laserinternational magazine of laser dentistry42010

i s sn 1616-6345 Vol. 2 • Issue 4/2010

| researchEffect of low level laser therapy during Rapid Maxillary Expansion

| case reportMinimally invasive dentistry (MID) concepts for the caries treatment by Er:YAG laser

| meetingsA very successful 20th Annual Congress of the DGL in Berlin

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I 03

editorial _ laser I

laser4_2010

Prof Dr Norbert Gutknecht

Editor-in-Chief

_Lights are shining in different colours in different wavelengths in different places almostall over the world.

In the past year 2010 we have been celebrating the 50th anniversary of lasers in dentistrywhich was the overall high light for the use of lasers in the different fields of dentistry. One flash-light during this highlight was the 12th WFLD (World Federation of Lasers Dentistry) Congress inDubai being embedded in the largest Dental exhibition in the middle East. Further more a bignumber of high class national laser conferences around the world have been completing thisshining impression. This has been reflected in a rising number of laser users due to the growingacceptance of this technology within the dental society.

The year 2010 was also filled with highlights of improved and new dental laser systems help-ing dedicated laser dentists to successfully improve their daily service towards their patients.

I wish all our dear laser users and laser interested colleagues a peacefull Christmas time anda bright shining New Year.

Prof Dr Norbert GutknechtEditor-in-Chief

It is Christmas time

research 10 case report 18 user report 24

meetings 34 meetings 42 education 46

I content _ laser

04 I laser4_2010

I editorial

03 It is Christmas time| Prof Dr Norbert Gutknecht

I research

06 Salivary flow rate before and after low level laser therapy| Sonja Pezelj-Ribarić, Nataša Gržetić, Miranda Muhvić Urek,

Irena Glažar, Davor Kuiš

10 Effect of low level laser therapy duringRapid Maxillary Expansion| Eyad Hamade, Rwaida Saimeh, Mina Mazandarani,

Maziar Mir, Norbert Gutknecht

I case report

14 Minimally invasive dentistry (MID) concepts for the caries treatment by Er:YAG laser| R. Kornblit, U. Romeo, A. Polimeni

18 Diode laser (810 nm) applications in clinical Orthodontics| Dr Deepak Rai, Dr Gurkeerat Singh

I user report

24 Use of the Er,Cr:YSGG and Er:YAG lasers in restorative dentistry | Prof Dr Giuseppe Iaria, Rolando Crippa, Giovanni Olivi,

Matteo Iaria, Stefano Benedicenti

28 The use of lasers in periodontal treatment| Howard Golan

32 Photosensitizers in dentistry| Dr D. Koteeswaran, Dr C. Pravda, Dr Ekta Ingle

II meetings

34 A very successful 20th Annual Congress of the DGL in Berlin| Dr Georg Bach, Leon Vanweersch

38 First year of AALZ Greece full of activities! | Dimitris Strakas

40 “Light Time—Good Time” | Giada Gonnelli

42 Revolutionary laser system was presented in Israel | Georg Isbaner

44 International events 2011/2012

II laser

46 “Lasers in Dentistry”| Leon Vanweersch, Dominique Vanweersch

I news

48 Manufacturer News

I about the publisher

47 | submission guidelines

50 | imprint

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I research _ LLLT

Fig. 1_Salivary flow rate before and

after LLLT. * Denotes significant dif-

ference between groups P < 0.001.

LLLT—low level laser therapy.

_Introduction

The therapy performed with lasers is often calledlow level laser therapy (LLLT) or just laser therapy.Several other names have been given to these lasers,such as soft laser and low intensity level laserwhereas the therapy has been referred to as bios-timulation. Low level laser therapy is a non-invasive,painless and athermal therapy, based on biologicalestimulative-regenerative, anti-inflammatory andanalgesic effects. LLLT also appears to have avirustatic and bacteriostatic effect. Some explana-tion of analgesic effect of LLLT are: it increases ATPproduction, improves local microcirculation, in-creases lymphatic flow, increased serotonin and en-dorphins, increased anti-inflammatory effectsthrough reduced prostaglandin synthesis.1

In vitro data suggest that LLLT facilitates collagensynthesis, keratinocyte cell motility, and growthfactor release and transforms fibroblasts to myofi-broblasts.1-4

Low level laser light is compressed light of awavelength from the cold, red part of the spectrumof electromagnetic radiation. It is different fromnatural light in that it is one precise color; it is co-herent, monochromatic and polarized. These prop-erties allow laser light to penetrate the surface of theskin or mucosa with no heating effect and no dam-age. The most commercially available lasers are thehelium-neon (He-Ne), emitting wavelengths of632.8 nm, and the semiconductor diodes, such asgallium-arsenide (GaAs) and gallium-aluminum-arsenide (GaAlAs), emitting wavelengths of 650 and830 nm, respectively.5

LLLT has also beene used to stimulate bone for-mation by increasing osteoblastic activity, vascular-ization, organization of collagenous fibers and ATPlevels.5

In recent studies, many authors have reprted sig-nificant pain reduction with LLLT in acute and chronicmusculoskeletal pain and also many authors have re-ported significant pain and symptoms of inflamma-tion reduction with LLLT in radiotherapy-induced oralmucositis and xerostomia in oral cancer patients ,and severe pain in patients submitted to hematopoi-etic stem cell transplantation.6,7

In our previous research we investigated thera-peutic response by determing the level of proin-flammatory cytokines TNF-alpha and IL-6 in wholeunstimulated saliva in patents with denture stom-atitis before and after LLLT.7

Salivary flow rate beforeand after low level lasertherapyAuthors_Sonja Pezelj-Ribarić, Nataša Gržetić, Miranda Muhvić Urek, Irena Glažar, Davor Kuiš, Croatia

Fig. 1

06 I laser4_2010

research _ LLLT I

Xerostomia is frequently associated with de-crease in the flow rate of saliva. The measurementof salivary flow is basic to understanding of theprocess of secretion and to our assesment of con-ditions and disease which lead to salivary hypo-function.8 Xerostomia is not a disease, but it may bea symptom of various medical conditions, a side ef-fect of a radiation to the head and neck, or a side ef-fect of a wide variety of medications. It may or maynot be associated with decreased salivary glandfunction. Xerostomia is often a contributing factorfor both minor and serious health problems. It canaffect nutrition and dental, as well as psychologi-cal, health. Some common problems associatedwith xerostomia include a constant sore throat,burning sensation, difficulty speaking and swal-lowing, hoarseness and/or dry nasal passages.9 Themanagement of xerostomia will include the identi-fication of the underlying cause. For many patientslittle can be done to alter the underlying cause. Forthose whose xerostomia is related to medicationuse, effective symptomatic treatment may be im-portant to maintain compliance with their medica-tion regime. Symptomatic treatment typically in-cludes four areas: increasing existing saliva flow,replacing lost secretions, control of dental cariesand specific measures such as treatment of infec-tions.10

Some investigators had effect of LLLT on mu-cositis and temporomandibular joint dysfunc-tion.11,12 LLLT may also have an effect on salivaryglands so it is important to know the effects of thistherapy on parotid and submandibular gland tis-sues.

The aim of this study was to investigate is it LLLTable to increase salivary flow rate.

_Materials and methods

A sample consisting of 20 consecutive subjectswere selected on a voluntary basis from patientswho presented for diagnosis and treatment of xe-rostomia at the Oral Medicine Unit of the MedicalFaculty University of Rijeka. All subjects were in-

formed of the aims and procedures of the research,as well as of the fact that their medical data wouldbe later used in the analysis. The Ethics Committeeof Medical Faculty of Rijeka (University of Rijeka)approved this study protocol. Only those subjectswho have given a written permission in form of aninformed consent were included. Each subjectcompleted a questionnaire for demographic andhealth information.

The clinical examination was performed accord-ing to the standard clinical criteria. We mesured thewhole saliva.

After initial evaluation and diagnosis, the pa-tients were divided in two groups:Group 1: before receiving LLLTGroup 2: after receiving LLLT

Xerostomia may be diagnosed with the aid ofsalivary collection tests (sialometry).Salivary flowrate should be measured by standardized tech-niques. As salivary secretion fluctuates betweenminimal and maximal rates during the day, it is im-portant to assess the salivary secretion consistentlyat an established time of the day, in order to prop-erly examine the evolution of the condition and itstreatment in every patient. Whole saliva can be col-lected by spitting, blotting, suctioning or drainingthe oral fluid. The normal flow rate for unstimu-lated, “resting” whole saliva is 0.3 to 0.5 ml/min.; forstimulated saliva, 1 to 2 ml/min. Values less than0.1 ml/min. are typically considered xerostomic, al-though reduced flow may not always be associatedwith complaints of dryness.9 We measured thewhole saliva.

The whole unstimulated saliva was collected be-tween 9:00 and 11:00 am using standard tech-niques described by Navazesh.13 Participants wererefrained from eating, drinking, using chewinggum, etc, for at least 1,5 hours prior to evaluation.Saliva specimens were collected from each partici-pant in sitting position, before and after LLLT. Sam-ples were obtained by requesting subjects to swal-low first, tilt their head forward, and expectorate all

Tab. 1_Descriptive statistics of sali-

vary flow rate before and after LLLT.

(S.D.—standard deviation;

LLLT—low level laser therapy)

I 07laser4_2010

Group Mean

(ml /5 min.)

S.D.

(ml /5 min.)

Median

(ml /5 min.)

Minimum

(ml /5 min.)

Maximum

(ml /5 min.)

Lower Quartile

(ml /5 min.)

Upper Quartile

(ml /5 min.)

BeforeLLLT

0.235 0.272 0.20 0.0 1.0 0.05 0.25

AfterLLLT

0.825 0.504 0.95 0.1 1.5 0.25 1.2

I research _ LLLT

saliva into 50 ml tubes for 5 min. without swallow-ing. The final volume and flow rate of saliva weredetermined gravimetrically (Analytical Balance,Model WTS-6001, Sartorius Corp., Long Island, NY,USA). Entire procedure was repeated after the finaltreatment, after four weeks. 20 subjects weretreated five days in week for four consecutiveweeks with a 685 nm GaAlAs (gallium-aluminium-arsenide) diode laser (Medio LASER Combi Dental,Iskra Medical, Ljubljana, Slovenia). The output ofthe laser was measured in 7 minutes and found tobe practically constant. The laser outputs were con-trolled weekly using analogue power meters pro-vided by the manufacturers. During each session,the laser treatment was delivered to the tissue by astraight optical fiber with a 1.2 mm spot size. Thetreatment areas, each one being a 1 cm2 surface.Laser applied on parotide glands with 10 minutes(685 nm, continues wave, 30 mW output power, 3.0J/cm2). The treatment time (t) for each applicationpoint was given by the equation: t(sec) = energy(J/cm2 ) x surface /cm2/ Power (W). The average en-ergy density delivered to the treatment areas was3.0 J/cm2 . The effect of laser light was evaluated af-ter the final treatment.

_Results

The sample included 20 patients (15 women and5 men), mean age 60.25±6.27.

Salivary flow rate were measured before and af-ter LLLT and the results are presented in table 1. Sali-vary flow rate after LLLT were significantly greaterthan salivary flow before LLLT (P < 0.001) (Fig. 1).

Statistical analysisStatistical analysis of data was performed using

Statistica for Windows, release 6.1 (StatSoft, Inc.,Tulsa, OK). The Kolmogorov-Smirnov normality testwas applied to our data. The results were comparedusing nonparametric Wilcoxon signed-rank test.Statistically significant difference was defined at P < 0.05.

_Discussion

LLLT is a non-invasive light source treatmentthat generates a single wavelenght of light. It emitsno heat, sound or vibration. Lasers with differentwavelenghts, varying from 632 to 904 nm, are usedin the treatment of musculoskeletal disorders. Thisnon-invasive nature of laser biostimulation hasmade lasers a choice of therapy. In our previous in-vestigation we investigated the effect of LLLT onpatients with denture stomatitis.7 We found a sta-tistically significant reduction in the salivary levelsof proinflammatory cytokines, TNF-alpha and IL-6

in patients with DS following treatment for 4 weekswith LLLT. This results may suggest that LLLT may bean efficacious choice of therapy in patients with DS.Simoes A et al.14 made a clinical case study report ondry mouth symptoms in a patient with Sjogren’ssyndrome. The patient was treated with LLLT. Adiode laser (780 nm, 3.8 J/cm2, 15 mW) was used toirradiate the parotid, submandibular, and sublin-gual glands. The salivary flow rate and xerostomiasymptoms were measured before, during, and afterLLLTT. Dry mouth symptoms improved during LLLT.In this study we found that the indicence in xeros-tomia is significatively reduced in patients treatedwith LLLT.

Xerostomia is not a disease but can be a symp-tom of certain diseases. It can produce serious neg-ative effects on the patients quality of life. Saliva isnecessary for carrying out the normal functions ofthe oral cavity, such as taste, speech, and swallow-ing. Depending on duration and extent of salivarydeficiency, severe changes of the oral mucosa andteeth will develop. Treatment of xerostomia may beperformed causally (withdrawal or exchange ofdrugs inhibiting salivary secretion) but will oftenonly be possible as a symptomatic therapy. For thispurpose there are available today saliva surrogatesolutions (‘artificial saliva’) and substances thatstimulate the secretion of the still intact salivarygland parenchyma. In this preliminary study, with asmall sample size, we found a statistically signifi-cant improvement in the salivary flow rate after thetherapy with low level laser.

_Conclusion

Treatment with LLLT was an effective method toimprove the quality of life of patient with xerosto-mia as an noninvasive, quick, safe, non-pharma-ceutical intervention._

Editorial note: The literature list can be requestedfrom the author.

08 I laser4_2010

Prof Sonja Pezelj-Ribari, PhD, DDSDepartment of Oral Pathology and PeriodontologySchool of Dentistry, Medical FacultyUniversity of RijekaCroatiaBra e Branchetta 20E-mail: sonja.pezelj-ribaric@medri.hrTel.: +385 51 345-645Fax: +385 51 345-630

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I research _ LLLT

Graph 1_The percentage of patient

distribution according to gender.

