laser international No. 2, 2012

Cover / Editorial / Content / Laser in oral surgery and medicine—Part II / Evaluation of combined Nd:YAG laser treatment of moderate periodontitis / The antibacterial effects of lasers in endodontics / Laser treatment of dentine hypersensitivity / A novel technique of Er:YAG laser-enhanced early implant stability / Laser therapy of oral haemangiomas / Lasers in oral implantology / Manufacturer News / “Laser Supported Dentistry” in Turkey / Innovation and information at IDS 2013 / Meetings / News / Imprint

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issn 2193-4665

Vol. 4 • Issue 2/2012

laser
international magazine of

laser dentistry

2

2012

| research
The antibacterial effects of lasers
in endodontics

| overview
Laser treatment of dentine hypersensitivity

| case report
A novel technique of Er:YAG laser-enhanced
early implant stability

[2] =>

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[3] =>

editorial

Laser (in)dispensable
in dentistry?

Dr Georg Bach

_Have you been following the coverage of dental congresses in the past few weeks? If so,
you might have felt just the same positive sensation as I have when I came across the fact that
scientific contributions on laser applications in implantology have gained a high rank in the past
congress season. By the way, the same holds true for scientific texts on implantology in dental
specialist publications.
The growing impact of laser applications on both congresses and scientific literature does indeed pose a snapshot of the current status of laser in dental therapies and might even express a
recent trend. This trend, in my view, bears various notable facets:
Many of the numerous implantological congresses and symposia intersecting with laser dentistry have included reports on the application of monochromatic light into their programs.
Moreover, whole sessions are dedicated to laser in both implantological and periodontal congresses and symposia. On such occasions, the high value of atraumatic laser incisions with significantly reduced hemorrhage is highlighted, along with the lack of alternatives to laser surface decontamination in the treatment of periimplantitis.
The antibacterial effects of lasers in endodontics and the advantages of laser therapy of oral
haemangiomas contribute to the wide range of applications of laser in dentistry.
As you can see, we are provided with a sufficient (and evidence-based) number of opportunities to pursue our passion for monochromatic light in dental therapy. It follows that our
résumé be “No (more) dentistry without laser”!_
With best regards,

Dr Georg Bach

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I content _ laser

page 16

page 24

I editorial

I education

03

40

Laser (in)dispensable in dentistry?

42

I research
Laser in oral surgery and medicine—Part II

Evaluation of combined Nd:YAG laser treatment of
moderate periodontitis

I meetings
43

International events 2012

44

DGL annual conference in Leipzig, Germany

| Dr Anna-Maria Yiannikou-Loucaidou

16

Innovation and information at IDS 2013
| VDDI

| Antonio Batista-Cruzado et al.

12

“Laser Supported Dentistry” in Turkey
| Prof Dr Aslihan Usumez et al.

| Dr Georg Bach

06

page 34

The antibacterial effects of lasers in endodontics

| Jürgen Isbaner

46

| Dr Selma Cristina Cury Camargo

“Scientifically, laser has now reached its
highest standard”
| Dajana Mischke

I overview
24

I news

Laser treatment of dentine hypersensitivity
| Dr Ute Botzenhart et al.

I case report
28

A novel technique of Er:YAG laser-enhanced
early implant stability

38

Manufacturer News

48

News

I about the publisher
50

| imprint

| Dr Kenneth Luk et al.

32

Laser therapy of oral haemangiomas
| Friedrich Müller et al.

I industry report
34

Cover image courtesy of Biolase Technology Inc.,
www.biolase.com.
Original Background: ©Excellent backgrounds
Artwork by Sarah Fuhrmann, OEMUS MEDIA AG.

Lasers in oral Implantology
| Dr Ilay Maden et al.

page 42

04 I laser
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page 44

page 48

[5] =>

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Fon: +49 241 8088-164
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[6] =>

I research

Laser in oral surgery
and medicine—Part II
Authors_Antonio Batista-Cruzado, Daniel Torres-Lagares, Blanca Moreno-Manteca, Gerd Volland,
Patricia Bargiela-Perez, Martin Jorgen & Jose-Luis Gutierrez-Perez, Spain

[BACKGROUND: ©PERFECTIONIST]

_The laser has been used in the field of oral surgery for a wide range of indications. In this article, we
focus on its surgical uses. The success of the surgical
treatment of lesions in the oral cavity depends greatly
on knowledge of the aetiology and histology of the lesion. There are pathologies that can be treated with
laser, such as cancer sores and hyperkeratosis. Others,
like candidiasis, cannot be treated with laser. Furthermore, laser has quickly become a predictable and
favourable treatment modality for leukoplakia, haemangioma and epulis.

06 I laser
2_ 2012

Although there is no specific treatment to prevent its
recurrence, abandoning these habits can decrease
the probability of recurrence, as well as the transformation into malignant tumours.
Vivek et al.24 treated 28 patients with histologically diagnosed leukoplakia in order to study efficacy, safety and acceptability of lasers, particularly
the Nd:YAG laser. After laser treatment, post-operative complications associated with ablation were assessed. They recorded only mild to moderate pain,
with slight swelling up to 72 hours post-treatment.
A follow-up study was initiated three years later. Approximately 92 per cent of the patients were found
to have been cured. Therefore, the authors regarded
Nd:YAG laser as an effective tool for the treatment of
this pathology.

In the last issue of laser, the authors gave an
overview on in vitro studies and in vivo animal studies
in this field. They continued by giving examples of in
vivo studies on humans on the subjects of wound and
bone healing supported by laser treatment. Finally, the
authors analysed soft-tissue surgery and examples of
cancer treatment via CO2 laser and photodynamic
therapy under the headline of “clinical studies”. They
continue this chapter in the present issue of laser by
discussing, among others, leukoplakia treatment, benign diseases and frenectomy. In the conclusion, they
sum up the positive effects of laser on oral surgery.

There are also studies that recommend CO2 laser
for the excision of leukoplakia. For example, Reddi
and Shafer25 found the CO2 laser to be of great success in the excision of leukoplakia in their study. They
also applied laser to the treatment of erythroplasia
and lichen planus.

Leukoplakia treatment
Leukoplakia is a premalignant lesion associated
with excessive consumption of alcohol and tobacco.

Treatment of lichen planus
Owing to its inflammatory effects, lichen planus
can be painful both in atrophic and erosive forms.

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research

Benign diseases
In this section, pathological entities treated with
laser in recent years are discussed. Attention is paid
to the technique applied, as well as frequency and impact of the laser used for the respective oral surgery.
Owing to the high frequency of pyogenic granuloma in the oral cavity, especially during pregnancy,
Jafarzadeh et al.28 reviewed this disease and considered treatments and new approaches. Possible treatment options are, among others, resection by means
of a scalpel, cryotherapy, the use of corticosteroids, or
the use of an Nd:YAG or CO2 laser. The authors state
that laser treatment can help control bleeding, does
not result in adverse effects and is therefore consid-

ered a successful treatment method with high acceptance by patients.

[PICTURE: ©CHRIS HARVEY]

The traditional treatment, therefore, makes use of
topical corticosteroids.
Cafaro et al.26 conducted a prospective cohort
study of 13 patients with lichen planus in order to investigate the effectiveness of LLLT. Patients were
given biostimulation by diode laser (904 nm, pulsed
mode). In general, a decrease in the size of the lesions
and pain, and overall stable results were observed.
The authors therefore recommend LLLT as a possible
treatment for patients with lichen planus, but recommend that future studies be done with a larger
group of patients in order to corroborate their results.
Aphthous stomatitis
LLLT has also been used in the treatment of recurrent aphthous stomatitis. The study by De Souza et
al.27 employed LLLT not as an inhibitor of the process,
but for its modulating and healing effect on tissues.
The authors assessed the effect of LLLT on aphthous
stomatitis in 20 patients divided into two groups.
Group I was treated with topical corticoids (triamcinolone acetonide) and group II was treated via diode
laser (670 nm, 50 mW). Patients reported a decrease
in pain already directly after laser treatment. Four
days post-treatment, the lesion had receded completely in group I, compared with complete recession
seven days post-treatment in group II.

