Lasers can be helpful to dental professionals for a wide range of soft-tissue and hard-tissue procedures. They can be used for both surgical and nonsurgical applications and by dentists as well as by dental hygienists. The benefits of incorporating lasers into dental treatments can include increased efficiency and precision, higher profitability, and ultimately, better outcomes for patients. Some of the barriers associated with dental lasers include a large initial financial investment, the need to make room for the equipment in the operatory, and a steep learning curve. Despite these challenges, many clinicians are implementing lasers to dramatically improve the level of oral care that they provide to their patients.
To provide our readers with a brief lay of the land, Inside Dentistry checked in with some of the profession's most knowledgeable experts about the expanding uses of lasers in dentistry, their recommendations on how best to achieve the requisite level of training, and their predictions regarding where laser technology will take dentistry in the future.
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Types of Dental Lasers and Their Uses
The term laser, which is an acronym for "light amplification by stimulated emission of radiation," refers to devices that produce an amplified beam of light. There are both surgical and nonsurgical lasers, or more precisely, ablative and non-ablative lasers. Some lasers can be used for both types of procedures. In general, ablative lasers are used to vaporize or remove tissue. Ablative lasers are used for debridement and disinfection of periodontal pockets, gingivectomy, frenectomy, caries removal, root canal disinfection during endodontic therapy, and more. Non-ablative lasers, meanwhile, are used to stimulate a healing or other response in tissue. For example, photodynamic therapy (PDT) and photobiomodulation (PBM) are types of non-ablative laser treatments.1-5
In dentistry, there are several different types of lasers that are available to choose from. Each category has its own wavelength, or range of wavelengths, and types of procedures that it is best suited for, and many models feature proprietary protocols developed by manufacturers. In the context of lasers, the term chromophore refers to a substance within a tissue that selectively absorbs a specific wavelength of light, allowing it to be targeted by a laser. Diode lasers, which typically have wavelengths between
810 nm and 980 nm, affect chromophores that include pigments such as hemoglobin and melanin, making them effective for soft-tissue procedures. Neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers have a wavelength of 1,064 nm. Like diode lasers, the chromophores of Nd:YAG lasers are pigments such as hemoglobin and melanin, so they are also appropriate for soft-tissue applications. Erbium lasers come in two types. The erbium-doped yttrium aluminum garnet (Er:YAG) laser has a wavelength of 2,940 nm, and the erbium and chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG) laser has a wavelength of 2,780 nm. Both of these lasers target water as their primary chromopohore, but they also target hydroxyapatite. This makes them ideal for hard tissue applications, but they can also be used for some soft-tissue procedures. And finally, carbon dioxide (CO2) lasers have a wavelength of 10,600 nm and target water as their chromophore, making them suited for soft tissue procedures. These lasers are good for cutting while eliminating bleeding. Other, more recently developed CO2 lasers have a wavelength of 9,300 nm and target hydroxyapatite for hard tissue procedures.
The Expanding Field of Laser Dentistry
According to Praveen R. Arany, BDS, MDS, MMSc, PhD, an associate professor in the department of oral biology at the University at Buffalo School of Dental Medicine, when dental lasers were first introduced in the 1980s, they were merely regarded as tools for the other fields of dentistry, like handpieces or curettes. But today, thanks to a better understanding of how laser-biologic tissue interactions work, the use of lasers is regarded as a separate field of dentistry.
Lasers can be used to accomplish all three of the primary goals in dentistry: removing diseased tissue, disinfecting, and stimulating a healing response. "When it comes to curetting, lasers are superior to traditional metal tools because the light energy disinfects and cauterizes while cutting, thus creating a bloodless field," Arany explains. "Because the light from lasers disperses, it is especially well suited for disinfecting pockets during periodontal treatment and canals during endodontic therapy-overcoming the limitations of mechanical instrumentation. Furthermore, light therapy is especially beneficial for triggering beneficial nonsurgical cellular responses."
