LASER = Light Amplification by Stimulated Emission of Radiation

Lasers are an exciting advancement in the field of dentistry, now well-established in the dental armamentarium for both soft tissue and hard tissue procedures. Multiple types of dental lasers exist, each with unique properties which have significant differences in their individual benefits and limitations.

Core Properties that determine benefits and limitations:
  • Type
  • Wavelength
  • Pulse

Dental Laser Types

There are 4 common laser types in dentistry: Diode, Nd:YAG, Erbium, and CO2 each with a unique laser-tissue interaction based on wavelength. Laser types are named after the active medium – the actual component that produces the laser energy when stimulated. The 1064 Nd:YAG wavelength is produced by Neodymium-doped Yttrium Aluminum Garnet.

Dental Laser Wavelength

Light is measured in wavelengths. Dental laser wavelengths are:

  • Diodes 830-1,064nm
  • Nd:YAG 1,064nm
  • Erbium 2,790-2,940nm
  • CO2 9.3-10.6nm

Each wavelength interacts with tissue differently: The 1064 wavelength passes through water and Hydroxyapatite; but is absorbed in melanin and hemoglobin.

Dental Laser Pulse Differences

The three primary pulse modes in laser dentistry have profound differences on how the laser energy (heat) affects the tissue.

Continuous: Laser energy is always “on”; potentially damaging heat can build in the tissue quickly. Continuous mode is like placing your finger over a candle flame and holding it there.

Gated Mode: A half on/half off exposure to laser energy; ability of the tissue to absorb the heat is limited. Gated mode is similar to slowly passing your finger through a candle flame, eventually it will be burned.

Free Running Pulse: Very short bursts of laser energy; adequate time between each pulse to allow the tissue to absorb and dissipate the heat to minimize thermal damage. Free running pulse is similar to rapidly moving your finger through the candle flame. There is plenty of time for the momentary high heat to be absorbed without harm.

Dental Laser Safety

Eye Protection – The patient, clinical staff and any observers must wear protective eyewear specific for the wavelength being used.

Plume Control – Laser procedures create a plume that may contain hazardous chemicals and microflora.

Sharps – Scored laser tips of quartz fibers are considered sharps and need to be disposed of as such.

Warning Sign – Warning signs need to be in a visible place and access to the operatory limited.

Dental Implant 101

Dental implants are increasingly popular options for missing teeth. The implant is a titanium post placed into your jaw that serves as a substitute for a tooth root, with the tooth crown placed on top. Many dental implants are long term solutions, but as more implants are placed, there are more cases of dental implants that fail. Experts estimate between 3-20% of implants fail. What happens when a dental implant fails?

PERI-IMPLANT DISEASE MIMICS PERIDONTAL DISEASE

Implants themselves can’t become diseased but the tissue around implants can become infected. Just as periodontal disease (gum disease) starts with minor inflammation that progresses if not treated, peri-implant disease starts as peri-mucosititis (minor inflammation around the implant). If left untreated, the inflammation continues until the bone around the implant erodes and the implant becomes loose. Initial inflammation could be due to existing periodontal bacteria, or due to foreign materials. When the crown of the implant is bonded to the base, small bits of the cement bonding may get stuck between the implant and gum line.

Signs/Symptoms of moderate-advanced Peri-Implantitis

 
     • SWELLING IN THE GUMS
     • IMPLANT MOBILITY
     • BLEEDING GUMS
     • CHANGE IN GUM COLOR SURROUNDING IMPLANT
     • HIGH GUM SENSITIVITY
     • IMPLANT EXPOSURE (GUM RECESSION PREVENTS
       ADHERENCE TO THE IMPLANT OR CROWN SURFACE)
     • MILD TO SEVERE PAIN AROUND IMPLANT SITE
     • EXCRETION OF PUS FROM THE IMPLANTS
       SURROUNDING TISSUES

Treatment Options

LAPIP TREATMENT
LAPIP is a first line treatment approach for failing implants or Peri-implantitis as it addresses the underlying causes affecting the health of both the bone and the implant, gum disease. A fiber the width of 3 human hairs is inserted between the implant and the gum. Laser energy kills bacteria, vaporizes cement, and stimulates stems cells found in your bone to reduce the bacterial infection and promote healing.

