Pattaya Smile Dental Clinic
111/57-8 Moo10 South Pattaya Rd.
 Banglamung,Cholburi Thailand 20150.

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Doctor Smile Dental Laser

   
Doctor Smile diode laser is becoming more and more well established in dental practices. Created for dental use, the Doctor Smile diodes find application in ENDODONTICS, PERIODONTICS, CONSERVATIVE and ORAL SURGERY.
 
Its excellent cutting precision, the sterilization of the operation field and its excellent ability to arrest bleeding (haemostasis) make the laser the best instrument for several applications.
 
The properties of laser devices allow its use as an alternative to traditional methods and, thanks to a special handpiece, in Tooth Whitening and in analgesic therapy.
 
Its reduced size and a trolley-bag provided with the kit, make the laser a light and easy to transport equipment.
 
All the devices are equipped with a series of pre-set treatments, integrated with the collaboration of many specialists of the field and confirmed by many scientific publications.

 

Laser whitening is effective and has become extremely popular over the past decade. Doctor Smile LWS -Laser Whitening System- apply with laser is the safest and fastest way to whiten the teeth, removing the most difficult discolouration from your teeth caused by different agents such as coffee, tobacco, wine and other pigmented stains. 
 
Laser activation accelerates the whitening process, enhancing the natural white of the teeth and offers the convenience and satisfaction of results in only one visit. The Laser Tooth Whitening procedure involves the cosmetic dentist removing any plaque from the teeth and then the application of a LWS peroxide-based gel. Once the LWS is applied to the teeth surface, the laser is used to activate the gel and initiate the whitening process.

 

 
Laser Whitening System improves whiteness better than any other treatment available

 

TREATMENTS

Laser technology is gaining more and more importance in the everyday work of dental practices. Also among scholars laser enjoys a growing popularity, as more and more  scientific articles have been released, which acknowledge the assets of laser in dentistry.
In view of the increasing diffusion of laser, the need for a correct and detailed information about the possible applications of laser technology, in order for the patient to benefit from the laser is felt among dentists of all countries.
Laser technology is the best solution for the treatment of several pathologies, particularly in the treatment of the soft tissues of the oral cavity, providing an almost painless application and enduring results.

 

To keep the pace with the fast and steady changes in high technology you have to be always conscious and open to every innovation, as well as to constantly update your knowledge, so as not to be cut off from the market.
 

 

The laser applications we introduce in this website have been divided into several macro-areas. In each area the foremost interventions have been concisely outlined..
 

Applications in Periodontics

Parodontitis and treatment of periodontal pockets

Curettage

Grafting gingival

 
 

Applications in Surgery

Gingivectomy

Gingivoplastic

Frenectomy

Hemostasis

Tumor Removal (fibromas, epulis)

Cyst Removal

Apicectomy

Opercolectomy

dainage and incision of abscess

Crown lengthening

Fistula

Oral Papillectomy
 
 

Applications in Endodontics

Decontamination of the Root Canal

Granuloma

Pulpectomy

Pulpotomy

 

Implantology

Uncovering of implants

Sterilisation and decontamination of implants

Perimplantitis

 

Prosthesis

Abutment Groove

 

Therapy 

Apthae

Herpes

Cheilitis Angles

Biostimolation

TMJ

Leucoplachie

Lichen Ruben Planus

 

Whitening

   
 

SURGERY

The application of the diode laser on surgery has yielded excellent results.
Laser treatments in contact mode are comparable to traditional scalpel treatments.
With a good knowledge of laser characteristics one can profit from them in the best way and perform a bloodless surgical operation with very clear view of the operating field. Moreover, laser acts as effective haemostatic without causing any harm to adjacent tissues.
The most widespread laser for such surgical applications is the laser with 810 nm wavelength. The laser ray possessing 810 nm wavelength is easily absorbed by such dark-coloured substances like hemoglobin and melanine (water is not so well absorbed), which enables a considerably deep cut.
There are some indisputable advantages laser has in comparison with the cold blade of a scalpel:
- the scalpel cuts more precisely, but, unlike the laser, it does not have any bactericidal or coagulant properties
- in comparison with the electric scalpel, laser does not cause any fasciculation of the muscular tissue
- the outcome of laser interventions is more predictable, since during the healing phase there is no tissue regression
- the antiseptic and biostimulating action of the laser reduces the necessity to resort to post-operative medicaments
In implant uncoverings , in the treatment of periodontal pockets as well as in vascular therapy diode lasers are more advisable than are more aggressive lasers like CO2 and Nd Yag. 
Distinctive features of diode lasers applied to surgery are:
- the notable cutting precision without alterations in the bones
- strong coagulating effect, which allows to have a bloodless operating field also on patients with coagulation disturbances
- drastic reduction of the required anaesthetics
- less pain for the treated as well as for the adjacent tissues
- less post-oparative disturbances
- less post-operative edemas
- no tissue retraction during the healing phase
- better appearance of the operated tissue after the operation
- healing improvement
- reduced need for post-operative medicines
On the grounds that the tissue does not retract during the healing phase, the laser becomes indispensable for "re-shaping" the oral soft tissue, if the surgical intervention is needed to re-locate the tissue correctly or to ablate it.
 
