):1127-44.
Pang P. Lasers in cosmetic dentistry. Gen Dent.
2008;56(7):663-70.
Parker S. Veriable CPD paper: introduction, history
of lasers and laser light production. Br Dent J.
2007;202(1):21-31.
Parker S. Lasers and soft tissue: ‘loose’ soft tissue surgery.
Br Dent J. 2007;202(4):185-91.
Parker S. Lasers and soft tissue: ‘xed’ soft tissue surgery.
Br Dent J. 2007;202(5):247-53.
Parker S. Laser regulation and safety in general dental
practice. Br Dent J. 2007;202(9):523-32.
Pearson GJ, Schuckert KH. The role of lasers in dentistry:
present and future. Dent Update. 2003;30(2):70-4, 76.
Press J. Effective use of the 810 nm diode laser within the
wellness model. Pract Proced Aesthet Dent. 2006;18:18-
21.
Sarver DM. Principles of cosmetic dentistry in orthodontics:
part 1. Shape and proportionality of anterior teeth. Am
J Orthod Dentofacial Orthop. 2004;126:749-53.
Sarver DM. Use of the 810 nm diode laser: soft tissue
management and orthodontic applications of
innovative technology. Practice Proced Aesthet Dent.
2006;18:7-13.
Sarver DM, Yanosky M. Principles of cosmetic dentistry in
orthodontics: part 2. Soft tissue laser technology and
cosmetic gingival contouring. Am J Orthod Dentofacial
Orthop. 2005;127:85-90.
Sarver DM, Yanosky M. Principles of cosmetic dentistry in
orthodontics: part 3. Laser treatments for tooth eruption
and soft tissue problems. Am J Orthod Dentofacial
Orthop. 2005;127:262-4.
Stabholz A, Zeltser R, Sela M, et al. The use of
lasers in dentistry: principles of operation and
clinical applications. Compend Contin Educ Dent.
2003;24(12):935-48.
Sulieman M. An overview of the use of lasers in general
dentist practice: 1. Laser physics and tissue interactions.
Dent Update. 2005;32(4):228-30, 233-4, 236.
Sulieman M. An overview of the use of lasers in general
dentist practice, laser wavelengths, soft and hard tissue
clinical applications. Dent Update. 2005;32(5):286-8,
291-4, 296.
Tracey SG. Light work. Orthod Products. 2005 (Apr-
May);88-93.
Yeh S, Jain K, Andreana S. Using a diode laser to uncover
dental implants in second-stage surgery. Gen Dent.
2005;53(6):414-7.
Author Profile
Stephen Tracey DDS, MS
Dr. Stephen Tracey is a native of
Southern California and a gradu-
ate of Loma Linda University
with a BS in Human Biology, a
DDS, and a MS in Orthodontics.
He is a member of the American
Dental Association, the American
Association of Orthodontists, the
World Federation of Orthodon-
tists, and the American Academy of Sleep Medicine. As
a pioneer in the application and use of soft tissue lasers in
orthodontics, Dr. Tracey is also a member of the Academy
of Laser Dentistry with prociency certication in both
diode and Er:YAG lasers. He was formerly Instructor of
the Year at Loma Linda University in 1995, he now serves
as Visiting Professor of Orthodontics at the University
of Ferrara in Ferrara, Italy. Dr. Tracey is an internation-
ally recognized lecturer, with past presentations made
in 22 countries on six continents. He has published nu-
merous articles in a variety of professional publications,
authored a chapter in a prestigious orthodontic textbook,
and presently serves on the Editorial Advisory Board for
Orthodontic Products. Personally, Dr. Tracey’s insatiable
curiosity combined with his passion for adventure have
led him to such diverse places and situations as shark
diving in the Bahamas, swimming from Alcatraz to San
Francisco, trekking the jungles of the Amazon, summiting
the peak of Mt. Rainier, and competing in the Ironman
Triathlon in Kona, Hawaii.
Disclaimer
The author(s) of this course has/have no commercial ties with
the sponsors or the providers of the unrestricted educational
grant for this course.
Reader Feedback
We encourage your comments on this or any PennWell course.
For your convenience, an online feedback form is available at
www.ineedce.com.
www.ineedce.com 13
Online Completion
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and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page.
