1. LASER IN PROSTHODONTICS

2. Light Amplification by Stimulated Emission of Radiation
Term coined by GORDON GOULD ,1957
Father of laser: Albert Einstein
Laser light is a man-made single
photon wavelength.
LASER LIGHT
VISIBLE LIGHT

4. Laser interaction with oral biologic tissues
Four different interaction
Reflection
Scatter (diffusion)
Absorption
Transmission

6. Uses In Dentistry
1. Excimer Lasers
Hard tissue ablation/ Dental Caries removal. Argon Fluoride / Xenon fluoride lasers are used. They have a wave length from193nm to 308nm.

7. 2. Gas Laser
Carbon dioxide lasers are used for intra oral and implant soft tissue surgery , aphthous ulcer , melanin pigmentation. Has a wavelength of 10600nm. Color- Infrared
Helium Neon Lasers has a wavelength of 637nm and is used for dentin hypersensitivity , analgesia etc. Color-Red
Argon lasers having a wavelength of 488nm & are used for tooth whitening , curing of composites , curettage etc Color-Blue

8. 3. Diode Lasers
Indium Gallium Arsenide Phosphorous are used for caries and calculus detection and has wavelength of 655nm. The color of the laser is Red.
Gallium Aluminum Laser – Intra oral Surgery , Implant soft tissue surgery , sulcular debridement , Pulpotomy , root canal disinfection removal of enamel caries etc, Wavelength- 840nm Color-Infrared

9. 4. Solid state Laser
Neodymium:YAG Laser – Intra oral soft tissue surgery , sulcular debridement , analgesia , Pulpotomy , root canal treatment, removal of gingival melanin pigmentation . Has a wave length of 1064nm and is infrared.

10. 5. Erbium Group
Erbium:YAG is used for modification of enamel and dentin surface , implant soft tissue surgery , sulcular debridement , osseous surgery , treatment of dentin hypersensitivity , apthous ulcer treatment etc

11. Why Lasers In Prosthodontics
Prosthodontics takes all concepts of dentistry and integrates effective comprehensive treatment planning.
It include a wide variety of patients seeking a diverse range of care:
Fearful patients
Patients with complex medical histories
Lasers have become an integral part of treatment for these patients
Patient allergic to anesthetics

12. Future Trends in Dentistry
Non-invasive Dentistry
Happy Dentistry

14. Advantages Easy and safe to handle
Painless, Bloodless & Clean surgical field.
Spot coagulation and vaporization gives excellent hemostasis.
Reduces Operating Time.
Anesthesia free soft and hard tissue cutting
No need for suturing
Instant sterilization of surgical site
No sensory disturbances
No postoperative discomfort, and swelling.
Superior and faster healing

15. Disadvantages Lasers can't be used :
fill cavities located between teeth
cavities around old fillings and large cavities (crown)
remove defective crowns or silver fillings
prepare teeth for bridges
Laser - more expensive

16. Classification of LASERS ON BASIS OF APPLICATION IN DENTISTRY
SOFT TISSUE LASERS
HARD TISSUE LASERS

17. SOFT TISSUE LASERS No suturing Little or No bleeding Painless Quicker
Atraumatic

18. HARD TISSUE LASERS Quicker More accurate More comfortable
Better results

19. Application in

20. FIXED PROSTHETICS/ESTHETICS
Soft tissue management around abutments.
Crown lengthening.
Osseous crown lengthening.
Troughing.
Formation of ovate pontic sites.
Soft tissue management around laminates
Bleaching
Removal of veneer

21. SOFT TISSUE MANAGEMENT AROUND ABUTMENTS
ARGON laser provide excellent Hemostasis and Coagulation
Gingival Retraction for making impression during a crown and bridge procedure becomes easy

22. CROWN LENGHTNING INDICATIONS Insufficient clinical crown length
Caries at gingival margin
Endodontic perforations near alveolar crest.
Unaesthetic gingival architecture.
Cosmetic enhancement.
INDICATIONS

23. LASER TROUGHING
is created around a tooth before impression making using Nd:YAG laser.
Minimizes impingement of epithelial attachment, less bleeding, reduced postopersative problems, lessen chairtime
This can entirely replace the need for retraction cord, electro cautery, and the use of haemostatic agents.
Gingival troughing  with the diode laser exposes finish lines 

24. FORMATION OF OVATE PONTIC SITES
Two most common causes of unsuitable pontic site:
1. Insufficient compression of alveolar plates after an extraction
2.Unsuitable pontic site results in un esthetic and non self cleansing pontic design.
For favorable pontic design laser re-contouring of soft and bony tissue may be needed

25. MODIFICATION OF SOFT TISSUE AROUND LAMINATES
The removal and re-contouring of gingival tissues around laminates can be easily accomplished with the Argon laser

26. Bleaching: Esthetics and smile are important issues in our modern society. Bleaching of teeth can now be performed in the Dental OPD. Diode lasers are used to bleach teeth effectively without causing much tooth sensitivity and alteration of the complexion of the tooth.