Actinic cheilitis is another medical condition that
can be treated with laser, since results show a high
clinical resolution and low recurrence. Its successful
treatment is based on the removal of epithelium
while avoiding the resulting scarred tissue. De Godoy
Peres et al.29 compared two protocols of low morbidity clinico-histologically in which CO2 laser was used
with different parameters. A biopsy was done before
and after laser treatment. In both groups, a significant reduction in epithelial dysplasia was achieved.
Therefore, the authors recommend the use of lasers
in cases of mild to moderate dysplasia.
Adipose tissue tumours are found frequently in
the maxillo-facial region, for example on the lips and
buccal mucosa. Although these tumours have traditionally been treated with a scalpel, laser can be a
valid alternative. Suture is not necessary, and there is
only minimal tissue scarring. Capodiferro et al.30 is an
insightful study on this topic.
Hyperkeratosis
Abnormal thickening of the stratum corneum
caused by an increase of keratin is known as hyperkeratosis. The biological behaviour of this lesion is related to different histopathological changes. Various
therapies, such as the use of scalpel, electrocautery,
cryotherapy, PDT and topical medications have been
proposed for its removal. Owing to advances in the
use of laser in the oral environment, laser therapy appears a promising method for treating hyperkeratosis.
Santos et al.31 sought to verify the advantages of
CO2 lasers (10,600 nm) and removed lesions by focusing the beam of light around each lesion. The removed tissue was then sent for histopathological ex-

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I research

Fig. 1

Fig. 2

Fig. 1_Long-term case of
vestibuloplasty. Situation on 15th
of June, 2003: no gingiva attached at
the lower jaw front.
Fig. 2_Long-term case of
vestibuloplasty. ER:YAG treatment
(1,000 µs, 15 Hz, 400 mJ, no water,
no air). Very low bleeding,
periosteum not damaged.
Gain of 10 mm.
Fig. 3_ Long-term case of
vestibuloplasty. Removal of peripac
periodontal dressing, three days after
the surgery.

amination. An improvement in haemostasis was
achieved by defocusing the laser beam. The authors
assert that this technique is easily applied and without post-operative complications.
Treatment of vascular lesions
Large vascular lesions in the orofacial region are
often very difficult to remove. Therefore, the use of
laser has been suggested as an effective way to remove major vascular lesions through photocoagulation. Angiero et al.32 investigated the effectiveness of
photocoagulation and treated 136 patients with a
diode laser. More than 98 % of these cases displayed
complete remission. The study therefore demonstrated that diode laser treatment can prevent recurrence and complication, while the healing time is
shortened.
Ostectomy
Stübinger et al.33–36 closely studied the use of
Er:YAG laser on bone tissue and its biological effects.
Applications range from different kinds of ostectomy, taking grafts from a tubercle and the chin, as
well as tooth extraction. Among the benefits of
Er:YAG laser treatment are high accuracy without
wasting bone, along with a low risk of traumatising
soft tissue or tissue charring, or of any complications
in the healing of wounds. In order to achieve the best
results, Stübinger et al.33–36 advocate the use of planning software. The amount of time needed for the
surgery and the lack of depth control are among the
disadvantages of the Er:YAG laser.
Third molar
Post-operative pain and oedema are common
after the surgical removal of the lower third molar.
Traditionally, non-steroidal anti-inflammatory
drugs and steroids have been used to treat these
symptoms. LLLT has only recently been considered
as a possible analgesic agent to control post-operative pain, lock-jaw or inflammation. Markovic and
Todorovic37 compared the analgesic effects of two
anaesthetics, the use of LLLT and the administration
of diclofenac in their study. Compared with the control group, who only received regular post-operative recommendations, participants treated with

08 I laser
2_ 2012

Fig. 3

laser showed significantly reduced post-operative
pain.
One year later, Markovic and Todorovic38 studied
the effectiveness of dexamethasone and the use of
LLLT in reducing post-operative swelling. The study
was conducted in 30 patients divided into four
groups. Group I was irradiated immediately after the
surgery. In addition to laser, an intramuscular injection of 4 mg dexamethasone was administered to
group II in the internal pterygoid muscle. Group III
was given 4 mg of systemic dexamethasone (intramuscular injection in the deltoid region) in addition
to LLLT, which was followed by 4 mg dexamethasone
intra-orally six hours after surgery. Group IV was the
control group and received only the usual post-operative recommendations. Group II showed the lowest incidence of oedema. The authors concluded that
LLLT can be recommended for the reduction of inflammation, an effect that can be increased by topical corticoids.
Amarillas-Escobar et al.39 conducted a similar
study on the extraction of wisdom teeth. Their study
employed 15 patients who were treated with a diode
laser (810 nm, 100 mW) intra-orally and extra-orally,
and a control group of 15 patients who were not irradiated. The experimental group showed no statistically significant differences compared with the
control group, although a reduction in post-operative pain, swelling and lock-jaw was detected.
Frenectomy
The term “frenectomy” refers to the complete removal of the frenulum from either the lip or the
tongue. This can be done by either conventional surgery using a scalpel or laser. Recently, possible postoperative discomfort for the patient has been widely
discussed.
Haytac and Ozcelik40 randomly selected 40 patients for their study who had originally been intended to undergo another form of treatment. Each
patient was asked to rate functional complications
and pain according to a scale from one to seven. All of
the patients perceived laser application positively

[9] =>

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[10] =>

I research
and experienced reduced discomfort with laser. See
for example a long-term case of vestibuloplasty from
2003 by Prof. Dr. Gerd Volland, where no gingiva was
attached at the lower jaw front (Fig. 1). After treatment with Er:YAG laser (1,000 µs, 15 Hz, 400 mJ, no
water, no air), only very low bleeding occurred and a
gain of 10 mm was noted (Fig. 2). Three days after the
surgery, the periodontal dressing was removed (Fig.
3), and the patient was free of pain seven days after
the surgery (Fig.4). The healing was completed six
weeks after the surgery and a gain of 7 mm was observed (Fig. 5). Three years later, the final gain was set
at 5,5 mm and no scarring occurred (Fig. 6). A followup in 2009 showed no recessions and stable results
(Fig. 7).

Fig. 4_ Long-term case of
vestibuloplasty. Fibrin cover seven
days after surgery.
Patient free of pain.
Fig. 5_ Long-term case of
vestibuloplasty. Situation on 28th of
July, 2003: healing complete.
Gain of 7 mm.

Fig. 4

Pathology of the salivary glands
Mucoceles, ranulas or sialolithiasis can result in
obstructive salivary-gland pathologies. Mucoceles
are produced by an accumulation of mucin from a
ruptured salivary-gland duct, usually caused by local trauma. They are characterised by a high percentage of relapse. Two approaches to removing
mucoceles have been suggested in the literature: resection by either scalpel or CO2 laser. Yagüe-García et
al.41 compared the effectiveness of using a scalpel
with that of a CO2 laser in removing mucoceles in
their study. They treated 38 patients using a scalpel
and 30 patients using a CO2 laser (5–7 W). The results
showed a repetition rate of 8.8 % for the conventional scalpel ablation. In 13.2 % of the cases, complications such as fibrous scars arose. In the laser
group, a follow-up study at 12 months showed no
complications or recurrence. The authors therefore
recommend laser treatment, since its results are
more predictable and its recurrence rate is lower
than that of the traditional treatment. Furthermore,
fewer complications occur. Huang et al.43 contributed to this line of argumentation in reporting on
laser vaporisation, a procedure that they recommend for children and non-cooperative patients especially.
Ranulas are due to an accumulation of mucin
caused by the obstruction of a salivary-gland duct
(generally that of the sublingual and submandibular

