10.

1515/bjdm-2016-0021

L SOCIETY
BALKAN JOURNAL OF DENTAL MEDICINE ISSN 2335-0245

CA
GI
LO
TO
STOMA

Technology of Lasers and Their Applications in

Oral Surgery: Literature Review

SUMMARY Theodoros Tachmatzidis, Nikolaos Dabarakis

The word “Laser” is an acronym for “Light Amplification by Aristotle University of Thessaloniki
Stimulated Emission of Radiation”. Recent advances in laser technology Dept. of Dentoalveolar Surgery
have brought a kind of revolution in dentistry. The purpose of this article is Implantology & Radiology
to provide an overview of clinical application of lasers in oral medicine and Thessaloniki, Greece
especially in oral surgery, including their advantages, disadvantages and
safety. LITERATURE REVIEW (LR)
Keywords: Lasers, dental application; Oral Surgery Balk J Dent Med, 2016; 20:131-137

Introduction
In ancient Greece, the exposure of the body to sun
the sun was used in heliotherapy for the restoration of
health. The Chinese used the sun to treat such conditions
as rickets, skin cancer and even psychosis. This use of
light for treatment of various pathologies is referred to as
phototherapy.
Based on Albert Einstein’s theory of spontaneous
and stimulated emission of radiation, Theodore Maiman
in 1960 introduced the first solid state ruby laser1. Shortly
thereafter, in 1961, Snitzer2 published the prototype for the Figure 1. Electromagnetic spectrum
Nd:YAG laser. The first application of a laser to dental tissue
was reported by Goldman et al3 and Stern and Sognnaes4. The absorption of the laser beam’s energy plays
However, modern relationship of operative dentistry and an important role and is illustrated by the absorption
laser takes its origins from an article published in 1985 by spectrum for each laser wavelength in the targeted tissue.
Myers and Myers5, describing in vivo removal of dental Apart from wavelength and absorption, reflection and
caries using a modified ophthalmic Nd:YAG laser4. transmission also play role in the interaction of laser with
The introduction of lasers in the field of oral surgery tissue. Transmission is the degree to which the laser’s
has replaced a lot of routine surgical techniques and has energy is able to penetrate into the tissue (Fig. 2).
resulted in several sophisticated products designed to
improve quality of treatments.
Lasers are heat producing devices converting
electromagnetic energy into thermal energy. The
most significant and basic characteristic of them is
wavelength, which defines the position of the laser in
the electromagnetic spectrum. The wavelength used in
medicine and dentistry generally ranges from 193 to
10.600nm, representing a broad spectrum from ultraviolet
to the far infra-red range (Fig. 1). Figure 2. Laser/tissue interaction
132 Theodoros Tachmatzidis, Nikolaos Dabarakis Balk J Dent Med, Vol 20, 2016

the laser active medium is energized, the laser photonic

The aim of this article is to provide an overview of
emission can occur inherently in a continuous wave
main characteristics of lasers, their clinical application
(CW) or free-running pulsed (FRP) emission mode. CW
in dentistry, especially oral surgery, pointing to their
means that energy is emitted constantly for as long as
advantages, disadvantages and safety.
the laser is activated. A “gated” or “super-pulsed” laser
is a variation of CW. The length of each pulse is called
“pulse width” or “pulse duration”. On the other hand, FRP
Mechanism of Dental Laser Action is a characteristic seen in lasers whose pulses have peak
powers in the 1000w range.
Light is a form of electromagnetic energy that • Radiation - refers to the light waves produced
behaves like a particle and wave. Its basic unit is photon. by laser as a specific form of electromagnetic energy6,7.
• Laser Light - Laser light used for dental The very short wavelength below approximately 300nm
procedures has 4 features: (1) It is monochromatic is called ionizing. Non ionizing radiations are those with
(laser light is of one specific colour, thus of a single wavelengths larger than 300nm and they have lesser
wavelength); (2) It is coherent (each wavelength is frequency and less photon energy. They cause excitation
identical in physical size and shapes); (3) It can be and heating of tissues with which they interact. All dental
collimated (photons can be collimated into an intensely lasers are non-ionizing.
focused energy beam that interacts with the target tissues); • Tissue interaction (Fig. 4) - The action of lasers
(4) It is efficient. on dental tissues and bacteria depends on the absorption
• Amplification (Fig. 3) - It is part of a process of laser by tissue chromophores (water, apatite minerals
that occurs inside the laser. The inner part of laser, or the and various pigmented substances) within the target
components of laser, are as follows: (A) Optical cavity tissue. The principle action of laser energy on tissue is
- which is the centre of the device. Core of the cavity photo-thermal8, and any mechanisms may be secondary
comprised of chemical elements, molecules or compounds to this process or may be totally independent. In general,
is called active medium. It can be a gas, a crystal or a lasers have four different interactions with the tissues.
solid-state semiconductor; (B) Two mirrors - one at each These are the following:
end of optical cavity, placed parallel to each other. One
mirror is reflective, which allows photons to be reflected
back and forth to allow further stimulated emission. The
other mirror is partially transmissive thus allowing light of
sufficient energy to exit the optical cavity; (C) Excitation
sources - either a flash lamp strobe device or an electrical
coil, which provides energy into active medium; (D)
Cooling system; (E) Focusing lenses; F) Other controls.