Arany cites the American Dental Association's (ADA) ADA Technical Report No. 133, Guide to Dental Lasers and Related Light-based Technologies: Technology, Science and Safety Considerations as a particularly noteworthy milestone in the evolution of laser dentistry as a separate kind of treatment.1 Since then, continued recognition by the ADA and the US Food and Drug Administration (FDA), combined with ongoing clinical research, has elevated laser dentistry even further. "Some of the newer nonsurgical treatments are particularly promising," Arany says. "There has been improved understanding of how nonsurgical light treatments, including those administered by both lasers and LEDs, can be used. This includes two specific kinds of nonsurgical treatment: PDT and PBM, which are new approaches for nonsurgical light or laser treatments." PDT can be used for infection control, whereas PBM works on a cellular level and is primarily used for tissue healing, often postsurgically. "We now have systematic reviews and meta-analyses, which are considered to be the highest level of clinical evidence, for the use of PDT in periodontal disease and PBM in supportive cancer care," Arany says.
Cherish Leung, DMD, MHA, MPH, a board-certified pediatric dentist with offices in Claremont and Cypress, California, uses lasers in clinical practice. She explains that both Nd:YAG and diode lasers can provide PBM. "PBM can be used to decrease inflammation and speed up healing through cellular level effects by increasing ATP production in mitochondria," she says. Leung adds that PBM can also be used to treat patients with temporomandibular joint issues.
Scott Benjamin, DDS, a private practitioner in Sidney, New York, who has been using lasers in his dental practice for more than 35 years, emphasizes that lasers enhance quality of care and improve efficiency. "Technology only has two roles: to increase the quality of care you are providing or to enhance efficiency, and the correct laser in the appropriate situation does both," he says. "When I incorporated lasers into my practice about 30 years ago, it was basically to use them for laser-assisted periodontal care, which introduced the concept of actually healing patients rather than basically amputating the inflamed tissue. The idea is that you have to have the right technology in the right place."
Today, Benjamin has an entire gamut of lasers at the ready in his practice. "I literally have 10 to 12 different wavelengths in my office-not only just lasers but also LEDs that are used for a variety of things, from mucosal screenings to therapeutic healing," he says. "Each wavelength has something that it does very well." Benjamin notes that incorporating lasers into his practice has made him more efficient as well as more profitable, especially because he can perform restorative procedures in all four quadrants at the same appointment.
In his practice, Benjamin uses lasers daily for everything from preparing teeth for restorative care to periodontal surgery and even for biopsies. He also believes that lasers are integral for endodontic therapy. "By using shock wave enhanced emission photoacoustic streaming (SWEEPS® ) with the Er:YAG 2,940 nm laser, where we are creating shockwaves inside the root canal system, we are now able to disinfect the entire endodontic system, which is something that's never been able to be done in any other way," he says. "Lasers are greatly enhancing our ability to perform endodontic procedures in a single visit with greater confidence."
Regarding PBM, Benjamin believes that it has been a game changer. "PBM is changing healthcare, with the idea of controlling inflammation and postoperative discomfort," he says. "We've been able to wipe out oral mucositis related to chemotherapy and radiation therapy, and that's the biggest quality of life change I've seen in healthcare."
Robert A. Horowitz, DDS, an author, educator, and clinician with a private practice in Scarsdale, New York, has used six different lasers in clinical practice during the past 25 years. Today, for patients with periodontal and peri-implant defects, Horowitz uses the LANAP® (Laser-Assisted New Attachment Procedure) and LAPIP™ (Laser-Assisted Peri-Implantitis Protocol) protocols as his first attacks of choice. "If my patient comes in with inflammation and/or bony defects around teeth or implants, that's what I'm going to do because I want to get the best local, regional, and systemic effects of healing, sterilization, and reduction of the inflammatory components," he says.
Horowitz received the full LANAP protocol training 7 years ago from Millennium Dental Technologies, manufacturer of the PerioLase® MVP-7™ Digital TruePulse, which is the Nd:YAG laser used in the protocols. "It is a free-running pulse laser," Horowitz explains. "The advantage is that it highly targets pigments like melanin, so you can use it for de-pigmenting lesions. In the periodontal realm, what's most important about that is that it targets inflamed tissue and the pigmented bacteria-what we call the periodontal pathogens." Other companies that offer advanced laser technologies for periodontal treatments include Fotona, with its LightWalker® and SP Dynamis Pro all-in-one Er:YAG and Nd:YAG laser systems, and J. Morita, with its AdvErL EVO Er:YAG laser system.
