Laser is one of the top innovative dental treatment options that were rigorously exploited over the past decade. Laser dentistry provides minimally invasive procedures and is thought to be the best choice for dealing with oral tissues.

Popularity of laser dentistry has increased due to the great results it showed with excision of overgrown tissues; it eliminated anesthesia, bleeding, suturing, pain and prolonged operative and healing times. This particular functionality allowed laser to be used for gum contouring (gingivectomy) which is a highly demanding procedure for patients with gingival hyperplasia or others with gummy smile. Moreover, laser has an antimicrobial action that can promote gum health and resolve gum diseases (e.g., peri-implantitis); it is also useful for taking tissue biopsies and to remove herpetic or aphthus ulcers.

Dental surgeons currently prefer using laser for many surgeries related to implants as well as other procedures with high level of complexity such as excision of throat tissues causing sleep apnea, removing oral tumors, recovery of damaged nerves, frenectomy and easing tongue frenulum for patients with restricted tongue movements. In addition, as a minimally invasive option, laser dentistry seems to be ideal treatment for fearful children who require smooth, painless procedures. In restorative dentistry, laser is an excellent option for detecting caries, treating sensitivity and preparing cavities for filling.

Another excellent use of laser is its application for reducing gag reflex with acupuncture on wrists for full dental treatment and high patient satisfaction.

Laser dentistry has a great advantage over traditional dental therapy that it gives instant, or at least faster, results. So, it is ideal for cosmetic procedures as the patient notices the changes right away. This applies for teeth whitening using laser light that has strong potential to target discolored areas and wash out the stains; in addition to crown-lengthening procedures which are highly demanding by prosthodontists.

“Laser also helps in removing infection from pockets, selectively removing epithelium so that inner lining of pocket is exposed undamaged connective tissue, and creating a stable clot so that healing can take place creating a connective tissue attachment. The histology of the laser-assisted surgery (LANAP surgery protocol) shows the new cementum and attachment formed. It requires total mouth bug kill penetrating all the periodontal tissues and bone and root to be effective and only an Nd:YAG laser can do this. Combined with removing all the other factors of the disease such as bite or systemic disease (diabetes must be controlled, etc.), it really offers patients an alternative to titanium. There is a ability to reattach gums to cementum with periodontal ligaments’ attachment; the most exciting thing that lasers can do. Taking pockets constantly from 10-15 mm depth to 3-4 mm and staying stable for a decade is so amazing.”

Dr. Tom Schoen, TJ Schoen Family Dentistry (Wabasha, Minnesota)

Two types of lasers are mainly used in dentistry which are hard-tissue and soft-tissue lasers. The difference in wavelength makes each of them more appropriate for managing specific type of tissues as each type of tissues absorbs wavelengths in a different way. When the wavelength (also know as pulse) is altered, laser light changes its penetration power and, in turn, its compatibility with tissues. Hard-tissue laser is used majorly for cutting bone as it targets calcium phosphate; and it needs little adjustment to cut into teeth as well. Soft-tissue laser uses light pulse which is easily absorbed by water and hemoglobin. Diode laser which applies continuous pulses carries out the cutting of soft tissues while sealing the blood vessels to prevent bleeding.

New generations of laser are now used by hygienists and dentists who do minor to major dental work. Erbium laser and CO2 laser use laser energy, and it is more applicable in medical procedures such as dermatology. Some dental clinicians apply diode laser as electro-surgery devices but they actually possess some limitations. For example, diode laser uses heat and many dentists might lose control on the heat or consistency of using such heat. Another limitation is that diode laser needs to drag through tissues letting debris to build up a coagulum at the tip which must be wiped off and thus surgery become intermittent.

Biomedical engineers try to take the advantages of both types of laser by applying high energy and heat in one cutting mode and for short duration. The cutting takes average 100 microseconds then turns off repeatedly. This mechanism won’t allow tissue debris to accumulate on the tip and secures smooth cutting process. The short cutting times do not cause overheating the tissue, promoting faster recovery and more positive patient’s experience.

Chair-side CAD/CAM users will more specifically notice this advantage as the intraoral scans won’t show any tissue tags that hinder proper designing of restorations.