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Versatility of an 810 nm Diode Laser in Dentistry: An Overview

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 Journal of Laser and Health Academy
Vol. 2007; No. 4; www.laserandhealth.com

Versatility of an 810 nm Diode Laser in Dentistry: An

Overview
Samo Pirnat
University of Ljubljana, Biotechnical faculty, Ljubljana

Abstract: absorption in chromophores found in soft tissue, e.g.

hemoglobin, resulting in excellent soft tissue incision,
The breakthrough for dental laser systems came in the ablation and coagulation performance as well as
mid 1990's. Among the various laser types with antimicrobial effectiveness, due to relatively deep
corresponding wavelengths, diode laser systems highly localized tissue heating. Hard tissue lasers are
quickly began establishing themselves as compact, highly absorbed in (carbonated) hydroxyapatite and
competitively priced and versatile additions to the water chromophores and are thus able to finely ablate
dentist's repertoire, predominantly for performing soft hard tissues without heating of the surrounding tissue.
tissue applications. Research has shown that near Soft tissue NIR lasers include solid crystal Nd:YAG
infrared (NIR) wavelengths are ideally suited for lasers (1064 nm) and diode lasers (810 nm and 980
numerous soft tissue procedures due to their high nm).
absorption in hemoglobin. This fact gives NIR laser
the ability to precisely and efficiently cut, coagulate,
Among the various lasers appearing in the mid 1990s,
ablate or vaporize the target tissue. The added
semiconductor diode lasers also made their debut.
advantage of laser performed surgical procedures is the
With several advantages, including their small size,
sealing of small blood and lymphatic vessels, resulting
price range and versatility regarding the possible
in hemostasis and reduced post-operative edema,
treatment applications, the diode lasers represent a
disinfection of target tissue due to local heating and
valuable addition to the dentist's repertoire.
production of eschar layer and decreased amount of
scarring due to decreased post-operative tissue
shrinkage. Among the available NIR wavelengths, Diode lasers can be used for a multitude of dental
research has shown the wavelengths around 810 nm to procedures which are predominantly soft tissue
be one of the most versatile with regard to the number procedures and include soft tissue surgery [1, 2, 3],
of possible treatment options, as this wavelength range periodontal pocket therapy [4, 5], peri-implantitis [6],
can be effectively used in the field of soft tissue but can also be used for certain applications involving
surgery, periodontics, endodontics, implantology and hard tissue (teeth), i.e. endodontics - root canal
tooth whitening. The versatility of the instrument, disinfection [7, 8, 9] and laser-assisted tooth whitening
combined with the latest achievements in diode laser [10]. The ability to perform the aforementioned
technology, compact design and affordability, should procedures depends on the appropriate technical
appeal to dental professionals seeking to optimize the characteristics, which the diode must posses. The most
procedures they currently perform and expand the important characteristic is the wavelength of the diode
number of services they offer. laser used as the wavelength determines how the laser
light will interact with the target tissue (absorption in
Key words: laser; diode; diode lasers; dentistry; soft the appropriate tissue chromophores, penetration
tissue; 810 nm depth into the tissue etc.). To date, research has shown
that NIR (near infrared) laser light around 810 nm to
be one of the most versatile wavelength ranges in
INTRODUCTION diode lasers available to the dentist with regard to the
number of different treatments it can be used for.
Other characteristics which also need to be considered
Even though Theodore Maiman had exposed an
include maximum power available to the user
extracted tooth to his ruby laser in 1960, the
(available power determines the number of procedures
breakthrough for lasers in the field of the dentistry
which can be done and the speed with which they can
came in the mid 1990s, with various laser types
be done), the way the laser beam can be modulated
(Nd:YAG, Er,Cr:YSGG, Er:YAG, CO2) with
(CW – continuous wave, pulsed mode) and the mode
corresponding wavelengths (1064 nm, 2780 nm, 2940
of delivery of the laser beam.
nm, 10600 nm) becoming available to the dentists to
address their needs for hard and soft tissue procedures.
Soft tissue NIR lasers are characterized by a high

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 Versatility of an 810 nm Diode Laser in Dentistry: An Overview

LLLT procedures.
OVERVIEW OF TECHNICAL The design of diode laser systems also brings several
CHARACTERISTICS OF A DIODE LASER advantages with it. Already mentioned was the small
size of the laser system, which can be of great benefit
as it means the device will take up very little office
Basic Design of a Diode Laser
space and assures great portability of the laser system
due to its low weight. Also mentioned was the
One of the advantages of diode lasers in comparison
attractive price range of diode lasers, which makes
to other laser systems, which is immediately apparent
them accessible to a wide range of dental professionals,
to the naked eye, is their size. The development of
who want to perform current procedures faster and
micro-structure diode cells which are capable of
more efficiently and wish to expand the services
emitting laser light has drastically reduced the bulk of
currently offered in their practice. Other benefits
laser systems. The latest dental diode lasers have been
include a very short time (usually a couple of seconds)
designed to have dimensions similar to a standard
in which the laser treatment beam is available to the
phone [Fig. 1].
user after switching the system on. Other laser systems
generally need a couple of minutes to reach the ready
status. Also, diode lasers consume very little power
when compared to other laser systems, thus saving the
user money and contributing to the protection the
environment. Another important aspect to consider is
the widespread use and the reliability of diode laser
technology, with more than 40 million pieces produced
annually which are being used in devices ranging from
DVD-players and laser pointers to state of the art
dental diode lasers.

