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Guest Editorial
ARTICLE IN PRESS
doi:
10.25259/JADE_25_2025

Emerging trends in laser dentistry

Department of Medical Informatics, University of the Potomac, Washington DC, United States.
Author image

*Corresponding author: Smriti Prakash Singh, Department of Medical Informatics, University of the Potomac, Washington, United States. smritipsingh23@gmail.com

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Singh SP. Emerging trends in laser dentistry. J Academy Dent Educ. doi: 10.25259/JADE_25_2025

INTRODUCTION

The word “Laser” is an abbreviated form for light amplification by stimulated emission of radiation. It is a technology that can amplify and produce a highly directional, intense, monochromatic, and coherent beam to interact with target tissues. The specific wavelength and power of the laser determine its interaction with the tissue, enabling a range of applications in dentistry.[1] Dental lasers are mostly classified into erbium: yttrium aluminum garnet laser (Er:YAG), erbium, chromium: yttrium, scandium, gallium garnet (Er,Cr:YSGG), carbon dioxide (CO2), and diode lasers. Each of them is equipped with unique properties and hence suited for specific procedures.[2]

The journey of laser technology in dentistry began in the late 1960s with the introduction of the ruby laser. Ruby lasers offered a good way to vaporize caries. However, this came at a cost, as the intense energy from the laser could cause permanent and damaging changes to pulp tissue.[3]

After that, researchers discovered the erbium laser wavelengths that were able to prepare cavities more effectively while avoiding pulpal damage. Research indicates that argon lasers work well for photo-polymerization of dental composites. In contrast, neodymium yttrium aluminum garnet laser (Nd:YAG) lasers are more versatile, finding applications in various endodontic therapies, prosthetic devices, gold alloys, and prosthetic devices. For example, Er:YAG lasers are particularly good at hard tissue ablation because they possess strong affinity to the water in enamel and dentin.[4]

This allows for precise removal of caries, cavity preparation, and enamel etching without compromising surrounding healthy tissue. CO2 lasers, on the other hand, target water and hemoglobin, making them ideal for soft-tissue procedures such as frenectomy, gum sculpting, and treatment of periodontal disease due to their hemostatic properties (ability to control bleeding). Diode lasers are gaining popularity for a variety of applications, including low-level laser therapy for pain management and biostimulation, as well as soft-tissue surgery due to their ability to target specific pigments.[5]

Early applications were focused on soft-tissue procedures such as frenectomies and gingivectomies. However, advancements in laser design and wavelength selection led to the development of more versatile lasers capable of interacting with hard tissues such as enamel and dentin.

Conventionally, dental procedures often relied on drills and scalpels, leading to discomfort, anxiety, and extended healing times for patients. Laser dentistry offers a paradigm shift, introducing minimally invasive techniques that utilize concentrated light energy to target specific tissues.[6] This leads to several advantages, including as follows:

Reduced pain and discomfort

Lasers can numb tissues through heat generation, minimizing the need for anesthesia and injections. In addition, the precise nature of lasers minimizes unnecessary tissue removal, reducing post-operative pain.

Minimally invasive procedures

Laser beams can precisely target specific areas, leading to smaller incisions and less bleeding compared to traditional methods. This translates to faster healing times and reduced risk of infection.

Improved patient experience

The overall experience for patients is significantly enhanced with laser dentistry. Reduced pain, minimal drilling sounds, and faster procedures contribute to a more relaxed and comfortable dental visit.[6]

Over the past few decades, laser dentistry has witnessed continuous refinement and innovation. Lasers have essentially become the main tool in this area. They are so versatile because they provide the right amount of power, incredible precision, and a way of working with tissues that make them suitable for a wide range of procedures in dentistry.

EXPANDING APPLICATIONS OF LASER TECHNOLOGY

Laser use in modern dental treatments has been possible since the 1990s, when its clinical advantages, such as high precision and significant reduction in post-operative discomfort for patients, were discovered.[7] Laser technology boasts a growing list of applications within dentistry. Here is a closer look at some established and emerging uses:

Hard tissue procedures

The predominant two are Er:YAG (2,940 nm) and Er,Cr:YSGG (2,780 nm), together with CO2 (10,600 nm). These wavelengths have an affinity for (carbonated) hydroxyapatite and water chromophores. However, although the water content of enamel and dentine is very low (3–5% in enamel and 13–15% in dentine), the specific way commercial dental lasers produce and deliver their energy is what ultimately dictates how they interact with and remove tissue. While the 10,600 nm light from CO2 lasers (the kind dentists usually work with) is great at being absorbed by water, it is not absorbed as well by tooth material (hydroxyapatite) as the 9,600 nm light that some laboratory CO2 lasers use. In addition, the 10,600 nm CO2 laser emits in continuous and gated-continuous wave (CW) modes, which not only renders the average power output low, but also significantly reduces the thermal relaxation potential. This can have devastating effects on dental hard tissues.