Figure 4. Laser/Tissue Interactions

1. Photo-thermal interaction (Tab. 1) - This occurs

with high powered lasers. The radiant energy absorbed by
tissue substances are transformed into heat energy, which
produce the tissue effect9.
Figure 3. Laser Components
Table 1. Target tissue effects in relation to temperature

• Stimulated Emission - The smallest unit

of energy is absorbed by the electrons of an atom or
molecule (of the active medium), creating a short
excitation; then a quantum is released, a process called
spontaneous emission. The mirrors at each end of the
active medium return the photons back and forth to
permit the emission of the laser beam. Depending on how
Balk J Dent Med, Vol 20, 2016 Lasers in Oral Surgery 133

a. 37°C to 50°C - The tissue temperature is elevated 2. Photo-chemical interaction - The basic
but is not destroyed (hyperthermia). principle of photochemical process is that specific
b. 60°C - The tissue whitens or blanches. Proteins wavelengths of laser light are absorbed by naturally
begin to denature without vaporization of the underlying occurring chromophores, which are able to induce certain
tissue. This phenomenon is useful in surgically removing biochemical reactions.
diseased granulomatous tissue, because if the tissue 3. Photo-mechanical interaction - This includes
temperature can be controlled, the biologically healthy photo-disruption or photo-dissociation and photo-acoustic
portion can remain intact. interactions. In photo-acoustic effects, the pulse of laser
c. 70°C - Produces desirable effect of haemostasis energy on the dental tissues can produce a shock wave.
by contraction of the walls of the vessel and is used for When this shock wave explodes the tissue, it creates an
coagulation. abraded crater.
d. 70°C to 80°C - The soft tissue edges can be
4. Photo-electrical interaction– This includes
welded together with uniform heating.
photo-plasmolysis, which describes how the tissue is
e. 100°C to 150°C - When the target tissue
removed through formation of electrically charged ion9.
containing water is elevated to a temperature of 100°C,
• Energy density (Fluency) - Energy density is
vaporization of the water within it occurs, a process
called ablation. There is a physical change of the state; the defined as energy (Joules) per square centimetre of spot
solid and liquid components turn into vapour in the form size (J/cm2). The laser beam spot size can be focused
of smoke or steam. As soft tissue is composed of a high or defocused. Depending on the degree of beam focus,
percentage of water, excision of the soft tissue commences the laser beam spot size can be altered and fluency will
at this temperature. In hard tissues, ablation does not accordingly change.
occur at this temperature, but the water component is
vaporized and the resulting jet of steam expands and then Classification of Lasers
explodes the surrounding matter into small particles. This Lasers used in dental practice can be classified
mixture of steam and solid is suctioned away. This micro- into several categories according to: (1) the range of
explosion is termed “spallation”. wavelength, (2) the lasing medium, such as gas laser and
f. >200°C - If the tissue temperature continues to solid laser, (3) tissue penetration - soft tissue and hard
be raised to about 200°C, it is dehydrated and then burned tissue lasers, (4) The risk related to laser application, and
in the presence of air. Carbon, as the end product, absorbs (5) potential hazards.
all wavelengths. Carbonization occurs with risk of soft Several types of laser are available based on the
tissue damage. It can be because of high power setting or wavelengths, which can be used in oral surgery. The most
slow movement of fibre tip across tissue surface. commonly used nowadays are the following (Tab. 2):
Table 2. Types of lasers and their characteristics

