Journal of Dental and Allied Sciences

REVIEW ARTICLE
Year
: 2017  |  Volume : 6  |  Issue : 1  |  Page : 28--31

Evolution and applications of lasers in oral and maxillofacial surgery


Luke Nandu Kale, Janardan Bhagwat Garde, Swapnil Shivdas Garde, Preetika Gupta 
 Department of Oral and Maxillofacial Surgery, Sinhgad Dental College and Hospital, Pune, Maharashtra, India

Correspondence Address:
Luke Nandu Kale
Department of Oral and Maxillofacial Surgery, Sinhgad Dental College and Hospital, Pune, Maharashtra
India

Abstract

With the advent of new and developing technology into the field of dentistry, it becomes increasingly important for dentists to become familiar with these developing techniques. The use of lasers in oral and maxillofacial surgery has seen a substantial increase in both, applications of lasers for different techniques, and also the number of surgeons opting to use them on a regular basis. This article serves to update practitioners on the development and current applications of these modern tools in regular practice so as to efficiently perform dental treatment and minimize complications associated with conventional techniques. The authors have reviewed articles on the subject from PubMed, Science Direct, and relevant textbooks so as to compile an accurate history of the evolution of lasers, its introduction to the field of dentistry and also its current applications in the field of oral and maxillofacial surgery.



How to cite this article:
Kale LN, Garde JB, Garde SS, Gupta P. Evolution and applications of lasers in oral and maxillofacial surgery.J Dent Allied Sci 2017;6:28-31


How to cite this URL:
Kale LN, Garde JB, Garde SS, Gupta P. Evolution and applications of lasers in oral and maxillofacial surgery. J Dent Allied Sci [serial online] 2017 [cited 2021 Jun 18 ];6:28-31
Available from: https://www.jdas.in/text.asp?2017/6/1/28/205442


Full Text



 Introduction



Since the advent of lasers, they have found tremendous application in all fields of science. In recent times, lasers are viewed as an integral part of many of the surgical and medical practices currently employed. Hence, it becomes increasingly important to understand the rationale behind the use of lasers so as to use them efficiently and without undue inhibitions.

 History of Development of Lasers



The development of lasers began in 1917 with Albert Einstein's theory of stimulated emission. His concept was based on quantum theory, which was developed in 1900 based on Max Planck's concept of light being composed of small packets of energy called quanta.[1] Development and application of stimulated emission gained no momentum until the beginning of the World Wars. The development of lasers was preceded by the development of Microwave Amplification by Stimulated Emission of Radiation (MASER) by Charles H. Townes in 1951. Using the principles of MASER as a background, Gordon Gould applied the same concept toward the development of light amplification by stimulated emission of radiation.[2] While working for the US Army Signal Corps, Theodore Maiman, and Irnee D'Haenens, his assistant, developed the first microwave amplifier for use on aircrafts. Using the experience gained while working with the Corps, Maiman employed the use of Ruby while working on the LASER. He used a pulsed flashlamp to optically pump a ruby and developed the first working model of a LASER. The first laser was tested successfully on May 16, 1960.[3] In the press conference that followed the development of the laser, on July 7, 1960, Maiman predicted the use of this concentrated light in medicine. This prediction was part of the five potential uses of lasers as visualized by him. A few years later, he recognized the use of these Lasers in surgery to provide a relatively bloodless field and as a potential replacement of the dentist's drill [Figure 1].[4]{Figure 1}

 Introduction of Lasers in Oral and Maxillofacial Surgery



The efficacy of these lasers as soft tissue incising agents was first studied by Yamamoto et al. in 1972 using ruby lasers.[5] The development of the CO2 laser and its tissue ablating properties led to an increased interest in the application of lasers to surgery. It was noted that the use of these lasers lead to reduced local hemorrhage and provided a clean surgical field to operate.[6] Designed specifically for use in dentistry, the dLase 300 Nd: YAG laser was introduced in the United States by Dr. Terry D. Myers and Dr. William D. Myers on May 3, 1990.[7] The introduction of the laser in dentistry must also be credited to Goldman L. who extensively studied the effects of the lasers on soft and hard tissues and has been a staunch advocate of their use in routine dental practice.

 Initial Use in Oral and Maxillofacial Surgery



Perhaps the first reported use of lasers specific to Oral and Maxillofacial surgery can be credited to Strong et al. for using CO2 lasers for excision of premalignant and malignant lesions among other surgical procedures.[8] Kaplan et al. used lasers for removal of oral cancers in 1974.[9] Ackermann described the use of Nd: YAG lasers for treating hemophiliacs for various oral surgical conditions in his paper in 1984.[10] Apfelberg used Argon laser to treat a variety of vascular lesions in the maxillofacial region in 1987.[11] These procedures served as a pathway for the general acceptance of the use of lasers in performing many routine procedures in oral and maxillofacial surgery. Lasers were not only being considered as an alternative to the scalpel in many of the surgical procedures but also led to the development of various treatment modalities like laser skin resurfacing that could not be sufficiently performed by the existing means available [Figure 2].{Figure 2}

 Indications for the Use of Lasers in Oral and Maxillofacial Surgery



Since its introduction into the field of oral and maxillofacial surgery, lasers have found increasing indications and relative superiority to conventional surgical procedures. The following is a list of the current indications of the uses of lasers in oral and maxillofacial surgery.