"The big advantage of the Nd:YAG and Millennium's protocols is that you are not only using it at the time of deep cleaning but also to remove the inflamed lining of the pocket," Horowitz says. "What that does is remove the inflamed tissue that is not osteogenic. It also removes the epithelium itself, which if present, is going to prevent gum connective tissue reattachment and bone formation. It's antibacterial and beneficial actions will also penetrate up to 8 mm into the tissue. It has a very high depth of penetration for the specific pigmented bacteria that cause local and/or systemic effects."
According to Horowitz, another difference between LANAP and other laser procedures is the last part of the process, which is hemostasis. "It's not coagulation, it's not clotting, and it's not singeing the tissue and creating a piece of charcoal in there to stop the bleeding," Horowitz explains. "What the hemostasis is doing is it's speeding up the process to stop the bleeding and let the now sterile granulation act as the nidus for new connective tissue and bone formation to occur right in that bony pocket, whether it's around a tooth or an implant. I know other companies have their own protocols, and I'm not saying that this is the only one, but this was the first one that was FDA-approved for these purposes." Beyond periodontal treatments, Horowitz uses the MVP-7 and diode lasers for frenectomies and gingivectomies as well as for biostimulation for wound healing, the treatment of ulcers, and postsurgical therapy.
Dental lasers also have applications for dental sleep medicine. Leung notes that the NightLase® protocol from Fotona, which can be performed with the company's LightWalker and Dynamis laser systems, uses an Er:YAG laser to tighten the soft palate and tonsillar pillars through non-ablative action, which causes collagen remodeling and neocollagenesis. "This can help to reduce snoring and is an adjunct to the treatment of sleep-disordered breathing," she says.
Dental hygienists can use lasers as well. Joy Raskie, RDH, director of education and CEO of Advanced Dental Hygiene, points out that diode lasers can be used by hygienists for pre-procedural laser bacterial reduction to reduce the bacteria in the gum pockets. "Post-procedurally, lasers can be applied to pockets of 4 mm or greater depth to not only eliminate bacteria but also stimulate gum tissue healing," she says. "Lasers are also effective in treating oral lesions, promoting faster healing, and reducing recurrence. Hygienists can perform PBM treatments as well."
Acquiring the Best Education and Training
It's no secret that when it comes to implementing dental laser technology, finding the right education and training can seem a bit daunting. The good news is that there are plenty of options available to dental professionals at every level. A great approach for dental professionals who want to incorporate lasers into clinical practice is to begin with foundational education and then proceed to device-specific training offered by manufacturers. "Once you understand the science and physics of lasers, they become very simple and easy to use," Benjamin says. "Unfortunately, many clinicians don't want to put the time into learning the science and truly understanding the concepts of laser technology and how they operate."
Benjamin notes that dispelling misinformation about lasers has been a challenge as well as helping his fellow dentists develop workflows. "To me, the biggest Achilles' heel beyond the lack of education is the lack of willingness to take the time to develop an efficient workflow," he says. "Because once you do that, lasers become an integral part of a dental practice." Reading peer-reviewed publications can be particularly helpful for dental professionals who want to increase their knowledge of laser dentistry. "Laser physics is not terribly complicated if you go back to the basics," Benjamin says. "Lasers are very simple. They only do two things. They heat something up or they modulate a response, and the challenge is controlling how that occurs for the outcomes that you're expecting. I would recommend that practitioners thoroughly understand the science before they buy the technology. It's a matter of using the right device in the right place to get the outcomes that you're looking for."
According to Arany, academic courses are a lot more rigorous and less biased because they're not trying to promote a particular kind of technique. "Like with every other technique, you need to understand that the laser is a tool and a technology that needs to be used in a very particular manner, and when we start doing that, we will get better clinical outcomes," he says. "However, I think it is a good thing that laser companies are teaching. The manufacturers know their units best, and they usually have very sophisticated clinical user groups of individuals who have been working with the technology for years to give them feedback. I support manufacturer training as an end point-after you acquire a foundational, or ‘big picture,' understanding of lasers in dentistry. First, clinicians need to understand the interaction of light with the biologic tissue. Just as we do not focus on handpieces and curettes in current dental education but rather the biologic aspects of teeth and oral tissues, we need to be focusing on light-tissue interactions. I think that when we get to that level of sophistication, it will result in higher levels of patient care and more consistent benefits."
