Laser Therapy
The use of diode and Er:YAG (erbium-doped yttrium aluminum garnet) lasers in the treatment of gum disease (periodontal disease) has become an increasingly important adjunct to non-surgical and surgical periodontal therapy. Each laser has distinct properties that make it suitable for specific clinical applications.
Diode Laser in Periodontal Therapy
Wavelength: Typically 810–980 nm
Target: Pigmented tissues and bacteria (melanin and hemoglobin)
Key Uses:
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Bacterial Reduction (Laser Bacterial Reduction - LBR):
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Used in conjunction with scaling and root planing (SRP) to reduce bacterial load in periodontal pockets.
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Disrupts the biofilm and destroys pigmented pathogenic bacteria like P. gingivalis.
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Laser-Assisted Pocket Decontamination:
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Can reduce inflammation and bleeding by coagulating infected tissues.
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Leads to faster healing and improved patient comfort.
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Biostimulation (Photobiomodulation):
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Low-level laser therapy (LLLT) promotes wound healing, collagen production, and tissue regeneration.
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Tissue Ablation & Hemostasis:
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Can remove the diseased epithelial lining of the pocket.
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Provides excellent hemostasis due to the coagulation of blood vessels.
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Er:YAG Laser in Periodontal Therapy
Wavelength: 2940 nm
Target: Water and hydroxyapatite (hard and soft tissue ablation)
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Key Uses:
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Root Surface Debridement:
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Gently removes calculus and bacterial biofilm without damaging the root surface.
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More conservative than ultrasonic scalers or hand instruments.
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Soft Tissue Surgery:
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Excise diseased pocket lining with minimal thermal damage.
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Promotes faster healing with less discomfort and inflammation.
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Bone Reshaping (Flap Surgery Adjunct):
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Can remove infected or necrotic bone in advanced cases.
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Promotes reattachment and regeneration.
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Minimally Invasive Periodontal Therapy (MIPT):
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Enables closed (non-surgical) treatment of moderate to deep periodontal pockets.
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Often used in laser-assisted new attachment procedures (LANAP alternatives, though LANAP officially uses Nd:YAG).
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Comparison Summary:
FeatureDiode LaserEr:YAG Laser
Tissue TargetPigmented soft tissuesWater-containing soft/hard tissue
ApplicationsBacterial reduction, coagulationCalculus removal, root detox, debridement
Tissue InteractionThermal (coagulates)Ablative (precise removal, minimal heat)
Cost/ComplexityLower cost, easier to useHigher cost, more advanced training needed
HealingGoodOften faster and less painful
Clinical Takeaway
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Diode lasers are best suited for soft tissue decontamination, inflammation control, and enhancing healing.
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Er:YAG lasers offer superior precision in both soft and hard tissue management, making them ideal for more advanced regenerative periodontal therapy.
When combined strategically with traditional therapies like SRP, both lasers can significantly improve clinical outcomes in the treatment of gingivitis, periodontitis, and peri-implant mucositis/peri-implantitis.
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