Fig. 1 Dental diode laser system (Fotona XD-2)

Only solid material active media (e.g. GaAlAs –

Gallium Aluminum Arsenide) is used in diode lasers. Fig. 2 Simplified schematic outline of a typical diode laser
Because of the crystalline nature of the active medium,
the ends of the crystal can be selectively polished Laser light emission modes
relative to internal refractive indices to produce totally
and partially reflective surfaces thus serving the same Lasers are said to be running in either continuous wave
function as the optical resonators of larger laser (CW) or pulsed mode. This relates to the rate of
systems. The discharge of current across the active emission of laser light with time and the prime benefit
medium releases photons from the active medium, of a pulsed mode will be the capacity of the target
finally resulting in the generation of laser light of a tissue to cool between successive pulses. The CW
specific wavelength, which is determined by the active mode is generally the fastest way to ablate tissues but
medium used [Fig. 2]. heat can build up and cause collateral damage to the
At the present, each diode "chip" produces relatively target and adjacent tissues. Modern dental diode lasers
low-energy output. Some low power diode lasers, can operate in both CW and pulsed mode. The factors
operating in milliwatt range, are usually being that determine the average power when the diode laser
advertised for low level laser therapy (LLLT). In order is operating in pulsed mode are the current power
to achieve the power necessary for various dental setting and the duty cycle setting. Duty cycle is a
procedures (e.g. soft tissue surgery), today's dental periodic phenomenon defined as the ratio of the
diode lasers employ banks of individual diode chips in duration of the phenomenon (pulsewidth) in a given
parallel to achieve the appropriate power levels (several period to the period (reciprocal value of the current
watts). Some dental diode lasers can also be set to frequency setting - number of pulses per second). To
lower power (milliwatt range) and can also perform clarify the previous statement, consider a following

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 Journal of Laser and Health Academy
Vol. 2007; No. 4; www.laserandhealth.com

example – when the diode is set to CW mode and the the transfer of electromagnetic energy [11]. Light
power is set to 2 W, the system will emit an average energy interacts with a target medium (e.g. oral tissue)
power of 2 W per second. When operating in pulsed in one of four ways [12] [Fig. 3]:
mode, a power setting of 2 W and the duty cycle set to
½ will result in an average power emission of 1 W per Transmission
second. Laser beam enters the medium and emerges distally
It is important to familiarize oneself with the various without interacting with the medium. The beam exits
average and peak powers that can be achieved when either unchanged or partially refracted.
using different emission mode settings of the laser
system in order to achieve an optimal transfer of the Reflection
energy from the laser beam to the target tissue, When either the density of the medium or angle of
resulting in a desired therapeutic effect. incidence are less than the refractive angle, total
reflection of the beam will occur. The incident and
Laser light Delivery to the Target Tissue emergence angles of the laser beam will be the same
for true reflection or some scatter may occur if the
Most dental diode lasers employ a flexible optic fiber medium interface is non-homogenous or rough.
(usually inserted into an appropriate handpiece for
comfortable handling) to deliver the treatment beam to Scatter
the desired area. There are a number of things to There is interaction between the laser beam and the
consider when using an optic fiber. When using medium. This interaction is not intensive enough to
parameters mentioned in application notes or in cause complete attenuation of the beam. Result of light
research papers, always note the diameter of the fiber scattering is a decrease of laser energy with distance,
described in those papers. Using a smaller diameter together with a distortion in the beam (rays travel in an
fiber will increase the power density at the fiber tip. As uncontrolled direction through the medium).
a result, you may need to decrease the power setting.
Increasing the power may be required when using a Absorption
larger diameter fiber. As a rule of thumb, in order to The incident energy of the laser beam is attenuated by
achieve the same rate of work after changing fiber the medium and converted into another form. With
diameters, a smaller diameter fiber will require less the use of dental diode lasers, the most common form
power and conversely, a larger diameter will require of conversion of laser energy is into heat or, in the case
more power. Another thing to keep in mind is the of very low energy values, biomodulation of receptor
speed of movement of the fiber tip during treatment. tissue sites seems to occur [13, 14]. Heat transfer
Tissue charring is an undesirable side effect of too mediated physical change in target tissue is termed
much power and/or the tip moving too slowly. Always photothermolysis.
use the least amount of power necessary to complete
your procedure and move the fiber tip using short 1-2
mm "paint brush" type strokes and move quickly when
working on soft tissue. Finally, regularly check the
condition of the optical fiber. Always cleave the fiber
tip after it becomes blackened (2-4 mm from the tip),
because tissue debris accumulate on the tip during
surgery and this causes the fiber tip to retain extreme
heat and begins to act as a "branding iron". This can
lead to unwanted tissue heating and can lead to rapid
tip deterioration and subsequent breakage. It is also
important to properly cleave the fiber so that no shard
is present on the fiber tip, as it may act as a miniature Fig. 3 Possible laser light - tissue interactions
scalpel and damage the small blood vessels, thus
interfering with hemostasis and coagulation.
Absorption
LASER – TISSUE INTERACTIONS
In any desired laser-tissue interaction, the goal is to
The basics achieve the maximum absorption of laser light by the
target tissue, as this will allow maximal control of the
In clinical dentistry, laser light is used to effect resultant effects.
controlled and precise changes in target tissue, through

