When it comes to pediatric dentistry, lasers present specific advantages even a kid can understand
For the past seven years I have had the pleasure of using the Erbium lasers in our pediatric group dental practice. Laser dentistry had become such an integral and important part of our pediatric practice, that we purchased a second Erbium Laser less than one year after purchasing the first. We now have three Erbium lasers so that my partner and I can each use one and have the third stationed in our “quiet” operatory.
The Erbium Laser is the only laser that has the ability to perform Class I through Class VI cavity preparations and perform soft tissue surgery. There are two wavelengths of Erbium lasers; the Erbium:YAG which is 2940 nm and the Erbium Chromium:YSGG at 2780 nm. The mechanism of action of the Erbium laser is that the water that is bound to the crystalline structures of the tooth absorbs the laser light readily and easily. The vaporization of the water within the mineral substrate causes a massive volume expansion, and this expansion causes the surrounding material literally to explode away.
Due to the fact that there is more water in dentin than enamel and more water in carious dentin, the ablation (this micro-explosion) of these tissues occurs at a varying rate. Thus, the Erbium laser is slower in ablating enamel than dentin. Erbium lasers have been shown to prepare dental hard tissues with efficacy. The efficiency and depth of the preparation corresponds to an increase in the power setting and use of a water spray.
The Erbium laser is slower in the removal of enamel compared to the highspeed handpiece and air abrasion. However, the laser is more precise than air abrasion for tooth preparation. Also, the Erbium laser numbs the tooth so that there is usually no need to anesthetize the patient. In the past 7 years, I have prepared hundreds of primary and permanent teeth with only a small percentage of the patients requesting local anesthetic.
The highspeed handpiece may cause microfractures of the enamel, which the laser does not. In the near future you will be able to use the laser for crown and veneer preparations. The Erbium laser can remove excess gingival tissue, which sometimes becomes hyperplastic and grows into the carious area where there is interproximal caries. Neither the handpiece nor the air abrasion unit can be used on soft tissue without causing bleeding, whereas the laser can be used to remove and cauterize any excess tissue. The Erbium Laser can be used for crown-lengthening procedures for crown and bridge restorations.
The Erbium laser has other advantages over the high-speed handpiece, including:
- Etching of the enamel occurs while preparing the tooth, which increases the bond strength up to 50%.
- The effect on the pulpal floor has been shown to cool the tooth whereas the high-speed handpiece heats the tooth.
- The laser sounds like a popcorn popper vs. the “whining” sound of the highspeed handpiece.
The air abrasion unit cannot remove caries as easily as the Erbium laser. The air abrasion unit is messy, while the laser is clean. Also, the powder from the air abrasion unit may cause abrasion of mouth mirrors and aluminum oxide dust in the operatory.
I have used the Erbium laser to perform the following soft tissue procedures:
- Excision of gingival over unerupted teeth
- Excision of hyperplastic gingival tissue to aid eruption of incisors and cuspids.
- Labial and lingual frenectomies
- Laser “bandaids” for aphthous ulcers
- Direct pulp capping
- Pulpotomies
- Excision of a fibroma
- Operculectomies
- Gingivectomies
- Gingivoplasties
The Erbium laser has been shown to be 98% bactericidal. Therefore, it can be used for direct and indirect pulp capping, pulpotomies, and pulpectomies. Here are some of my patient’s and parent’s comments when the Erbium laser has been used:
After performing my first lingual frenectomy after 27 years of dentistry, my 4-year-old patient was asked by her mother how she felt. Isabella looked up at her mother and responded, “Great.”
Recently, one of my 8-year-old patients required a labial frenectomy. After performing the surgery, the father asked me if his son could play soccer that evening. I told him that there would be no problem and prescribed over-the-counter analgesics. When I called his father the next day, he informed me that not only was he able to play soccer, he had not needed any analgesics.
Michael, a six-year-old mentally challenged patient, had been up the previous night with dental pain. The operculum overlying the erupting lower right first permanent molar was large and swollen. After administering a topical and local anesthetic, I removed the excess tissue with the Erbium Laser. There was no bleeding, due to the cauterizing effect of the laser. When the mother was asked the following day, how Michael was feeling, she replied; “Like a different child.”
“It was neat. I didn’t even feel anything.” This was said after the laser preparation of a Class I caries on a 7-year-old, Nicole.
“I think I’m going to go the dentist more often.” This was said by a 19-year-old college student after completing his restorations utilizing the Erbium laser.
“I wanted my daughter to have a positive dental experience. I found your name on the Academy of Laser Dentistry’s Web Site”, said the mother of 5-year-old Jennifer.
What’s the bottom line? Less stress, less burnout, and more FUN doing dentistry! On my way home from the office one evening shortly after I purchased the Erbium Laser, I called my wife and said: “I just realized something; I only gave two injections today, one for an SSC and one for an extraction.”
REFERENCES
- Convissar, R.A. The Dental Clinics of North America. Philadelphia: W.B. Saunders, 2000
- Hadley, J.,et al. A Laser-Powered Hydrokinetic System. JADA. 2000; 131: 777-785
- Miserendino, L.J., Pick, R.M.: Lasers in Dentistry. Chicago. Quintessence International, 1995
- Coluzzi, D.J. An Overview of Laser Wavelengths Used in Dentistry. Chapter in: The Dental Clinics of North America. Philadelphia: W.B. Saunders, 2000
- Eversole, L.R. and Rizoiu, I.M. Preliminary Investigations on the Utility of an Erbium, Chromium YSGG Laser. CDA Journal. 1995; December, 41-47
- Visuri, S.R., et al. Shear Strength of composite bonded to Er:YAG laser-prepared dentin. J. Dent. Res., 1996; 75:1, 599-605
- Takamori, K. A Histopathological and Immunohistochemical Study of Dental Pulp and Pulpal Nerve Fibers in Rats After the Cavity Preparation Using Er:YAG Laser. J. Endod. 2000; Feb. 26:2
- Keller, U., Hibst, R. Effects of Er:YAG Laser in Caries Treatment: A Clinical Pilot Study. Lasers in Surgery and Medicine 1997; 20:32-38
- Hicks, M.J., et al. Caries-like lesion initiation and progression in sound enamel following argon laser irradiation: An in-vitro study. ASDC J Dent Child. 1993; 60:201-206