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Lasers > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the goals for surgical procedures with lasers?

A
  • Minimize all photobiotic effects without causing unwanted collateral damage.
  • Use of laser with power well below surgical thresholds for biostimulation.
  • Use of minimal energy in performace of laser therapeutic procedures.
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2
Q

What lasers would you use for Soft Tissue and Hard Tissue?

A
  • Soft Tissue
    • CO2
    • Erbium
    • Diode
    • Nd-YAG
  • Hard Tissue
    • Erbium
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3
Q

What are the indications for laser use with intra and extra oral soft tissue?

A
  • Ablating
  • Incising
  • Excising
  • Coagulation
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4
Q

What are the indications for laser use intra-oral hard tissue surgery?

A
  • Cutting
  • Shaping
  • Contouring
  • Wavelength tissue penetration
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5
Q

What’s the difference between laser surgery and conventional surgery?

A
  • Laser
    • Decreased internal tissue damage
    • Less traumatic (depth control)
    • Few myofibroblasts - less scaring
    • Healing rate 2-3 weeks
    • Secondary intention healing
    • Hemostasis
    • Contraction of vascular wall collagen
    • Reduction in surgical time
  • Blade
    • Healing rate 7-10 days
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6
Q

What is the scaring mechanism?

A
  • With lasers - fewer myofibroblasts = less scaring
  • Less contraction and smoother healing
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7
Q

What is the healing mechanism with lasers?

A

It is prolonged for laser surgery

  • Due to sealing of blood vessels and lymphatics
  • Time for neovasuclarization
  • New blood vessels where circulation has been impaired
  • Secondary intention healing
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8
Q

What is the clotting mechanism with lasers?

A
  • Photocoagulation results as denaturation of proteins occur (60-100C range)
  • Hemostasis achieved by
    • Contraction of vascular wall collagen
    • Constriction of vessel opening
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9
Q

What lasers has the FDA approved/

A
  • CO2 laser
  • Argon laser
  • Nd-YAG laser
  • Diode laser
  • Er-YAG laser
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10
Q

What are the characteristics of the “non-contact” application mode?

A

CO2 Laser

  • Focused - cutting
  • Defocused - surface vaporization
  • Articulated arm, mirror - delivery system of choice wavelength 9000-11000 nm
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11
Q

What are the procedures indicated for non contact application mode?

A
  • Removal of fibroma, lipoma, papilloma, veruca, haemangioma, frenulectomy, epulis fissuraturm
  • Uncovering implants
  • Gingivectomy, gingivoplasty, troughing, vestibulo-extensions (with grafting)
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12
Q

What are the procedures indicated for the Defocused Mode?

A
  • Apthous ulcer coagulation
  • Hemostasis
  • Hyperlasia (palatal, medication induced)
  • White lesions
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13
Q

What is the indication and applications for the Nd-YAG and Diode in oral surgery?

A
  • Incision and Excision
    • Removal of fibroma, lipoma, papilloma, frenulum - contact
    • Uncovering implants - contact
    • Apthous ulcers, herpetic lesions - non contact
    • Venous lake syndrome - non contact
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14
Q

What is the indication and applications for the Erbium Laser in oral surgery?

A
  • Water absorption - non contact
  • Short pulses
    • Lower thermal diffusion, no carbonization, low coagulation characteristics
  • Clinical applications
    • Small lesions, leukoplakia, gingevectomy, gingivoplasty
  • Bone surgery
    • Short high peak power pulses, water and air coolant, high H2O absorption
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15
Q

Which lasers are in contact and which are not?

A
  • Contact
    • Nd-YAG laser
    • Diode laser
  • Non-Contact
    • CO2 laser
    • Erbium laser
    • Nd-YAG laser (gingivectomy, uncovering implants)
    • Diode laser (gingivectomy, uncovering implants)
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16
Q

Why is a diode tip activated?

A

Tip activation is necessary for cutting, diode becomes a hot blade, this increase in fluence is necessary for quick, efficient cutting. When used for perio therapy, tip is not activated and it works as a true optical laser.

17
Q

What is the need for controlling lateral thermal damage?

A
  • It could extend up to 500 um from target - scaring
  • Lateral thermal damage is controlled by:
    • Speed of application
    • Faster pulse, less time available for conduction into tissues
  • Mid and Long IR = 100% absorption in epithelium - minimal collateral damage
18
Q

What are the 3 basic parameters for successful surgery?

A
  1. Power
  2. Time on Target
  3. Spot size of the beam

Adjusting these parameters allows you to create:

  • Deep thin cuts for incision and excision
  • Wide superficial surface vaporization for tissue ablation
    • Crucial to prevent scaring
19
Q

What are the surgical techniques for ablation and vaporization?

A
  • To increase depth, increase power
    • Slower movement = bad!
  • To decrease depth, decrease power, move faster, widen spot size
  • Remove char after each pass
  • Surface of hundreds of microns to 1-2mms
20
Q

What are the surgical techniques for incision and excision?

A
  • Make thin, deep cuts when trying to simulate a scalpel blade
  • High power density
  • Small spot size 0.1-0.5mm
  • Gated mode, low fluence, minimize depth of penetration
  • Connect dots, rapid controlled movement
21
Q

How does laser energy affect specifc perio pathogens?

A
  • Lowers bacterial levels in red and orange and complexes without antibiotic regimens (which just cover biofilm)
    • Orange Complex
      • F nucleatum, F periodontium, P micros, P intermedia, P nigrescens, S constellatus, E nodatum, C showar, C gracilis, C rectus
    • Red Complex
      • P gingivalis, T denticola, B forsythius, E nodatum
22
Q

How do you minimize potential adverse outcomes?

A
  • Adverse Outcomes
    • Excessive temperature elevation
    • Excessive dehydration of tissues
    • Laterla thermal conduction (excessive)
    • Pain
  • To do so:
    • Use lowest possible energy
    • Shortest amount of time
23
Q

What are the visual tissue changes that occur at specific temperatures?

A
  • 37-60˚C - Shrinkage of tissue
  • 60-65˚C - Blanching
  • 65-90˚C - White, gray
  • 90-100˚C - Puckering
  • 100˚C - Smoke plume
24
Q

What are the photobiologic effects?

A
  • Lower bacterial levels in the red and orange complexes without antibiotic regimens
  • Ablation and vaporization of inflammed tissue
  • Redeveloping proper gingival architechture
  • Using energy to affect the process of biostimulation
    • Enhance mesenchymal activity

Lasers (1 decks)

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