Questions
1. Short clinical crowns ________.
a. prevent ideal bracket placement
b. compromise the effectiveness of aligner treatment
c. result in over-extrusion of teeth
d. a and b
2. The predecessor of the laser was the
________.
a. taser
b. maser
c. staser
d. none of the above
3. The term “laser” is an acronym for
________.
a. light acceleration by the stimulated emission of
radiation
b. light amplication by the stimulated emission of
radiation
c. light amplication by the stimulated extrusion of
radiation
d. none of the above
4. Wavelength is dened as the ________
distance between any two corresponding
points on the wave.
a. vertical
b. horizontal
c. diagonal
d. three-dimensional
5. Laser light________.
a. is monochromatic
b. consists of a single wavelength of light
c. may be invisible to the human eye
d. all of the above
6. A laser is composed of an ________.
a. energy source
b. active lasing medium
c. optical cavity or resonator
d. all of the above
7. ________ is an example of a Class I laser.
a. A laser pointer
b. An argon curing light
c. A dental laser
d. all of the above
8. Class 4 lasers ________.
a. produce high-powered light
b. are hazardous to the eyes
c. are hazardous to the skin
d. all of the above
9. Nearly all dental and medical lasers are
________ lasers.
a. Class 1
b. Class 2
c. Class 3
d. Class 4
10. The interaction of a target tissue with
the light energy produced by a laser can
involve ________.
a. reection of the beam or transmission of the laser
energy
b. scattering of the laser energy
c. absorption of the laser energy
d. all of the above
11. Scattering of laser energy results in
________.
a. a weakening of the intended energy
b. possible undesirable transfer of heat to adjacent
nontarget tissue
c. a strengthening of the intended energy
d. a and b
12. Transmission of laser energy means that
it ________.
a. goes directly through the tissue to affect non target
tissue
b. goes directly through the tissue, affecting it
positively as it proceeds
c. goes directly through the tissue, with no effect on
the target tissue
d. a and c
13. Vaporization of the water within tissue
occurs when a temperature of ________ is
reached.
a. 80 degrees C
b. 100 degrees C
c. 120 degrees C
d. none of the above
14. Ablation of soft tissue commences at
________.
a. 60 degrees C
b. 80 degrees C
c. 100 degrees C
d. 120 degrees C
15. At temperatures below 100 degrees but
above approximately________, proteins
begin to denature without vaporization of
the underlying tissue.
a. 50 degrees
b. 60 degrees
c. 70 degrees
d. all of the above
16. Carbonization ________.
a. is undesirable
b. occurs at temperatures above 200 degrees
c. involves tissue dehydration and burning
d. all of the above
17. The rst laser was developed by Maiman
in ________ .
a. 1950
b. 1960
c. 1970
d. 1980
18. An absorber of light is termed a
________.
a. hemaphore
b. chromophore
c. chromatophore
d. none of the above
19. Lasers used in dentistry are generically
named for the ________ contained within
the device.
a. reactive medium
b. active medium
c. passive medium
d. all of the above
20. Selection of the most appropriate laser
for orthodontic applications is ideally
determined by examining ________.
a. procedure specicity
b. portability and ease of operation
c. cost
d. all of the above
21. Erbium lasers can perform ________ .
a. only hard tissue procedures
b. only soft tissue procedures
c. both hard and soft tissue procedures
d. none of the above
22. Diode lasers can perform ________ .
a. only hard tissue procedures
b. only soft tissue procedures
c. both hard and soft tissue procedures
d. none of the above
23. The smallest diode laser weighs in at
________.
a. 1.5 ounces
b. 1.7 ounces
c. 1.9 ounces
d. none of the above
24. An argon laser has a wavelength in the
range of ________.
a. 0.38 – 0.41 microns
b. 0.43 – 0.48 microns
c. 0.48 – 0.51 microns
d. none of the above
25. A diode laser has a wavelength in the
range of ________.
