When I hear the word lasers, the first thing that comes to mind is Star Wars.  If only dentistry was as exciting as Star Wars! So now that we all agree on that, let’s see how lasers are changing dentistry and what we have to look forward to in the future. It’s actually some pretty cool stuff, even if you would probably rather be watching Star Wars.

There are several different types of lasers currently in use in dental offices today.

Soft Tissue Lasers (Diode):

This is the typical laser you’ll see in a general office and is also the least expensive costing several thousand dollars. It is only used for cutting soft tissue (ex. gum tissue). This type of laser doesn’t actually use the laser tip to cut tissue. It has a glass fiber than transmits the laser pulse which is charred and then heated up by the laser pulses. It is this heated glass tip that actually does the cutting. It isn’t as efficient in cutting tissue as say a scalpel would be but it makes up for that in the fact that there is little to no bleeding afterwards and the tissue heals beautifully. There are a couple of good applications for this type of laser…

• Frenectomies (for example with tongue ties or a frenum between your top front teeth that contributes to the teeth wanting to spread apart).
• Removing a small amount of gum tissue around a tooth before taking an impression for a crown
• Stopping bleeding
• Reduction in symptoms for cold sores

Combined Hard and Soft Tissue Lasers (Carbon Dioxide, Neodymium Yttrium Aluminum Garnet aka Nd: YAG, and Er:YAG):

These types of lasers are the more cutting edge side of lasers in dentistry. They have the ability to cut both hard and soft tissue as well as some restorative materials. They can cut teeth, bone, and tissue. Each type has a slightly different application and usefulness. These lasers are also currently very expensive costing upwards of $100,000 in some cases. This has limited their adoption significantly. One of the biggest benefits to these types of lasers is that the amount of anesthetic needed to numb a tooth is much more limited and in some cases not needed at all due to laser pulses effects on the nerve. Some current procedures that are performed with these types of lasers include…

• Frenectomies – as explained above
• Gingivectomies  – Excess gum tissue is removed for a better esthetic look
• Laser assisted new attachment protocol (LANAP) – Periodontist’s often perform this procedure in which the laser is used to clean the pockets around teeth and in many cases it can help to regrow bone around teeth, which was previously impossible
• Biopsies – Suspicious areas can be easily removed with a laser for evaluation by a pathologist.
• Crown lengthening surgery – Bone is removed around a tooth to allow more space for a crown to be fitted to a tooth.
• Preparation of teeth for cavities – These lasers can be used to remove decay and prepare teeth for fillings. It actually cuts the decayed area more readily due to the increased water content of those areas. It can’t cut amalgam or porcelain but does cut tooth structure and composite filling material.

One of the biggest things that limits the effectiveness of these lasers is that they don’t interact with dental amalgam or porcelain so a conventional dental drill has to be used in these cases. Many, many teeth have one of these materials in them. Until this hurdle is overcome and the price comes down, adoption of these types of lasers will likely be very slow.