Fig. 1_Insertion of RME.

Fig. 2_After expansion.

_Introduction

Orthodontic tooth movement is the result of alveo-lar bone remodeling due to response to mechanicalstimulus at the interface with periodontal ligament. Al-though Wolff’s law is generally considered to be aphilosophical statement but states the effect that, overtime, the mechanical load applied to living bone influ-ences the structure of bone tissue. Bone remodelingcan be categorized into two different types:1,2

_External bone remodeling, in which the outer geom-etry of bone tissue adapts due to change in appliedforces, while the material properties remain constant;

_Internal bone remodeling in which internal structureof bone tissue remodels due to changes in appliedforces, in fact, this type of bone remodeling is relatedto remodeling of spongy bone in which elasticity pa-rameters of bone tissue change.

Sutures are considered as the growth sites of in-tramembranous bones3,4,5,6 in the craniofacial complex.Accordingly, it is fair to assume that if sutures were notpresent, craniofacial bones might grow only in thick-ness.

The tissues surrounding sutures, such as the duramater7, have a significant effect on sutural patency andgrowth. Earlier studies have repeatedly confirmed thatcompressive forces applied across sutures reduce bonedeposition and induce bone resorption, while tensionalforces increase bone deposition. This response charac-teristic makes sutures important target areas for or-thodontic: orthopedic appliances designed to controlvertical and transverse growth of the maxilla, such aspalatal expander and cervical, high-pull and protrac-tion headgears.

The dramatic development of technology in thelast decades offers a small but a powerful tool to beused in clinical trials, which is the Laser Beam. LLLT is

Effect of low level lasertherapy during RapidMaxillary ExpansionAuthors_Eyad Hamade, Rwaida Saimeh, Mina Mazandarani, Maziar Mir/UAE, Norbert Gutknecht/Germany

10 I laser4_2010

Fig. 1 Fig. 2

Graph 1

research _ LLLT I

a type of laser that penetrates deeply into the tissueand affects the cells. This is due to its specific wave-length and low energy level. Treatment with lasertherapy is not based on heat development but on pho-tochemical and photobiological effects in cells andtissue. Discomforting pain is a burdensome side effectaccompanying orthodontic treatment and/or ortho-pedic procedure due to force application for move-ment. Several studies showed an effective pain re-duction after different dental treatments using LLLT.Also it has been shown that LLLT is an effectivemethod to prompt bone repair and modeling aftersurgical procedures.

_Aim of the study

_Our aim is to take advantage of the technological de-velopment, in order to increase the bone formationquality, accelerate the formation rate and thereforedecreasing the relapse rate.

_Also, we hope to take our patients through a rela-tively short and happy orthodontic treatment jour-ney, without a discomforting pain.

_Materials and Methods

Patient selection _Twenty patients of both genders participated in the

research, and were distributed as following._All the patients and their legal guardians were in-

formed of our intent to apply LLLT during orthodon-tic treatment and they approved to go through it(Consent).

_Orthodontic Treatment

_After thorough clinical examination, the followingdiagnostic tools were obtained for each patient:

1- X-rays_A-Panoramic view._B-Lateral Cephalometric View._C-Antero-Posterior view._D-Upper maxillary CT scan with 3 mm sections

thickness._2-Appropriate Photographs. _3-Model cast._In addition, the followings were taken at the end of

the expansion period:

1- X-rays_A-Upper maxillary CT scan with 3 mm sections thick-

ness._B-Antero-Posterior view_The treatment plan for these patient included Rapid

maxillary expansion because of the presence of pos-terior crossbite or there was not enough space for acomplete alignment.

Graphs 2 & 3_Bone density.

Graph. 2: The bone density at the opened suture

site was higher in the lased group than control

(non-lased) group. Graph. 3: Bone density in the

posterior region was higher than the anterior region

in both groups. However it was higher in lased than

non-lased group.

Graph 4_ Pain Study.

The pain level was higher in the non-lased group

throughout the entire treatment.

I 11laser4_2010

Graph 2

Graph 3

Graph 4

I research _ LLLT

Fig. 4a_Before

Fig.4b_After

Fig. 5a_Before

Fig. 5b_After

_The appliance chosen was a Hyrax expander, McNa-mara type.

_The Hyrax expander was opened twice daily till wereached an overcorrection position (Figs. 1 & 2).

_After one week of achieving the required expansion,Hyrax was removed temporarily to allow taking the CTscan image without artifact effect of the metal (Figs.3 & 4).

_Laser therapy protocol

a- Selected locations for laser application:1- Mid palatal Suture (9 J/cm2).2- Intermaxillary suture (4 J/cm2).3- Zygomaticomaxillary suture (2 J/cm2) per side.b- The laser handpiece was held in contact with the tis-

sues and sweeping movements were performed.

_Pain questionnaire

At every visit (after 1mm), every patient was askedabout the pain experienced during this period and wasrecorded and ranked according to the following sched-ule (Table 1).

In order to study the statistical pain differences, thequestionnaire was divided into three phases eachphase for a duration of one week.

_Results

_Bone density study (Hounsfield unit)._Pain study.

_Discussion

_Orthodontic tooth movement involves both model-ing and remodeling activity that is modulated by sys-temic factors such as nutrition, metabolic bone dis-eases, age and drug usage history.

_According to several studies LLLT is an effective toolused to prompt bone repair and modeling post sur-gery. This is referred to the biostimulation effect of theLLLT.

_This effect had been well studied in the medical fieldand proven to have an enhancing effect on fibroblastgrowth.

_Tooth movement and/or orthopedic movement is de-pendent on a painful and inflammatory adaptation ofthe alveolar process.

_To relieve such pain, several methods have been used.One of them is to use drugs (NSAIDs). Although thesecould be effective in relieving pain, they may also re-duce the rate of tooth movement.

_The biostimulation effect of the LLLT was also reportedto be effective in reducing the pain arising from den-tal treatment procedures.

_Conclusion

_The (Ga-Al-As) low level laser used in this study is con-sidered to be an effective tool during orthodontictreatment as:

_The rate of bone density raised significantly._The pain level reduced significantly.

Editorial note: The literature list can be requested fromthe editorial office.

12 I laser4_2010

Degree of Pain Rank Value

No pain 0

Mild pain 1

Moderate pain 2

Severe pain 3

Intolerable pain 4 Dr Maziar MirBritish Lasik Centre, Dubai, UAE, and Department ofPreventive and Conservative Dentisry,RWTH Hospital, Aachen, GermanyE-mail: mmir@ukaachen.de P.O. Box: 74064, Dubai, UAE

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I case report _ caries treatment

_Introduction

The dental caries lesion is a bacterial infection cre-ated by cariogenic bacteria resulting in increased pro-portions of acid, producing consequently a low pHthat produce a demineralization of the tooth struc-ture.1,2 In the past, carious treatment approach wasmainly a surgical removal of the infected tissue andthe subsequent tooth reconstruction with a dentalrestorative material. At that time, diagnosis of carieslesions was carried out at more advanced diseasestages than the incipient lesions detected today andinstrumentation was limited to slow rotary and handinstruments.

The cavity preparation had an excessive toothstructure reduction even for relatively small lesions,removing not only the caries tissue but also healthyintegrate tooth tissue in order to follow the conceptsof extension for prevention, resistance and reten-tion.3,4

The modern operative dentistry is moving to aminimally invasive approach, in which caries aremanaged as an infectious disease and the focus is on

maximum preservation of tooth structures.5,6 The in-troduction of adhesive dental materials made it pos-sible to conserve tooth structure using, minimal inva-sive preparation, because adhesive materials don’t require any incorporation of mechanical retentionfeatures. Minimally invasive dentistry (MID) adopts aphilosophy that integrates prevention, remineraliza-tion and minimal intervention for the placement andreplacement of restoration. MID reaches the treat-ment objective using the least invasive surgical ap-proach with the removal of minimal amount of healthtissue.7

Nowadays the erbium laser can be the answer tothe MID requirements.The wavelength of Er:YAG laseris 2,940 nm that correspond to the absorption peak ofwater is indicated for hard dental tissue and bone ab-lation where the main substances are water and hy-droxyapatite. Maximum absorption in water results inan effective microexplosion mechanism. The explo-sive vaporization creates a plume of ablation of thecarious tissues. The ablative action is also due to acombination of photothermal and photoacoustic ef-fect caused by the microexplosions of water on thetarget tissue.

Minimally invasive dentistry(MID) concepts for the caries treatment by Er:YAG laserAuthors_R. Kornblit, U. Romeo, A. Polimeni, Italy

14 I laser4_2010

Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5

case report _ caries treatment I

The purpose of this clinical article is to showtrough out clinical cases the capacity of an Er:YAGlaser (FOTONA—Slovenia) to remove caries tissue, fol-lowing the concept of MID .

_Clinical cases

Caries with a depth from just in dentine to half-way of the dentine thickness (at least 1 mm away fromthe pulp chamber) were treated, following the re-quirements of MID in operative dentistry. The param-eters used were: VSP mode (140 s per pulse), Energyfrom 150 mJ to 200 mJ, frequency from 15 Hz to20 Hz, fluence from 30 to 40 J/cm2. Both eyes of pa-tient’s and operator's were protected by laser safetyeyewear (UNIVET, 705.00.00.00.BL, certificated CE,Dir. 89/686/CEE).

The caries were ablated in focus mode using theEr:YAG laser with the mirror handpiece R2 at a dis-tance between 0.8 to 1 cm from the tooth with slowfluid continuous movements, under water-coolingusing tap water and the high speed suction to han-dling the plume of the carious tissues. The preparationof the cavities was limited to vaporizing of the in-fected layer leaving the affected one, without any ab-lation of healthy tooth structure.

The removing of the amorphic dentine waschecked with the probe and in some cases we finishedto remove the infected layer using a dental excavator(ASA stainless 1700-2).

All the teeth were restored in the same appoint-ment using acid etch Scotchbond Etchant (3M ESPE,Dental Products), adhesive Scotchbond 1 XT (3MESPE, Dental Products) and composite Z100 MPRESTORATIVE (3M ESPE, Dental Products).

The resin composite was polymerized in a conven-tional mode with a commercial halogen light 52 W,spectrum 400–515 nm (Polylight 3 Steril, CASTELLINI),curing for 40 seconds each layer of the resin compos-ite (at least two layers for filling) with the light tip at8 mm distance from the tooth surface.

_Case 1

Thirty years old male with occlusal dental caries (I class of Black) of the lower right second molar (Fig. 1). The treatment was done without anesthetic,using a rubber dam. The non sustained enamel andcarious tissues were removed by Er:YAG laser follow-ing the modality and the parameters descrived above(Figs. 2 & 3). The cavity was filled with composite resinas descrive above (Fig. 4).

_Case 2

Forty two years old female with mesio-occlusialdental caries (II class of Black) of the upper left firstmolar (Fig. 5). The treatment was done without anes-thetic, using a rubber dam. The non sustained enameland carious tissues were removed by Er:YAG laser fol-lowing the modality and the parameters descrived(Figs. 6 & 7). The treatment was completed with acomposite restoration (Fig. 8).

_Case 3

Twenty nine years old female with occlusal dentalcaries (I class of Black) of the lower right first molar(Fig. 9). The treatment was performed under a rubberdam using the Erbium to remove the carious tissue(Fig. 10). During the application was not necessary touse anesthetic. The non sustained enamel and carioustissues were removed by Er:YAG laser following themodality and the parameters descrived in the generalpart (Figs. 11 & 12). The cavity was filled with com-posite resin (Fig. 13).

_Discussion and conclusions

The modern operative dentistry can be based on aminimally invasive techniques where caries removaland cavity preparation can be completed with mini-mal tissue removal. The conservation of hard dentaltissue increases the longevity of the restored tooth.8

The use of Er:YAG laser is efficient, effective, safe andsuitable for caries removal and cavity preparation9,10,generating similar heat increases under water-cool-

I 15laser4_2010

Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10

I case report _ caries treatment

ing compared to the preparation with high-speed in-strument.11,12

The aiming beam of Er:YAG laser (incorporated inthe system) delimit an ablating spot area of 0.8 mmdiameter (in fact the ablating area is even smaller) sothat irradiating dental hard tissue with laser in fo-cal mode allows to ablate areas not larger than 0.8mm in diameter.13

Removing only small areas of dental caries can't bedone with the conventional burs because even thesmallest one, when drilling, takes off more tissue. Ad-ditionally the burs are removing tissue tridimension-ally comparing to the laser beam that is vaporazingjust the irradiated surface. Having the possibility toablate with Er:YAG laser small areas helps in reachingone of the most important goal of MID that is themaximum preservation of dental tissue. The MID di-vided the carie lesion in two layers. The infected layerwhich is heavily bacteria contaminated is composedof soft amorphic dentin (denatured collagen matrix)without any potential ability to remineralize. The un-derlying layer, the affected one that is less contami-nated by bacteria, is partially demineralized with anintact collagen matrix conserving the potential toremineralize. The goal of MID is to eliminate the in-fected layer of the caries conserving the below af-fected layer.14

The diamond and tungsten carbamide burs are in-discriminant in their removal of carious tissue, usu-ally removing infected and affected dentin simulta-neously without the possibility to distinguish be-tween the two zones, sometime even extending intounderlying intact dentin. Using the Er:YAG laser beamfor caries removal the visual control of the ablatingarea is better than with the conventional instrumentsand having the possibility to vaporize such small ar-eas of 0.8 mm diameter, it is possible to vaporize onlyinfected tissue and to stop the moment the affectedzone is reached as suggested by MID.

The bactericidal effect of laser system on dentinsurface was demonstrated in a several studies. The

good disinfection of the contaminated dentin pre-vents failure of the restoration process (secondarycaries).15,16 Decontaminating the affected layer afterremoving the soft amorphic dentine can help in pre-venting possible future pulp complications.

