Оглавление
Georgios E. Romanos. Advanced Laser Surgery in Dentistry
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Advanced Laser Surgery in Dentistry
About the Author
List of Contributors
Preface
Acknowledgement
1 Laser Fundamental Principles
1.1 Historical Background
1.2 Energy Levels and Stimulated Emission
1.3 Properties of the Laser Light
1.4 The Laser Cavity
1.4.1 Active Medium
1.4.2 Pumping Mechanism
1.4.3 Lenses – Resonator
1.5 Laser Application Modes
1.5.1 Beam Profiles
1.6 Delivery Systems
1.6.1 Direct Coupling
1.6.2 Articulated Arms
1.6.3 Fiber Systems and Flexible Hollow Guides
1.7 Applicators
1.7.1 Handpieces
1.7.2 Fiber Applicators
1.8 Laser Types Based on the Active Medium
1.8.1 Gas Lasers
1.8.1.1 CO2 Laser (10 600 nm)
1.8.1.2 CO2 Laser (9300 nm)
1.8.1.3 Argon‐Laser
1.8.1.4 He:Ne Laser
1.8.2 Crystal Lasers
1.8.2.1 Nd:YAG Laser
1.8.2.2 Er:YAG Laser
1.8.2.3 Er,Cr:YSGG Laser
1.8.2.4 Ho:YAG Laser
1.8.2.5 Alexandrite Laser
1.8.3 Liquid (Dye) Lasers
1.8.4 Semiconductor (Diode) Lasers
1.8.4.1 Blue Light (445 nm)
1.8.5 New Developments in Laser Technology. 1.8.5.1 Fiber Laser
1.8.5.2 Thulium (Tm:YAP) Laser
1.8.5.3 Superpulse Diode Laser
1.8.6 Lasers for Research Applications. 1.8.6.1 Free‐Electron Laser
1.8.6.2 Nuclear‐Pumped Gas Lasers
1.8.6.3 X‐Ray Laser
1.9 Laser and Biological Tissue Interactions
1.9.1 Photochemical Effects
1.9.1.1 Biostimulation
1.9.1.2 Photodynamic Therapy (PDT)
1.9.2 Photothermal Effects
1.9.2.1 Fractional (Photo)‐Thermolysis
1.9.3 Ionizing or Nonlinear Effects. 1.9.3.1 Photoablation
1.9.3.2 Photodisruption
References
2 Lasers and Wound Healing
2.1 Introduction
2.2 Wound Healing and Low Power Lasers
2.3 Wound Healing and High‐Power Lasers
2.3.1 Wound Healing and CO2 Laser
2.3.2 Wound Healing and the Nd:YAG Laser
2.3.3 Wound Healing and Other Laser Wavelengths
2.4 Lasers and Bone Healing
References
3 Lasers in Oral Surgery
3.1 Introduction
3.2 Basic Principles
3.3 Excision Biopsies
3.4 Removal of Benign Soft Tissue Tumors
3.4.1 Surgical Protocol for Removal of Small Tumors
Clinical Cases. Clinical Cases Excision Biopsy of a White Lesion (Leukoplakia)
3.4.2 Surgical Protocol for Removal of Larger Soft Tissue Tumors
Clinical Cases. Clinical Cases Removal of a Fibroma of the Maxilla
Removal of an Irritation Fibroma
Removal of an Irritation Fibroma in Combination with a Local Vestibuloplasty
Removal of an Irritation Fibroma in the Mandible
Removal of a Fibroma of the Buccal Mucosa
Removal of a Fibroma of the Tongue with an Er:YAG Laser
Removal of a Fibroma in the Maxillary Alveolar Ridge
Removal of a Palatal Adenoma
Removal of Fibroepithelial Palatal Hyperplasia
Removal of Large Palatal Fibromas
Removal of Large Palatal Fibromas
Removal of a Pyogenic Granuloma
Removal of a Fibroma at the Buccal Mucosa Using a Diode Laser
Removal of a Fibroma at the Buccal Mucosa Using a CO2 Laser
Removal of Hyperplastic Gingiva Underneath Bar Restoration
Removal of Hyperplastic Peri‐implant Mucosa Underneath Bar Restoration
Removal of an Ossifying Fibroma Using a CO2 Laser
Removal of an Ossifying Fibroma Using a Diode Laser
Removal of a Papilloma of the Lip
Removal of a Papilloma of the Lip
Removal of a Lipoma in the Buccal Mucosa
Removal of a Lipoma of the Tongue
Removal of a Giant Cell Granuloma of the Gingiva
Removal of an Adenoma of the Sublingual Salivary Gland
3.5 Removal of Drug‐Induced Gingival Hyperplasias and Epulides. 3.5.1 Removal of Drug‐Induced Gingival Hyperplasias
3.5.2 Removal of Epulides
Clinical Cases. Clinical Cases Removal of an Epulis Fibromatosa
