Laser technologies have long left the pages of science fiction novels and the walls of research laboratories, having gained strong positions in various areas human activity, including medicine. Dentistry, as one of the most advanced branches of medical science, has included the laser in its arsenal, arming doctors with a powerful tool to combat various pathologies. Application of lasers in dentistry opens up new possibilities, allowing the dentist to offer the patient wide range minimally invasive and virtually painless procedures meeting the highest clinical standards of dental care.

Introduction

The word laser is an acronym for “Light Amplification by Stimulated Emission of Radiation.” The foundations of the theory of lasers were laid by Einstein in 1917, but only 50 years later these principles were sufficiently understood and the technology could be implemented practically. The first laser was designed in 1960 by Maiman and had nothing to do with medicine. Ruby was used as the working fluid, generating a red beam of intense light. This was followed in 1961 by another crystal laser using neodymium yttrium aluminum garnet (Nd:YAG). And only four years later, surgeons who worked with a scalpel began to use it in their activities. In 1964. Bell Laboratories physicists produced a laser using carbon dioxide (CO 2) as the working medium. In the same year, another gas laser was invented, which later proved valuable for dentistry - the argon laser. In the same year, Goldman proposed the use of lasers in the field of dentistry, in particular for the treatment of caries. Pulsed lasers were later used for safe work in the oral cavity. With the accumulation of practical knowledge, the anesthetic effect of this device was discovered. In 1968, the CO 2 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. The mid-1980s saw a resurgence of interest in the use of lasers in dentistry to treat hard tissues such as enamel. In 1997, the US Food and Drug Administration finally approved it for use on hard tissues A well-known and popular laser today is erbium (Er:YAG).

Benefits of laser treatment

Despite the fact that lasers have been used in dentistry since the 60s of the last century, a certain prejudice among doctors has not yet been completely overcome. You can often hear from them: “Why do I need a laser? I can do it with a boron faster, better and without the slightest problem. Extra headache! Of course, any work in the oral cavity can be performed on a modern dental unit. However, the use of laser technology can be characterized as higher quality and more comfortable, expanding the range of possibilities, allowing the introduction of fundamentally new procedures. Let's look at each point in more detail.

Quality of treatment: using a laser, you can clearly organize the treatment process, predicting the results and timing - this 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. In this case, pulses of equal energy, depending on the duration, can produce different effects on the target tissue. As a result, by changing the time from one pulse to another, it is possible to obtain a variety of effects using the same energy level: pure ablation, ablation and coagulation, or only coagulation without destruction of soft tissue. Thus, by correctly selecting the parameters of duration, magnitude and pulse repetition rate, it is possible to select an individual operating mode for each type of tissue and type of pathology. This allows almost 100% of the laser pulse energy to be used to perform useful work, excluding burns of surrounding tissues. Laser radiation kills pathological microflora, and the absence of direct contact of the instrument with the tissue during surgery eliminates the possibility of infection of the operated organs (HIV infection, hepatitis B, etc.). When using a laser, tissues are processed only in the infected area, i.e. their surface is more physiological. As a result of treatment, we obtain a larger contact area, improved marginal fit and significantly increased adhesion filling material, i.e. better quality filling.

Comfort of treatment: The first and, perhaps, most important thing for the patient is that the effect of light energy is so short-lived that the effect on the nerve endings is minimal. During treatment the patient experiences less pain, and in some cases you can refuse pain relief altogether. In this way, the treatment can be performed without vibration and pain. The second and important advantage is that the sound pressure created during laser operation is 20 times less than that of high-speed turbines. Therefore, the patient does not hear any frightening sounds, which is psychologically very important, especially for children - the laser “removes” dental office the sound of a working drill. It is also necessary to note a shorter recovery stage, which is easier compared to traditional interventions. Fourthly, it is also important that the laser saves time! The time spent on treating one patient is reduced by up to 40%.

Expanding capabilities: The laser provides more opportunities for the treatment of caries, carrying out preventive “laser programs” in pediatric and adult dentistry. Huge opportunities are emerging in the surgery of bone and soft tissue, where treatment is carried out using a surgical handpiece (laser scalpel), in implantology, prosthetics, in the treatment of mucous membranes, removal of soft tissue formations, etc. A method for detecting caries using a laser has also been developed - in this case, the laser measures the fluorescence of bacterial waste products in carious lesions located under the surface of the tooth. Studies have shown excellent diagnostic sensitivity this method compared to the traditional one.

