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Laser in dentistry. Diode laser in dentistry

Operating principle of a laser beam

Intracellular membrane systems are very sensitive to its action, especially mitochondria - the energy stations of the cell. It influences the course of biochemical reactions, molecular structure, i.e. influences the course of fundamental processes in the body, its energy potential. Its low power stimulate regeneration processes, activate hemodynamics, have anti-inflammatory and analgesic effects, increase the biological potential of liquid media. Helium-neon laser induces red helium-cadmium laser - blue light. U blue light anti-inflammatory effect is well expressed.

The biological effectiveness of low-intensity laser radiation in the red part of the spectrum with a wavelength of 0.628 microns has been most studied. Are becoming more active metabolic processes, proliferation, enzymatic activity, microcirculation, improve rheological properties blood, the activity of the coagulation and anticoagulation systems of the blood changes, erythropoiesis is stimulated. This causes the anti-inflammatory, analgesic, and trophic effect of laser radiation. When blood is irradiated deoxygenated blood acquires the features of an arterial one, i.e. becomes scarlet in color, its viscosity decreases, and oxygen saturation increases. This is called the “scarlet blood” or hypocoagulation symptom. The red blood cells of adults become similar to the red blood cells of children, i.e. stick together, stretch into a string and penetrate into previously inaccessible areas of organs due to necrosis, ischemia, and blockage. Immunity is stimulated.

The devices used are “LG - 75”, “APL -01”, “Mustang”, etc. Methodology: exposure to radiation is local and intracavitary, on acupuncture points, extra- and endovascular. Power density from 0.1 to 250 mW/cm2. Exposures range from a few seconds to 20 minutes.

Interaction of laser with tissue

The effect of laser radiation on biological structures depends on the wavelength of the energy emitted by the laser, the energy density of the beam, and the temporal characteristics of the beam energy. The processes that can occur are absorption, transmission, reflection and dispersion.

Absorption - The atoms and molecules that make up the tissue convert laser light energy into heat, chemical, acoustic or non-laser light energy. Absorption is affected by wavelength, water content, pigmentation and tissue type.

Transmission – laser energy passes through the tissue unchanged.

Reflection – reflected laser light does not affect tissue.

Scattering - individual molecules and atoms take laser ray and deflect the beam force in a direction different from the original one. Ultimately, the laser light is absorbed in a large volume with a less intense thermal effect. Scattering is affected by wavelength.

Types of lasers in dentistry

Argon laser (wavelength 488 nm and 514 nm): Radiation is well absorbed by pigment in tissues such as melanin and hemoglobin. The wavelength of 488 nm is the same as in curing lamps. At the same time, the speed and degree of polymerization of light-curing materials by laser far exceeds similar indicators when using conventional lamps. When using an argon laser in surgery, excellent hemostasis is achieved.

Diode laser (semiconductor, wavelength 792–1030 nm): radiation is well absorbed in pigmented tissue, has a good hemostatic effect, has anti-inflammatory and repair-stimulating effects. The radiation is delivered through a flexible quartz-polymer light guide, which simplifies the surgeon’s work in hard-to-reach areas. The laser device has compact dimensions and is easy to use and maintain. On this moment This is the most affordable laser device in terms of price/functionality ratio.

Neodymium laser (wavelength 1064 nm): radiation is well absorbed in pigmented tissue and less well absorbed in water. In the past it was most common in dentistry. Can operate in pulse and continuous modes. Radiation is delivered via a flexible light guide.

Helium-neon laser (wavelength 610–630 nm): its radiation penetrates well into tissues and has a photostimulating effect, as a result of which it is used in physiotherapy. These lasers are the only ones that are commercially available and can be used by patients themselves.

Carbon dioxide laser (wavelength 10600 nm) has good absorption in water and average in hydroxyapatite. Its use on hard tissues potentially dangerous due to possible overheating of enamel and bone. This laser has good surgical properties, but there is a problem with delivering radiation to tissues. Currently, CO2 systems are gradually giving way to other lasers in surgery.

Erbium laser (wavelength 2940 and 2780 nm): its radiation is well absorbed by water and hydroxyapatite. The most promising laser in dentistry, can be used to work on hard dental tissues. Radiation is delivered via a flexible light guide. Indications for laser use:

· Preparation of cavities of all classes, treatment of caries;

· Processing (etching) of enamel;

· Sterilization of the root canal, impact on the apical focus of infection;

· Pulpotomy;

· Treatment of periodontal pockets;

· Implant exposure;

· Gingivotomy and gingivoplasty;

· Frenectomy;

· Treatment of mucosal diseases;

· Reconstructive and granulomatous lesions;

· Operative dentistry.

Introduction

The word laser is an acronym for “Light Amplification by Stimulated Emission of Radiation.” The foundations of laser theory were laid by Einstein in 1917. Surprisingly, it was only 50 years later that these principles were sufficiently understood and the technology could be implemented practically. The first laser using visible light was developed in 1960, using ruby as the laser medium, generating a red beam of intense light. This was followed in 1961 by another crystal laser using neodymium yttrium aluminum garnet (Nd:YAG). In 1964, physicists at Bell Laboratories produced a gas laser using carbon dioxide (CO2) as the laser medium. In the same year, another gas laser was invented - which later proved valuable for dentistry - the argon laser. Dentists who studied the effects of ruby laser on tooth enamel found that it caused cracks in the enamel. As a result, it was concluded that lasers have no prospects for use in dentistry. However, in medicine, research and clinical use of lasers has flourished. In 1968, the CO2 laser was first used for soft tissue surgery. Along with the increase in the number of laser wavelengths, indications for use in general and maxillofacial surgery have also evolved. It was not until the mid-1980s that there was a resurgence of interest in the use of lasers in dentistry to treat hard tissues such as enamel. Although only some types of lasers, such as Nd:YAG, are suitable for treating hard tissue, potential hazards and lack of specificity for dental tissue limit their use.