 
Gingivectomy
 
 
The word gingivectomy indicates the surgical ablation of the gingival tissue performed in the area of the epithelial attachment, in order for a new marginal gingival tissue to grow.
This method is used to remove gingival or periodontal pockets, to access and operate on periodontal tissue, which would otherwise be not accessible and to reach the interior part of the pocket and eliminate the tartar.
The hypertrophy and hyperplasia of the gengiva is to trace back to many causes:
inflammations, pharmaceutical causes or mechanical-traumatic causes.
The laser is an instrument which helps to heal this illness and limitate the pain for the patient.
For those patients who have coagulation problems the laser is particularly helpful because it contributes to the scar process, it vaporises the tissue and keeps the operating field bloodless.
Anaesthetics are not always necessary , although their use is recommended in case the patient reports to feel pain.
 
Gingivoplastic
 
 
The word gingivoplastic refers to the re-shaping of the gingiva and to the restoration of the physiologic morphology of the gingiva. This surgical intervention is often associated with gingivectomy: the tissue in excess is ablated without bleeding and the gingival tissue is re-shaped , in order for the periodontal apparatus to gain back its correct morphology. With diode lasers, if the biologic opening is large enough, it is possible to re-shape the gingival profile, so that it looks perfectly normal again.
 
Frenectomy
 
 
The frenulus is a thin thread of muscles and fibres coated with a mucosa thatruns from the alveolar mucosa to the muco-gingival joint line (vestibular frenulus) and from the ventral face of the tongue to the lower part of the mouth (lingual frenulus).
Performing a frenectomy means to partially remove the frenulus or to relocate it elsewhere.
This intervention ha s the aim of improving the stability of the teeth or of alleviating the traction downwards exerted by a short lingual frenulus.
Usually this intervention is performed on very young patients and for this reason laser turns out to be the most appropriate choice.
The patient that undergoes a laser treatment does not feel any pain; in case of need an anesthetic gel can be applied on the frenulus surface.
The irradiated tissue is instantly vaporised, whereas the operating field is bloodless (this facct also helps to make the patient more collaborative).
The post operative recovery takes place easily and fast without any stitches.
 
Haemostasis
 
 
Haemostasis means literally "absence of blood". One of the features of diode and Nd:Yag laser is to bring about an instant scar processand to avoid the occurrence of small haemorrhages that would occur by using traditional methods.
The procedure prescribes first of all to thouroughly cleanse the wound and to remove the blood in excess before beginning with the actual treatment. Afterwards the fiber has to get several times in contact with the wound.
The duration of the treatment depends on the dimensions of the tissue that has to be treated.
This procedure suits evry intervention, in which it is necessary to get a clear operating field where the natural coagulation process occurs too slowly or is not satisfactory.
 
Surgical ablation of tumours
 
 
The laser as cutting instrument enables the removal and the ablation of parts of tissue as well as of both benign and malignant neo-formations.
 
Fibromi: fibromi show up chiefly in the area of the buccal (area?)and must be ablated if they grow bigger or if they disturb the patient. The ablation occurs by 810 nm laser irradiation at low power.
 
Haemangioma: are  often unaesthetic and irritating and tend to grow to bigger and bigger. Traditional therapies are based on invasive interventions such as plastic surgery or electro-coagulation.
By using the laser within 1.5 W and 2W powerthe tissue ablation is perfect and the adjacent areas are clearly visible.
 
Epulis: epulis is a tumour that affects the periodontal area and is caused by inflammatory stimuli as a result of an inadequate oral hygiene. Therapy consists in the removal of the inflammation and in the subsequent ablation of the tumour. Depending on the kind of intervention, a subsequent gingivoplastic might be necessary.
 
Cyst ablation
 
Cysts can also be eliminated with the same tissue ablation technique.
Cysts are made of a membrane that contains liquid, soft substance and gas.
There are several kinds of cysts:
- dental cysts: they affect a single tooth and its supporting structure
- follicular cysts: they contain a tooth or a part of a tooth, originating from the enamel
- radicular cysts: they appear in the area of the root canal and are caused by granulomic processes due to root inflammationscaused by chronical parodontitis of the apex
- retention cysts: caused by the obstractionof a salivar gland
- sebaceous cysts: due to the obstruction  of a sebaceous gland
- traumatic cysts: due to a wound or a trauma
The dental cyst can be determined either by a wrong development of the tissues reponsible for the odontogenesis or by inflammatory stimuli.
The most frequent groups of cysts are follicular and radicular cysts: they usually show a painless decourse and can be detected by a radiographic exam that clearly highlights the external membrane delimiting the area.
Cyst ablation can be very painful for the patient: by using the scalpel one had to stitch up the area completely, whereas with the laser no more stitches are required  and no swelling, nor tissutal traumas show up. The tooth impression can be takenduring the same sitting.
 
