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Lasers in Dentistry: Minimally Invasive Instruments for the Modern Practice
Restorative Dentistry

Course Author(s): Steven R. Pohlhaus, DDS

Restorative Dentistry

Er:YAG and Er,Cr:YSGG machines are multi tissue lasers that 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, very large 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
Video 1.
No narrative to video.
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.
This image depicts a series of four photos showing the steps for a Class I Composite restoration.
  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 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.
ce394 fig10 Class III Composite
Diagnodent and transillumination reveal interproximal caries in teeth 9 and 10. No radiographs are needed.
Figure 11. Class III Composite.
This image depicts a Class III Composite restoration with teeth prepared without anesthesia by Er,Cr:YSGG laser.
Teeth prepared without anesthesia by Er,Cr:YSGG laser.
Figure 12. Class III Composite.
This image depicts a Class III Composite final restoration.
Final Restorations.
Figure 13. Class II Composite - Minimally invasive prep.
This image depicts a Class II Composite restoration preparation.
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.
This image depicts a Class II Composite restoration tunnel preparation with Er:YAG laser without local anesthesia.
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.
This image depicts incisal composites Diagnodent indicate incisal dentin caries in medication induced xerostomic patient.
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.
This image depicts incisal composites final preparations done anesthesia free with Er:YAG laser.
Final preparations done anesthesia free with Er:YAG laser.
Figure 17. Incisal Composites.
This image depicts incisal composites final restoration.
Composite restoration.
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