Advanced Laser Surgery in Dentistry

GEORGIOS E. ROMANOS, DDS, PhD, Prof. Dr. med. dent., Diplomate of the American Board of Periodontology, is tenured Professor in the Department of Periodontology and Director for LASER Education at the School of Dental Medicine in Stony Brook, New York, United States and Professor in the Department of Oral Surgery and Implant Dentistry and Board Certified Oral Surgeon at Johann Wolfgang Goethe University in Frankfurt, Germany.

• About the Author xiList of Contributors xiiiPreface xvAcknowledgement xvii1 Laser Fundamental Principles 1Georgios E. Romanos1.1 Historical Background 31.2 Energy Levels and Stimulated Emission 31.3 Properties of the Laser Light 31.4 The Laser Cavity 41.4.1 Active Medium 41.4.2 Pumping Mechanism 51.4.3 Lenses – Resonator 51.5 Laser Application Modes 51.5.1 Beam Profiles 71.6 Delivery Systems 71.6.1 Direct Coupling 71.6.2 Articulated Arms 71.6.3 Fiber Systems and Flexible Hollow Guides 81.7 Applicators 91.7.1 Handpieces 91.7.2 Fiber Applicators 101.8 Laser Types Based on the Active Medium 111.8.1 Gas Lasers 111.8.2 Crystal Lasers 141.8.3 Liquid (Dye) Lasers 171.8.4 Semiconductor (Diode) Lasers 171.8.5 New Developments in Laser Technology 191.8.6 Lasers for Research Applications 241.9 Laser and Biological Tissue Interactions 241.9.1 Photochemical Effects 271.9.2 Photothermal Effects 291.9.3 Ionizing or Nonlinear Effects 332 Lasers and Wound Healing 41Georgios E. Romanos2.1 Introduction 412.2 Wound Healing and Low Power Lasers 422.3 Wound Healing and High-Power Lasers 442.3.1 Wound Healing and CO2 Laser 442.3.2 Wound Healing and the Nd:YAG Laser 472.3.3 Wound Healing and Other Laser Wavelengths 502.4 Lasers and Bone Healing 513 Lasers in Oral Surgery 57Georgios E. Romanos3.1 Introduction 573.2 Basic Principles 573.3 Excision Biopsies 583.4 Removal of Benign Soft Tissue Tumors 593.4.1 Surgical Protocol for Removal of Small Tumors 593.4.2 Surgical Protocol for Removal of Larger Soft Tissue Tumors 623.5 Removal of Drug-Induced Gingival Hyperplasias and Epulides 803.5.1 Removal of Drug-Induced Gingival Hyperplasias 803.5.2 Removal of Epulides 813.6 Removal of Soft Tissue Cysts 833.7 Frenectomies and Vestibuloplasties 873.7.1 Frenectomies 873.7.2 Vestibuloplasties 923.8 Removal of Precancerous Lesions (Leukoplakia) 993.9 Surgical Removal of Malignant Soft Tissue Tumors 1063.10 Laser Coagulation 1063.11 Lasers in Vascular and Pigmented Lesions 1073.11.1 Laser Types 1073.11.2 Removal of Vascular Alterations with the “Ice Cube” Method 1083.12 Exposure of Impacted, Unerupted Teeth 1213.12.1 Exposure of an Unerupted Teeth for Orthodontic Reasons 1223.13 Removal of Sialoliths Using the Laser 1234 Lasers and Bone Surgery 129Georgios E. Romanos4.1 Introduction 1294.2 CO2 Laser 1294.3 Excimer Laser 1304.4 Er:YAG and Ho:YAG Lasers 1304.5 Laser Systems for Clinical Dentistry 1315 Lasers in Periodontology 139Georgios E. Romanos5.1 Introduction 1395.2 Laser-Assisted Bacteria Reduction in Periodontal Tissues 1405.3 Removal of Subgingival Calculus 1425.4 Removal of Pocket Epithelium 1445.5 Retardation of the Epithelial Downgrowth 1495.6 Laser Application in Gingivectomy and Gingivoplasty 1525.7 Laser-Assisted Hemostasis in Periodontics 1545.8 Photodynamic Therapy in Periodontology 1565.9 Gingival Troughing for Prosthetic Restorations 1655.10 Fractional Photothermolysis in Periodontology 1655.11 Education and Future of Lasers in Periodontal Therapy 1786 Lasers and Implants 185Georgios E. Romanos6.1 Introduction 1856.2 Laser-Assisted Surgery Before Implant Placement and Implant Exposure 1856.3 Laser Application During Function 1876.4 Laser Applications in Peri-implantitis Treatment 1886.5 Recent Laser Research on Implants 1996.6 Implant Removal 2046.7 Laser-Assisted Implant Placement 2046.8 Future of Laser Dentistry in Oral Implantology 2047 Photodynamic Therapy in Periodontal and Peri-Implant Treatment 209Anton Sculean and Georgios E. Romanos7.1 Biological Rationale 2097.2 Use of PDT as an Alternative to Systemic or Local Antibiotics 2117.3 Conclusions 2128 Understanding Laser Safety in Dentistry 215Vangie Dennis, Patti Owens and Georgios E. Romanos8.1 Laser Safety 2158.2 International Laser Standards 2158.3 Regulatory Agencies and Nongovernmental Organizations 2158.3.1 Food and Drug Administration 2158.3.2 FDA Center for Devices and Radiological Health 2168.3.3 American National Standards Institute 2168.3.4 Occupational Safety and Health Administration 2168.4 State Regulations 2188.5 Nongovernmental Controls and Professional Organizations 2188.5.1 American Society for Lasers in Medicine and Surgery 2188.5.2 Association of periOperative Registered Nurses (AORN) 2188.6 The Joint Commission (TJC) 2188.7 Standards and Practice 2188.7.1 Laser Safety Officer 2188.8 Hazard Evaluation and Control Measures 2198.9 Administrative Controls 2198.10 Procedural and Equipment Controls 2198.11 Laser Treatment Controlled Area 2208.12 Maintenance and Service 2218.13 Beam Hazards 2218.13.1 Eye Protection 2218.13.2 Skin Protection 2238.14 Laser Safety and Training Programs 2238.15 Medical Surveillance 2238.16 Nonbeam Hazards 2238.17 Electrical Hazards 2248.18 Smoke Plume 2248.19 Fire and Explosion Hazards 2248.20 Shared Airway Procedures 2258.21 Conclusion 226Appendix A: Suggested Reading 227Appendix B: Physical Units, Laser Parameters, Physical Parameters, Important Formulas 229Index 231

"'Advanced Laser Surgery in Dentistry' is a very useful guide for oral and maxillofacial surgeons, periodontists and implant dentists, as well as for general dentists, to be present in the libraries of dental students and residents who want to improve their understanding of oral procedures and dental-based laser technology." - STOMATOLOGY EDU JOURNAL, 2021 VOLUME 8 ISSUE 2