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Use of Diode Lasers for Cosmetic Dental Procedures: Potential for Tissue Damage?

posted in Cosmetic Dentistry

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Dr. L. asks:
I am moving my practice more in the direction of cosmetic dentistry and away from basic, needs-driven dentistry. Despite the downturn in the economy, I am having more and more patients coming in for cosmetic procedures. I have been taking many courses in this area to keep at the current edge. I am a bit concerned about the use of the diode laser for soft tissue troughing for final impressions for crowns, bridges and veneers. Every course I take involves the use of the diode laser. The lecturer may pack cord also, but they always use the diode laser. Every lecturer assures the audience that this will not cause permanent soft tissue damage, gingival recession and that all the tissue lased away will simply grow back. Is this true? Is there any potential for tissue loss or damage?

6 Responses to “ Use of Diode Lasers for Cosmetic Dental Procedures: Potential for Tissue Damage? ”

• Dr Kimsey January 6th, 2009

  
  

  Its like everything else it depends. Laser settings allowing excessively large thermal zone, aggressive use, use in thin biotypes all can cause serious problems.
  The basic need for attached tissue and biologic width is still there.

• dr caplan January 8th, 2009

  
  

  i have been using lasers in israel since 1997 and use co2 eryag and diode . in general because of the risk of bone resorbtion i believe that one should be very careful with diode lasers so use low values you can always repeat the lase , if the tooth is non vital it is much easier to use co2 and in general co2 is best for soft tissue applications , however near vital teeth one should be careful with co2 so if you have both you can get the best balance, er yag is great but can cause bleeding although if you use very low values you and can even cause coagulation the technician has to be told that you used lasers so he understands the immpression

• Kenneth S. Magid, D.D.S. January 13th, 2009

  
  

  I have to completely disagree with Dr Caplan. The basic principle of laser use…with any wavelength…is to use the highest power you can control for the shortest period of tissue contact time to minimize lateral thermal damage. I also don’t think that the CO2 is “easier” to use than the diode because CO2 laser energy must be kept away from tooth structure which is not true of a diode.

  The erbium can be used to modify soft tissue but a smooth cut with complete hemostasis is more difficult but can be accomplished without water and with a longer pulse width.

  I think from your description of your needs a diode laser and appropriate education would serve your purposes well.

  Ken Magid
  Director of Laser Dentistry
  NYU Collge of Dentistry

• Dr.Aslan Y.GOKBUGET January 14th, 2009

  
  

  Dear Dr.L,
  Using Diode laser you should take some conditional factors into consideration.First penetration depth diod lasers penetration in non pigmented tissue is high..up to 1-4 mm.ıt means if you are using more than 3W and long aplication time it could be harm to the bone tissue.Second you have to use contack with the tissue.Third you should use very short pulse…between 810 -1064 nm wave lenght is very well adsorb by pigmented tissue like hemoglobin …I recommend you short duration,contact use very short pulse and not more than 3W…Nd-Yag laser is much more favorible than diods.Education about laser also very important.

• dutchy January 27th, 2009

  
  

  Dear dr L,
  I agree with Ken Magid in most things. It depends on which diod laser you buy how deep it will penetrate into the tissue. For example the 980 nm laser will be very efficient in cutting through soft tissue, but its penetration depth in gingiva is deeper then the 810 nm. I personally use the 810 nm or the nd-yag. You always can repeate the procedure. You need to follow the same rules when cutting through tissue with the knife: thin or thick biotype, fenestration?, biological width, ….. This can influence the outcome of your procedure. The CO2 laser is very suffiient to cut through softtissue, but is has also an interaction with hydroxylapatite. This is the reason why you should kept it away from the teeth, because you don’t want to cut it and produce heat into the teeth. If we can produce a CO2 laser with very very short pulses this may be the best laser to cut hard tissue likeenamel and denine without producing heattransfer into the tissues. So you need to know which tissue interaction your laserbeam ( wavelength) will give to use it safe. If you use laser on tissue then during the use it will be modified and giving a differend reaction from your beam which in most times prevent depth penetration of the thermal effect. With different settings and different lasers you can obtain cold abblation, hot abblation no abblation ( just Heattransfer). The problem with the diodlaser is that in the interaction with tissue you have more scattering and scattering in most cases is more heat penetration into the tissues.But a faster interaction with your tissue can prevent this. This can be overcome by using the right settings for your laser systems. I like to use it and I have a diodlaser, nd-yag and er-yag and you can do amazing things with these devices, but like with all the instruments we use in dentistry you can also produce some damage. Good luck.

• Dr A.Balouch June 1st, 2009

  
  

  Dear Dr …

  I never use lasers in my office, but I want to buy laser (diodlaser, nd-yag and er-yag ).I do not know which one is better .I want to know which model and brand could I use for dental implant surgery (osteotomy)and hard tissue treatment.
  Please advice me to choose the best one.

  Best regards
  Thank you for your recommendation.

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