Aplicaciones del laser de diodo en odontologia

El láser de diodo tiene numerosas aplicaciones en la especialidad de Cirugía Bucal siendo utilizado preferentemente para realizar intervenciones quirúrgicas sobre los tejidos blandos siempre que no impliquen un excesivo sangrado. En Endodoncia, Implantología Bucofacial y Periodoncia se emplea por su importante efecto bactericida. También se utiliza en procedimientos de blanqueamiento dentario. Es importante controlar adecuadamente el tiempo de aplicación y la potencia de trabajo para evitar el sobrecalentamiento de los tejidos vecinos, lo que produciría su necrosis. Siempre que se utilice el láser de diodo se debe efectuar la protección ocular recomendada tanto para el profesional, sus ayudantes y personal auxiliar, como para el paciente.

Aplicaciones del laser de CO2 en odontologia

La incorporación de las nuevas tecnologías en las ciencias de la salud es, hoy en día, una realidad, ante la cual los profesionales sanitarios deben estar preparados. La tecnología láser ofrece numerosas ventajas en casi la totalidad de las especialidades odontológicas. De la amplia gama de láseres disponibles, el láser de CO2 destaca por sus aplicaciones en el ámbito de la cirugía bucal, especialmente en la cirugía de los tejidos blandos, aunque su uso también ha sido estudiado en otras disciplinas como la odontología conservadora y la endodoncia. Su uso no está exento de riesgos, y el odontólogo especializado en cirugía bucal debe poseer los conocimientos y las habilidades pertinentes para su utilización. Las características del láser de CO2 permiten una cirugía rápida y cómoda para el profesional y unas molestias postoperatorias mínimas para el paciente.

Aplicaciones de los láseres de Er:YAG y de Er,Cr:YSGG en odontologia

Los láseres de Er:YAG y de Er,Cr:YSGG por su longitud de onda son bien absorbidos, tanto por el agua que contienen los tejidos blandos como por los cristales de hidroxiapatita presentes en los tejidos duros. Estas características hacen posible que estos láseres puedan ser absorbidos por los tejidos duros. Se presentan los múltiples usos y aplicaciones que tiene esta tecnología en Odontología, tanto en cirugía de tejidos blandos, como sus aplicaciones sobre tejidos duros, como por ejemplo los tratamientos de la caries o la cirugía ósea reemplazando en ambos casos al instrumental rotatorio. Desde la incorporación de estos láseres en los tratamientos odontológicos, se ha abierto una nueva perspectiva en relación con el uso de la anestesia local. Con la utilización de esta tecnología se pueden realizar tratamientos quirúrgicos poco extensos sin necesidad de aplicar anestesia locorregional, si bien su uso más común es para diversos procedimientos de terapéutica dental.

Aplicaciones del láser en odontologia

Existen diferentes tipos de láseres que pueden tener aplicación en Odontología, y éstos pueden ser utilizados con diferentes fines. El propósito de este artículo es comentar, de forma genérica, el empleo de diferentes tipos de láseres en diversos tipos de tratamientos habituales en la práctica odontológica. No todos los láseres producen los mismos efectos; tampoco un mismo láser produce el mismo efecto sobre diferentes tejidos, y, según sean los parámetros de emisión utilizados, incluso el mismo láser puede producir diferentes efectos sobre el mismo tejido. Para poder incorporar el láser a la praxis diaria, el profesional debe conocer, entre otros extremos, las indicaciones, las contraindicaciones y la forma de utilización del tipo o tipos de láseres que desee utilizar, antes de su aplicación en clínica.

Aplicaciones del láser blando en odontología

Las principales aplicaciones del láser blando en Odontología son como analgésico, antiinflamatorio, cicatrizante y hemostático. Algunos estudios in vitro parecen demostrar que el láser blando modifica ciertas reacciones a nivel bioquímico, pero a la hora de su aplicación clínica no hay unanimidad respecto a su efectividad ya que, frente a los estudios cuyos resultados son positivos, están los que no los obtienen y lo relacionan a un posible efecto placebo. A esta controversia se suma el hecho de que los estudios sobre el láser blando son difíciles de evaluar, porque en la mayoría falta la especificación de alguno de los parámetros que intervienen en la emisión láser. Otra aplicación del láser blando en Odontología se realiza sobre células marcadas con un fotosensibilizador para obtener un efecto destructivo selectivo de dichas células. Este procedimiento parece ser útil sobre células cancerosas y microorganismos patógenos.

Incidence of anatomical variations and disease of the maxillary sinuses as identified by cone beam computed tomography: a systematic review.