Diode laser in dentistry

Despite the diversity lasers used in dentistry, the most popular today for a number of reasons is diode laser. The history of the use of diode lasers in dentistry is already quite long. Dentists in Europe, who have long adopted them, can no longer imagine their work without these devices. They are distinguished by a wide range of indications and relatively low price. Diode lasers are very compact and easy to use in clinical settings. Diode safety level laser devices very high, so hygienists can use them in periodontics without the risk of damaging the tooth structure. Diode laser devices are reliable due to the use of electronic and optical components with a small number of moving elements. Laser radiation with a wavelength of 980 nm has a pronounced anti-inflammatory effect, bacteriostatic and bactericidal effect, and stimulates regeneration processes. Traditional areas of application for diode lasers are surgery, periodontics, endodontics, with surgical procedures being the most popular. Diode lasers make it possible to perform a number of procedures that were previously performed by doctors with reluctance - due to heavy bleeding, the need for suturing and other consequences of surgical interventions. This occurs because diode lasers emit coherent monochromatic light with a wavelength between 800 and 980 nm. This radiation is absorbed in a dark environment in the same way as in hemoglobin - meaning that these lasers are effective at cutting tissues that have many blood vessels. Another advantage of using a laser on soft tissue is that there is a very small area of ​​necrosis after tissue contouring, so the tissue edges remain exactly where the doctor placed them. This is a very significant aspect from an aesthetic point of view. Using a laser, you can contour your smile, prepare your teeth, and take impressions during one visit. When using a scalpel or electrosurgical units, several weeks must pass between tissue contouring and preparation to allow the incision to heal and the tissue to shrink before the final impression is taken.

Predicting the position of the cut edge is one of the main reasons why diode lasers are used in aesthetic dentistry for recontouring of soft tissues. It is very popular to use a semiconductor laser to perform frenectomy (frenuloplasty), which is usually underdiagnosed because many doctors do not like to perform this treatment according to standard techniques. With a conventional frenectomy, stitches must be placed after cutting the frenulum, which can be uncomfortable in this area. In the case of laser frenectomy, there is no bleeding, no stitches are needed, and healing is more comfortable. The absence of the need for sutures makes this procedure one of the fastest and easiest in a dentist's practice. By the way, according to surveys conducted in Germany, dentists who offer patients diagnostics and treatment using lasers are more visited and successful...

Types of lasers used in medicine and dentistry

The use of lasers in dentistry is based on the principle of selective action on various tissues. Laser light is absorbed by a specific structural element that is part of the biological tissue. The absorbing substance is called a chromophore. They can be various pigments (melanin), blood, water, etc. Each type of laser is designed for a specific chromophore, its energy is calibrated based on the absorbing properties of the chromophore, as well as taking into account the field of application. In medicine, lasers are used to irradiate tissues with preventive or therapeutic effect, sterilization, for coagulation and cutting of soft tissues (operational lasers), as well as for high-speed preparation of hard dental tissues. There are devices that combine several types of lasers (for example, for treating soft and hard tissues), as well as isolated devices for performing specific highly specialized tasks (lasers for teeth whitening). They have found application in medicine (including dentistry) following types lasers:

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 with a laser is much higher. When using an argon laser in surgery, excellent hemostasis is achieved.

Nd:AG laser(neodymium, 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.

He-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 themselves.

CO 2 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, CO 2 systems are gradually giving way to other lasers in surgery.

Er:YAG laser(erbium, 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.

Diode laser(semiconductor, wavelength 7921030 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 at the moment This is the most affordable laser device in terms of price/functionality ratio.

Diode laser KaVo GENTLEray 980

There are many manufacturers offering laser equipment on the dental market. KaVo Dental Russland presents, in addition to the well-known universal KaVo KEY Laser 3, called the “clinic on wheels,” the KaVo GENTLEray 980 diode laser. This model presented in two modifications - Classic and Premium. The KaVo GENTLEray 980 uses a wavelength of 980 nm, and the laser can operate in both continuous and pulsed modes. Its rated power is 6-7 W (at peak up to 13 W). As an option, it is possible to use the “micropulsed light” mode at a maximum frequency of 20,000 Hz. The areas of application of this laser are numerous and, perhaps, traditional for diode systems:

Surgery: frenectomy, implant release, gingivectomy, removal granulation tissue, flap surgery. Mucosal infections: canker sores, herpes, etc.

Endodontics: pulpotomy, canal sterilization.

Prosthetics: expansion of the dentogingival sulcus without retraction threads.

Periodontology: decontamination of pockets, removal of marginal epithelium, removal of infected tissue, gum formation. Let's consider clinical example application of KaVo GENTLEray 980 in practice - in surgery.

