Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2012 | Month : May | Volume : 6 | Issue : 3 | Page : 533 - 536

Lasers in Conservative Dentistry: An Overview

Gaurangi Kakodkar, Ida de Noronha de Ataide, Rajdeep Pavaskar

1. MDS (Final year, Endodontics), Goa Dental College and Hospital, Bambolim (403202) Goa, India. Phone: 91-9923794559 E-mail: kakodkargaurangi@gmail.com 2. MDS (Head of Department of Endodontics Goa Dental College and Hospital, Bambolim (403202) Goa, India. E-mail: idanataide@yahoo.com 3. MDS (Final year, Endodontics) Goa Dental College and Hospital, Bambolim (403202) Goa, India. E-mail: rajpavaskar@gmail.com

Correspondence Address :
Dr. Gaurangi Kakodkar
MDS (Final year, Endodontics)
Phone: 91-9923794559
E-mail: kakodkargaurangi@gmail.com

Abstract

Lasers are surely one of the most promising technologies in the practice of dentistry. Throughout the last two decades, numerous scientific publications have emerged in literature, concerning laser equipments and their applications in the field of dental medicine. Presently, laser equipments are available on a large scale. The article reviews the applications of laser in Conservative dentistry and specifies the clinical importance of the lasers in each and every application.

Keywords

Heart rate Variability, Time domain method, Frequency domain method, Mobile phone users and non-users

How to cite this article :

Gaurangi Kakodkar, Ida de Noronha de Ataide, Rajdeep Pavaskar. LASERS IN CONSERVATIVE DENTISTRY: AN OVERVIEW. Journal of Clinical and Diagnostic Research [serial online] 2012 May [cited: 2019 Aug 19 ]; 6:533-536. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=May&volume=6&issue=3&page=533-536&id=1934

