Prepared by:

Athraa A. MahmoodM.Sc. of Periodontics

IntroductionHigh power lasers such as:• Carbon dioxide (CO2)• Neodymium- doped: Yittrium-Aluminium-Garnet (Nd:YAG)• Diode laserswere approved for soft tissue treatment in oral cavity because of their excellent softtissue ablation and homeostatic characteristics.

• The Erbiumdoped: Yittrium-Aluminium-Garnet (Er:YAG) laser: was approved in1997 for hard tissue treatment in dentistry. which will be able to clinical dentalpractice, in particular periodontal treatment. It was introduced as analternative or an adjunctive to conventional scaling and root debridement.

Advantages of Laser Surgery1. Decreased tissue damage and thus enhanced healing: No incisions,

stitches, post-op bleeding, swelling, pain, gum recession, toothsensitivity.

2. Patient comfort :less chair time.

3. Hemostasis and coagulation are possible, making the laseressential for medically compromised patients.

4. Some procedures can be performed with topical anesthesia only.

5. The concept of minimally invasive dentistry (MID) can be achieved.

6. Lasers are safe to use if the user adheres to protocols.

Disadvantages• Laser irradiation• the cost and size of laser device

A. Soft tissue applicationsB. Hard tissue applications

APLICATION OF LASER IN PERIODONTIC

1. Gingivectomy• When patients present with problems of tissue overgrowth or

hyperplasia from various causes, laser are used effectively to

perform laser gingivectomy.

A. Soft tissue applications

2. Gingivoplasty• For small tissue aberrations, pseudopockets seen after

periodontal surgery, or small areas of reverse tissue architecture

with an otherwise healthy periodontium.

• all of the dental lasers are effective in performing gingivoplasty.

3. FrenectomyAll types of laser systems can be used ; however, Depth of penetration of Diode & Nd:YAG more than Erbium & CO2.

Lingual frenectomy

4. Removal of benign lesions

Before 3 Months post operation

5. Incisional or excisional biopsy

Before

6 Weeks post operation

6. Exposure of Implants

Before After

• Lasers can be used to uncover implants, whether single or multiple

7. Mucogingival surgery• For coagulation of bleeding areas, seal of soft-tissue graft

(donor sites), lasers are excellent in controlling the bleeding.

• Recontour of recipient area and more esthetic results

• For vestibuloplasty:

Before

Two-day postoperative Two-week postoperative

• Lasers are effective for crown lengthening related to excessivesoft tissue or in areas of passive eruption.

• laser type : Diode, Nd:YAG & CO2.

8. Soft tissue crown lengthening

9. The Laser Assisted New Attachment Procedure

Periodontal probeindicates excessivepocket depth.

Laser irradiation, selectivelydissects epithelium, diseased tissue& pathological proteins, tactilefeedback from the fiber alerts thepractitioner to the presence of rootroughness, & opens that pocket foraccess & visibility.

Ultra sonic & specialhand instrumentsused to remove rootroughness.

The tissue is compressed against theroot surface & a stable fibrin clotforms at the gingival crest.

Laser finishes debriding pocket& establishes coagulation.

10. Melanin hyperpigmented gingiva

Melanin

hyperpigmented gingivaPost-operative

result in 2 weeks

Final result after orthodontic

and restorative treatment

• Diode & Nd:YAG are attracted by hyperpigmented tissuewith melanin so we need less power than coral pinkgingiva.

B. Hard tissue applications

1. Scaling & root planning.

2. Bone procedures.

3. Whitening procedure

4. Hard tissue crown lengthening• Alter underlying osseous structure >> Erbium Laser to

clear removal of bony defect.

Preoperative views

Immediate postoperative views