of Dental Laser as an Adjunct for Periodontal Surgery

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© Springer Nature Switzerland AG 2020

S. Stübinger et al. (eds.)Lasers in Oral and Maxillofacial Surgeryhttps://doi.org/10.1007/978-3-030-29604-9_10

10. Utilization of Dental Laser as an Adjunct for Periodontal Surgery

Fernando Suárez López del Amo1  , Pimchanok Sutthiboonyapan2   and Hom-Lay Wang3  
(1)

Private practice, Tacoma, WA, United States
(2)

Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
(3)

Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
 
 
Fernando Suárez López del Amo
Email: fsuarez@soundsurgicalarts.com
 
Pimchanok Sutthiboonyapan
Email: pimchanok.s@chula.ac.th
 
Hom-Lay Wang (Corresponding author)
Email: homlay@umich.edu
10.1 Introduction
10.2 History of Lasers in the Periodontal Field
10.3 Types of Lasers Used in Periodontics: Characteristics and Indications
10.4 Applications of Lasers in Periodontal Therapy
10.4.1 Treatment of Periodontal Diseases
10.4.2 Soft Tissue Applications
10.4.3 Hard Tissue Indications
10.5 Current Status
10.6 Conclusions
References

Abstract

While presenting with numerous indications, the long-term effectiveness of lasers has been repeatedly questioned. As such, laser usage for periodontal applications remains a topic of controversy. These devices can successfully replace and/or serve as an adjunct to conventional instruments in a variety of procedures providing also with certain advantages such as hemostatic and antibacterial effects. This chapter aimed at summarizing the characteristics and current available applications of lasers for periodontal surgical procedures.

Keywords

LasersPeriodonticsLaser therapyPeriodontal surgery

10.1 Introduction

As defined by the Glossary of Periodontal Terms, periodontal surgery encompasses any surgical procedures aimed at the treatment of periodontal disease or the modification of the morphology of the periodontium [1]. Included in this category are procedures for correction of both mucogingival deformities and bone atrophies. This broad spectrum of operations grouped under the term “periodontal surgery” can also be accomplished by a great variety of different approaches. From traditional instruments and classic surgical techniques to more advanced tools and regenerative methods, periodontal surgery has significantly evolved with time. Similarly, materials and devices are constantly introduced in the periodontal arena aiming at facilitating and more predictably treating the complex scenarios that clinicians face routinely. Although not new to the periodontal field, laser therapy has recently gained major attention due to the promising results and broad range of clinical applications.

10.2 History of Lasers in the Periodontal Field

The use of lasers in the periodontal field has significantly evolved during the last decades. The development of new devices along with more applications and clearances from the Food and Drug Administration (FDA) have made the employment of lasers an integral part of today’s practice in periodontal surgery. Initially, the first laser prototype (ruby crystal laser) was developed by Maiman in 1960 [2]. However, it wasn’t until years later that lasers were first applied to dental tissues [3, 4]. Later on, in 1989, Myers suggested the use of lasers for oral soft tissue surgery, leading the way and establishing the foundation for the use of lasers in periodontics [5]. Today, lasers are used in multitude of different periodontal and peri-implant procedures including surgical and nonsurgical approaches [6, 7]. In spite of the increasing number of investigations in the periodontal arena, the utilization of lasers for periodontal surgery remains a topic of controversy.

10.3 Types of Lasers Used in Periodontics: Characteristics and Indications

The field of periodontology embraces multitude of different procedures with distinct objectives and methodologies. From classical nonsurgical therapies for bacterial elimination to more advanced procedures involving periodontal regeneration, flap mobilization, and implant dentistry, the periodontal arena gathers together a broad spectrum of procedures. Consequently, it is no surprise that these operations can be performed with great variety of instruments and devices. As such, lasers can be applied in multitude of different clinical scenarios. Depending on the lasers’ characteristics, mostly determined by the wavelength, these devices can be applied to both periodontal nonsurgical and surgical procedures. Today, some of the most commonly used lasers in the periodontal field include argon; carbon dioxide (CO2); diodes; erbium, chromium:yttrium-selenium-gallium-garnet (Er,Cr:YSGG); erbium:yttrium-aluminum-garnet (Er:YAG); neodymium:yttrium-aluminum-garnet (Nd:YAG); neodymium:yttrium-aluminum-perovskite (Nd:YAP); and holmium:yttrium-aluminum-garnet (Ho:YAG). Table 10.1 describes some of the most common applications of the lasers employed in the periodontal field; however, it is not intended to be a complete description of all possible indications. The following section summarizes the most relevant lasers used to date in periodontal surgery:

  • Carbon dioxide (CO2): 10,600 nm wavelength.

    • The CO2 has gated or continuous waveform . It exhibits a high absorption coefficient in water. With its low scatter and penetration, it absorbs at the tissue surface and produces thin layer of coagulation. CO2 laser is effective at ablating soft tissue but creates severe carbonization due to high heat production. With the large amount of thermal change, this laser should be avoided in hard tissue procedures in order to prevent tissue damage.

    • FDA approved the use of CO2 laser in intraoral soft tissue surgery, aphthous ulcer treatment, sulcular debridement, coagulation at extraction sites, and laser-assisted new attachment procedure (LANAP).

  • Diode: 635–950 nm wavelength.

    • Diode lasers generated gated or continuous waveform. They mainly absorb in pigmented tissues due to less water absorption coefficients than CO2 lasers. Their penetration is deep and produces the most coagulation effect with moderate carbonization. It has been shown to carbonize cementum only when blood is presented.

    • Diode lasers demonstrate good tissue cut ability. FDA approved the use of diode lasers in intraoral soft tissue surgery, aphthous ulcer treatment, sulcular debridement, coagulation of extraction sites, decontamination, subgingival calculus detection, and removal of inflamed pocket epithelium.

  • Neodymium:yttrium-aluminum-garnet (Nd:YAG): 1064 nm wavelength.

    • Nd:YAG laser exhibits pulsed waveform. It also has less water absorption coefficients than CO2 laser but is able to deeply penetrate into tissue. It produces a thick coagulation with moderate carbonization favoring hemostasis. Major thermal changes can occur when this laser is used on hard tissue and, thus, it should be avoided for these procedures.

    • FDA approved this laser for intraoral soft tissue surgery, aphthous ulcer treatment, and laser-assisted new attachment procedure (LANAP).

  • Erbium:yttrium-aluminum-garnet (ER:YAG): 2940 nm.

    • Er:YAG laser  is free-running pulsed. It has high absorption ability in both water and hydroxyapatite. This helps thermal effect on surrounding tissue. Er:YAG laser can ablate soft tissue with minimal coagulation and without carbonization. In addition, with water coolant, this laser is able to ablate hard tissue effectively.

    • This is the only FDA-approved laser for hard tissue procedure including osteotomy, osseous crown lengthening, and osteoplasty. Other indications include intraoral soft tissue surgery, aphthous ulcer treatment, sulcular debridement, and subgingival calculus removal.

Table 10.1

Common clinical applications of lasers in periodontal field

Application

Soft tissue incision, ablation and coagulation

Aphthous ulcers

LANAP

Subgingival curettage

Bacterial elimination

Scaling of root surfaces (calculus removal)

Osteoplasty and ostectomy

Peri-implantitis

Type of laser

Argon

X

              

CO2

X

X

X

X

      

X

Diode

X

X

  

X

X

    

X

Er,Cr:YSGG

X

X

  

X

  

X

X

X

Er:YAG

X

X

  

X

  

X

X

X

Nd:YAG

X

X

X

X

X

    

X

Nd:YAP

X

    

X

X

      

Ho:YAG

X

    

X

X

      

CO2 carbon dioxide, Er:YAG erbium:yttrium-aluminum-garnet, Er,Cr:YSGG erbium, chromium:yttrium-selenium-gallium-garnet, Nd:YAG neodymium:yttrium-aluminum-garnet, Ho:YAG holmium:yttrium-aluminum-garnet, Nd:YAP neodymium:yttrium-aluminum-perovskite

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