Selective caries removal and cavity preparation

Traditional dental drills used for cavity preparation can be unpleasant for patients as they produce noise, vibration, and potential discomfort caused by them. Instead of the usual dental drill, laser dentistry provides a gentler and often more comfortable experience for patients.

When dentists need to work on hard tissues such as enamel and bone, Er:YAG lasers are their go-to. These lasers can also remove various dental materials such as cement used for crowns, composite, and glass ionomer. What’s really great is how accurately these lasers work, allowing dentists to remove just the decayed part of a tooth while leaving the healthy areas pretty much untouched.[8] This translates to:

  1. The targeted nature of laser ablation minimizes the need for local anesthesia. Discomfort associated with vibration and heat generation is also significantly reduced compared to traditional drills

  2. Lasers offer exceptional control over the depth and width of tissue removal, resulting in more conservative and precise cavity preparations. One of the big advantages of using lasers is that they help to preserve healthy tooth structure and also reduce the need for extensive restorations

  3. Laser ablation minimizes the risk of microfractures in teeth compared to drills, hence improving the longevity of restorations.

Beyond cavity preparation

The versatility of lasers in hard tissue procedures extends beyond caries removal. Er:YAG lasers can also be used for the following procedures:

Caries prevention: Low-level laser therapy is being used as a potential preventive measure for dental caries. Studies suggest that it can stimulate dentin remineralization, reducing the need for future fillings.[9]

Lasers can be used to prepare the tooth surface for bonding by selectively removing the enamel’s outer layer. Using laser improves adhesion compared to traditional etching methods and may lead to more durable restorations.[10]

Selective enamel ablation: In certain orthodontic procedures, lasers can be used for precise enamel reduction to create space for tooth movement. In a result, it offers greater control and minimizes the need for tooth extraction.[11]

Laser teeth whitening

It is often used in conjunction with bleaching agents, which can accelerate the whitening process and achieve better results. Laser-assisted tooth bleaching works through two main mechanisms: Photothermal and photochemical. The photothermal method uses a laser to activate and boost the bleaching agent usually hydrogen peroxide or carbamide peroxide to work even better. The laser’s energy increases the rate of the chemical reactions in the bleaching process by heating the bleaching agent, which enhances its effectiveness. This approach can help breakdown of chromogenic compounds more effectively, leading to faster whitening. In the photochemical method, laser light is absorbed by the bleached surfaces and directly induces the photooxidation of the chromogenic macromolecules. The energy from the laser light interacts with the pigment molecules, causing a chemical reaction that breaks down the color-producing compounds, resulting in a lighter shade of the tooth.[12] The laser in this method is used to produce reactive oxygen molecules. These molecules then go to work on the chromogenic molecules, essentially degrading them. Each laser used in these procedures is characterized by several critical parameters: The wavelength of the emitted light (measured in nanometers, nm), the power density of the beam (measured in watts per square centimeter, W/cm2), and the type of energy emitted – whether pulsed or continuous. Additional features include the pulse rate and pulse duration, which influence the overall effectiveness and safety of the procedure.[13-15] Picking the right laser settings is crucial for getting good teeth whitening results. Using different wavelengths and power can lead to different levels of whiteness and also affect the chances of any issues such as effectiveness and risk.