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 Versatility of an 810 nm Diode Laser in Dentistry: An Overview

Absorption is determined by matching incident laser [18] (when using equal power settings for the
beam energy (wavelength) to the electron shell energy mentioned lasers).
in target atoms. Absorption of laser energy in the
target tissue leads to generation of heat and rising heat
levels lead to dissociation of covalent bonds (in tissue
proteins), phase transfer from liquid to vapour (in
intra- and inter-cellular water), onto phase transfer to
hydrocarbon gases and production of residual carbon
[15]. Secondary effects can occur because of heat
generation (through conduction).

When predicting the conversion of electromagnetic

energy to heat effects in target tissue, unwanted change
through conductive thermal spread must be taken into
account and reduced to lowest possible level. The
ability to control a progressively increasing heat
loading of target tissue is termed as thermal relaxation
[16]. Thermal relaxation rates are proportional to the Fig. 4 Absorption coefficients of various tissue
area of tissue exposed and inversely proportional to chromophores relative to laser wavelength
the absorption coefficient of the tissue, assuming fixed
values of thermal and light diffusivity for the tissue in Incident Angle of Laser Beam
question.

Maximum control of laser-tissue interaction can be

Factors Associated with Absorption and Thermal achieved if the incident laser beam is perpendicular to
Relaxation the tissue surface. Reducing the incident angle towards
the refractive angle of the tissue surface will increase
the potential for true light reflection with an associated
Some of the more important factors that affect the reduction in tissue change [19].
thermal relaxation of the target tissue and absorption
of laser light by the target tissue (separately and/or
collectively) [17] are: Exposure time and Laser Emission Mode

Laser Wavelength and Tissue Composition Pulsing of laser light delivery will allow some cooling
to occur in-between pulses.
Parts of the tissue that absorb laser light energy are
termed chromophores. Oral tissues contain several Beam diameter and beam movement
chromophores: hemoglobin, melanin and other
pigmented proteins, (carbonated) hydroxyapatite and As laser light exits the optic fiber, divergence of the
water. The absorption coefficients for the listed beam will occur. Consequently, the spot size of the
chromophores with regard to the wavelengths used in beam (relative to the target tissue) will determine the
dental lasers is shown in Fig. 4. Generally, pigmented amount of laser energy (fluence – J/cm2) being
tissues will better absorb visible or NIR wavelengths, delivered over an area [20]. The spotsize will increase
whereas non-pigmented tissues absorb longer with increasing distance (optic fiber – target tissue).
wavelengths. In addition, absorption peaks of water Therefore, thermal changes at the target site can be
and hydroxyapatite coincide for example with effectively controlled by modifying the amount of
Er:YAG. energy delivered to the target site via moving the
handpiece closer or farther from the target site. To
Water as a constituent of every living cell will influence summarize, for any chosen power setting, the smaller
the penetration of longer wavelength laser light into the beam diameter, the greater the concentration of
the tissue, whilst non-pigmented surface components heat effects.
will enable greater penetration for visible or NIR
wavelengths. For example, a CO2 laser might penetrate Faster laser beam movement will also reduce heat
the oral epithelium to a depth of 0.1-0.2 mm whilst build-up in the target tissue and aid thermal relaxation.
NIR wavelengths can result in penetration of 4-6 mm

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 Journal of Laser and Health Academy
Vol. 2007; No. 4; www.laserandhealth.com