Clinical case

IN in this example A 43-year-old patient had a fibrolipoma on the lower lip, which was successfully treated surgically using a diode laser. He applied to the Department of Dental Surgery with complaints of pain and swelling of the lower lip mucosa in the buccal area for 8 months. Despite the fact that the risk of traditional lipoma in the head and neck area is quite high, the appearance of fibrolipoma in the area oral cavity, and especially on the lip - rare case. To determine the causes of the neoplasms, it was necessary to conduct a histological examination. As a result clinical trials it was found that the neoplasm was well separated from the surrounding tissues and covered with an intact mucous membrane (Fig. 1 - fibrolipoma before treatment). For the purpose of diagnosis this education was removed surgically under local anesthesia when using a diode laser with a 300 nm fiber and a power of 2.5 Watt. Stitching of the edges was not necessary, since no bleeding was noticed either during the surgical procedure or after it (Fig. 2 - fibrolipoma 10 days after the intervention). Histological studies The tissue taken for analysis showed the presence of mature non-vacuolated fat cells surrounded by dense collagen fibers (Fig. 3 - histology). Morphological and structural changes No tissue was noticed due to the thermal effects of the diode laser. The postoperative course of treatment was calm, with a visible decrease in surgical scar after 10 days and without signs of relapse over the next 10 months.

Result: in the described case surgery removal of fibrolipoma of the lower lip was carried out without hemorrhages, with minimal tissue damage, which allows for subsequent conservative treatment. Also noted fast recovery patient. The ability to avoid noticeable sutures after excision is also undoubtedly positive factor from an aesthetic point of view. Conclusion: surgical treatment benign neoplasms of the oral mucosa using a diode laser is an alternative to traditional surgery. The effectiveness of this method was confirmed by the results of the removal of lip fibrolipoma.

Today, no one can be surprised by the presence of dental clinic modern equipment, including all kinds laser installations, which can be widely used for diagnosis, treatment, prevention and teeth whitening. In dentistry, the use of lasers in recent years They even separated it into a whole area called laser dentistry. With the beginning of the use of lasers in dentistry, patients have the opportunity to forget about pain, and therefore about fear during dental treatment, as well as other unpleasant sensations that invariably accompany a dental appointment.

Use of laser in dentistry

What is a laser

A laser (or quantum generator) is technical device emitting light in a narrow spectral range of the beam electromagnetic waves. In accordance with various tasks, several types of lasers have been developed and used for use in dentistry: argon, carbon dioxide, diode, neodymium and others. The work of lasers in dentistry is based on the radiation of the laser beam length, which can be most effective in treatment or prevention dental diseases. The light radiation used is not constant, but is produced in certain pulses, which also depends on the modernity of the equipment. Laser dentistry is essentially a non-contact method of application. dental procedures. With the help of a laser, a dentist has the opportunity to create the most comfortable physical and psychological conditions for dental patient. As is probably already clear from the above, when using this type of dental manipulation, the impact on the teeth and surrounding tissues occurs using a laser beam.

Benefits of using a laser

The use of laser in combination with traditional methods It is practically becoming a standard in dentistry, and its advantages have already been proven by practice and are undeniable: accuracy, speed, painlessness, safety. Dental lasers that exist today make it possible not only to remove damaged tooth tissue pathological process, but also to disinfect, reduce bleeding, coagulate soft fabrics oral cavity. For example, if bleeding occurs, a laser can painlessly localize the lesion in a fraction of a second.

Disinfection

The laser also has unique capabilities for disinfecting the oral cavity. It has been proven that pathogenic microflora of the oral cavity does not tolerate exposure laser radiation, thereby efficiency dental treatment increases many times. For example, in the treatment of dental canals, a laser can be used for disinfection purposes. root canal tooth with pulpitis and periodontitis.

Accuracy

Another undeniable advantage of a dental laser is the fairly high selectivity of treatment when using a laser - only damaged tissue(for example, when initial caries), there is no need for sutures when surgical interventions. As a result, wound healing occurs as quickly as possible and almost painlessly. There is also the possibility of performing a sterile biopsy procedure and bloodless surgical procedures. Dental lasers have been successfully used to treat diseases of the oral mucosa, such as keratoses, leukoplakia, red lichen planus, aphthous ulcerative stomatitis, etc.

Antibacterial properties of laser

For periodontal diseases, laser treatment is also highly effective due to its antibacterial properties and selectivity of action. With the help of a laser beam, it is possible to get rid of subgingival dental deposits, remove the formed pathological “pockets”, bleeding and, as a result of all – bad smell from the mouth, while achieving good aesthetic treatment results. Associated pathological problems such as bleeding gums and inflammation can be eliminated after the first session.

