Er:YAG and Er,Cr:YSGG lasers are FDA approved for cutting tooth, bone and soft tissue. Their extremely short pulses and high peak power allow for efficient enamel and dentin photoacoustic ablation. Erbium lasers can prepare all classes of restorations. Many restorations can be accomplished without local anesthesia. Experienced laser practitioners report needing anesthesia only ten to 20% of the time, usually for amalgam removal, larger lesions, or particularly sensitive teeth.
Advantages of using erbium laser for operative dentistry include:
Precise ablation allows for minimally invasive preparations
Smear layer removal
Disinfection of preparations
Eliminates the noise, heat, and vibration of high speed rotary instrumentation
Reduced need for local anesthesia
Selective caries removal due to carious dentin’s higher water content and softer consistency
A Class III lesion prepared with an Er:YAG laser. This patient was not anesthetized and was comfortable throughout the procedure.
Source: Dr. Mark Collona.
Figure 9a. Class I Composite.
1. No discernible explorer stick but Diagnodent indicated caries in distal fissure, mesiolingual cusp, and some early decay under the sealant in the mesial pit. 2. Some remaining decay revealed by caries indicator in distal fissure after initial Er:YAG laser preparation. 3. Final preparation; no anesthesia was used. 4. Final restoration, the mesial sealant was removed with the laser and resealed.
Figure 9b. Class I Composite.
The Diagnodent helps guide the clinician regarding the location and depth of the lesions. The minimally invasive preparations were restored with a Glass Ionomer (Equia Forte/Fuji).
Figure 10. Class III Composite.
Diagnodent and transillumination reveal interproximal caries in teeth 9 and 10. No radiographs are needed.
Figure 11. Class III Composite.
Teeth prepared without anesthesia by Er,Cr:YSGG laser.
Figure 12. Class III Composite.
Figure 13. Class II Composite - Minimally invasive prep.
Class II preparation with non-traditional outline. Lasers allow for minimally invasive approach to all classes of restorations. Er:YAG laser with local anesthesia used in this case.
Figure 14. Class II Composite - Tunnel prep.
Tunnel preparation with Er:YAG laser without local anesthesia. This tooth was restored with a sandwich technique with a glass ionomer base and composite occlusally.
Figure 15. Incisal Composites.
Diagnodent indicate incisal dentin caries in medication induced xerostomic patient. Incisal dentin caries is a common problem in medicated patients with anterior attrition or parafunctional wear.
Figure 16. Incisal Composites.
Final preparations done anesthesia free with Er:YAG laser.
Figure 17. Incisal Composites.