Med Tech

Different Laser Surgical Procedures used in dentistry

Using technology in the field of healthcare is not a new concept. This technology is only beneficial if the doctor or the controller behind the tool has the proper knowledge on how to use it. Such technologies can help to improve both the doctor’s and the patient’s experience for the better. 

LASER or Light Amplification by Stimulated Emission of Radiation is the process of using radiation to either visualise or manipulate surfaces. The first-ever application of Laser in Dentistry was done by Theodore Maiman in 1960 and has since been helpful in both soft tissue and hard tissue dentistry procedures.

Hard tissue lasers work on the teeth and bones and their maximum absorption is of hydroxyapatite in water which is around 980nm infrared. The most common hard tissue laser is the Erbium-YAG laser. Soft tissue lasers or Diodes work on the gums (gingiva), the skin of the mouth, lips and tongue as it has the absorption spectra of hydroxyapatite in melanin and haemoglobin (present in lips and gums) which is around 400nm-600nm blue light to red light. 

In hard tissue application, the laser is used for tooth decay prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation, and for diagnostic purposes. Soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesions. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.

MedPiper Technologies and Journomed along with IDA Smartcity conducted a webinar on August 1st, 2021 where the speaker, Dr. Sana Farista spoke about the different types of Laser Surgical Procedures used in Dentistry. Dr. Sana Farista is a periodontist and laser specialist surgeon based in Mumbai. Over the last seven years, she has developed several novel non-invasive procedures that help to improve oral hygiene, aesthetics and health. Dr. Farista covered all the details about the various types of procedures that are done with different types of lasers and how she mostly uses the least invasive photobiomodulation techniques. 

Many of the aesthetic dental procedures can be performed using different modes such as burrs, scalpel and knife and electrocautery. Out of the four techniques, Electrocautery gives rise to the least amount of bleeding and scarring, but it takes a long time to heal and giving painkillers post-procedure is a necessity. With laser and scalpel, healing happens extremely fast, however, with a scalpel, the anaesthesia needs to be injected whereas with lasers only topical anaesthesia is required. The commonly available lasers in dentistry have wavelengths of 810 nm, 940nm and 980nm. 

Some of the common dentistry procedures where lasers are used are as follows: 

  1. Gingival Depigmentation: Due to smoking, there can be residual remains on the gums, giving the gums an uneven appearance. The scrapes can be removed from the epithelium using lasers. Using blue light lasers allows for better visualisation. 
  2. Operculectomy: In some cases, the operculum, a part of the gum tissue, can grow over the tooth and cause a lot of pain. In this procedure, this operculum can be easily removed and it can help treat pericoronitis. The area to be removed is marked and cut into using lasers followed by restoration. 
  3. Frenectomy: The frenum is a small fold or ridge of tissue that supports or checks the motion of the part to which it is attached, in particular a fold of skin beneath the tongue, or between the lip and the gum. This tissue can sometimes cause speech and eating issues. Frenectomy involves removing that part of the connective tissue present either at the top or the bottom of the mouth which will help correct these issues. Frenotomy is the complete removal of the frenum including the part where it attaches to the bone of the jaw. 
  4. Vestibulopathy: This surgery involves deepening the cavity between the gingiva and the teeth and it is done before the attachment of prosthetic teeth or dentures or dental implants. 
  5. Leukoplakia: Lasers can be used to remove any kind of white patches or spots present inside of the mouth. However, it is necessary to test these patches for cancer first before doing any kind of laser surgery. 
  6. Teeth Whitening: This is one of the most common dental procedures done that involves blue light lasers. The gums are first protected with a gingival barrier and then a chromophore (a colored substance) is applied onto the teeth which helps to absorb the laser. Normally, a blue color bleaching agent is applied and then the teeth are exposed to blue laser light quadrant by quadrant for 20 seconds. After five minutes the bleaching agent is removed and the teeth are washed. 
  7. Ulcer healing: This surgery involves using lasers and healing ulcers through the process of photobiomodulation. Photobiomodulation or low-level laser therapy applies low-level lasers to relieve pain or it stimulates and enhances cell function. 
  8. Aesthetic procedures like lip depigmentation, lip repositioning and smile correction can also be done using low-level lasers. 

The field of laser-based photochemical reactions holds great promise for additional applications, particularly for targeting specific cells, pathogens, or molecules. A further area of future growth is expected to be a combination of diagnostic and therapeutic laser techniques. Looking to the future, it is expected that specific laser technologies will become essential components of contemporary dental practice over the next decade.

Author: Parvathi Nair

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