- Email: [email protected]
Erbium laser for caries removal
Clinical Significance..—Worldwide, we see a troubling percentage of dentists subject to burnout. This study identified about 25% of dentists in Northern Ireland as being at serious risk for professional burnout. Attention to preventing such burnout and to supporting dental professionals in their work environment is needed.
Gorter RC, Freeman F: Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland. Community Dent Oral Epidemiol 39:87-95, 2011 Reprints available from RC Gorter, Social Dentistry & Behavioural Sciences, Academic Ctr for Dentistry Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, The Netherlands; e-mail: [email protected]
Laser Technology Erbium laser for caries removal Background.—The conventional method for managing caries excavation is the use of a rotary bur. However, this highly efficient low-cost technique generates considerable noise and vibration. An erbium laser beam is a relatively new method, not yet widely used, that is quieter and vibrates less. It may also be less painful, reducing the need for local anesthesia. When the laser beam encounters the tooth surface, light is absorbed by water molecules in the dental hard-tissues, thus they heat up quickly, and then subsequently vaporize. This reaction creates a high localized pressure and a microexplosion that ablates the dental hard-tissue. Both rotary burs and lasers can raise the temperature and increase the risk of thermal injury to the pulp. For the erbium lasers, peak surface temperature during ablation of enamel varies between 300 C and 800 C, depending on the system. Continuous water cooling is required to avoid thermal damage from the laser. The method of excavation can also affect the surface properties of dental hard-tissues and compromise bonding with adhesive restorative materials. This can alter the longevity of the restoration. A systematic literature review was conducted to evaluate the current evidence regarding the use of laser technology for the removal of carious tissue. The focus was the laser’s effectiveness for removing carious tissue, potential biological complications, effect on the longevity of restorations, patient responses, and cost-effectiveness of the laser treatment. Methods.—Twenty-three studies were identified in the literature search, and 16 were selected to cover the effect of laser treatment. No studies were relevant to economic factors. Results.—The studies were extremely heterogeneous so no meta-analyses were performed. With respect to cavity preparation and the removal of caries, studies have shown that the laser is as effective as a rotary bur for these
270
Dental Abstracts
applications. However, rotary instruments achieve carious tissue removal more quickly. Whether the laser harms the pulp remains to be determined. There is insufficient scientific evidence to determine whether cavity preparation by laser compromises restoration longevity and how children respond to laser treatment. However, adults have been shown to prefer laser treatment to rotary instrumentation. Discussion.—The scientific evidence comparing removal of carious tissues by laser and rotary bur is limited. It is clear that treatment time with lasers is prolonged, but insufficient evidence is available to clarify the status of biological or technical complications. However, adults have reported less pain and greater satisfaction with this approach. In addition, because there is less pain, there may be less need for local anesthesia.
Clinical Significance.—Lasers offer the advantages of being quieter and producing less vibration, both of which address patient concerns regarding dentistry. It is essential that continuous water cooling be used during laser treatment to avoid thermal injury to the tissues. Further study is needed to determine whether local anesthesia can indeed be reduced when laser technology is used to remove carious tissues.
Jacobsen T, Norlund A, Englund GS, et al: Application of laser technology for removal of caries: A systematic review of controlled clinical trials. Acta Odontol Scand 69:65-74, 2011 Reprints available from S Tranaeus, The Swedish Council on Health Technology Assessment, PO Box 3657, SE 103 59 Stockholm, Sweden; e-mail: [email protected]
Gorter RC, Freeman F: Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland. Community Dent Oral Epidemiol 39:87-95, 2011 Reprints available from RC Gorter, Social Dentistry & Behavioural Sciences, Academic Ctr for Dentistry Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, The Netherlands; e-mail: [email protected]
Laser Technology Erbium laser for caries removal Background.—The conventional method for managing caries excavation is the use of a rotary bur. However, this highly efficient low-cost technique generates considerable noise and vibration. An erbium laser beam is a relatively new method, not yet widely used, that is quieter and vibrates less. It may also be less painful, reducing the need for local anesthesia. When the laser beam encounters the tooth surface, light is absorbed by water molecules in the dental hard-tissues, thus they heat up quickly, and then subsequently vaporize. This reaction creates a high localized pressure and a microexplosion that ablates the dental hard-tissue. Both rotary burs and lasers can raise the temperature and increase the risk of thermal injury to the pulp. For the erbium lasers, peak surface temperature during ablation of enamel varies between 300 C and 800 C, depending on the system. Continuous water cooling is required to avoid thermal damage from the laser. The method of excavation can also affect the surface properties of dental hard-tissues and compromise bonding with adhesive restorative materials. This can alter the longevity of the restoration. A systematic literature review was conducted to evaluate the current evidence regarding the use of laser technology for the removal of carious tissue. The focus was the laser’s effectiveness for removing carious tissue, potential biological complications, effect on the longevity of restorations, patient responses, and cost-effectiveness of the laser treatment. Methods.—Twenty-three studies were identified in the literature search, and 16 were selected to cover the effect of laser treatment. No studies were relevant to economic factors. Results.—The studies were extremely heterogeneous so no meta-analyses were performed. With respect to cavity preparation and the removal of caries, studies have shown that the laser is as effective as a rotary bur for these
270
Dental Abstracts
applications. However, rotary instruments achieve carious tissue removal more quickly. Whether the laser harms the pulp remains to be determined. There is insufficient scientific evidence to determine whether cavity preparation by laser compromises restoration longevity and how children respond to laser treatment. However, adults have been shown to prefer laser treatment to rotary instrumentation. Discussion.—The scientific evidence comparing removal of carious tissues by laser and rotary bur is limited. It is clear that treatment time with lasers is prolonged, but insufficient evidence is available to clarify the status of biological or technical complications. However, adults have reported less pain and greater satisfaction with this approach. In addition, because there is less pain, there may be less need for local anesthesia.
Clinical Significance.—Lasers offer the advantages of being quieter and producing less vibration, both of which address patient concerns regarding dentistry. It is essential that continuous water cooling be used during laser treatment to avoid thermal injury to the tissues. Further study is needed to determine whether local anesthesia can indeed be reduced when laser technology is used to remove carious tissues.
Jacobsen T, Norlund A, Englund GS, et al: Application of laser technology for removal of caries: A systematic review of controlled clinical trials. Acta Odontol Scand 69:65-74, 2011 Reprints available from S Tranaeus, The Swedish Council on Health Technology Assessment, PO Box 3657, SE 103 59 Stockholm, Sweden; e-mail: [email protected]