Coolants relaxation potential, which can lead to disastrous

effects on dental hard tissue [25, 26]. In contrast, both
erbium lasers can reach high peak powers due to their
Coolants can control or limit the temperature rise of
pulsed emission modes and have relatively high
target and associated tissues. Coolants can be either
absorption in water. High peak powers combined with
endogenous (e.g. blood flow) or exogenous (e.g. air,
high absorption in water effectively results in an
water, pre-cooling of tissue).
instant vaporization of the water content in enamel
and dentin, leading to explosive dissociation of the
NIR Laser light and Soft Tissue Cutting tissue and ejection of micro-fragments, resulting in
precise tissue ablation. Both lasers also employ co-axial
When correct parameters are used, a central zone of water sprays, which help to disperse the ablated tissue
tissue ablation is surrounded by an area of irreversible and cool the target [27]. The result is the ability to
protein denaturation (coagulation, char). Around this selectively ablate carious dental tissue due to higher
central zone, a reversible, reactionary zone of edema water content when compared to healthy enamel and
will develop along a thermal gradient. Ideally, the dentin. Additionally, pulpal temperature rise is minimal
incision line will equal the beam diameter. Heat build- when using erbium laser wavelengths and therefore has
up will also disinfect the targeted and surrounding area less potential to cause thermal damage to the pulp
and the production of a surface coagulum discourages when compared to rotary instrumentation [28]. Of the
bacterial contamination of the wound. When using two erbium laser, the Er:YAG appears to be better
NIR lasers on soft tissue there is minimal or no suited for hard dental tissues. Er:YAG wavelength has
bleeding due to a combination of sealing of small a higher absorption coefficient for water (13,000/cm
vessels through tissue protein denaturation and for Er:YAG vs. 4,000/cm for Er,Cr:YSGG), resulting
stimulation of Factor VII production in clotting. The in a more efficient ablation of dental hard tissue. For
heat buildup also allows for the sealing of small example, the ablation threshold for enamel is 9-11
lymphatic vessels which results in a reduced post- J/cm2 for Er:YAG and 10-14 J/cm2 for Er,Cr:YSGG
operative edema. Suturing is usually not necessary also [29]. The precise mode of action of Er,Cr:YSGG laser
due to the surface coagulum. The formation of scar on dental hard tissue is another contested issue -
tissue should be minimal due to reduced post- claims have been made as to the involvement of the
operative tissue shrinkage [1, 3, 21]. atomized water spray, used with the Er,Cr:YSGG
("hydrokinetic effect") [30]. The hypothesis is that
water droplets axial to the laser beam absorb kinetic
When comparing NIR lasers - the Nd:YAG (1064 nm) energy. The droplets are then accelerated and help with
and diode lasers (805 nm, 810 nm), the mentioned hard tissue ablation. Research into this effect has
wavelengths have a similarly high absorption in soft questioned the validity of such claims and as
tissue which translates into excellent incision previously mentioned, with comparable incident
performance and coagulation of tissue [22, 23]. energies, the ablation rate of the Er, Cr:YSGG for
enamel is slightly slower than that of Er:YAG [31].
NIR Laser light and Hard Tissue The Er:YAG is also superior to Er, Cr:YSGG with
regard to heat produced with laser ablation of bone
[32]. Higher water content and lower density of bone
NIR wavelengths have little absorption in dental hard compared to enamel allows faster cutting, through
tissue and have the potential to cause thermal cracking dislocation of hydroxyapatite and cleavage of the
and amorphous change in the hydroxyapatite crystal collagen matrix. The relative ease of bone cutting
structure. Additionally, they can also have a deleterious establishes the Er:YAG wavelength as the preferred
effect on pulp tissue due to the intra-pulpal choice when compared to other laser wavelengths.
temperature rise because of relatively high
transmission of NIR wavelengths through enamel and
dentin [24]. CLINICAL APPLICATIONS

From the clinician's viewpoint, two wavelengths have "Loose" Soft-Tissue Surgery with the 810 nm
the ability to effectively interact with dental hard tissue, Diode Laser
Er:YAG (2940 nm) and Er,Cr:YSGG (2780 nm).
Another wavelength which was tested on dental hard Applications include the removal of fibromata, labial
tissues was the CO2 laser, but the laser's CW and gated and lingual frenectomies, small hemangiomata,
CW emission modes render its power output low and mucocele, denture granulomata, treatment of non-
have a significantly negative impact on the thermal erosive lichen planus, aphthae and herpes lesions [3,

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 Versatility of an 810 nm Diode Laser in Dentistry: An Overview