The introduction of resin-based compositerestoration in dentistry helped to reach the goals ofMID. Conditioning the dentine surface removes thesmear layer and opens the dentine tubules, after burpreparation, forming a defined hybrid layer and resintags of the composite material into the openedtubules. The ablation of dental hard tissue with Er:YAGlaser leaves dentin surface without smear layer (un-like after bur preparation) The lack of smear layer al-lows the formation of hybrid layer and resin tag hy-bridization into the opened dentin tubules resultingin a better retention of the adhesive composites. Ad-ditionally some studies showed an enlargement ofdentin tubules.17

The irradiated enamel at SEM have the character-istic appearance of a lava flow.18,19 This appearance isdue to the complete opening of the prism core with apartial ablation of the interprismatic structure. The ir-regular aspect of the peripheral enamel is due to thefragility of the hexagonal form of the prisms thatlooks “ready to break”. The irregularity of the enamelsurface after Er:YAG laser irradiation can be compen-sated with the application of phosphoric acid that at-tacks and regularize the previously opened prisms; bythis way the enamel surface increases the micro-in-filtration of the bonding. It is important to rememberthat using an adhesive system after laser preparationof the tooth, the enamel surface prepared by lasershould be follow by acid etching to allow less mi-croleakage at the interface enamel-composite, how-ever, this has no influence regarding bond strengthand/or shear bond strength values.20,21

The conclusion of this clinical experience is thatthe Er:YAG laser is a valid option in the removal of den-tal caries respecting the concepts of minimally inva-sive dentistry.

Editorial note: The literature list can be requestedfrom the editorial office.

16 I laser4_2010

Fig. 11 Fig. 12 Fig. 13

Prof Umberto RomeoUniversity of Rome “La Sapienza”Department of Oral Science Via Caserta, 6 00162 Rome, ItalyE-mail: umberto.romeo@uniroma1.it

_contact laser

Projekt7_Anzeigen Stand DIN A4 10.09.10 12:29 Seite 1

I case report _ clinical orthodontics

CASE 1

Fig. 1_Large midline diastema with

thick frenum.

Fig. 2_Orthodontic closure

of diastema.

Fig. 3_High labial frenum.

Fig. 4_Diode laser frenectomy.

Fig. 5_Healed site after 7 days.

_Dentistry has changedexponentially, osseoin-tegration, dental bonding & kinetic energy toothprepration are current clinical buzzwords. The arenaof Dental Esthetics has expanded to cover morethan just simply restoring compromised teeth, butinvolves revamping smiles in entirety. Soft tissueharmonization have become paramount to overalldevelopment of Dentofacial Esthetics.

Unique versatility and vast potential of dentallasers allows many procedures that enhance over-all treatment success. Lasers have become an in-dispensable clinical tool in Orthodontist’s arma-mentarium.1 Diode lasers allow safe fast efficientincisions with better field of visibility as there isminimal bleeding, and above that patient per-

ceives a pressure less cut which often requires nosuturing.2 This article will present clinical case re-ports where diode laser* has been used for benefitof orthodontic patients.

_Case report 1

Frenectomy for midline diastema correctionLabial thick & high attached frenum is com-

monly regarded as contributing etiology for main-taining midline diastema.3 It is an accepted con-temporary view that midline diastema first shouldbe corrected with Orthodontics and then frenec-tomy so that scarring that results after conven-tional scalpel based frenectomy doesn’t interferewith tooth movement.4 With diode laser the proce-

Diode laser (810 nm) applications in clinical OrthodonticsAuthors_Dr Deepak Rai & Dr Gurkeerat Singh, India

18 I laser4_2010

Fig. 4 Fig. 5

Fig. 2

Fig. 3

Fig. 1

case report _ clinical orthodontics I

dure can be done before complete closure or afteras healing of laser wound doesn’t involve any scarring.5 The following patient had large diastema(Fig. 1) and was treated with fixed appliances to first close the diastema (Fig. 2) followed by frenec-tomy (Figs. 3 & 4). The healing was uneventful (Fig. 5).

_Case report 2

Canine exposure in labial sulcusLabially erupting canines are common maloc-

clusion (Fig. 6).6,7 Conventional exposure withscalpel based method leads to extensive bleeding

(Fig. 7) and the field of operation requires specialhydrophilic moisture insensitive primers to bondorthodontic attachments. Use of diode laser810 nm ensures easy exposure with minimal bleed-ing and least patient discomfort (Figs. 8, 9 & 10).The clear bloodless field ensures fast predictablebonding (Fig. 11), thus enabling fast correction ofmalocclusion (Fig. 12).

_Case report 3

Canine exposure on palatal aspect.Palatally impacted canines8 are difficult situa-

tion requiring surgical raising of an extensive mu-

CASE 2

Fig. 6_Labially erupting 43.

Fig. 7_Conventional scalpel surgery.

Fig. 8_AMD Picasso diode laser*

2.3 W, rep mode.

Fig. 9_Diode laser bloodless

incision.

Fig. 10_Exposed 23.

Fig. 11_Orthodontic attachment

bonded in dry field.

Fig. 12_23 Orthodontically extruded.

CASE 3

Fig. 13_Palatal 23 exposure.

I 19laser4_2010

Fig. 6 Fig. 8

Fig. 9 Fig. 10 Fig. 11

Fig. 12 Fig. 13 Fig. 14

Fig. 15 Fig. 16 Fig. 17

Fig. 7

I case report _ clinical orthodontics

Fig. 14_Orthodontic attachment for

alignment.

CASE 4

Fig. 15_Gingival hyperplasia during

orthodontic treatment.

Fig. 16_Diode laser assisted

gingivoplasty.

Fig. 17_Healed site.

CASE 5

Fig. 18_Palatal gingival hyperplasia

with lingual appliance.

coperiosteal flap, with sutures at the end and an ex-tensive postoperative discomfort and swelling.

Diode laser allows exposure without any extensiveflap (Fig. 13) and generally no sutures are required af-ter the procedure. Patient experiences minimal painor discomfort. Bloodless field ensures instant bond-ing of orthodontic attachment (Fig. 14).

_Case report 4

GingivoplastyOrthodontic fixed appliances are generally associ-

ated with issues of good oral hygiene maintenance.9

In many cases we notice gingival hyperplasia (Fig. 15).Such enlargement further impedes good hygiene andis commonly associated with bleeding.10,11 Diode lasercan be used effectively in such situations (Figs. 16 &17).

_Case report 5

Palatal gingival hyperplasia Lingual Orthodontic appliances are generally as-

sociated with gingival hyperplasia, preventing usfrom the access to gingival hooks to engage elas-tomeric attachments (Fig. 18).It is difficult to sculptgingiva around lingual braces with scalpel due to poor

20 I laser4_2010

Fig. 20Fig. 21

Fig. 18

Fig. 28

Fig. 26

Fig. 27

Fig. 24

Fig. 22 Fig. 23

Fig. 25

Fig. 19

case report _ clinical orthodontics I

access and poor visibility. Even electrocautery wouldnot be indicated due to chance of sparking on contactwith metal braces.12 Diode Laser (2W Repetitivemode) allowed us to sculpt the hyperplastic gingivaeasily without any bleeding or discomfort allowingeasy access to engage elastic attachments (Fig. 19).

_Case report 6

Diode laser assisted removal of odontome in maxil-lary anterior region preventing eruption of perma-nent incisor

Patient was a 10 year old girl with unerupted cen-tral incisor (Fig. 20). Radiovisiographic evaluationsuggested mesiodens (Fig. 21). Diode laser was used

to give primary incision and simultaneous frenec-tomy at 2W repetitive mode, followed by 2.3W con-tinous mode, ensuring bloodless field of operation(Fig. 22).The tooth like mass was removed (Fig. 23) andorthodontic eruption appliance was bonded (Fig.24).Histologic examination revealed it to be an odon-tome (Fig. 25).13,14 The tooth erupted in few monthswith orthodontic active guidance (Fig. 26).

_Case report 7

Laser assisted circumferential supracrestal fibro-tomy/ LACSF / pericision

Control of tooth rotation correction in Ortho-dontics from relapse is always a challenge. Perma-

Fig. 19_After diode laser gingivo-

plasty.

CASE 6

Fig. 20_Unerupted incisor with high

frenum in 10 year old girl.

Fig. 21_RVG image showing tooth

like mass.

Fig. 22_DIODE 810 nm assisted

incision.

Fig. 23_Extraction of tooth like mass

and orthodontic attachment bonded.

Fig. 24_Post extraction RVG.

Fig. 25_Histological section:

compound composite odontome.

Fig. 29 Fig. 30 Fig. 31

DHJ

1/10

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I case report _ clinical orthodontics

Fig. 26_Erupted tooth.

CASE 7

Fig. 27_Laser assisted circumferen-

tial supracrestal fibrotomy.

CASE 8

Fig. 28_Orthodontic microimplant for

anchorage.

Fig. 29_Inflammation around

microimplant.

Fig. 30_Decontamination and

biomodulation with laser at low

power.

Fig. 31_ Corrected malocclusion

with healed site.

CASE 9

Fig. 32_Severe deep bite, class II

DIV 2, missing upper 12,22.

Fig. 33_extensive mucogingival

destruction.

Fig. 34_After preliminary scaling.

Fig. 35_Laser assisted

vestibuloplasty.

Fig. 36_Lingual appliance to

consolidate spaces.

Fig. 37_Improved gingival

attachments.

nent lingual bonded retention is essential. It is alsosuggested to do circumferential supracrestal fibro-tomy to allow elastic fibres to reorganize favorablywithout causing relapse of correction.15,16,17 Conven-tional scalpel assisted CSF is associated with bleedingand requires infiltration anaesthesia .The authors aretrying diode laser at different settings of power & arecurrently evaluating success of this laser assisted cir-cumferential supracrestal fibrotomy (LACSF) (Fig. 27).

_Case report 8

Diode laser assisted salvaging of orthodontic mi-croimplant

Extensive work is being done on use of lasers in sal-vaging osseointegrated dental implants.18 We triedusing diode laser for orthodontic microimplantwhich is used for short term. The patient received twoorthodontic microimplants for retraction (Fig. 28),the one on left side was rigid but showed some in-flammation of tissue around the implant (Fig. 29).Diode laser was used at 0.5 W to decontaminate andallow healing of tissue around microimplant. The im-plant survived and served its orthodontic purpose(Figs. 30 & 31).

_Case report 9

Vestibuloplasty in patient with mucogingival prob-lem before undergoing Lingual Orthodontics

The patient had severe deep bite, associated withextensive mucogingival damage, with poor oral hy-giene19 (Figs. 32 & 33). After initial scaling and rootplanning (Fig. 34), Diode laser was used to perform

vestibular extension (Fig. 35). Lingual appliances werebonded and spaces were consolidated with good oralhygiene maintenance (Figs. 36 & 37). Diode laser canalso be used as low level therapy during orthodontictooth movement20 and especially during situationwhere heavy orthopedic forces are applied as in rapidmaxillary expansion.This is an area where the authorsare guiding a postgraduate research project in theirdepartment.

The incorporation of lasers in routine orthodonticpractice is the order of the day. The practices that em-brace this technology will surely flourish and will havesatisfaction of providing best dental care to there pa-tients.

*AMD LASERS TM, LLC, www.amdlasers.com

22 I laser4_2010

Fig. 36 Fig. 37Fig. 35

Dr Deepak RaiMDS (Orthodontics)Diploma Dental Lasers (Vienna)Pursuing Masters in Laser Dentistry (SOLA, Vienna)Associate Professor.Dept. of OrthodonticsSRCDSR, Faridabad, IndiaE-mail: raidentalcare@gmail.com

Dr Gurkeerat SinghProfessor and Head of Dept. of OrthodonticsSRCDSR, Faridabad, India

_contact laser

Fig. 32 Fig. 33 Fig. 34

Master of Science (M.Sc.) in Lasers in Dentistry

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AALZ_A4.pdf 07.10.2010 14:56:33 Uhr

I user report _ restorative dentistry

_The Er,Cr:YSGG laser has an active medium ofyttrium-scandium-gallium-garnet doped with er-bium and chromium ions and emits free-runningpulsed laser energy at a wavelength of 2,780 nm. theEr:YAG laser has an active medium of yttrium-alu-minium-garnet doped with erbium ions and emitsfree-running pulsed laser energy at a wavelength of2,940 nm. These wavelengths have a high absorptionin water, which makes their application appropriatewhen ablating oral soft tissue or dental hard tissue.This article examines the principles of use for theEr:YAG and Er,Cr:YSGG lasers in clinical restorativedentistry and reviews the literature regarding differ-ent aspects of the use of laser energy on hard tissues.

_Introduction

In 1989, Keller and Hibst illustrated the potentialof the Er:YAG laser (2.94 µm wavelength) for the ef-fective ablation of dental hard tissues.1 As a resultthere was new development and marketing of free-running, mid-infra-red wavelength lasers during the

1990’s. These advantages permitted to address laserwavelengths that were complementary to target tis-sue elements, allowing clinically-significant ablationrates that did not cause pulpal or collateral thermalinjury using proper energy levels. The erbiumchromium YSGG (2,780 nm) and the erbium YAG(2,940 nm) laser wavelengths are well absorbed bywater and hydroxyapatite contained at differentcomponent rates in hard tissue and appeared to of-fer safe use in cavity preparation.2–4 The vaporizationof interstitial water provided by the Er,Cr:YSGG andEr:YAG lasers results in an explosive dislocation oftarget hard tissue. These laser wavelengths offer sev-eral advantages for restorative dentistry, includingprecision, selective ablation of target hard tissue andcarious lesions, less conductive thermal stimulationof the pulp, reduced collateral damage that might re-sult from rotary instrumentation (such as tactile andthermal damage), and so forth.

