“Do all dentists use lasers?” This is a question I hear daily from patients. I am not sure of the correct way to approach the answer. The answer, of course, is no. Only about 1 in 10 dentists use lasers, but why?
In a recent conversation with a dental laser salesman, I was reminded that he had visited my office in 1997 to sell me a Nd:YAG laser. My response to the sales pitch was, What would I use a laser for in my practice? Eight years later, with 6 years of everyday laser usage, I don’t think I could practice without my lasers…1997 was not my time for laser dentistry, but now is.
An Nd:YAG laser was developed in 1999 with added features, and it came with required hands-on training and a protocol that would make the purchase profitable. This laser purchase allowed me to increase the number of surgical and periodontal procedures I personally perform. The continued evolution of erbium hard-tissue lasers sold me on this technology in 2001. Newer, faster, better laser technology is always becoming available. These two instruments afford me hundreds of new treatment options.
My practice is a 25-year-old, suburban family practice. I just relocated and renovated the office this year. Lasers have replaced scalpels, retraction cord, packing instruments, periodontal packing materials, bone grafts, resorbable membranes, sutures, and dry-socket paste in my armamentarium. Laser techniques have decreased my use of local anesthetics, allowed my amalgam-less bonding to evolve to new levels, and decreased my referrals out of practice for periodontics, endodontics, and oral surgery. I had a part-time periodontist working in my office for 10 years, before laser periodontal surgery became available to me.
I use only free pulsed Nd:YAG and Er:YAG lasers. Of course, there are many options using traditional and laser techniques to achieve comparable end results, using many different means in dentistry.
The following two case reports demonstrate everyday laser usage in my practice.
CASE NO. 1
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Figure 1. Fractured tooth No. 7. |
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Figure 2. Nd:YAG laser used to perform gingivectomy/ gingivoplasty and troughing. |
Figure 3. Final restoration on tooth No. 7. Note healthy gingival tissues. |
The emergency patient is always a challenge. Lasers provide me so many more treatment options for immediate results. Figure 1 is a preoperative photo of a 30-year-old male with fractured tooth No. 7. He needed a more aesthetic smile now, because he was leaving on a long vacation within the week.
The treatment plan consisted of one-step root canal therapy, post and core buildup, caries removal and composite restorations on adjacent teeth, gingivectomy and gingivoplasty, final impression for a porcelain crown, and temporization. The crown would be seated in a week.
To prepare the tooth for the final impression, the Nd:YAG was used for gingivectomy/gingivoplasty and troughing (Figure 2). Note that there will be no gingival recession after this laser procedure.
In the postoperative photo at 1 month post-lase with final restorations (Figure 3), note healthy gingival contours. The tooth was restored with a CAPTEK porcelain crown (Precious Chemicals Company).
CASE NO. 2
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Figure 4. Tooth No. 10 preoperatively. |
Figure 5. Tooth No. 10 had 10-mm pockets on the MB and ML aspects. |
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Figure 6. Immediately after laser surgery. |
Figure 7. Three-year postoperative radiograph. |
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Figure 8. Three-year postoperative result. |
A 60-year-old female presented with a mobile tooth No. 10 (Figure 4). A radiograph showed severe bone loss (Figure 5), and the tooth was vital. Ten-millimeter pockets existed on the MB and ML aspects of the tooth; all other periodontal probings of adjacent teeth were 3 mm or less.
The treatment plan consisted of the Laser Assisted New Attachment Procedure (LANAP) using the PerioLase Nd:YAG (Millennium Dental Technologies) and Millennium Dental Technologies patented technique.1 Figure 6 shows the results immediately after laser treatment and occlusal adjustment. There was no loss of gingival margin height during surgery.
Figures 7 and 8 show the case 3 years later, with splinting removed and the final porcelain veneer restoration. No mobility is present, and no pockets greater than 4 mm exist.
CONCLUSION
My original laser was purchased for periodontal therapy, but my uses for lasers grow daily. The ability of a light beam to ablate tissue with rapid precision, to reduce bacteria, to produce hemostatis, to remove diseased tooth structure, to operate below the threshold of pain, to minimize discomfort associated with the healing process, and to perform new treatment modalities is changing my daily approach to dentistry.
Laser use in dentistry will continue to increase as dentists continually strive to provide better patient care. More patient-friendly treatment procedures will become available, with the patient able to take advantage of this exciting, developing technology.
Reference
1. Yukna RA, Evans G, Vastardis S, et al. Human periodontal regeneration following the laser assisted new attachment procedure (LANAP). Paper presented at: IADR/AADR/CADR 82nd General Session; March 10-13, 2004; Honolulu, Hawaii. Available at: http://iadr.confex.com/iadr/2004Hawaii/techprogram/abstract_47642.htm.
Dr. Cranska is a certified LANAP provider. He is a member of the Aca-demy of Laser Dentistry (ALD), holds Advanced Profiency Dental Laser certification (ALD 2001), and is a certified Laser Dentist and Trainer by the Institute for Advanced Laser Dentistry (1999, 2004). Dr. Cranska is a clinical consultant and certified laser trainer for Millennium Dental Technolo-gies. He maintains a private practice in Severna Park, Md. More laser information is available at cranska.com. He can be reached at drcranska@cranska.com.
Disclosure: Dr. Cranska has no financial interest in any laser company. He is compensated as a consultant for presenting, lecturing, and training from Lumenis and Millennium Dental Technologies.
