Soft-Tissue Dental Lasers: An Industry Update for Practitioners

The dental laser, if designed and used properly, can be a revolutionary addition to the clinician's armamentarium, providing dentists a precise, minimally invasive means of addressing an array of oral conditions. This article provides an industry update on soft-tissue dental lasers.

Most recent notable advancements in soft-tissue dental laser applications are related to laser-assisted airway disorder treatments and feature refined techniques for laser frenotomies and soft-palate tissue remodeling. The recently published American Dental Association (ADA) Technical Report on Dental Lasers¹ and the latest revision of the American National Standards Institute (ANSI) Laser Safety Standard for Healthcare² are invaluable "must-have" resources for dedicated laser practitioners seeking to make informed decisions regarding the most efficient and safe implementation of both ablative and non-ablative soft-tissue laser treatments.

Industry Spotlight

Request your sample today!

OMNICHROMA Flow BULK, a one-shade bulk fill composite, shade-matches any tooth color from A1 to D4. A low viscosity, light-cured material, placed in 3.5mm increments.

Laser-Tissue Interaction Science Update From ADA

The ADA's long-awaited Technical Report on Dental Lasers brings further clarity to the use of dental lasers with respect to their vascular soft-tissue applications based on soft-tissue's optical absorption spectra (Figure 1).¹ (To view Figure 1, which diagrams optical absorption coefficient spectra at different histologically relevant concentrations of water, hemoglobin, oxyhemoglobin, and melanin, visit compendiumlive.com/go/cced2090.) Specifically, most commercially available dental lasers can be separated into three distinct laser wavelength groups characterized by their stark differences in the strength of the optical absorption by the soft tissue:

Circa 1,000 nm - diodes and neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers.These are lasers with extremely low absorption strength, under 1 cm-¹, which explains why they cannot cut (ie, incise, vaporize, ablate) soft tissue optically in dental applications. Currently, commercially available dental diodes and Nd:YAG lasers cut the soft tissue only as a hot tip cautery device and not as an optical laser beam device. Such hot tip cautery devices are characterized by slow cutting and excessive depth of thermal damage.^1,3,4

Circa 3,000 nm - erbium lasers.With absorption strength of approximately 10,000 cm-¹, which is more than 10,000 times stronger than that of the diode laser wavelengths cited above, these lasers are the most efficient for soft-tissue cutting. Extremely high absorption by water, specifically for the very low water content present in enamel, makes these lasers effective and safe for hard-tissue uses where thermal spread is contraindicated (as opposed to a lateral thermal spread in soft-tissue applications). Extremely high absorption by soft tissue also makes these lasers highly inefficient for hemostasis and coagulation on the surgical margins.^1,4

Circa 10,000 nm - carbon dioxide (CO₂) lasers. These lasers have absorption strength that is approximately 1,000 times greater than that of diode lasers and about 15 times weaker than that of erbium lasers (when comparing a classic CO₂ laser at 10,600 nm versus a classic Er:YAG laser at 2,940 nm). Such intermediate values of absorption explain the acceptable hemostasis and coagulation depth of at least 50 µm (given the capillary blood vessel diameters in the range of 20 µm to 40 µm^1,4).⁴

The ADA's report reaffirms CO₂ lasers as the optimal choice for soft-tissue surgeries, providing an ideal compromise for achieving both high-speed cutting and hemostasis/coagulation. The report is available free of charge to ADA members and can be downloaded from the ADA website.

Laser Safety Regulations and Training Update

The ANSI Z136.3 Standard for Safe Use of Lasers in Health Care² is updated by the Laser Institute of America (LIA) every 5 to 6 years to reflect the ever-growing sophistication of medical and dental laser technology and its applications. The standard specifies laser hazards and corresponding laser safety measures, both mandatory and optional, covering laser safety officer appointment and training, the use of proper eye protection, the handling of laser plume and flammable gases, and so on. The latest 2024 edition of the standard is available from the LIA website.

Any dental laser user can benefit from the LIA's online laser safety courses, which are both comprehensive and relatively affordable. Discounted rates are available to American Laser Study Club members at the ALSC website.

