Laser-Assisted
Periodontal Therapy

Soft Tissue Laser-Assisted Class V Composite Restorations:
Written by Dr. Hargrove & published by "Contemporary Esthetics and Restorative Practice" on July 2001.

A myriad of different types of lasers are available on the market for use in dental procedures. All have different strengths and weaknesses. The biolitec 980 nm diode laser, also called The Cosmetic Dental Laser, can be used for cosmetic, general, periodontal, and other soft tissue procedures. It combines the advantages of CO2, Nd:Yag, and argon lasers. Photobiology has identified 980 nm as the optimal wavelength for enhanced tissue absorption in water and hemoglobin [1]. An important distinction of this wavelength is that cutting and coagulation can be performed optically, not thermally. While other wavelengths excel in one area, the 980 nm wavelength can offer the combination of coagulation, precise soft tissue ablation, and controlled depth of penetration, which can provide patients with reduced postoperative pain and swelling with enhanced healing time [1].
  In the author's experience, having implemented the biolitec 980 NM into a high-tech armamentarium and using it daily in procedures such as frenectomy, gingivectomy, sulcular debridement, gingival troughing, and hemostasis-it was more precise than the electrosurge previously used. In the author's opinion, the traditional electrosurge can make it difficult to control the depth of penetration and can create a great deal of collateral thermal damage. A benefit of the 980 NM is that it provides a more durable hemostasis than an electrosurge, which often provides a creme brulee effect. In restoring Class V lesions, complete isolation from crevicular fluid can be very difficult to achieve-especially when the lesion is well below the crest of the free gingival margin. Many times, gingivectomy or gingival contouring will be necessary to gain access or to obtain optimal esthetics.

General Tips to Follow: Anesthesia is not required in many surgical procedures. If the patient is experiencing discomfort and/or pain, one tip is to lower the output energy being used and administer a topical anesthetic. Cooling the area with the central evacuation system held a few millimeters from the surgical site while lasing the proves effective, along with the copious water irrigation of the site being lased. If your patient still experiences pain, an appropriate amount of anesthesia should be administered.
   An important distinction of the 980 NM diode from other lasers is that, in all cases, an activated uncharred fiber should be used with copious water spray. While using the laser in soft tissue procedures, the tip of the fiber accumulates carbon. This accumulation is protein that has been ablated and vaporized by the laser's energy. If allowed to accumulate on the fiber, it will reduce the efficiency of the laser when incising, excising, and coagulating. Another tip is to periodically use a 2 x 2 cotton sponge to wipe the tip and remove excess tissue and carbonization.

Procedure: The following two cases demonstrate the use of this laser to achieve a thoroughly dry field that is devoid of blood or crevicular fluid. In addition, Case I demonstrates enhanced gingival contour, improving the patient's esthetics.
  When performing these procedures, the fiberoptic tip should be held perpendicular to the tissue. Ablation of the tissue can be accomplished using a paintbrush motion. The goal of gingival excision is to vaporize the tissue one layer at a time. Only light pressure should be used when in contact mode, and only 2 mm to 3 mm of the fiber tip should be exposed at the end of the cannula (Figures 2 and 7).

Figure 1. Cervical anomaly of tooth No. 9 causing deviation in contour of gingival free margin; Case I.	Figure 2. Tissue ablation to gain access and to correct contour of tooth No. 9.	Figure 3. Tissue after it is lased, demonstrating the cervical anomaly.
Figure 4. Tissue immediately after it is lased and the composite placed.	Figure 5. Three-day postoperative appearance of the tissue.	Figure 6. Class V lesion on tooth No. 11; Case II.

Case I: Lidocaine 2% 36 mg and epinephrine 1:100,000 0.036 mg were distributed to the patient, who exhibited a cervical anomaly on tooth No. 9 (Figure 1). The tissue was ablated via the 980 NM diode laser (Figure 2), using the Continuous Wave setting with a 0.05/0.05 pulse at 5 W. Copious water irrigation and suction were employed to remove the plume and any excess water. This made the composite restoration area more visible and granted better access for the removal of caries without tearing the free gingival margin (Figure 3). After being lased with the biolitec 980 NM, the tissue did not have charred appearance, which is often created by many Nd:Yag or other diode lasers (Figure 4). This feature is of special interest for today's esthetically-driven practices. Three days after the procedure was completed, the tissue was almost totally healed (Figure 5).

Case II: Lidocaine 2% 36 mg and epinephrine 1:100,000 0.036 mg were distributed to the patient, who exhibited deep cervical caries on tooth No. 11. Caries extended well below the free gingival margin (Figure 6). Tissue was ablated with the diode laser (Figure 7), using a Continuous Wave setting with a 0.05/0.05 pulse at 10 W. Once again, copious water irrigation and suction were employed to remove the plume and any excess water. Figure 8 shows the lased area immediately after Class V lesion was restored with composite. At the 1-week postoperative appointment, the tissue had returned to normal condition (Figure 9).

Figure 7. Tissue ablation to gain access to restore lesion.	Figure 8. Immediate postoperative view after the tissue lased and the restoration placed.	Figure 9. One-week postoperative appearance of tissue.