Laser one-on-one

Dr. Diana Constantinescu

 Laserul in stomatologie
 Dentiștii au început să exploreze utilizarea laserelor în domeniul lor la începutul anilor 1960.
Inițial, laserele dentare foloseau un rubin pentru mediul activ. Dispozitivul a emis impulsuri
neregulate și a vaporizat cu succes smalțul dinților. Cu toate acestea, au existat preocupări cu
privire la siguranța acestei tehnologii, deoarece unii cercetători au crezut că pulpa dentară ar
putea fi afectata.
 Pe baza laserelor pe bază de rubin, cercetătorii stomatologici au început să investigheze
posibilitățile laserelor CO2 și laserelor Er:YAG. Eforturile lor au fost răsplătite cu lansarea în
1990 a primului sistem laser dezvoltat special pentru uz clinic în cabinetele stomatologice.
Astăzi, tehnologia continuă să evolueze, oferind pacienților acces la posibilități de tratament
mai eficiente și mai blânde pentru a le susține sănătatea orală.
 ACRONIMUL LASER

Light
Amplification by
Stimulated
Emission of
Radiation

1964 -Townes, Basov si Prokhorov castiga

premiul Nobel pentru descoperirea laserului.
 INTERACTIUNE
LASER-TESUT

 ABSORBTIE
 TRANSMISIE
 DISPERSIE
 REFLEXIE
Graficul curbelor de absorbtie
 ABLATIE MEDIATA DE APA

APA:
 Conditioneaza ablatia

AVANTAJELE ABLATIEI LASER:

 Fara efecte termice
 Fara vibratie (laser 300 Hz/ freza 5000 Hz)
 Fara microfisuri
 Fara smear-layer
 Ablatie selectiva a dentinei alterate (dentina alterata este mai hidratata)
 Aplicatii
 Laserul Waterlase Iplus 2790 nm
 Tratamentul leziunilor carioase
 Chirurgia tesutului dur si moale
 Terapia parodontala asistata laser
 Tratamentul periimplantitei
 Proceduri de iradiere (hiperestezie
dentinara, leziuni herpetice si aftoase)
 Terapie endodontica (indepartarea
detritusului dentinar)
 Laserul dioda Epic X 940 nm
 Chirurgia tesutului moale (homostaza!)
 Terapie parodontala asistata laser
(decontaminare si chiuretajul tesutului de
granulatie)
 Decontaminare endodontica
 Proceduri de iradiere (albire dentara,
decontaminare, biomodulatie, tratamentul
leziunilor herpetice si ale leziunilor aftoase)
 De ce laser in stomatologie?
Avantaje

 Posibilitatea obtinerii unei decontaminari superioare oricarui alt instrument

 Eliminarea necesitatii prescrierii de terapie AB post-interventii
 Confortul pacientului: eliminarea sau reducerea cantitatilor de anestezic
 Posibilitatea realizarii unor interventii minim-invazive
 Pacienti anxiosi, copii si adolescent, pacienti cu diverse patologii, femei insarcinate.
 Timp mai scurt al interventiilor!!!
 Interactiunea laser- tesut
 Interactiunea dintre laser si tesut depinde in mod direct de proprietatile optice ale tesutului .
 Smatul este un tesut mineral in mare masura, compus din 85% tesut mineral, 12 % apa si 3%
componenta organica
 Dentina/Cement: 33% material organic, aprox. 20% apa
 Dentina carioasa: 27-54% apa
 Aparitia cariilor afecteaza in mod direct componenta de apa si minerale. Pe masura ce se
produce demineralizarea, volum pierdut este inlocuit de apa.
 Parametri 2790 nm/ Waterlase iPlus
 PUTERE= se masoara in W si determina puterea efectiva a laserului
 HERTZ= reprezinta rata de repetitie/ secunda a pulsurilor laser
 S mode/ H mode= durata pulsului
 APA= are rol in procesului de ablatie
 AER= impinge moleculele de apa in tesuturi si elimina produsul de ablatie

*Rata Hertz este invers proportinala cu ablatia!!!

