Laser magazine – 1/2013 – The diode laser as an electrosurgery replacement

Glenn van As BSc. , D.M.D

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The diode laser has become the “soft-tissue handpiece” in many dental offices. The advantages of being able to work around metals including dental implants, a reduced need for anesthetic, a reduced risk of recession postoperatively, the ability to reduce bacteria, and to use the diode to photo-coagulate vascular lesions have all provided dentists with a new alternative for soft-tissue surgery.

Upon completion of this course, the clinician will be able to:

1. The reader should understand the advantages of the diode laser over electrosurgery units when used in clinical practice.
2. After completing this course the clinician should be able to recognize the value of the diode laser when used around metallic objects such as dental implants.
3. The article will allow viewers to see how diode lasers, unlike electrosurgery units can offer the ability to ablate soft tissue with only topical anesthetic.
4. Cosmetic recontouring and venous lake photocoagulation are two procedures that diode lasers can easily complete and the article covers these procedures.
5. Finally the role of the laser in disinfection inside periodontal pockets and in endodontic applications is covered and should be understood after completing this article
For additional reading on the topic presented by Glenn A. van As please refer to:
1. Christensen GJ. Soft-tissue cutting with laser versus electrosurgery. J Am Dent Assoc. 2008 Jul;139(7);981–984.
2. van As G, The Diode Laser as an Electrosurgery Replacement. Dentaltown. June 2010. pgs. 56–64.
3. Robertson PB, Luscher B, Spangberg LS, Levy BM. Pulpal and periodontal effects of electrosurgery involving cervical metallic restorations. Oral Surg Oral Med Oral Pathol. 1978 Nov; 46 (5); 702–720.
4. Yoshino T, Aoki A, Oda S, Takasaki AA, Mizutani K, Sasaki KM, Kinoshita A, Watanabe H, Ishikawa I, Izumi Y.  Long-term histologic analysis of bone tissue alteration and healing following Er:YAG laser irradiation compared to electrosurgery.  J Periodontol. 2009 Jan;80 (1); 82–92.
5. Skaria AM. Electrocoagulation and hazardous damage to a dental prosthesis. J AmAcadDermatol.2006;54(3):543–544.
6. Massei G, Szmukler-Moncler S. Thermo-explantation. A novel approach to remove osseointegrated implants. European Cells and Materials Vol.7. Suppl. 2, 2004 (page 48).
7. Wilcox CW, Wilwerding TM, Watson P, Morris JT. Use of electrosurgery and lasers in the presence of dental implants. Int J Oral Maxillofac Implants 2001;16(4): 578–582.
8. Deppe H, Horch HH. Laser applications in oral surgery and implant dentistry. Lasers Med Sci 2007; 22 (4):217–221.
9. Yeh S, Jain K, Andreana S. Using a diode laser to uncover dental implants in second-stage surgery. Gen Dent 2005;53(6):414–417.
10. Coleton SH. The use of lasers in periodontal therapy. Alpha Omega 2008;101(4): 181–187.
11. Khadra M, Lyngstadaas SP, Haanaes HR, Mustafa K. Effect of laser therapy on attachment, proliferation and differentation of human osteoblast-like cells cultured on titanium implant material. Biomaterials Vol 26, Issue 17, June 2005, 3503–3509.
12. Romanos GE (2002) Treatment of periimplant lesions using different laser systems. J Oral Laser Appl 2:75–81.
13. Massei G, Szmukler-Moncler S. Thermo-explantation. A novel approach to remove osseointegrated implants. European Cells and Materials Vol.7. Suppl. 2, 2004 (page 48).
14. Wilcox Cw, Wilwerding TM, Watson P, Morris JT. Use of electrosurgery and lasers in the presence of dental implants. Int J Oral Maxillofac Implants 2001;16(4): 578–582.
15. Catone GA (1997) Lasers in periodontal surgery. In: Catone GA, Alling CC (eds) Laser applications in oral and maxillofacial surgery. Saunders, Philadelphia, pp 181–196.
16. Jajouta K. Soft tissue lasers. Am J. Ortho. Dentofac. Orthoped. 2005;127:527–528.
17. Kalas P, Upile T, Stavrianos C,  Angouridakis N, Jerjes W. Mucogingival overgrowth in a geriatric patient. Derm Online Journ. 16 (8):7. 2010.
18. Kafas P, Stavrianos C, Jerjes W, Upile T, Vourvachis M, Theodoridis M, Stavrianou I. Upper-lip laser frenectomy without infiltrated anaesthesia in a paediatric patient: a case report. Cases J. 2009; 2: 7138. Published online 2009 May 20. doi: 10.1186/1757-1626-2-7138.
19 White JM, Swift EJ. Lasers for Use in Dentistry. Journal of Esthetic and Restorative Dentistry. Vol 17, Issue 1, page 60, January 2005.
20. Adams TC, Pang PK. Lasers in aesthetic dentistry. Dent Clin North Am. 2004 Oct; 48(4):833-60, vi.
21. Meeks T. Creating beautiful smile symmetry: tissue considerations. Dent Today. 2009 Oct;28(10):98,100–101.
22. Pang P. Lasers in cosmetic dentistry. Gen Den. 2008 Nov-Dec;56 (7):663-70.