• CO2 Laser (10,600nm wavelength, 5-15W) - a very high empathy for water. It is delivered through a
The carbon dioxide laser is a gas-active medium laser and hollow tube-like waveguide in continuous or gated pulsed
the light energy is placed at the end of the mid-infrared mode10. It has the highest absorption in hydroxyapatite
invisible non-ionizing portion of the spectrum. This compared to other dental lasers (about 1000 times greater
is most commonly used in soft tissue periodontal and than erbium), but can lead to thermal damage if there is
oral surgery. The CO2 wavelength is 10.600nm and has a contact with hard tissue11. It leaves a char layer on root
134 Theodoros Tachmatzidis, Nikolaos Dabarakis Balk J Dent Med, Vol 20, 2016

surface. Some disadvantages are the high cost and the 6mm depth before it is attenuated to 10% of its original
large size. CO2 laser has a shallow depth of penetration strength. It belongs to invisible near-infrared portion of
into tissue and it is used ideally for soft tissue incision and the electromagnetic spectrum. Energy is scattered rather
ablation, sub-gingival curettage, superficial lesions and than absorbed. The Nd:YAG laser is ideal for ablation of
removal of sialoliths. haemorrhagic tissue. It provides a relatively conservative
• Erbium Laser - The erbium “family” laser has procedure, which is related to rapid wound healing18. With
two wavelengths: Nd:YAG laser procedures anaesthesia is required in less
• Er:YAG (yttrium aluminium garnet) laser - than 50% of cases19.
(2.940nm) - it has an active medium of a solid crystal of
The wide-spread belief that Nd:YAG lasers have the
yttrium aluminium garnet that is doped with erbium12;
highest penetration depths in the soft tissue is only partly
• (Er,Cr):YSGG (yttrium scandium gallium
correct. A study conducted at the RWTH Aachen19 proved
garnet) laser - (2.780nm) - it has an active medium of a
solid crystal of yttrium scandium gallium garnet that is that a free-running pulse Nd:YAG laser has a penetration
doped with erbium and chromium. There is absence of depth of approximately 0.1mm to 0.3mm, whereas a
melting, charring and carbonization. The absorption in continuous wave mode Nd:YAG laser has a penetration
water of this laser is two to three times lower than that of depth of up to 6mm.
Er:YAG laser and their thermal effects on the tissue are • Diode Laser - (range from about 800nm to
much higher if not administered correctly. 980nm wavelength, 1-10W power) - it is a solid active
The erbium wavelengths have a high empathy medium laser that includes semi-conductor crystals using
for hydroxyapatite and the highest absorption of water some combination of aluminium or indium, arsenic and
compared to other dental laser wavelengths. This is the gallium. Due to crystalline nature, the ends of the crystal
preferable laser for treatment of dental hard tissue, but can be polished relative to internal refractive indices to
also, in contact mode with special surgical tips, it can be produce totally and partially reflective surfaces. The light
used to cut soft tissues. The benefits of treating patients energy is placed at the starting of the near-infrared portion
with the erbium family of lasers include bactericidal of the invisible non-ionizing spectrum. Each machine
effects, which can sterilize the area, and analgesic effect employs a flexible optic fibre (300μm diameter) to deliver
on the target tissues, similar to the Nd:YAG devices13.
the treatment beam to the desired area.
Also many studies have shown that the erbium laser
These lasers are said to be running in either CW
energy applied to bone releases growth factors that
or pulsed mode. Pulsing is achieved by electronically
enhance regeneration of bone14. In maxillary alveolar
bone, the speed of laser is comparable with that of a bur switching the laser on and off. With this method, the
and slightly slower in the mandible, reflecting the greater laser power in pulse is not increased, but is in the order of
mineral density of cortical bone15,16. several Watts. In comparison, free-running pulse Nd:YAG
The difference between CO2 and Er:YAG laser lies in laser systems, which can generate high peak powers,
their differing absorption coefficients: Er:YAG lasers are individual pulse powers can reach several thousands of
much more strongly absorbed in the water. On the other Watts. Research has shown that diode laser is one of
hand, CO2 lasers show very high absorption on the tissue the most versatile with regard to the number of possible
surface. treatments options and can be effectively used in the field
• Argon Laser - (488nm, 514nm wavelength, of soft tissue surgery20. In oral surgery, these machines
1-20W power) - it is a laser with an active medium of can be used in numerous clinical procedures, such as
argon gas that is energized by a high-current electrical various types of soft tissue surgery, second stage implant
discharge. It is fibre optically delivered with fibre recovery, in peri-implantitis, sub-gingival curettage etc.
diameter 300μm in continuous wave and gated pulsed There are many indications and researches, which show
modes. The light energy is placed in the visible spectrum. that diode laser can be used to perform these procedures
Argon lasers are readily absorbed by haemoglobin
with added bonus of disinfecting the treated area. But the
and melanin; thus, they have excellent haemostatic
most important benefits in comparison to all other types
capabilities. These lasers are useful in the treatment of
of laser are the ease of operation, the sub-millimetre
pigmented lesions, vascular anomalies and soft tissue
incisions and ablations17. Neither wavelength is well dimension and their extreme compactness21,22,23.
absorbed in dental hard tissues or in water. Generally, surgical procedures in soft tissue require a
• Nd:YAG (Neodymium yttrium aluminium cautious approach. For instance, a 810nm diode and CO2
garnet laser) - (1064nm wavelength) - it has a solid lasers are very well suited for frenectomies (operations
active medium, which is a garnet crystal combined with on the frenula of the lips, cheeks or tongue). Cautions
rare earth elements yttrium and aluminium, doped with is required when using Nd:YAG and 980nm diode lasers
neodymium ions. The Nd:YAG with a very long pulse because the higher thermal effect of these wavelengths
duration (between 90μs and 150μs) penetrates water up to (<100μs) can very often cause necrosis.
Balk J Dent Med, Vol 20, 2016 Lasers in Oral Surgery 135

