Abstract
In this era of fast developing technologies and innovative ideas, the need for faster treatment has become a necessity. Treatment with lasers that is much less time-consuming and painless is accepted and appreciated by the patient. Use of Lasers is not new; they have been in use for decades since their development by Maiman in 1960. Lasers have travelled a long way from ruby lasers to erbium lasers and are being fondly used in every aspect of dental treatment. This article aims at elaborate the use and applications of lasers in the field of esthetic dentistry.
Keywords: Esthetic dentistry, chromophore, complete dentures, dental laboratory, fixed prosthodontics, implantology, lasers, maxillofacial prosthodontics, removable prosthodontics
Introduction
Lasers are the acronym for “light amplification by stimulated emission of radiation” named in 1957 by Gordon Gould. The first laser to be used was that introduced by Theodore Harold Maiman in 1960 was the Ruby laser.1 Lasers are now being used extensively as an adjunct to dental treatment to increase the prediction and precision of the treatment.
Laser Physics
Light is a form of electromagnetic energy that behaves as a particle wave. The basic unit of this energy is called as photon.2
Laser light has three main properties that differentiate it from normal light.3 They are:
Collimation: Refers to the beam having specific spatial boundaries which ensure that there is a constant beam size and shape that is emitted from the laser unit.
Coherence: A unique property of lasers that states that they have identical frequency and identical wavelength.
Monochromatism: The property of lasers that it possesses one specific color which is finely focused.
Laser tissue interaction
Absorption
The amount of energy that is absorbed by the tissue depends on the tissue characteristics, primarily water content, presence of pigments, laser wavelength and their emission modes. In general, shorter wavelengths are readily absorbed in pigmented tissue and blood elements.4
Transmission
The second effect is transmission of the laser energy directly through the tissue with no effect on the target tissue, inverse of absorption. This effect is also dependent on the wavelength of laser light.2
Reflection
The third effect is a reflection, which is the beam redirecting itself off the surface, having minimal or no effect on the target tissue.5
Scattering
The fourth effect is a scattering of the laser light which weakens the intended energy and possibly produces no useful biological effects instead scattering causes heat transfer to the tissue adjacent to the surgical site, and unwanted collateral damage could occur.6
The main effect of laser is due to the absorption of laser by various components of the tissue it is exposed to. The primary component that absorbs specific laser energy is termed as chromophores. The chromophore for various lasers differs (Table 1).
Table 1.
Chromophores of various lasers.
Application of Lasers to Aid in Dentistry
The successful of prosthetic treatment mainly depends on the pre-operative evaluation of the supporting hard and soft tissue structures and their proper preparation.7
Fixed prosthodontics
Crown lengthening
Soft tissue management around abutments
Modification of soft tissue around laminates
Osseous crown lengthening
Troughing
Formation of ovate pontic sites (Figure 1)
Altered passive eruption management
Veneer removal
Dentinal hypersensitivity
Tooth preparation (Figure 2).
Figure 1.
Laser assisted ovate pontic site preparation.
Figure 2.
Effect of erbium laser on tooth enamel.
Implantology
Second stage uncovering
Implant site preparation
Peri-implantitis.
Removable prosthetics
Tuberosity reduction
Torus reduction
Soft tissue modification
Epulis fissurata
Denture stomatitis
Residual ridge modification.
Complete denture prosthodontics
Prototyping and computer aided design and computer aided manufacturing (CAD/CAM) technology.
Analysis of occlusion by CAD/CAM.
Analysis of accuracy of impression by the laser scanner.
Laser application in dental laboratory
Laser titanium sintering – direct metal laser sintering (Figure 3)
Laser ablation of titanium surfaces
Laser assisted hydroxyapatite coating
Laser welding of titanium components of the prostheses (Figure 4).
Figure 3.
Metal crowns formed with direct metal laser sintering.
Figure 4.
Laser welding.
Laser in maxillofacial prosthodontics
Planning the shape and position of the prostheses
Three-dimensional acquisition of optical data of the extra-oral defects - selective laser sintering technology.
Esthetic procedures
Laser bleaching
Laser depigmentation.
Orthodontic esthetic enhancement8
Laser etching
Laser debonding
Laser scanning
Laser holography
Laser welding
Laser spectacular reflectance.
The latest application of lasers includes low-level laser therapy. The biostimulatory effect of lasers is implied in low-level laser therapy.9 The various applications of low-level laser therapy are:
Dentinal hypersensitivity
Temporomandibular disorders
Treatment of pain during orthodontic tooth movement
Bone implants interphase for better healing.
Lasers are also used effectively in pediatric and apprehensive patient with much cooperation and helps in better treatment.10
Conclusion
Lasers have become a ray of hope in dentistry. When used ethically and effectively, lasers are an exceptional “magic wand” in the treatment for many clinical conditions that dentists treat on a daily basis. However, lasers have never been the “magic tool” that many people have hoped for. It has got its own limitations. The addition of laser to dental treatment enhances the dentist’s ability to perform more clinical procedures, increase confidence and experience.
Footnotes
Conflicts of Interest: None
Source of Support: Nil
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