[Lasers in dentistry 4. Removal of carious tissue using lasers]

Many lasers are available today for clinical application in dentistry. For the removal of caries in enamel or dentin only few lasers can be used. Er:YAG lasers have a wavelength that coincides with the absorption maximum of water. Because of this characteristic the ablative effect in enamel and dentin is high and these lasers can be used beneficially for caries removal and small preparations. The possible side effects of Er:YAG lasers with water-cooling are minor compared to those of rotary instruments. A pulpal reaction will occur only if there is a very thin dentin layer over the pulp or direct application of the laser beam to the pulp. There is no increased heating with the Er:YAG laser so with vital teeth there is a positive reaction by the formation of reparative dentin. To the existing indications for lasers like caries removal and preparation of small cavities, in the future new techniques can be added like the use of dyes for enhancement of absorption of the laser radiation, and minimal invasive techniques using feedback from a system for caries detection.