Laser dentistry – A Better Modality, or a Gimmick?

 

I recently attended a local dental society meeting and as usual, I greeted and talked to many of my colleagues.  One colleague in particular which is a good periodontist started a conversation that made me feel good.  He said that he remembered a question that I had asked him several years ago at another meeting.  The question I asked him was, what was his opinion on the use of lasers to treat periodontal disease?  At that time there were very few, (maybe one) studies from a reputable source about the use of lasers, in the treatment of periodontal pockets in a non-surgical procedure.  I had bought an expensive laser and was very interested in the potential benefits to my patients, and anticipated that they would welcome the opportunity to treat their condition with advanced technology that could avoid the need to do periodontal surgery, promote shorter healing periods and cause less discomfort than the conventional surgical modalities.  He told me, that  he did not believe that lasers could be used as an alternative to surgery and he would need to see more proper studies before  he would consider purchasing such expensive equipment.  This time he said that he now was a believer.  His group had purchased the NdYag laser and “it had changes his practice”. 

I have been using the Er,Cr,YSGG laser for many years now and have seen excellent results with different procedures.  The laser allows me to do procedures such as crown lengthening without the trauma to the tissues of laying a flap and exposing the bone.  The ability to do this as a “closed procedure” means that the patient will experience less discomfort and will heal quicker.

 

Similar results are obtained for other surgical procedures, such as the removal of soft tissue lesions for biopsy, gingivectomies, second stage exposure of dental implants and treatment of localized periodontal pockets in patients with periodontitis.  In the case of patients with periodontitis, this minimally invasive therapy may require more that one visit over several months and excellent oral hygiene to treat the pockets.

In summation, Laser use in dentistry has not become widespread because of the high cost of the equipment (and maintenance) and misconceptions about the technology from lack of adequate studies in the literature, but new studies are being conducted and the advantages of this modality of therapy are already evident.

 

 

West Palm Beach Dentist   Carlos Boudet, DDS, DICOI
1840 Forest Hill Blvd, Suite 204
West Palm Beach, Florida  33406
Phone: (561) 968 6022

 Website: http://www.boudetdds.com

Implant Blog: http://www.palm-beach-implants.com

 

Lasers In Dentistry

There has been a tremendous amount of technological advances in dentistry in the past ten years. The dental laser is one of those advances that is causing a lot of excitement in the dentists that have adopted the technology, and skepticism and controversy in those that do not use it.

The main reason that more dentists are not using the dental laser is cost as some of the hard and soft tissue lasers can cast upwards of $60,000 dollars. These high end lasers are used for soft tissues and hard tissues also such as bone and teeth.

A more recent addition to the dental laser technology that has made the use of the dental laser more affordable to the dental practitioner has been the diode laser. The diode laser is very small in size compared to the all tissue lasers, and is meant for soft tissue applications and is gaining popularity due to their lower cost and better tissue response than the older technology of electrosurgery. The diode laser cannot be used for hard tissues such as bone and teeth.

One statement that always comes up when dentists talk about lasers is “ all the procedures that I would do with a laser I can do with the equipment I already have”. The dentist that uses the laser knows that although a lot of the procedures done with the laser can be done with a scalpel or an electrosurgery unit, the laser has certain advantages, such as faster healing, less trauma to the surrounding tissues and less post-operative discomfort. With additional training, dentists can do procedures that are not possible with conventional dental equipment such as the LANAP procedure in periodontics.
This brings us to the most interesting and controvertial topic which is the use of the laser in the treatment of gum disease, a topic that has some periodontists very excited while the majority still resist with skepticism.

Gum disease in its moderate to advanced stages is routinely treated by periodontists with periodontal surgery. The purpose of the procedure is to eliminate the deep spaces between the gums and the roots called “periodontal pockets” that harbor bacteria and do not allow the individual to clean properly when brushing and flossing. Periodontal surgery is also used for regenerative procedures where the dentist tries to regain the lost bone and gum tissues with bone grafts or gingival grafts. When the dentist performs periodontal surgery an incision is made around the teeth with a scalpel in order to peel the gums away from the bone and allow visualization of the bone defects for remodeling or regeneration. The diseased soft tissue is also removed in the process. The surgery has some negative aspects such as moderate discomfort after the procedure, healing that takes several weeks, sensitivity to temperature changes, and gingival recession caused by the loss of soft tissue removed during the surgery.
Periodontal surgery is well accepted as the standard of care for the treatment of moderate to advanced periodontal disease.
The laser procedure uses a special laser to treat periodontal disease by first removing the diseased gum tissue in the periodontal pocket in layers so thin that are not possible with a scalpel, then the pocket is decontaminated and sealed with a "clot". This procedure has been show in literature reports to regenerate some of the lost bone from around the treated teeth, without the negative aspects of periodontal surgery.

The American Academy of Periodontology says that there has not been enough research published to substantiate the claims of successful bone and new attachment regeneration with the laser and additional studies are needed, but several well known and respected dentists have published excellent results, and more articles are being published all the time.

It is the opinion of this author that lasers such as the ND YAG and the Erbium YAG lasers will be increasing in popularity as they are minimally invasive and offer an alternative to surgery.

Carlos Boudet, DDS
West Palm Beach Dentist
http://www.boudetdds.com/