Application of Lasers in Oral combining photo-initiators with specific wavelengths

can enhance bactericidal properties40-45, and there are
Surgery
fewer risks of post-operative infections;
There are plenty of soft and hard tissue procedures ●● Tissue surface sterilization;
that can be performed with lasers in oral surgery. ●● Faster healing response. Laser energy can aid healing
through photo-bio-modulation;
Soft Tissue Clinical Applications ●● Decreased swelling, oedema and scarring46,47;
For many intraoral soft tissue surgical procedures, ●● Reduced pain and discomfort after surgery48.
the laser is a viable alternative to the scalpel. The most Reports of pain relief mechanisms appear to
popular and effective lasers nowadays for soft tissue originate in stimulating oxidative phosphorylation in
procedures are CO2, Nd:YAG and Diode lasers. There mitochondria and through modulating inflammatory
are many categories of soft tissue procedures that can be responses49;
treated by lasers, such as gingivectomy and gingivoplasty, ●● Minimally invasive surgical procedures, compared to
frenectomy, de-epithelialization of reflected flaps, conventional techniques;
depigmentation, measure blood flow-lesion ablation24, ●● Increased patient acceptance50,51;
second stage exposure of dental implants, sub-gingival ●● Reduced surgical time.
debridement curettage25, incisional and excisional
biopsies of both benign and malignant lesions, removal
of granulation tissue26, coagulation of free gingival graft
donor site, irradiation of apthous ulcers, removal of Precautions Before and During
diseased tissue around the implants27,28 etc. Laser Surgery
Hard Tissue Clinical Applications
Safety glasses are necessary for eye protection by all
There are a number of surgical procedures in hard
operatory personnel including the patient;
tissues that can be done by lasers, such as the removal
1. Protection of patient’s throat and delicate oral
of impacted teeth under bone, apicoectomies, osseous
re-contouring, implant and bone osteotomies29, bone tissues from accidental beam impact;
grafting, jaw continuity defects, removal of inflammatory 2. Use of wet gauze packs or towels to avoid
tissues around implants, crown lengthening, uncovering of reflection from shiny metal surfaces;
permanent teeth for orthodontic purposes etc. 3. Adequate high speed evacuation should be used
The erbium (Er) family of lasers can be the lasers to capture laser plume, which is biohazard;
of choice for the most of those procedures. Er lasers use 4. Speed of movement of the laser beam over
extremely short pulse durations and can easily ablate the target tissue in order not to occur thermal damage
layers of calcified tissue with minimal thermal effects. - exposure of bone to heating at levels equal to or more
To date, alternative laser systems, including super-pulsed than 47°C is reported to include cellular damage leading
Nd:YAG, diode, CO2, Ho:YAG etc. have not been proven to osseous resorption. Temperature levels of equal to or
so effective for use in hard tissue procedures. more than 60°C result in tissue necrosis52. Additionally,
if soft tissue temperature increases above 200°C charring
and carbonization occur53.
5. The clinician’s awareness of safety control
Laser Advantages in Dentistry measures and hazards and the recognition of existing
standards of care are significant points for dental
The advantages of lasers in comparison to other practitioners to avoid complications and failures54.
conventional dental equipment are reported by various
authors and include:
●● Increased coagulation30-35, yielding a dry surgical
field for better visualization. This mechanism occurs Conclusions
when there is tissue absorption and controlled heat
build-up. The warming of soft tissue more than 60°C In conclusion, the application of laser, nowadays,
will result in protein denaturation and coagulation36, involves habitual use of different procedures and
which are properties useful in haemostasis (Er lasers dental devices. Laser technology seems to be a feasible
are the exception to this general statement, since they and effective adjunct to conventional dental surgical
provide limited haemostasis)37-39; techniques, showing many documented benefits and
●● Reduction in bacteraemia - Using lasers for surgical advantages in the clinician’s daily practice. Lasers have
techniques can lead to tissue temperatures effective significantly contributed to dental care in the 21st century,
in reducing bacteria39. Studies have shown that and are expected to become an essential component
136 Theodoros Tachmatzidis, Nikolaos Dabarakis Balk J Dent Med, Vol 20, 2016