PURPOSE: To analyze available evidence on the incidence of anatomical variations or disease of the maxillary sinuses as identified by cone beam computed tomography (CBCT) in dentistry. MATERIALS AND METHODS: A focused question was developed to search the electronic databases MEDLINE, EMBASE, the Cochrane Oral Health Group Trials Register, and CENTRAL and identify all relevant papers published between 1980 and January 19, 2013. Unpublished literature at ClinicalTrials.gov, in the National Research Register, and in the Pro-Quest Dissertation Abstracts and Thesis database was also included. Studies were included irrespective of language. These results were supplemented by hand and gray literature searches. RESULTS: Twenty-two studies were identified. Twenty were retrospective cohort studies, one was a prospective cohort study, and one was a case control study. The main indication for CBCT was dental implant treatment planning, and the majority of studies used a small field of view for imaging. The most common anatomical variations included increased thickness of the sinus membrane, the presence of sinus septa, and pneumatization. Reported sinus disease frequency varied widely, ranging from 14.3% to 82%. There was a wide range in the reported prevalence of mucosal thickening related to apical pathology, the degree of lumenal opacification, features of sinusitis, and the presence of retention cysts and polyps. More pathologic findings in the maxillary sinus were reported in men than in women, and the medial wall and sinus floor were most frequently affected. CONCLUSION: CBCT is used primarily to evaluate bony anatomy and to screen for overt pathology of the maxillary sinuses prior to dental implant treatment. Differences in the classification of mucosal findings are problematic in the consistent and valid assessment of health and disease of the maxillary sinus.

Utilización de otros láseres en odontología: Argón, Nd:YAP y Ho:YAG

Las ventajas que la incorporación del láser ha proporcionado a la Odontología abarcan todos los ámbitos. Así, los láseres de Argón, de Nd:YAP y de Ho:YAG, tienen aplicaciones muy concretas y de gran interés tanto en el campo de la terapéutica dental como en la especialida de cirugía bucal. Las aplicaciones principales del láser de Argón se centran en la polimerización de los materiales de restauración, en la endodoncia y dentro del ámbito de la cirugía bucal, en el corte de tejidos blandos, principalmente para la exéresis de lesiones vasculares y pigmentadas. El láser de Nd:YAP se utiliza principalmente en el campo de la endodoncia y la periodoncia, y el láser de Ho:YAG se emplea en cirugía periapical y en la cirugía artroscópica de la articulación temporomandibular.

Treatment of oral mucocele - scalpel versus C02 laser

Objective: To compare the results obtained after oral mucocele resection with the scalpel versus the CO2 laser, based on the complications and recurrences after surgery Patients and Methods: Of the 68 patients we studied who have mucocele, 38 were resected with a scalpel and the remaining 30 with the CO2 laser (5-7 W). Patient sex and age were documented, along with location of the lesion as well as size, symptoms, duration, etiological factors, type of treatment, complications and recurrences after surgical removal. Results: The sample comprised 40 males and 28 females, aged between 6-65 years. The histological diagnosis was extravasation mucocele in 95% of the cases. The most frequent location was the lower lip (73.5%). The mean lesion diameter was 9 mm , and in most cases no evident etiological factor was recorded. The mean duration of the lesion was 4 months. Among the cases of conventional surgical removal of mucocele, recurrence was recorded in 8.8% of the cases, and 13.2% of the patients suffered postoperative complications - the most frequent being the presence of fibrous scars. There were no complications or relapses after a minimum follow-up of 12 months in the cases subjected to CO2 laser treatment. Conclusions: Oral mucocele ablation with the CO2 laser offers more predictable results and fewer complications and recurrences than conventional resection with the scalpel

Laser treatment of 13 benign oral vascular lesions by three different surgical techniques

Objectives: Benign Oral Vascular Lesions (BOVLs) are a group of vascular diseases characterized by congenital, inflammatory or neoplastic vascular dilations clinically evidenced as more or less wide masses of commonly dark bluish color. If traumatized BOVLs are characterized by a great risk of hemorrhage and their treatment usually requires great caution to prevent massive bleeding. In the last decades lasers have dramatically changed the way of treatment of BOVLs permitting the application of even peculiar techniques that gave interesting advantages in their management reducing hemorrhage risks. The aim of this study was to evaluate the capabilities and disadvantages of three laser assisted techniques in the management of BOVLs. Study design: In this study 13 BOVLs were treated by three different laser techniques: the traditional excisional biopsy (EB), and two less invasive techniques, the transmucosal thermocoagulation (TMT) and the intralesional photocoagulation (ILP). Two different laser devices were adopted in the study: a KTP laser (DEKA, Florence, Italy, 532nm) and a GaAlAs laser (Laser Innovation, Castelgandolfo, Italy, 808nm) selected since their great effectiveness on hemoglobin. Results: In each case, lasers permitted safe treatments of BOVLs without hemorrhages, both during the intervention and in the post-operative period. The minimally invasive techniques (TMT and ILP) permitted even the safe resolution of big lesions without tissue loss. Conclusions: Laser devices confirm to be the gold standard in BOVLs treatment, permitting even the introduction of minimal invasive surgery principles and reducing the risks of hemorrhage typical of these neoplasms. As usual in laser surgery, it is necessary a clear knowledge of the devices and of the laser-tissue interaction to optimize the results reducing risks and disadvantages

Comparative study of upper lip frenectomy with the CO2 laser versus the Er, Cr: YSGG laser