1. Laser beam principle

Main physical process, which determines the action of laser devices, is stimulated emission of radiation. This emission is formed during the close interaction of a photon with an excited atom at the moment of exact coincidence of the energy of the photon with the energy of the excited atom (molecule). As a result of this close interaction, the atom (molecule) passes from an excited state to a non-excited one, and the excess energy is emitted in the form of a new photon with absolutely the same energy, polarization and direction of propagation as that of the primary photon. The simplest principle The operation of a dental laser consists of oscillating a beam of light between optical mirrors and lenses, gaining strength with each cycle. When sufficient power is reached, the beam is emitted. This release of energy causes a carefully controlled reaction.

2. Interaction of laser with tissue

Methods laser surgery are used for manipulations on the skin much more often than on any other tissues. This is explained, firstly, by the exceptional diversity and prevalence of skin pathologies and various cosmetic defects, and secondly, by the relative ease of implementation. laser procedures, which is associated with the superficial location of objects requiring treatment. The interaction of laser light with tissue is based on the optical properties of the tissue and the physical properties of laser radiation. The distribution of light entering the skin can be divided into four interrelated processes.

Reflection. About 5-7% of light is reflected at the level of the stratum corneum.

Absorption (absorption). Described by the Bouguer-Lambert-Beer law. The absorption of light passing through tissue depends on its initial intensity, the thickness of the layer of material through which the light passes, the wavelength of the light absorbed, and the absorption coefficient. If the light is not absorbed, there is no effect on the tissue. When a photon is absorbed by a target molecule (chromophore), all of its energy is transferred to that molecule. The most important endogenous chromophores are melanin, hemoglobin, water and collagen. Exogenous chromophores include tattoo dyes, as well as dirt particles impregnated during injury. Scattering. This process is mainly due to the collagen of the dermis. The importance of the scattering phenomenon is that it rapidly reduces the energy flux density available for absorption by the target chromophore and, consequently, the clinical effect on the tissue. Dissipation decreases with increasing wavelength, making longer wavelengths ideal for delivering energy to deep dermal structures.

Penetration. The depth of light penetration into subcutaneous structures, as well as the intensity of scattering, depends on the wavelength. Short waves (300-400 nm) are intensely scattered and do not penetrate deeper than 100 microns. Longer waves penetrate deeper because they are scattered less.

3. Lasers in dentistry

Argon laser (wavelength 488 nm and 514 nm): The radiation is well absorbed by pigment in tissues such as melanin and hemoglobin. The wavelength of 488 nm is the same as in curing lamps. At the same time, the speed and degree of polymerization of light-curing materials by laser far exceeds similar indicators when using conventional lamps. When using an argon laser in surgery, excellent hemostasis is achieved.

Diode laser (semiconductor, wavelength 792-1030 nm): radiation is well absorbed in pigmented tissue, has a good hemostatic effect, has anti-inflammatory and repair-stimulating effects. The radiation is delivered through a flexible quartz-polymer light guide, which simplifies the surgeon’s work in hard-to-reach areas. The laser device has compact dimensions and is easy to use and maintain. At the moment, this is the most affordable laser device in terms of price/functionality ratio: YAG laser (neodymium, wavelength 1064 nm): radiation is well absorbed in pigmented tissue and worse in water. In the past it was most common in dentistry. Can operate in pulse and continuous modes. Radiation is delivered via a flexible light guide. Ne laser (helium-neon, wavelength 610-630 nm): its radiation penetrates well into tissues and has a photostimulating effect, as a result of which it is used in physiotherapy. These lasers are the only ones that are commercially available and can be used by patients independently. The laser (carbon dioxide, wavelength 10600 nm) has good absorption in water and average absorption in hydroxyapatite. Its use on hard tissue is potentially dangerous due to possible overheating of enamel and bone. This laser has good surgical properties, but there is a problem with delivering radiation to tissues. Currently, CO2 systems are gradually giving way to other lasers in surgery.

Erbium laser (wavelength 2940 and 2780 nm): its radiation is well absorbed by water and hydroxyapatite. The most promising laser in dentistry, can be used to work on hard dental tissues. Radiation is delivered via a flexible light guide. Indications for the use of a laser almost completely repeat the list of diseases that a dentist has to deal with in his work. The most common and popular indications include:

· Preparation of cavities of all classes, treatment of caries;

·Processing (etching) of enamel;

· Sterilization of the root canal, impact on the apical focus of infection;

Pulpotomy;

· Treatment of periodontal pockets;

·Exposition of implants;

Gingivotomy and gingivoplasty;

·Frenectomy;

Treatment of diseases of the mucous membrane;

·Reconstructive and granulomatous lesions;

·Operative dentistry.

IMAGES

1 Frenectomy operation using a surgical laser (hereinafter, the figures are given from left to right): a - before the operation: a short powerful frenulum, which caused gum recession in the area of the upper incisors; b - condition after laser excision of the short frenulum. The operation was performed without the use of anesthesia and traditional methods of hemostasis; c - a week after surgical treatment.