Soft-Palate Tissue Remodeling Update

A notable development in the field of laser-assisted treatments of airway disorders is the advent of the soft-palate non-ablative CO₂ laser treatment.^5-7 Just like the soft-palate non-ablative Er:YAG laser treatment,⁸ the mechanism of action using this modality is mucosal collagen contraction, which is coagulation-driven by the heat conducted from the superficially laser-treated surface of the soft palate into the deeper tissue. The commonality between the different laser types used for such non-ablative treatment is that the total (per treatment) laser fluence (or laser energy density, per treatment) is in the approximate range of 10 joules/cm², per treated area. The aforementioned 15:1 difference between the absorption coefficient of the Er:YAG laser 2,940 nm wavelength and the CO₂ laser 10,600 nm wavelength by the soft tissue^1,4 results in a significant clinical advantage for CO₂ lasers: the non-ablative treatment time with a CO₂ laser can be approximately 15 times shorter than that of an Er:YAG laser (eg, 2 to 3 minutes versus 30 to 45 minutes).

A critical aspect in using this novel minimally invasive, non-ablative soft-palate tissue remodeling treatment is proper patient evaluation and selection, as discussed by Zaghi.⁶ To illustrate the effectiveness of such non-ablative treatment, Figure 2 and Figure 3 depict a case presentation of soft-palate treatment with a 10,600 nm CO₂ laser. In the author's opinion, this method of non-ablative soft-palate tissue remodeling is in its infancy, and future advances will rely heavily on clinical aspects of patient selection and aftercare.⁶

Laser Frenotomy Efficacy and Training Update

The field of laser tongue-tie release has seen significant advancement, including developments documented in two studies in particular. Ghaheri et al demonstrated in 47 infant patients in a randomized, controlled study that frenotomy significantly improved tongue parameters during feeding.⁹ Similar improvements were seen with patient-reported outcomes when tongue-tie was released. Zaghi et al demonstrated in 445 patients in a prospective cohort study that postoperative outcomes (eg, pain, bleeding, revisions, etc.) of frenuloplasty were significantly improved with refinement of the techniques, including the use of the 10,600 nm CO₂ laser.¹⁰

A comprehensive variety of laser frenotomy courses are available (both online and in-person) from such organizations as the Tongue-Tied Academy (tonguetiedacademy.com), The Breathe^® Institute (thebreatheinstitute.com), and the American Laser Study Club (americanlaserstudyclub.org). Courses cover all aspects of the treatment for all patient ages, including pre- and post-procedure protocols, procedure techniques, and hands-on laser lab training.

Conclusion

The evolution of soft-tissue dental lasers continues to revolutionize modern dentistry, offering high levels of precision, efficiency, and safety. From advancements in airway disorder treatments and laser frenotomies to the refinement of soft-palate tissue remodeling, these tools expand the clinician's capacity to deliver patient-centered care. With the support of resources like the ADA's Technical Report on Dental Lasers and ANSI's updated safety standards, dental professionals are better equipped to navigate the complexities of laser technology. As the field advances, continued education and proper training remain essential to help ensure the optimal use of this transformative technology for improved patient outcomes and innovative dental care practices.

Figures and Images

Figure 1

Figure 2

Figure 3

Figure 1

Figure 1

Figure 2

Fig 2 and Fig 3. Non-ablative 10,600 nm CO2 laser soft-palate tissue remodeling case presentation (courtesy of Ben A. Sutter, DMD). A 38-year-old Caucasian female patient presented with a history of restless sleep, daytime sleepiness, and an overall concern of never obtaining a restful sleep. Upon clinical and CBCT examination, an elongated soft palate was noted, as seen in Fig 2 (pretreatment photograph). After treatment options were presented, the patient elected to proceed with non-ablative soft-palate tissue remodeling. The laser treatment “on” time was less than 2 minutes and total chairtime was about 20 minutes, including consultation, presentation of treatment options, and answering all of the patient’s questions.

Figure 3

Fig 2 and Fig 3. Non-ablative 10,600 nm CO2 laser soft-palate tissue remodeling case presentation (courtesy of Ben A. Sutter, DMD). Fig 3 shows the result at 3.5 days post-treatment. The patient noticed improved, easier breathing when walking out to her car immediately after the treatment. She reported that she regained better sleep quality and started waking up feeling rested, and that her husband said her snoring changed from being very loud to a soft faint.