cosmetic dentistry_ beauty & science

32 I I industry report _ lasers For tooth whitening, lasers can also be used for activation of the bleaching gel (Figs. 5a & b), which decreases the treatment time as well as post-operativesensitivity.Asthelaserisabsorbed by the appropriate gel, the heat is only superficial and the contact time is decreased, leading to less or no sensitivity. The Er:YAG laser beam is uniquely absorbed in the water molecules that are contained in all gels. The more water content (the more the gel is “soft” and a bit runny), the better the resulting bleach- ing interaction (known as the TouchWhite pro- cedure, patented by Fotona). The colour is not of importance for this interaction, unlike with Nd:YAG and diode lasers, which are absorbed more efficiently in pigments and therefore re- quire specially coloured gels to be effective. Nd:YAG and diode lasers have very specific indications, such as the treatment of herpetic lesions (Figs. 6a & b) and non-invasive haeman- gioma,whichcanpresentaestheticproblemstoo. The advantages of treating a herpetic lesion by laser are that the pain is relieved shortly after lasing, the lesion heals faster and reoccurrence is less frequent in the treated area. For haemangioma treatment, the lesion is coagulated by the strong absorption of the laser energyinhaemoglobin,afterwhichitiseitherleft to be removed by mast cells or ablated. The bio-modulation effect of these lasers is also advantageous, helping to increase cell turn- over and blood circulation (with an anti-inflam- matory effect), eliminate pain, improve nerve transmission,promotemyo-relaxation,stimulate the release of growth hormones, and improve many more aspects of healing. Other procedures like frenectomy or removal of overgrown tissue (lasers can be used to safely and easily remove tissues, like overgrowth, pig- mentation, etc. but it is essential to be certain about the nature of the tissue that is being re- moved) can be carried out for aesthetic reasons in the anterior region (Figs. 7a & b). Erbium lasers are preferred for soft-tissue surgeries like these because they are fast, require minimum anaesthesia and do not cause a delay in healing. It is important, however, to be able to modify the parameters: if the pulse duration can be increased above 600 microseconds, preferably up to 1,000 microseconds, the quantity of heat delivered will rise—still without damaging the tissue—and cause haemostasis. If this cannot be achieved with the particular Er:YAG laser system, thenasecondwavelengthmustalsobeemployed, such as diode or Nd:YAG in order to effect haemostasis. Diode and Nd:YAG lasers can be used from start to finish for all soft-tissue interventions to yield blood-free surgery; however, this requires more anaesthesia and a longer healing time. All of these benefits and many more increase the comfort of the patient and give dentists more reasons to enjoy their profession. For achieving a full and successful integration of laser technol- ogy into a clinician’s treatment offering, and to make effective use of the investment made, as wellastoensurethehealthandsafetyofpatients, it is necessary to obtain an adequate education in both the biophysical interactions underlying these treatment protocols and the specific prop- erties of each laser device._ All procedures presented in this article were performed using a LightWalker AT dental laser system (Fotona). Figs. 6a & b_Before (a) and four days after treatment of herpetic lesions (b). Figs. 7a & b_Before removal of overgrown tissues (a) and immediately after the removal with an erbium laser (b). cosmeticdentistry 1_2013 Dr Ilay Maden PhD,MSc,BDS Mühürdar Caddesi 69 34710 Istanbul Turkey ilaymaden@gmail.com _contact cosmeticdentistry Fig. 7a Fig. 7b Fig. 6a Fig. 6b