Objectives: To compare upper lip frenulum reinsertion, bleeding, surgical time and surgical wound healing in frenectomies performed with the CO2 laser versus the Er, Cr:YSGG laser. Study design: A prospective study was carried out on 50 randomized pediatric patients who underwent rhomboidal resection of the upper lip frenulum with either the CO2 laser or the Er,Cr:YSGG laser. Twenty-five patients were assigned to each laser system. All patients were examined at 7, 14, 21 days and 4 months after the operation in order to assess the surgical wound healing. Results: Insertion of the frenulum, which was preoperatively located between the upper central incisors, migrated to the mucogingival junction as a result of using both laser systems in all patients. Only two patients required a single dose of 650 mg of paracetamol, one of either study group. CO2 laser registered improved intraoperative bleeding control results and shorter surgical times. On the other hand, the Er,Cr:YSGG laser achieved faster healing. Conclusions: Upper lip laser frenectomy is a simple technique that results in minimum or no postoperative swelling or pain, and which involves upper lip frenulum reinsertion at the mucogingival junction. The CO2 laser offers a bloodless field and shorter surgical times compared with the Er,Cr:YSGG laser. On the other hand, the Er,Cr:YSGG laser achieved faster wound healing.

Aplicaciones del láser Nd:YAG en odontologia

El láser de Nd:YAG está compuesto por un granate de itrio y aluminio, contaminado por neodimio. Emite a una longitud de onda de 1064 nm, en el infrarrojo cercano. A diferencia de otros láseres, el láser de Nd:YAG, puede transmitirse a través de fibra óptica, lo cual permite una fácil aplicación de este tipo de energía en espacios anatómicos bucodentarios de difícil acceso. Este hecho, asociado al potente efecto bactericida que produce esta longitud de onda, lo convierten en una herramienta ideal en los tratamientos endodóncicos y periodontales, en los que puede mejorar los resultados obtenidos con las técnicas convencionales. También se utiliza en ciertos tratamientos de Cirugía Bucal, principalmente para las exéresis de lesiones de tejidos blandos.

Histologic evaluation of thermal damage produced on soft tissues by CO2, Er,Cr:YSGG and diode lasers

Objective: The aim of this in vitro experimental study was to perform histological evaluation of the thermal effect produced on soft tissue irradiated with CO2, Er,Cr:YSGG or diode lasers. Study design: Porcine oral mucosa samples were irradiated with Er,Cr:YSGG laser at 1 W with and without water / air spray, at 2 W with and without water / air spray, and at 4 W with water / air spray, with CO2 laser at 1 W, 2 W, 10 W, 20 W continuous mode and 20 W pulsed mode and diode laser at 2W, 5W, and 10W pulsed mode. The thermal effect was evaluated measuring the width of damaged tissue adjacent to the incision, stained positively for hyalinized tissue with Hematoxylin-Eosin and Masson Trichrome stains. Besides, histological changes in the irradiated tissue were described using subjective grading scales. Results: The evaluated lasers developed a wide range of thermal damage with significant differences between groups. The samples with lowest thermal effect were those irradiated with Er,Cr:YSGG laser using water / air spray, followed by CO2 and diode lasers. Conclusions: Emission parameters of each laser system may influence the thermal damage inflicted on the soft tissue, however, the wave length of each laser determines the absorption rate characteristics of every tissue and the thermal effect

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Thermal increment due to ErCr: YSGG and CO2 laser irradiation of different implant surfaces. A pilot study

Objective: An evaluation and comparison is made of the thermal increment at different implant surfaces during irradiation with CO2 and ErCr:YSGG lasers. Study design: Five threaded and impacted implants with four types of surfaces were inserted in an adult pig rib: two implants with a hydroxyapatite surface (HA)(impacted and threaded, respectively), a machined titanium surface implant (TI mach), a titanium plasma spray surface implant (TPS), and a sandblasted, acid-etched surface implant (SBAE). A 0.5-mm diameter bone defect was made in the implant apical zone, and a type-K thermocouple (Termopar)® was placed in contact with the implant. The implants were irradiated in the coronal zone of each implant with a CO2 (4 W continuous mode) and an ErCr:YSGG laser (1.5 W, pulsed mode) first without and then with refrigeration. The temperature variations at the implant apical surface were recorded. Results: An apical temperature increase was recorded in all cases during CO2 and ErCr:YSGG laser irradiation without refrigeration. However, when the ErCr:YSGG was used with a water spray, a decrease in temperature was observed in all implants. The acid-etched and sandblasted surfaces were those most affected by the thermal changes. Conclusions: The ErCr:YSGG laser with a water spray applied to the sealing cap or coronal zone of the implants does not generate thermal increments in the apical surface capable of adversely affecting osseointegration and the integrity of the peri-implant bone tissue

A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations

Objectives: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000 adrenaline) for anterior maxillary infiltration in healthy volunteers. Material and methods: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy (dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. Results: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. Conclusions: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articaine