Fig. 5

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2_ 2012

glands), which is usually the result of previous local
trauma. Marsupialisation, the removal of the ranula
with or without the sublingual gland, laser splitting,
and vaporisation of the ranula have been proposed
as possible treatments. Lai and Poon44 present a series of three cases in which ranulas were removed
and the injuries vaporised using CO2 laser. The authors state that this treatment can be recommended
because of the precision of excision, a clear and sterilised operating field and the low risk of damage to
the Wharton’s duct and the gingival nerve. Furthermore, CO2 laser treatment results only in minimal or
no recurrence. Zola et al.45 present an alternative
method for removing ranulas. They used an
Er,Cr:YSGG laser (1.5 W). The authors found their
treatment to offer advantages similar to those found
by Lai and Poon.44
Sialolithiasis is the mechanical obstruction of
salivary glands or their excretory ducts owing to the
formation of concretions. It accounts for 30 % of
salivary gland pathologies and mainly affects the
submaxillary glands (83–94 %), followed by the
parotid (4–10 %) and sublingual glands (1–7 %).
Yang and Chen46 present 19 clinical cases entailing
the removal of stones from the Wharton’s duct in
their article. All of the patients were treated with a
CO2 laser (4–6 W). Their success rate was 95 % and
only very few complications occurred. For this reason, the authors advocate CO2 laser treatment as the
first technique to be used to treat this pathology.
Bisphosphonates
The clinical scope of avascular necrosis caused by
bisphosphonates ranges from a single fistula to
large areas of exposed necrotic bone tissue. Additional symptoms are paraesthesia, pus, swelling,
pain and even fracture. The treatment and management of avascular necrosis resulting from bisphosphonates has proven to be challenging, as no treatments have been effective in the long term. Depending on the patient’s health, possible treatments are
the temporary or permanent suspension of bisphosphonate use, use of local or systemic antibiotics or
hyperbaric oxygen, and surgical debridement of the
lesions. The combination of these therapies may
bring about more predictable results.
The use of LLLT has been increasingly favoured as
an alternative for treating this type of pathology. In
their 2010 review of the treatment of avascular
necrosis by LLLT, Vescovi and Nammour47 explain the
effects of the laser on the healing process. Laser
stimulation increases organic bone matrix, osteoblast proliferation and capillary growth. Owing to its
strong affinity to water and hydroxyapatite, the
Er:YAG laser can be easily applied to both soft and
bone tissue. Necrotic bone is vaporised in the course

[11] =>

research

of conservative surgery until healthy bone is
reached. Another advantage of Er:YAG laser treatment is its bactericidal action, which increases the
healing of bone tissue. Er:YAG laser treatment therefore appears to be a promising technique, since it is
regarded as safe, well tolerated by patients and allows minimally invasive treatment of the disease in
the early stages.
In a study in 2008, Vescovi et al.48 present their
clinical results of the treatment of 28 patients affected by osteonecrosis. They treated the four groups
of patients with an Nd:YAG laser in combination with
medical and surgical treatment. Group I was treated
medically only, for example via antibiotics and antiseptics. Group II was treated medically and surgically.
Group III was treated medically and via LLLT. Finally,
group IV was treated medically, surgically and using
LLLT. Twelve of the 14 patients treated with LLLT
showed significant clinical improvement and reduction in symptoms, nine patients exhibited complete
clinical success. The authors state that while the results of their study were not conclusive, the results indicate that Nd:YAG laser treatment has significant
potential to treat lesions caused by bisphosphonateassociated osteonecrosis.
In 2010, Vescovi et al.49 published the results of a
similar study. Between 2004 and 2008, 91 patients
underwent stomatological observation and 55 sites
affected by osteonecrosis were examined. These
were divided into four groups and different therapeutic modalities were studied. Group I comprised
13 lesions that were treated medically (1 g amoxicillin three times a day and 250 mg metronidazole
twice a day, orally) for a minimum of two weeks.
Group II consisted of 17 lesions that were treated
medically and via LLLT using an Nd:YAG laser
(1,064 nm) once a week for two months. Group III
consisted of 13 cases of avascular necrosis treated
surgically by the removal of necrotic bone, debridement, alveolar removal and corticotomy. Finally,
group IV comprised 12 lesions treated using an
Er:YAG laser (2,040 nm) in combination with LLLT using an Nd:YAG laser.
All of the lesions treated with the Er:YAG laser
showed a clinical improvement of 100 % and complete healing in 87.5 % of the cases. The group IV results differed significantly from those of the other
groups. The authors suggest that the reason for this
is increased accessibility to both soft and bone tissue
using the Er:YAG laser. They therefore highlight the
role of the Er:YAG laser in the treatment of osteonecrosis and conservative surgery. Consequently,
a surgical approach combined with LLLT can be considered the most efficient treatment method for bisphosphonate-associated osteonecrosis.

Fig. 6

Fig. 7

_Conclusion
In the last 20 years, lasers have become an excellent tool in oral surgery. Especially in soft-tissue surgery, laser enables the practitioner to excise tumors
of different types in a safer and more precise manner
than with conventional techniques using a scalpel or
electrotome.

Fig. 6_Long-term case of
vestibuloplasty. Situation on 15th of
May, 2006: no scars.
Final gain of 5,5 mm.
Fig. 7_Long-term case of
vestibuloplasty. Situation on 25th of
November, 2009. Stable results, no
recessions.

Modern laser application is based on our knowledge about absorption and other aspects of working
with a laser beam. Over the past ten years, 980 nm and
810 nm diode lasers have evolved in particular. They
are relatively inexpensive and provide a good compromise between superficial visible absorption and
penetration, in favor of achieving optimal coagulation without necrosis in the depths of the tissue.
As a consequence, fibromas, papillomas or lipomas can be removed even from sites like the lips and
the cheek with a clear operating field and predictable
results. In addition, sutures can be reduced to a minimum and scar formation is also reduced. For hard tissues, erbium lasers appear to be the best choice because of their high absorption in water. Their effect is
based on thermomechanical principles, unlike diode
lasers, which interact thermally. Therefore, water
spray is essential. This way, bone can be removed
without inhibiting healing owing to thermal necrosis. Thus applied, laser can increase the positive effects of oral surgery by providing reliability for the
surgeon and comfort for the patient._

_contact

laser

Prof Dr MSc mult Gerd Volland
Facultad de Odontología
Cirurgia bucal
Universidad de Sevilla
C/ Avicena s/n Sevilla, Spain
dr.volland@t-online.de

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I research

Evaluation of combined
Nd:YAG laser treatment
of moderate periodontitis
A randomised controlled clinical study
Author_Dr Anna-Maria Yiannikou-Loucaidou

_Introduction
One of the main goals of dentistry is the prevention
of disease. Minimally invasive methods of treatment
are preferred. For this reason, the concept of treatment
in periodontology has radically changed over the past
decades. While in the early days, extensive surgical interventions used to be the centre of attention, today
more conservative treatment is the focus.
Treatment procedures recently transitioned from
surgical to non-surgical, after the potential of scaling
and root planning (SRP) to eliminate inflammation
and arrest progression of periodontal disease was successfully demonstrated in a number of clinical trials
(Axelsson & Lindhe 1978; Badersten et al. 1984;
Hirschfeld & Wasserman 1978; Lovdal et al. 1961). Researchers debate whether there is a significant reduction in the depth of the periodontal pocket when the
Nd:YAG laser is applied as an adjuvant therapy.
The balance of evidence seems to favour the improvement of the pocket depth with the use of Nd:YAG
as an additional tool for the periodontal treatment, but
more research still is needed in this area in order to
evaluate the effectiveness of laser treatment with different settings.

aimed at providing insight into the existing debate in
scientific literature regarding the bleeding index and
the depth of the periodontal pocket.
The hypothesis of this study is that the application
of the Nd:YAG laser as an adjunct tool to local, nonsurgical SRP therapy will result in a significantly
greater reduction of the bleeding index and the periodontal pocket depth than the traditional mechanical
treatment of periodontitis alone. Consequently, the
null hypothesis states that there will be no significant
differences between the two test groups on the two
clinical parameters of bleeding index and pocket
depth.

_Materials and methods
A total of 20 healthy patients (twelve women, eight
men), aged between 35 and 55, with mild periodontitis (pockets of a depth of 4 to 6 mm) participated in this
study. Patients were excluded from this study according to the following criteria: smokers, pregnant
women or nursing mothers, type I and type II diabetics, patients currently under antibiotic treatment and
patients who had taken antibiotics within three
months prior to their selection for the study, patients
suffering from cardiovascular disease (high-risk heart
disorder) and patients with contagious diseases (El
Yazami et al. 2004).

_Aims of the present study
The objective of this study is to examine whether
the use of Nd:YAG laser as an adjunct to traditional SRP
improves the results of traditional therapy, especially
concerning the bleeding index and the depth of the periodontal pocket. Furthermore, the present study is

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The patients were randomly selected to be divided
into two groups of ten persons each. Group 1 was chosen to be the test group. Patients were treated according to the protocol of AALZ (Aachen Dental Laser Center) with SRP, using manual instruments combined
with the Nd:YAG laser. Group 2 was assigned to be the

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control group and the patients were treated with SRP
using manual instruments. Additionally, all of the patients were given instructions for oral hygiene routines and methods.
Clinical assessments of the BOP (bleeding on probing) index and mean PD (periodontal pocket depth)
were recorded prior to phase 1, immediately after
phase 2 and three months after phase 3.