a. 0.51 – 0.68 microns
b. 0.61 – 0.78 microns
c. 0.71 – 0.88 microns
d. 0.81 – 0.98 microns
26. The active medium of the diode laser
is a solid-state semiconductor, made of
________.
a. aluminum, gallium, arsenide, and occasionally
indium
b. aluminum, selium, arsenicum, and occasionally
indium
c. zinc, aluminum, silicate and occasionally iridium
d. aluminum, gallium, arsenide, and occasionally
selenium
27. All diode wavelengths are absorbed
primarily by ________.
a. melatonin and hemoglobin
b. proteins and hemoglobin
c. hemoglobin and lipids
d. melanin and hemoglobin
Online Completion
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online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “ Take Exam” link, complete all the program questions and submit your
answers. An immediate grade report will be provided and upon receiving a passing grade your “Verication Form” will be provided immediately for viewing and/or printing. Verication Forms can be viewed
and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page.
Questions
14 www.ineedce.com
28. ________ can be performed using a diode
laser.
a. Gingival recontouring
b. Soft tissue crown lengthening
c. Exposure of soft-tissue-impacted teeth
d. all of the above
29. Ablation procedures can safely be
performed in close proximity to enamel,
orthodontic appliances, and temporary
anchorage devices because diode laser
wavelengths are ________.
a. not absorbed by tooth structure and metal
b. poorly absorbed by tooth structure and metal
c. well absorbed by tooth structure and metal
d. none of the above
30. It is critical that all protective eyewear
worn is ________.
a. generic for all wavelengths
b. wavelength-specic
c. light-specic
d. a and c
31. Sunglasses and safety glasses designed
for use with visible dental curing lights
are ________ at protecting the eye from
potentially irreversible damage as a result
of exposure to dental laser light.
a. highly effective
b. moderately effective
c. ineffective
d. effective depending on the manufacturer of the
sunglasses
32. ________ can help prevent accidental
exposure of nontarget tissue.
a. Limiting access to the surgical environment
b. Minimizing reective surfaces
c. Ensuring that the laser is in good working order
with all manufacturer safeguards in place
d. all of the above
33. High-volume suction should be used to
________.
a. evacuate any vapor plume created during tissue
ablation
b. prevent possible exposure to infectious pathogens
c. remove objectionable odors
d. all of the above
34. Each ofce should have a designated staff
member ________.
a. supervise the proper use of the laser
b. oversee the use of protective eyewear
c. be familiar with pertinent regulations and
coordinate staff training
d. all of the above
35. When a ber-optic cable is used with a
diode laser to transmit laser light to the
target tissue, a ________ optical ber is
recommended.
a. 200-micron
b. 400-micron
c. 600-micron
d. 800-micron
36. The amount of outer cladding removed
is determined by the ________.
a. width of the ber
b. width of the handpiece
c. length of the handpiece
d. a and b
37. A disposable plastic tip is tted over
the ber tip and placed on the end of
the handpiece, leaving approximately
________ exposed.
a. 2 mm of ber
b. 3 mm of ber
c. 4 mm of ber
d. 5 mm of ber
38. Before each patient use, 2-3 mm is cut
off the end of the ber with ________ in
order to avoid cross-contamination.
a. ceramic scissors
b. a cleaving stone
c. sterile stainless steel scissors
d. a or b
39. The ber tip is “initiated” by placing
some form of ________ on the end of the
ber.
a. activated liquid
b. liqueed gas
c. pigment
d. none of the above
40. To prevent collateral thermal damage
to adjacent tissue, the Academy of Laser
Dentistry recommends using ________.
a. the most refracted power that can effectively
accomplish a desired procedure
b. attenuated energy sources
c. the least amount of power that can effectively
accomplish a desired procedure
d. all of the above
41. For most soft tissue ablation procedures,
a setting of ________ will result in excel-
lent tissue removal with minimal thermal
degeneration of adjacent tissue.
a. 1 to 1.2 watts
b. 2 to 2.2 watts
c. 3 to 3.2 watts
d. 4 to 4.2 watts
42. Frenectomy procedures often require
settings as high as ________.
a. 1.2 watts
b. 1.4 watts
c. 1.6 watts
d. 1.8 watts
43. Diode lasers produce a continuous wave
of laser light that can be “pulsed” only
through the use of a ________.
a. mechanical gate
b. chemical gate
c. biomechanical gate
d. biochemical gate
44. Leaving the ber tip in one spot too long
will result in ________.