33, 34]. The etiology of the lesion should be assessed attached to the tooth), minimum 3 mm in depth,
and as with a scalpel, the abnormal tissue should be which will help to maintain gingival margin stability,
placed under tension to enable accurate cleavage alveolar bone height and health and prevent
(whenever possible). With regard to diode laser overgrowth [37, 38, 39]. Power settings of 1.5-3.0 watts
surgery, the laser handpiece tip is generally held very with intervals should be optimal for most, if not all
close to the tissue surface. This allows the laser energy gingival procedures [36]. Again care must be taken to
to effect the incision and minimizes the build-up of avoid thermal damage to the underlying periosteum
debris on the tip, which can lead to unwanted thermal and bone, together with root surface at gingival margin
damage to the tissue. For most minor intra-oral levels. Therefore assessment of the thickness,
surgical procedures, the recommended average power vascularity and position of any target gingival tissue,
setting is in the range of 2-4 W [33]. together with an assessment of adjacent bone and
tooth tissue, is recommended. Also, to minimize the
buildup of carbonized debris, post-ablation tissue
As was already mentioned, the 810 nm wavelength
should be discarded using a curette, damp cotton wool
diode laser transverses the epithelium and penetrates 2
or gauze [36].
– 6 mm into the tissue. When laser cutting is in
progress, small blood and lymphatic vessels are sealed
due to the generated heat, thereby reducing or Periodontal Therapy with the 810 nm Dental
eliminating bleeding and edema. Denatured proteins Diode Laser
within tissue and plasma are the source of the layer
termed "coagulum" or "char", which is formed
The main use for the 810 dental diode laser in the
because of laser action and serves to protect the
periodontal therapy is the removal of diseased pocket
wound from bacterial or frictional action. Clinically,
lining epithelium and disinfection of periodontal
during 48-72 hours post-surgery, this layer becomes
pockets. Optic fiber delivery systems, with 200-320 µm
hydrated from saliva, swells and eventually
fiber diameters, enable extremely easy access into the
disintegrates to later reveal an early healing bed of new
periodontal pocket. After hard and soft deposits have
tissue [33].
been removed through scaling and/or root-planing,
the pocket architecture is re-assessed, with emphasis
Care must be taken when working near anatomical on the depth. The fiber is then measured to a distance
sites that might be damaged through excessive power of one to two millimeters short of the pocket depth
values [35]. For example, excessive power settings and is inserted at an angle to maintain contact with the
might cause thermal damage to the underlying soft tissue wall at all times. The fiber is then used in
periosteum and bone. Damage to these anatomical light contact, sweeping mode to cover the entire soft
sites can be avoided by using appropriate (lower) tissue lining. Power setting of 0.8-1 W should suffice
power levels, keeping the laser beam parallel to and to ablate the epithelial lining. Start with the ablation
away from the underlying bone and employing proper near the base of the pocket and slowly proceed
irradiation time intervals to allow sufficient tissue upwards. Often some bleeding of the pocket site will
cooling [33]. occur, possibly due to damage to the inflamed pocket
epithelium, but in terms of laser hemostasis, the power
levels used are low and aimed at removing the
"Fixed" Soft-Tissue Surgery with the Diode Laser
epithelial surface and disinfecting the pocket [4, 5, 40].
The fiber tip should be regularly inspected and cleaned
The 810 nm diode laser can be used for numerous with a damp sterile gauze or cleaved in order to
"fixed" soft tissue procedures including gingival prevent the buildup of debris on the fiber tip. The
hyperplasia, tooth exposure and hyperpigmentation. treatment time per pocket should be around 20-30 s,
Additionally, there is a range of gingival adaptation amounting possibly to 1-2 minutes per tooth site. Re-
procedures, both to allow restorative procedures and treatments should follow at weekly intervals during the
to allow access to restorative margins during maximum four week period. Pocket probing and
restorative procedures [36]. The laser energy will act measurement to establish benefits of treatment is not
primarily as a means of incision, excision or ablation, advised during this period [40]. With regard to the
with the same advantages over the scalpel that were disinfection of periodontal pockets, studies [4, 41] have
mentioned previously (no or minimal bleeding, no shown the effectiveness of diode laser in eliminating
sutures, less chance for infection of the wound). When bacteria commonly implicated in periodontal disease
possible, any laser surgical procedure in and around and bone loss (e.g. Actinobacillus actinomycetemcomitans,
the gingival cuff should seek to preserve a biological Porphyromonas gingivalis). When using the diode laser,
width (the zones of connective and epithelial tissues care must be taken to avoid unwanted heating, both of

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 Journal of Laser and Health Academy
Vol. 2007; No. 4; www.laserandhealth.com