_Pre-treatment examination
Every patient was initially assessed by taking his or
her medical history (Armitage 2004; Raffetto 2004).
The patients underwent a clinical and radiographical
examination prior to the treatment. Their X-rays were
taken with the bitewing technique with the Planmeca
dixi 3 digital intra-oral digital imaging system. Two periodontal parameters were registered and charted:
BOP and PD. Measurements were taken for six aspects
of each tooth: mesiobuccal (mb), buccal (b), distobuccal (db), mesiolingual (ml), lingual (l), and distolingual
(dl) using calibrated periodontal probes.

_Initial therapy
Initial therapy entailed removing plaque and polishing the teeth, as well as giving instructions and encouraging the patients.

_Closed curettage
Closed curettage was carried out with mechanical
root planning using hand instruments—Gracey
curettes # 1/2, 3/4, 7/8, 11/12, and 13/14 for both of the
groups (Schwarz et al. 2003). The average amount of
instrumentation in each group was nine minutes for
single-rooted teeth and ten minutes for multi-rooted
teeth.

_Laser treatment
De-epithelisation of the sulcus was performed in
one session, one week after the cleaning of the last
quadrant with a 2,940 nm Er:YAG laser. The following
settings were applied: frequency 20 Hz, energy
100 mJ, average output 2 W, with the aid of an RO7
handpiece, without water, only with the use of air, and
pulse duration 750–950 µs. The laser was used for the
de-epithelisation of the sulcus, effectively removing
the epithelium of the sulcus. This treatment was executed by continuously moving the tip of the RO7
handpiece back and forth from the gingival crest.

Fig. 2

face of the sulcus were frequently wiped off with a cotton roll or wet gauze (Harris et al. 2002). Scientific literature shows that the concept of de-epithelisation
encompasses the promotion of reattachment and the
formation of new connective tissue.

Fig. 1_Mean PD values (mm) during
the three phases of treatment for
both groups.

One week after the de-epithelisation of the sulcus,
pocket sterilisation (Fig. 1) was performed with a 1,064
nm Nd:YAG (output power 2 W, frequency 20 Hz, with
the aid of a 300 µm fibre, pulse duration 75 to 100 µs).
Before the use of the Nd:YAG laser in the pockets, the
area was dried with air. With the aid of a 300 µm thick
quartz fibre placed on the bottom of the pocket, the
pocket was irradiated circularly for 30 to 40 seconds
parallel to the surface of the root, maintaining contact
with the tissue. This procedure was performed in the
entire mouth without anaesthesia, only with the application of topical anaesthetic gel. When signs of
bleeding occurred, the fibre was applied to the next
pocket. The procedure was repeated three times in intervals of four to seven days.
It is important to note that this interval time between the treatments must be strictly kept. If the patients are treated earlier than four days, more tissue
will be removed, the wound will be larger and shrinking will occur. A treatment later than seven days can
result in recolonisation of the periodontal bacteria.

Fig. 2_Mean BOP (%) for both groups
throughout the treatment.

During this procedure, the surface of the sulcus appeared to be a whitish colour and the tip of the RO7
handpiece became covered in the removable epithelium cells. These cells on the handpiece and the sur-

Fig. 3

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The researcher chose the setting parameters above because it was reported that Nd:YAG laser irradiation
with a setting of 100 mJ, 20 Hz, 2 W for 30 seconds only
inhibits the DNA metabolism and the cell division rate
(Gutknecht et al. 1998). In this case, a safe soft-tissue
laser treatment can be performed. White et al. (1994)
examined in vitro the changes of intra-pulpal temperatures during Nd:YAG laser irradiation of root surfaces
at 0.3 to 3.0 W (30 to 150 mJ/pulse, 10 or 20 Hz). They
reported that within the parameters outlined in their
study, pulsed Nd:YAG laser energy should not cause
any devitalising rise in the intra-pulpal temperature
when it is applied to root surfaces with adequate remaining dentine thickness (Aoki et al. 2004).

_Statistical analysis
The data collected was tested for normality by Q-Q
plots and Kolmogorov–Smirnov tests. The data was
found to be normally distributed and parametric tests
were conducted to examine significant differences
between the mean values. Dependent t-tests were
used to check for significant differences between the
same subjects before, during and at the end of the
treatment, and three months post-treatment. This
procedure was carried out in both groups. In addition,
independent t-tests were used to check for significant
differences between the two groups at each phase,
that is, pre-treatment, at the end of the treatment and
three months post-treatment.

_Results
According to the statistical analysis, there were significant differences (p < 0.05) for each group between
phases 1 to 2 and phases 2 to 3 for BOP and PD. More
specifically, the mean PD value decreased in the lasercombined SRP therapy group from 1.28 ± 0.54 mm
(p < 0.05) at the end of the therapy, to 0.25 ± 0.32 mm
(p < 0.05) after three months and in the SRP group
from 1.03 ± 0.81 mm (p < 0.05) at the end of the treatment, to 0.54 ± 0.38 mm (p < 0.05) three months posttreatment (Fig. 2).
Furthermore, the BOP mean value decreased in the
group under laser-combined SRP therapy from 21.6 ±
9.5 % (p < 0.05) at the end of the therapy to 7.3 ±
6.03 % (p < 0.05) three months post-treatment and in
the SRP group from 30.07 ± 20.65 % (p < 0.05) at the
end of the treatment to 7.06 ± 8.66 % (p < 0.05) three
months post-treatment, showing a statistically significant decrease (p < 0.05) between phases 1 and 2
and phases 2 and 3 (Fig. 3).
No significant difference (p > 0.05) in the PD mean
values occurred in the comparisons of the two groups
(pre-treatment: t = 0.2, p = 0.845; end of treatment:
t = - 0.6, p = 0.56; three months post-treatment:

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t = 0.4, p = 0.72). When the two treatment groups were
compared for mean differences in BOP values (%), no
statistically significant differences emerged (p > 0.05)
at any phase of the treatment.

_Discussion
Two parameters of periodontal disease were investigated in this randomised controlled study, the probing depth and the sulcus haemorrhage. The aim of the
present study was to compare the clinical results of
these parameters after non-surgical periodontal
treatment to those of SRP via hand instruments or
Nd:YAG laser as an adjunct tool to the conventional
mechanical instrumentation. The results have demonstrated that non-surgical periodontal treatment with
both of the two treatment modalities leads to a significant reduction in PD and BOP. However, when the two
treatment groups—test and control—were compared
for mean differences in BOP values and in PD values at
each phase of the treatment, there were no significant
differences.

_Conclusion
At this stage and within the framework of the present study, it appears that the use of Nd:YAG combined
with non-surgical periodontal treatment improves
the clinical outcome of an initial periodontal therapy.
The findings should be confirmed by a study of a larger
number of patients, a longer follow-up period, different treatment-planning protocols and different energy settings. Furthermore, basic and clinical studies
are required in order to clarify the application of the
Nd:YAG laser as a complementary therapy in periodontal therapy.
A bright future lies ahead for laser applications in
periodontal procedures. Laser-assisted therapy is a
successful treatment option that can effectively help
the patient to maintain optimal periodontal health._
Editorial note: A complete list of references is available
from the publisher.

_contact
Dr Anna-Maria Yiannikou-Loucaidou
RWTH Aachen University
Yiannikou Dental Polyclinic
8 Alkeous and Pindarou St.
1060 Nicosia, Cyprus
Tel.: +357 22 764765
Fax: +357 22 756160
annamariadentist@yahoo.com

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The antibacterial
effects of lasers in
endodontics
Author_ Dr Selma Cristina Cury Camargo, Brazil

Clinically, apical periodontitis is not evident as
long as the necrotic tissue is not infected with microorganisms.4–6 There are up to 40 isolated species of
bacteria present in the root canal. Cocci, rods, filaments,
spirochaetes, anaerobic and facultative anaerobic microorganisms are frequently identified in primary infections. Fungus can also be isolated.2,7 Endodontic
microbiota can be found suspended in the main root
canal, attached to the canal walls and deep in the
dentinal tubules at a depth of up to 300µm (Figs.
2a–c). The absence of cementum dramatically increases bacterial penetration into dentinal tubules.8–11

_Endodontic infection

It has been shown that bacteria can also been
found outside the root-canal system, located at the
apical cementum and as an external biofilm on the
apex.12–15 Following conventional endodontic treatment, 15 to 20% of non-vital teeth with apical periodontitis fail.16–18 The presence of bacteria after the
decontamination phase or the inability to seal root
canals after treatment are reasons for failure.2 The
remaining contamination in endodontically treated
teeth continues the infectious disease process in the
periapical tissue.

