Pulsed lasers in dentistry: sense or nonsense?

Abstract

The great interest in the field of laser applications in dentistry provokes the question, if all these new techniques may really fulfill advantages, which are expected after initial in-vitro studies. Whereas laser surgery of soft oral tissues has been developed to a standard method, laser treatment of dental hard tissues and the bone are attended with many unsolved problems. Different laser types, especially pulsed lasers in a wide spectrum of wavelengths have been proofed for dental use. Today neither the excimer lasers, emitting in the far uv-range from 193 to 351 nm, nor the mid-infrared lasers like Nd:YAG (1,064 μm), Ho:YAG (2,1 μm) and Er:YAG (2,96 μm) or the C0₂-laser (10,6 μm) show mechanism of interaction more carefully and faster than a preparation of teeth with diamond drillers. The laser type with the most precise and considerate treatment effects in the moment is the short pulsed (15 ns) ArF-excimer laser with a wavelength of 193 nm. However this laser type has not yet the effectivity of mechanical instruments and it needs a mirror system to deliver the radiation. Histological results point out, that this laser shows no significant pathological alterations in the adjacent tissues. Another interesting excimer laser, filled with XeCI and emitting at a wavelength of 308 nm has the advantage to be good to deliver through quartz fibers. A little more thermal influence is to be seen according to the longer wavelength. Yet the energy density, necessary to cut dental hard tissues will not be reached with the laser systems available now. Both the pulsed Er:YAG- (2,94 μm, pulse duration 250 s) and the Ho:YAG -laser (2,1 μm, pulse duration 250 μs) have an effective coupling of the laser energy to hydrogeneous tissues, but they do not work sufficient on healthy enamel and dentine. The influence to adjacent healthy tissue is not tolerable, especially in regard of the thermal damage dentine and pulp tissues. Moreover, like the 193 nm ArF-excimer laser radiation the Er:YAG-laser radiation could also only be delivered via mirror systems, while the radiation of the Ho:YAG-Laser can be well transmitted through quartz fibers. The energy of the well known and in other medical disciplines often used Nd:YAG - laser (1,064 μm, pulse duration 150 us) laser can be transmitted through fiber systems without problems, but this laser has not the effectivity to work sufficient on healthy hard dental tissues due to the high transmission in mineralized dental tissues. The thermal injuries of this laser type are not tolerable. The short pulsed TEA-C0₂-laser (9,6 and 10,6 μm, pulse duration 200-300 ns), which has an excellent coupling not only to the hydrogeneous tissues but also to the mineralized tissues could be an alternative system to prepare dental tissues. The greatest disadvantage of this system is the noneffective delivery of the light energy through flexible fiber systems, which are still in development. Another good chance perhaps will have the q-switched Neodym, Erbium and Holmium:- YAG lasers with pulse durations of about some hundred ns. Both, possible thermal influences and possible disruptive effects should be small enough to let the adjacent tissues undamaged.