the tooth and periodontal attachment apparatus. reaches over 1 mm deep into the dentin [9], surpassing
Without tactile feedback, coupled with the "blind" the effective range of chemical disinfectants, such as
treatment of non-reflected periodontal flaps, caution is NaOCl and displaying moderate effectiveness against
paramount and a thorough diagnosis of the diseased Enterococcus faecalis even in the deeper layers of dentin.
periodontium must be obtained prior to laser use [40]. The procedure can be carried out by drying the root
canal with sterile paper tips enlarging the root canal
opening up to ISO 30. After measuring the canal
Using the 810 nm Dental Diode Laser in
depth, the optic fiber should be inserted in the
Implantology and Endodontics
prepared root canal down to the apex - in no case
further. The optic fiber is then led in slow, circular,
In implantology, the 810 nm dental diode laser can be spiral-forming movements from the apical to the
used for second stage implant recovery and the coronal part, while the laser is activated. The
treatment of peri-implantitis. procedure should be repeated four times for five
seconds. Be cautious to always keep the fiber-optic
In second stage implant recovery care must be beam delivery tip moving when the laser is activated to
exercised to avoid contact with the implant body. Soft avoid excessive temperature rise on the tooth surface,
tissue ablation leads to precise and predictable healing which can be detrimental to the tissues surrounding
and the procedure can usually be performed with the the tooth. If necessary, repeat the laser treatment after
use of a topical anesthetic. The appropriate power three to seven days, but not more than twice in total.
setting for the removal of gingival tissue overlying the The power should be set in the range of 1-1.5 W [9,
implant cover screw is 1-2 W. The advantages of using 47].
a diode laser to perform this procedure are easier
visual access to the cover screw due to hemostasis and Teeth Whitening using the 810 nm Dental Diode
the production of the protective coagulum to aid in Laser
healing and patient comfort [42].
Teeth whitening procedures continue to grow in
Peri-implantitis is described as one of the most popularity due to the increased desire for whiter teeth
important causes of implant loss and is not restricted with increasing number of articles being published on
to any one type of implant design or construction [43, the subject in the popular press and on television in
44]. It can be recognized as a rapidly progressive regular intervals. This has resulted in renewed interest
failure of osseo-integration [45], in which the from the dental profession in the process of teeth
production of bacterial toxins leads to inflammatory whitening, as the procedure itself is relatively simple
change and bone loss [46]. Always, an assessment must and non-invasive to carry out. Current bleaching
be made to determine the causative factors associated systems are based primarily on hydrogen peroxide
with the condition (infection, implant overloading, (HP) or carbamide peroxide (CP). These bleaching
occlusion and other local, systemic and life-style systems usually exist in a form of a gel which is applied
factors), to establish whether the implant can be saved on the tooth surface and activated via light, for
[42]. Curettage of granulation tissue is especially example. Activation of HP causes formation of free
important. Research has shown that a diode laser can radical ions, which immediately seek available targets
be used to perform the procedure with the added to react with. Long-chained molecules that "stain" the
bonus of disinfecting the treated area. Use of tooth react with the free radicals, altering the optical
appropriate coolant (eg. water spray) is needed to structure of the molecule and creating a different
avoid any detrimental heat effects to the surrounding optical structure. The stain on the tooth surface
tissues [42, 6]. Effective power range is from 1-1.5 W disappears, or the large molecules become virtually
[6]. dissociated into smaller, shorter chained molecules,
giving the tooth surface a brighter appearance. 810 nm
In endodontics, published papers [7, 8, 9] indicate the laser light also generates heat on the tooth surface. In
effectiveness of the diode laser root canal treatment order to prevent excessive conduction of heat to the
(disinfection of the root canal), with slightly inferior pulp and avoid pulpal necrosis, proper laser power
bactericidal performance against Enterococcus faecalis must be used and according to the recently published
when compared to a solid-state NIR Nd:YAG laser research, an up to 2 W setting should be well within
system [9]. The fine diameters of optic fibers (200-320 safety margins with regard to the pulp tissue as well as
µm) enable effective delivery of laser light to the root being high enough to accelerate the bleaching process
canal to help with reduction of bacterial by causing the breakdown of the HP gel to reactive
contamination. The antibacterial effect observed free radicals that penetrate the tooth to cause the

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 Versatility of an 810 nm Diode Laser in Dentistry: An Overview

oxidation of stain molecules within the tooth structure efficiency and safety with which the procedures can be
[10]. One thing to keep in mind with regard to the performed. When the Nd:YAG laser is incorporated
parameters in the aforementioned study [10] is the fact within a solid crystal Er:YAG laser system, the cost of
that no spot size was mentioned, making energy this additional solid crystal Nd:YAG laser wavelength
density (fluence) impossible to calculate. Therefore is not very high. However, when considering buying
manufacturer's instructions should be carefully only a single soft tissue laser, then an 810 diode laser
examined with regard to the proper spot size and may be the second best choice due to its lower price
power settings when performing the procedure. and smaller size. If the clinician's main use for the laser
system lies in soft tissue procedures then the 810 nm
dental diode laser undoubtedly represents a worthwhile
CONCLUSION
investment.