of contemporary dental practice in the near future. 17. Narang S, Maytreyee R, Singh N, Khare K, Jain P. Clinical
The advance of technology and knowledge of various application of soft tissue lasers in periodontics. Journal of
applications in daily praxis will improve the use of laser Orofacial Research. 2015;5(3):94-98.
18. Romanos G, Pelekanos S, Strub JR. Effects of Nd:YAG
and our understanding of the great spectrum of benefits
laser on wound healing processes: Clinical and
regarding surgery and healing.
immunohistochemical finding in rat skin. Lasers in Surgery
As Dr Theodore Maiman, the inventor of the first and Medicine 1995;Vol 16(4):368-379.
laser stated: “The medical application of the laser is 19. Gutknecht N. State of the art in lasers for dentistry. Journal
fascinating for two reasons. It is optimistic mission on the of the laser and health academy Vol.2008;No3/1.
one hand while, on the other, it counteracts the original 20. Das UK, Maiti N. Versatile diode. Journal of dental and
impression of the laser being a death ray”. medical sciences 2013; Vol 6, Issue1:01-06.
21. Goharkhay K, Mortiz A, Wilder-Smith P, Schoop U,
Kluger W, Jakolitsch S, Sperr W. Effects on oral soft
tissue produced by a diode laser in vitro. Lasers Surg Med
1999;25(5):401-406.
References 22. Walinski CJ. Irritation fibroma removal: A comparison
of two laser wavelengths. Gen Dent 2004(May-
1. Maiman TH. Stimulated optical radiation in ruby. Nature, June);52(3):236-238.
1960; 187:493-494. 23. Adams TC, Pang PK. Lasers in Aesthetic Dentistry, Dent
2. Snitzer E. Optical maser action of Nd (+3) in a barium Clin North Am. 2004(Oct);48(4):833-860,vi.
crown glass. Phys Rev Lett, 1961; 7:444-446 24. Ryden H, Bjelkhagen H, Soder PO. Intrasulcular laser
3. Goldman L, Hornby P, Meyer R, Goldman B. Impact of the Doppler readings before and after root planning. J Clin
laser on the dental caries. Nature, 1964; 203:417. Periodontol, 1995; 22:817-823.
4. Stern RH, Sognnaes RF. Laser inhibition of dental caries 25. Aoki A, Sasaki K, Watanabe H, Ishikawa I. Lasers in non-
suggested by first tests in vivo. J Am Dent Assoc, 1972; surgical periodontal therapy. Periodontology 2004;36:59-97
85:1087-1090. 26. Williams TM, Cobb CM, Rapley JW, Killoy WJ. Histologic
5. Myers TD, Myers WD. In vivo caries removal utilizing the evaluation of alveolar bone following CO2 laser removal
YAG laser. J Mich Dent Assoc, 1985; 67:66-69. of connective tissue from periodontal defects. Int J
6. Coluzzi DJ. Fundamentals of dental lasers: science and Periodontics Rest Dent 1995;15:497-506.
instruments. Dent Clin N Am, 2004; 48:751-770. 27. Strauss R. Lasers in oral and maxillofacial surgery. Dent
7. Convissar RA. The biologic rationale for the use of lasers in Clin N Am, 2000; 44(4): 861-888.
dentistry. Dent Clin N Am, 2004; 48:771-794. 28. Kato T, Kusakari H, Hoshino E. Bactericidal efficacy of
8. White JM, Goodis HE, Tran KT. Thermal laser effects on carbon dioxide laser against bacteria-contaminated titanium