Introduction
LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. Hard Townes and Arthur L.Schawlow (1) in 1953 achieved a “MASER Optic” (Microwave Amplification by Stimulated Emission of Radiation). W.R. Bennet and D.R. Heriott (2) have elaborated the first laser with Helium-Neon in 1961. C.K.N Patel produced the first laser with CO2 in 1964. In Romania, the first laser with CO2 and Nd was produced in 1968. Stern and Sognnaes in 1964 began looking at the possible uses of the ruby laser in dentistry. A pioneer in the area of clinical periodontal and oral surgery is Pick, who, along with his colleagues in 1985, reported on laser gingivectomy. Maiman generated the first laser beam by using a ruby rod. In 1961, the first gas and continuously operating laser was described by Javan et al. The first laser was introduced into the fields of medicine and dentistry during the 1960s by Goldman et al, but the thermal damage was too great to consider this laser as a clinical instrument (2). Light is a form of electromagnetic energy that exists as a particle, and travels in waves, at a constant velocity. The basic unit of this radiant energy is called a photon; the wave of photons travels at the speed of light and it can be defined by two basic properties. The first is amplitude, which is defined as the vertical height of the wave oscillation from the zero axis to its peak. This correlates with the amount of energy in the wave: the larger the amplitude, the greater the amount of energy that can do useful work. A joule is a unit of energy; a useful quantity for dentistry is a millijoule, which is one-one thousandth of a joule. The second property of a wave is wavelength, which is the horizontal distance between any two corresponding points on the wave. This measurement is very important, both with respect to how the laser light is delivered to the surgical site and to how it reacts with the tissue. Wavelength is measured in meters; and dental lasers have wavelengths on the order of much smaller units by using the terminology of either nanometers (10- 9 meters) or microns (10-6 meters.) As the waves travel, they oscillate several times per second, and this is termed as ‘frequency’. Frequency is inversely proportional to the wavelength: the shorter the wavelength, the higher the frequency and vice versa (3). Original Article Dentistry Section A laser is a device that transforms the light of various frequencies into a chromatic radiation in the visible, infrared, and ultraviolet regions, with all the waves in the phase being capable of mobilizing immense heat and power when they are focused at a close range (4). It emits light through a process called stimulated emission, which features the collimated (parallel) and coherent (temporally and spatially constant) electromagnetic radiation of a single wavelength. When it reaches the biological tissues, the laser light can be reflected, scattered, absorbed, or transmitted to the surrounding tissues. The emission of wavelength mainly influences these modes of interaction in the target tissue and it must therefore be selected with caution for any diagnostic or therapeutic interventions (5). Amplification is a part of a process that occurs inside the laser. Identification of the components of a laser instrument is useful in understanding how light is produced. An optical cavity is there at the center of the device. The core of the cavity is comprised of chemical elements, molecules, or compounds and these are called the active medium. Lasers are generically named after the material of the active medium, which can be a container of gas, a crystal, or a solid-state semi-conductor. Surrounding this core is an excitation source, either a flash lamp strobe device, an electrical circuit, or an electrical coil, which pumps the energy into the active medium. There are two mirrors, one at each end of the optical cavity, which are placed parallel to each other; or in the case of a semi-conductor, there are two polished surfaces at each end. These mirrors act as resonators and help in collimating and amplifying the developing beam. A cooling system, focusing lenses, and other controls complete the mechanical components (6). Stimulated emission is the process which takes place within the active medium due to the pumping mechanism, and it was postulated by Albert Einstein in 1916. The light waves which are produced by the laser are a specific form of radiation, or electromagnetic energy. The electromagnetic spectrum is the entire collection of wave energy which ranges from gamma rays, whose wavelengths are about 10-12meters, to radio waves, whose wavelengths can be thousands of meters (7).
Types of Lasers
The laser systems which have been developed to date have been classified according to the active medium that is stimulated to emit the photon energy. This divides the laser systems into solidstate (Nd:YAG, Er:YAG, Er,Cr:YSGG), gas (CO2, Argon, Helium- Neon), diode, excimer, and dye lasers. Laser systems also can be classified by their maximum output level, that is, low output (soft) or high output (hard). Lasers may also be classified according to their oscillation mode (continuous or pulsed wave). The pulsedwave mode can be used by producing independent pulses (a freerunning pulse), as in the Nd:YAG, Er:YAG, and the Er,Cr:YSGG lasers, or by interrupting a continuous wave (gated or chopped pulse), as seen in the CO2 and the diode lasers (5).
Clinical Applications
Diagnostic/curing lasers: The DIAGNOdent is used for caries and calculus detection by emitting a nonionizing laser beam at a wavelength of 655nm (at a 90 0 angle) towards a specific darkened groove on the occlusal surface of a patient’s tooth where bacterial decay is suspected, or along the long axis of a root surface to detect the presence of a bacteria-laden calculus. This diagnostic technology, in which the photons of this laser wavelength are absorbed into any existing bacteria in these areas of the patient’s tooth, is called laser-induced fluorescence. The instrument’s digital display indicates the number of bacteria in this area of the tooth and it may correspond to the extent of decay of the existence of the calculus (8),(9).
Cavity preparation:
Cavity preparation by using lasers has been an area of major research interest ever since lasers were initially developed in the early 1960s. At present, several laser types with similar wavelengths in the middle infrared region of the electromagnetic spectrum are being used commonly for cavity preparation and caries removal. The Er: YAG laser was tested for preparing dental hard tissues for the first time in 1988. It was successfully used to prepare holes in the enamel and dentine with low ‘fluences’ (energy (mJ)/unit area (cm2)). Even without water-cooling, the prepared cavities showed no cracks and low or no charring, while the increase in the mean temperature of the pulp cavity was about 4.3degrees C). In 1989, it was demonstrated that the Er: YAG laser produced cavities in the enamel and dentine without any major adverse side effects (10).
Clinical note:
Only erbium lasers are used for tooth preparation. There should be at least 1mm of clearance between the end of the laser tip and the tooth structure.
• frequency range: 2 to 20 hz
• pulse energies : 50 to 1000 mj
• power: 1-8 w (depending on the type of tissue.)(Table/Fig 1)