2 Obtaining a block bone graft using a surgical laser: a - view before surgery; b - after detachment of soft tissues, a graft of the required shape and size is cut out; c - laser “scalpel” allows you to obtain donor tissue with intact periosteum

4. Use of laser in dentistry

Laser machines successfully treat caries initial stage, while the laser removes only the affected areas without affecting healthy tissue tooth (dentin and enamel).

It is advisable to use a laser when sealing fissures (natural grooves and grooves on the chewing surface of the tooth) and wedge-shaped defects.

Carrying out periodontal operations in laser dentistry allows you to achieve good aesthetic results and ensure complete painlessness of the operation. Laser treatment of gums and photodynamic therapy using a special laser device and algae eliminates bleeding gums and bad breath after the first session. Even with deep pockets, it is possible to “close” the pockets in a few sessions. This results in faster healing of periodontal tissue and strengthening of teeth.

Dental laser devices are used to remove fibroids without sutures, perform a clean and sterile biopsy procedure, and perform bloodless surgical operations on soft tissues. Diseases of the oral mucosa are successfully treated: leukoplakia, hyperkeratoses, red lichen planus, treatment aphthous ulcers in the patient’s oral cavity (nerve endings close).

In the treatment of dental canals (endodontics), a laser is used to disinfect the root canal for pulpitis and periodontitis. The bactericidal effectiveness is 100%.

The use of laser technology helps in treatment hypersensitivity teeth. In this case, the microhardness of the enamel increases to 38%.

In aesthetic dentistry, using a laser, it is possible to change the contour of the gums, the shape of the gum tissue to form beautiful smile, if necessary, the frenulum of the tongue can be easily and quickly removed. Effective and painless laser teeth whitening with long-lasting results has gained the most popularity recently.

When installing a denture, the laser will help create a very precise micro-lock for the crown, which allows you to avoid grinding down the adjacent teeth. When installing implants, laser devices allow you to ideally determine the installation site, make a minimal tissue incision and ensure the fastest healing of the implantation area.

Laser dental treatment has other advantages - for example, when traditionally preparing a tooth for filling, it can be very difficult for a dentist to completely remove softened dentin without damaging healthy tooth tissue. The laser copes with this task perfectly - it removes only those tissues that have already been damaged as a result of the development of the carious process.

Therefore, laser dental treatment is much more effective than traditional technologies, because the service life of fillings largely depends on the quality of carious cavity preparation. In addition, in parallel with preparation, the laser provides antibacterial treatment of the cavity, which avoids the development of secondary caries under the filling. Laser treatment of caries, in addition to the listed qualities, provides dental treatment without pain and does not affect healthy tooth tissue. Thanks to such serious advantages of this technology, laser dental treatment is widely used not only in adult, but also in pediatric dentistry.

The latest dental units allow not only laser dental treatment, but also a variety of surgical procedures without the use of anesthesia. Thanks to the laser, the healing of mucosal incisions occurs much faster, eliminating the development of swelling, inflammation and other complications that often arise after dental procedures.

IN surgical dentistry There is almost always a risk of wound infection after tooth extraction, dental implantation and other interventions. Tissue injuries resulting from surgery and patient failure to comply with recommendations can cause the development of a secondary infection. The use of laser in surgical dentistry can significantly reduce the likelihood of wound infection, reduce the amount of anesthetic administered, and significantly reduce bleeding of the surgical wound.

It is also important that after using a laser during surgical procedures, rapid healing of the wound is observed, which results in a more comfortable condition for the patient after the operation.

The antibacterial properties of the laser allow it to be used to treat not only caries, but also periodontitis. The laser effectively treats the roots of teeth and ensures complete sanitation of pathological pockets, resulting in shorter treatment times, and the manipulations themselves do not cause discomfort to patients.

Laser dental treatment is especially indicated for patients suffering from hypersensitive teeth, pregnant women, patients suffering from allergic reactions for painkillers. To date, no contraindications to the use of laser have been identified. The only disadvantage of laser dental treatment is its higher cost compared to traditional methods. Prices for laser dental treatment are much higher and this is primarily due to the high cost of laser equipment. Despite this, the advantages laser treatment teeth justify the costs. This is evidenced by rave reviews from patients who have experienced laser dental treatment.

laser dentistry treatment beam

Conclusion

Lasers are comfortable for the patient and have a number of advantages compared to traditional treatment methods. Currently, the advantages of using lasers in dentistry have been proven by practice and are undeniable: safety, accuracy and speed, absence of undesirable effects, limited use of anesthetics - all this allows for gentle and painless treatment, acceleration of treatment time, and therefore creates more comfortable conditions for the doctor, and for the patient.

Laser dentistry is an innovation that dentists use when treating the most demanding patients. Laser in dentistry is one of the safest and most painless methods of treatment due to the rapid laser treatment of various types of tissue, the surface of which remains smooth and heals faster than using other technologies.

The use of a laser in dentistry eliminates the occurrence of microcracks and infections; it does not create vibration or make noise. In addition, a laser can treat hard dental tissues in the same amount of time as a bur, but the treatment is unnoticed by the patient.

Laser in dentistry is indispensable for treatment severe cases, which are difficult to cope with using standard equipment. Getting rid of a dental cyst is more successful using a laser than using traditional methods.

Lasers are also used to remove tartar. The use of laser radiation in this procedure has already been recognized as the most effective method: the process takes little time, is painless, soft gum tissue is not injured when removing deposits.

