Lasers: the next generation

by Stewart Rosenberg, DDS

The first generation of dental lasers was essentially for soft tissue only. Although the quality of dentistry we could perform and the return on investment were significant, most dentists failed to see the value of lasers for their practices. Now, however, since the introduction of the erbium:YAG and erbium, chromium:YSGG lasers - the so-called “hard-tissue lasers” - dentistry is finally taking notice. According to a recent survey, more than 35 percent of dentists plan to purchase a laser in the next three years.

In my practice, I use diodes for hygiene and low-level laser bio-stimulation for faster healing following traumatic procedures such as oral surgery and TMJ therapy. I use my erbium, chromium:YSGG lasers daily to cut cavity preps and may even do inlay and crown preparations, usually without anesthesia.

The biggest impact lasers have had on my practice is in the procedures I used to either ignore or refer to specialists. I can now perform periodontal therapy, laser-assisted extractions, biopsies, frenectomies, apicoectomies, endodontics, cosmetic recontouring of soft tissue, hard tissue crown lengthenings, eliminate root sensitivity, expose implants, and save failing implants. If you had come to my office six years ago with a tooth flapping in the breeze, I would have referred you to an oral surgeon. Now, I do nearly all of my own extractions, referring only severely medically impaired patients and the few who prefer general anesthesia.

I insert a 14 mm long zirconium tip, used as a laser osteotome, into the ligament space between the tooth or root tip and the bone, and start lasing as I gradually move the tip in an apical direction. The tooth slowly begins to move apically. Since the laser energy penetrates a few millimeters beyond the end of the tip, I don’t have to go very far before the tooth loosens enough to virtually remove it with my fingers, but I can go all the way to the apex if necessary.

I have even been able to easily remove ankylosed teeth with this technique. Because trauma is minimized, no bone is fractured or lost. The laser decontaminates the socket and helps remove any granulation tissue. There is no swelling, no dry sockets, and little or no postop discomfort. To remove a single tooth and graft the socket normally requires 20 minutes, half of which involves delivering postop instructions and writing up the chart.

Here’s a typical example: A new patient presented as an emergency with a periapical abscess and lost post-retained crown on the upper left central incisor. Impressions for a provisional partial denture were taken and the patient was rescheduled for the following day. The laser was used in the ligament space to loosen the root without risking loss of the buccal plate of bone or fracture of the root. Preserving this alveolar ridge is a critical factor in the future restoration. The atraumatically extracted tooth was removed with a pair of cotton pickups. The laser then was used in the socket for decontamination and removal of granulation tissue. The socket was grafted with a suitable bone graft material, and a barrier membrane was placed.

Low-level laser therapy was applied, using the diode laser with bleaching wand at 3 watts continuously. Implant placement will be accomplished in approximately three months. Meanwhile, other necessary restorative and periodontal treatment will be addressed.

Dr. Stewart Rosenberg is a founding member and past president of the Academy of Laser Dentistry, the World Congress of Minimally Invasive Dentistry, and serves on the board of the World Clinical Laser Institute. He is a fellow of the International Society of Laser Dentists, the American Society of Laser Medicine and Surgery, ESOLA, AACD, and the AGD. He is director of Advanced Laser Training Seminars and maintains a private practice in Laurel, Md. He can be reached by e-mail at [email protected].