a. unnecessary collateral damage
b. carbonization
c. too little tissue being removed
d. a and b
45. Moving the tip too quickly will result in
________.
a. poor contours
b. scattering of energy
c. insufcient absorption of energy to produce
ablation
d. none of the above
46. Any remnants of slightly carbonized
tissue remaining at the surgical margins
are removed with light pressure using a
micro-applicator brush soaked in _______
solution.
a. 3% carbamide peroxide
b. 3% hydrogen peroxide
c. 3% chlorhexidine gluconate solution
d. 3% povidone iodine
47. Postoperatively, patients are advised to
________.
a. keep the area clean and plaque-free with gentle
brushing
b. avoid foods and liquids that may cause pain or
irritation to the sensitive tissue while it is healing
c. use over-the-counter analgesics as needed
d. all of the above
48. Isolated areas of transient tissue
hypertrophy can easily be removed with
the ________.
a. air abrasion device
b. scalpel
c. diode laser
d. all of the above
49. Use of a soft tissue laser contributes to
gingival health by ________ of the area
adjacent to the ablated tissue.
a. carbonization
b. sterilization
c. recontouring
d. none of the above
50. When used properly, lasers________.
a. are effective for soft tissue procedures for orthodon-
tic patients
b. are safe for soft tissue procedures for orthodontic
patients
c. contribute to aesthetic outcomes for orthodontic
patients
d. all of the above
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INSTRUCTIONS
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Completing a single continuing education course does not provide enough information
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AGD Code 135
Educational Objectives
1. List and describe the development of lasers.
2. List and describe the scientic principles on which lasers are based.
3. List and describe laser setup and troubleshooting in practice.
4. List and describe periodontal considerations when using a laser.
5. List and describe the procedures for which a diode laser can be used in the orthodontic practice.
Course Evaluation
Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.
1. Were the individual course objectives met? Objective #1:
Yes
No
Objective #3:
Yes
No
Objective #2:
Yes
No
Objective #4:
Yes
No
Objective #5:
Yes
No
2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0
3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0
4. How would you rate the objectives and educational methods? 5 4 3 2 1 0
5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0
6. Please rate the instructor’s eectiveness. 5 4 3 2 1 0
7. Was the overall administration of the course eective? 5 4 3 2 1 0
8. Do you feel that the references were adequate? Yes No
9. Would you participate in a similar program on a dierent topic? Yes No
10. If any of the continuing education questions were unclear or ambiguous, please list them.
___________________________________________________________________
11. Was there any subject matter you found confusing? Please describe.
___________________________________________________________________
___________________________________________________________________
12. What additional continuing dental education topics would you like to see?
___________________________________________________________________
___________________________________________________________________
ANSWER SHEET
Lasers in Orthodontics
Name: Title: Specialty:
Address: E-mail:
City: State: ZIP: Country:
Telephone: Home (
) Oce (
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Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all
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you 3 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 216.398.7822
www.ineedce.com Customer Service 216.398.7822 15
DISC2011ORTHO
... A palavra laser é uma abreviatura para "Light Amplification of Stimulated Emission of Radiation" que na Língua Portuguesa significa Amplificação da Luz por Emissão Estimulada de Radiação. O laser é uma radiação que se encontra no espectro de luz que varia do infravermelho ao ultravioleta, passando pelo espectro visível 2,3,4,7,14,18 (Fig. 1). ...
... A holografia utiliza a luz laser (He-Ne) para reproduzir tridimensionalmente e com alta qualidade a imagem dos modelos de gesso, permitindo uma análise tridimensional, a sobreposição e o armazenamento dos modelos 18,19 . O holograma é resistente e apresenta aproximadamente o mesmo tamanho de radiografias e fotografias. ...
... A vantagem é que substitui o armazenamento dos próprios modelos de gesso, que são frágeis, pesados, e requerem grande espaço para armazenamento. Atualmente o holograma apresenta algumas desvantagens ao medir a sobressaliência, a sobremordida e medidas de profundidade, pois nesses casos as medidas não são tão precisas 18,19 . ...
