Laser Applications in Periodontology

*Sura Dakhil Jassim*

## **Abstract**

Laser have various periodontal applications including calculus removal (erbium yttrium scandium gallium garnet and erbium yttrium aluminum garnet lasers), decontamination of root and implant surfaces and bio stimulation, incision and ablation, osseous surgery, excision of the soft tissue, and bacterial reduction. This chapter analyzes the most important occasions in which lasers are used in implant and periodontal field practices. There is a strong evidence that laser is used for surgical and nonsurgical periodontal therapies including root bio modification, bacterial decline and decontamination of infected implant surface (in peri-implantitis), and removal of the pocket epithelium. This chapter also highlights the most common disadvantages as well as the advantages of using lasers in periodontal therapy. Waterlase® and Periowave™ systems are recent devices that have further revolutionized the laser technology for its favorable clinical applications; however, the procedural cost with the laser device constitutes an obstacle for its routine application.

**Keywords:** erbium yttrium scandium gallium garnet laser, erbium yttrium aluminum garnet laser, periodontal therapy, peri-implantitis, bacterial reduction

### **1. Introduction**

LASER, an abbreviation of light amplification by stimulated emission of radiation, was first established by Maiman in 1960 [1], a scientist of the Hughes Aircraft Company. Based on the theory originally proposed by Albert Einstein, Maiman used the ruby crystal that produces a coherent radiant light when activated by energy. Goldman et al. [2], a dermatologist experimenting laser for tattoo removal, showed painless surface crazing of enamel after focusing two pulses of red light beam from ruby crystal. Following experiments by Stern and Sognnaes [3], pendulum shifted from ruby laser to CO2 and Nd:YAG lasers for better interactions with dental hard tissues. The 1970s and 1980s sought use of lasers for soft tissue surgical procedures, and Lenz et al. [4] were among the pioneers to report oral surgical application of CO2 laser, together with Frame [5], Pecaro [6], and Pick [7] who used the same for oral soft tissue lesions and periodontal procedures. Myers and Myers [8] described the use of modified ophthalmic Nd:YAG laser for removal of dental caries and received the US FDA's permission for selling Nd:YAG laser device in 1989 [9]. After Myers's suggested use in soft tissue surgery [10], Nd:YAG laser was eventually used in periodontal procedures [11, 12], and since then lasers have been used largely by researchers and clinical periodontal practitioners.

Lasers can be used in a focused beam (for excisions and incisions) and in an unfocused beam (for ablation and coagulation). Some evidence suggests that lasers used

as an adjunct to scaling and root planning (SRP) may provide additional benefits [13]. It had been shown that using lasers in periodontal treatment had a beneficial role in controlling of bacteremia, bacterial reduction, effective subgingival calculus elimination (using Er:YAG lasers), improved eradication of the pocket epithelium in pockets involving teeth, and enhancement of periodontal regeneration in humans and animals without a destructive effect on the neighboring pulp tissues and bone [14–21]. In India the capability of using laser device at laboratories and institutes offers a huge chance to the researchers and scientists concerned in the field of free electron lasers, semiconductor lasers, solid-state lasers, and gas lasers [22]. So because of the importance of the subject and the wide use of laser in India, this chapter focuses on the most important types of laser used in the India as well as in Iraq.