Laser radiation is also used in the treatment of periodontitis and gingivitis. Laser in dentistry allows you to eliminate pathological soft tissues and all infected microflora. Regeneration of soft tissues of the alveolar process is faster.

Use of laser in dentistry: indications and contraindications

Indications

Contraindications

♦In the treatment of the carisogenic process, since the affected areas of tooth enamel and dentin are removed without negative influence to surrounding healthy tissue.

♦For bleeding gums.

♦When eliminating unpleasant odors from oral cavity, which occurs due to the destruction of all pathogenic bacteria.

♦In the treatment of pulpitis and periodontitis for root canal treatment.

♦To strengthen the gums - periodontal irradiation is carried out to create local immunity.

♦To remove various tumors on soft tissues.

♦When whitening teeth.

♦In the treatment of dental cysts, since more effective treatment of root canals and suppression of the pathological focus is possible.

♦To relieve hypersensitivity of hard tissues.

♦During dental implantation.

♦Severe cardiovascular diseases.

♦Reduced blood clotting.

♦Pathologies of the lungs caused by dangerous infectious diseases and functional disorders breathing.

♦Malignant neoplasms both in the oral cavity and in the body as a whole.

♦Dysfunction of the endocrine system.

♦High sensitivity of enamel.

♦Neuropsychic disorders.

♦Recovery period after any surgical intervention.

Types of lasers used in dentistry

The use of lasers in dentistry is based on the principle of selective exposure of different types of tissue to a laser beam, since a specific structural component of a biological tissue absorbs laser radiation differently. As we noted above, the role of an absorbing substance, or chromophore, can be played by water, blood, melanin, etc. The specific chromophore determines the type of laser device. The absorption characteristics of the chromophore and the location of application determine the laser energy.

Types of lasers in dentistry depend on characteristics such as pulse duration, discharge, wavelength, and penetration depth. The following types of lasers are distinguished:

Today, laser dentistry centers can be equipped not only with lasers that perform a highly specialized function, such as teeth whitening, but also with devices that combine several types of lasers. For example, these are devices that can work with both hard and soft tissues.

The laser has several operating modes. These are pulsed, continuous and combined. Depending on the operating mode of the laser, its power, or energy, is selected.

The table below shows the types of lasers in dentistry, their penetration depth and types of absorbing chromophores:

Laser	Wavelength, nm	Penetration depth, µm (mm)*	Absorbing chromophore	Fabric types	Lasers used in dentistry
Nd:YAG frequency doubling			melanin, blood
Pulse dye			melanin, blood
Helium-neon (He-Ne)			melanin, blood	soft, therapy
Ruby			melanin, blood
Alexandrite			melanin, blood
			melanin, blood	soft, whitening
Neodymium (Nd:YAG)			melanin, blood
Goldmium (Ho:YAG)
Erbium (Er:YAG)				hard (soft) hard (soft)
Carbon dioxide (CO 2)				hard (soft) soft

* Light penetration depth h in micrometers (millimeters), at which 90% of the power of laser light incident on biological tissue is absorbed

Argon laser. The wavelength of the argon laser is 488 nm and 514 nm. The first wavelength indicator is similar to that of polymerization lamps. However, under the influence of laser light, the rate and degree of polymerization of reflective materials significantly increases. Optimal absorption of laser radiation is achieved by melanin and hemoglobin. Argon laser is used in dentistry, surgery and to improve hemostasis.

Nd:YAG laser. The wavelength of the neodymium laser (Nd:YAG) is 1064 nm. Radiation is well absorbed in pigmented tissues and slightly worse in water. This type of laser has been quite popular in dentistry. The neodymium laser is capable of operating in continuous and pulsed modes. A flexible light guide directs laser radiation to the target tissue.

He-Ne laser. The helium-neon laser in dentistry (He-Ne) has a wavelength of 610 nm to 630 nm. The radiation of this laser is very well absorbed by tissues and has a photostimulating effect. For this reason, helium-neon laser is widely used in physical therapy. In addition, it is available for free sale, which allows it to be used not only in medical institutions, but also at home.

CO 2 laser. The wavelength of the carbon dioxide laser (CO 2) is 10600 nm. Its radiation is perfectly absorbed in water; in hydroxyapatite, absorption occurs at an average level. The carbon dioxide laser cannot be used on hard tissue because there is a risk of overheating the enamel and bone. Despite the outstanding surgical features This type of laser is being pushed out of the dental surgical laser market. This is due to the problem of directing the radiation to the tissue.

Er:YAG laser. Erbium laser in dentistry (Er:YAG) is characterized by wavelengths of 2940 nm and 2780 nm. The radiation of this laser, which is delivered using a flexible light guide, is perfectly absorbed by water and hydroxyapatite. The erbium laser is the most promising in dentistry because it can be used on the hard tissues of the tooth.

Diode laser. The diode laser is a semiconductor laser, its wavelength is 7921030 nm. The radiation is absorbed by the pigment. This type of laser has a positive hemostatic, anti-inflammatory and repair-stimulating effect. Laser radiation is delivered using a flexible quartz-polymer light guide, which allows the surgeon to perform manipulations in hard-to-reach areas. The use of a diode laser in dentistry is characterized by its compactness, ease of maintenance and use. In addition to these advantages, it is worth noting the availability of this device for use in terms of the price of the laser and its functionality.

Why is the diode laser the most common in dentistry?

The use of diode laser is quite popular these days for many reasons. This type of laser long time used in dentistry. For example, in Europe, not a single manipulation takes place without its use.