27. Removal of veneer: Restoration can be dislodged without cutting with the help of laser beams. The laser energy passes through porcelain glass unaffected and is absorbed by the water molecules present in the adhesive. Debonding takes place at the junction of the silane and the resin without causing any trauma to the underlying tooth.

28. REMOVABLE PROSTHETICS
Tuberosity reduction
Torus reduction
Soft tissue lesions
Residual ridge modification

29. TUBEROSITY REDUCTION
Treatment of enlarged tuberosity: The most common reason for enlarged tuberosities usually is soft tissue hyperplasia and alveolar hyperplasia accompanying the over-eruption of unopposed maxillary molar teeth. The excision of the surplus soft tissue may be performed with any of the soft tissue lasers. Cutting of the bony tissue may be done with Erbium laser.

30. Surgical treatment of tori and exostoses
Tori and exostoses are formed mainly of compact bone.
They may cause ulceration of oral mucosa.
They may also interfere with lingual bars or flanges of mandibular prostheses.
Soft tissue lasers may be use to expose the exostoses and Erbium lasers may be use for the osseous reduction.

31. SOFT TISSUE LESIONS Epulis fissurata and denture stomatitis caused by:
Persistent trauma from a sharp denture flange
Over compression of the posterior dam area
The lesion can be excised with any of the soft tissue lasers and the tissue allowed to re epithelialize.

32. RESIDUAL RIDGE MODIFICATION
For proper retention, stability and support for the prosthesis, residual ridge modification is done with lasers, in pre prosthetic preparation phase for
Under cuts
Flabby tissue

33. IMPLANTOLOGY Second stage uncovering. Implant site preparation.
Peri-implantitis.

34. SECOND STAGE UNCOVERING

35. Two implants are being uncovered using a scalpel.
Excess soft tissue being
removed using laser

36. Immediately healing caps are laser exposed and soft tissue is recontoured
Soft tissue healing within 2 weeks

37. IMPLANT SITE PREPARTION
Lasers can be used for the placement of mini implants especially in patients with potential bleeding problems, to provide essentially bloodless surgery in the bone

38. PERI-IMPLANTITIS
Lasers can be used to repair ailing implants by decontaminating their surfaces with laser energy.
Lasers can also be used to remove inflamed granulation tissue around an already osseointegrated implant.
Diode, CO2 & Er:YAG lasers can be used for this purpose.

39. Sinus lift procedure: Lasers can also be used in the sinus lift procedure. The procedure can be done by making the lateral osteotomy with a decreased incidence of sinus membrane perforation. The yttrium-scandium-gallium-garnet (YSGG) laser is the optimal choice for not cutting the sinus membrane. The YSGG laser can also be used to make the osteotomy for a ramal or symphyseal block graft. Bone grafts done with lasers have been demonstrated to decrease the amount of bone necrosis from the donor site and the osteotomy cuts are narrower, resulting in less postoperative pain and edema.7

40. RECENT ADVANCES IN LASERS

41. MAXILLOFACIAL PROSTHESIS
Topologic data of the patient’s deformity is acquired using laser surface digitizing, the procedure is called Laser Holography Imaging
Lasers aid in creating a visually realistic prosthesis that can provide an illusion
of normal appearance.

42. Laser welding
An attractive alternative method to join dental casting alloys such as broken clasp
Advantages over Conventional Soldering
No need for investment and soldering alloy
Working time is decreased
Easy to operate
Minimal heat damage to denture base resin

43. Ultraviolet (helium-cadmium) laser-initiated polymerization of liquid resin in a chamber, to create surgical templates for implant surgery and major reconstructive oral surgery.

44. Laser scanning of casts can be linked to computerized milling equipment for fabrication of restorations from porcelain and other materials.

45. THANKS