Leung echoes this view. "Although lasers have certainly changed the face of dentistry, it is important to remember that they are simply another tool in our arsenal as doctors of dental medicine," she says. "We must fully understand how lasers work and be knowledgeable of the best techniques in order to maximize patient outcomes and minimize negative effects."
For Raskie's part as a laser hygiene educator, she believes that an ideal training program should cover five key areas: physics, safety, procedural training, patient communication and education strategies, and treatment planning. Raskie emphasizes that she feels strongly that dentists should attend hygiene certification programs with their hygienists. "When a team attends together, that is where we see the most production of lasers in the practice," she says. "It can transform your hygiene department."
Other sources of laser education include the Academy of Laser Dentistry (ALD) and the American Dental Education Association's (ADEA) Special Interest Group on Lasers in Dentistry. It is also important to note that for dental professionals at all levels, adhering to safety precautions, including wearing protective eyewear, observing proper handling techniques, and following manufacturer guidelines, is essential.
What Does the Future Hold?
Many of the contributors to this article predict that in the future, there will be a laser by every dental chair. "Peri-implantitis is going to be the dental disease of the future, and in my view, the only way to appropriately treat peri-implantitis is with an Er:YAG laser," Benjamin says. "It's going to be a major aspect of dentistry, and I think it's not a matter of if you're going to own an Er:YAG laser but when." Even more important, he adds, is preventing peri-implantitis in the first place, which is why every one of his own patients with an implant is being treated with PBM as a matter of routine care during every hygiene visit.
"I think that laser technology will continue to improve in quality and gain traction," Horowitz says. "More dentists will be trained on it, which will give us an advantage in decreasing periodontal and peri-implant disease at the early stages."
"One of the next major advancements in laser dentistry is the potential for full-mouth laser bacterial reduction as part of routine hygiene visits," suggests Raskie. "In the future, hygienists may be able to use a laser to target and eliminate bacteria around all of the teeth in just 5 minutes. This means that instead of undergoing traditional methods, patients could simply relax in the chair while the laser effectively eradicates harmful bacteria."
"The biggest frontier is the recognition that a laser is more than a tool," Arany offers. "The light technology can do a lot more than any of the metal instruments can. When you recognize that, you value the additional clinical benefits your patients are getting. The value proposition has been missing in how we communicate about laser technology." Arany also notes that lasers are becoming more affordable these days, thus lowering the financial barriers for many dentists. He also anticipates the day when the industry develops a truly all-in-one laser that can easily fit on a dental chair. "Eventually, someone is going to build a laser that has multiple if not all of the relevant wavelengths to enable the large breadth of laser applications," he says.
The Bottom Line
Lasers are transforming the landscape of modern dentistry, offering significant advancements in both the precision of treatments and the comfort of patients. From enhancing periodontal therapies, restorative procedures, and endodontic treatments to improving healing times with PBM, lasers provide dentists with an invaluable tool for achieving better clinical outcomes. Although the investment in technology and training can pose initial challenges, the long-term benefits-both in terms of patient care and practice efficiency-are undeniable. "Once you understand the science and have the appropriate technology, the sky is the limit," Benjamin says.
References
1. American Dental Association. Technical Report No. 133 Guide to Dental Lasers and Related Light-based Technologies: Technology, Science and Safety Considerations. ADA website. https://engage.ada.org/p/eg/ada-technical- report-no-133-guide-to-dental-lasers-and-related-light-based- technologi-1342. Published 2020. Accessed April 9, 2025.
2. American Dental Association. Technical Report No. 189 (proposed) Photobiomodulation (PBM) in Oral Health: the Technology, Science, and Safety Considerations. ADA website. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/dental-standards/aip-review/189_aip_11_23.pdf. Published November 1, 2023. Accessed April 9, 2025.
3. Arany PR. Photobiomodulation therapy. JADA Found Sci. 2025;4:100045.
4. Smiley CJ, Tracy SL, Abt E, et al. Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015;146(7):508-524.e5.
5. Sachelarie L, Cristea R, Burlui E, Hurjui LL. Laser technology in dentistry: from clinical applications to future innovations. Dent J (Basel). 2024;12(12):420.x