Article
Full-text available
O laser vem sendo amplamente utilizado na área da saúde, encontrando-se em franca evolução na Odontologia, beneficiando o paciente com tratamentos atraumáticos, sem dor, com melhor pós-operatório, entre muitas outras vantagens. A Ortodontia também tem muito a ganhar com a utilização da luz laser, apesar de suas aplicações e seus efeitos não se encontrarem bem difundidos entre os profissionais. O presente trabalho objetivou realizar uma revisão na literatura a fim de elucidar o ortodontista sobre como ele poderá se beneficiar desta forma de energia, elevando a qualidade do seu trabalho e melhorando as condições do tratamento tanto para o profissional como para o paciente.
... Distraction osteogenesis lengthens bones and fills gaps, which are then filled with newly formed bone, and this process is accelerated with the use of laser or US. 3,[11][12][13]21 In this study, new bone formation in the rabbits showed a greater capacity of bone regeneration with the application of a therapeutic laser, which produces tissue biostimulation. 4,8,12,13,22,25 Investigators have evaluated different treatment periods of fractures using LIUS and verified that the consolidation was accelerated in all groups studied, independent of the period or duration of treatment. ...
... 3,[11][12][13]21 In this study, new bone formation in the rabbits showed a greater capacity of bone regeneration with the application of a therapeutic laser, which produces tissue biostimulation. 4,8,12,13,22,25 Investigators have evaluated different treatment periods of fractures using LIUS and verified that the consolidation was accelerated in all groups studied, independent of the period or duration of treatment. 2,4,5 The period evaluated in the present research was 24 days, with a consolidation period of 14 days, resulting in a considerable recuperation of bone density, with LIUS producing a greater response in the US2 mandibles of animals in the L-US group that received LIL on the opposite side. ...
... The effects of the laser on cell metabolism and multiplication are known. 8,9,13,29,30 However, there are controversies about the best working power and the adequate number of sessions to obtain the desired result. ...
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Purpose: To assess the effects of low-level laser versus ultrasound irradiation on bone mineral density after distraction osteogenesis using cone-beam computed tomographic analysis in an experimental study. Materials and methods: Distraction osteogenesis was performed with rapid maxillary expansion devices (Hyrax-Morelli, Sorocaba-São Paulo-Brazil). After a 2-day latency period, the distraction devices were activated for 10 days at a rate of 1 mm/day. Four groups of 6 animals were distributed as follows: 1) control, 2) laser irradiation on the right side, 3) ultrasound irradiation on the right side, and 4) laser irradiation on the right side and ultrasound on the left side. Cone-beam computed tomography was used to determine bone mineral density by measuring the recovery (percentage). Analysis of variance and the Tukey test (P = .05) were used for statistical analyses. Results: The influences of low-intensity laser and ultrasound irradiation on bone mineral density were statistically significant. The analyses showed greater bone mineral density recuperation in the mandibular side with the ultrasound application. Conclusions: The results of this study suggest an acceleration of bone mineral density after laser and ultrasound irradiation. Ultrasound irradiation showed the greatest effects and the laser power positively influenced the recuperation of the bone density on the side opposite its application, causing a cross reaction or even exacerbating the inherent action of ultrasound irradiation.
... 23 It is a relatively new technique that has been introduced into orthodontics within the last twenty years. [24][25] It soon gained its place in solving a variety of problems relating to orthodontic treatment ranging from ceramic bracket debonding 26 and enamel surface etching 27 to mucogingival surgery. 28 Lasers with different wavelengths can manage both hard and soft tissue problems. ...
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Laser technique now is widely applied in orthodontic treatment and proved to have many benefits. Soft tissue lasers can be used to perform gingivectomy, frenectomy and surgical exposure of tooth with less bleeding and swelling, improved precision, reduced pain and less wound contraction. Other laser applications include enamel etching and bonding and bracket debonding. Lower level lasers have the potential effects of pain control and accelerating tooth movement. Clinicians must be aware of the safety issues and risks associated with laser and receive proper training before the laser treatment is started.
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Lasers have increased the treatment efficacy by many folds in the field of dentistry. Incorporating lasers in the orthodontic treatment leads to better patient as well as operator’s comfort. First developed almost a century ago, lasers were instigated in dental practice in 1989. The motive of this review paper is to discuss the utility of dental lasers in the speciality of Orthodontics.