Removal of an Epulis Granulomatosa (Pregnancy EpuIis)
3.6 Removal of Soft Tissue Cysts
Clinical Cases. Clinical Cases Removal of a Mucous Retention Cyst in the Lower Lip
Removal of a Ranula
Intraoral Removal of an Epidermoid Cyst
3.7 Frenectomies and Vestibuloplasties
3.7.1 Frenectomies
Clinical Cases. Clinical Cases Removal of a Lingual Frenum
Removal of Frenum in the Maxilla and Mandible
Frenectomy with CO2 Laser
Frenectomy of Labial Frenum with a Diode‐Pumped Nd:YAG Laser
Frenectomy in the Mandible with a Diode (810 nm) Laser
Frenectomy in the Anterior Maxilla with a Diode (810 nm) Laser
3.7.2 Vestibuloplasties
Clinical Cases. Clinical Cases Vestibuloplasty in the Maxilla
Vestibuloplasty in the Maxilla
Vestibuloplasty with a Diode (980 nm) Laser as a Complication of Wrong Power Settings
Vestibuloplasty to Increase Keratinized Tissue Width with a Nd:YAG Laser
Vestibuloplasty with an Er:YAG Laser
Vestibuloplasties in Conjunction with Soft Tissue Tumors
Vestibuloplasty in Conjunction with Soft Tissue Tumor Using a CO2 Laser
3.8 Removal of Precancerous Lesions (Leukoplakia)
Clinical Cases. Clinical Cases Removal of a Verrucous Leukoplakia in the Alveolar Ridge
Removal of Multiple Leukoplakia Lesions
Removal of a Leukoplakia in the Gingiva
Removal of Leukoplakia in the Periodontal Tissues with Recurrence
Removal of a Leukoplakia of the Gingiva with an Nd:YAG Laser
Removal of Leukoplakia in the Tongue
3.9 Surgical Removal of Malignant Soft Tissue Tumors
3.10 Laser Coagulation
Clinical Case. Clinical Case Coagulation in Patients with Coagulopathies
3.11 Lasers in Vascular and Pigmented Lesions
3.11.1 Laser Types
3.11.2 Removal of Vascular Alterations with the “Ice Cube” Method
Clinical Cases. Clinical Cases Removal of Hemangioma of the Buccal Mucosa
Removal of a Hemangioma of the Lower Lip
Removal of Telangiectasias in Morbus Osler's Disease
Removal of a Large Hemangioma of the Lower Lip
Removal of a Large Hemangioma of the Tongue
Removal of a Large Hemangioma of the Tongue
Removal of a Hemangioma in the Oral Mucosa with a Diode Laser
Removal of a Hemangioma in the Lower Lip with a Diode Laser
Other Clinical Examples of Hemangioma Removal Using the Ice Cube Technique. Case 1
Case 2
Case 3
Case 4
Removal of an Amalgam Tattoo with an Nd:YAG Laser
Removal of a Nevus of the Upper Lip
3.12 Exposure of Impacted, Unerupted Teeth
Clinical Cases. Clinical Cases Exposure of a Semi‐impacted Tooth During Pregnancy
Exposure of an Unerupted Canine for Orthodontic Reasons
3.12.1 Exposure of an Unerupted Teeth for Orthodontic Reasons
3.13 Removal of Sialoliths Using the Laser
Clinical Case. Clinical Case Removal of Deeply Localized Sialoliths of the Submandibular Gland
References
4 Lasers and Bone Surgery
4.1 Introduction
4.2 CO2 Laser
4.3 Excimer Laser
4.4 Er:YAG and Ho:YAG Lasers
4.5 Laser Systems for Clinical Dentistry
Case 1 Removal of Lingual Exostoses
Case 2 Removal of Exostosis
References
5 Lasers in Periodontology
5.1 Introduction
5.2 Laser‐Assisted Bacteria Reduction in Periodontal Tissues
5.3 Removal of Subgingival Calculus
5.4 Removal of Pocket Epithelium
5.5 Retardation of the Epithelial Downgrowth
Clinical Case. Clinical Case Pocket Elimination with the Nd:YAG Laser
5.6 Laser Application in Gingivectomy and Gingivoplasty
Clinical Cases. Clinical Case Removal of a Drug‐Induced Gingival Hyperplasia
Gingivectomy with CO2 Laser in a Patient Due to Combination Therapy of Medications
5.7 Laser‐Assisted Hemostasis in Periodontics