Endodontic treatment can attain success rates of
between 85 and 97%.1 Adequate treatment protocols, knowledge and infection control are essential
to achieving such rates (Figs. 1a–d).2 It is well known
that apical periodontitis is caused by the communication of root-canal micro-organisms and their byproducts to the surrounding periodontal structures.
Exposure of dental pulp directly to the oral cavity or
via accessory canals, open dentinal tubules or periodontal pockets is the most probable route of the
endodontic infection.2,3

Retreatments are the first choice for failed root
canals. The microbiota found in persistent infections
differ from that in primary infection (Figs. 3a–c). Facultative anaerobic Gram-positive (G+) and -negative
(G-) micro-organisms and fungi are common.19–21
Special attention is given to Enterococcus faecalis,
a resistant facultative anaerobic G+ cocci, identified
in a much higher incidence in failed root canals.22–25
Bacterial control plays a significant role in endodontic success. Adequate and effective disinfection of the
root-canal system is necessary.

Fig. 1

Fig. 1_Success in endodontic
treatment: apical radiolucency repair.

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Fig. 2_Primary infection: black
pigmented strains and G-rods.
Fig. 3_Persistent infection.

Fig. 2

_Endodontic therapy
The bacterial flora of the root canal must be actively eliminated through a combination of debridement and antimicrobial chemical treatment. Mechanical instrumentation eliminates more than 90%
of the microbial amount.26 An important point to note
is the adequate shaping of the root canal. Evaluating
the antibacterial efficacy of mechanical preparation
itself, Dalton et al.27 conclude that instrumentation to
an apical size of #25 resulted in 20% of canals free of
cultivable bacteria. When shaped to a size of #35,
60% showed negative results.
An Irrigating solution has been used with mechanical instrumentation to facilitate an instrument’s cutting efficiency, remove debris and the
smear layer, dissolute organic matter, clean inaccessible areas and act against micro-organisms. Sodium
hypochlorite is the most common irrigant used in endodontics.28 It has an excellent cleansing ability, dissolves necrotic tissue, has a potential antibacterial effect and, depending on the concentration, is well tolerated by biological tissues. When accompanied by
mechanical instrumentation, it reduces the number
of infected canals by 40 to 50%.

Fig. 4a

Fig. 3

Other irrigating solutions can also be used during
endodontic preparation. EDTA, a chelating agent used
primarily to remove the smear layer and facilitate the
removal of debris from the canal, has no antibacterial
effect.29 Chlorhexidine gluconate has a strong antibacterial effect on an extensive number of bacterial
species, even the resistant E. faecalis, but it does not
break down proteins and necrotic tissue as sodium
hypochlorite does.30
As mechanical instrumentation and irrigating
solutions are not able to eliminate bacteria from the
canal system totally—a requirement for root-canal
filling—additional substances and medicaments have
been tested in order to address the gap in standard
endodontic protocols. The principal goal of dressing
the root canal between appointments is to ensure
safe antibacterial action with long-lasting effects.31 A
great number of medicaments have been used as
dressing material, such as formocresol, camphorated
parachlorophenol, eugenol, iodine-potassium iodide,
antibiotics, calcium hydroxide and chlorhexidine.
Calcium hydroxide has been used in endodontic
therapy since 1920.31 With a high pH at saturation (pH
above 11), it induces mineralisation, reduces bacteria

Figs. 4a & b_Nd:YAG laser
intra-canal irradiation.
Fig. 5_Nd:YAG laser irradiation,
deep penetration.

Fig. 4b

Fig. 5

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_Lasers in endodontics
Lasers were introduced to endodontics as a complementary therapy to conventional antibacterial
treatment. The antibacterial action of Nd:YAG,
diodes, Er:YAG and photoactivated disinfection
(PAD) have been explored by a number of investigators. In the following section, each laser is evaluated
with the aim of selecting an adequate protocol with
a high probability of success in teeth with apical periodontitis.
Nd:YAG laser
The Nd:YAG laser was one of the first lasers
tested in endodontics. It is a solid-state laser. The
active medium is usually yttrium aluminium garnet
(Y3Al5O12), where some Y 3+ ions are replaced by
Nd3+ions. It is a four-level energy system operating
in a continuous wave or pulsed mode. It emits a
1,064 nm infra-red wavelength. Thus, this laser
needs a guide light for clinical application. Flexible fibres with a diameter between 200 and 400 µm are
used as delivery systems. The laser can be used on intra-canal surfaces, in contact mode (Figs. 4a & b).

Fig. 6a

Figs. 6a & b_Diode 980 nm
intra-canal irradiation.

and dissolves tissue. For extended antibacterial effectiveness, the pH must be kept high in the canal and in
the dentine as well. Sustaining the pH depends on the
diffusion through dentinal tubules.32
Although most micro-organisms are destroyed
at pH of 9.5, a few can survive a pH of 11 or higher, such
as E. faecalis and Candida.21 Because of the resistance
of some micro-organisms to conventional treatment
protocols—and the direct relation between the presence of viable bacteria in the canal system and the
reduced rate of treatment success—additional effort
has to be made to control canal system infection.

The typical morphology of root-canal walls
treated with the Nd:YAG laser shows melted dentine
with a globular and glassy appearance, and few areas
are covered by a smear layer. Some areas show dentinal tubules sealed by fusion of the dentine and deposits of mineral components.33,34 This morphological modification reduces dentine permeability significantly.35,36 However, because the emission of the
laser beam from the optical fibre is directed along the
root canal and not laterally, not all root-canal walls
are irradiated, which gives more effective action at
the apical areas of the root.37 Undesirable morphological changes, such as carbonisation and cracks,
are seen only when high energy parameters are used.
One of the major problems regarding intra-canal
laser irradiation is the temperature increase at the
external surface of the root. Laser light exerts a thermal effect when it reaches tissue. The heat is directly
associated with the energy used as well as time and
irradiation mode. An increase in temperature levels
above 10°C per minute can cause damage to periodontal tissues, such as necrosis and anchylosis.
Lan38 evaluated in vitro the temperature increase
on the external surface of the root after irradiation
with a Nd:YAG laser under the following energy
parameters: 50, 80 and 100 mJ at 10, 20 and 30 pulses
per second. The increase of temperature was less
than 10°C. The same results were obtained by Bachman et al.39, Kimura et al.40 and Gutknecht et al.41
In contrast to the external surface, the intra-canal
temperature rises dramatically at the apical area,

Fig. 6b

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promoting effective action against bacterial contamination. For the Nd:YAG laser, 1.5W and 15Hz, are
safe energy parameters for temperature and morphological changes.33,41

100 mJ/30 pulses per second for 30 seconds was safe
to surrounding root tissues. Maresca et al.,52 using
human teeth indicated for apical surgery, corroborated Suda et al.’s51 and Ianamoto et al.’s53 results.
Koba et al.54 analysed histopathological inflammatory response after Nd:YAG irradiation in dogs at 1
and 2 W. Results showed significant inflammatory
reduction at four and eight weeks compared with
the non-irradiated group.
Clinical reports published in the literature confirm
the benefits of intra-canal Nd:YAG irradiation. In
1993, Eduardo et al.55 published a successful clinical
case that combined conventional endodontic treatment with Nd:YAG irradiation for retreatment, apical
periodontitis, acute abscess and perforation. Clinical
and radiographic follow-up showed complete healing after six months.
Similar results were shown by Camargo et al.56
Gutknecht et al.57 reported a significant improvement in the healing of laser-treated infected canals,
when compared with non-irradiated cases.

Fig. 7_Er:YAG laser.