Apicectomy
 
The apicectomy is indicated for the cases in which the root canal (both artificial or natural)is obstructed. In presence of a granuloma or of a root canal difficult to access (not reachable by usual canal instruments), one usually resorts to apicectomy, which is anyway an invasive intervention, debilitating for the patient , because the tooth becomes shorter and duration.  
The intervention consists in the surgical removal of the radicular apex of a tooth, as well as the ablation of the surrounding soft tissue affected by sevral pathologies.
Apicectomy is performed in order to cure the complications deriving from a tooth with necrotic pulp, or affected by abscesses or granulomi, but only when the endodontic treatment cannot be applied.
In presence of a dental granuloma it is necessary to operate because the affection cannot spontaneously heal, nor by means of pharmaceutical therapy.
Since at the basis of this pathology there is an infective process, it is advisable to operate with the laser on account of its bactericidal properties.
 
Operculectomy
 
This operation consists in the ablation of a part of the gingiva which is generally located on an emerging wisdom tooth. The traditional operating method prescribes the use of the scalpel, but the laser, in comparison to that, does not only sensibly reduce the post-operative swelling but also causes much less pain to the patient.
 
Abscess incision and drainage
 
An abscess is a suppurative process that grows around the tooth, depending on where it is located. One usually distinguishes between periapical abscess (pus around the radicular apex) and periodontal abscess (pus inside the periopdontal tissues).
The most frequent cause are infections.
To incide an abscess means to open up an artificial fistula in order for the purulent material to stream out.
In comparison to traditional abscess drainage techniques, the use of the diode laser allows to operate in a much less painful way for the patient. By decreasing the employed energy, or by using a topic anaesthetic, it is possible to put pain under control
By means of the laser the bleeding is minimized, so that the drainage can be performed without compression. In this way the problem of the blood stagnation caused by gauzes is eliminated.

Thanks to its powerful antiseptic effect the laser ray eliminates the risk of post-operative infections.

The treatment is effected by vaporising the superficial mucosa layer with  the rapid   movement of the fiber perpendicular on the operating area.

During the operation it is recommended to regularly cleanse the fiber tip with a gauze soaked in hypochloride.

 

Crown lengthening

 

Crown lengthening is an operation which is sometimes necessary in order to uncover a further part of the tooth and to perform a restorative intervention on the crown, without damaging the connective attachment of the area.
 
The purpose of this surgical operation is to extend the crown surface of tooth by moving the gingival attachment to the apex, either with or without removing the bone supporting structure.
There could be different reasons for undergoing a crown-lengthening: aesthetic reasons, subgingival caries, wide fracture under the gingiva  close to the alveolar crest, the necessity of lengthening the prosthetic props, in order to increase their adherence.

This can even be a pre-prosthetic operation. The traditional method prescribes, if the crown is not visible and the root  emerges directly from the gingiva, to first open up a gingival flap and then to ablate the bone all around its perimeter with a sterile bur, in order for the tooth to come out of the gingiva.

With the laser it is possible to vaporise the flap and to ablate the whole tissue around the bone without damaging the bone itself.

In most of the cases it is not necessary to resort to anesthetics but, if need be, it is recommended to begin with a low power output and to increase it gradually according to requirements. 

 
Fistula

 

It is an abnormal opening in the gingival tissue, whereby a peri-apical abscess drains.

For this kind of operation it is important to use a sharp fiber, not so long as to reach too close to the bone.

The operation is performed by the tecnique called "intraluminal coagulation".

The fiber is introduced into the fistula up to the end of the duct. Thereafter the duct is irradiated, which brings about an internal and subsequently also external coagulation.

 

Oral papillectomy

 

Papillectomy is an operation consisiting in the ablation or in the reduction of the papillae of the oral cavity.
The laser desensitizes the operating zone and brings about  the reduction of the papillae by vaporising the tissue, which does not need any stitches.

 

 
 
Plastic Surgery

 

Idiopathic crown lengthenings characteristically appear in patients who have undergone an odontoiatric treatment before. Before proceeding with the treatment one has to assess the biologic width. If the operating area displays an adequate biologic width, the laser can re-shape the gingival contour without having to open up the gingiva.

In case the operating area is too narrow, it is necessary, after having detach the gingival flap, to operate on the marginal bone in order to create a harmonic contour that ends at least 3mm before the adherent gingiva. If necessary, the gingiva can be reduced, so as to get the best aesthetic result.