Biopsy procedures

Minimal bleeding occurs with use of a laser as compared to the scalpel. This provides a relatively bloodless field. The laser also coagulates the adjacent area due to its thermal effects. Postoperative swelling is also significantly reduced.

Laser vaporization

Used for the removal of large, epithelium-confined surface lesions. The use of a scalpel in these lesions would result in removal of tissue more than what is sufficient for the management of these lesions.

Laser ablation

Used for gingival contouring, management of hyperplastic lesions, hyperkeratosis, and stomatitis nicotina. Conservative treatment can be provided as it is possible to remove cell layers selectively from superficial surfaces.

Coagulation/hemostasis

Hemostasis while using lasers is achieved by contraction of the collagen of the vascular wall of vessels having diameter up to 500 μm. This leads to a reduction in the vessel diameter and bleeding is controlled. This property greatly facilitates the treatment of vascular defects and also for the control of hemorrhage. Once it is ensured that the surgical field is dry and saliva-free, the laser is directed over the tissues in defocused mode till the bleeding is arrested.

Surgical extraction of teeth

Not only can the flap be raised with the help of soft tissue lasers but also bone removal can be facilitated by the use of CO2, diode or erbium lasers. Passi et al.[12] and Romeo et al.[13] have performed studies to compare the efficacy of lasers versus burs for the removal of bone. Abu-Serriah et al. have described a procedure for the removal of partially impacted third molars in 2004.[14]

Apicoectomy

The effect of the laser not only enables removal of part of the root structure but also facilitates sterilization of the root in an infected area.

Preprosthetic surgery

All of the surgical procedures performed for enabling prosthetic rehabilitation can also be performed with the help of lasers. They can be used to treat epulis fissurata, perform vestibuloplasty, tuberosity reduction procedures, removal of tori, and correction of ridge abnormalities.

Frenectomy

Lasers provide a quick procedure for the excision of high frenal attachments. They also can be used in the lingual region where there is high vascularity due to the minimal bleeding caused by their use.

Sialolitotomy

The laser can be used to incise and expose the duct. A characteristic feature while using lasers is a flash of light that is observed when the light reaches the sialolith.[15] This helps in localization of the sialolith in the duct.

Marsupialization of a ranula

All the beneficial effects of using lasers for performing surgical procedures can be employed for the marsupialization of a ranula. Definitive treatment of the lesion can later be rendered also with the help of a laser.

In implantology

Lasers can be useful in the management of peri-implantitis for the disinfection of the region. They can also be used for exposure of the implant during the second stage of the surgery.

Uvulopalatopharyngoplasty

Laser assisted uvulopalatopharyngoplasty is a less morbid procedure as compared to the use of a scalpel for the treatment of snoring and sleep apnea.

Temporomandibular joint arthroplasty

Ho: YAG laser is used for these procedures since it is minimally absorbed by water which is in high-content in the synovial fluid. Lasers can be used to perform more precise surgical procedures. Currently, lasers are used to treat symptomatic anterior disk displacements,[16] synovectomy and ankylosis.

Cosmetic procedures

Lasers are currently employed for blepharoplasty, endoscopic browlift, cosmetic skin resurfacing, and scar revision.

Advantages of laser surgery

Lasers have stood the test of time and in spite of heretic criticism, they are widely used because of the following advantages that they offer:

Lasers incise tissue more efficiently than a scalpel as they provide the added advantages of sterilization of the field of operation, decrease mechanical trauma by a contact-free incision and minimizes postoperative swelling, pain, and scarring [17]Effectively coagulates blood vessels in the field of operation thereby maintaining a bloodless fieldIncreased precision and accuracy in surgical procedures due to it ablative properties and effective control on the depth of penetration of the laser beamHistologically, the wound shows less wound contracture and scarring due to reduced myofibroblasts [18]Better healing as compared to scalpel woundsReduced need for sutures.

Disadvantages of lasers

Although the use of lasers has multiple advantages over the use of a scalpel, it still carries a few disadvantages:

The speed of healing may be delayedIncidence of increased pain 4–7 days postoperativelyLaser plume generated during the procedure may be harmful to the persons in the operating roomScattered and reflected laser beams pose a massive health hazard to the operator, assistants and patientsHigh cost and operator training.

Types of lasers

Lasers can best be described according to their gain medium and are broadly classified on this basis as:

Gas lasers

These include:

Helium-neon lasers: Nitrogen laserArgon laser: Carbon dioxide laserKrypton laser: Carbon monoxide laserXenon ion laser: Excimer laser.

Solid-state lasers

These include:

Ruby laser: Nd: YAG laserEr: YAG laser: Ho: YAG laser.

Other types of lasers

Diode lasers, dye lasers, semiconductor lasers, and chemical lasers are the other lasers that are available currently.

 Conclusion



As laser technology is developing rapidly it is finding greater application in the field of oral and maxillofacial surgery. Hence, it becomes important for the surgeon to acquire knowledge about the same so that surgical procedures can be carried out more effectively and efficiently. Identifying situations in which using a laser would prove to be superior to using conventional techniques and utilizing them is of prime importance. The surgeon must also be aware of the safety considerations and follow safety guidelines strictly. Lasers can prove to be a very effective tool in the management of a wide variety of conditions with greater efficiency than is currently possible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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