YOSHIDA CO2 LASER - FAQ
Q1. Is it okay to irradiate the exposed pulp directly by laser?
A: Vital Pulp Therapy (protection of pulp) is extremely important in dentistry. If the pulp is exposed at the time of caries treatment, you must implement the infection control measure. Immediately remove the soft dentin using a bur or excavator and irradiate the surface of exposed pulp by 1W output laser and form a char layer. It is no harm to leave the char layer that is coating the exposed pulp. Cover the pulp by a-TCP and then temporarily fill the opening with glass ionometer cement. After 4 week observation, implement the restorative procedure and be sure to check the condition by X-ray after 3 months.
Q2. Are the patient afraid of the laser?
A: Quite a few patients have negative image on laser therapy. Some are afraid of the laser because they have never had laser treatment before. Some have preconceived idea that laser treatment is expensive. However, once they receive their first laser treatment and experience a reduction in pain, their image on laser drastically changes for the better. It leads to more opportunities for laser application in the treatment.
Q3. At which stage of implant treatment do you use the laser?
A: By changing the power density, a wide range of reaction i.e. incision, vaporization, hemocoagulation and albuminous denaturation, can be applied, therefore, we utilize CO2 laser in various stages in implant treatment. By utilizing CO2 laser, simplification of procedures, improvement of treatment efficiency, such as shortening of the healing period can be achieved, and it enables implant treatment with high predictability. In particular, for adjusting and sculpting of soft tissue surrounding implant for esthetic purpose, CO2 laser is highly useful.
Comment: For laser application in implant treatment, proper use of laser irradiation is important. By irradiating the tissue surrounding the implant at the time of 1st surgery, it can promote healing of soft tissue. Also, at the time of 2nd surgery, vaporizing the gingiva and uncovering the cover screw and then attaching a healing abutment lead to the fast healing of gingiva. Furthermore, it does not require a suture so you can minimize the burden of patient.
Q4. GBR- Complete closure of the scar is difficult
A: Whether being able to prevent the dehiscence of the scar in the healing process following alveolar ridge augmentation is a crucial factor which makes a big difference in the result. There are various ways to prevent dehiscence, but as one example, achieving the favorable healing by primary intention is very important. CO2 laser irradiation after the surgery will promote the good healing by primary intention. Also, it is reported that CO2 laser irradiation promotes regeneration of bone tissue.
Comment: Clinical cases which the wound was closed immediately after GBR but dehiscence along the suture gradually occurs, are often reported. Let’s look at how the dehiscence occurs. When mucosal tissue of incised section try to fuse with each other in the healing process (by primary intention), dehiscence may occurs due to the strong tension or incomplete suture. If the dehisced wound is irradiated by CO2 laser, the rate of proliferation of stratified squamous epithelium which speed is faster compared to the connective tissue, is elevated and the edge of the dehisced membrane will be covered by the epithelium. In such condition, it will no longer fuse even if contact is made with each other. Therefore, it is important to secure the blood supply first by performing proper relating incision and tight suture after GBR and immediately achieve the fusion between membrane by irradiating the CO2 laser.
Q5. Is laser effective for prosthetic procedure?
A: Management of the soft tissue is extremely important in order to achieve the favorable result of the prosthetic treatment for esthetic purposes. And it is definitely simpler to remove some after applying little more than your estimation. Minimize the loss of soft tissue and the bone as much as possible for extraction case, and depending on the case whether orthodontic extrusion or grafting of the tissue, sufficient amount of tissue may be required. For the process of “elimination” of the tissue, CO2 laser become very useful. Especially for the sensitive adjustment of the soft tissue, CO2 laser is an excellent option. Less bleeding and faster healing time.
Comment: Socket preservation is very important in prosthetic procedure and CO2 laser is a powerful tool for it. After extraction, irradiate the site to create a blood clot. By irradiating the surface to form a char layer at the end, it results in smother surface when healed. CO2 laser is also effective for gingivoplasty. Irradiate the gingiva to reshape but make sure all the char layer is removed from the irradiated surface. Another laser application that CO2 laser is effective for is the removal of melanin. Vaporize the melanin and immediately wipe the irradiated site with gauze soaked in saline and completely remove the char layer. Remaining melanocyte may result in relapse.
Q6. How do you use laser in curettement of granulation after tooth extraction?
A: The secret to the successful socket preservation is to perform a thorough curretage of the socket. However, in the cases like maxillary sinus being too close to the site where curettage is required, use of a rotational handpiece may not be the preferable. Vaporizing the fine granulation by CO2 laser allows a precise procedure while maintaining the vision of surgical site, so as a result, the stress level of the doctor is greatly reduced. It is important to remember that laser irradiation should be performed without making a contact with the bone, and that char layer should be removed thoroughly without fail.
Also, you have to take precautions especially for scattered laser light when using CO2 laser with a mirror for maxillary site. Be sure to protect the eyes of the patients as well as the doctor and the assistants by wearing laser protection glasses.
Q7. Is there any case of laser application for full denture?
A: When we say laser application in surgery, you would immediately think of implant related procedure. However, laser application in removal of flabby gum, alveolar ridge augmentation and vestibular extension of patient with full denture is highly useful. When laser is used for incision, it minimizes not only the bleeding, but also the post-surgery pain as much as possible.
Comment: Yes, there are many clinical cases that laser can be utilized. Vaporize the soft tissue at 2W to remove the flabby gum or frenectomy, just as the removal of soft tissue. When doing this procedure, make sure all the char layer is removed completely from the tissue. If wide range of tissue is needed to be removed, it is recommended that removal procedure is divided into several application rather than completing it all at once. After completion of removal, irradiating the surgical site (cher free irradiation) at 0.5W will contribute in shortening the healing process.
Q8. I have a patient complaining of bleeding after FGG
A: Since there are full vascular system on the palate and very close to greater palatine artery and its branches, we often experience bleeding during and after the surgery. Has it occurred to you that even after you confirmed that the bleeding has stopped after the surgery, a phone call from your patient caught you by surprise telling you that the bleeding started again when he went home?
By keeping the blood clot at the donor site by CO2 laser after collecting the tissue for grafting, post-operative bleeding problems will likely reduce.
Comment: First thing you should remember when the arteriole was damaged at the time of gingival incision for grafting from the palate, was to stay calm. Immediate hemostasis of the arterial hemorrhage is not easy even by CO2 laser, so astriction should be performed first. Use the sterilized gauze soaked in saline to apply pressure with and change the gauze and continue this procedure until bleeding stops. After bleeding has stopped, carbonizing the blood clot by CO2 laser irradiation will minimize the risk of re-breeding.