intraoral soft tissue, teeth and bone in vitro In: Proceedings implant and subsequent cellular adhesion to irradiated area.
of the Third International Congress on Lasers in Dentistry. Lasers Surg Med, 1998; 23(5):299-309.
International Society for Lasers in Dentistry. University of Utah 29. Nelson JS, Orenstein A, Liaw LH, Bern’s MW. Mid-
Printing Services, Salt Lake City, Utah, 1993; pp 189-190. infrared erbium:YAG laser ablation of bone:the effect of
9. Sebeena Mathew, Deepa Natesan Thangara. Lasers in laser osteotomy on bone healing. Lasers Surg Med, 1989;
Endodontics: JIADS 2010(Jan-March);Vol1(1):31-37. 9(4):362-374.
10. Pogrel MA, Muff DF, Marshell GW. Structural changes in 30. Pick RM, Pecaro BC. Use of the CO2 laser in soft tissue
dental enamel induced by high energy continue wave CO2 dental surgery. Lasers Surg Med, 1987; 7(2):207-213.
laser. Laser Surgery Medicine, 1993; 13:89-96. 31. White JM, Goodis HE, Rose CL. Use of the pulsed Nd:YAG
11. Fujiyama K, Deguchi T, Murakami T, Fujii A, Kushima K, laser for the intraoral soft tissue surgery. Lasers Surg Med,
Takano-Yamamoto T. Clinical effect of CO2 laser in reducing 1991; 11(5):455-461.
pain in orthodontics. Angle Orthod, 2008; 78:299-303. 32. Pedron IG, Ramalho KM, Moreira LA, de Freitas
12. Van G. Erbium lasers in dentistry. Dent Clin N Am, 2004; PM. Association of two lasers in the treatment of
48:1017-1059. traumatic fibroma: Excision with Nd:YAP laser and
13. Harashima T, Kinoshita J, Kimura Y, Brugnera A, Zanin photobiomodulation using InGaAIP: A case report. J Oral
F, Pecora JD, et al. Morphological comparative study Laser Appl, 2009; 9(1):49-53.
on ablation of dental hard tissue at cavity preparation by 33. Miyazaki H, Kato J, Watanabe H, Harada H, Kakizaki H,
ER:YAG and Er,Cr:YAG lasers. Photomed Laser Surg, Tetsumura A, Sato A, Omura K. Intralesional laser treatment
2005; 23:52-55. of voluminous vascular lesions in the oral cavity. Oral
14. Kesler G, Shvero DK,Tov YS, Romanos G. Platelet derived Surg Oral Med Oral Pathol Oral Radiol Endod, 2009;
growth factor secretion and bone healing after Er:YAG 107(2):164-172.
laser bone irradiation. Journal of Oral Implantology. 34. Genovese WJ, dos Santos MT, Faloppa F, de Sousa Merli
2011;37(sp1):195-204. LA. The use of surgical diode laser in oral laser in oral
15. Hibst R. Mechanical effects of erbium:YAG laser bone hemangioma: A case report. Photomed Laser Surg, 2010;
ablation. Lasers Surg Med 1992;12(2):125-130. 28(1):147-151.
16. Peavy GM, Reinisch L, Payne JT, Venugopalan V. 35. Romanos G, Nentwig GH. Diode laser (980nm) in oral and
Comparison of cortical bone ablations by using infrared maxillofacial surgical procedures: Clinical observations
laser wavelengths 2.9 to 9.2μm. Lasers Surg Med based on clinical applications. J Clin Laser Med Surg, 1999;
1999;25(5):421-434. 17(5):193-197.
Balk J Dent Med, Vol 20, 2016 Lasers in Oral Surgery 137