The diode laser is distinguished from other types of lasers by its large list of indications, low cost, compactness, ease of use in a clinical setting, high level safety and reliability. The latter property is achieved through the use of electronic and optical components with a certain number of moving components. These characteristics, for example, allow hygienists not to be afraid of disturbing the tooth structure when eliminating periodontal problems.

Laser radiation with a wavelength of 980 nm is characterized by significant anti-inflammatory, bactericidal and bacteriostatic properties, and also accelerates the recovery period after the procedure.

Diode laser is popular in surgery, periodontics, and endodontics. It is in great demand in the field of surgical procedures.

The use of a diode laser is relevant when carrying out procedures that are accompanied by heavy bleeding, the need for sutures and others negative consequences surgical intervention.

The diode laser emits coherent monochromatic light with a wavelength of 800 to 980 nm. Radiation is absorbed by a dark medium similar to hemoglobin, therefore, when dissecting tissues with big amount vessels, a diode laser is indispensable.

The use of a diode laser in dentistry on soft tissues is characterized by a minimal area of necrosis, which becomes possible as a result of tissue contouring. Their edges maintain the location specified by the doctor, which is a significant aesthetic factor. For example, using a diode laser, you can contour your smile, prepare your teeth, and take an impression in one visit to the dentist. The use of a scalpel or electrosurgical devices for tissue contouring leads to a long process of tissue healing and shrinkage before tooth preparation and impression taking.

The ability to clearly establish the position of the tissue incision edge makes the diode laser popular in aesthetic dentistry. In this area, it is used in soft tissue recontouring and frenuloplasty (frenectomy). This procedure when using traditional techniques, it is accompanied by the need for sutures, which is very difficult to implement, while the use of a diode laser ensures the absence of bleeding, sutures, as well as a quick and comfortable recovery.

Which laser device should you buy for your dental clinic?

Among the variety of laser devices used in clinical dentistry, six main types can be distinguished:

Laser physiotherapeutic devices with gas emitters (for example, helium-neon, type ULF-01, “Istok”, LEER, etc.), semiconductor (for example, ALTP-1, ALTP-2, “Optodan”, etc.).
Laser device “Optodan”, which allows for magnetic laser therapy. For this purpose, a special commercially produced magnetic attachment with a power of up to 50 mT is used.
Specialized laser devices such as ALOC, used for intravenous irradiation of blood. However, recently their popularity has fallen due to the spread of a new patented, highly effective technique for irradiating blood through the skin in the area of the carotid sinuses using the Optodan laser device.
Laser devices for laser reflexology, for example, “Nega” (2-channel), “Contact”. The Optodan device is also suitable for these purposes when using a special light guide attachment for reflexology.
Laser surgical devices(analogue of a laser scalpel) of a new generation (“Doctor”, “Lancet”) with computer control.
Laser technological installations (Kvant, etc.), which are used for the production of dentures.

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State budgetary educational institution of higher professional education

Novosibirsk State Medical University

Faculty of Dentistry

Laser technologies in dental practice

Novosibirsk 2013

Introduction

1. Laser beam principle

Conclusion

Literature

Introduction

Today we can say with firm confidence that the use of lasers in dentistry is justified, cost-effective and is a more advanced alternative to existing methods of treatment and prevention of dental diseases, as evidenced by a large number of research conducted by domestic and foreign scientists. Application laser technologies opens up completely new possibilities, allowing the dentist to offer the patient a large list of minimally invasive, virtually painless procedures in safe, sterile conditions that meet the highest standards clinical standards providing dental care.

The process of widespread introduction of laser technologies into dental practice has been hampered for a long time by both the high cost of surgical lasers and their bulkiness and operating difficulties, requiring a powerful three-phase electrical network, liquid cooling, and qualified technical personnel. But now the situation has changed radically thanks to the improvement of laser systems. New Generation medical devices characterized by:

*small dimensions and weight;

*low power consumption from a conventional single-phase network;

*no need for liquid cooling;

*high reliability and long service life;

*high stability of parameters;

*ease of management and maintenance;

*low sensitivity to mechanical and climatic factors.

Today, lasers are successfully used in almost all areas of dentistry: the prevention and treatment of caries, endodontics, aesthetic dentistry, periodontology, treatment of diseases of the skin and mucous membranes, maxillofacial and plastic surgery, cosmetology, implantology, orthodontics, orthopedic dentistry, technologies for manufacturing and repairing prostheses and devices.

The use of lasers makes it possible to clearly organize the treatment process, which is due to technical characteristics and the operating principle of the laser. The interaction of the laser beam and the target tissue produces a clearly defined result. By correctly selecting the parameters of duration, magnitude and pulse repetition rate, you can select an individual operating mode for each type of tissue and each type of pathology.

laser dentistry fabric

1. Laser beam principle

The main physical process that determines the action of laser devices is stimulated emission of radiation. This emission is formed during the close interaction of a photon with an excited atom at the moment of exact coincidence of the energy of the photon with the energy of the excited atom (molecule). As a result of this close interaction, the atom (molecule) passes from an excited state to a non-excited one, and the excess energy is emitted in the form of a new photon with absolutely the same energy, polarization and direction of propagation as that of the primary photon. The simplest principle of operation of a dental laser is to oscillate a beam of light between optical mirrors and lenses, gaining strength with each cycle. When sufficient power is reached, the beam is emitted. This release of energy causes a carefully controlled reaction.

