(B) Peri-Implantitis / Mucositis – Physiotherapy

Technique: Low-energy laser, non-contact irradiation to improve local microcirculation, reduce inflammation, and eliminate bacteria.

For bony involvement (peri-implantitis with bone loss):

• Surgical flap reflection and debridement are mandatory – granulation tissue must be physically removed

• Laser plays only an adjunctive role for disinfection and physiotherapy – it cannot replace surgical debridement

Clinical Value: Providing laser physiotherapy maintenance during routine recall visits not only gives patients the sense of receiving active treatment at every visit, but also effectively reduces the incidence of peri-implantitis. This is a powerful tool for building patient compliance with regular recall schedules.

III. Endodontics: Standardized Parameters and Procedure

(A) Root Canal Disinfection

Principle: Conventional chemical irrigants penetrate only 5–20 microns, while semiconductor laser can penetrate up to 700 microns or deeper. Bacteria hidden deep within dentinal tubules, which cannot be reached by medicaments, can be effectively targeted by laser.

Technique:

1. Use a 200 μm fiber (thinner, allowing insertion deep into the root canal)

2. Do not carbonize the fiber

3. After root canal preparation is complete, insert the fiber into the canal and irradiate with an up-down lifting motion

4. Can be used in conjunction with root canal irrigants

Important Note: The laser provides disinfection only – the standard procedures of root canal preparation and obturation cannot be omitted.

(B) Dentin Hypersensitivity Treatment – Step-by-Step Protocol

Step 1: Indication Assessment

First, identify the cause of the patient’s chief complaint of sensitivity:

Step 2: Tooth Surface Preparation

Keep the tooth surface dry (saliva interferes with the effect). Use a 2B pencil to draw over the sensitive area.

Safety of pencil application:

• Pencil “lead” is actually graphite, not lead – non-toxic

• Easily removed with a cotton pellet

• Ink is not recommended – although it applies easily, it is very difficult to remove

• Commercial proprietary staining agents are available but expensive (hundreds of euros for a few applications overseas) – the pencil is a cost-effective alternative

Step 3: Laser Irradiation

• Fiber: Not carbonized

• No local anesthesia – patient feedback (“does it hurt?”) is essential for controlling the endpoint

• After irradiation, dentinal tubules appear sealed

Why No Local Anesthesia?

Desensitization requires a moderate amount of heat to seal the dentinal tubules, but the heat must be kept within a safe range. The patient’s verbal response of “pain” is the signal to stop. With anesthesia, there is no feedback, and the clinician may over-irradiate, potentially causing pulp damage.

Step 4: Post-Procedure Management

Desensitization is not permanent.

With normal brushing and eating, the sealed superficial dentinal tubules may become exposed again over time.

Patient communication: Inform the patient that if sensitivity recurs, they can return for another desensitization session – this does not mean the first treatment was unsuccessful.

Fluoride application timing:

• Before desensitization – laser activates the fluoride effect

• After desensitization – fluoride coating prolongs the duration of effect

• Both approaches are supported by literature – either is acceptable

Not applicable to cracked teeth: Although a crack may appear very small, it is too large for the laser to seal.

IV. Oral Surgery: Key Points for Various Procedures

(A) Frenectomy

Labial Frenum Classification and Surgical Indications:

Laser Excision Technique:

• Administer local anesthesia → carbonize the fiber → proceed with cutting

Recommended “Three-Cut Method” (reported in literature):

Lingual Frenectomy – Special Considerations:

(F) Hemostasis (Coagulation) – Step-by-Step

This is the most frequently asked-about and most misunderstood procedure.

Step 1: Identify the Nature of the Bleeding

Step 2: Locate the Exact Bleeding Point

1. Apply pressure with a cotton pellet over the bleeding area

2. Immediately upon removal, identify the specific bleeding point

3. If an assistant is available, have them continuously blow air with the air syringe to keep the field clear

Step 3: Coagulation Technique

1. Carbonize the fiber tip

2. Directly contact the bleeding vessel or tissue with the carbonized fiber tip – do NOT just touch the surface clot!

3. Hold for 2–3 seconds

4. Press again with a cotton pellet, locate the next bleeding point, and coagulate

5. Repeat until bleeding stops

Why Do Many Clinicians Fail to Coagulate Effectively?