This article examines the principles for using theEr,Cr:YSGG and Er:YAG lasers in clinical restorative

24 I laser4_2010

Use of the Er,Cr:YSGG and Er:YAG lasers in restorative dentistry Authors_Prof Dr Giuseppe Iaria, Rolando Crippa, Giovanni Olivi, Matteo Iaria, Stefano Benedicenti, Italy

Fig. 1 Fig. 2

user report _ restorative dentistry I

dentistry and reviews the literature concerning dif-ferent aspects of laser energy on hard tissues.

_Basic considerations

Using a laser requires delivering light energy ofsufficient value to effect tissue change without caus-ing unwanted collateral thermal damage by con-ducting excess heat into the surrounding tissues.5 Todo this it is essential to establish a rate of interactionthat is commensurate with a time frame that allowssuch interaction to be clinically acceptable in termsof total time required for each procedure.

The rate and the speed of dental hard tissue abla-tion depends on the appropriate laser energy, in ad-dition to the wavelength, pulse duration, pulse shape,repetition rate, power density, thermal relaxationtime of the tissue, and delivery mode.6-8

The speed of ablation is also affected by the fluor-idation of the tissue, the presence of ablation prod-ucts and the incident angle of the delivery tip relativeto the tooth: placing the delivery tip parallel to theaxis of the enamel prisms, in order to access the in-terprismatic, higher-water content structure max-imises the speed of ablation. Ablation is more effi-cient and heat transfer is minimized when the pulsewidth is reduced and peak power values rise.9-11 In ad-dition the use of sharp curettes to remove grosscaries can reduce laser use to an acceptable time-frame. The depth of laser ablation depends on the pa-rameters utilized, principally on the energy used perpulse and the number of pulses delivered. To avoidand prevent cracks or structural modifications, thetip (where present) must not touch the surface, nor

should excessive energy be applied. When relativelyhigh fluences are involved, it is possible that the laserlight is absorbed by the mineral, which results in ab-lation and/or disruption of the mineral with somestructural modification.12-14 Many conflicting factorsinterfere with the recommended power value forlaser-assisted ablation of dental hard tissue .The ab-lation threshold of human enamel has been reportedto be in the range of 12–20 Joules/cm2 and for dentin,8–14 Joules/cm2 for the Er:YAG and Er,Cr:YSGG laserwavelengths. For an average laser delivery spot-size,using a free-running pulsed emission mode, this mayequate to approximately 150–250 mJ/pulse.

It is recommended that the clinician follow man-ufacturer’s guidelines in establishing laser treatmentprotocols for a given laser, keeping in mind the dif-fering operating parameters of air/water/spot sizeand any power losses that may occur within differingdelivery systems.

_Use of co-axial water spray

The use of water spray with mid-infrared lasers al-lows working on hard tissues with thermal increasesof less than 5 °C: it is essential to prevent debris fromaccumulating at the bottom of the cavity, which canlead to conductive heat damage.15-16

The effects of excessive incident power, the build-up of ablation products, which cause thermal dam-age to the target and surrounding tissue and the re-moval of such products by means of a co-axial waterspray have been discussed in the literature.17-21 Theaffinity of mid-infrared laser wavelengths with wa-ter contained in the tissue allows for selective ablation,

I 25laser4_2010

Fig. 4 Fig. 5

Fig. 3 Fig. 6 Fig. 7

I user report _ restorative dentistry

in which greater absorption takes place in deminer-alised tissue, which is richer in organic material and hasa higher percentage of water. This absorption offerssome protection to the sound underlying tissue whilereducing penetration from the beam. To prevent build-up, ablation products should be removed by means ofa co-axial water spray. If water spray is not used, laserlight is then absorbed by the mineral and the hydro -xyapatite crystal themselves may be heated above theirmelting point.

In consequence, either some disruption of the crys-tal structure occurs with subsequent resolidification ina different form, or direct ablation of the mineral occurs,but there also is conductive heat transfer to interstitialfree water. Relatively high fluences are needed at thesewavelengths for this transfer of heat to occur. A micro-cavitated surface that may enhance retention of com-posite resin can be achieved by using Er,Cr:YSGG orEr:YAG lasers to irradiate enamel and dentin but waterspray must be utilized. Conversely, the absence of waterspray can lead to cracks in enamel or melted dentin, re-sulting in unsubstained enamel prisms and flat adhe-sion dentin surfaces with closed tubules. The negativeeffects could lead to marginal leakage and non-adhe-sion of the composite material.

_Exceptions to using water spray

There are two clinical situations which can be treatedwith lasers without the simultaneous use of a co-axialwater spray: the desensitizing technique and the pulpcapping. The desensitizing technique must be donewithout water and without the laser tip making directcontact with the tooth. In addition the laser should beused for a short time only and with low power (few pps,very long releasing time, few mJ). For the pulp cappingthe technique must be carried out without water butwith air cooling and the tip must touch the surface foronly a few seconds.

_Cavity margin considerations

A succession of studies has identified the fragility oflaser-irradiated enamel, relative to the stability of thepost-restoration margins. Studies have proposed a

combined approach of combined laser-irradiation,acid-etch techniques, to overcome such potential prob-lems. It may be necessary to remove grossly overhang-ing and unsupported enamel with a rotary bur, scalpelsor an ultrasonic device either to expedite cavity prepa-ration or provide a stable post-restoration margin.22-27

_Acid-etch considerations

Er:YAG laser irradiation produces a surface visuallysimilar to an acid-etch pattern but without a smearlayer. While the surface produced by the Er:YAG laser issimilar to the conventionally prepared, etched enamelsurface, it still requires acid etching to obtain an equiv-alent bond strength. The use of acid etching for enameland dentin surface modification is must be carried outeach time before bonding application. Laser irradiationof enamel is not a valid alternative to acid-etching pre-treatment for resin composite materials adhesion. As aresult, Er,Cr:YSGG and Er,YAG irradiation alone cannotbe recommended as a viable alternative to acid etch-ing.28, 29

_Avoidance of dehydration

Before bonding application the dentin surface mustnot be dehydrated: the use of lasers without water—mist before composite restorations is no longer recom-mended. Laser ablation does not produce a smear layer,which would impede adhesion to laser-irradiated sur-faces. Nevertheless, a selective ablation of organic tis-sue occurs when these lasers are uses; as a result, thereis less collagen left to be exposed or hybridised after laserconditioning of dentin, indicating that acid-etching andwater spray after laser treatment is advisable.30, 31

_Choice of composite restorative materials

The choice of composite materials must be made onthe basis of the depth and width of dentin craters. Thelaser irradiation of enamel and dentin by Er,Cr:YSGG orEr:YAG lasers results in a “super-rough”, micro-cavi-tated surface that may predispose to ideal retention ofcomposite resin but it is necessary to remember this dif-ference from laser to bur in the choice of materials. The

26 I laser4_2010

Fig. 9 Fig. 10Fig. 8

user report _ restorative dentistry I

use of composite nano or micro-filled is fundamental toproperly restore laser ablated cavities. Whenever possi-ble, it is advisable to first use a layer of flowable com-posite. The seal at enamel margins in Er,Cr:YSGG andEr:YAG lased cavities depends on the resin compositeformulation of the corresponding adhesive.32, 33

_Isolation and safety considerations

A rubber dam isolation technique must be used inevery procedure to maintain decontamination providedby the laser. Safety measures should include the use ofspecific protection glasses for the doctor, the assistantand patient, the use of appropriate face-masks to avoidplume aspiration, high-speed aspiration of plume anddebris. In addition the dentist must use non-reflectinginstruments. Magnification is recommended to allowthe dentist better control of his or her work.

_Summary

The Er,Cr:YSGG laser has an active medium of yt-trium-scandium-gallium-garnet doped with erbiumand chromium ions and emits free-running pulsed laserenergy at a wavelength of 2,780nm. The Er:YAG laserhas an active medium of yttrium-aluminium-garnetdoped with erbium ions and emits free-running pulsedlaser energy at a wavelength of 2,940 nm. These wave-lengths have a high absorption in water, which makestheir application appropriate when ablating oral softtissue as well as dental hard tissue. Advantages of usingthese laser wavelengths in restorative dentistry includeprecision, selective ablation of target hard tissue andcarious lesions, reduced collateral damage that mightbe caused by rotary instrumentation (tactile and ther-mal damage), less conductive thermal stimulation of

the pulp, no vibrations, and so forth. However, it is es-sential to apply knowledge and accepted laser settingsand modes of application and also to follow the clinicalaspects and rules to obtain the best results. Using theselasers and co-axial water spray simultaneously is alwaysadvisable, with the two clinical exceptions of the desen-sitising technique and pulp capping. Other main pointsto consider are the cavity margins that need to be fin-ished, the use of acid after laser treatment that permitsthe best adhesion, and the choice of composite materi-als, which must be based on the surfaces produced bythe laser treatment. Specific safety is necessary whenusing these devices._

_References

1. Keller U, Hibst R. Ablative effect of an Er:YAG laser on enamel anddentin. Dtsch Zahnarztl Z.1989 Aug;44(8):600–2.

2. Pelagalli J, Gimbel CB, Hansen RT, Swett A, Winn DW. 2nd Inves-tigational study of the use of Er:YAG laser versus dental drill forcaries removal and cavity preparation—phase I. J Clin LaserMed Surg. 1997;15(3):109–15.

Editorial note: The whole literature list can be re-quested from the author.

I 27laser4_2010

Prof Dr Giuseppe IariaUniversity of Genoa, Italy

Via S. Eustaccio, 1925128 Brescia, ItalyE-mail: iariagiuseppe@virgilio.it

_contact laser

Fig. 11 Fig. 12 Fig. 13

Fig. 14 Fig. 15 Fig. 16

I user report _ periodontal treatment

_There are some dentists that em-brace technology. Technology can im-prove the delivery of dentistry and alsohelp traditional dental philosophiesevolve. For example, a patient presentswith an emergency; a broken cusp onan upper bicuspid, bellow the free gin-gival margin. Technology, lasers andCAD/CAM specifically, allows the clini-cian to provide endodontics, osseouscrown lengthening, an adhesive corebuild up and a definitive porcelain

restoration all in a single appointment.

The advantages to this type of treatment are ob-vious. However, the dentist must be willing to alterhis/her current dental philosophy and many timesmake an initial financial investment that is largerthan what the clinician is used to. The traditional wayto provide treatment such as endodontics in 1–2 vis-its, a post and core, an elastomeric impression, pro-visional restoration, referral to a specialist, surgicalhealing time and then definitive cementation of therestoration currently is a valid and overwhelminglyused treatment sequence. Sometimes, however,newer technology can perform these tasks just aswell if not better then traditional methods all the

while improving the dental experience for the pa-tient. Lasers have been used in dentistry for the re-moval of soft tissue for more than two decades. Car-bon dioxide, Nd:YAG, and Diode lasers have been verypredictable and successful for the removal of oralsoft tissue. In the last decade, the erbium lasers havebeen used for soft tissue and for restorative, en-dodontic, and surgical procedures. Erbium lasers areefficient in removing enamel, dentin and bone. How-ever, the last five years have seen a tremendous pushby the laser manufacturers for the lowest cost andmost portable diode lasers. Due to their more ap-proachable price point, and an increasing number ofU.S. jurisdictions allowing hygienists to use thesetools, the diode lasers have had sort of a renaissance.

One of the most impacted areas of laser use in ageneral practice has been in the area of periodontaltreatment. The treatment of periodontal disease isoften a difficult arena for the general dentist to en-ter. As a chronic disease that so often relies on thehost response for success, true treatment success isoften never seen. Often times the general dentistchooses not to treat periodontal disease, referringpatients to a specialist. As will be shown in subse-quent paragraphs, this modality many times resultsin the patients never getting treated at all. Lasershave allowed me to treat many different periodontalcases. It has introduced patients to periodontaltreatment in a minimally invasive way ensuring thatalmost all patients diagnosed with periodontal dis-ease get treatment. Lasers have allowed me to in-crease the services that I provide in my practice byadding periodontal procedures that would have notbeen done before the integration of laser technology.Finally, introducing more and more patients to peri-odontal treatment has increased my referrals to periodontal specialists.

The use of lasers in periodontal treatmentAuthor_Howard Golan, USA

28 I laser4_2010

Fig. 2a Fig. 2b

Fig. 1

user report _ periodontal treatment I

_The controversy:Science vs. Clinical results

I have always been an advocate of evidenced baseddentistry. I rely on the results of science more thanever before. From endodontics to adhesive dentistryscientific evidence is important in formulating mytreatment decisions and protocols. Periodontal dis-ease has and continues to be researched heavily. Eachyear the systemic impact of periodontal disease is being uncovered and understood each day. The peri-odontal community aims to base its treatment deci-sions on the science. However, there is no absolutecure for periodontal disease. It is a complicated oftenchronic multi-factorial disease process. Bacteria arejust one factor. However, one must also look at patientcompliance, environmental factors including the pa-tient’s restorative history, and systemic issues. Thus, itis essential that clinicians in evaluating and treatmentplanning a patient for periodontal disease look at awide spectrum of factors, many of which might con-flict with the scientific literature. Lasers have beencontroversial because of the claims of the manufac-turers that are not solidly backed up by science. Thereis no question that the lack of multi-center, doubleblind, and randomized trials inhibits the ability oflasers to gain widespread acceptance in the peri-odontal community. However, many times each andevery day practitioners, general and specialists alike,practice dentistry based on anecdotal evidence. Rely-ing on their own successes and failures to treat theirpatients. If we as clinicians only practice what andhow science tells us to practice then we are manytimes doing a disservice to the patient. Dentistry isboth a science and an art and the individual judgmentof the clinician is often as important as a published re-search article. Thus, we can use lasers and the sciencethat it available. As just one battalion in a large armyagainst the fight against periodontal disease. Lasersprovide advantages that traditional therapies do not.When used properly, laser therapy is a big weapon inthis fight.

_What do lasers have to offer?