Aesthetic effect

Laser technology is successfully used in treatment hypersensitivity teeth, in aesthetic dentistry the possibilities of laser for teeth whitening with long-lasting results are widely known. When installing a denture, the laser will help create an accurate micro-lock for the crown, and when installing dental implants, the laser will ideally make a minimal tissue incision at the installation site and provide fast healing implantation areas.

Expensive but effective

Using laser in dentistry is expensive but effective

In conclusion, I would like to note that laser dentistry is an additional modern opportunity improve the quality of treatment and dental services. A relative disadvantage of using lasers in dentistry is the high cost of the equipment and, as a result, high cost procedures, which, however, is seriously offset by the advantages that the use of laser provides in the treatment of teeth and gums.

Introduction

Lasers and laser systems in dentistry: description, classification and characteristics

Effect of lasers on tissue

Interaction of laser with hard tooth tissue

Mechanism and features laser preparation hard tooth tissues

References

Introduction.

In the 1960s, the first lasers for medical purposes were introduced. Since then, science and technology have made huge leaps in development, allowing the use of lasers for a huge number of procedures and techniques. In the 90s, lasers made a breakthrough in dentistry; they began to be used to work with soft and hard tissues. Currently, in dentistry, lasers are used for the prevention of dental diseases, in periodontics, therapeutic dentistry, endodontics, surgery and implantology. The use of lasers is an appropriate method for daily assistance to dentists in many types of work. For some procedures, such as frenulotomy, lasers have proven so clinically effective that they have become the gold standard among physicians. They allow you to work in a dry field, which provides excellent visibility and reduces operating time. With lasers, the likelihood of scarring is very low and virtually no stitches are required. They also ensure absolute sterility of the working field, which in most cases is an absolute necessity, for example when sterilizing a root canal.

Lasers and laser systems in dentistry: description, classification and characteristics

Laser devices produce different wavelengths that interact with specific molecular components in animal tissues. Each of these waves affects certain tissue components - melanin, hemosiderin, hemoglobin, water and other molecules. In medicine, lasers are used to irradiate tissues with a simple therapeutic effect, for sterilization, for coagulation and resection (operational lasers), as well as for high-speed tooth preparation. Laser light is absorbed by a specific structural element that is part of the biological tissue. The absorbing substance is called a chromophore. They can be various pigments (melanin), blood, water, etc. Each type of laser is designed for a specific chromophore, its energy is calibrated based on the absorbing properties of the chromophore, as well as taking into account the field of application.

Laser interactions with calcium-containing tissues have been studied using various wavelengths. Depending on such laser parameters as pulse duration, discharge wavelength, penetration depth, the following types of lasers are distinguished: pulsed dye, He-Ne, ruby, alexandrite, diode, neodymium (Nd: YAG), goldmium (No: YAG), erbium (Er: YAG), carbon dioxide (CO2).

In medicine, lasers are used to irradiate tissues with a preventive or therapeutic effect, sterilization, for coagulation and cutting of soft tissues (operational lasers), as well as for high-speed preparation of hard dental tissues. Lasers produce surface changes in enamel such as crater formation, melting and recrystallization.

In dentistry, the CO2 laser is most often used to treat soft tissues and the erbium laser is used to prepare hard tissues. There are devices that combine several types of lasers (for example, for treating soft and hard tissues), as well as isolated devices for performing specific highly specialized tasks (lasers for teeth whitening).

There are several laser operating modes: pulsed, continuous and combined. Their power (energy) is selected in accordance with the operating mode.

Table 1. Types of lasers, penetration depths and chromophores

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

In dentistry, the CO2 laser is most often used to treat soft tissues, and the erbium laser is used to prepare hard tissues.

Operating mode of lasers and their energy.

Erbium:

Impulse, energy/impulse ~300…1000 mJ/imp.

CO2 laser:

Pulse (up to 50 mJ/mm2)

Continuous (1-10W)

Combined

A typical laser device consists of a base unit, a light guide and a laser tip, which the doctor uses directly in the patient’s oral cavity. For ease of use, various types of handpieces are available: straight, angled, for power calibration, etc. All of them are equipped with a water-air cooling system for constant temperature control and removal of prepared hard tissue.

When working with laser equipment, special eye protection must be used. The doctor and patient must wear special glasses during preparation. It should be noted that the danger of vision loss from laser radiation is several orders of magnitude less than from a standard dental photopolymerizer. Laser beam does not dissipate and has a very small illumination area (0.5mm² versus 0.8cm² for a standard light guide).

The laser operates in a mode that sends out an average of about ten beams every second. The laser beam, hitting hard tissue, evaporates a thin layer of about 0.003 mm. The preparation occurs quite quickly, but the doctor can control the process by immediately interrupting it with one movement. After laser preparation, an ideal cavity is obtained: the edges of the walls are rounded, whereas when preparing with a turbine, the walls are perpendicular to the tooth surface, and after that additional finishing has to be carried out.