Soft tissue procedures

Laser technology offers significant advantages in various soft tissue procedures as it promotes faster healing and improved patient comfort. Two key features of using laser technology are reduced bleeding intraoperatively and less pain postoperative procedures in comparison to conventional techniques such as electrosurgery. Common applications of lasers are as follows:

Gingival sculpting and crown lengthening

Traditional methods for gum reshaping or crown lengthening often involves scalpels and sutures. Using laser technology, a dentist can perform more precise and bloodless tissue removal, minimizing discomfort and post-operative bleeding. Apart from that, lasers also promote faster healing due to their biostimulatory effects.[16]

Frenectomy and frenuloplasty

Frenectomy involves removing a frenulum, a small piece of tissue connecting the lip or cheek to the gum while frenuloplasty involves repositioning the frenulum.[13] The standard technique for this problem, developed by Archer in 1961 and Kruger in 1964, was based on the idea that in cases of midline diastema cases with an aberrant frenum, to ensure the removal of the muscle fibers which were supposedly connecting the orbicularis oris with the palatine papilla.[17]

Lasers offer a minimally invasive and bloodless approach for these procedures, reducing discomfort and promoting faster healing. Compared to the traditional use of scalpels, laser treatments provide a higher level of precision and significantly reduce bleeding. As a result, patients typically experience less pain after the procedure and recover more quickly.

When it comes to lingual frenectomies with a CO2 laser, it is considered a safe and effective method. One of the pulses is that the surgery does not take as long and is pretty straightforward. Patients also tend to have no infections after, less pain and swelling, and often end up with just a small scar or none at all.[18]

It has been noted that diode and Er:YAG lasers have been used for labial frenectomies (a procedure on the upper lip tie) in babies. In addition, the Er,Cr:YSGG laser has been used for the same procedure in adolescents and prepubescent kids.

Periodontal treatment

Lasers can be used for effective debridement (removal of infected tissue) in periodontal pockets. Their ability to target inflamed tissue and promote blood clotting minimizes bleeding and discomfort compared to traditional scaling and root planing procedures.

In addition, laser irradiation can potentially enhance tissue regeneration and healing. Following are ways to use lasers to treat periodontal diseases.[19] The erbium lasers are effective in removing calculus and reducing probing pocket depth (PPD). It has been suggested that the erbium wavelengths present the broadest range of application for clinical dentistry and are likely the most suitable lasers for periodontal therapy.[20] Several studies have demonstrated safe and effective root substance removal without negative thermal effects, comparable with conventional instrumentation.[21] Keller et al.[22] reported effective removal of calculus from the root surface without thermal alteration of the surface using Er:YAG laser scaling at 120 and 150 mJ/pulse.

Photodynamic therapy (PDT): This technique utilizes lasers in combination with photosensitizing agents to target and destroy specific cells. PDT has potential applications in the treatment of oral precancerous lesions and certain types of oral cancer.[23] Antimicrobial photodynamic therapy (aPDT) is a non-invasive therapy that is capable of eliminating periodontopathic bacteria; it uses a low-power laser as a light source and has been used to treat periodontal and peri-implant diseases. The great advantage of the use of aPDT as an adjunctive treatment along with conventional periodontal treatment is that it is a low cost, local therapy that has no systemic effects and does not cause bacterial resistance, particularly compared with the use of antibiotic therapy. In addition, aPDT may be very useful for patients exhibiting modifying systemic factors that are capable of altering the biological response of the periodontal tissues during the tissue repair process following conventional treatment or even influencing the progression of the disease.[24]

Photobiomodulation (PBM): PBM is also known as low-level laser therapy. It is a kind of light therapy that involves using non-ionizing light sources in the red or near-infrared spectral region (700–1100 nm). It does not involve using any additional photosensitizer.[25] PBM helps speed up healing by stimulating the cell compartment and enabling tissue restoration.[26] This means faster recovery after dental procedures such as extractions and gum surgery, and it also helps with mouth injuries. Unlike PDT, which aims to kill cells, PBM’s goal is to heal and regenerate damaged or dying tissues.[27]

Pigmentation removal

Laser technology successfully addresses unwanted melanin pigmentation in gums, often referred to as “gummy smiles.” Using laser, one can precisely target pigmented tissues without damaging surrounding healthy gums, resulting in an esthetically pleasing appearance.[28]

Fibroma removal and soft tissue excisions

Fibromas are small benign tumors in the mouth. They can be effectively removed using lasers. The use of laser technology provides benefits such as minimal bleeding, faster healing, and reduced risk of infection compared to traditional excision methods. Similarly, lasers offer a more controlled and advanced approach for removing other soft tissue lesions in the oral cavity. Laser energy also possesses inherent hemostatic properties, allowing for efficient bleeding control during surgical procedures. This minimizes blood loss and facilitates faster healing.[29,30]

DIFFERENT LASER TYPES AND WAVELENGTHS

The correct choice of wavelength is significantly important to ensure the expected interaction in biological tissues, i.e., the photons of the laser beam must be absorbed by a biological tissue for the local thermal effect to be achieved. The amount of energy a laser delivers to tissue is determined by its emission mode, peak power, and energy density. Simply put, more energy delivered means a greater temperature increase in that tissue. Different temperature changes can lead to different effects in the treatment area. This is why having different laser types, each with its own unique light wavelength, is so beneficial in dentistry.