Fig. 7

The primary use of the Nd:YAG laser in endodontics is focused on elimination of micro-organisms
in the root-canal system. Rooney et al.42 evaluated
the antibacterial effect of Nd:YAG lasers in vitro.
Bacterial reduction was obtained considering
energy parameters. The researchers developed different in- vitro models simulating the organisms
expected in non-vital, contaminated teeth. Nd:YAG
irradiation was effective for Bacillus stearothermophilus,43,44 Streptococcus faecalis, Escherichia
coli,45 Streptococcus mutans,46 Streptococcus
sanguis, Prevotella intermedia 47 and a specific micro-organism resistant to conventional endodontic
treatment, E. faecalis.48–50 Nd:YAG has an antibacterial effect in dentine at a depth of 1,000 µm
(Fig. 5).50
Histological models were also developed in order
to evaluate periapical tissue response after intracanal Nd:YAG laser irradiation. Suda et al.51 demonstrated in dog models that Nd:YAG irradiation at

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Camargo et al.58 compared in vivo the antibacterial effects of conventional endodontic treatment
and the conventional protocol associated with the
Nd:YAG laser. Asymptomatic teeth with apical radiolucency and necrotic pulps were selected and divided into two groups: conventional treatment and
laser-irradiated. Microbiological samples were taken
before canal instrumentation, after canal preparation and/or laser irradiation and one week after treatment. The results showed a significant antibacterial
effect in the laser group compared to conventional
treatment. When no other bactericidal agent was
used, it was assumed that the Nd:YAG laser played a
specific role in the bacterial reduction for endodontic treatment in patients.
Diodes
The diode laser is a solid-state semiconductor
laser that uses a combination of gallium, arsenide,
aluminium and/or indium as the active medium. The
available wavelength for dental use ranges between
800 and 1,064 nm and emits in continuous wave
and gated pulsed mode using an optical fibre as the
delivery system (Figs. 6a & b). Diode lasers have
gained increasing importance in dentistry owing to
their compactness and affordable cost. A combination of smear layer removal, bacterial reduction and
reduced apical leakage are advantages of this laser
and make it viable for endodontic treatment. The
principal laser action is photo-thermal.
The thermal effect on tissue depends on the irradiation mode and settings. Wang et al.59 irradiated
root canals in vitro and demonstrated a maximum

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Fig. 8

temperature increase of 8.1°C using 5 W for seven
seconds. Similar results were obtained by Da Costa
Ribeiro.60 Gutknecht et al.61 evaluated intra-canal
diode irradiation with an output of 1.5 W and observed a temperature increase of 7°C in the external
surface of the root using a 980 nm diode laser at a
power setting of 2.5 W at a continuous and chopped
mode, and found that the temperature increase
never exceeded 47°C, which is considered safe for
periodontal structures.41
Morphological changes at the apical portion of
the root after intra-canal diode irradiation were observed in clean intra-canal dentinal surfaces with
sealed dentinal tubules, indicating melting and recrystallisation.62 In general, near infra-red wavelengths, such as 1,064 and 980 nm, promote fusion
and recrystallisation on the dentinal surface, sealing
dentinal tubules.
The apparent consensus is that diode laser irradiation has a potential antibacterial effect. In most
cases, the effect is directly related to the amount of
energy delivered. In a comparative study by Gutknecht et al.,63 an 810 nm diode was able to reduce
bacterial contamination by up to 88.38 % with a
distal output of 0.6 W in continuous wave mode.
A 980 nm diode laser has an efficient antibacterial
effect of an average of between 77 to 97 % in root
canals contaminated with E. faecalis. Energy outputs of 1.7, 2.3 and 2.8 W were tested. Efficiency was
directly related to the amount of energy and dentine
thickness.64

The morphology of a dentinal surface irradiated
with an Er:YAG laser is characterised by clean areas,
showing open dentinal tubules free of a smear layer,
in a globular surface. Bacterial reduction using the
Er:YAG was observed by Moritz et al.65

Fig. 8_Therapeutic plan.

Stabholz et al.37 describe a new endodontic tip
that can be used with an Er:YAG laser system. The tip
allows lateral emission of the radiation rather than
direct emission through a single opening at the far
end. It emits through a spiral tip located along the
length of the tip. Examining the efficacy of the
spiral tip in removing the smear layer, Stabholz et al.66
found clean intra-canal dentinal walls free of a
smear layer and debris under SEM evaluation.
Photoactivated disinfection
PAD is another method of disinfection in endodontics and is based on the principle that photoactivated substances, which are activated by light of a
particular wavelength, bind to target cells. Free radicals are formed, producing a toxic effect to bacteria.

Fig. 9_Intra-canal laser irradiation,
molar.

Er:YAG laser
Er:YAG lasers are solid-state lasers with a lasing
medium of erbium-doped yttrium aluminium garnet
(Er:Y3Al5O12). Er:YAG lasers typically emit light with
a wavelength of 2,940nm, which is infra-red light.
Unlike Nd:YAG lasers, the output of an Er:YAG laser
is strongly absorbed by water because of atomic resonances. The Er:YAG wavelength is well absorbed by
hard dental tissue. This laser was approved for dental procedures in 1997. Smear layer removal, canal
preparation and apicoectomy are indications for
endodontic use (Fig. 7).

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For this reason, laser procedures have been incorporated into conventional therapeutic concepts to
improve endodontic therapy (Figs. 8a–d).
Clinical studies have proven the benefits of an
endodontic laser protocol in apical periodontitis
treatment. For endodontic treatment, the protocol
entails standard treatment strategies for cleaning
and shaping the root canal to a minimum of #35,
irrigating solutions with antibacterial properties and
intra-canal laser irradiation using controlled energy
parameters. Ideal sealing of the root canal and adequate coronal restoration are needed for an optimal
result.

Fig. 10

Fig. 10_Intra-canal laser irradiation,
technique.

Toluidine blue and methylene blue are examples of
photoactivated substances. Toluidine blue is able to
kill most oral bacteria. In in vitro studies, PAD has an
effective action against photosensitive bacteria such
as E. faecalis, Fusobacterium nucleatum, P. intermedia, Peptostreptococcus micros and Actinomycetemcomitans.67,68 On the other hand, Souza et
al.,69 evaluating PAD antibacterial effects as a supplement to instrumentation/irrigation of canals infected with E. faecalis, did not prove a significant effect regarding intra-canal disinfection. Further adjustments to the PAD protocols and comparative
research models may be required before recommendations can be made regarding clinical usage.

_Discussion and conclusion
There are good reasons to focus the treatment of
non-vital contaminated teeth on the destruction of
bacteria in the root canal. The possibility of a
favourable treatment outcome is significantly
higher if the canal is free from bacteria when it is obturated. If, on the other hand, bacteria persist at the
time of root filling, there is a higher risk of treatment
failure. Therefore, the prime objective of treatment is
to achieve complete elimination of all bacteria from
the root-canal system.2,31
Today, the potential antibacterial effect of laser
irradiation associated with the bio-stimulation action and accelerated healing process is well known.
Research has supported the improvement of endodontic protocol. Laser therapy in endodontic treatment offers benefits to conventional treatment,
such as minimal apical leakage, effective action
against resistant micro-organisms and external apical biofilm, and an increase in periapical tissue repair.

22 I laser
2_ 2012

In practice, little additional time is required for
laser treatment. Irradiation is simple when flexible
optical fibres of 200 µm in diameter are used. The
fibre can easily reach the apical third of the root
canal, even in curved molars (Fig. 9). The released
laser energy has an effect in dentine layers and beyond the apex in the periapical region. The laser’s effect extends to inaccessible areas, such as external
biofilm at the root apex.
The irradiation technique must adhere to the following basic principles. A humid root canal is required and rotary movements from the coronal portion to the apex should be carried out, as well as scanning the root canal walls in contact mode (Figs.
10a–c). The power settings and irradiation mode depend on one’s choice of a specific wavelength.
Nd:YAG, diodes of different wavelengths,
Er:YAG, and low-power lasers can be used for different procedures with acceptable results. Laser
technology in dentistry is a reality. The development
of specific delivery systems and the evolution of
lasers combined with a better understanding of
laser–tissue interaction increase the opportunities
and indications in the endodontic field._
Editorial note: A complete list of references is available
from the publisher.