Restoration removal:
The Er: YAG laser is capable of removing cement, composite resin and the glass ionomer. The efficiency of the ablation is comparable to that of enamel and dentine. Lasers should not be used to ablate the amalgam restorations, however, because of the potential release of mercury vapour. The Er: YAG laser is incapable of removing gold crowns, cast restorations and ceramic materials because of the low absorption of these materials and the reflection of the laser light. These limitations highlight the need for adequate operator training in the use of lasers (11).
Etching:
Laser etching has been evaluated as an alternative to the acid etching of enamel and dentine. The Er: YAG laser produces micro-explosions during hard tissue ablation that result in microscopic and macroscopic irregularities. These micro-irregularities make the enamel surface microretentive and they may offer a mechanism of adhesion without acid-etching. However, it has been shown that adhesion to the dental hard tissues after Er: YAG laser etching is inferior to that which is obtained after conventional acid etching (12).
Photopolymerisation:
(13), (14) The argon laser is one promising source, as the wavelength of the light which is emitted by this laser is optimal for the initiation of polymerization of the composite resins. The argon laser at 488nm (blue) is used. The argon wavelength activates camphorquinone , a photoinitiator that causes polymerisation of the resin composites. The argon laser radiation is also able to alter the surface chemistry of both the enamel and the root surface dentine, which reduces the probability of the recurrent caries.
Clinical Note:
It is used at 250+_ 50 mw/ cm2 for 10 seconds.
CAD/CAM technology:
This technology eliminates the need for conventional intra-oral impression materials. Instead, laser scanners take an optical impression of a prepared tooth and the opposing dentition and they take a bite registration to produce an interactive three-dimensional image. This three-dimensional laserbased imaging technology enables the dentist to take an optical impression and to create a computer file with this data. A virtual model is created, based on the transmitted data and a precise master model is made. The physical model is sent to the laboratory where a final restoration is made (15), (16).
Caries Prevention:
Controversial results can be found in the literature regarding the demineralization and the acid-resistance of enamel and dentin after the Er:YAG laser treatment. An increased temperature is necessary to achieve the photothermal effect and the enhancement of the enamel acid resistance. According to Fried et al (1989), the energy density which is necessary to reach the enamel acid resistance by using the Er,Cr:YSGG laser is approximately 8-13 J/cm2. This is expected to decrease the enamel solubility by promoting the thermal decomposition of the more soluble carbonate hydroxyapatite into the less soluble hydroxyapatite, with corresponding changes in its crystallinity (17),(18).
Laser Desensitization:
Dentinal hypersensitivity is one of the most common complaints in the dental clinical practice. Various treatment modalities such as the application of concentrated fluoride to seal the exposed dentinal tubules have been tested to treat the condition. However, the success rate can be greatly improved by the ongoing evaluation of lasers in hard tissue applications. A comparison of the desensitising effects of an Er:YAG laser with those of a conventional desensitising system on cervically exposed hypersensitive dentine showed that the desensitizing of hypersensitive dentine with an Er: YAG laser was effective, and that the maintenance of a positive result was more prolonged than with other agents (19).
Clinical note:
Er:YAG 30mJ and 10 Hz with water spray, for 2 minutes. OR Nd:YAG , 30mJ, 10Hz for 2 minutes.The laser should be placed 10mm from the target site and it should be slowly brought towards the tooth in a circling motion. If the patient feels discomfort, it should be pulled back by 1mm and then it should be slowly circled again. This procedure should be repeated until it is 1mm away from the tooth. Advanta ges and disadvanta ges of Lasers (5),(7),(20)
Advantages
• They are often less painful and so this reduces the need for administering anaesthesia.
• Some people are afraid of the conventional drill. They are more at ease with lasers.
• When soft tissue has to be handled, lasers lessen the swelling and the bleeding.
• During cavity treatment, lasers help in retaining more of the tooth that is intact.
Disadvantages
• When a tooth has already got a filling, it is not possible to use a laser there.
• The treatments for which lasers can be used are very limited. They can’t be manoeuvered around cavities which are present between two teeth or around bigger cavities that need to be fitted with a crown. Nor can they be used where there are old fillings, or to remove silver fillings, or damaged crowns. Laser technology is also not helpful in preparing the teeth for receiving bridges.
• Even where a laser is utilized, the conventional drill is still required for the bite adjustment, and for shaping and polishing the filling.
