CLINICAL COMMUNICATION

 

Lasers in Paediatric Dentistry

 

 

R Mulder^I; G Melman^II; V Karic^III

^IBChD(UWC), MSc(Dent)(UWC). Lecturer, Department of Orthodontics and Paediatric Dentistry. University of the Western Cape, Tygerberg, Cape Town, South Africa
^IIBDS(Wits), MSc(Dent)(Wits). Specialist in Paediatric Dentistry (U.K.). Department of Paediatric Dentistry, University of the Witwatersrand, School of Oral Health Sciences, Johannesburg, South Africa
^IIIBDS(Bgd, EU), MSc(Dent)(Wits). Senior Lecturer, Division of Operative Dentistry, University of the Witwatersrand, School of Oral Health Sciences, Johannesburg, South Africa

Correspondence

 

 

INTRODUCTION

Many clinicians will be faced with the un-cooperative paediatric patient presenting at their practices with a "fear of the unknown". Establishing trust with these patients is essential in order to achieve a productive interaction with the child. The hard tissue lasers (Er:YAG and Er,Cr:YSGG) have the advantage of not producing the high pitched sound and vibrations associated with turbines.¹ The 'tell-show-do" method can be used to illustrate the water spray with the lowest possible energy setting of the laser in the paediatric patient's mouth, which may assist in alleviating fear associated with the restorative procedures.

 

A SYNOPSIS OF LASERS IN PAEDIATRIC DENTISTRY

The hard tissue lasers target the water molecules present in the enamel and dentine producing expansive vaporisation. The effect of the hard tissue laser on the tooth and bone constitutes true ablation ie. surgical removal. The rate of ablation of tooth structure during cavity preparation with the laser is comparable to that of the turbine in clinical practice. The hard tissue laser has the advantage of less thermal and mechanical damage to the surrounding tooth structure, compared with the turbine.^2,3

The absorption coefficient of the Er,Cr:YSGG (4000cm-1) is lower than that of the Er:YAG (13000cm-1) for enamel,⁴ however both lasers will allow acceptable clinical parameters for tooth preparation.⁵ The water content of carious dentine is higher (27% -54%) than that of healthy dentine (20%-24%).⁶ Dentinal tubules in primary teeth are anatomically larger in diameter than those found in secondary teeth. Therefore carious dentine in primary teeth will have a faster rate of ablation, which must be taken into consideration when the laser energy parameters are selected for the procedure.

Using the concept of minimally invasive restorative procedures, the erbium and 9300-nm CO₂ lasers allow the operator to remove only diseased tissue, thereby preserving the healthy, unaffected tooth structure. The effect of the CO2 for tooth ablation is limited due to the low interaction with the hydroxyapatite. Erbium lasers also avoid the small microfractures in enamel which are produced with the use of conventional dental handpices.⁷

Diode lasers and the hard tissue lasers can be utilized successfully in various soft tissue procedures including frenectomies, opperculectomies, and exposure of unerupted teeth, gingivoplasties and tissue biopsies.⁸

 

CONCLUSION

The AAPD recognised the use of lasers in paediatric dentistry as a complementary method for soft- and hard tissue procedures in infants, children and patients with special health care needs. The AAPD stated that it is essential that the clinician receive: "didactic, experiential education and training on the use of lasers before applying this technology on paediatric dental patients".⁹

 

ACRONYMS

Er:YAG: Erbium-doped Yttrium Aluminum Garnet

Er,Cr:YSGG: Erbium-Chromium-doped Yttrium Scandium Gallium Garnet

AAPD: American Academy of Paediatric Dentistry

 

References

1. Takamori K, Furukama H, Morikawa Y, Katayama T, Watanabe S. Basic study on vibrations during tooth preparations caused by high-speed drilling and Er:YAG laser irradiation. Lasers Surg Med 2003; 32(1):25-31        [ Links ]

2. Glockner K, Rumpler J, Ebeleseder K, Stadtler P. Intrapulpal temperature during preparation with the Er:YAG laser compared to the conventional burr: an in vitro study. J Clin Laser Med Surg 1998; 16: 153-7        [ Links ]

3. Pelagalli J, Gimbel C B, Hansen R T, Swett A, Winn DW 2nd. Investigational study of the use of Er:YAG laser versus dental drill for caries removal and cavity preparation - phase I. J Clin Laser Med Surg 1997; 15: 109-15        [ Links ]

4. Freiberg R J, Cozean C D. Pulsed erbium laser ablation of hard dental tissue: the effects of atomized water spray versus water surface film. Proc SPIE 2002; 4610: 74-84        [ Links ]

5. Harashima T, Kinoshita J, Kimura Y et al. Morphological comparative study on ablation of dental hard tissues at cavity preparation by Er:YAG and Er,Cr:YSGG lasers. Photomed Laser Surg 2005; 23: 52-5        [ Links ]

6. Le Geros RZ. Calcium phosphate in oral biology and medicine.Monogr Oral Sci 1991; 15:1-201        [ Links ]

7. Olivi G, Margolis FS, Genovese MD. Paediatric Laser Dentistry-A User's Guide. Quintessence International 2011:11:148        [ Links ]

8. Convissar RA. Principles and Practice of Laser Dentistry. 2nd edition. Elsevier. 2016: 182. ISBN: 978-0-323-29762-2        [ Links ]

9. American Academy of Pediatric Dentistry. Policy on the Use of Lasers for Pediatric Dental Patients. Reference Manual 2013; 37(6):79-81        [ Links ]

 

 

Correspondence:
Vesna Karic
Division of Operative Dentistry,
School of Oral Health ,
University of the Witwatersrand, Sciences, Johannesburg.
E-mail: Vesna.Karic@wits.ac.za