|Year : 2014 | Volume
| Issue : 1 | Page : 78-82
|Diode lasers: A magical wand to an orthodontic practice
Vipul Kumar Srivastava1, Shally Mahajan2
1 Department of Conservative Dentistry, Chandra Dental College and Hospital, Safedabad, Barabanki, Uttar Pradesh, India
2 Department of Orthodontics and Dentofacial Orthopedics, Chandra Dental College and Hospital, Safedabad, Barabanki, Uttar Pradesh, India
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|Date of Submission||26-Jun-2013|
|Date of Decision||09-Mar-2013|
|Date of Acceptance||24-Dec-2013|
|Date of Web Publication||21-Apr-2014|
| Abstract|| |
LASER (Light Amplification by Stimulated Emission of Radiation) is a powerful source of light, which has innumerable applications in all the fields of science including medicine and dentistry. It is one such technology that has become a desirable and an inseparable alternative to many traditional surgical procedures being held in the field of dentistry, and orthodontics is no exception. The current article describes the uses of a diode laser as an indispensable tool in an orthodontic office.
Keywords: Bleaching, diode laser, gingival depigmentation, hemostasis, low-level laser therapy, laser setting, TMDs
|How to cite this article:|
Srivastava VK, Mahajan S. Diode lasers: A magical wand to an orthodontic practice. Indian J Dent Res 2014;25:78-82
In 1917, Albert Einstein laid the foundation for the invention of the laser when he first theorized that photoelectric amplification could emit a single frequency or stimulated emission.
In 1960, American physicist Theodore Maiman  at the Hughes Research Laboratories in Malibu, California, built the first functioning Ruby laser. Since then, there have been significant developments in this field and their wide applications in the clinical, diagnostic, and research world.
Lasers are capable of easily ablating and reshaping the oral soft tissues along with additional advantages such as increased hemostasis, painless, lesser inflammation, and faster healing with less wound contraction. ,
Depending upon the classification of lasers according to their potential to cause biological damage, nearly all medical and dental lasers fall into class 4 type. This class of lasers produces high-powered light that is hazardous to view at all times. Exposure to the eye or skin by both direct and scattered laser beams of this intensity, even those produced by reflection from diffusing surfaces, must be avoided at all times. Therefore, proper safety measures should be ensured while using such type of lasers.
Many laser wavelengths are used for clinical use both for hard and soft tissues.  Shorter wavelengths ranging from 532 nm (nanometers) to 1064 nm are better absorbed by pigmented molecules like hemoglobin and melanin, whereas longer wavelengths ranging from 3,000 nm and 10,600 nm experience better interaction with the water and mineral content of the tissue. The most common lasers used in dentistry today are the CO2 laser, the Nd: YAG laser, the Erbium lasers (Er: YAG and Er, Cr: YSGG), and the diode laser. Each produces a different wavelength of light and is generically named for the active medium contained within the device. Since no single laser wavelength can be used to optimally treat all dental diseases, there is no one perfect dental laser.
The three unique characteristics of this high-intensity light that makes it different from the ordinary light is the property to generate that the laser beam is monochromatic (single color), coherent (unidirectional), and highly collimated (very parallel).
A laser is composed of three principal parts: An energy source, an active lasing medium, and an optical cavity or resonator. The laser energy produced can have four different interactions with a target tissue namely, reflection, absorption, scattering, and transmission. While all the interactions are occurring simultaneously, it is the interaction of absorption that is of importance in dentistry. When laser light is absorbed, the temperature of the target tissue is raised based upon the content of water content of the tissue, resulting in a number of photothermal effects.
Applications of lasers in the field of orthodontics are myriad. The use of this technology ranges from diagnosis (laser fluorescence to detect any caries, laser surface scanning of craniofacial anomalies) to laser etching for efficient bonding procedures. Minor surgical procedures like exposure of impacted teeth, frenectomy, crown lengthening, canine exposure, operculectomy, atraumatic implant placement procedures can be elegantly carried out by the orthodontist himself. ,
| Diode Laser in an Orthodontic Office|| |
Diode lasers are basically lasers whose active medium is a semi-conductor made of aluminum, gallium, arsenide, and occasionally indium, similar to that found in a light-emitting diode. They are soft tissue lasers with wavelengths ranging from 810 nm to 1064 nm (in the near infra red region of the spectrum). Absorption of energy gives diode lasers their ability to precisely cut, coagulate, ablate or vaporize the target soft tissue. 
The laser energy is absorbed by pigmentation in the soft tissues, and this makes the diode laser an excellent tool to hemostatic agent. Because it is used in contact mode, it also provides tactile feedback during the surgical procedure. The diode laser can often be used without anesthesia to perform very precise anterior soft tissue esthetic surgery or surgery in other areas of the mouth without bleeding or discomfort. ,,,
Diode lasers are ideally suited to fulfill the needs of the orthodontic clinician as they are procedure-specific, easy to operate, portable, and cost-effective. All the other wavelength lasers as compared to diode are hampered by their larger size and higher cost.
To prevent collateral thermal damage to adjacent tissue, the Academy of Laser Dentistry (ALD) recommends using the least amount of power that can effectively accomplish a desired procedure. For most soft tissue ablation procedures, a setting of 1 to 1.2 watts will result in excellent tissue removal with minimal thermal degeneration of adjacent tissue. Areas of denser tissue, such as the palate and the fibrous tissue distal to the lower second molars, may require settings closer to 1.4 watts, while frenectomy procedures often require settings as high as 1.6 watts.
Impacted or unerupted tooth exposure
The bloodless surgical exposure of the unerupted or impacted tooth is the paramount to the strong adhesion of the bracket to the enamel. It is one of the most important steps of orthodontic procedures. The main aim while performing this procedure is that the surgery should be as minimally invasive as possible and bleeding must be avoided.
