Laser Application in Dentistry

Dental Laser

Dental Laser

While the development of laser technology has made significant gains over the past years, the range of treatments has hardly expanded.

High expectations of patients, an increasing range of dental lasers, as well as a rapid surge of publications on this topic have created the impression that it is no longer possible to do without them. However, the reality looks different!

For applications in the dental lab, the laser welding process with a pulsed Nd:YAG laser (1.06 μm wave length) has been developed to the point where it can be used and offers significant benefits both to the dental technician as well as to the dentist, for example in the production and repair of prosthesis parts made of metal. In this area, the laser application has clear advantages – however, that is the only one so far.

There are also solid scientific findings and long-term clinical experiences in the surgical application of the cw-Nd:YAG laser (1.06 μm wave length), as well as for the use of the cw-C02 laser (10.6 μm wave length) in the local treatment of various infections of the oral mucosa. Whether the laser will replace the scalpel in the future is uncertain, because the laser application is expensive and very complex compared to the scalpel.

The Er:YAG laser (2.94 μm wave length) can be used for the low-pain preparation of cavities; however, contrary to the conventional therapy with rotary instruments, it requires more time. Another disadvantage of the use of lasers is the fact that classic bonding procedures – such as gluing ceramics, for example – are more difficult or not possible at all.

The suitability of lasers for the selective removal of caries has been tried, but has not yet gained wide application due to the costs associated with it. Removing restoration materials with lasers – regardless of the type – may lead to the development of hazardous flue gases or vapors. Therefore, the clinical application of such a procedure poses a safety risk for both the patient as well as the practitioner. The goal of a deep caries treatment – the sealing or sterilization of the dentin wound and the stimulation of the formation of irritation dentin – can only be achieved within certain limits with the laser systems available today, since structural modifications of the dentin due to the laser irradiation cannot be precisely controlled.

Regarding root canal treatments, the application of lasers is still primarily researched in experiments; no real advantages have become known. While none of the lasers currently available can be used for reconditioning a root canal, it is possible to reduce the bacterial count in the root canal after a mechanical reconditioning by using flexible fibers. However, when compared to chemical disinfection, one must question the practical relevance of this method. A sufficient surface sealing of the root canal by fusing the dentin canals is not possible under practical conditions. Also, the removal of fractured fiber elements in the root canal continues to pose an unsolved problem.

Laser-assisted endo-surgical procedures are still stuck in clinical trials at this time. In periodontology, laser applications are currently discussed within the framework of soft tissue surgery, the fiber-optical irradiation of pockets, and the treatment of sensitive tooth necks. There are no placebo-controlled studies.

Prior to a routine application of these laser procedures, issues regarding benefits and possible side-effects must be clarified in a definite manner. Among those in particular are questions regarding injuries to the periodontium and the root’s surface as well as the uncontrollable depth effect of the radiation. As for the application of bio-stimulation lasers, there are currently no controlled double-blind studies that could prove a therapeutic effectiveness of the so-called “soft lasers”. Scientific evidence for reproducible therapeutic effects of laser acupuncture is still missing.

It’s impossible to imagine many branches of industry without any laser technology, but in dentistry, the initial hype regarding lasers seems to be fading away.

This post is also available in: German

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