2. Interaction of laser with tissue

Transmission - laser energy passes through the tissue unchanged.

Reflection - reflected laser light does not affect tissue.

Scattering - Individual molecules and atoms receive the laser beam and deflect the beam's force in a direction different from the original one. Ultimately, the laser light is absorbed in a large volume with a less intense thermal effect. Scattering is affected by wavelength.

3. Types of lasers in dentistry

They have found application in medicine, including dentistry. Various types lasers:

1. Argon laser with a wavelength of 488 nm and 514 nm (the radiation is well absorbed by pigment in tissues, such as melanin and hemoglobin gem). If there are certain positive points(when using an argon laser in surgery, excellent hemostasis is achieved) there are strong disadvantages of this laser for medical use - deep penetration into tissue requires the use of energy, which can lead to scar formation in the mucous tissues. This significantly reduces the possibility of using the argon laser in dentistry, and it has now been replaced by new and more selective lasers;

2. Helium-neon laser with a wavelength of 610 - 630 nm (its radiation penetrates well into tissues and has a photostimulating effect, as a result of which it is used in physiotherapy). These lasers are widely used in therapy and are poorly used in dentistry due to their main disadvantage - low output power, not exceeding 100 mW;

3. Neodymium (Nd:YAG) laser with a wavelength of 1064 nm (radiation is well absorbed in pigmented tissue and worse in water). In the past, it was common in dentistry, but currently its role in dental procedures is decreasing due to the price/functionality ratio - due to the limited scope of its application (suitable for soft tissue surgery, but not used for teeth whitening, carious lesion removal and cavity treatment);

4. Erbium (EnYAG) laser with wavelengths of 2940 and 2780 nm (its radiation is well absorbed by water). In dentistry it is used for the preparation of hard dental tissues. But the use of this laser has significant disadvantages - the methods of its use have limited opportunities and the laser cannot be used for all types of dental interventions. And also the big disadvantages include the very high cost of the laser device and, accordingly, quite high costs procedures with his participation that are necessary to pay for the laser;

5. Carbon dioxide (CO2) with a wavelength of 10600 nm (has good absorption in water). Its use on hard tissue is potentially dangerous due to possible overheating of enamel and bone. There is also the problem of delivering radiation to tissues. Exposure to a CO2 laser can cause the appearance of rough scars due to heat conduction and heating of surrounding tissues, and when working on hard tissues, it can also cause the effect of carbonization (charring) and melting of hard tissues. Currently, CO2 lasers are gradually giving way to other lasers;

6. Diode laser (semiconductor) with a wavelength of 630 - 1030 nm (radiation is well absorbed in pigmented tissue, has a good hemostatic effect, has anti-inflammatory and repair-stimulating effects). The radiation is delivered through a flexible light guide fiber, which simplifies the dentist’s work in hard-to-reach areas. The laser device has compact dimensions and is easy to use and maintain. The safety level of diode laser devices is very high. At the moment, this is the most affordable laser device in terms of price/functionality ratio. And, despite the variety of lasers used in dentistry, the most popular today is the diode laser.

The use of diode lasers is based on two main principles:

principle:

* alternative use of high-intensity laser radiation as a scalpel as a multidisciplinary surgical instrument;

* physical factor having wide range biological action.

4. Classification of lasers by technical characteristics

I. By type of working substance

1. Gas. For example, argon, krypton, helium-neon, CO 2 laser; group of excimer lasers.

2. Dye lasers (liquid). The working substance is an organic solvent (methanol, ethanol or ethylene glycol) in which chemical dyes such as coumarin, rhodamine, etc. are dissolved. The configuration of the dye molecules determines the working wavelength.

3. Metal vapor lasers: helium-cadmium, helium-mercury, helium-selenium lasers, copper and gold vapor lasers.

4. Solid state. IN this type The emitters use crystals and glass as the working substance. Typical crystals used are yttrium aluminum garnet (YAG), yttrium lithium fluoride (YLF), sapphire (aluminum oxide), and silicate glass. Solid material is usually activated by adding small amounts of chromium, neodymium, erbium or titanium ions. Examples of the most common options are Nd:YAG, titanium sapphire, chromium sapphire (also known as ruby), chromium doped strontium lithium aluminum fluoride (Cr:LiSAl), Er:YLF and Nd:glass (neodymium glass).

5. Lasers based on semiconductor diodes. Currently, in terms of their totality of qualities, they are one of the most promising for use in medical practice.

II. According to the laser pumping method, those. along the path of transferring the atoms of the working substance to an excited state

Optical. The activating factor is electromagnetic radiation, which differs in quantum mechanical parameters from that generated by the device (another laser, incandescent lamp, etc.)

Electrical. The atoms of the working substance are excited by the energy of an electric discharge.

Chemical. To pump this type of laser, the energy of chemical reactions is used.

III. By power of generated radiation

Low intensity. They generate luminous flux power of the order of milliwatts. Used for physiotherapy.

High intensity. They generate radiation with a power of the order of watts. They are used quite widely in dentistry and can be used for the preparation of enamel and dentin, teeth whitening, surgical treatment of soft tissues, bone, and for lithotripsy.

Some researchers identify a separate group of medium-intensity lasers. These emitters occupy an intermediate position between low- and high-intensity and are used in cosmetology.

5. Classification of lasers by area of practical application

Therapeutic. They are usually represented by low-intensity emitters used for physiotherapy, reflexology, laser photostimulation, photodynamic therapy. This group includes diagnostic lasers.