Lasers (Light Amplification by Stimulated Emis-sion of Radiation) use light energy to have a clinical

effect of oral tissue. This light energy can be convertedto heat and that heat is used to remove tissue and de-stroy bacteria. However heat can have negative ef-fects on tissue. Hard tissue burning or melting andpossible soft tissue necrosis must be avoided or atleast minimized. Other lasers use the potential energyof light and convert it to kinetic energy with anothersubstance (e.g. water) to remove or ablate tissue. Thisallows the effective and efficient removal of infectedepithelium and granulation tissue without thenecrotic effects of heat. This provides less post-oper-ative issues such as swelling and pain. Lasers are alsoeffective in removing hard tissue including bone andcalculus. In fact the U.S. Food and Drug Administra-tion has approved a laser for calculus removal. Fur-thermore, because of the ability to collimate and bendlight, lasers can access areas such as furcation androot anatomy that even surgical access with curettesand ultrasonics could not. Thus many procedures thatwere once absolute surgical cases can be treated non-surgically. The treatment of periodontal disease re-quires the proliferation of some cells while excludingother cells. To get re-attachment and regeneration,epithelial cells need to stay away from the healing sitewhile fibroblasts and odontoblasts should be encour-aged to enter. Lasers have the ability to assist in bothareas.

For exclusion, lasers can de-epithelialize the area,by removing the epithelium to the connective tissue,both on the internal pocket wall and the externalpocket wall. The fast growing epithelium is retardedto allow the slower moving fibroblasts and os-

I 29laser4_2010

Fig. 3

Fig. 4a Fig. 4b Fig. 5a

I user report _ periodontal treatment

teoblasts to do their work. Forproliferation and migration,lasers when introduced to the oraltissue at power levels too low tocut, have actually been shown toincrease the proliferation and mi-gration of the osteoblasts and fi-broblasts. This is called photo-biomoduation or low-level lasertherapy (LLLT). The use of LLLT isever expanding in medicine anddentistry. In dentistry, LLLT is used

for pain relief, such as TMD and wound healing and tocontrol inflammation, which is essential for the suc-cessful treatment of periodontal disease. Finally, theLLLT allows patients to heal from laser proceduresfaster and with fewer incidents by supporting thewound healing response and suppressing the inflam-matory response.

_Laser assisted periodontal therapy:Clinical situations

Treat General/Refer SpecificOne of the biggest challenges in a general practice

is getting patients to actually go to a periodontistonce referred. Patients are consistently referred butmany times but never follow through. If their condi-tion goes untreated it affects their health, their mouthand does not allow me to go forward with other treat-ment such as prosthetics. Patients are more likely tofollow through with treatment when it can be all ac-complished within the general office. Often peri-odontal disease is not acutely painful and thus pa-tients will prolong the treatment until there is anacute problem. A less expressed but as significant of areason for patient’s not to the specialist is fear. Peri-odontal surgery does not have a great reputation. Ir-respective of the ability of the clinician. Patients hearstories of pain, swelling, bleeding and sensitivity. Thelast thing clinician’s want are patients not going hav-ing treatment because of fear. However, when sent tospecialists for specific procedures on a finite numberof periodontal sites, the patient is more likely to seektreatment. Specifically, we have seen that a patientthat is referred for the treatment of tooth #14 (max-illary left first molar) does not hesitate to go for treat-

ment compared to a patient that is sent to that verysame referral for the upper left quadrant.

Therefore, our philosophy is to treat as much ofthe disease process in the general practice non-sur-gically, then upon re-evaluation send only the non-responsive areas to the periodontal specialist for sur-gical intervention. Introducing a laser into the non-surgical equation provides the patient with a mini-mally invasive non-surgical option. The laserprovides something different, something new thatmost patients are not familiar with. Scaling thereforeis not the primary therapy but an adjunct to lasertherapy. Thus, the patient realizes that surgery willonly be done after all non-surgical options are ex-hausted and that those treatments will not be painfuland there is no reason to fear “gum” treatment. Whensurgical intervention is recommended, the patientunderstands the efforts made and that surgery mustbe accomplished in a localized area, minimizing thepotential uncomfortable post-operative conse-quences. With this philosophy, we have seen a three-fold increase in the number of patients referred to theperiodontist that actually have the treatment com-pleted within a reasonable time of referral. This iscompared to referrals before lasers were introducedinto the practice.

Site Specific Treatment —he recall patientWhen a minimally invasive procedure is available

to patients, it takes much less effort to educate a pa-tient and get the patient to accept treatment. Whena laser is placed inside the hygiene treatment room,a recall patient with an isolated periodontal pocketcan be treated at the time of recall. In many jurisdic-tions in the United States, hygienists can use lasersfor periodontal treatment. This allows the dentist todiagnose the condition on examination, instruct thehygienist what to do and leave the room and returnto treating his own patients. Thus, a patient can notonly have their cleaning and checkup but also takecare of a dental issue without having to return untilthe next recall. Even in those States that do not allowa hygienist to use a laser (such as the author’s) thelaser in the hygiene room still allows for this but thedentist does the treatment with the laser. Moreover,site-specific treatment adds a new dimension to thetreatment spectrum. Instead of just a scaling androot planing procedure, the dentist can perform, andthus bill a profitable and more definitive treatmentwith a laser. Figs. 1 & 2 illustrate a patient on a recallvisit that exhibited a 5 mm pocket on the mesial ofmaxillary left first molar. Laser assisted site specifictreatment was performed in the hygiene room witha Er, Cr:YSGG laser (Waterlase MD, Biolase Technol-ogy, Irvine, CA) and a 940 diode laser (EZlase, BiolaseTechnology). The perio charting shows initial and 3 and 6 mos recall probing depths.

30 I laser4_2010

Fig. 6a Fig. 6b

Fig. 5b

user report _ periodontal treatment I

I 31laser4_2010

Management of the hopeless periodontal patientMany times a patient presents to the office with the

following history: Patient has a history of periodontaldisease with significant bone loss and periodontal pock-eting. The patient had four quadrants of periodontalsurgery to treat this condition many years ago. Upon ex-amination, the periodontal pocketing is still present orhas returned and the clinician recommends periodon-tal surgery again. However, the patient tells you thathe/she will “never go through that again.” The patienthad a bad experience with surgical intervention will notentertain the idea of referral to a periodontist. Thus, thepast never has the treatment recommended. Further-more, there are patients where through everyone’s bestefforts the treatment is never successful. These patientsare referred to as “refractory” cases. These patients areparticularly difficult since they have spent much moneyand time and do not see results. Many times they needsignificant extractions and implants, but at the presenttime refuse this treatment due to financial or emotionalobstacles. Every dental practice has these patients. Lasertherapy provides an opportunity to manage, stabilize ortreat these patients at reasonable cost and minimal in-tervention compared to surgical therapy or extractions.Refractory cases will not be “cured” with laser therapybut if we can stabilize the disease process then we pro-vide an invaluable service to the patient. Laser treatmentmight occur every recall visit or with increased fre-quency depending on the extent of the disease process.Often we can maintain a patient with his or her ownteeth longer than originally thought. This is an area oflaser dentistry that was unexpected but has become oneof the most rewarding. The figures bellow illustrates atypical hopeless case. Patient is 48 with a long history ofperiodontal treatment including numerous SC/RP visitsand surgery. Patient’s hopeless maxillary anterior wasrestored with implants. The lower arch was treated withlaser therapy and scaling. Though there is no evidenceof regeneration, the change in the marginal bone is ev-ident three years later. This patient is now five years posttreatment with stable periodontal tissues (Figs. 3 & 4).Patient is compliant with 3 mos recall.

Prosthetic replacement: Marriage of technologiesPatients with crown and bridge often present with

periodontal pocketing and inflammation. Often, theprosthetics either invades biologic width or the crowns

are under-contoured bellow the gingi-val margin. Treatment of this situationwould include replacement of thecrowns and treatment of the soft tis-sue. If there is biologic width invasionthen a crown lengthening procedure isneeded to adjust the height of the alve-olar bone. This condition is oftencaused by the fundamental need ofmechanical retention of the crowns.Due to caries, fracture and short clinical crown heights,the crown preparation needs to be placed significantlyunder the free gingival margin in order for the crown tostay on. Technological advances in ceramics and adhe-sion allow for posterior restorations to be adhesivelybonded to the tooth allowing for equi- and supra-gin-gival restorations. These restorations coupled with lasertherapy can resolve a periodontal pocket within weekswithout surgery and more trauma to the root surfaces.If biological with correction is needed, then the use of alaser to incise the attachment and remove the bone canoften be accomplished without flap reflection. This min-imizes post-operative pain, swelling and leads to morepatient acceptance and profitable treatment for thedental practice. Figs. 4–9 illustrate pocketing and in-flammation associated with crowns on the maxillaryleft first and second molars. The crowns were removedand laser assisted periodontal debridement and curet-tage was performed. Fig. 7 shows 14 day healing prior tocementation. Fig. 8 are the adhesively bonded ceramiccrowns (eMAX, Ivoclar Vivadent, Amherst, NY). Fig. 9shows the initial and 3 mos recall periodontal charting.

This article is designed to introduce the dental com-munity to lasers and their use in periodontal treatmentin a general dental practice. The use of lasers does noteliminate the need for surgery, and especially the won-derful work of periodontal specialists. However, when aphilosophy of minimally invasive treatment is em-ployed, then patient and dentist work together to helpthe patient accomplish their periodontal treatmentgoals. There will be an increase in periodontal treatmentplan acceptance and an increase in periodontal referralsthat actually result in treatment._

Editorial note: The literature list can be requestedfrom the editorial office.

Fig. 7 Fig. 8a

Howard GolanDDS, JD, MWCLI369 Old Courthouse RoadNew Hyde ParkNY 11040, USAE-mail: hsgolan@optonline.netWeb:www.enamelrules.com

_contact laser

Fig. 9

Fig. 8b

I user report _ photosensitizer

_Photodynamic therapy (PDT), also known asphotoradiation therapy, phototherapy, or pho-tochemotherapy, involves the use of a photoactivedye (photosensitizer) that is activated by exposureto light of a specific wavelength in the presence ofoxygen (Konopka et al.). The transfer of energy fromthe activated photosensitizer to available oxygenresults in the formation of toxic oxygen species,such as singlet oxygen and free radicals. These veryreactive chemical species can damage proteins,lipids, nucleic acids, and other cellular components.Depending on the type of agent, photosensitizersmay be injected intravenously, ingested orally, or ap-plied topically.

Although a number of different photo-sensitizing compounds such as methyleneblue, rose bengal, and acridine are known

to be efficient singlet oxygen generators(and therefore potential photodynamic

therapy agents), a large number of photosensitizers are cyclic

tetrapyrroles or structural deriv-atives of this chromophore; in

particular porphyrin, chlo-rin, bacteriochlorin, ex-

panded porphyrin, andphthalocyanine (PC’s)derivatives.

This is possibly be-cause cyclic tetra -pyrrolic derivativeshave an inherentsimilarity to the naturally occurringporphyrins present

in living matter con-

sequently they have little or no toxicity in the absenceof light (Leanne et al.).

Photosensitizers can be categorized by theirchemical structures and origins. In general, they canbe divided into three broad families:

_Porphyrin-based photosensitizer (e.g., Photofrin,ALA/PpIX, BPD-MA),

_Chlorophyllbased photosensitizer (e.g., chlorins,purpurins, bacteriochlorins), and

_Dye (e.g., phthalocyanine, naphthalocyanine)(Zheng Huan et al.).

_Photosensitizer families (Allison et al.)

_Porphyrin platform_HpD (hematoporphyrin derivative)_HpD-based_BPD (benzoporphyrin derivative)_ALA (5-aminolevulinic acid)_Texaphyrins

_Chlorophyll platform_Chlorins_Purpurins_Bacteriochlorins

_Dyes_Phtalocyanine_Naphthalocyanine.

_Generations of photosensitizers

Most of the currently approved clinical photosen-sitizers belong to the porphyrin family. Traditionally,the porphyrins and those photosensitizers developedin the 1970s and early 1980s are called first genera-tion photosensitizers (e.g., Photofrin). Photofrin® (di-

Photosensitizers in dentistryAuthors_Dr D. Koteeswaran, Dr C. Pravda and Dr Ekta Ingle, India

32 I laser4_2010

user report _ photosensitizer I

hematoporphyrin ether), available for 30 years in itscommercial form, and hematoporphyrin derivatives(HPDs) are referred to as first-generation sensitizers.Photofrin® is the most extensively studied and clini-cally used photosensitizer.

Porphyrin derivatives or synthetics made since thelate 1980s are called second generation photosensi-tizer (e.g., ALA). Second-generation photosensitizersinclude 5-aminolevulinic acid (ALA), benzoporphyrinderivative (BPD), lutetium texaphyrin, temoporfin(mTHPC), tinethyletiopurpurin (SnET2), and tala-porfin sodium (LS11). Foscan® (mTHPC), the most po-tent second-generation photosensitizer, has been re-ported to be 100 times more active than Photofrin® inanimal studies. These photosensitizers have a greatercapability to generate singlet oxygen; however, theycan cause significant pain during therapy, and, be-cause of their high activity, even dim light (60 Wattbulb) can lead to severe skin photosensitivity(Dougherty et al.).

The third agent, ALA, is an intrinsic photosensitizerthat is converted in situ to a photosensitizer, proto-porphyrin IX. Topical ALA and its esters have been usedto treat pre-cancer conditions, and basal and squa-mous cell carcinoma of the skin.

Third generation photosensitizers generally referto the modifications such as biologic conjugates (e.g.,antibody conjugate, liposome conjugate) and built-inphoto quenching or bleaching capability. Third-gen-eration photosensitizers include currently availabledrugs that are modified by targeting with monoclonalantibodies. These terms are still being used althoughnot accepted unanimously and dividing photosensi-tizing drugs into such generations may be very con-fusing. In lot of cases, the claim that newer generationdrugs are better than older ones is unjustified. Thepremature conclusions on novel or investigationalphotosensitizers may send a misleading message toresearchers or clinicians by suggesting that the olderdrugs should be replaced by the newer ones orwrongly imply to patients that newer photosensitiz-ing drugs are superior to older ones.