23. Magid KS, Strauss RA. Laser use for esthetic soft tissue modification. Dent Clin North Am. 2007 Apr;51(2):525–545.
24. Lee EA. Laser-assisted gingival tissue procedures in esthetic dentistry. Pract Proced Aesthet Dent. 2006 Oct;18(9):suppl 2–6.
25. Gherlone EF, Maiorana C, Grassi RF, Ciacaglini R, Cattoni F. The use of 980-nm Diode and 1064-nm Nd:YAG Laser for Gingival Retraction in Fixed Prostheses. J Oral Laser Appllications. 2004; 4:183–190.
26. Kravitz ND, Kusnoto B. Soft-tissue lasers in orthodontics: an overview. Am J Orthod Dentofacial Orthop. 2008 Apr;133(4 Suppl):S110–114.
27. Tezel A, Kara C, Balkaya V, Orbak R. An Evaluation of Different Treatments for Recurrent Aphthous Stomatitis and Patient Perceptions: Nd:YAG Laser versus Medication. Photomed Laser Surg. 2009 Feb;27(1):101–106.
28. Colvard M, Kuo P. Managing aphthous ulcers: laser treatment applied. J Am Dent Assoc. 1991 Jun;122(6):51–53.
29. Kotlow L. Lasers and pediatric dental care. Gen Dent. 2008 Nov-Dec;56(7): 618–627.
30. Schindl A, Neuman R. Low-intensity laser therapy is an effective treatment for recurrent herpes simplex infection. Results from a randomized double-blind placebo- controlled study. J Invest Dermatol. 1999: 113 (2): 221–223.
31. Vélez-Gonzalez M et al. Treatment of relapse in herpes simplex on labial and facial areas  and of primary herpes simplex on genital areas and “area pudenda” with low power HeNe-laser or Acyclovir administered orally. SPIE Proc. 1995; Vol. 2630: 43–50.
32. Kotlow LA. Elimination of a venous lake on the lower vermillion of the lower lip via 810-nm diode laser. J Laser Dent 2007;15(1):20–22.
33. Genovese WJ, dos Santos MT, Faloppa F, de Souza Merli LA. The use of surgical diode laser in oral hemangioma: a case report. Photomed Laser Surg. 2010 Feb; 28(1):147.
34. Azevedo LH, Galletta VC, de Paula Eduardo C, Migliari DA. Venous Lake of the Lips Treated Using Photocoagulation with High-Intensity Diode Laser. Photomed Laser Surg. 2010 Apr;28(2):263–265.
35. Angiero F, Benedicenti S, Romanos GE, Crippa R. Treatment of Hemangioma of the Head and Neck with Diode Laser and Forced Dehydration with Induced Photocoagulation. Photomedicine and Laser Surgery. April 2008, 26 (2): 113–118.
36. Kuvvetli SS, Sandalli N, Topcuoglu N, Kulekci G. Antibacterial efficacy of diode and Er:YAG laser irradiation in experimentally contaminated primary root canals. J Clin Pediatr Dent. 2009 Fall; 34 (1): 43–48.
37. Cobb CM, Low SB, Coluzzi DJ. Lasers and the Treatment of Chronic Periodontitis. Dent Clin N Am. 2010; 54;35–53.
38. Aoki A, Mizutani K, Takasaki AA, et al. Current status of clinical laser applications in periodontal therapy. Gen Dent 2008;56(7):674–687.
39. de Souza EB, Cai S, Simionato MR, Lage-Marques JL. High-power diode laser in the disinfection in the depth of the root canal dentin.Oral Surg Oral Med Oral Pathol Radiol Endod. 2008 Jul;106(1):e68–72.
40. Sennhenn-Kirchner S, Schwarz p, Schliephake H, Konietschke F, Brunner E, Borg-von Zepelin M. Decontamination efficacy of erbium:yttrium-aluminium-garnet and diode laser light on oral Candida albicans isolates of a 5-day in vitro bioflim model. Laser Med Sci. 2009 May:24(3):313-20. Epub 2008 May 6.
41. Schoop U, Kluger W, Devisbegovic S,Goharkhay K, Wernisch J, Georgopoulous A, Sperr W, Moritz A. Innovative wavelengths in endodontic treatment. Lasers Surg Med 2006 Jul;38(6):624–630.
42. Gutknecht N, Franzen R, Schippers M. Lampert F. Bactericidal effect of a 980-nm diode laser in the root canal wall dentin of bovine teeth. J Clin Laser Med Surg. 2004 Feb;22(1):9–13.
43. Schoop U, Kluger W, Moritz A, Nedjelik N, Georgopoulos A, Sperr W. Bactericidal effect of different laser systems in the deep layers of dentin. Laser Surg Med. 2004;35(2): 111–116.
44. Hmud R, Kahler WA, George R, Walsh LJ. Cavitational effects in aqueous endodontic irrigants generated by near-near infrared lasers. J Endo. 2010 Feb;36 (2): 275-8. Epub 2009 Dec.4.
45. Alfredo E, Marchesan MA, Sousa-Neto MD, Brugnera-Junior A, Silva-Sousa YT. Temperature variation at the external root surface during 980-nm diode laser irradiation in the root canal. J Dent. 2008 Jul;36(7):529-34. Epub 2008 May 6.
46. Gutneckt N, Franzen R, Meister J, Vanweersch L. Mir M. Temperature evolution on human teeth root surface after diode laser assisted endodontic treatment. Laser Med Sci.2005 Sep;20(2):99-103. Epub 2005 Jul 9.
47. Theodoro LH, Haypek P, Bachmann L, Garcia VG, Sampaio JE, Zezell DM, Eduardo Cde P. Effect of ER:YAG and Diode laser irradiation on the root surface: morphological and thermal analysis. J Periodontol. 2003 Jun;74(6): 838–843.
48. da Costa Ribeiro A, Nogueira GE, Antoniazzi JH, Moritz A, Zezell DM. Effects of diode laser (810 nm) irradiation on root canal walls: thermographic and morphological studies. J Endod. 2007 Mar;33(3):252-5. Epub 2006 Dec 13.