_contact
Dr Selma Camargo
University of São Paulo
Rua Pinto Gonçalves, 85/54 Perdizes
São Paulo, SP 05005-010
Brazil
selmacris@me.com

laser

[23] =>

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I overview

Laser treatment of
dentine hypersensitivity
An overview Part II
Author_Dr Ute Botzenhart, Dr Andreas Braun & Prof Matthias Frentzen, Germany

_Introduction
More than two decades ago, laser applications in
the treatment of dentine hypersensitivity were introduced to dentistry. Many clinical studies using different laser types have been published since. This
overview summarises the basic and clinical aspects,
including treatment protocols.
In the last issue of laser, conventional approaches
towards the treatment of dentine hypersensitivity
were discussed with regard to a set of criteria for a
successful treatment as proposed by L. I. Grossman
(1935). The authors came to the conclusion that, so
far, no conventional therapy has been able to meet all
the criteria. The authors then moved on to studies on
laser treatment. Studies on GaAIAs laser and He-Ne
lasers were introduced and analysed. Part I of this article was finished by a comparison between He-Ne
lasers and Nd:YAG lasers.
Fig. 1_Laser wavelength and
absorption spectrum of the different
laser types used for desensitization in
human tissues.

Fig. 1

24 I laser
2_ 2012

Part II in this issue of laser continues with studies
on the application of Nd:YAG lasers in dental therapies as well as an overview on Er:YAG lasers.

_Middle-output power lasers:
Nd:YAG laser
The Nd:YAG laser with a wavelength of 1,064 nm
belongs to the group of middle-output power lasers.
Matsumoto et al. (1985b) referred to the application of
this laser type in the therapy of dentine hypersensitivity. Since then, it has been established for the therapy
of dentine hypersensitivity in a number of studies (Dilsiz et al. 2009; Yonaga et al. 1999; Kobayashi et al.
1999; Gutknecht et al. 1997; Lan et al. 1996; RentonHarper et al. 1992; Gelsky et al. 1992; White et al. 1990;
Goodis et al. 1989; Matsumoto et al. 1985b).
The energy level used ranges from 0.3 to 10 W, with
the most frequent use of 1 or 2 W (Kimura et al. 2000b).
The methods of application are highly dependent on
the laser energy used and vary according to this, from
0.3 W for 90 seconds in non-contact mode up to 2 W
for 0.5 seconds with the application of an absorber in
contact mode (Kimura et al. 2000b). In different studies, the efficiency of therapy ranges from 5 to 100 %
(Kimura et al. 2000b). Among the middle-output
power lasers, the Nd:YAG laser is regarded as exceedingly effective (Dilsiz et al. 2010b; Birang et al. 2007; De
Magalhaes et al. 2004; Yonaga et al. 1999). In a comparative in vitro study of the ability of Er,Cr:YSGG,
Nd:YAG, CO2 and diode lasers to melt dentinal tubules,
all laser types had a statistically significant ability to
seal perpendicular dentine and occlude dentinal
tubules partially or totally, but the highest reduction in
mean tubule diameter resulted from the Nd:YAG laser
with 53 % effectiveness (Gholami et al. 2011). Comparable results were also found by Dilsiz et al. (2009),
comparing immediate and late therapeutic effects after Nd:YAG (1 W, 10 Hz, 60 seconds, non-contact mode,
without cooling) and diode-laser application (25 mW,
9 Hz, 100 seconds). Both were effective in reducing
dentine hypersensitivity, but there was a higher suc-

[25] =>

overview

cess rate after Nd:YAG laser application, especially after immediate application and 60 days after concluding the treatment.
Abed et al. (2011) compared the sealing ability of
Nd:YAG laser application (1 W, 10 Hz, 60 seconds, noncontact mode without cooling) to that of a resin (Seal
& Protect®, DENTSPLY DeTrey) applied to exposed human dentinal tubules in vitro. Compared with the control group, laser application showed a homogeneous
dentinal surface with less exposed tubules and a reduction in the diameter of the exposed tubules of
50 %. Nevertheless, in this study, the resin was much
better, with a 90 % sealing ability compared with the
control group (Abed et al. 2011).
Effects of Nd:YAG laser application
When using Nd:YAG laser light and black ink as an
absorption amplifier, it is recommended that deep
penetration of laser light through enamel and dentine
be evaded so that excessive harmful effects on the pulpal tissue can be avoided (Launay et al. 1987) and surficial sealing effects can be enhanced (Morioka et al.
1984; Gelsky et al. 1993; Yonaga et al. 1999; Kobayashi
et al. 1999). The closure or narrowing of dentinal
tubules (Lan & Liu 1995, 1996) and direct nerve analgesia are assumed to be mechanisms of Nd:YAG laser
light action (Whitters et al. 1995). In an in vitro SEM examination, the melting of dentinal tubule openings
and the solidification of the dentine surface with a
penetration depth varying between 1 to 7 µm were observed, depending on irradiation parameters (30 mJ,
0.3 W, 7 Hz; 40 mJ, 0.4 W, 7 Hz for 43 seconds with a
ten-second interval; De Magalhaes et al. 2004).
In a study by Moriyama et al. (2004), morphological and chemical changes in human dentine surfaces
resulting from Nd:YAG laser irradiation with different
pulse durations were observed. SEM analysis confirmed a melting and resolidification with larger resolidification structures and a smoother surface after
using long pulses. An increased concentration of
calcium and phosphorous was also found in all irradiated samples compared with the control group, possibly making it less susceptible to acid dissolution
(Moriyama et al. 2004). Laser of a wavelength of
1,064 nm also demonstrates effects upon microcirculation (Funato et al. 1991; Zennyu et al. 1996).
Causes of the analgesic effects of Nd:YAG lasers
A multitude of theories on the way in which the
Nd:YAG laser induces its analgesic effect have been
suggested (Kimura et al. 2000b). For example, laser energy is thought to interfere with the sodium pump and
alter the cell membrane permeability and/or affect the
endings of sensory axons (Myers et al. 1991). Not only
can Nd:YAG laser application block off the depolarisation of very slow C-fibre afferences, but it can also af-

Fig. 2

fect fast-conducting A-ß-fibres (Orchardson et al.
1997). It is also thought that a desensitising effect can
be achieved by denaturing the odontoblast process
and by overheating dentinal fluid (White et al. 1990;
Goodis et al. 1989).
A glazing of the dentine was described after the application of Nd:YAG laser light to the exposed tooth
neck (Birang et al. 2007; Lan et al. 2004; Dederich et al.
1984; Halket et al. 1996). The result was a glazed, noncavernous surface with closure of the exposed tubules
and without surface cracks. When using an Nd:YAG
laser, the sealing depth is dependent on the chosen parameters and the optical properties of dentine. With
the use of 30 mJ/pulse and 10 Hz, the sealing depth is
less than 4 µm (Liu et al.1997). In an in vivo study by
Gutknecht et al. (1997), different laser parameters for
Nd:YAG laser application were tested. Roughly the
same success rates were detected in each case. It was
concluded that Nd:YAG laser light must have been effective even with a low-energy dose. Manton et al.
(1992) compared the effect of the Nd:YAG laser with
that of an untreated control group. Directly before and
after laser application, as well as after three and
28 days, the time it took for teeth to become painful after cold stimuli was measured. Nd:YAG laser light application showed a statistically significant clinical improvement over a period of 28 days. These results were
confirmed by a study by Yonaga et al. (1999). Recrudescence occurred after more than two months. After a
follow-up period of one year, the effectiveness of
Nd:YAG laser application was 85.4 % effective compared with 90 % immediately after the application
(Zhang 1990).

Fig. 2_SEM examination of a human
cervical dentinal surface after
removal of the smear layer with 50 %
citric acid for one minute to open up
the dentinal tubules and simulate
hypersensitive dentine and
application of Bifluorid 12®
(combination of sodium fluoride and
calcium fluoride, 1,000 xmagnification). Dentinal tubules are
totally or partially closed by
fluoride-containing covering layer.