In conclusion, research has proven that the 810 nm is

REFERENCES
the premier wavelength available in today's dental
diode laser systems when considering the versatility of 1. Goharkhay K, Moritz A, Wilder-Smith P, Schoop U,
the system. It can be used for a variety of procedures Kluger W, Jakolitsch S, Sperr W. Effects on oral soft tissue
produced by a diode laser in vitro. Lasers Surg Med. 1999;
which are routinely carried out in a modern dental 25(5): 401-406.
practice, including a multitude of soft tissue 2. Crippa R, Calcagnile F. The Use of Laser Technology for
procedures, such as soft tissue surgery, periodontal Submandibular Calculosis: A Case Report. J Oral Laser
therapy as well as being an efficient tool for use in Applications 2003; 3: 173-176
3. Stubinger S, Saldamli B, Jurgens P, Ghazal G, Zeilhofer HF.
implantology, endodontics and tooth whitening. When Soft tissue surgery with the diode laser-theoretical and
compared to "classical" dental techniques, the 810 nm clinical aspects. Schweiz Monatsschr Zahnmed. 2006; 116(8):
dental laser offers distinctive advantages, such as the 812-820
ability to cut, coagulate, ablate or vaporize target tissue 4. Moritz A, Schoop U, Goharkhay K, Schauer P,
elements, enabling dry-field surgery through the sealing Doertbudak O, Wernisch J, Sperr W. Treatment of
periodontal pockets with a diode laser. Lasers Surg Med.
of small blood vessels (hemostasis), disinfection of the 1998;22(5):302-311.
tissue, reduced post-operative edema (through the 5. Kreisler M, Al Haj H, d'Hoedt B. Clinical efficacy of
sealing of small lymphatic vessels) and decreased semiconductor laser application as an adjunct to
amount of scarring, contributing to faster and more conventional scaling and root planing. Lasers Surg Med.
2005 Dec; 37(5): 350-355.
effective treatment resulting in improved treatment 6. Maiorana C, Salina S, Santoro F. Treatment of Periimplantitis
outcome and increased patient comfort and with Diode Laser: A Clinical Report. J Oral Laser
satisfaction. Applications 2002, 2: 121- 127
7. Moritz A, Gutknecht N, Schoop U, Goharkhay K,
Doertbudak O, Sperr W. Irradiation of infected root canals
The main limitation of the 810 nm diode laser is its with a diode laser in vivo: results of microbiological
lack of ability to perform hard tissue procedures (e.g. examinations. Lasers Surg Med. 1997; 21(3):221-226.
cavity preparation, bone cutting). The currently 8. Gutknecht N, Alt T., Slaus G, Bottenbergd P, Rosseel P,
Lauwers S, Lampert F. A Clinical Comparison of the
optimal solution for such procedures appears to lie in Bactericidal Effect of the Diode Laser and 5% Sodium
the use of an 2940 nm Er:YAG laser. Additionally, the Hypochlorite in Necrotic Root Canals. J Oral Laser
current technology limits the available peak powers Applications 2002; 2: 151-157
when compared to solid-state lasers, such as the solid 9. Schoop U, Kluger W, Moritz A, Nedjelik N, Georgopoulos
A, Sperr W. Bactericidal effect of different laser systems in
crystal Nd:YAG laser. The inherent CW emission the deep layers of dentin. Lasers Surg Med. 2004; 35(2): 111-
mode of the diode lasers means that peak powers 116.
cannot be used as effectively as is the case with 10. Sulieman M, Rees JS, Addy M. Surface and pulp chamber
Nd:YAG lasers, which can have an inherent pulsed temperature rises during tooth bleaching using a diode laser:
emission mode and have a wide variety of available a study in vitro. Br Dent J. 2006 Jun 10; 200(11): 631-634;
11. Knappe V, Frank F, Rohde E. Principles of lasers and
pulse widths. The solid crystal Nd:YAG laser has a biophotonic effects. Photomed Laser Surg 2004; 22: 411-417.
special position among soft tissue lasers. It is capable 12. Ball K A. Lasers: the perioperative challenge. 2nd ed. P. 14-
to deliver energy in short bursts with approximately 17. St Louis: Mosby-Year Book, 1995.
1000 times higher intensities compared to those of 13. Kujawa J, Zavodnik L, Zavodnik I, Buko V, Lapshyna A,
Bryszewska M. Effect of low- intensity (3.75-25 J/cm2) near-
diode lasers. In addition, the Nd:YAG laser infrared (810 nm) laser radiation on red blood cell ATPase
wavelength has the most homogeneous (2 to 3 mm) activities and membrane structure. J Clin Laser Med Surg.
penetration into the oral tissue. For this reason, the 2004 Apr;22(2):111-117.
combination of solid state lasers such as an 1064 nm 14. Kujawa J, Zavodnik L, Zavodnik I, Bryszewska M. Low-
Nd:YAG and an 2940 nm Er:YAG might represent a intensity near-infrared laser radiation-induced changes of
acetylcholinesterase activity of human erythrocytes. J Clin
nearly optimal choice when considering the spectra of Laser Med Surg. 2003 Dec;21(6):351-355.
possible soft and hard tissue treatment options and the 15. Moshonov J, Stabholz A, Leopold Y, Rosenberg I, Stabholz

