Lasers in Dentistry

What is Laser Peridontal Surgery

Laser Peridontal Surgery is a non-invasive and an extremely gentle way of avoiding scalpel and sutures. There are mild or severe gum diseases and in such cases the best form of treatment for them is the use of laser treatment. The use of the Laser Peridontal Surgery goes on to eliminate bacteria in the mouth by as much as 90% and this can be a great way to keep gum disease at bay. The other merit of the Laser Peridontal Surgery is that you won’t have to deal with loss of gum tissue. There is no pain or bleeding involved when you use Laser Peridontal Surgery as no cutting or invasive methods are needed.

Lasers to treat gum diseases

There are several different kinds of applications in which the laser can be used in the field of:

1. Chronic periodontitis treatment
2. Treatment of common soft tissue concerns like soft tissue crown lengthening, Tissue retraction for impressions, frenectomy
3. Decrease of denture hyperplasia and drug induced gingival overgrowth
4. Depigmentation of gingiva
5. As an adjunct to scaling and root planning called SRP
6. For hemostasis
7. Excisional and incisional biopsies

There are different kinds of lasers used in periodontics:

• Carbon dioxide laser,
• Nd: YAG laser and
• Diode laser

                                        Nd: YAG Laser         Diode Laser

The thing about diode lasers is that they have great soft tissue ablation and haemostatic characteristics. On the other hand, when they are applied to the root surface or alveolar bone, carbonisation and thermal injury may occur. Consequently, these lasers are used in the treatment of gingivectomy, frenectomy and other soft tissue procedures. Lately Er:YAG and Erbium chromium doped: Yittrium selenium-gallium garnet laser scaling has been seen as an adjunct to conventional scaling and root debridement. These lasers efficiently and successfully ablate iological tissues that contain water molecules.

The use of lasers during periodontal therapy can be extremely beneficial as there is hardly any bleeding, swelling and discomfort to the patient during the dental surgery. Nevertheless, each laser has different wavelengths and power levels that allow it to be used at different frequencies and gives the most safety during different kinds of periodontal procedures. There may be injury caused to periodontal tissues in case of an inappropriate wavelength and/or power level is used during a periodontal procedure.

Lasers for Treatment of Chronic Periodontitis:

The key to successful treatment of chronic periodontitis is the gain of clinical attachment level. Various dental laser wavelengths have been used by clinicians in treatment of periodontitis. Most commonly used lasers by dentists are diode lasers, Nd:YAG , Er:YAG and Er, Cr:YSGG and CO2. Lasers can also be used for pocket decontamination procedures.

Laser technology to treat gum problems and soft tissue concerns
 

 

Before                                                           After

Healthy gums after pockets elimination and disinfection using dental lasers

Laser mediated periodontal therapy is used to decrease the sub gingival bacterial loads. Laser assisted new attachment procedure is done with them to remove the unhealthy tissue. Lasers such as Erbium lasers work effectively in being able to remove the calculus build up on teeth and reducing progressive periodontal diseases. They demonstrate safe and effective root substance removal without any kind of negative thermal effects. Diode lasers result in a remarkable amount of reduction in subgingival microbial populations with it. The carbon dioxide wave length is effective in removing the soft tissue and the inflamed pocket tissues while achieving good hemostasis.

Lasers can address the concern of soft tissue problems:

Lasers are used in soft tissue surgery. The advantages of lasers in soft tissue surgery are:

1. The laser cut is more exact and accurate than that of any scalpel
2. The cut is clearly seen initially because the laser seals off blood vessels and lymphatics leaving a clear dry field for the dentist to work on.
3. The laser sterilizes as it cuts, which goes on to reduce the risk of blood-borne diseases
4. Minimal postoperative pain and swelling for the patient which reduces recovery time
5. Less postoperative infection because the wound is closed up with biologic dressing
6. Less wound contraction during mucosal healing. This results in no formation of scars
7. Less damage to the surrounding tissues.