They only coagulate the surface clot, not the vessel itself.

The surface clot turns black and appears to have stopped bleeding, but when irrigated, bleeding resumes. You must identify the specific vessel/tissue point and have the carbonized fiber directly contact that point to achieve hemostasis.

(A) Ulcer Physiotherapy

Technique: Non-contact, no carbonization, low energy – adjust until the patient feels a comfortable warmth.

Effects:

Patient Expectation Management:

Physiotherapy does not guarantee non-recurrence, especially for aphthous ulcers caused by psychological stress or immune factors where the etiology is unclear – recurrence remains possible.

Treatment Course Recommendation: Once daily for 3 consecutive days.

• Day 1: Pain may still be present in the evening

• Day 2: Continue treatment

• Day 3: Significant improvement observed

  (B) Absolute Contraindication: Do NOT Treat Potentially Malignant Lesions

  Lichen planus and leukoplakia both carry a certain risk of malignant transformation.

  At the clinical practice level, it is strongly recommended NOT to treat these conditions.

  Even though literature reports suggest that semiconductor laser may have some therapeutic effect on lichen planus and a lower carcinogenic risk compared to other lasers – if malignant transformation occurs, the patient will only attribute it to your treatment.

  It is not worth taking the “what if” risk for a few hundred yuan in procedure fees.

  Clinical Rule for Oral Medicine:

  First, ask yourself: “Is malignant transformation possible for this lesion?” If any risk exists, do not perform treatment.

  (C) Hemangioma (Vascular Lesion)

  Stratified assessment is critical:

  Type	Treatment Outcome
  Dark venous hemangioma	Better response
  Superficial hemangioma	Poor response

  Technique

  Administer local anesthesia.Apply high-energy irradiation until the hemangioma turns dark, shrinks and presents morphological changes.Necrotic tissue will slough off within 2 to 3 weeks.

  Site Limitations

  Location	Recommendation	Reason
  Mucosal surface (lip, tongue, floor of mouth)	Treatable	Minimal aesthetic concerns
  Skin surface	Not recommended	Scar formation after healing

  

  VI. Teeth Whitening: Clarifying the Mechanism of Lasers

  Correction of Common Misconceptions

  The laser itself cannot whiten teeth.

  The function of the laser is to activate the whitening gel (main component: H₂O₂), enhancing its permeability and decomposition activity.

  Laser energy is primarily absorbed by pigments within the gel.

  Red gel exhibits superior absorption at the 980 nm wavelength.

  Procedure

  Step	Operation
  1. Preoperative Examination	Check for caries and enamel cracks. Inform patients of possible postoperative sensitivity.
  2. Apply Gingival Barrier	Light-cure to protect the gingiva
  3. Administer 35% hydrogen peroxide whitening gel	Apply to a thickness of approximately 1 mm
  4. Use dedicated whitening handpiece	This is not a standard optical fiber. Maintain a distance of 1–3 mm from the tooth surface (Do not contact the tooth surface; otherwise the gel will spread outward).
  5. Irradiation	1–2 minutes per quadrant; roughly 5–6 minutes for the full arch.
  6. Remove gel	Use high-volume suction. Never wipe with cotton balls or gauze. Contact of the gel with lips and mucosa may cause burns and ulcers.

  True Advantages of Laser-Assisted Whitening

  Comparison Item	Conventional Protocol	Laser-Assisted Protocol
  Gel Concentration	40%	35%
  Postoperative Sensitivity	Significant — some patients require analgesics	Mild — excellent tolerance
  Whitening Efficacy	Good	Comparable to the 40% gel protocol — equivalent effect with fewer adverse sensations