Oct. 20, 1998 SAN FRANCISCO -- If one new development exemplifies dentistry in the 21st century to patients, it may well be the laser. The stuff of science fiction for most of the last century, the laser is now an option for some dental procedures. Right now, patients are no doubt most excited by the fact that cavity preparation with lasers may not require local anesthesia.
Lasers are not any faster than a dental handpiece when it comes to cavity preparation, but procedural time might be faster overall because the dentist does not have to wait for an injected anesthetic to take effect, says G. Lynn Powell, D.D.S, a member of the American Dental Association's (ADA) Council on Scientific Affairs and assistant dean for dental education at the University of Utah School of Medicine.
A panel of dentists, who have used lasers extensively, including Dr. Powell, will describe the various new uses and discuss the future of lasers in dental treatment in a presentation at the ADA's 139th Annual Session in San Francisco, October 26.
While he sees a bright future for laser light in the dental practice, Dr. Powell also cautions that the dental handpiece is not going the way of the horse and buggy just yet. "If a dentist does not have a laser, that has no bearing on the quality of his or her work," Dr. Powell says. "The laser is an adjunct that has some usefulness and advantages," he adds. "But, lasers can't do certain things such as remove amalgam fillings or make crown preparations. Will they replace the handpiece? Maybe someday."
The Food and Drug Administration has approved the use of dental lasers for soft tissue (gum) surgery, the curing of composite and other light activated esthetic restorations, the bleaching or whitening of teeth, treatment of apthous ulcers (canker sores), sulcular debridement (cleaning out of periodontal pockets) and, most recently, cavity preparation.
In a position statement, The ADA Council on Scientific Affairs reviewed the use of the erbium:yttrium-aluminum-garnet (Er:YAG) laser for the preparation of cavities in accessible, small-to-moderate-sized lesions. The Council adds it is cautiously optimistic that the Er:YAG laser system "may prove useful" for other restorative procedures in the near future. The Council also believes laser technology to be "a promising and rapidly changing field of dentistry" and has invited manufacturers to submit their laser systems for evaluation under the ADA's Seal of Acceptance program, which assures dentists and the public that product labeling is clear and advertising claims are true in fact and implication.
Lasers are now being studied in clinical trials for other applications such as decay prevention and root canal treatment. Previous studies found the carbon dioxide (CO2) laser reduces tooth enamel demineralization. By heating the tooth enamel without damaging the tooth pulp, the laser makes teeth more resistant to the acids that can lead to decay, but without any visible change to the tooth surface.
In endodontics, for which lasers are closest to another FDA clearance, Er:Yag, diode and argon wavelengths have been used in other countries to clean out root canals without removing hard tissue. They also have been used as an adjunct to the by-hand preparation of root canals to remove any remaining organic material left behind before the canal and tooth are sealed.
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