About the Author xi
List of Contributors xiii
Preface xv
Acknowledgement xvii
1 Laser Fundamental Principles 1
Georgios E. Romanos
1.1 Historical Background 3
1.2 Energy Levels and Stimulated Emission 3
1.3 Properties of the Laser Light 3
1.4 The Laser Cavity 4
1.4.1 Active Medium 4
1.4.2 Pumping Mechanism 5
1.4.3 Lenses – Resonator 5
1.5 Laser Application Modes 5
1.5.1 Beam Profiles 7
1.6 Delivery Systems 7
1.6.1 Direct Coupling 7
1.6.2 Articulated Arms 7
1.6.3 Fiber Systems and Flexible Hollow Guides 8
1.7 Applicators 9
1.7.1 Handpieces 9
1.7.2 Fiber Applicators 10
1.8 Laser Types Based on the Active Medium 11
1.8.1 Gas Lasers 11
1.8.2 Crystal Lasers 14
1.8.3 Liquid (Dye) Lasers 17
1.8.4 Semiconductor (Diode) Lasers 17
1.8.5 New Developments in Laser Technology 19
1.8.6 Lasers for Research Applications 24
1.9 Laser and Biological Tissue Interactions 24
1.9.1 Photochemical Effects 27
1.9.2 Photothermal Effects 29
1.9.3 Ionizing or Nonlinear Effects 33
2 Lasers and Wound Healing 41
Georgios E. Romanos
2.1 Introduction 41
2.2 Wound Healing and Low Power Lasers 42
2.3 Wound Healing and High-Power Lasers 44
2.3.1 Wound Healing and CO2 Laser 44
2.3.2 Wound Healing and the Nd:YAG Laser 47
2.3.3 Wound Healing and Other Laser Wavelengths 50
2.4 Lasers and Bone Healing 51
3 Lasers in Oral Surgery 57
Georgios E. Romanos
3.1 Introduction 57
3.2 Basic Principles 57
3.3 Excision Biopsies 58
3.4 Removal of Benign Soft Tissue Tumors 59
3.4.1 Surgical Protocol for Removal of Small Tumors 59
3.4.2 Surgical Protocol for Removal of Larger Soft Tissue Tumors 62
3.5 Removal of Drug-Induced Gingival Hyperplasias and Epulides 80
3.5.1 Removal of Drug-Induced Gingival Hyperplasias 80
3.5.2 Removal of Epulides 81
3.6 Removal of Soft Tissue Cysts 83
3.7 Frenectomies and Vestibuloplasties 87
3.7.1 Frenectomies 87
3.7.2 Vestibuloplasties 92
3.8 Removal of Precancerous Lesions (Leukoplakia) 99
3.9 Surgical Removal of Malignant Soft Tissue Tumors 106
3.10 Laser Coagulation 106
3.11 Lasers in Vascular and Pigmented Lesions 107
3.11.1 Laser Types 107
3.11.2 Removal of Vascular Alterations with the “Ice Cube” Method 108
3.12 Exposure of Impacted, Unerupted Teeth 121
3.12.1 Exposure of an Unerupted Teeth for Orthodontic Reasons 122
3.13 Removal of Sialoliths Using the Laser 123
4 Lasers and Bone Surgery 129
Georgios E. Romanos
4.1 Introduction 129
4.2 CO2 Laser 129
4.3 Excimer Laser 130
4.4 Er:YAG and Ho:YAG Lasers 130
4.5 Laser Systems for Clinical Dentistry 131
5 Lasers in Periodontology 139
Georgios E. Romanos
5.1 Introduction 139
5.2 Laser-Assisted Bacteria Reduction in Periodontal Tissues 140
5.3 Removal of Subgingival Calculus 142
5.4 Removal of Pocket Epithelium 144
5.5 Retardation of the Epithelial Downgrowth 149
5.6 Laser Application in Gingivectomy and Gingivoplasty 152
5.7 Laser-Assisted Hemostasis in Periodontics 154
5.8 Photodynamic Therapy in Periodontology 156
5.9 Gingival Troughing for Prosthetic Restorations 165
5.10 Fractional Photothermolysis in Periodontology 165
5.11 Education and Future of Lasers in Periodontal Therapy 178
6 Lasers and Implants 185
Georgios E. Romanos
6.1 Introduction 185
6.2 Laser-Assisted Surgery Before Implant Placement and Implant Exposure 185
6.3 Laser Application During Function 187
6.4 Laser Applications in Peri-implantitis Treatment 188
6.5 Recent Laser Research on Implants 199
6.6 Implant Removal 204
6.7 Laser-Assisted Implant Placement 204
6.8 Future of Laser Dentistry in Oral Implantology 204
7 Photodynamic Therapy in Periodontal and Peri-Implant Treatment 209
Anton Sculean and Georgios E. Romanos
7.1 Biological Rationale 209
7.2 Use of PDT as an Alternative to Systemic or Local Antibiotics 211
7.3 Conclusions 212
8 Understanding Laser Safety in Dentistry 215
Vangie Dennis, Patti Owens and Georgios E. Romanos
8.1 Laser Safety 215
8.2 International Laser Standards 215
8.3 Regulatory Agencies and Nongovernmental Organizations 215
8.3.1 Food and Drug Administration 215
8.3.2 FDA Center for Devices and Radiological Health 216
8.3.3 American National Standards Institute 216
8.3.4 Occupational Safety and Health Administration 216
8.4 State Regulations 218
8.5 Nongovernmental Controls and Professional Organizations 218
8.5.1 American Society for Lasers in Medicine and Surgery 218
8.5.2 Association of periOperative Registered Nurses (AORN) 218
8.6 The Joint Commission (TJC) 218
8.7 Standards and Practice 218
8.7.1 Laser Safety Officer 218
8.8 Hazard Evaluation and Control Measures 219
8.9 Administrative Controls 219
8.10 Procedural and Equipment Controls 219
8.11 Laser Treatment Controlled Area 220
8.12 Maintenance and Service 221
8.13 Beam Hazards 221
8.13.1 Eye Protection 221
8.13.2 Skin Protection 223
8.14 Laser Safety and Training Programs 223
8.15 Medical Surveillance 223
8.16 Nonbeam Hazards 223
8.17 Electrical Hazards 224
8.18 Smoke Plume 224
8.19 Fire and Explosion Hazards 224
8.20 Shared Airway Procedures 225
8.21 Conclusion 226
Appendix A: Suggested Reading 227
Appendix B: Physical Units, Laser Parameters, Physical Parameters, Important Formulas 229
Index 231