ALTERNATIVE SURGICAL OPTION
a scalpel is used to cut the gum and flap back the tissue. The implant is cleaned, additional growth factors may be placed in the area to help promote bone growth, then the tissue is sewn back together.

WHAT TO EXPECT

DURING TREATMENT
LAPIP treatment focuses on eliminating the infection around the implant. If the implant is very loose, it may be splinted to adjacent teeth. It is very common for patients to quickly resume normal activities or return to work.


THE FIRST FEW DAYS
The first few days following the LAPIP protocol you may experience mild soreness of the treated areas- generally alleviated with Ibuprofen. The gum tissues around the implant may appear slightly discolored. Splints may be fabricated to stabilize and immobilize the implant. It is important that you wear these splints as instructed to promote healing. Expect to have your bite adjusted during visits several times over the coming months; this is very important for healing.
     • Do not brush or floss for the first 7-10 days after treatment.
     • Follow a soft diet as recommended by your treating dentist.
     • Do not smoke. Smoking interferes with the healing process by impairing the body’s defense
       mechanisms.

Gum Disease Stages

Gums disease begins when a film called plaque accumulates on the teeth and calcium from saliva hardens the plaque — this calcified plaque is called tartar or calculus. Certain types of germs that live in this plaque and calculus damage gum tissue. Your body tries to fight this infection with an inflammatory attack, sending white blood cells to the area to destroy the bacteria. This inflammation causes the tissue to bleed easily when you brush or floss. This stage of the condition is called Gingivitis.

If the infection and inflammation persist the result is a chronic inflammatory condition where, in addition to the gums, ligament and bone around the teeth are destroyed — often with no symptoms. At this stage it is called Periondontitis.

Sign/Symptoms of Moderate-Advanced Gum Disease

     • Gums that are red, swollen and bleed easily
     • Gums that seem to have pulled away from the teeth
     • Bad breath and halitosis
     • Pus between your gums or teeth
     • Teeth that seem to be loose or moving away from one another
     • Changes in the way your teeth fit together when you bite
     • Change in the way your partial denture or implant supported restorations fit
     • Sensitive or receding gums
     • Painful chewing
     • Or no symptoms at all…

Treatment Options

Treatment Options for Gum disease
Success is determined by the treatment’s ability to reduce or eliminate gum inflammation, slow, or stop attachment loss and decrease pocket depth — and that can vary depending on the type of treatment.


Traditional Gum Surgery
A scalpel is used to cut the gums then fold or “flap” the gums back in order to expose the roots of the teeth and the jawbone. This allows the dentist to clean all the tartar from the roots and view the bone supporting the teeth. If any damaged bone is present, the bone is then reshaped and/or bone graft material is placed. The top of the gums may also be cut in order to achieve a periodontal pocket that is 3mm deep to allow the patient to clean effectively. For example, if you had a 6 millimeter pocket depth, then 3 millimeters of gum tissue (healthy or diseased) would have to be removed to create a 3 millimeter pocket. The gums are then stitched back in place and recovery begins.

Laser Gum Surgery
The LANAP protocol can ONLY be performed by a dentist who is certified in the procedure. Be sure to ask if the doctor is LANAP certified. During LANAP treatment, the PerioLase MVP-7 dental laser is used instead of a scalpel. The laser fiber is inserted between the gum and tooth, without cutting the gums. The laser light energy targets the source of the inflammation without hurting or removing any healthy gum tissue. This helps to slow or stop attachment loss and decrease pocket depth, and allowing the body to recover from the chronic infection without the need for scalpel or sutures. The gums are not cut to reduce pocket depth. The tops of your teeth (biting surface) are adjusted to keep from hitting your other teeth.