8
 Journal of Laser and Health Academy
Vol. 2007; No. 4; www.laserandhealth.com

A. Lasers in dentistry. Part B – interaction with biological Irradiation vs a Pharmaceutical Method (5-year Study). J Oral
tissues and the effect on the soft tissues of the oral cavity, Laser Applications 2004, 3: 191 – 209
the hard tissues of the tooth and the dental pulp. Refuat 35. Spencer P, Cobb C M, Wieliczka D M, Glaros A G, Morris P
Hapeh Vehashinayim 2001; 18: 21-28, 107-108. J. Change in temperature of subjacent bone during soft
16. van Gemert M J, Lucassen G W, Welch A J. Time constants tissue laser ablation. J Periodontol 1998; 69: 1278-1282.
in thermal laser medicine: II. Distributions of time constants 36. Parker S. Lasers and soft tissue: 'fixed' soft tissue surgery. Br
and thermal relaxation of tissue. Phys Med Biol 1996; 41: Dent J. 2007 Mar 10; 202(5): 247-53.
1381-1399. 37. Lanning S K, Waldrop T C, Gunsolley J C, Maynard J G.
17. Dederich D N. Laser/tissue interaction: what happens to Surgical crown lengthening: evaluation of the biological
laser light when it strikes tissue? J Am Dent Assoc 1993; 124: width. J Periodontol 2003; 74: 468-474.
57-61. 38. Gracis S, Fradeani M, Celletti R, Bracchetti G. Biological
18. Ball K A. Lasers: the perioperative challenge. 2nd ed. P. 19. integration of aesthetic restorations: factors influencing
St Louis: Mosby-Year Book, 1995. appearance and long-term success. Periodontol 2000. 2001;
19. Gaspar L, Kasler M, Orosz M. Effect of CO2 laser beam 27: 29-44.
angle of incidence in the oral cavity. J Clin Laser Med Surg 39. Adams T C, Pang P K. Lasers in aesthetic dentistry. Dent
1991; 9: 209-213. Clin North Am 2004; 48: 833- 860, vi.
20. Myers T D, Murphy D G, White J M, Gold S I. Conservative 40. Parker S. Lasers and soft tissue: periodontal therapy. Br Dent
soft tissue management with the low-powered pulsed J. 2007 Mar 24; 202(6): 309-315.
Nd:YAG dental laser. Pract Periodont Aesthet Dent 1992; 4: 41. Moritz A, Gutknecht N, Doertbudak O, Goharkhay K,
6-12 Schoop U, Schauer P, Sperr W. Bacterial reduction in
21. Fisher S E, Frame J W, Browne R M, Tranter R M. A periodontal pockets through irradiation with a diode laser: a
comparative histological study of wound healing following pilot study. J Clin Laser Med Surg. 1997 Feb;15(1):33-37.
CO2 laser and conventional surgical excision of canine 42. Parker S. Surgical laser use in implantology and endodontics.
buccal mucosa. Arch Oral Biol 1983; 28: 287-291. Br Dent J. 2007 Apr 14; 202 (7):377-386.
22. Rastegar S, Motamedi M, Jacques SL, Kim MB. Theoretical 43. Martins MC, Abi-Rached RS, Shibli JA, Araujo MW,
analysis of equivalency of high-power diode laser (810 nm) Marcantonio E Jr. Experimental peri-implant tissue
and Nd:YAG laser (1064 nm) for coagulation of tissue. breakdown around different dental implant surfaces: clinical
Predictions for prostate coagulation. [Proceedings of the and radiographic evaluation in dogs. Int J Oral Maxillofac
Laser-Tissue Interaction 111. 21-24 Jan (1992). Los Angeles] Implants 2004; 19: 839-848.
Washington, Soc of Photo-Optical Instrumentation 44. Shibli JA, Martins MC, Lotufo RF, Marcantonio E Jr.
Engineers. Microbiologic and radiographic analysis of ligature induced
23. Millard MJ, Matthews L, Aronoff BL, Hults D. Soft Tissue peri-implantitis with different dental implant surfaces. Int J
Studies With 805 nm Diode Laser Radiation: Thermal Oral Maxillofac Implants 2003; 18: 383-390.
Effects With Contact Tips and Comparison With Effects of 45. Mombelli A. Etiology, diagnosis, and treatment
1064 nm Nd:YAG Laser Radiation. Lasers Surg Med 1993; considerations in peri-implantitis. Curr Opin Periodontol
13:528–536. 1997; 4: 127-136.
24. Allen D J. Thermal effects associated with the Nd/YAG 46. Leonhardt A, Renvert S, Dahlen G. Microbial findings at
dental laser. Angle Orthod 1993; 63: 299-303. failing implants. Clin Oral Implants Res 1999; 10: 339-345.
25. Launay Y, Mordon S, Cornil A, Brunetaud J M, Moschetto 47. Gutknecht N, Franzen R, Meister J, Wanweersch L, Mir M.
Y. Thermal effects of lasers on dental tissues. Lasers Surg Temperature evolution on human teeth root surface after
Med 1987; 7: 473-477. diode laser assisted endodontic treatment. Lasers Med Sci.
26. Anic I, Dzubur A, Vidovic D, Tudja M. Temperature and 2005 Sep; 20(2):99-103.
surface changes of dentine and cementum induced by CO2
laser exposure. Int Endod J 1993; 26: 284-293.
27. Hoke J A, Burkes E J Jr, Gomes E D, Wolbarsht M L.
Erbium: YAG (2.94 mum) laser effects on dental tissues. J
Laser Appl 1990; 2: 61-65.
28. Rizoiu I, Kohanghadosh F, Kimmel A I, Eversole L R.
Pulpal thermal responses to an erbium,chromium:YSGG
pulsed laser hydrokinetic system. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 1998; 86: 220-223.
29. Apel C, Meister J, Ioana R S, Franzen R, Hering P,
Gutknecht N. The ablation threshold of Er:YAG and
Er:YSGG laser radiation in dental enamel. Lasers Med Sci
2002; 17: 246-252.
30. Riziou I, Kimmel A. Atomized fluid particles for
electromagnetically induced cutting. US Patent 5,741,247.
1998.
31. Freiberg R J, Cozean CD. Pulsed erbium laser ablation of
hard dental tissue: the effects of atomized water spray versus
water surface film. Proc SPIE 2002; 4610: 74-84.
32. Jahn R, Bleckmann A, Duczynski E et al. Thermal side
effects after use of the pulsed IR laser on meniscus and bone
tissue. Unfallchirurgie 1994; 20: 1-10.
33. Parker S. Lasers and soft tissue: 'fixed' soft tissue surgery. Br
Dent J. 2007 Mar 10; 202(5): 247-253.
34. Bladowski M, Konarska-Choroszucha H, Choroszucha T.
Comparison of Treatment Results of Recurrent Aphthous
Stomatitis (RAS) with Low- and High-power Laser

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