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ePaper created 2016-05-18, 11:28:18 | version 1.38.0
dual wavelength laser CE article | 11 roots 2 2016 The use of the new generation erbium lasers for repair of incipient hard-tissue disease allows the dentist to provide a stress-free means of restoring teethinaminimallyinvasivemanor,mostoftenwith no shot and no numb lip, without the need for any local anaesthetics. The erbium laser can be used for restoring primary and permanent teeth, eliminating or reducing the amount of local anaesthetics. In most cases, the pa- tientwillnotrequirenumbingforClass1,2(sometimes), 3, 4, 5, 6 restorative procedures using bonded restor- ative materials. Using the concept of minimally inva- siverestorativeprocedures,theEr:YAGlaserallowsthe operator to remove only diseased tissue and thus pre- servesmuchmoreofthehealthyunaffectedtooth. Incaseswherealloyispreferred,thelaser’sanalge- siaeffectmayalsoallowthedentisttocreatearestor- ative preparation using a conventional handpiece that is not meant for bonding. The erbium laser is ef- fectivebecauseofitseffectonitstarget,waterwithin the tooth structure. This effect occurs when the laser heats up water within the target tissue, causing it to create small microscopic explosions (photothermal followed by photoacustical effects). When applied to soft tissue, bone or teeth and cavities, the explosions then cause the areas to be vaporized. Er:YAG laser 2,940 nm: Soft-tissue procedures Thereisawidearrayofsoft-tissueproceduresthat are able to be completed using the all-purpose laser: maxillary and mandibular frenum revisions, lingual frenum revisions, treatment of pericoronal pain or infection, removal of hyperplasic tissue because of drugsorpoororalcareinorthodonticpatients,biop- sies, treatment of aphthous ulcers and herpes labia- lis, pulpotomies, removal of impacted teeth and in adults apicoectomies and bone recontouring. Pulpotomies Parentsoftenexpressconcernabouttheneedtotake radiographs because of the nature of X-rays and their possiblesideeffectsontheirchild’soverallhealth.They question the use of alloys because of the chemical make-up of the alloy. Whether these should be a real concern in today’s dental care is open to debate, de- pending on your individual beliefs. There are also con- cernsbymany,althoughnotasloudly,abouttheeffect ofvariouspulpotomyproceduremedicamentsusedin pulpotomyproceduressuchasformocreosol. Lasersprovideasafe,non-chemicaleffectivealter- nativetreatmentforpulpotomies.Duringeightyears, post-treatment results on more than 4,000 pulpoto- mies using the erbium (2,940 nm) laser provides am- ple evidence that this method is both effective and safe for children without the need for introducing chemicals or using electrosurgery methods. When the final result of orthodontic positioning of thefrontteethresultsingingivalhypertrophy,thelaser can be a useful tool to increase crown length and give the patient a more aesthetic smile. This may often be accomplished without the need for local anaesthesia. Patients who have medically induced hyperplasic tis- sue,suchaspatientsrequiringdilantoin,canalsohave theirtissuereducedandreshapedwiththeerbium. In addition to the many examples described in this article,laserscanbeusedforadditionalproceduresnot usuallyrequiredinpaediatricdentistry,suchasrevisions oftheabnormalmandibularfrenum,oftenavoidingthe needforsoft-tissuegrafts,crown-lengtheningproce- dures where bone requires recontouring, apicoecto- mies,removalofboneyexostoses,removalofthirdmo- larimpactions,removalofrootremnants,incisingand draining soft-tissue infections, advanced periodontal treatmentsandthelatestinadvancedendodontictreat- mentviaphotoninducedphotoacousticstreaming. Figs.1 & 2: Representative sample images of root canal dentinal walls irrigated with 17 per cent EDTA and PIPS for 20 seconds.(Photos courtesy ofTechnology4Medicine) Fig.1 Fig.2 22016