This makes certain that lasers have a shorter operative time and faster postoperative recuperation period.

The uses of soft tissue lasers in dental practice broadly fall into these categories:

1.    Improving gingival shape and contour,
2.    Lengthening crowns,
3.    Idealizing tooth proportionality, and
4.    Resolving crown/height asymmetries
5.    Frenectomy procedure.

Final aesthetic outcome of dental treatment are gingival shape and gingival contour. Gingival shape is all about the curvature of the gingival margin of the tooth. Gingival contour is different from gingival shape and refers to a more 3-dimensional description of gingival topography.

The best gingival contour has sharp interdental papillae and equally tapered gingival margins at the cervical margin of the teeth. Re-contouring is possible with the help of a diode laser.  As there is no bleeding, the wound is sealed during the procedure, and contouring can be extremely accurate. Three weeks after gingival shaping and contouring, the tooth has a much more aesthetic look to it on the whole.

 Contouring of the Gums

       Before                                                                 After

 

Excess gum Tissue Reshaped Using Lasers

Before                                                             After

There are specific lasers that can be used for frenectomy and they are called Diode lasers.  The diode light and the mechanics used for it have changed the field of dentistry completely. The entire process is completely pain free and could be used with infiltrated local anesthesia. Topical anesthesia is given and then the procedure is performed. The duration of treatment with lasers is very slow as there is no pain induced. The procedure need not have stitches and therefore the healing is fast and free of all complications.

Reduction of denture hyperplasia and drug induced gingival overgrowth by lasers:

Lasers are also used to treat another form of gum disease which is drug induced gingival overgrowth. Medicines like phenytoin, calcium channel blockers such as nifedipine, procardia etc, antihypertensive tablets, and immunosuppressant causes gingival inflammation. To control gingival swelling by drugs, good oral hygiene is a must and no one can do away with it. If the condition is relentless, then lasers can be used for the removal of excessive gum tissue and contouring of the soft tissues to produce functional and aesthetic results.

Denture hyperplasia is a smooth tumor like mass which forms in the space that exists between the cheeks and the gums. This is the result of a constant irritation caused by dentures that don’t fit one well. If this is noticed then the best thing is realignment or replacement of the existing denture. Lasers can be used to reduce tumor like mass.

Depigmentation of gums by lasers:

Lasers can also be used for gum bleaching and the method used is called the water lease system. Erbium:YAG  lasers is a secure and well-organized treatment. It causes alteration in the melanin pigment in gingival tissues and produces a great pink-looking gum.  It is a method that is fast, painless and ensures that one gets good results. Dark gums look ugly and they can be changed into pink and healthy looking ones in a single one sitting with a dentist. The good thing is that the results are not temporary and will last you a lifetime. The way melanin pigment worked on by the laser, it does allow the dark gums to return.

Depigmentation of Gums by Lasers

The patient needs to find out the cause of the discoloration. Healthy gums with no gum disease in them such as swelling or inflammation are perfect for gum bleaching. However, if the gums are not healthy then first the infection needs to be treated. Gum bleaching can only be done on healthy gums. A smoker needs to quit smoking before opting for the gum bleaching.

Process for Gum Bleaching:

1. The process depends on the degree, intensity and kind of discoloration.
2. Local anesthesia is used and it is a painless procedure.
3. What determines the use of laser treatment is the intensity and degree of discoloration the gum.
4. If the discoloration is not really deep then no surgery is needed. Minor surgery and the use of lasers is enough.
5. Curing is very rapid and the patient does not have to bear with any soreness or pain afterwards.

Lasers as an addition to scaling and root planning (SRP)

Diode lasers are used as an addition to scaling and root planning. Lasers are far better in their efficiency when you compare them with more conventional treatment options. They are good enough to be able to control the bleeding. Scaling and root planning along with the use of laser go on to produce reasonable clinical improvement when compared to conventional scaling and root planing.