Currently, only four photosensitizers are com-mercially available: Photofrin, ALA, VisudyneTM (BPD;Verteporfin), and Foscan. The first three have beenapproved by the FDA, while all four are in use in Eu-rope.

_Indications for photosensitizers

_ALA-based PDT for the treatment of oral pre-malig-nant lesions

_as an adjunctive in treatment of chronic periodon-titis and periimplantitis

_for disinfection of root canals in endodontic therapy_treatment of early head and neck carcinomas_palliative treatment for refractory head and neck

cancer_as an intra-operative adjuvant therapy, for recurrent

head and neck cancer.

_Bibliography

01. Ackroyd, Roger, Kelty, Clive, Brown, Nicola, Reed, Malcolm.History of photodetection and photodynamic therapy. Nov2001.

02. Allman R, Cowburn P, Mason M. Effect of photodynamic ther-apy in combination with ionizing radiation on human squa-mous cell carcinoma cell lines of the head and neck. BritishJournal of Cancer 2000; 83(5): 655–661.

03. Amy Forman Taub. Photodynamic therapy: Other uses. Der-matol Clin 2007; 25: 101–109.

04. Hain-Ming Chen, Chin-Tin Chen, Hsiang Yang. Successfultreatment of oral verrucous hyperplasia with topical 5-aminolevulinic acid-medicated photodynamic therapy. OralOncology 2004; 40: 630–637.

05. Hanna Gerber, Piotr, Kamil Jurszyszyn. Photodynamic therapyin the treatment of the oral leukoplakia – Preliminary report.Dent. Med. Probl 2004; 41 (2): 225–228.

06. Hsin-Ming Chen, Chuan-Hang Yu, Tsuimin Tsai. Topical 5-aminolevulinic acid-mediated photodynamic therapy for oralverrucous hyperplasia, oral leukoplakia and oral erythroleuko-plakia. Photodiagnosis and Photodynamic Therapy 2007; 4:44–52.

07. Konopka K, Goslinski T. Photodynamic therapy in dentistry. JDent Res 2007; 86(8).

08. Leanne B. Josefsen and Ross W. Boyle. Photodynamic Ther-apy and the Development of Metal-Based Photosensitisers.Metal-Based Drugs Volume 2008, 24 pages.

09. Ron R Allison, Gordon H Downie, Rosa Cuenca, Xin-Hua, CarterJH Childs, Claudio H Sibata. Photosensitizers in clinical PDT.Photodiagnosis and Photodynamic Therapy 2004; 1: 27–42.

10. Zheng Huang. A review of progress in clinical photodynamictherapy. Technol Cancer Res Treat 2005; 4(3): 283–293.

I 33laser4_2010

Dr D. Koteeswaran MDS, FICDDepartment of Oral Medicine and RadiologyMeenakshi Ammal Dental CollegeAlapakkam Main RoadMaduravoyalChennai 600095, IndiaTel.: +91 9840145918Fax: +91 44 23781631E-mail: drdkoti@yahoo.com

_contact laser

I meetings _ Annual Congress of DGL

_More than 250 participants visited the yearlycongress of the DGL, which was held together withthe 14th LASER START UP, a symposium specially or-ganized for new comers in the world of laser dentistry.Many dentists praised again this very nice concept ofsharing two congresses in laser dentistry at one loca-tion, which was this year the Palace Hotel in the heartof Berlin.

20 years DGL was the jubilee topic of this congress.Prof Dr Norbert Gutknecht, president of the DGL, re-

viewed with happiness the past 20 years of this sci-entific society, which is fully associated with the Ger-man Association of Dentistry—the main scientificdental society in Germany. Prof Gutknecht stated thatthe DGL in particular and laser dentistry in total arenow definitive accepted in general dentistry. He men-tioned further that in the future dental laser researchshould focus on the integration of laser light withother high-tech therapy methods like CAD/CAM.Gutknecht’s stated his credo: Laser therapy is a profitfor dentistry in general.

A very successful 20th

Annual Congress of theDGL in BerlinAuthors_Dr Georg Bach, Leon Vanweersch/Germany

34 I laser4_2010

meetings _ Annual Congress of DGL I

Gutknecht welcomed in his presidential openingspeech many invited national and internationalguests. Among these guests were Prof Joseph Ar -nabat (President of the Spanish Dental Laser Societyand Organizing Chairman of the WFLD World Con-gress 2012 in Barcelona), Prof Umberto Romeo (Or-ganizing Chairman of the European Division WFLDLaser Congress 2011 in Rome), Prof Carmen Todea(President of the Romanian Dental Laser Society) aswell as Prof Carlos de Paula Eduardo (a long-timeFriend of the DGL and Division President of the South-

American WFLD Division), and last but not least theHonorary President of the DGL, Prof Friedrich Lampert(University Aachen). The DGL President shared notonly his vision concerning the past but also concern-ing the future in his lecture about the future of laserdentistry. Gutknecht stated that there is still a longway to go, and new techniques but also new wave-lengths will improve the spectrum of indications inlaser dentistry and simplify many dental proceduresin daily dental therapy.

Many other well-known lecturers gave their state-ments of laser dentistry during the two days congressand here we can only mention some of them. Dr GeorgBach (Freiburg/Breisgau) declared the curious situa-tion that on the one side we have very valid and ex-cellent scientific results, on the other side the accept-ance within the universities and other scientific soci-eties is still very conservative and critical. Dr Bach ob-served also an improving number of laser dentists butby far not so fast as it could be. Bach sees the solutionin a systematic development of education in laserdentistry and a better cooperation between the DGLand the different other dental societies in Germany.

Interesting were the results from three differentlecturers in the field of laser supported endodontics.Dr Michael Hopp (Berlin), Prof Carmen Todea(Timisoara) and Dr Iris Brader, MSc (AALZ, UniversityAachen) were unanimous in their statement that theNd:YAG laser offers the best wavelength for bacterialreductions in the root canal. Especially Dr Iris Bradershowed with a success rate of 91 % successfullytreated cases an even better clinical result in her pri-vate dental clinic then in Gutknecht’s publicationfrom some years ago.

Two lectures in the field of peri-implantitis ther-apy with lasers showed the success story in this fieldagainst classical methods. Prof Dr Herbert Deppe(University Munich) showed the significant advan-tages of CO2 laser therapy against conventional ther-apy methods. Assoc-Prof Dr Sabine Sennhenn-Kirch-

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I meetings _ Annual Congress of DGL

ner (University Göttingen) presented success rateswith diode and Er:YAG laser therapy. The field of peri-implantitis therapy is already now the definite do-main of laser therapy.

Prof Carlos de Paula Eduardo (University SãoPaulo) showed again very convincing results out of hispreferred scientific research field in esthetic dentistry.Especially the fascinating pictures in his presentationwere highly appreciated by the auditorium.

Dr Rene Franzen (AALZ, University Aachen) pre-sented a basic lecture highlighting the importance ofunderstanding the absorption of diode lasers in softtissues. Dr Jörg Meister (AALZ, University Aachen)gave a lecture about the biophysical understanding oferbium lasers in dentistry. Andreas Querengässer(AALZ, University Aachen) presented interesting re-sults of laser activated rinsing solutions in the rootcanal with an Er,Cr:YSGG laser. Dr Thorsten Kuypers,MSc (AALZ, University Aachen) demonstrated thesuccessful combination of Er:YAG cavity preparationwith CAD/CAM manufactured crown inlays, Dr RalfBorchers, MSc (AALZ, University Aachen) compareddifferent diode laser settings in oral surgery, Dr PeterKleemann, MSc (AALZ, University Aachen) showedthe exiting possibilities of laser-supported orthodon-tics and Dr Peter Fahlstedt, MSc (AALZ, UniversityAachen) presented several clinical cases with differ-ent wavelengths.

A further absolute domain of laser dentistry is lasersupported pediatric dentistry. Dr Gabriele Schindler-Hultzsch, MSc (AALZ, University Aachen) showed herown Laserkids®-Concept in a Split-Mouth-Design.She showed the very high acceptance of laser den-tistry by kids! Also Dr Maziar Mir, Msc (AALZ, Univer-sity Aachen) presented different clinical cases in pe-diatric dentistry. Another highlight of the congresswas the lecture of Prof Dr Dr Siegfried Jänicke (Uni-versity Osnabrück) about lasers in oral and maxillofa-cial surgery. He stated that the CO2-laser as scalpel

substitute in oral surgery is definitive. Another pro-found scientist in this field is Prof Umberto Romeo(University Rome), who showed significantly betterresults in laser surgery in comparison with conven-tional methods. Also Dr Stefan Grümer, MSc (AALZ,University Aachen) gave a comprehensive lectureabout periodontal surgery with a Nd:YAG laser.

Prof Dr Anton Sculean (University Bern) and As-soc-Prof Dr Andreas Braun (University Bonn) pre-sented in their respective lectures the promising pos-sibilities of photodynamic therapy in the field of peri-odontology.

A very important part of the congress was also theLASER START UP 2010. Beside the lecturers, whichgave introduction lectures for dentists interested inthe field of laser dentistry or starting laser dentists,also the leading dental laser companies and distribu-tors are part of the success of the LASER START UPcongresses (since 14 years), as already written for thesecond time now organized together with the DGLcongress. Especially the Saturday is the day where in-troduction workshops and laser demonstrations bythe companies are given. The concept of this LASERSTART UP congress is divided in four fields:

_Laser basics and laser physics_Presentation of the indications in laser dentistry_Presentation of all wavelengths in laser dentistry_Demonstration of legal aspects and invoicing of

laser therapy.

The LASER START UP 2010 and the integratedworkshops and demonstrations were also this yearvery well visited. In the main podium at the end of thesecond congress day the auditorium had also the ul-timate chance to discuss their view on laser dentistrywith all lecturers of the congress. After an hour of in-tensive exchange and discussions Prof Gutknecht,DGL president, closed this very informative and suc-cessful DGL congress 2010 in Berlin._

36 I laser4_2010

I meetings _ Laser Safety Course

_AALZ’s vision is to educate dentists from allover the globe and make them specialists in the fieldof laser dentistry. The AALZ educational programs arebased on fundamental laser physics, neutral and ob-jective information on current laser systems, skilltraining and evidence based description of dental in-dications. That is the reason that AALZ has become a

synonym of quality educational programs amongstdentists who are willing to buy or already use a lasersystem in their clinic. As with many other countriesthat became again clear with Greek colleagues. In2010 AALZ Greece was established by AALZ and RWTHAachen University adjunct faculty members Dr Anto-nis Kallis and Dr Dimitris Strakas. In this first yearmany Greek dentists have participated in our pro-grams and added their names to the long list of ourstudents over the years.

On January of 2010 the first Laser Safety Coursewas held in Athens and was followed by one more inJune. During the 30th Panhellenic Dental Congress inOctober 2010, AALZ Greece participated with its ownexhibitor booth. Supported by AALZ’s General Man-ager Mr. Leon Vanweersch, the booth attracted the in-terest of many Greek colleagues, who were informedin detail about the offered accredited programs andthe future scheduled dates of them.

Already in November the first Mastership/Fellow-ship Status Program of AALZ Greece was ready to ini-

First year of AALZGreece full of activities!Author_Dimitris Strakas, Greece

38 I laser4_2010

meetings _ Laser Safety Course I

tiate. A day before, on November 14 a very profes-sionally organized meeting was held in Kastri, in thenorthern part of Athens. About 100 dentists gatheredfrom early morning (although an election day forGreece) to enjoy the one-day Congress ‘Improve-ments and Innovations in Laser Treatments’. Main lec-turer and invited speaker of the event was Prof Nor-bert Gutknecht who captured the audience’s interestwith his three lectures on different aspects of laserdentistry, including laser assisted endodontic treat-ments, cavity preparations with erbium lasers andprinciples of periodontal therapy using Nd:YAG anddiode lasers.

Very interesting lectures were also given on vari-ous topics, including marketing management of amodern dental laser office, clinical presentations oflaser treatments and aesthetic facial applicationswith new generation laser systems. One very interest-ing part of the day was the on-spot live clinical appli-cations on patients, that were taking place in a sepa-rated area of the hall and the procedure was projectedvia camera on screen. The audience could really watchlive the treatments and the comfort of the patientsduring the procedure.

At the end of the day, Prof Norbert Gutknecht gavea welcome speech to the participants of the firstGreek Mastership Course, emphasizing the fact thatAALZ’s educational programs are still the only ac-credited by the German Government and the Euro-pean Union. Investing your professional future inlaser dentistry, means that you seek the professional

education offered by AALZ and RWTH Aachen Uni-versity. On Monday and Tuesday, November 15 and 16,the first Module of the Mastership Course took place.Dr Rene Franzen, physicist of RWTH Aachen Univer-sity, covered many topics in the field of laser physicsand laser safety (Laser Safety Officer certification) intwo long days. Laser structure, function and handlingand laser-tissue interactions were also explained indetail. At the end of the second day Dr Franzen gavealso a presentation about the ILIAS system, the ex-tremely helpful e-learning platform that AALZ’s stu-dents use throughout their studies. Although tired,the participants were extremely satisfied by the qual-ity of Module I and this was an inspiration for them toexpand their level of understanding concerning thefundamentals of laser dentistry in the upcomingModules.

The second Module of the Mastership Course inGreece is set for 27, 28 February & 1 March 2011. Due tothe intense demand of many other dentists, AAZ Greecewas literally forced to repeat the first Module on 25 and26 February 2011, thus giving the opportunity to thosewho apply on time to participate. For those interestedplease E-mail aalzgreece@gmail.com or visit the web-site www.aalz.gr.