36. Knappe V, Frank F, Rohde E. Principles of lasers and CO2 laser and conventional surgical excision of canine
biophotonic effects. Photomed Laser Surg, 2004; 22(5):411-417. buccal mucosa. Arch Oral Biol, 1983; 28(4):287-291.
37. Ishikawa I, Aoki A, Takasaki AA. Potential applications of 48. Haytac MC, Ozcelik O. Evaluation of patient perceptions
erbium:YAG laser in periodontitis. J Periodontal Res, 2004; after frenectomy operations: A comparison of carbon
39(4):275-285 dioxide laser and scalper techniques. J Periodontol, 2006;
38. Coluzzi DJ. Fundamentals of lasers in dentistry: Basic 77(11):1815-1819.
science, tissue interaction and instrumentation. J Laser 49. Walsh LJ, Goharkhay K, Verheyen P, Moritz A. Low level
Dent, 2008; 16(Spec. Issue):4-10. laser therapy. Chapter 13 in: Moritz A, Beer F, Goharkhay
39. Russell AD. Lethal effects of heat on bacterial physiology K, Schoop U, Strassl M, Verheyen P, Walsh LJ, Wernish
and structure. Sci Prog, 2003; 86(1-2):115-137. J, Wintner E. Oral laser application. Berlin, Germany:
40. Schultz RJ, Harvey GP, Fernandez-Beros ME, Quintessenz Verlags GmbH, 2006; pp 521-539.
Krishnamurthy S, Rodriguez JE, Cabello F. Bactericidal 50. Bader H. Use of lasers in periodontics. Dent Clin North Am,
effects of the neodymium:YAG laser: In vitro study. Laser 2000; 44:779-792.
Surg Med, 1986; 6(5):445-448. 51. Wigdor H, Walsh J, Featherstone JDB, et al. Lasers in
41. Parker S. Photodynamic antimicrobial chemotherapy in the
dentistry. Lasers Surg Med, 1995; 16:103-133.
general dental practice. J Laser Dent, 2009; 17(3):131-138.
52. Eriksson RA, Albrektsson T. Temperature threshold levels
42. Meisel P, Kocher T. Photodynamic therapy for the
for heat induced bone tissue injury: A vital microscopic
periodontal diseases: State of the art. J Photochem
study in the rabbit. J Prosthet Dent, 1983; 50:101-107.
Photobiol B, 2005; 79(2):159-170.
53. Miserendino LJ, Levy G, Miserendino CA. Laser interaction
43. De Oliveira RR, Schwartz-Fiho HO, Novaes AB Jr, Taba M
with biologic tissues. Chapter 3 in: Miserendino LJ, Pick
Jr. Antimicrobial photodynamic therapy in the non-surgical
RM (Ed). Lasers in Dentistry. Chicago: Quintessence
treatment of an aggressive periodontitis: A preliminary
randomized controlled clinical study. J Periodontol, 2007; Publishing Co Inc, 1995; pp 39-55.
78(6):965-973. 54. Mason C, Hopper C. The use of CO2 laser in the treatment
44. Prates RA, Yamada AM Jr, Suzuki LC, Hashimoto MCE, of gingival fibromatosis: A case report. Int J Paediatr Dent,
Cai S, Gouw-Soares S, Gomes L, Ribeiro MS. Bactericidal 1994; 4:105-109.
effect of malachite green and red laser on Actinobacillus
Received on May 28, 2016.
actinomycetemcomitans. J Photochem Photobiol B, 2007;
Revised on July 28, 2016.
86(1):70-76.
Accepted on August 30, 2016.
45. Chan Y, Lai C-H. Bactericidal effects of different laser
wavelengths on periodontopathic germs in photodynamic
therapy. Lasers Med Sci, 2003; 18(1):51-55.
46. Luomanen M, Meurman JH, Lehto V-P. Extracellular matrix Correspondence Author:
in healing CO2 laser incision wound. J Oral Pathol, 1987; Theodoros Tachmatzidis
16(6):322-331. 90 Venizelou Str, Neapoli
47. Fisher SE, Frame JW, Browne RM, Tranter RMD. A Thessaloniki, Greece
comparative histological study of wound healing following E-mail: tax-teo@hotmail.com