Diode laser is an excellent choice of treatment modality as it is an excellent hemostatic agent allowing bonding of bracket to the exposed tooth chairside without the need to wait for the next day. 
Laser surgery is routinely performed by using only topical anesthetic, and laser setting at 1.2 to 1.4 Watts after the initiation of the laser tip [Figure 1]. The procedure is performed with the laser tip in light contact with the tissue, and using sweeping brush strokes, the tissue can be easily removed [Figure 2] and [Figure 3]. There is rarely any bleeding or discomfort, since the blood vessels and nerve endings are sealed while the tissue is removed, which is particularly beneficial in an open orthodontic clinic.
Many times, patients undergoing orthodontic treatment or taking medications such as Dilantin may develop gingival hyperplasia. This may contribute to caries formation or enamel decalcification within the deep gingival pocket. This can be easily prevented by re-shaping the gingival tissue or removal of the excess of gingival tissue [Figure 4] along with the instructions given to the patient to maintain meticulous oral hygiene.
Various adjunctive procedures like gingival re-contouring, depigmentation [Figure 5], bleaching [Figure 6] of teeth create magical results after the commencement of orthodontic treatment improving the overall esthetics.
|Figure 2: (a) Immediately after exposure of impacted laterals (b) after 1 Week|
Click here to view
The extension of the maxillary frenum into the palatal area or inserting into the interproximal area between the upper central incisors may contribute to the midline diastema. Intercepting or preventing these problems associated with the abnormal placement of frenum may require revision of this abnormal attachment at an early age or during orthodontic treatment. Diode lasers are excellent in-office tool as they prevent bleeding and at the same time, reducing the chances of infection, swelling, discomfort, post-surgical scaring, and also no need for irritating sutures or unsightly periodontal dressing. 
The use of soft-tissue lasers result in a shorter operative time and faster postoperative recuperation. , Laser surgery is routinely performed by using only topical anesthetic, which is particularly beneficial in an open orthodontic clinic [Figure 7]. There is markedly less bleeding (particularly for frenal surgery), minimal swelling, and post-surgically, patients report less discomfort and fewer functional complications (speaking and chewing), and require fewer analgesics than do patients treated with conventional scalpel surgery. ,
| Low-level laser therapy (LLLT)|| |
Pain and discomfort are often the complaints we hear from our patients during the duration of orthodontic treatment. It starts right from the time separators or atraumatic implants are placed to the time of banding and bonding and continues every time we move from a lighter to a heavier archwire. The complaint time usually prolongs for a week to ten days. Low-level laser therapy have been shown to accelerate tooth movement during orthodontic treatment and also effectively reduce pain level.  Also, while the treatment progresses, some of the patients encounter some debilitating conditions like recurrent aphthous ulcers or herpes labialis. 
Diode lasers can bring instant relieve to these conditions and also often abort or shorten the duration of the herpes labialis lesion and aphthous ulcer lesion [Figure 8]. This is termed as low-level laser therapy (LLLT), the reason being that the levels of energy density delivered are low when compared to other forms of laser therapy as practiced for ablation, cutting, and thermally coagulating tissue. The treatment involves placing the laser tip in a non-contact mode at 0.1-0.5 watt over the entire lesion and moving the tip in a circular motion for 15 seconds. The entire process needs to be repeated 2 to 3 times until the patient indicates that the lesion no longer feels uncomfortable. Large lesions may require the need a second session in the next 24 to 48 hours. ,
Orthodontic and temporomandibular joint discomfort
Patients having orthodontic adjustments or having temporomandibular joint discomfort may experience relief using the laser over the area for 3 minutes using very low doses of laser therapy in non-contact mode. More than 1 treatment over a 24-to 48-hour period may be needed to reduce the discomfort. ,
Controlling gag reflex
While taking diagnostic records like impression-making and intraoral radiographs, some patients may gag and in extreme case, may also vomit and that is one of the biggest hurdles while doing treatment. Using lower doses of laser energy placed over the P-6 acupuncture point on each wrist may prevent the gag approximately 1 inch above the wrist crease. The probe is placed on each wrist for 1 to 2 minutes. ,
Diode lasers are excellent tool to safely remove any gingival fibrotic lesions or growths, mucoceles, and other non-hemangioma type lesions without an orthodontist being dependent on anyone and sending the specimen for biopsies.
| But Before Using Lasers|| |
Before buying lasers, it is very important to get ourselves as well as our dental staff properly trained to make the best use of this technology you have invested in and also avoid any potential hazard associated with it. There are many laser certification programs being conducted all over the world by many laser manufacturing companies as Continuing Dental Education (CDE) and many internationally acclaimed academies dedicated to laser Dentistry like Academy of Laser Dentistry (ALD), World Clinical Laser Institute (WCLI), and Society for Oral Laser Applications (SOLA) imparting basic as well as advanced laser training certifications ensuring every dentist to be properly certified and trained in laser usage. There are also many training seminars, in-office tutorials, DVD, online courses, and Webinars provided by the manufacturer on the purchase of a dental laser to make sure the safety and safe use of this wonderful invention.
| Conclusion|| |
The use of lasers in orthodontics, and in particular diode lasers, has made it possible for orthodontic clinicians to more easily address the challenges faced on a daily basis in an orthodontic practice. With nearly some years of experience using lasers, I cannot imagine practicing without them. When used properly, diode lasers are effective and safe for soft tissue procedures and contribute to the overall wellbeing of the orthodontic patients. Moreover, it can be used as a practice-builder for you in your orthodontic office.
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Vipul Kumar Srivastava
Department of Conservative Dentistry, Chandra Dental College and Hospital, Safedabad, Barabanki, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
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