There are a number of different types of lasers currently available: argon, CO2, ND:YAG, and diode are the most common lasers used for soft tissue procedures. Each of these types of lasers will cut soft tissue effectively, and each is better at some procedures than others. All of them have many of the same benefits in common1:
(1) Because of the predictability of healing of the surgical cut with a laser, it is possible to perform soft tissue alteration and the final preparation at the same appointment.
For soft tissue recontouring many dentists have found diode lasers to be highly effective. The diode laser is considered to be an excellent soft tissue cutting instrument, it is an effective coagulator, and many of the diode lasers are small, making them easy to move from one operatory to another. Lastly, unlike some other types of lasers, the diode laser uses a standard 110-v line.
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| Figure 1. Preoperative condition. |
Figure 7. The diode laser is used to create an ovate pontic site. |
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| Figure 2. Evaluating the soft tissue. | Figure 8. The final restoration demonstrating a natural appearing emergence profile of the pontic. |
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| Figure 3. The final preparations after the soft tissue has been recontoured. | Figure 9. A preoperative view of tooth No. 10 to be aesthetically enhanced. |
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| Figure 4. The patient’s temporary veneers are finished to the new tissue height. | Figure 10. A diode laser is used to carefully recontour the soft tissue. |
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| Figure 5. Two weeks after the recontouring and preparation the patient returns for delivery of the veneers. | Figure 11. The final soft tissue recontouring and preparations. |
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| Figure 6. A 1-year postoperative view shows excellent tissue health and stability. | Figure 12. The final restoration at the 1-week postoperative visit. |
Aside from soft tissue recontouring, the diode laser has numerous other clinical applications2:
CLINICAL CASES
Case 1
Prior to any preparation of the case the patients soft tissue level was evaluated to see if it was possible to remove any gingival tissue to improve the length-to-width ratio of the teeth, thereby enhancing the final aesthetic result (Figure 2). The periodontal evaluation revealed that there was room to recontour the soft tissue without violating biological width.3,4
When the patient returned for her delivery appointment 2 weeks later the provisional veneers were removed. Figure 5 demonstrates the soft tissue has healed at exactly the same level as the surgical incision that was made at the preparation appointment. The soft tissue irritation present around tooth No. 9 is a factor of an overcontoured provisional restoration, and not a result of the use of the diode laser.
Case 2
A 16-year-old female was referred to our office by her orthodontist. Tooth No. 7 was congenitally missing. The orthodontist correctly chose to maintain tooth No. 6 in its natural position and create the appropriate amount of space to allow placement of a prosthesis replacing tooth No. 7.
Case 3
A 24-year-old woman presented to our office with cosmetic concerns associated with tooth No. 10 (Figure 9). According to the patient, 8 years ago upon the completion of her orthodontic treatment, her general dentist placed direct-bonded composite resin on her peg lateral. The patient expressed a desire to have a more natural appearing restoration placed on tooth No. 10.
CONCLUSION
When used properly a soft tissue laser can become an important piece of equipment for many cosmetic and restorative procedures. For those who use a laser on a daily basis it has become an invaluable instrument to provide higher-quality dentistry. The uses of the laser go far beyond the cases demonstrated here.1,2 It has been shown by many laser users that the routine use of a laser is economically beneficial to the practice as well.1,7,8
References
1. Miyasaki M. No laser? Here’s what you’re missing. Dent Econ. February 2002;70-74.
2. Benjamin S. Dental lasers: Part 2. Soft tissue laser applications. PPAD. 2002;14:328-330.
3. Kois J. Altering gingival levels: the restorative connection. Part 1. Biological variables. J Esthet Dent. 1994;6:3-9.
4. Robbins JW. Esthetic gingival recontouring: caveat emptor. Cont Esthet Rest Dent. April 2002;66-74.
5. Radz GM. Beyond the maryland bridge. AACDJ. Spring 1996;18-22.
6. Lowe RA. Ovate pontic design: maximizing esthetics, function of fixed partial bridges. Dent Prod Report. June 2002;68-71.
7. Vitale W. Using lasers to increase revenues. Dent Econ. July 2001;34-38.
8. Jameson J. How to profit from lasers: an interview with Dr. Gerald Bittner, Jr. Dent Econ. July 2001;40-42.
Dr. Radz’s practice, the Colorado Center for Aesthetic Dentistry, is located in downtown Denver, Colo. Dr. Radz has completed both AEGD and GPR residency programs. He has been an instructor of several postgraduate teaching institutes. Dr. Radz lectures and publishes extensively on aesthetic-related materials and techniques. Aside from his private practice Dr. Radz is president of Snow Mountain Seminars and is currently the program cochairmain for the American Academy of Cosmetic Dentistry’s 2003 annual meeting. Dr. Radz may be contacted at radzdds@aol.com.