Surgical. High-intensity emitters, the action of which is based on the ability of laser light to dissect, coagulate and ablate (evaporate) biological tissue.

Auxiliary (technological). In dentistry they are used at the stages of manufacturing and repair of orthopedic structures and orthodontic devices.

6. Use of laser in dentistry

Using laser systems, early stage caries is successfully treated, while the laser removes only the affected areas without affecting healthy tooth tissue (dentin and enamel).

It is advisable to use a laser when sealing fissures (natural grooves and grooves on the chewing surface of the tooth) and wedge-shaped defects.

Carrying out periodontal operations in laser dentistry allows you to achieve good aesthetic results and ensure complete painlessness of the operation. Laser treatment of gums and photodynamic therapy using a special laser device and algae eliminates bleeding gums after the first session, and also bad smell from mouth. Even with deep pockets, it is possible to “close” the pockets in a few sessions. This results in faster healing of periodontal tissue and strengthening of teeth.

Dental laser devices are used to remove fibroids without sutures, perform a clean and sterile biopsy procedure, and perform bloodless soft tissue surgeries. Diseases of the oral mucosa are successfully treated: leukoplakia, hyperkeratoses, lichen planus, treatment of aphthous ulcers in the patient’s oral cavity (nerve endings are closed).

In the treatment of dental canals (endodontics), a laser is used to disinfect the root canal for pulpitis and periodontitis. The bactericidal effectiveness is 100%.

The use of laser technology helps in the treatment of dental hypersensitivity. In this case, the microhardness of the enamel increases to 38%.

In aesthetic dentistry, using a laser, it is possible to change the contour of the gums, the shape of the gum tissue to form a beautiful smile; if necessary, tongue frenulums can be easily and quickly removed. Effective and painless laser teeth whitening with long-lasting results has gained the most popularity recently.

In surgical dentistry, there is almost always a risk of wound infection after tooth extraction, dental implantation and other interventions. Tissue injuries resulting from surgery and patient failure to comply with recommendations can cause the development of a secondary infection. The use of laser in surgical dentistry can significantly reduce the likelihood of wound infection, reduce the amount of anesthetic administered, and significantly reduce bleeding of the surgical wound.

It is also important that after using a laser during surgical procedures, rapid healing of the wound is observed, which results in a more comfortable condition for the patient after the operation.

Laser dental treatment is especially indicated for patients suffering from hypersensitive teeth, pregnant women, and patients suffering from allergic reactions to painkillers. To date, no contraindications to the use of laser have been identified. The disadvantage of laser dental treatment can only be considered higher, compared to traditional methods, price. Prices for laser dental treatment are much higher and this is primarily due to the high cost of laser equipment. Despite this, the benefits of laser dental treatment are worth the cost. This is evidenced by rave reviews from patients who have experienced laser dental treatment.

7. Application of high-intensity laser radiation

The use of high-intensity laser radiation as a scalpel as a multidisciplinary surgical instrument. Etiologically targeted, local periodontal therapy includes complete removal of subgingival microbiological film, granulation and subgingival deposits. To implement this, clinicians must assess and ensure:

1) access to periodontal pockets (areas of infection);

2) control of the etiological factor - to reduce dental plaque, stone and endotoxins;

3) the appearance of a periodontal reparative response;

4) performing the above procedures with minimal removal of dental cement and damage to the surface of the restorations.

The periodontal pocket, which is essentially infected wound, requires treatment based on the general principles of treating such wounds:

1) surgical treatment of the wound;

2) disinfection;

3) creating conditions for healing due to the body’s defenses.

In order to effectively remove (evaporate) subgingival microflora, dental plaque and biofilm, sterilize treated tissues, and improve the adhesion of fibroblasts to the root surface, laser technologies are used.

Laser curettage technique: a glass optical fiber is inserted into the periodontal pocket, the laser is activated, the fiber moves 2-3 times from the apex to the crown parallel to the root surface. Thus, the tooth is irradiated from all sides. Treatment of one periodontal pocket takes approximately 30-60 seconds. depending on its depth. Appearance of lung bleeding from the pocket is an indicator towards the end of the treatment procedure.

If necessary, a laser can be used to change the contour of the gums, gingivectomy, and gingivoplasty.

Laser exposure can be used to treat diseases of the oral mucosa, with the aim of evaporating pathologically altered soft tissues and stimulating the regeneration of neighboring areas. For this purpose, various modes of exposure are used.

During surgical treatment, the optical fiber must be held almost perpendicular to the pathological tissue, which is removed by small circular movements of the laser tip. The procedure is completed when the entire pathologically altered surface is coagulated and covered with a crust. Performing surgical manipulations, as a rule, does not require the use of anesthesia. There is no bleeding during treatment.

Benefits of laser surgery

* Bloodless surgery gives the surgeon an excellent view during the entire procedure, which reduces operating time. The wounds remain open for more a short time, which reduces the risk of infection.

* Simultaneous tissue disinfection reduces the likelihood of infection, which is one of the most common complications after surgery.

* Reduced need for local anesthesia- little or no pain after laser surgery will give the patient more comfort and reduce the time of the surgical procedure.

* The absence of the need for sutures after laser surgery is a normal situation and therefore increases the patient's comfort to an even greater extent.

* Laser surgery allows for faster wound healing with less post-operative discomfort and swelling.

