مجلة طبيبي العربي

مقال في تطبيقات الليزر للدكتور حاتم البيطار

A laser is a high tech devise that generates a tiny beam of very concentrated light. This beam of light brings energy into your mouth through a tiny fiber, to help remove areas of infection and remove gum disease around the teeth with great precision and accuracy.

The laser beam sterilizes the affected area and seals off blood vessels, which minimizes the chance of infection or bleeding. Patients are also much more comfortable during and after treatment with laser therapy. The need for local anesthetic is reduced but it is usually used to make sure that you feel absolutely nothing during the treatment

Shortly after the invention of lasers in the early 1960's, lasers were investigated for their use in gum treatment. Recent developments have made it possible to use lasers effectively in the dental office, for treatment of all soft tissues, including gums. Soon lasers will be used routinely for work on teeth and cavities also.

Are Lasers Dangerous

In the hands of a skilled specially trained periodontist, lasers are very safe. In fact the primary safety factor used during laser treatment is proper protective eyewear. Dental lasers are very low powered, which is essential for treating the delicate tissues of the mouth. In addition, the controlled heat and light of the laser destroys many bacteria and viruses in the mouth and inside periodontal pockets.

benefits of laser dentistry

There are many benefits of laser dentistry:

Reduced risk of infection

Decreased Sensitivity.

Less time in the dental chair.

Less post-treatment discomfort.

Apart from the fact that laser treatment is very gentle and quiet and heals with very little post-operative discomfort or bleeding, laser treatment may be very beneficial for the following situations:

Blood Thinners: If you are on Coumadin or take aspirin every day and your MD does not want you to stop them, then laser treatment is beneficial because of the reduced chance of bleeding during treatment.

If you have high blood pressure and the use of Epinephrine is contraindicated, then laser treatment is for you.

If you are allergic or hypersensitive to Epinephrine, causing rapid heartbeat whenever you get Novocaine, then the use of laser treatment is beneficial, since Epinephrine is not necessary to be used.

Laser Pocket Treatment Procedure

Chemical curettage may be used to de-epithelialize the inner pocket wall. The laser is then used to remove all debris, vaporize bacteria, and do any necessary gingivoplasty. Scaling and root planing is done conventionally with curettes and ultrasonics.

There is minimal bleeding and Orabase is used by the patient to cover any sore spots. A few Motrin are all that is needed for discomfort.

The current mode of dealing with disease causing organisms within the human body is through the use of chemotherapeutics, delivered both systemically and locally. There are 2 problems we face with this modality. The first is that there will always be a certain percentage of the patient population that will have contra-indications for using certain chemotherapeutics. They may have systemic reactions to certain medications or as is the case for women, they may be pregnant. The second is the fact that the over use of medications for infection, specifically antibiotics, has resulted in what are being called “superbugs”, or pathogens that are resistant to current medications available for use.

Lasers currently used in dentistry for the treatment of periodontal disease exert their bacterial reduction effect through Photothermal means.4 Used well below the surgical parameters used for other laser therapies, dental lasers deliver light energy locally to the infected site to eradicate the bacteria by causing a rupture of the cell wall. Laser

energy is delivered by light to which there are no contra-indications and to which the bacteria cannot develop a resistance to.

with the first devices being both expensive and bulky. Both of these factors, along with few clinical studies, limited the growth of lasers in dentistry. This is not the case any longer. The evolution of the laser device has made them user friendly, operatory friendly, with some devices being slightly larger than a palm pilot, and very affordable. Couple this with the extensive clinical studies already done and currently being done on the incorporation of lasers into dental procedures and lasers become a device to be considered for every dental office.

Where to incorporate lasers in periodontal therapy

Periodontal disease is indicated by bleeding gingiva, increased pocket depths, recession, bone loss, furcation involvement, mobility and exudate, often resulting in the loss of the tooth. As the pocket depths increase, the accumulation of both hard and soft debris increases, creating the perfect site for the advancement of the periodontal disease process. To determine the necessary treatment, a full periodontal assessment is required and should include notation of all of the factors mentioned above.

Exhibited disease can be at any stage progression to incorporate adjunctive laser therapy. Sites that bleed at any probed depth are diseased and can benefit from the addition of the laser energy for bacterial control

When to incorporate lasers

The laser should be used during the phase one, non-surgical therapy much like ultrasonic instruments. It is during these appointments that the diseased pocket sites require thorough debridement of both the hard and soft debris. The effectiveness of the removal of the hard debris from the root surface can be measured easily by exploring the

smoothness of the root surface. It is the effectiveness of the removal of the soft debris that can be more difficult and since we know that the soft debris is the biofilm, instrument modalities beyond the hand scaler must be considered.

The pocket space can be effectively “flushed” by the use of ultrasonic instrumentation but what of the tissue itself. Exposing the diseased

tissue to laser energy will assist bacterial control by penetrating as many as 3mm to 4mm of tissue.4 As the appointment process moves

along, previously treated sites should be revisited to control bacteria and allow for optimum healing.

Once the primary therapy appointments are finished, the patient is placed on a maintenance program. The laser can be easily incorporated into these appointments to assist in the bacterial control and to maintain periodontal health.5 It only takes a few seconds of laser exposure at each regressing site to achieve a bactericidal effect, thereby eliminating the need for additional chemotherapeutics. Since the oral cavity can never be pathogen free, the laser will always be an effective instrument choice for the periodontal maintenance patient.