*Durata pulsului este invers proportionala cu ablatia!!!
• Nici o interventie fara apa!!!
• Tesut dur: non-contact (distanta de lucru de aprox 2 mm)
• Tesut moale: contact usor (miscari de pensulare + tensiune)
Proceduri de iradiere: non-contact fara anestezie
 Terapia odontala laser
 Parametrii:
 Putere: 4-8 W
 Rata de repetitie: 15-20 Hz
 Durata pulsului: H mode (scurta)
 Apa: 80-90%
 Aer: 80-90%
 Tips: Mz 8 / Non contact! Distanta de lucru: 1-2mm
 Bond prep (crearea suprafetei retentive)
 Putere: 4.50 W
 Rata de repetitie:50 Hz
 Durata pulsului: H mode
 Aer 60%
 Apa 80%
Chirurgia tesutului
moale si dur
 Chirurgia tesutului moale
 Parametrii:
 Putere: 2.50 W
 Rata de repetetie: 50 Hz
 Durata pulsului: S/M
 Apa: 30-40%
 Aer: 40%
 Tips: Mz 8
 Mod contact
 Initial situation
Patient: male. 38 years old, with no medical history.
The patient underwent orthodontic treatment and in order to obtain a more
harmonious smile, we performed a crown lengthening procedure on the
superior premolars on both sides and also on tooth 1.1.
 Measuring the free gingiva
This step is very important in order to determine if bone plasty is need or not.
After the measurements, I decided to do a bone recontouring only for the
premolars.
 Ginvectomy with 940 nm diode laser
Power: 1.5 W
Mode of
operation:
chopped (P3)
Tip diameter:
0.4mm
Initiated tip,
contact mode,
parallel to the
tooth axis.
Deepithelialization of the gingival margin
Immediate after
 1.Gingivectomy
Power: 2.5 W
Repetition rate: 50 Hz
H mode
Water: 40%
Air: 20%
Tip: Mz 8
Contact mode
Tip direction: parallel to the
tooth axis.
During the gingivectomy
Clinical aspect after gingivectomy
Laser settings for osseous recontouring and bone plasty
Measuring the bone level
 During bone recontouring
Intermittent measuring of bone level
 During bone recontouring
Measurement of the new bone level.
Final aspect after tissue plasty
After one week
Final aspect
 Terapia parodontala
 Stadii:
 Initial
 Moderat
 Sever cu pierderi dentare
 Sever avansat cu afectare functionala
 extindere/ distributie topografica/ localizata/ generalizata.
 Grade: A (usoara) B (moderata) C (severa)
 Mild periodontitis
 Moderate periodontitis
 Advanced periodontitis
 Severe periodontitis
 Stadializare
 Stadiul 1: fara pungi, pierdere de atasament minima, pierdere de os minima
 Stadiul 2: PPD 5-6 mm, pierdere de atasament moderata, pierdere de os in 1/3 coronara
 Stadiul 3: PPD 7mm si peste, distructie avansata a parodontiului, pierderi de os in 1/3 medie,
pungi infraosoase.
 Stadiul 4: evolutie severa a stadiului anterior, peste 5 dinti pierduti, afectare parodontala severa.

 Grade:
 A- risc redus de recidiva, evolutie lenta
 B- evolutie progresiva evidenta
 C- risc ridicat de recidiva, evolutie severa
 Eubioza vs Disbioza

 Disbioza:
Modificarea proportiilor dintre speciile prezente la
nivel subgingival, numarul patogenilor crescand in
detrimentul speciilor nepatogene, benefice.
Alterarea comunicarii intre mediatorii locali de
inflamatie avand ca si consecinta inflamatia
distructiva si pierderea de os.
 Protocol terapeutic
 Anamneza
 Consult clinic, fotografii diagnostic
 Radiografii retroalveolare, OPT, CBCT
 Recoltare flora (analiza PCR)
 Parodontometrie
 Analiza ocluzala
 Tratament parodontal asistat laser
 Reevaluare/ parodontometrie la 8-12 sapt.
 Tratament laser
 Reevaluare/ parodontometrie la 16-24 sapt
 Tratament laser
 Protocol terapeutic
 DECONTAMINARE: 940 nm, 1-1,5 W, cw, 60s/ monoradiculari, 120s/pluriradiculari
 DEBRIDEMENT: detartraj US supra si subgingival
 DECONTAMINARE: 940 nm, 1-1,5 W, cw, 60s/monoradiculari si 120s/pluriradiculari