The immediate success of the Mastership Coursein Greece is just one more proof that the high stan-dards and high quality of studies which AALZ offerssince 1991, have set AALZ’s brandname not only as pioneer but also as constant leader in laser dentistryeducation for dentists worldwide._

I 39laser4_2010

Dr Antonis KallisDr Dimitris StrakasTel.: +30 21 06251577 Fax: +30 21 06254856E-mail:aalzgreece@gmail.com Website: www.aalz.gr

_contact laser

I meetings _ WFLD

_The WFLD is the membership organization ofthe specialty of laser used in dentistry worldwide. “Themission of the society is to stimulate the research in thedifferent fields, to coordinate long-term clinical stud-ies using lasers as main instrument during the treat-ment and to establish an educational foundation fordentists who are intending to use or are already usinglasers in their daily treatments”, the Past President ofWFLD, Prof Norbert Gutknecht said in his welcomemessage, one of the invited speakers presenting a topicof “Minimal Invasive Caries Treatment”.

“The WFLD decided to create five divisions and theEuropean Division demonstrated to be very active. Af-ter the successful meetings of 2007 in Nice (France) and2009 in Istanbul (Turkey), Rome takes in charge this sci-entific meeting“, reported Prof Jean Paul Rocca, Presi-dent of WFLD, one of the main invited speakers havingas topic “Diode laser may combine different wave-lengths—a new technical approach” adding that “Italymay be considered an advanced country in terms oflaser dentistry” and concluding that the ExecutiveBoard of the WFLD look forward the meeting in Rome.

Prof Adam Stabholz, President of the European di-vision and an invited speaker in the Endodontic section,confirmed that “It will be a unique opportunity for re-searchers and clinicians from many countries world-

wide, in the field of laser dentistry, to share their knowl-edge and to learn more about the latest advancementin this area”.

It wasn’t a co-incidence that for the Chairperson ofthe congress was chosen Prof Antonella Polimeni. Sheis the Director of the Oral Science Department at theSapienza University. The answer in her welcome mes-sage is: “We choose the Oral Science Department ofSapienza University to give an Academic imprint to thecongress, to provide the highest quality scientific pro-grams and the most updated information regardingthe applications of lasers to our fellow colleagues.”

The Chairperson of the scientific program Prof Um-berto Romeo is preparing a wide program compre-hending lectures, oral presentations and posters to al-low everybody to participate actively to this culturalevent. The deadline for abstract submission was fixedfor 15 February 2011. The program will take place in aday and a half and will be divided in five different sec-tions of dentistry: Laser Research, Endodontics, Peri-odontology and Implantology, Operative and Paedi-atric Dentistry, Oral Surgery and LLLT. Each section willhave oral presentations and one or two invited speak-ers. For the first time in the history of WFLD, it has beendecided to have an renowned invited speaker, that willpresent the state of art in field of his specialty followed

“Light Time—Good Time” 3rd European Congress of WFLD in Rome

Author_Giada Gonnelli, Italy

The 3rd Congress of the World Federation for Laser Dentistry (WFLD) will be held in Rome from 9–11 June 2011 at the De-

partment of Oral Science of Sapienza University of Rome.

40 I laser4_2010

meetings _ WFLD I

by another renowned invited speaker, that will presentthe potentiality of laser in that field. For example in theEndodontics Section Prof Giuseppe Cantatore fromItaly, one of the most important Endodontists in Eu-rope, will speak about the last innovations in Endodon-tic followed by Prof Adam Stabholz, the Dean of theFaculty of Dentistry at the Jerusalem University and theHead of the Endodontic Department, that will presentthe potentially of Lasers in Endodontics. “Prof WilderSmith Petra from Beckman Laser Institute of Universityof California, Prof Yossi Shapira, Head of the PaediatricDentistry Department at Hadassah University ofJerusalem and Prof Anton Sculean, Chairman of theDepartment of Periodontology, Dental School at theUniversity of Bern, are among the invited speakers” re-ported Romeo, concluding that “contextually there willbe a series of workshops organized by the leading lasercompanies that will take place on Thursday morning aswell as the Basic Laser Course that will give the oppor-tunity to get the certification of the WFLD”

“But what does the title of the congress say?: LightTime is for us fans of laser also Good Time “, added ProfRoly Kornblit, Chairperson of Organizing Committee.So we are preparing a social program that will exalt thebeauty and the specialty of the city of Rome, demon-strating also the social and cultural characteristic of

this beautiful country, already Thursday evening, afterthe opening ceremony, during the welcome cocktail,typical Italian food and famous Italian wines will beserved. After the cocktail it will be possible to partici-pate to a tour by bus and see Rome by night. The socialdinner was fixed for Friday evening in one of the mostimportant monuments of Rome, the “Terrazza Caf-farelli at the Museum Capitolini”, an informal momentfor exchanging different views of laser enjoying aunique view of Rome. For those who will remain inRome, we are organizing a guide tour to the famous“Villas of Tivoli” and a dinner with music in a tram thatgoes around the city center of Rome at the end of thecongress on saturday afternoon._

www.wfld-ed-rome2011.com

_information laser

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I meetings _ user meeting

_During an extraordinary training session in TelAviv, Israel, a revolutionary type of dental lasers hasbeen presented to the participants. This new technol-ogy seems to resolve most of the main technologicalhurdles in laser dentistry.

In co-operation with NMT Munich, Germany, andSyneron Dental Lasers dentists from Germany andBulgaria had the chance of getting to know theground breaking laser technology. The LiteTouch™Er:YAG-Laser (wavelength 2,940 nm) works with theso called “Laser-in-the-Handpiece™“-technology.Thereby the laser is generated in the handpiece itselfand does not need to be transmitted via fibre of a laserengine. This new design is a revolution in itself. Theprevious fibre technology is too susceptible to failureand thus too expensive in maintenance.

Therefore, the technological risk is also an eco-nomical risk for the investing dentist. Not few dentistsbought expensive laser machines in the past and re-alized that they were not suitable for everyday use.

The LiteTouch™ provides the doctor with the secu-rity and handling flexibility which is needed for a suc-cessful therapy. Ira Prigat, President of Syneron Den-tal Laser, sums it up: “With a conventional laser witha fibre the dentist cannot concentrate fully on his job.He needs to be concerned about the bulky, suscepti-ble and pricey fibre.” – And this is where Syneroncomes up with the solution.

In 2007, physicists, engineers and laser specialistscame up with a new laser concept: the “Laser-in-the-Handpiece™“-technology. This compression is a mile-stone in industrial history. Furthermore the Lite-Touch™ can be used for soft and hard tissue therapiesand covers a vast spectre of indications: implantol-ogy, restorative dentistry, periodontics, paediatricdentistry and soft and hard tissue surgery etc.

Especially with the possibilities of minimal inva-sive treatment unnecessary traumata of healthy tis-sue can be avoided. In addition a new range of dentaltherapy opens up. The wound healing improves due to

Revolutionary laser systemwas presented in IsraelAuthor_Georg Isbaner, Germany

42 I laser4_2010

meetings _ user meeting I

the disinfecting effect of the laser. The patient can an-ticipate less swelling and bleeding. Obviously, this isnot a unique feature of the LiteTouch™—however itsflexibility, controllability, indication spectre, its effi-ciency, reliability and compactness seem to be unpar-alleled.

Prigat emphasises as well that the outer design hasa decisive impact on the daily practice: “Ultimately wetreat humans, and if our patients are already intimi-dated by the enormous size and noise of the laser en-gine, we cannot use the laser as often as we would liketo. And this is not economical.” In contrast the Lite-Touch™ is a very small and compact device whichweights just about 20 kilos and is just as big as a com-mon computer terminal. One can imagine that in thefuture this new technology is a fully integrated partof the treatment unit.

Asked how Syneron wants to approach such a con-servative market like Germany, Prigat said that a tai-lor made concept is decisive. “What are the require-ments and demands? It is not enough to sell a laser.Long-term support is necessary. You cannot change

the work habit of a dentist from one day to the other.That is why we train our customers step-by-step withthe help of our German distributors.” This intentionwas met by the personal training of the German den-tists in Israel.

In his seminar, Dr Avi Reyhanian, renowned inter-national laser specialist from Israel, demonstrated thepractical advantages of periodontal therapy with theLiteTouch™. Dr Mark Levin, Tel Aviv, addressed the ad-vantages of the D-Touch™ (wavelength 810 nm,980 nm) that can be used in periodontics, endodon-tics and soft tissue management. In bio-stimulationand aesthetic therapy the D-Touch™ can be used aswell. This was confirmed in Dr Levin’s clinic during thenext day, where the participants could follow severallaser treatments via live video stream.

The Israel journey was completed by visits to thebest restaurants in Tel Aviv in the evening and a his-torical trip to Jerusalem and the Dead Sea. All to-gether, the participants were convinced by this ex-traordinary event. They will return home with newideas for their own laser dentistry._

I 43laser4_2010

I meetings _ events

International events

44 I laser4_2010

2011

Start Mastership Course „Lasers in Dentistry“Scandinavia—Batch 2 Where: Akersberga/Stockholm, SwedenDate: 7–10 January, 2011Websites: www.ilsd.se, www.aalz.de

ALD 2011Where: San Diego, CA, USADate: 3–5 March 2011Website: www.laserdentistry.org

IADR 89th General Session & ExhibitionWhere: San Diego, CA, USADate: 16–19 March 2011Website: www.iadr.org

34th International Dental ShowWhere: Cologne, GermanyDate: 22–26 March 2011E-mail: ids@koelnmesse.deWebsite: www.ids-cologne.de

33rd Asia Pacific Dental CongressWhere: Manila, PhilippinesDate: 3–6 May 2011Website: www.apdc2011.com

3rd European Congress World Federation forLaser Dentistry (WFLD)Where: Rome, ItalyDate: 10 & 11 June 2011Website: www.wfld-org.info

FDI Annual World Dental CongressWhere: Mexico City, MexicoDate: 14–17 September 2011Website: www.fdiworldental.org

Annual Congress of DGLWhere: Düsseldorf, GermanyDate: 28–29 October 2011Website: www.startup-laser.de

Greater New York Dental MeetingWhere: New York, NY, USADate: 25–30 November 2011Website: www.gnydm.org

2012

LaserOptics BerlinWhere: Berlin, GermanyDate: 19–21 March 2012Website: www.laser-optics-berlin.de

IDEM International Dental ExhibitionWhere: SingaporeDate: 20–22 April 2012Website: www.idem-singapore.com

The 44th SCANDEFA invites you to exquisitely meet the Scandinavian dental market and sales partners from all over the world in springtime in wonderful Copenhagen

SCANDEFA, organized by Bella Center, is being held in conjunction with the Annual Scientific Meeting, organized by the Danish Dental Association (www.tandlaegeforeningen.dk).

More than 200 exhibitors and 11.349 visitors participated at SCANDEFA 2010 on 14,220 m2 of exhibition space.

www.scandefa.dk

Welcome to the 44th Scandinavian Dental Fair The leading annual dental fair in Scandinavia

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Bella CenterCopenhagen

2011

Reservation of a boothBook online at www.scandefa.dk Sales and Project Manager, Jo Jaqueline Ogilviejjo@bellacenter.dk, T +45 32 47 21 25

Travel informationBella Center is located just a 10 minute taxi drive from Copenhagen Airport. A regional train runs from the airport to Orestad Station, only 15 minutes drive.

Book a hotel in Copenhagenwww.visitcopenhagen.com/tourist/plan_and_book

Scandefa_Ann_A4_ENG_2011.indd 1

APRIL 7- 9, 2011 COPENHAGEN

14/06/10 12:01:50

I laser _ education

_The 12th master course “Lasers in Dentistry”started on 8 September 2010 in Aachen, Germany,and course number 13 started on 26 September inthe city of Ras Al Khaimah in the United Arab Emi-rates. This postgraduate Master of Science pro-gramme has been offered since 2004 at the RWTHAachen University and has already more than 180graduates from all countries around the world.

The Rector of RWTH Aachen University, Prof DrSchmachtenberg, inaugurated officially in Aachenthe course and welcomed the 19 candidates whowill get a taste of student’s life again. He introducedthe University of Excellence (RWTH Aachen Univer-sity) where they will study beside their daily work intheir clinics for the next two years.

All important theories and application optionspertaining to laser use in dentistry are taught. Theparticipants obtain sound theoretical knowledge inlectures and seminars led by renowned, competentand experienced international scientists. Skilltraining sessions, exercises, practical applications,live operations and workshops guide the masterstudents towards using lasers successfully andprofessionally in their own clinics. During the tenmodules, students remain in steady contact withthe RWTH Aachen University and the lecturers be-tween attendance days via the ILIAS e-learning sys-tem. This kind of segmentation allows established

dentists to remain active in their clinics while get-ting their accredited Master of Science degree. Sci-entific Director of this course is Prof Dr NorbertGutknecht, Professor at RWTH Aachen University,Director of the AALZ—Aachen Dental Laser Center,President of the German Dental Laser Society (DGL)and Executive Director and Past President of theWorld Federation for Laser Dentistry (WFLD). Lead-ers of the profession—outstanding professors areon the staff. “Postgraduate education by the bestprofessors in the fields of physics, medicine anddentistry is in my opinion the ideal situation”, saysDr Dimitri Strakas from Greece—one of the firstgraduates in this master course. He states further-more: “The organisation and realisation of thismaster course is very professional. For those den-tists who want the best clinical and scientific back-grounds, I see no alternative options to this coursefrom RWTH Aachen University.”

The RWTH Aachen University Master of Sciencecourse “Lasers in Dentistry” is the first and only ac-credited laser dentistry Master program in Germanyand indeed in Europe, recognized in the EU and allcountries of the Washington Accord (USA and An-glo-American nations) and of the Bologna Reformas an internationally valid academic degree.

The next courses start in September 2011 andregistrations are already open (www.aalz.de)._

“Lasers in Dentistry”12th Master of Science course at RWTH Aachen

Authors_Leon Vanweersch, Dominique Vanweersch, Aachen

46 I laser4_2010

about the publisher _ submission guidelines I

I 47laser4_2010

submission guidelines:Please note that all the textual components of your submissionmust be combined into one MS Word document. Please do not submit multiple files for each of these items:

_the complete article;_all the image (tables, charts, photographs, etc.) captions;_the complete list of sources consulted; and_the author or contact information (biographical sketch, mailingaddress, e-mail address, etc.).