Lasers for Hemostasis

The healing of lasers is usually very predictable as the cell is vaporized as it was cut. Many dentists opt to use a combination of the blade and laser for hemostasis and refining the tissue margin. In incising and draining of the abscess, the laser is used for hemostasis and tissue vaporization. This ensures that there is less of an open wound that could result in an infection due to the nearness of pus and bacterial drainage. Before the use of lasers, the dentists used epinephrine injection for hemostasis.

Now, laser is used for hemostatic and makes it a simple and uncomplicated procedure. This ensures that the use of laser is the best instrument for a advanced, exact, hemostatic cut.


Information provided by www.identalhub.com

Single Implant vs. Bridge

Information provided by world.org

A 3 Unit Bridge vs. Dental Implant for Replacing Single Missing Tooth

Replacing one single missing tooth with a 3 unit bridge was the most effective tooth replacement treatment prior to dental implants becoming available.

This particular type of dental bridge comprises of three prosthetic teeth joined alongside each other in a row, the tooth in the centre bridges the gap with the false teeth on each side being attached over 2 healthy natural teeth.
Although this type of treatment previously considered as the most effective available treatment for decades, with other more advanced dentistry options available it is no longer regarded as the best possible type of restorative dental treatment in many cases.
The main disadvantage with a 3 unit bridge is that it necessitates the shaping and reduction in size of both teeth on each side of the gap to make it possible for the bridgework to be attached. As the bridge consists of three prosthetic teeth which are fixed to each other, they need to be maintained differently to the patients other teeth.

The use of a  specialized dental cleaning device known as a floss-threader is required to clean the area where the bridge joins onto the teeth as these areas are extremely vulnerable to tooth decay.
Partly because of the problems associated with dental bridgework, dental implants have become the most preferred option for replacing one missing tooth.  The finished implant functions not only as a replacement tooth but also as a tooth root; this has a significant advantage over a 3-unit bridge as the placing of an implant ensures the preservation the jawbone in the area of the missing tooth.
Furthermore, an implant does not require the wearer to use any specialist cleaning equipment or additional oral hygiene techniques, in contrast to a bridge. Implanted teeth should be taken care of simply by brushing twice a day and regular flossing, in a similar manner as maintaining natural teeth.
If a decaying or damaged tooth is to be replaced with a dental implant it would be advisable to have a consultation with the dental surgeon before the tooth is removed.
It is possible that the dental surgeon may be able to extract the tooth himself and place the implant immediately after the tooth extraction. This approach has the added benefit of shortening the overall treatment time by up to 16 weeks.
If the tooth was extracted anything more than 6 months prior to the implant being placed it would be likely that a bone graft would be required, often necessitating the need for a healing period of four months to allow the grafted bone tissue to integrate with the jaw.
The Longevity of Implants and Dental Bridges
The implant and abutment should last for patient’s lifetime; but the ceramic crown would be expected to last for a decade or longer. The interval between having a crown initially placed and replacement of the crown would depend heavily on the oral hygiene routine of the patient.
Crowns which are generally intended to last in excess of 10 years might need to be replaced after 2 or 3 years if a poor oral hygiene routine is exercised.
A dental bridge is also expected to last for approximately 10 years before it needs to be replaced, but the likelihood of other problems occurring is significantly greater.
In the event the teeth which support the bridge failing due to tooth decay or periodontal disease, considerable dental work will be required to restore the dental bridge; this could include building up both teeth on either side with a dental bonding compound. The restorative dental work in some cases may include a replacement three unit bridge being manufactured.
Conclusion
Generally a single dental implant is the preferred method for replacing a single missing tooth due to greater reliability, a lower likelihood of complications and the preservation of the adjacent healthy teeth; although, the final decision should be taken on a case by case basis.
In some instances it is not practical to place dental implants due to a lack of bone mass in the jaw, the position of nerves or the maxillary sinus, or due to certain pre-existing health conditions of the patient. In many instances both methods should be considered with the advantages and disadvantages of each being explained to the patient.

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