Clinical Case. Clinical Case Nonsurgical Periodontal Therapy in a Patient with Bleeding Disorder
5.8 Photodynamic Therapy in Periodontology
Clinical Cases. Clinical Case Combined Frenectomy and Vestibuloplasty for Improvement of Keratinized Tissue Width
Removal of a Gingival Tumor during Pregnancy Using a Diode Laser
Crown Lengthening with the Nd:YAG Laser
Crown Lengthening with the CO2 Laser
Crown Lengthening with Osseous Recontouring
Crown Lengthening in the Anterior Teeth to Improve Esthetics
Mandible
Crown Lengthening in the Maxillary Arch for Esthetic Purposes
5.9 Gingival Troughing for Prosthetic Restorations
5.10 Fractional Photothermolysis in Periodontology
5.11 Education and Future of Lasers in Periodontal Therapy
References
6 Lasers and Implants
6.1 Introduction
6.2 Laser‐Assisted Surgery Before Implant Placement and Implant Exposure
6.3 Laser Application During Function
6.4 Laser Applications in Peri‐implantitis Treatment
Clinical Cases. Clinical Cases Uncovering of Two‐Staged Implants
Uncovering of Two‐Staged Implants
Excision of Peri‐implant Gingival Hyperplasia
Soft Tissue Management Around Implants with the Pulsed Diode Laser
Soft Tissue Management Around Implants with the CO2 Laser
Laser‐Supported Treatment of Peri‐impIantitis
Peri‐impIantitis Treatment Before Functional Loading
Peri‐impIantitis Treatment with Autogenous Bone Grafting Material
Laser‐Supported Treatment of Peri‐impIantitis
Peri‐impIantitis Treatment with a Diode Laser
Peri‐impIantitis Treatment Associated with Postoperative Complications
6.5 Recent Laser Research on Implants
6.6 Implant Removal
6.7 Laser‐Assisted Implant Placement
6.8 Future of Laser Dentistry in Oral Implantology
References
7 Photodynamic Therapy in Periodontal and Peri‐Implant Treatment
7.1 Biological Rationale
7.2 Use of PDT as an Alternative to Systemic or Local Antibiotics
7.3 Conclusions
References
8 Understanding Laser Safety in Dentistry
8.1 Laser Safety
8.2 International Laser Standards
8.3 Regulatory Agencies and Nongovernmental Organizations. 8.3.1 Food and Drug Administration
8.3.2 FDA Center for Devices and Radiological Health
8.3.3 American National Standards Institute
8.3.4 Occupational Safety and Health Administration
FDA Classification of Medical Devices
Class I
Class II
Class III
Laser Classification Systems
Class 1 – IEC, FDA, ANSI Z136
Class 1M – ANSI Z136, IEC
Class 1C – IEC, ANSI Z136.3
Class 2 – IEC, FDA, ANSI Z136
Class 2a – FDA
Class 2M ‐ IEC, ANSI
Class IIIa ‐ FDA
Class 3R – IEC, ANSI
Class 3B – IEC, FDA, ANSI
Class 4 – IEC, FDA, ANSI
8.4 State Regulations
8.5 Nongovernmental Controls and Professional Organizations. 8.5.1 American Society for Lasers in Medicine and Surgery
8.5.2 Association of periOperative Registered Nurses (AORN)
8.6 The Joint Commission (TJC)
8.7 Standards and Practice
8.7.1 Laser Safety Officer
8.8 Hazard Evaluation and Control Measures
8.9 Administrative Controls
8.10 Procedural and Equipment Controls
8.11 Laser Treatment Controlled Area
8.12 Maintenance and Service
8.13 Beam Hazards. 8.13.1 Eye Protection
8.13.2 Skin Protection
8.14 Laser Safety and Training Programs
8.15 Medical Surveillance
8.16 Nonbeam Hazards
8.17 Electrical Hazards
8.18 Smoke Plume
8.19 Fire and Explosion Hazards
8.20 Shared Airway Procedures
8.21 Conclusion
References
Appendix A. Suggested Reading
Appendix B. Physical Units
Laser Parameters
Physical Parameters
Important Formulas
Index
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p
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