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| The New Dental Lasers, Can They Cut It in the Field of Dentistry? |
| By Marc Lazare, DDS New York, NY |
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In recent years, lasers have been incorporated into patient treatment in many different forms. Even in dentistry, several kinds of lasers have been available for soft tissue applications, such as for contouring the gums to enhance the appearance of one’s smile, treating mouth ulcers and for performing surgical procedures in an almost bloodless environment. Another type of laser, one that uses Argon technology, has been used to set certain bonding materials, and functions very well in boosting the effects of whitening gels in a procedure known as power bleaching.
Until 1997, however, there was no laser option for treating cavities. Then, on May 7, 1997, the FDA approved the Er:YAG laser (erbium:yttrium-aluminum-garnet), the first laser for use in treating human dental cavities.
Despite their promise, these early laser cavity treatments have been reported to cause some damage to the tooth structure being prepared, and also tended to cause considerable amounts of heat during the treatment process, in some cases adversely affecting the patient’s nerve.
Since then, we have seen tremendous advances in laser tools for dentistry. The hard tissue dental lasers currently available to dentists have proven to be safer and more proficient cutting instruments than the one originally approved in 1997. A new laser, the Er, Cr:YSGG (erbium chromium yttrium scandium gallium garnet) laser operates at a wavelength of 2780nm and is capable of precisely cutting through both hard and soft tissues. This laser uses a method known as laser hydrokinetics, in which water particles, energized by the laser, remove the tissue being treated.
The laser dentistry promises great potential in minimizing patient discomfort and circumventing a patient’s fear of the “drill.” In most cases, lasers will also eliminate the need for local anesthesia. Traditional drills tend to have an irritating sound and transmit uncomfortable vibrations, while the new dental lasers have more of a “popcorn popping” sound whenever each energy pulse engages water. Traditional drills may also create micro cracks and fissures in the tooth during treatment, which weaken the tooth structure over time. Lasers, on the other hand, do not cause these cracks and fissures.
We have not yet achieved “state of the art” with dental lasers, as they have a number of limitations. For instance, some dentists feel that dental lasers are not as precise when it comes to creating the ideal tooth preparation for a filling. However, the laser alternative is ideal for the removal of cavities in the pits and fissures of the teeth, and some studies have shown that its use may even enhance the bonding effect in some dental restorations. Other limitations include the inability to prepare teeth for crown and bridge restorations, veneers, inlays and onlays, and for the removal of silver fillings.
Currently, hard tissue dental lasers (the ones used on tooth surfaces) are limited to just the preparation of teeth for fillings. When compared to the traditional drills, lasers cut enamel relatively slowly. Nor do lasers completely eliminate the need for local anesthesia during treatment. In 1997 the Journal of the American Dental Association (JADA) published a study conducted at five clinical sites with institutional review boards. They study found that some patients did feel discomfort during cavity preparation, but only about 2% requested or required anesthetic. It is also important to note that in the two phases of the study only 77 patients had been treated with a laser, the other 80 patients were in the control group. Since millions of Americans do experience fear and anxiety associated with the sound and vibrations of the dental drill, and since some reports claim that up to 50% of the U.S. population do not seek regular preventive care because of the fear associated with dental procedures, the results of this study are promising. Although this sample size may be too small to conclude that 98% of individuals will not require anesthetic, the results are impressive nonetheless.
Ultimately, the use of lasers for dental treatments has yet to fully evolve. Drill is still faster, more predictable and easier to use, in some respects, than the dental laser.
Although the FDA has approved the use of the hard-tissue dental laser, the ADA (American Dental Association) has not yet given the tool its Seal of Approval. While ADA is optimistic about the future applications of lasers in dentistry, the organization is still reviewing the scientific data relating to the safety and effectiveness of these laser systems. Among the ADA’s concerns are its usefulness in cavity removal and preparation (particularly in posterior teeth), and the limited number of peer-reviewed studies on these hard-tissue lasers.
Many dentists are already offering laser treatment options to their patients. As with any emerging technology, however, we are bound to see marked improvements through further study, revision and next-generation laser models. More clinical trials, longer term studies on nerve responses, a significant drop in price, and perhaps a few more technological advances are going to be required before laser technology becomes widely used and accepted by most dentists.
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