The most common and popular indications for laser surgery include:

* oral surgery using a laser - operations to remove hemangiomas, fibroids, epulide, opening an abscess (septic operations), etc.;

* frenectomy;

* gingivectomy, atraumatic gingivoplasty, changing the shape of the gums and papilla;

* formation of the gingival groove;

* removal of hyperplastic tissues;

* ensuring hemostasis and obtaining a dry surface for impressions.

Gingivectomy for hyperplasia

The laser is used to make a focused incision around the desired gingival area and then excise or ablate excess hyperplastic tissue. Advantages of this procedure include no bleeding, more precise control than is possible with electrosurgery, and no need for a postoperative periodontal dressing.

Cosmetic reshaping of gums

In cases of asymmetry of the gum tissue or excess gum tissue in certain areas, a laser can be used to precisely shape the tissue into an ideal contour. This is also a convenient technique for papillary hypertrophy after orthodontic treatment or when the unaesthetic shape of the papilla changes. Removal of greater tissue thickness can be achieved by evaporation in a direction perpendicular to the tissue.

Gingivectomy to gain access

A laser can be used to remove tissue when there is no access to subgingival lesions of the teeth. This procedure is similar to gum recontouring, but care must be taken to preserve the gingival attachment. The depth of the pockets should be measured before surgery. The absence of bleeding allows immediate restoration or impression taking.

Frenectomy

Using a laser, you can easily and quickly excise the frenulum of the tongue or lip. Excision can be carried out in a continuous or pulsed mode. In any case, there is no need for a bandage and healing is usually excellent. The absence of bleeding and the elimination of stitches makes this technique ideal for children and adults. The manipulation is usually performed without local anesthesia.

Removal of benign tumors

The laser is an ideal tool for the removal of cosmetically undesirable benign tumors or hemartoma lesions. If the diagnosis of benignity has been confirmed, the laser is used to excise the lesion or perform ablation. In the same way, a laser can be used to remove fibromas, granulomas, hemangiomas, lymphangiomas of the gums and tongue, etc.

Opening of the gingival sulcus

Diode and neodymium lasers are convenient for bloodless opening of the gingival sulcus before taking an impression. This eliminates the need for retraction cords and vasoconstrictors. The tip of the laser fiber is placed below the edge of the sulcus and the tissue is removed as a ledge to expose the preparation margin.

Conclusion

The use of modern laser technologies also makes it possible to obtain an economic effect by reducing the length of the patient’s disability.

The main indications for the use of diode and neodymium lasers are:

1) periodontal diseases (epulis, hypertrophic gingivitis, pericoronoritis, etc.);

2) diseases of the mucous membrane of the mouth and lips (long-term non-healing erosion of the mucous membrane of the tongue and cheek, limited hyper- and parakeratosis, erosive-ulcerative form of lichen planus, leukoplakia, etc.);

3) benign neoplasms oral cavity and lips (fibroma, retention cyst of minor salivary glands, hemangioma, radicular cyst, candyloma, papilloma, etc.);

4) elimination of the pathology of the anatomical and topographical features of the structure of the soft tissues of the oral cavity (small vestibule of the oral cavity, short frenulum of the tongue, short frenulum of the upper and lower lip and etc.);

5) carrying out the second stage of intraosseous implantation (implant opening), etc.

Literature

1. Burgonsky V.G. Theoretical and practical aspects of the use of lasers in dentistry // Modern dentistry. - 2007. - No. 1. - P. 10-15.

2. Burgonsky V.G. Possibilities of using laser technologies for treatment and prevention in periodontal and surgical dental appointment// Modern dentistry. - 2009. - No. 5. - P. 64-69

3. Kodylev A.G., Shumsky A.V. Application of erbium-chromium laser in complex treatment periodontitis // Endodontics today. - 2008. - No. 1. - pp. 36-40

4. Kunin A.A. Modern aspects endodontic dental treatment // Clinical dentistry. - 2003. - No. 1. - pp. 18-19

5. Burgonsky V.G. Information about the seminar dedicated to the use of laser technologies in dental practice // Modern Dentistry. - 2008. - No. 1. - P. 135.

6. Zubachik V.M., Barilyak A.Ya. Rationale for the use of laser radiation in combination with silver nanoparticles for disinfection of the root canal of a tooth // Modern Dentistry. - 2008, No. 3. - P. 27-30.

7. Markina N.V. Lasers in dentistry: modern achievements and development prospects // Russian Dental Journal. - 2002. - No. 4. - C/ 41-44.

8. Selection of laser wavelength and treatment effectiveness various diseases oral mucosa and periodontal // Lasers in science, technology, medicine: Sat. scientific Trudovo.-M., 2005.-P.115-116 (In collaboration with L.A. Grigoryants).

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4. Use of laser in dentistry

Using laser systems, early stage caries is successfully treated, while the laser removes only the affected areas without affecting healthy tooth tissue (dentin and enamel).

It is advisable to use a laser when sealing fissures (natural grooves and grooves on the chewing surface of the tooth) and wedge-shaped defects.

In the treatment of dental canals (endodontics), a laser is used to disinfect the root canal for pulpitis and periodontitis. The bactericidal effectiveness is 100%.

The use of laser technology helps in the treatment of dental hypersensitivity. In this case, the microhardness of the enamel increases to 38%.

Laser in dentistry. Diode laser in dentistry

Use of laser in dentistry: indications and contraindications

Types of lasers used in dentistry

Why is the diode laser the most common in dentistry?

Which laser device should you buy for your dental clinic?

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4. Use of laser in dentistry