Lasers have been around for a long time, but they were not indicated for use in dentistry due to the amount of heat they generated and the potential damage they could cause.
However, in the late 1990s, a new generation of laser technique was developed: free-running pulse lasers that allow high heat in short bursts, with a lot of time for the tissue to recover and cool down. This gave laser therapy some applications for the dental industry, especially periodontics.
Types of Lasers
Lasers are categorized by whether they are for use on hard or soft tissue. The difference between them is their wavelength, which is determined by the way the laser light is generated.
- Er:YAG lasers: Treats hard tissue — that is, tooth, bone, and implant surfaces — and treats select soft tissues.
- Nd:YAG and diode lasers: Treats soft tissue, such as the gums around the teeth, the cheeks, skin, and any other soft tissue.
- The most recent application of this is called NightLase®, which is a safe and non-surgical method to minimize snoring! For more information about having this done in our office, go to http://www.nightlase-chicago.com.
Methods of Laser Use
LANAP®: One treatment option is called Laser Assisted New Attachment Procedure. This is a technique taught specifically by Millenium Dental Technologies, and only dentists certified by Millenium should use it. Treatment is done with a Periolase® soft-tissue laser for the entire procedure: removing diseased tissue, targeting the bacteria, then creating a “fibrin glue” so the gum re-attaches.
WPT®: Wavelength-Optimized Periodontal Therapy uses an Nd:YAG in a similar manner to the LANAP® technique. In addition, a hard-tissue laser (Er:YAG) is used to help remove the calcified deposits on the root surface, modify bone, and remove the smear layer on the tooth to allow greater bone regeneration. This technique uses both hard- and soft-tissue lasers; what we call dual laser wavelength therapy. Bone grafts, growth factors, and barrier membranes can be used in conjunction with these therapies, and the results are very effective. Dr. Dalessandro has been certified in - and teaches - this technique.
Diode: A diode laser is an inexpensive laser that works through semi-conductors instead of the more advanced lasers that send light through crystals to create more variables in treating disease. Diode lasers are used for disinfection in gum pockets, and they can be used to trim some soft tissue. Dentists can also use them for minor soft procedures during crown preparation, or removal of small lesions. Also, hygienists can use a diode laser for additional bacterial decontamination during routine hygiene visits as a preventive measure.
However, diode lasers should not be used around implants, and they should not be used to treat complex cases of periodontal disease or soft tissue aesthetics, because they are too hot and cause too much thermal damage.
When and Why to use a Laser
Occasionally, a laser procedure cannot reach to all depths of a deep pocket; or the teeth have too many indentations in the root surfaces; or an implant needs to be treated, and implant surfaces are quite irregular.
In these cases, it may be necessary to release a flap of the tissue in a small area to get access so that adequate debridement can be completed. However, the need for this flap surgery is minimized due to the advent of laser therapy.
Healing is usually very efficient; pain medication is seldom necessary; and the healing results have been superior to traditional periodontal therapy, as long as all the basic treatment principles are adhered to, and as long as the patient follows basic care: post-operative compliance, good home care, and regular professional periodontal maintenance visits.
Laser therapy has advanced substantially within the last several years and continues to advance at a very rapid rate. This has been phenomenal for both dentistry and patient care. The incorrect use of a laser is detrimental to a patient’s health, so laser therapy should be used prudently and only by highly qualified, trained, and skilled personnel.
Make sure you are an educated consumer and ask questions of the doctor who is treating you. Most dental offices have a diode laser, and they do have good applications, but the Er:Yag lasers and Nd:Yag lasers are far superior and should be used to treat advanced cases. When you're being treated, please ask what type of laser is being used and whether it’s appropriate for your case.