It is often necessary to cure also gingival hyperplasiae due to the assumption of medicines, for instance medicines derived from idontoin or immunodepressors. For such patients, it is necessary to first of all proceed with a gingivectomy at regular intervals, since it is not possible to interrupt the assumption of the medicines.

With diode laser such hyperplastic alterations can be removed and perfectly re-shaped. Patients can resume their noprmal eating habits without any limitations, immediately after the anesthetic effect is over.

   
 

PERIODONTICS

Periodontics
 
Periodontics is the branch of Dentistry dealing with the tissue that surrounds the tooth and gives it the necessary stability and props it up.
The periodontal system can be viewed as the supporting structure of the tooth; its component parts are the alveolar bone, the alveolar-dental joint, the root cementum and the gingiva.
In the last decade the application of the laser in periodontics has been thoroughly researched and the results of the studies supplied evidence for the huge benefits of the laser treatment.
The main asset of the laser is the possibility to use extremely thin fibres with 300 micron diameter that irradiate and decontaminate areas which are very difficult to access to traditional instruments. 

 

Over the last decade laser applications in periodontics have been exhaustively studied, which brought to the demonstration of the advantages of this technique for those who use it.

 
His main assets are the chance to use very thin fibres (300 micron diameter) and thus to irradiate and decontaminate areas which are difficult to reach.

 

Periodontitis

 

The illness known as Periodontitis is caused by infections or inflammations of the periodontium and affects 3 people out of 5. Once the periodontitis has established and started to grow, it is very unlikely to regress spontaneously: only by the intervention of a specialised dentist can priodontitis be put under control and cured.
The goal that has to be achieved is the restoration of the gingiva to the normal state, as well as the reparation of the alveolar bone and the recovery of the physiological shape and function of the mucosa.
Gram-negative anaerobic bacteria are the most frequent responsible for chronic periodontitis in adult patients.
The treatment begins with the cure of radicular surfaces and the elimination of possible concrements and of the infected cement, so as to enable a non inflammated connective attachment.
Thanks to the decontaminating effect the diode/nd-yag laser allows a wide and fast decontamination of the gingival pocket.
In the first phase of the treatment, the tooth profits from an analgesic effect that allows later the doctor to operate more freely on the operating field, without having to worry about possible damage to the patient. The choice of the most suitable fibre for the operation has to be made according to the kind of periodontal pocket the dentist has to work on. The deeper and the bigger the pocket is, the bigger will be the diameter of the fiber that operates inside it.
It is recommendable, during this phase not to adjust the power at more than one watt, so as to avoid thermal damage.

 

“Chronic periodontitis in adult patients is caused most of the times by some anaerobic bacteria, like Actinobacillus actinomycetem comitans, Prevotella intermedia or Porphyromonas gingivalis, belonging to the class gram negative. In deep periodontal pockets, these bacteria find their ideal habitat and  cause inflammatory reactions in the soft tissues and in the bone: the teeth loss is only the ultimate consequence of the course of the disease if an adequate therapy is not undertaken in time. The main part of the therapy consists in the treatment of the root surface with manual, rotating or ultrasound instruments, whereby alla concrements, as well as the infected cement are removed, so as to obtain a non inflammated connective re-attachment or a long epithelial attachment.

In case of persisting infections, it is advisable to apply also local antibiotics, besides utilizing normal solutions and disinfecting gel.

Diode laser simplifies and improves the tissue healing considerably. Just like in the root canal, it is possible to decontaminate the gingival pocket thoroughly (Bach, Mall 1998;2000). The pocket is opened up by introducing the laser fibre into the sulcus.
The fibre is selected according to the dimensions of the pocket: the bigger and deeper the pocket is, the bigger will be the fibre diameter. After having carried out the pocket decontamination, it can be proceded with the treatment of the root surface by means of manual instruments. By virtue of the haemostatic effect of the laser, an excellent operating view is guaranteed.
 Finally, the pocket has to be decontaminated, which thanks to the laser light divergence can be performed with sufficient light also in the most difficult to reach areas.
In order for the operation to be successful, it is important to take care not to regulate the power output too high, in order to avoid thermic damage (power output should be regualted at 1W in CW and the exposition time at 10/20 sec)….
…The decontamination can be effected either with open or with closed pocket or as flap surgery.
In this regard the laser can be used in the treatment of the granulated tissue inside the pocket. Moreover, it is possible to dry and treat this tissue so that it subsequently can be easy detached by means of curettes.
 
It is also possible to perform all other therapies without any limitations.

It is also important to check after each periodontal treatment if it is necessary to alleviate the pressure on the teeth by the insertion of adequate spring systems, in order to avoid the risk of overloads or wrongly positioned loads. “

 

Data from www.dentelink.com
     
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