These include:

CO2 lasers

In the past, these lasers were mainly used for soft tissue ablation. This is because they have a lot of power and are excellent at hemostatic properties. However, they may cause deeper thermal damage. They are also used for caries prevention and coagulation. CO2 lasers emit wavelength 10600 nm and work as CW as well as pulsed wave modes.[31]

Er:YAG lasers

These lasers are well suited for the ablation of both hard and soft tissues, offering good precision and minimal thermal damage. They are particularly useful for superficial lesions and vaporization of tumors.

Since its approval for soft tissue treatment by the US Food and Drug Administration in 1999, the Er:YAG laser has been studied and effectively applied for periodontal soft tissue management without causing major thermal side effects.[32] The Er:YAG laser emits light of a wavelength of 2940 nm and its laser energy is highly absorbed by water. Theoretically, its absorption coefficient for water is 10 times that of the CO2 laser (10,600 nm) and 15,000–20,000 times that of the Nd:YAG laser (1064 nm).[33] Due to its high absorption by water, less tissue degeneration with very thin surface interaction occurs after Er:YAG laser irradiation. The temperature rise is minimal in the presence of water irrigation, allowing hard and soft tissue removal without any carbonization.[34] On top of that, the Er:YAG laser has the ability to effectively sterilize and soft tissue ablation, and it can be used as a smooth knife. Another reported advantage of Er:YAG laser irradiation is its high bactericidal effect.

Diode lasers

Diode lasers use a solid semiconductor material as an active medium – a mix of aluminum, gallium, arsenide, and sometimes indium – as the source of their laser light. This material is what generates the laser beams, which have wavelengths typically ranging from around 810–980 nm. All the different types of light from diode lasers are mainly absorbed by tissue pigments such as melanin and hemoglobin. Hence, these lasers are getting more and more attention because they are really good at targeting specific blood vessels within the tumor. This can impede tumor growth and blood supply, potentially enhancing treatment efficacy. They are also used in decontamination and endodontics.[35]

Holmium:YAG lasers

These lasers offer high ablation rates and good hemostatic properties, making them suitable for ablating bulky lesions and performing complex resections.[36]

Argon laser

When using the argon laser, it is important to know that it emits wavelengths in two different bands of the electromagnetic spectrum: One in the blue spectrum at 488 nm, which can be used in dental bleaching and composite polymerization, and another in the green spectrum ranging from 512 nm to 540 nm. The KTP laser (532 nm) emits in this latter band. This laser is used in dental bleaching as well as in soft tissue surgeries.[37]

Nd:YAG

The Nd:YAG laser belongs to short laser wavelength, has a wavelength of 1,064 nm, and operates in a free-running pulsed mode.

Because pigmented tissues soak up the Nd:YAG laser light so well, this type of laser is excellent for surgical procedures on the soft tissues in the mouth. With good hemostasis, it is an effective surgical laser for cutting and coagulating dental soft tissues.

In addition to its surgical applications, there has been research on using the Nd:YAG laser for non-surgical sulcular debridement in periodontal disease control and the laser-assisted new attachment procedure. Traditional mechanical methods of mechanical debridement are not as good for the complete curettage of soft tissue, and the data indicate safe application of the Nd:YAG laser for removal of the pocket-lining epithelium in periodontal pockets, without causing necrosis or carbonization of the underlying connective tissue in vivo.[38]

EMERGING FRONTIERS IN LASER DENTISTRY

New laser types are being developed with even greater precision and specific tissue interaction capabilities. These advancements will further refine existing procedures and pave the way for new frontiers. The future seems full of growth and opportunities for the laser industry. Here are some exciting new directions that are being explored:

Artificial intelligence (AI) integration

AI is poised to transform laser dentistry by optimizing treatment plans and enhancing precision. AI-powered systems can analyze patient data, such as medical history, imaging scans, and even genetic information, to personalize treatment protocols. This can lead to more accurate diagnoses, reduced treatment times, and improved outcomes.[39]

PBM therapy

PBM, also known as low-level laser therapy, is gaining traction for its potential to stimulate tissue repair and reduce inflammation. In dentistry, PBM can be used to accelerate wound healing after procedures, alleviate pain, and even treat certain oral conditions like temporomandibular joint disorders.[40]

Laser-assisted implantology

Lasers are increasingly used in implant surgery to improve precision and reduce invasiveness. Laser-assisted osseointegration can enhance bone-to-implant contact, leading to faster healing and improved implant stability. In addition, lasers can be used to sterilize implant sites and reduce the risk of infection.[41]

3D printing and laser technology

The combination of 3D printing and laser technology is opening up new possibilities in dentistry. 3D-printed surgical guides can be used to precisely position implants, while lasers can be used to create highly customized restorations with unparalleled accuracy. This integration can streamline the entire treatment process and improve patient outcomes.[42]

Laser-activated drug delivery

Lasers can be used to deliver drugs directly to target tissues. It improves efficacy and reduces side effects. Laser-activated drug delivery can be particularly beneficial for treating oral infections and delivering medications to hard-to-reach areas.[43] The classification of various laser systems employed in dentistry, different types, abbreviations, active/host medium, doping atoms, and corresponding wavelengths, is presented in Table 1.

Table 1: Most used lasers in dentistry.
Laser Abbreviation Active medium Hosting medium Doping atom Wavelength (nm)
Argon Ar Gas - - 488 and 514
Carbon dioxide CO2 Gas - - 9300, 9600, and 10,600
Diode - Semiconductor - - 445, 635–810, 940–970, 1064
Neodymium-doped Yttrium-aluminum-garnet Nd:YAG Solid YAG crystal Neodymium 1064
Erbium-doped yttrium-aluminum-garnet Er:YAG Solid YAG crystal Erbium 2940
Erbium-doped Yttrium-scandium-gallium-garnet Er, Cr:YSGG Solid YSGG crystal Erbium and chromium 2780

YAG: Yttrium-aluminum-garnet, YSGG: Yttrium-scandium-gallium-garnet

Virtual reality (VR) and augmented reality (AR) in laser dentistry

VR and AR technologies can improve the patient experience and communication between the dentist and patient. VR can be used to simulate procedures, allowing patients to better understand the treatment process and reduce anxiety before dental procedures. AR can be used to overlay digital information onto the patient’s oral cavity, helping the dentist during procedures and improving accuracy.[44]

LIMITATIONS AND CONSIDERATIONS

Laser dentistry offers numerous advantages. Although the risks related to laser dentistry are relatively small, it is important to acknowledge current limitations/risks with technology.

Cost

One of the major limitations of laser technology is as it involves a significant investment for dental practices. The initial cost of acquiring laser equipment can be high, potentially limiting its wider adoption.[45]

Limited applications

Although the range of applications for lasers in dentistry is expanding. There are still procedures where traditional methods remain the preferred approach in comparison to laser technology. Even though lasers are used in restorative dentistry, they have their limits. They might not be the ideal tool for tackling deep cavities or removing hard materials such as amalgam or ceramic crowns.

For these cases, conventional cutters remain more effective and faster than laser. Furthermore, the laser has limitations in penetration depth, making it difficult to treat very deep caries or tooth structures that require removing a large amount of tooth tissue.[46] This area still needs a lot of research for more advancements in laser technology.

Training and expertise

Utilizing lasers effectively requires additional training and expertise for dentists. It is important to get treatment from a qualified dental professional, as using the wrong wavelength or power level could damage tissue. Ensuring proper training and certification is crucial to maximize the benefits of laser dentistry and minimize potential risks.[47]

CONCLUSION

Even with the constraints, the future of laser dentistry emerges bright. As technology continues to evolve and costs become more affordable, laser technology is set to play a more integral part in the dental landscape. As laser technology in dentistry offers potential for minimally invasive procedures, improved patient comfort, and integration with digital workflows, it paints a promising picture for the future of oral healthcare. In addition to these, the potential applications of lasers in areas such as biostimulation and oral cancer therapy also promise more impactful advancements in dentistry.

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