Release date: 10 January 2013
Expiration date: 10 January 2016


Glenn van As BSc. , D.M.D

Dr. Glenn A. van As graduated from the faculty of dentistry at the University of British Columbia, which is located in Vancouver, Canada in 1987.He immediately went into private practice in Lynn Valley with his father Dr. A.W.H. van As in June of that year.In October of 1988, they moved together into their new office – Canyon Dental Centre.Since that time, Glenn has built a High tech- High touch dental practice where the entire dental team is committed to using the latest technologies available to provide the highest level of clinical excellence in dentistry.

In addition to being in full time private practice, Glenn has served as an assistant clinical professor at U.B.C. from 1989-1999. His areas of interest and expertise involve the utilization of the Dental Operating Microscope for all of his clinical dentistry and in the use of multiple wavelengths of hard and soft tissue lasers for many procedures in his private general practice. Since 1999, Glenn has lectured over 250 times internationally, provided hands on workshops, and published internationally both in journals and textbooks on the value of both multiple wavelengths of lasers and practicing with the high magnifications obtainable with the dental operating microscope.He serves as a reviewer of many magazines including PPAD, Inside Dentistry and Dental Tribune.

Glenn is a member of many organizations including the British Columbia Dental Association, the Canadian Dental Association, the American Academy of Cosmetic Dentistry, the Academy of Microscope Enhanced Denistry (AMED) and the Academy of Laser Dentistry (ALD). He has obtained both standard and advanced levels of proficiency in laser usage from the Academy of Laser Dentistry ( ), and was distinguished with the Leon Goldman award for world wide clinical excellence in the field of laser dentistry in 2006.In addition, Glenn is a founding member of the Academy of Microscope Enhanced Dentistry, and in 2004-2005 served as the 2nd President of the group ( ).

Glenn is an active member on many web forums dealing with lasers and microscopes in general practice, and acts as a consultant for many high technology companies dealing with endodontic, laser and microscope products.

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