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The purpose of this in vitro study was to evaluate the potential use of pulsed CO2 laser radiation to remove selectivity residues of orthodontic bonding resin that remain after debonding of fixed orthodontic appliances. Current techniques used for removal of orthodontic bonding resin after removal of fixed appliances include rotary instruments, debonding pliers, and ultrasonic scalers. These techniques, however, are time-consuming and inefficient, and may damage tooth enamel. A standardized cylinder of orthodontic bonding resin was bonded to the buccal surfaces of 100 extracted premolar teeth, which were then divided into 10 groups of 10 specimens each. In 9 groups, the resin was ablated using 1 of 9 different laser parameters, while in the remaining control group, the resin was removed with a slow speed tungsten carbide bur. Specimens were evaluated by light microscopy and scanning electron microscopy (SEM) to assess the amount of resin remaining and the extent of the damage to the underlying enamel. The 2 W/100 ms combination was optimal, with a high efficiency of resin removal and the least enamel damage. Higher laser powers increased the extent of enamel damage without enhancing resin removal. This laser technique appears promising, however, further studies of the extent of thermal changes at the level of the dental pulp are necessary to establish more fully the risk-benefit ratio.
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Within a general practice setting, there are few benign pathological conditions of the attached or keratinised gingival complex that are not amenable to simple surgical intervention. The majority of surgical procedures are adjunctive to the delivery of restorative dentistry. There is an understandable dogma worldwide towards the management of soft tissues as they interface with restorative procedures. Contemporary teaching, both at undergraduate and postgraduate level, would recognise the need for a period of wound healing and stability, based on scalpel-induced incisional therapy. The use of laser wavelengths, based on predictable evidence-based protocols, has re-defined the surgical management of keratinised mucosa that is bound to the underlying periosteum and bone. This can be seen as being of benefit to the clinician in determining the outcome, and the patient in achieving quality results.
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Dental lasers currently have 24 clinical indications for use that are recognized by the FDA. This article explores the scientific basis for these clinical indications in patient diagnosis and treatment. Multiple examples of relevant clinical applications for these wavelengths are explored in detail and illustrated via clinical photographs.
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The role of the BDJ is to inform its readers of ideas, opinions, developments and key issues in dentistry - clinical, practical and scientific - stimulating interest, debate and discussion amongst dentists of all disciplines.
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Schawlow and Townes1 have proposed a technique for the generation of very monochromatic radiation in the infra-red optical region of the spectrum using an alkali vapour as the active medium. Javan2 and Sanders3 have discussed proposals involving electron-excited gaseous systems. In this laboratory an optical pumping technique has been successfully applied to a fluorescent solid resulting in the attainment of negative temperatures and stimulated optical emission at a wave-length of 6943 å. ; the active material used was ruby (chromium in corundum).
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Laser light energy has been shown in other studies to degrade resins by thermal softening, thermal ablation, or photoablation. If this technology could be successfully applied to bracket debonding, fracturing of both bracket and enamel during debonding might be eliminated. Both polycrystalline alumina and single crystal alumina (sapphire) ceramic orthodontic brackets were bonded to the labial surfaces of lower deciduous bovine incisor teeth with the acid-etch technique as currently practiced in dentistry. Under an externally applied stress of either zero or 0.8 MPa, the brackets were debonded by irradiating the labial surfaces of the brackets with laser light at wavelengths of 248 nm, 308 nm, and 1060 nm, and at light power densities of between about 3 and 33 W/cm2. 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. The results showed that under the conditions of this study, no enamel or bracket damage was present in any sample. The polycrystalline brackets debonding times were about 3 seconds, 5 seconds, and 24 seconds for 248 nm, 308 nm, and 1060 nm of radiation, respectively. 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. All sapphire brackets debonded in less than 1 second. At sufficiently high power levels, debonding of sapphire brackets is caused by either thermal ablation or photoablation resulting from direct interaction of the light beam with the resin. The ablative decomposition of the resin causes a rapid buildup of gas pressure along the bonding interface, which blows the still cool bracket off the tooth after only one or a few laser light pulses.