• Though laser can reduce the need for the administration of anaesthesia, it cannot eliminate it totally.
• Above all, the treatment does not come cheap.
• Lasers produce an intense, highly directional beam that is absorbed to some degree if it is directed, reflected, or focused on an object. The eye is a critical target for laser injuries.
Other uses of Lasers in Dentistry
In endodontics, lasers have been used as an adjuvant treatment in both low-intensity laser therapy and in high intensity laser treatment to optimize the outcome of the clinical procedures. The clinical application of a low-intensity laser in endodontic therapy has been considered to be useful in: post-pulpotomy (with the laser beam being applied directly to the remaining pulp and on the mucosa towards the root canal pulp); post-pulpectomy (with the irradiation of the apical region); and periapical surgery (irradiating the mucosa of the area which corresponds to the apical lesion and the sutures). High-intensity lasers such as Nd:YAG (neodymium: yttrium, aluminum, garnet), Ho: YAG (holmium: yttrium, aluminum, garnet), Er:YAG (erbium: yttrium, aluminum, garnet), Excimer, CO2 (carbon dioxide) and diode have been recommended successfully as adjuvant methods in the endodontic treatment of contaminated canals, to remove bacteria from the root dentinal surfaces as well as from the deep dentinal layers. Also, the use of lasers in replacing aerosol-producing handpieces in periapical surgery can reduce the risk of contamination of the surgical environment by blood borne pathogens. The unique properties of the laser light as they pertain to endodontic surgery, have been listed as follows: precision; coagulation; decreased postoperative pain, oedema and reduced scarring; sterilization; and selective absorption (21),(22),(23),(24).In gingivectomy and gingivoplasty ,various lasers can be used. The laser which is routinely used for removing gingival hyperplasia is the CO2 laser. Also, the Nd: YAG laser can be used in the treatment of hyperplastic gingiva by gingivectomy, phrenectomies, bridectomies, gingivectomies in hypertrophies and tumoural lesions; gingivoplasties with physiognomic or hygienic purposes; scaling and planning of root surfaces (in combination with the use of curettes); minor adjustments of the healing area, in the first stage of implant introduction; revealing of the implant, in the second stage; and gingival retraction, with the purpose of prosthetic impression. The Nd: YAG and the diode lasers are the prime candidates for use as adjuvant lasers in closed curettage. The recommended setting of 1.25 W to 3 W is used, in order to avoid the risk of irreversible damage which results from the blind guidance of the beam in the gingival pockets (23). The main applications of lasers in orthodontics are laser scanning, holography, and applications on soft and hard tissues. Plaque gingivitis, as a direct consequence of the retention of the bacterial plaque in orthodontic patients, can benefit from laser therapy. The lasers which have been reported as having been tested in this regards are the CO2 and the Nd: YAG lasers, which have proved their ability in destroying bacterial plaque (20),(21),(22),(23),(24).
Dental Laser Welding
Laser welding is an advantageous method of connecting or repairing metal prosthetic frameworks, because there are fewer effects of heating on the area which surrounds the spot which has to be welded, and no further procedures, such as those which are used for conventional soldering, are necessary. Laser welding has been increasingly applied for fabricating the metal frameworks of prostheses and for other procedures, such as recovering the metal ridge and the cusp, blocking holes on the occlusal surfaces after excess occlusal adjustment, thickening the metal framework, or adding contact points after excess grinding and adjusting of the crown margins. Low Level Laser Therapy (LLLT) is a method that is almost painfree and sterile, and it can be used by all the practitioners. The purpose of using LLLT is to supply direct biostimulative light energy to the body’s cells .

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Gutknecht N, Alt T, Slaus G, et al. A clinical comparison of the bactericidal effect of the diode laser and 5% sodium hypoclorite in necrotic root canals. J Oral Laser Aplications 2002;2:151-57.
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Gutknecht N, Moritz A, Conrads G, et al. Bactericidal effect of the Nd:YAG laser in in vitro root canals. J Clin Laser Med Surg. 1996;14: 77-80.
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Negretu ML, Sinescu C, Cozarov D, Culea I, Rominu M, Pop DM, et al. Repairing method of fixed partial prostheses in dentistry: laser welding. Laser in dentistry, Conference XIV, CA (USA) Jan 2008; 68:309-12.

Tables and Figures
[Table / Fig - 1]
DOI and Others

DOI: JCDR/2012/3564:1934

DECLARATION ON COMPETING INTERESTS:
No competing Interests.


Date of Submission: Sep 17, 2011
Date of Peer Review: Nov 11, 2011
Date of Acceptance: Jan 02, 2011
Date of Publishing: May 01, 2012

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