Lasers have been used in dentistry for approximately two decades and are suitable for multiple procedures, including soft tissue treatment. Lasers for soft tissue treatments are available at varying powers and wavelengths and can be used for procedures that would otherwise be performed using electrosurgery or a scalpel. Laser dentistry generates very little or zero heat and is a far gentler form of surgery. When used correctly, dental lasers enable soft tissue to be effectively, precisely, and safely removed.
Uses for soft tissue lasers include: gingivectomies and periodontal treatments, frenectomies, ablating and removing aphthous ulcers, gingival contouring, crown lengthening, troughing, soft tissue incisions, and removing soft tissue lesions. Can also be used as an alternative to retraction cord to isolate margin prep for a crown.
Different Types of Soft Tissue Dental Lasers
Soft tissue dental lasers that have been cleared by the FDA include carbon dioxide lasers, argon lasers, diode lasers, Nd:YAG lasers, H:YAG lasers, and Er,Cr:YSGG lasers. Each laser differs in the way the energy is produced, whether it is supplied in a continuous or pulsed manner, and the wavelength of the light emitted by the laser. The lasers with the highest wavelengths are carbon dioxide lasers, operating at around 10,600 nm. Er,Cr:YSGG, Nd:YAG, and Er:YAG lasers operate at 2780 nm, 1064 nm, and 2950 nm, respectively. Diode lasers have wavelengths between 810 and 980 nm, and argon lasers have the lowest wavelengths, between 457 and 502 nm. Diode lasers are the most frequently used laser in dentistry for soft tissue treatments.
Laser therapy provides the following advantages:
- Treatment will not harm dental hard tissue
- Laser therapy shouldn’t injure the dental pulp
- The patient will need minimal local anesthetic, and most patients prefer to receive some form of anesthesia
- Diode lasers are safe for use around dental implants
- They are also safe around PFM and full-metal crowns, and gold alloy and amalgam restorations
- Dental lasers provide excellent hemostasis
- Soft tissue removal is very precise and predictable, and the pen-style holder provides good visibility
- Stitches and periodontal packs may not be required, which can be especially advantageous for pediatric or special needs patients
Laser therapy can be appealing for the patient if they feel at all anxious about treatment. After treatment, most laser therapy patients will experience reduced post-operative pain, gingival swelling, and discomfort. No stitches are required due to hemostasis. There may be occasions when other techniques, such as electrosurgery, may be quicker, but laser treatment tends to be more comfortable and less traumatic for the patient. Knowing that their dental practitioner uses a high-tech approach to dental care can also be reassuring. Soft tissue treatment allows procedures to be performed on young children and infants who would otherwise require a general anesthetic.
Treating Patients with Periodontal Disease
One of the most effective uses of soft tissue dental lasers is in treating patients with periodontal disease. During therapeutic treatments, the laser energy is transmitted through a thin fiber and easily penetrates deep into periodontal pockets. The energy produced by the laser is readily absorbed by hemoglobin, melanin, and other chromophores found in periodontal disease, so treatment explicitly targets unhealthy tissues. Non-surgical treatment usually requires scaling and root planing to remove irritants from tooth root surfaces and decrease the inflammatory response. Using scaling and root planing with laser therapy increases treatment efficacy. Laser soft tissue treatment can be helpful in several of the ways briefly outlined below:
- All lasers produce heat, and this thermal conductivity can be useful in eliminating gram-negative bacteria.
- The laser probe is easily introduced into the periodontal pocket, and the energy generated helps to eliminate bacteria, especially the bacterium A. Actinomycetemcomitans, which has been discovered in the atherosclerotic plaque associated with coronary heart disease.
- The laser tip is similar to that of a Cavitron, except that it is angled away from the tooth and toward the diseased tissues to remove bacteria and necrotic tissue.
- Troughing removes the sulcular epithelium, and the increased access facilitates the use of ultrasonic tools to remove calculus more effectively.
- When necrotic surfaces on tooth roots are removed, inflammation decreases, which, in turn, aids reattachment.
Periodontal laser therapy can be more effective than using conventional deep scaling and root planing alone, and the gentle nature of the treatment makes it more acceptable to patients. Many clinicians use laser therapy in conjunction with scaling and root planing, rather than in place of conventional therapy.
Gingival Contouring with Soft Tissue Lasers
Gingival contouring using a soft tissue laser can provide a more comfortable treatment for the patient. Using a diode laser allows the clinician to quickly and precisely remove excess tissue with minimal or no bleeding, post-operative pain, or swelling. Laser energy cauterizes and seals capillaries, achieving hemostasis and preventing edema. Tissue damage is minimal, because a continuous sweeping motion is used during treatment. Healing occurs in a matter of days, and patients generally report low levels of discomfort during the healing process.
Benefits of Using Laser Surgery for Frenum Removal
Labial frenal attachments can inhibit lip movements, and sometimes the tissue can prevent the closure of a diastema during orthodontic treatment. Traditional frenectomies require the mechanical excision of the frenum, placement of stitches, and often considerable post-operative discomfort. With soft tissue laser therapy, the frenal attachment can be gently ablated before the laser coagulates and cauterizes the surgery site.
Safety When Using Lasers
Laser soft tissue treatment is extremely safe, provided operatory staff are adequately trained. It is vital for the clinician to understand the characteristics of the chosen wavelength, the limitations, and the thermal implications of the energy produced. For some treatments, it may be better to combine two different wavelengths for an optimal treatment outcome. One of the most critical factors is safeguarding eye health; protective eyeglasses must be worn when laser units are in use. Failure to wear glasses is one of the most commonly reported injuries associated with laser use.
Thanks to the introduction of newer and more affordable dental lasers, soft tissue treatment in general dentistry is likely to increase. Many procedures that were traditionally completed using mechanical methods can now be performed using a dental laser. Laser-assisted treatment is minimally invasive and requires less anesthesia, no stitches, fewer or no post-op visits, and greater patient satisfaction.
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