Surgery. No one wants to hear the word. Electrosurgery or radiosurgery. Again, no one wants to hear the word let alone have the procedure. But laser surgery. Now you are talking high tech, and yes, patients are more willing and open to the idea of having a procedure with a laser.
So, what is a laser and what kind of laser is, in my opinion, most beneficial to the general practitioner? The word laser is actually and acronym for Light Amplification by Stimulated Emission of Radiation. Further, lasers are named for the material that is stimulated. Therefore, in a soft tissue diode laser that I will discuss, the stimulated substance is a semiconductor that operates at 810 nm and ideally suited for soft tissue procedures. Others in this category would include the CO2 and Nd:YAG lasers. Hard tissue lasers, that can also be used for soft tissue procedures, include the Er:YAG, Er, and Cr:YSGG lasers.
This article focuses on the soft tissue diode laser and its extensive uses in general dentistry. As it is with any device, there is a learning curve. That said, if you can use an electrosurgery device you can easily adapt to laser therapy, and will be amazed by the ease of use and its versatility. A diode laser has distinct advantages over both the scalpel and the electrosurgery unit.
First, it is far gentler than either electrosurgery or scalpel. Unlike electrosurgery lasers do not require the placement of a grounding plate (very low tech!). Second, it generates little or no heat which can impact on implant longevity. And with implants, when the healing cap is removed, lasers can safely remove any tissue tags not possible with electrosurgery for fear of the electrode contacting the metal implant platform and the resulting current destroying the osseointegration. In a similar situation, you can safely remove hypertrophic tissue around orthodontic wires and/or brackets. Also, unlike most electrosurgery units, the soft tissue diode laser is safe to use with patients who have a pacemaker. Third, tissue separates gently and easily with the laser and hemostasis is achieved rapidly and there is minimal post-operative swelling. But most important, patients will like the idea that their practitioner is “high tech” in the approach to their dental well-being.
Such procedures as gingival contouring, operculectomy, periodontal therapy, troughing, gingivectomy, uncovering unerupted teeth, removal of fibrous tissue, removal of tissue tags around uncovered implant platforms and treatment of apthus ulcers are just some of the many uses for a soft tissue diode laser. Utilization will depend on each individual practitioner but in all cases two initial criteria must be met:
First, a laser should be affordable, easy to use, and have a small footprint to avoid cluttering the countertop. If the laser is out of sight you will never use it. Secondly, the unit should have several presets for various procedures but allow the operator to vary the settings with regard to continuous versus pulse output, duration of pulse and wattage. The unit that meets this criteria is the Picasso Soft Tissue Diode Laser (AMD Lasers).
The Picasso Soft Tissue Diode Laser is high tech and low stress. It has one fiberoptic cable that is threaded thru a handle and used as the operating tip. After each use, the used portion of the fiber optic cable (usually 3-5 mm) is cleaved and discarded and the fresh new tip face is ready for use. Picasso requires no water or air connections and can be easily transferred between operatories. It is in use so frequently however, that it is more practical to have one in every operatory.
As mentioned previously, there are many uses for the soft tissue diode laser. When treating patients with periodontal disease, the laser probe can be introduced into the pocket and provide a bactericidal and detoxifying effect. Studies have shown that there is a remarkable reduction in the bacterium called A. Actinomycetemcomitans with the introduction of the laser compared to that accomplished with deep scaling and root planning alone. It is also interesting to note that in light of all the increased awareness of the mouth-body connection that A. Actinomycetemcomitans has been found in artherosclerotic plaque associated with coronary heart disease.1-6
In daily practice, think of the laser handpiece as the soft tissue handpiece and the conventional drill as the hard tissue handpiece. The more common uses will involve troughing prior to impressions, operculectomy and gingivectomy. In all these instances the soft tissue diode laser is ideal as a simultaneous cutting and coagulating instrument. With gingival troughing, you no longer have pack cord and/or introduce another hemostatic agent. No longer will you have to refer a patient for an operculectomy or removal of hyperplastic tissue. These procedures are necessary when combating the increased risk of decay and periodontal disease by having areas inaccessible to routine hygiene. In all cases you will be providing treatment with less trauma, increased healing, and faster patient recovery.7-8,
Lasers are now so truly affordable that the practitioner has to ask, “Can I really do without it?” The Picasso Soft Tissue Diode Laser is a user-friendly, “right out of the box” solution for initiating laser dentistry into practice immediately with superb results. This is a gentle, easy-to-use device that will enable you to perform procedures faster and more comfortably for your patients. It is high tech without the high cost and high stress normally associated with introducing new equipment into daily practice. OH
Dr. Glazer is a Fellow and Past President of the Academy of General Dentistry, and former Assistant Clinical Professor in Dentistry at the Albert Einstein College of Medicine (Bronx, NY). Dr. Glazer is an Attending Dentist at the Englewood Hospital (Englewood, NJ). Additionally, Dr. Glazer is the Deputy Chief Forensic Dental Consultant to the Office of Chief Medical Examiner, City of New York. He lectures on cosmetic dentistry, forensic dentistry and patient management. Dr. Glazer maintains a general practice in Fort Lee, NJ.
Oral Health welcomes this original article.
1. Akoi, Mizutani, Takasaki et al. Current status of clinical lase applications in periodontal therapy. General Dentistry, Nov-Dec 2008, 674-687
2. Moritz, Gutknecht, Doerbudak, et al. Bacterial reduction in periodontal pockets through irradiation with a diode laser: a pilot study. Journal of Clincial Laser Med Surg.; Feb. 1997 15(1): 33-37
3. Ciancio, Wound healing of periodontal pockets using the diode laser. Applications of 810nm Diode Laser Technology: A clinical forum, 14-17
4. Andreanna, The use of diode lasers in periodontal therapy. Dentistry Today, Nov 2005; Vol. 24 No. 11
5. Ciancio, Efect of a diode laser on actinobacillus actinomycetemcomitans. Biological Therapies in Dentistry. Nov/Dec 2006: Vol. 22 No.3
6. Spahr, Klein, Khuseyinova, et al.; Periodontal infections and coronoary heart disease: role of periodontal bacteria and imporatnace of total pathogen burden in the Coronary Event and Periodontal Disease (CORODONT) study. Arch Internal Medicine: 2006 166:554-559
7. Goharkhay K., Moritz A., Wilder-Smith P., Schoop U., Kluger W., Jakolitsch S., Sperr W.; Effects on oral soft tissue produced by a dione laser in vitro. Lasers Surg. Med. 1999: 25(5): 401- 406.
8. Adams TC., Pang PK.: Lasers in Aesthetic Dentistry; Dental Clinics of North America, 2004 Oct: 48(4) 833- 869 vi.