In addition, the cavity after laser preparation remains sterile, as after long-term antiseptic treatment, since laser light kills pathogenic flora.

Laser dissection is a non-contact procedure; the components of the laser system do not directly contact the tissues - dissection occurs remotely. In addition to the undoubted practical advantages, the use of a laser helps to significantly reduce the cost of treatment. By working with a laser, you can completely eliminate burs, antiseptic solutions, and acid for etching enamel from everyday expenses. The time spent by the doctor on treatment is reduced by more than 40%.

For most of the population, visiting the dentist is associated with a certain torture: the sound of a drill, the aroma of medicine, discomfort. But that's it more Doctors are trying to move away from these “old-fashioned” methods. In particular, using laser dental treatment in my practice.

Treatment of dental cysts - description of the procedure

Laser dentistry is a technique in which a diode laser is used to remove dead or putrefactive tooth tissue. It allows you to remove caries and other formations on teeth in a matter of minutes, without damaging healthy tissue.

Laser operating principle is very simple: by heating the surface of the tooth, most of the liquid is removed from it. After this, the “protected” inflamed space is released. The laser beam burns out all harmful microorganisms and frees up space for further mechanical cleaning.

Treatment of dental cysts with a laser is carried out similarly to any other operations. A cyst is a formation with dense, hard walls, inside of which there is large number bacteria or dead tissue. Outwardly it may not be noticeable, but in everyday life causes great discomfort. In particular, previously a dental cyst was treated with great effort.

This purulent sac forms in the roots, so to remove it, in any case, it would be necessary to remove the tooth, clean out the abscess and install an implant in its place. There is another method - surgical, for its implementation in in the right place An incision is made in the gums corresponding to the cyst, the dental surgeon uses instruments to pull out the bag, and then sutures the tissue.

The disadvantage of mechanical methods is the likelihood of not completely clearing out the pus - you simply cannot be thoroughly sure that there is no dead tissue in the bag. In addition, the regeneration process is quite lengthy and unpleasant. Healing of the gums after cyst removal lasts from a week to a month.

Painless removal laser cysts are produced as follows:

After the end of the session, the patient can begin normal life. The advantages of this technology are obvious. Lack of any side effects, the possibility of use during pregnancy and even treatment of baby teeth.

But the laser treatment method also has some disadvantages:

• High cost of the session. Cosmetic procedure caries removal will cost at least $30, and gum treatment can cost $50 or more;
• Low prevalence. Many dentists studied and spent most of their years working on drills. Quite difficult to find good specialist who can adjust the laser to the desired depth and power;
• Failure to solve underlying problems. A laser machine cannot remove holes in teeth, stone growths and many other troubles.

Treatment of dental granuloma - description of the procedure

– this is an inflammation of periodontitis and the formation of a purulent sac at the root of the tooth. The symptoms are very similar to a cyst, but are more difficult to treat. The disease is asymptomatic: gradually from pulpitis to granuloma. Another significant difference from a cyst is its thin walls. They are very fragile and, when inflamed, can burst at the slightest touch. As a result, it will be felt sharp pain when biting, talking or simply touching the tooth.

Due to the soreness of the gums in this disease, treatment is carried out strictly under sedation. Depending on the severity, it can be superficial or deep.

How does laser treatment of granuloma work?

To learn more about laser treatment, we recommend watching a video about the procedure in a professional clinic.

Indications and contraindications

When is diode laser dental treatment necessary:

Contraindications for laser dental treatment:

1. Pulmonary and vascular pathology. This is a categorical contraindication. If you have problems with blood vessels, then the laser should not be used under any circumstances;
2. Blood clotting diseases, including varicose veins, diabetes and others;
3. Malignant formations or postoperative period;
   Individual intolerance laser techniques, high sensitivity enamel, tendency to sharp nervous excitement.

Photos before and after

Despite the disadvantages of dental treatment with the Proxsys laser, reviews claim that this is the best modern way get rid of cysts and caries.

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 effect 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

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 photon energy 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

Laser surgery methods are used to manipulate the skin much more often than any other tissue. This is explained, firstly, by the exceptional diversity and prevalence of skin pathologies and various cosmetic defects, and secondly, 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: 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.

PICTURES

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 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 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 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.

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. 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, and patients suffering from allergic reactions to painkillers. To date, no contraindications to the use of laser have been identified. The only disadvantage of laser dental treatment is the 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 benefits of laser dental treatment are worth the cost. 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.