 ERBIUM LASER:
 Chiuretajul peretelui intern al pungii parodontale 1.5 W, 30 Hz, H mode,20-40 % apa, 30-50%
aer
 Conditionare radiculara 1.5 W, 15 Hz,/ 3.75 W, 50 Hz, H mode
 Dezepitelizalrea peretelui extern 2-4mm vestibular, oral, proximal.
 Confimarea sangerarii !!! Spatiul chiuretat se umple cu sange. Compresa, P, captarea cheagului,
hemostaza.
 Initial situation

Patient: female, 35 years old with no medical history.

Periodontal diagnosis: moderate chronic marginal periodontitis
The patient needs to be stable before initiating a prosthetic treatment.
 Treatment sessions:
1st session: diode laser decontamination
supragingival scaling
periodontal probing
photographic documentation
panoramic x-ray
hygiene instructions

2nd session: diode laser decontamination

scaling and root planning with piezo scaler and curettes
Er,Cr-YSGG laser pocket debridement and outer
deepithelialization
 Periodontal probing
Masuratori paro/rx]
Scaling and root planning
Laser pocket debridement
 Outer deepithelialization
In order to
synchronize both
epithelial and
conjunctive tissue
healing, this step is
needed.
 Clinical aspect after 10 days.
It is still to early to do a probing evaluation but the clinical aspect of the
gingiva is healthy and the patient is maintaining a good oral hygiene.
After a complete evaluation, we will decide if it is safe to continue with
the prosthetic treatment.
Labial frenectomy
with 940 nm diode
laser
 Initial situation
Patient: 15 years old with no medical history.
On clinical examination we observe a high insertion of the inferior labial
frenulum and chronic inflammation of the gingival papilla between teeth
3.1 and 4.1.
I decided to do a professional cleaning and also frenectomy and
gingivectomy.
 Scaling and anesthetic injection
The anesthetic used was articaine.
Laser settings

Power: 1.5 W
Mode of operation: CW
Tip diameter: 0.4 mm
Initiated, in contact.
Tip direction: parallel to the hard
tissue.
 During the procedure
Constant tension in the lower lip
After the frenectomy, the papilla plasty was done and also
deepithelialization.
Immediate after
 Patient care
I instructed the patient to
keep a good oral hygiene,
to do local applications
of vitamin E and some
functional exercises 2-3
times a day.
After one week
Er,Cr:YSGG
Indeparteaza smear-layerul de la nivelul canalului radicular.
940 nm: 1 W, 2mm/ canal/ 1secunda x 4 repetari.
Cosmetic procedures
Pacient: 45 years old, heavy smoker and coffee amateur. She used numerous home bleaching kits in the
past, increasing the enamel’s porosity and thus, enabling a more intense nicotine pigment fixation.
On clinical examination, I observe also an intense gum pigmentation due to nicotine and decide to do also a
gum depigmentation using the 940 nm diode laser.
During the depigmentation procedure
 Results after one week
The gum depigmentation procedure was a success.
2. Gingivectomy with
Er,Cr-YSGG
 Initial aspect
Patient: years old, with
no medical history.
Main complain: the
asymmetry between the
superior lateral incisors.
We decide to perform a
gingivectomy on tooth
2.1 in order to obtain a
more harmonious smile.
 Measuring the free gingiva
The measurements were done in order to determine the need of a bone recontouring.
At 3 mm physiological space, we decide that there is no need to do also a bone plasty
 Laser settings
Tip Mz6 in slight contact, parallel to the tooth axis.
During the procedure
Immediate after clinical aspect
Deephitelization
 Patient care

At the end of the procedure,

we apply vitamin E and
instruct the patient to
maintain a good oral hygiene.
Final result after one week
Va multumesc!