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Text lengthArticle lengths can vary greatly—from 1,500 to 5,500 words— depending on the subject matter. Our approach is that if you need more or less words to do the topic justice, then please makethe article as long or as short as necessary.

We can run an unusually long article in multiple parts, but thisusually entails a topic for which each part can stand alone be-cause it contains so much information.

In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and ifyou have specific questions, please do not hesitate to contact us.

Text formattingWe also ask that you forego any special formatting beyond theuse of italics and boldface. If you would like to emphasise certainwords within the text, please only use italics (do not use underli-ning or a larger font size). Boldface is reserved for article headers.Please do not use underlining.

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Any formatting contrary to stated above will require us to removesuch formatting before layout, which is very time-consuming.Please consider this when formatting your document.

Image requirementsPlease number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase lettersto designate these in a group (for example, 2a, 2b, 2c).

Please place image references in your article wherever they are appropriate, whether in the middle or at the end of a sentence.If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed withinbrackets and before the period.

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_We require images in TIF or JPEG format._These images must be no smaller than 6 x 6 cm in size at 300 DPI._These image files must be no smaller than 80 KB in size (or theywill print the size of a postage stamp!).

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Questions?Eva Kretzschmanne.kretzschmann@oemus-media.de

LIMO

Two parallel wavelengths forquick, uncomplicated surgical treatment

At the BIOS 2011 (booth 8601) LIMO presents the particularly compact diode laserwith a wavelength of 1,470 nm that has been supplemented by an additional par-allel wavelength: 980 nm, 940 nm or 810 nm. This long establishedstandard wavelength on the medical market, combined withthe expedient wavelength of 1,470 nm, can be individu-ally controlled. The power rating of the fiber-coupledlaser is 15 W and 30 W. On request, a power rating of>100 W can also be supplied. The dimensions of the po-tential-free housing are greatly reduced but, however,completely equipped: protective window, fiber contact switch, monitordiode and pilot laser are already integrated. The combination of a compact designwith all additional and safety features makes it suitable for integration into OEMappliances, without causing additional development and production costs. Fur-thermore, the high-performance laser module makes it possible for the end user

to operate at practically all working and ambient temperatures and in nearly all op-erating modes of cw up to the most varied pulsed conditions. Without exception,the LIMO diode laser modules are maintenance-free, so that flexible warranty pe-riods can be provided. This has the advantage that costs are completely eliminatedin the event of replacement. The product is optimally suitable in the end use formedical treatment in the field of modern surgery and urology. The two wavelengthsmake higher absorption possible of the laser in water and haemoglobin. In addi-tion to the high removal rates, the treatment can be carried out ambulant, quickand with care. Further advantages for operative treatment are:

– safe and high precision treatment (less bleeding, protection of theadjacent tissue)

– minimum postoperative complaints– quick, uncomplicated healing (no stitches)

LIMO

Lissotschenko Mikrooptik GmbH

Bookenburgweg 4–8

44319 Dortmund, Germany

E-mail: kontakt@limo.de

Web: www.limo.de

I manufacturer _ news

Manufacturer NewsSirona

Training for laser users

Safety is of paramount importance when laser treatment is be-ing carried out. It is vitally necessary that dentists should have com-pleted a certified training course of the type offered by Sirona. Ourtraining course provides comprehensive and hands-on tuition on allaspects of the use of lasers, as well as giving users useful tips on safetyand clinical application.

Details of the training and continuing education courseprovided by the Sirona Dental Academy may be found onwww.sirona.de under the heading “Service”or on the product pages of SIROLaser Advance and SIROLaser Xtend.

Safety when using a laser begins with the selection of a suitable surgery. Thedoor of the surgery must display a warning sign. No unauthorised persons mustbe allowed to enter the surgery while treatment is being carried out. Patients andall other persons present must wear laser protection glasses to prevent injuries

to the eyes. The law requires that there must be a laser safety officer presentin practices using a class 3b and 4 dental laser and that this officer must

hold proof of specialised knowledge and expertise in the clinical applica-tion of lasers and laser protection. As the first point of contact within the

practice on questions relating to the laser, this person is responsiblefor guaranteeing and monitoring certain safety standards.

Sirona Dental Systems GmbH

Fabrikstraße 31

64625 Bensheim, Germany

E-Mail: contact@sirona.de

Web: www.sirona.de

48 I laser4_2010

Laservision

New multi-use lasersafety eyecaps for patients

During medical laser treatment eyeprotection of the patients is ex-tremely important. By offering thecompletely novel laser safety eye-caps “CAP2PROTECT” LASERVISIONtakes care of this challenge and pro-vides patients excellent eye protec-tion for laser treatment in the facial

area. Present eye caps are made in most cases out ofrigid material like metal or plastics. They are typicallyconnected together with a nose bridge and hold in po-

sition by an additionalhead strap. In contrast tothat the new LASERVI-SION eye caps feature aunique self-adhesive ef-fect. This effect is a basicmaterial characteristicand doesn’t become losteven after multiplereuses. The adhesive partof the cap keeps it se-

curely in a position which protects the eye of the pa-tient against incident laser radiation and stray lightfrom all directions. As designed for the medical mar-ket, the caps are of course suitable for sterilisation. Inorder to increase laser protection and mechanicalstability the eye caps feature an additional metal in-sert on the top side. Due to its small size and thicknessthe wearing comfort is not affected at all.

LASERVISION GmbH & Co. KG

Siemensstr. 6

90766 Fuerth, Germany

E-mail: info@lvg.com

Web: www.uvex-laservision.com

manufacturer _ news I

KaVo

Early identification ofcaries—pain-free andsafe

The KaVo DIAGNOdent pen, a unique instrument fordiagnosing caries, utilises the differing fluores-cence of healthy and diseased tooth substance toquickly and reliably identify early-stage caries. Inaddition to caries detection, the DIAGNOdent pencan be used with a special Perio probe for the reli-able and comfortable identification of periodontitis.

This patented diagnostic system is small, compactand cable-free. The DIAGNOdent pen even allowsthe diagnosis of hidden caries which is difficult tofind with a probe or X-ray since it is below the intactenamel surface. Even very fine lesions are reliablyrevealed without exposing patients to radiation.Caries can also be easily identified in the approximalarea with a new, special approximal probe. With theapproximal prism, the laser beam is deflected 100°to allow the scanning of the tooth around the contact

surface. The entire approximal area can be scannedin quadrants in just a few minutes. The DIAGNOdentpen’s actual readings are communicated as a digi-tal and acoustic signal. This confirms to the patient,the need for treatment and greatly increases com-pliance. In addition to the detection of caries, the DIAGNOdent pen also detects calculus in periodon-tal pockets. The Perio probe detects concrements inthe deepest pockets reliably and without pain de-spite the presence of saliva or blood and is thereforean ideal control instrument after root cleaning.

Residual concrements can be confidently removed.A gentler, more thorough cleaning of pockets isthereby enabled with substantially enhanced heal-ing, whilst saving the user time by avoiding unnec-essary treatment.

Clinical studies by Prof Frentzen, M.D. at the University of Bonn, confirm that the use of the DIAGNOdent Perio probe for concrement detectionand control of treatment improves the postopera-tive bleeding index and noticeably reduces pocketdepth in comparison to the use of a conventionalprobe.

Overall, the DIAGNOdent pen—a state-of-the-artinstrument for reliable caries and calculus detec-tion—is an ideal addition to the diagnostic reper-toire of any dental practice.

KaVo Dental GmbH

Bismarckring 39

88400 Biberach/Riß, Germany

E-mail: info@kavo.com

Web: www.kavo.com

I 49laser4_2010

Fotona

PIPS® RevolutionizingNew Root Canal Treat-ment Available Only withFotona Lasers

Fotona has signed an agreement which gives Fotona den-tal lasers exclusive rights to perform PIPS®, a ground-breaking new photoacoustic root canal treatment. PIPS®

uses Er:YAG laser energy at sub-ablative power levels forcleaning and debriding the root canal system with speciallydesigned handpieces and fiber tips. It is a minimally inva-sive technique because the tip is only inserted one thirddeep into the coronal canal. This also gives the peace ofmind that the tip will not break inside the curved canal.Shockwaves created by the laser stream cleaning solutionstwice as deep through the root canal system as could be

achieved using traditional methods, in this way reachingevery corner and making the procedure that much moreeffective. The canals and subcanals are left clean and thedentinal tubules are completely free of smear layer.

Additional advantages of PIPS® include preserving moreof the tooth endoskeleton because of its minimal inva-siveness and the technique requires less filling andsoaking time for chemical agents, saving you up to 30minutes depending on the complexity of the root canalstructure.

Fotona d.d.

Stegne 7

1210 Ljubljana, Slovenia

E-mail: info@fotona.com

Web: www.pips-endo.com

www.fotona.com

elexxion

OdoBleach for laserpower bleaching withelexxion diode lasers

Elexxion, an established manufacturer ofhigh-quality dental lasers that fea-ture German technology anddesign, has just launchedOdoBleach, a special newbleaching set. Used in combina-tion with an elexxion diode laser,OdoBleach is the preferred choice for

laser power bleaching. With OdoBleach, treatmentcan now be completed in only one single session,which of course results in a significant increase inproductivity and practice revenue performance.

OdoBleach contains titaniumdioxide and hydrogen per-

oxide, and the com-bined effect is inten-sified by the use of anelexxion diode laser.

OdoBleach is specificallydeveloped to achieve optimal re-

sults with the wavelength of elexxiondevices. This new bleaching technology means

fast-acting treatment, no surface alteration, no hy-persensitive reaction and exceptional economic ef-ficiency. Each OdoBleach set includes a liquid damand desensitization syringe, to give patients glea -ming white teeth in a single session. That makes iteasier to schedule appointments efficiently and cal-culate costs. All elexxion products are availablethrough our regional distributors.

elexxion AG

Schützenstraße 84

78315 Radolfzell, Germany

E-mail: info@elexxion.com

Web: www.elexxion.com

Copyright Regulations _laser international magazine of laser dentistry is published by Oemus Media AG and will appear in 2010 with one issue every quarter. The

magazine and all articles and illustrations therein are protected by copyright. Any utilization without the prior consent of editor and publisher is inad-mi ssible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.

Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to theeditorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right tocheck all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicitedbooks and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, representthe opinion of the afore-mentioned, and do not have to comply with the views of Oemus Media AG. Responsibility for such articles shall be borne by the author.Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumedfor information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.

PublisherTorsten R. Oemus oemus@oemus-media.de

CEOIngolf Döbbeckedoebbecke@oemus-media.de

Members of the BoardJürgen Isbanerisbaner@oemus-media.de

Lutz V. Hillerhiller@oemus-media.de

Chief Editorial ManagerNorbert Gutknechtngutknecht@ukaachen.de

Co-Editors-in-ChiefSamir NammourJean Paul Rocca

Managing EditorsGeorg BachLeon Vanweersch

Division EditorsMatthias FrenzenEuropean Division

George RomanosNorth America Division

Carlos de Paula EduardoSouth America Division

Toni ZeinounMiddle East & Africa Division

Loh Hong SaiAsia & Pacific Division

Senior EditorsAldo Brugneira JuniorYoshimitsu AbikoLynn PowellJohn FeatherstoneAdam StabholzJan TunerAnton Sculean

Editorial BoardMarcia Martins Marques, Leonardo Silberman,Emina Ibrahimi, Igor Cernavin, Daniel Heysselaer,Roeland de Moor, Julia Kamenova, T. Dostalova,Christliebe Pasini, Peter Steen Hansen, Aisha Sul-tan, Ahmed A Hassan, Marita Luomanen, PatrickMaher, Marie France Bertrand, Frederic Gaultier,Antonis Kallis, Dimitris Strakas, Kenneth Luk, Mu-kul Jain, Reza Fekrazad, Sharonit Sahar-Helft, La-jos Gaspar, Paolo Vescovi, Marina Vitale, CarloFornaini, Kenji Yoshida, Hideaki Suda, Ki-Suk Kim,Liang Ling Seow, Shaymant Singh Makhan, Enri-que Trevino, Ahmed Kabir, Blanca de Grande, JoséCorreia de Campos, Carmen Todea, Saleh GhabbanStephen Hsu, Antoni Espana Tost, Josep Arnabat,Ahmed Abdullah, Boris Gaspirc, Peter Fahlstedt,Claes Larsson, Michel Vock, Hsin-Cheng Liu, SajeeSattayut, Ferda Tasar, Sevil Gurgan, Cem Sener,Christopher Mercer, Valentin Preve, Ali Obeidi,Anna-Maria Yannikou, Suchetan Pradhan, RyanSeto, Joyce Fong, Ingmar Ingenegeren, Peter Klee-mann, Iris Brader, Masoud Mojahedi, Gerd Voll-and, Gabriele Schindler, Ralf Borchers, StefanGrümer, Joachim Schiffer, Detlef Klotz, HerbertDeppe, Friedrich Lampert, Jörg Meister, ReneFranzen, Andreas Braun, Sabine Sennhenn-Kirch-ner, Siegfried Jänicke, Olaf Oberhofer, ThorstenKleinert

Executive ProducerGernot Meyermeyer@oemus-media.de

Designer Sarah Fuhrmanns.fuhrmann@oemus-media.de

Customer ServiceMarius Mezgerm.mezger@oemus-media.de

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Printed byMessedruck Leipzig GmbHAn der Hebemärchte 604316 Leipzig, Germany

laserinternational magazine of laser dentistryis published in cooperation with the World Federa-tion for Laser Dentistry (WFLD).

WFLD President

University of Aachen Medical FacultyClinic of Conservative DentistryPauwelsstr. 3052074 Aachen, GermanyTel.: +49 241 808964Fax: +49 241 803389644ngutknecht@ukaachen.dewww.wfld-org.info

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