Comparative Tables

The tables below can be useful quick-check guides to compare the effects and uses of all the wavelengths in the field of periodontology and implant dentistry

Mechanisms of Action In Flapless Periodontal Therapy

Action Nd:YAG Diode CO2 Er:YAG Er,Cr:YSGG
 
Pocket lining removal +++ +++ ++ ++ ++
Granulation tissue removal + + ++ +++
Outer epithelial disruption/ removal +++ +++ + ++ ++
Bactericidal +++ +++ ++ + ++
Biofilm Removal / disruption ++ + +++ +++
Calculus removal ++ ++
Smear Layer removal +++ +++
Endotoxin removal + +++ +++
Lipopolysaccharide removal + ++ ++
Lipopolysaccharide inhibition +++ +++ + +
Root surface modification ++ +++ +++
Bone Biostimulation +++ +++ + + ++
Bone decortication to release stem cells, bleeding, cytokines, BMPs +++ +++
Use of other instruments required +++ +++ +++ + +
Flapless surgical protocol +++ (LANAP) + +++
(ErLCPT)
+++
(RePair)

A dual or multi-wavelength approach is often more beneficial to be able to achieve all the steps in a procedure with optimum benefit.

Key:  All lasers need correct settings and parameters to be used safely in any procedure, and training is paramount before embarking on their use

Not suitable for this procedure
+ Can be used in this procedure, but extra caution needed
+ Can be used
++ A good application
+++ An ideal application, or laser of choice, or safest to use

Procedures that Lasers can be used for – classified by suitability, effectiveness and safety

Operator experience and delivery mechanisms and tips (dependent on manufacturers specific machines) will have a role in effectiveness for these procedures

  Nd:YAG Diode CO2 Er:YAG Er:,Cr:YSGG
Perio pockets – non surgical disinfection +++ +++ + + ++
Perio pockets – biofilm removal +++ +++
Perio pockets – curretage ++ ++ + +++ +++
Perio pockets – calculus removal +++ +++
Perio pockets- flapless Surgery ++ + +++ +++
Perio Pockets – flapped Surgery ++ +++
Split thickness flap + + ++ ++
Tunnelling in furcation defects +++ +++
Root amputation ++ (9.3) +++ +++
Periodontal Regenerative Surgery ++ + +++ +++
Crown Lengthening – soft tissue +++ +++ + ++ +++
Crown Lengthening – hard tissue +++ +++
Tissue thinning (gingival hyperplasia) + + ++ ++ +++
Gingivectomy +++ +++ ++ ++ +++
Frenectomy +++ +++ +++ ++ +++
Fibreotomy + + ++ ++
Vestibular deepening +++ +++ +++ ++ ++
Reverse Vestibuloplasty (gummy smile) ++ + ++ +++
Removal of Composite restorations +++ +++
Harvesting graft from palate ++ ++
Preparing graft recipient bed ++ ++
Tunnel preparation for grafting ++ ++
Root Surface modification ++ +++ +++
De-epithelialisation of papillae + + + +++ +++
Biopsy ++ ++ ++ ++ +++
Operculectomy +++ +++ ++ ++ +++
Removal of soft tissue swellings +++ +++ +++ ++ +++
Denture Stomatitis ++ ++ ++ ++ ++
Haemangioma removal +++ +++ +++ + ++
Depigmentation +++ +++ ++ +++ +++
Bone removal +++ +++
Restoration of biologic width +++ +++
Oral Ulceration +++ +++ ++ + ++
Haemostasis +++ +++ +
Desensitisation ++ ++ + + ++
Atraumatic extraction +++ +++
Socket Preservation +++ +++
Sinus lifting procedures +++ +++
Implant placement – bone site + +
Implant Exposure ++ ++ + + ++
Peri-implantitis – flapless + ++ ++ +++
Peri-implantitis – flapped + ++ +++ +++
Photo-biomodulation +++ +++ + + +
Post-op healing time for wounds ++ ++ ++ +++ +++

A Dual- Wavelength approach is often ideal to achieve all steps in a procedure and benefit the most from laser use.

Key:  All lasers need correct settings and parameters to be used safely in any procedure, and training is paramount before embarking on their use

Not suitable for this procedure
+ Can be used in this procedure, but extra caution needed
+ Can be used
++ A good application
+++ An ideal application, or laser of choice, or safest to use

The differences with Er:YAG and Er,Cr:YSGG explained from a clinical view-point

First and foremost, however, both are excellent and ideal to use in periodontal treatments

  Er:YAG Er,Cr:YSGG
Water absorption 2940nm wavelength is the peak for water absorption. Rapid ablation with minimal heat accumulation. The tip may need to be closer to the tissue being cut due to higher absorption in water spray over the surface characteristic.  Working distance is 1mm or less with a tipped handpiece. Lower absorption in water-containing tissue permits some localised heat accumulation depending on the settings. Greater heat enables haemostasis and is of no consequence in safe ablation of hard tissues providing sufficient water spray applied. In being able to work slightly further from the tissues, the distance is 2mm or less
Cutting speed The penetration depth of cut will be less (1um), and so the laser can potentially be slower to achieve the same cut.  Laser screening on ablation debris is also a factor. Of course, settings can be altered to optimise ablation The penetration depth is greater, and more energy required to ablate; however more tissue removed and cuts efficiently. Understanding of laser tissue interaction important to optimize cutting efficiency.
Thermal damage May be less potential for thermal or other collateral damage because the tip has to be so close to the tissues and absorption is more superficial Thermal damage not an issue providing adequate water spray applied. Tip must not be used in contact with hard tissues to avoid tip damage, stall out and excess heat accumulation.
Root damage  Is able to remove calculus, but greater potential for root damage due to less penetration depths; therefore flapless calculus removal should be carried out with more caution Used in combination with lateral firing tips permits safe energy density to remove smear layer without root damage. Must be used with plenty of water to ensure heat dissipation from the tip particularly at depth.
Haemostasis Poor haemostasis; need a secondary  thermal effect with ablation to achieve a bloodless cut.  This could impact on tissue healing time if greater thermal damage is created Better haemostasis – not as much energy to achieve a bloodless cut may result in faster healing; however, erbium lasers in general are not the optimum wavelengths to stop bleeding once it starts and should be used with caution for vascular lesions
Manufacturers Several manufacturers – so different delivery systems, handpieces and tips available specific to the system.  Not all Er:YAG lasers will be the same Only one manufacturer – all tips and settings reported in the literature apply and will be available from the same manufacturer

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