Lasers in Dentistry?

[trypmo]

I saw this topic mentioned peripherally in another thread, but I think its discussion might merit a thread of its own. What's the score on the use of lasers in dentistry, and where can I look to find more information about it? I'd really like to learn more about lasers in diagnosis and treatment, whether it's in perio or OMS or general cavity-filling stuff or whatnot. Thanks!


Related question: do you think lasers will someday replace drills as the instrument of choice for getting rid of decayed material preparatory to filling a cavity??

 

[mmapcpro]

I hear that thisisit has sharks with friggin laser beams attached to their heads in his office.

😛

 

[ShawnOne]

i think you meant

I hear that thisisit has sharks with friggin laser beams attached to their friggin heads in his office.

 

[DrJeff]

I've had a Nd:Yag soft tissue laser in my office for just over a year abd a half now, and absolutely love it. My partner and I use it on average 3 or 4 times a day for a host of things from tissue retraction/cauterization prior to crown impressions and/or class 5 composite restorations, perio treatment, tissue excision, root canal sterilization, palliative treatment of apthous/herpetic lesions, and root surface desensitization. The laser has paid for itself atleast twice over already, and its initial cost was over $25,000

My partner and I after being very satisfied with the soft tissue laser are now seriously looking into adding atleast 1, if not 2 hard tissue lasers in the coming months for the office. The main "fear" that we had about the hard tissue laser was about limited control of tooth structure removal, but with newer advances in tip design, this appears to be fastly becoming a non issue.

The other added benefit that we've found, aside from delivering better, faster, more comfortable treatment to our patients, is word of mouth referrrals, or as I call it, the "cool" factor. You can actually see the look of "WOW!" in many patients eyes when you start talking about the laser and its uses to the patients, and we get many new patients saying that "my friend, Mr/Mrs X was telling me about how great and painless your laser is, and I was wondering someone that might need to be treated by it?"😀 😀

Will the laser ever completely replace the handpiece, I don't know, but while I do have alot of fun my my laser, there still is nothing like the feeling of a high speed handpiece and a fresh coarse diamond bur taking down an axial wall during a crown prep😍 😀

 

[ddstothecor]

Is there any concern about cutting on tooth tissue and the generation of heat associated with the laser?

 

[UBTom]

ddstothecor:

The nice thing about the dental lasers is that tissues react differently to different wavelengths- For example, the wavelength of a soft tissue laser cuts through soft tissues but does not do much to hard tissues like bone or teeth.

There are also different operating modes which can minimize heat damage which you can set, such as pulse modes where you can select the intervals and beam intensity.

Another exciting application that is up-and-coming is photodynamic therapy (PDT). You can target tissues you want to destroy with the laser by applying a reactive dye designed only to stick to that certain type of tissue, and the laser activates the reactive dye taken up to destroy the tissue. Neat stuff!

PDT is going to be the wave of the future. Pretty soon we should see reactive dyes that react only to carious dentin.. Paint it onto a cavity, let the carious dentin take up the dye, then zap it with the laser-- Voila!

Speaking of lasers.. I wonder where can I buy a phased plasma rifle in the 40-watt range.. (I was channel surfing last night and The Terminator was on.. 😀 )

 

[trypmo]

Originally posted by UBTom
PDT is going to be the wave of the future. Pretty soon we should see reactive dyes that react only to carious dentin.. Paint it onto a cavity, let the carious dentin take up the dye, then zap it with the laser-- Voila!

Cool! Actually, that's the kind of procedure I'd been thinking I'd like to work on developing: you could conjugate a photoreceptor molecule to an antibody and then to a membrane protein in the bacteria and give it enough juice to zap the material within an n micron spherical radius. Kind of like CALI (chromophore-assisted laser inactivation) of proteins on the single-cell level. Do you know which schools/groups might be doing research on this topic?

 

[gryffindor]

trypmo,

Send tinkerbell a PM. I think she's mentioned being involved with laser research at UCSF before.

 

[trypmo]

Thanks, griffin04, and congrats on your soon-to-be 500th post!

 

[trypmo]

Originally posted by DrJeff
I've had a Nd:Yag soft tissue laser in my office for just over a year abd a half now, and absolutely love it. My partner and I use it on average 3 or 4 times a day for a host of things from tissue retraction/cauterization prior to crown impressions and/or class 5 composite restorations, perio treatment, tissue excision, root canal sterilization, palliative treatment of apthous/herpetic lesions, and root surface desensitization. The laser has paid for itself atleast twice over already, and its initial cost was over $25,000

My partner and I after being very satisfied with the soft tissue laser are now seriously looking into adding atleast 1, if not 2 hard tissue lasers in the coming months for the office. The main "fear" that we had about the hard tissue laser was about limited control of tooth structure removal, but with newer advances in tip design, this appears to be fastly becoming a non issue.

The other added benefit that we've found, aside from delivering better, faster, more comfortable treatment to our patients, is word of mouth referrrals, or as I call it, the "cool" factor. You can actually see the look of "WOW!" in many patients eyes when you start talking about the laser and its uses to the patients, and we get many new patients saying that "my friend, Mr/Mrs X was telling me about how great and painless your laser is, and I was wondering someone that might need to be treated by it?"😀 😀

Wow; that sounds fantastic, and thanks for your great reply! I can definitely see myself using one of those. Is it really painless to the patients (the nerves would still be stimulated somehow, wouldn't they)? Can you use it on kids? Does it use water or oil immersion, or something different? What's the output power? I'm sooooo interested in this!

 

[DrJeff]

Originally posted by trypmo
Wow; that sounds fantastic, and thanks for your great reply! I can definitely see myself using one of those. Is it really painless to the patients (the nerves would still be stimulated somehow, wouldn't they)?

I can say from personal experience both in the palliative treatment of an apthous ulcer and while having excessive tissue removed around my implant prior to cementation, both done without anesthesia, that if used properly, the most I felt was a very slight pinch. The key is to use the Laser starting far away from the tissue you desire to work on at low output(my Laser has a max output of 6 Watts, and I'll generally start with my first preset of 1.2 Watts/100 hertz at a distance of about 2cm above the itssue and slowly in a paintbrush stroke manor work downto and then into the tissue over about a 1.5-2 minute time span.

Can you use it on kids?

I've used my Laser on patients from age 4 to age 80

The hard tissue Laser we're looking at (Waterlase) had a live patient demo video that I saw that had them performing everything from cavity preparations to excisional biopsies to rppt canal treatment without anesthesia, and from folks on the dentaltown.com forum that have them they report a similar lack of need for anesthesia with the waterlase. Plus, as for the pain perspective, as my staff put it, if they can go through laser bikini hairline removal with a non-cooling irbium laser (my local general surgeon does this, not my office) than our "wimpy" patients can have some simple dental work done
😉 😀