Hu (2004) analysed the effect of a pulsed Nd:YAG
laser in the therapy of dentine hypersensitivity compared with a control group treated with NaF. The effectiveness immediately after laser application, and
one month and six months after was significantly better compared with the control group (Hu 2004). Cia-

laser
2
I 25
_ 2012

[26] =>

I overview
ramicoli et al. (2003) also confirmed the results of the
studies described above. The effect of Nd:YAG laser irradiation (2 W, 100 mJ, 20 Hz, 60 seconds, with air cooling) compared with conventional fluoridation (Bifluorid 12®, VOCO, Fig. 2) immediately after and one, two,
three and four weeks after application showed a significant improvement in VAS scores to air blast immediately after and one week after laser treatment (Kara
et al. 2009). Whereas at weeks two, three and four in
the fluoridated group, VAS scores decreased up to
nearly 75 to 85 % of the baseline scores, VAS scores remained nearly unchanged in the laser group. Fluoride
was applied in three consecutive visits in this study, but
laser was only applied once. Nd:YAG laser irradiation
thus appears to be a suitable tool for the immediate
and successful reduction of pain within a shorter
treatment time.
Recurring dentine hypersensitivity
The mechanism of the recurrence of dentine hypersensitivity is unknown (Yonaga et al. 1999), but it is
assumed that after laser treatment, a reappearance of
symptoms depends on the initial intensity of the dentine hypersensitivity before the application (Yonaga et
al. 1999). The irradiation of the cervical region with
Nd:YAG laser light under the use of an absorber enhances the efficiency—with this method, a recurrence
of the symptoms can be delayed (Yonaga et al. 1999).
According to this study, morphological aspects, in addition to analgesic effects, are assumed to be important for the sustainability of treatment effects (Yonaga et al. 1999).
Side-effects
The thermal impacts of laser light on the pulpal tissue constitute a problem for using Nd:YAG laser in
vivo. Compared with other laser types, the Nd:YAG
laser beam has deep penetration into dentine, bone
and soft tissue (Dederich 1993; Zennyu et al. 1996). Exposure of dentine beyond the safety threshold can
cause thermal damage to the pulpal tissue (Yonaga et
al. 1999; Zhang 1990; Matsumoto et al. 1988; Zach et
al. 1965). However, clinical studies state that despite
the danger of thermal damage, no side-effects were
found (Yonaga et al. 1999).
Other clinical studies examined a partial oxygen
saturation of pulpal blood in anterior hypersensitive
teeth after Nd:YAG laser irradiation (1 W, 10 Hz, 60 seconds, non-contact mode, without cooling) as a possible indicator of pulpal damage. A slight but significant
increase in the oxygen saturation of the pulpal blood
was observed immediately and one week after laser
application compared with the control group. However, partial oxygen saturation of pulpal blood in lasertreated teeth had gained its pretreatment level at follow-up measurement after one month, thus maintaining the teeth vitality and indicating no irreversible

26 I laser
2_ 2012

damage in the dental pulp after laser application
within the limit of desensitisation parameters (Birang
et al. 2008).
The additional use of an absorber defines the depth
effect of Nd:YAG laser light and reduces the possibility of side-effects. Zapletalova et al. (2007) tested different dye solutions for topical application in combination with Nd:YAG laser energy and found erythrosin
to be the best agent to avoid damage to the dentinal
structure. Sealing of tubules occurred after four doses
of 30 mJ pulses (total energy density 33 J/cm2).
Concerning efficiency and simplicity, the application of Nd:YAG laser light is a relevant treatment
method for clinical practice (Yonaga et al. 1999). The
great variances in the different studies can be explained by morphological differences that inevitably
occur on account of intra- and inter-individual variation of the dentine structure and depend, among others, on the age and clinical history of the teeth
(Moriyama et al. 2004). For example, in their SEM examination of the occluding ability of Nd:YAG laser on
exposed human dentine compared with a resin, Abed
et al. (2011) discovered that the number and diameter
of dentinal tubules vary significantly from tooth to
tooth even for different sections of the same tooth.
This confirms most of the clinical findings morphologically.
Combined treatment with Nd:YAG laser and fluoride
The clinical application of the Nd:YAG laser and NaF
varnish, as well as Nd:YAG laser light alone, showed
significant improvement in dentine hypersensitivity in
each case (Kumar et al. 2005). However, the combination of the Nd:YAG laser and NaF varnish showed a
greater efficiency compared with either of these used
alone (Kumar et al. 2005). SEM examinations confirm
the clinical results. A reduction in the number of open
tubules was combined with an improvement in the efficiency of the therapy (Kumar et al. 2005). The study
by Ciaramicoli et al. (2003) supports the above results.
Hsu et al. (2006) also hypothesised the improved desensitising effect of a combined treatment. A fluoridecontaining dentine desensitiser was first applied and
this was followed by Nd:YAG laser irradiation
(1,062 nm, 33 mJ, 50 pulses/second [pps] for two minutes in slight contact) resulted in long-lasting acid and
brushing resistance. The posttreatment was carried
out very briefly and the integration of fluoride into the
dentinal surface was not confirmed by structural
analysis. This confines the validity of this study. Qualitative microanalysis of ions and ultrastructural
changes in dentine exposed to Nd:YAG laser (1.5 W,
100 mJ, 15 Hz, 60 seconds, energy density 125 mJ/cm2,
with black ink as dye solution) and flouride solutions
(10 % SnF2 for 30 minutes; 10 % SrCl2 for 30 minutes)
proved the capability of the Nd:YAG laser to alter the

[27] =>

overview

dentinal structure by melting and resolidification of
the surface with an occluding effect on exposed dentine and additionally altering the absorption of ions,
leading to a better infiltration into the dentinal structure (Glauche et al. 2005). After the combined use of
the Nd:YAG laser and 10 % SnF2, Sn2+ could be detected up to 250 µm in EDX analysis compared with
100 µm without laser application. The combined use of
the Nd:YAG laser and 10 % SrCl2 resulted in an uptake
of Sr2+ up to 500 µm compared with 23 µm without
laser irradiation (Glauche et al. 2005).

Comparative studies of Er:YAG lasers
Schwarz et al. (2002) compared the efficiency of
Er:YAG laser application (80 mJ/pulse and 3 Hz) and a
conventional treatment and observed a significant
improvement in symptoms directly after the application of both of the two treatments and after six months
compared with the control group. However, at two and
six months, the group treated with fluoride varnish
showed an increase in dentine hypersensitivity compared with the group treated with laser. The latter had
the same level as directly after the laser treatment.

_Middle-output power lasers:
Er:YAG laser

Another comparative in vivo study evaluating the
effect of the Er:YAG and CO2 lasers and the combination of these laser types with fluoride application (NaF)
proved the efficiency of the two treatment options.
With the use of Er:YAG laser light at energy levels of
60 mJ at 30 Hz for 10 seconds without water/air spray
alone or in combination with fluoride, the clinical improvement in discomfort determined by a cold-air
blast and VAS score was significantly reduced one
week, one month and six months after treatment compared with a control group treated solely with fluoridation. No significant differences between Er:YAG
laser application and CO2 laser application as a single
dose or as a combined treatment were observed (Ipci
et al. 2009).

Today, there are only a few clinical studies on the
application of the Er:YAG laser (2,940 nm) in the therapy of dentine hypersensitivity. A possible explanation
for the desensitising effect of the Er:YAG laser is its
high absorption in water; thereby an evaporation of
dentinal fluid and the retention of the smear layer with
a deposition of insoluble salts in the exposed dentinal
tubules are assumed (Moritz et al. 2006). Another possible explanation for the Er:YAG laser effects in the
treatment of dentine hypersensitivity is an analgesic
effect on the pulpal nerves, which would explain the
immediate effect and the progressive increase of
symptoms after irradiation over time (Badran et al.
2011).
SEM analysis of human dentine after Er:YAG laser irradiation (300 mJ, 10 pps, ten seconds; up to 700 mJ,
10 pps, ten seconds, with and without water cooling)
demonstrated that laser energy of 500 mJ/pulse at
10 pps for ten seconds was sufficient for inducing melting and recrystallisation of dentine crystals (Lee et al.
2004). At irradiation parameters of 60 mJ, 2 Hz, without air/water-cooling on human dentine in vitro for 30,
60 or 120 seconds, a partial reduction in tubule diameter (30 seconds), an almost complete obliteration of exposed tubules with visible signs of melting (60 seconds)
and complete occlusion with a rugous melted dentinal
surface were observed (Badran et al. 2011). A decrease
in dentine permeability in 26.05 % was also achieved at
60 mJ and 2 Hz for four applications of 20 seconds in
vitro (Aranha et al. 2005). The use of water-cooling is
important for the reduction of thermal effects (Lee et
al. 2004). Firoozmand et al. (2008) proved that the in
vitro use of an Er:YAG laser (250 mJ, 4 Hz, 80 s,
19 mJ/cm2, non-contact mode, with constant watercooling) for cavity preparation on bovine dentine did
not exceed the critical temperature of 5.5 °C.
Clinical investigations of Er:YAG laser application
(100 mJ, 3 Hz, two applications of 60 seconds) have
found an acceptable therapeutic effect with reduction
in pain over a period of up to six months (Birang et al.
2007).

Similar results in an in vitro study that compared
the occluding ability of the Er:YAG laser (60 mJ, 30 Hz,
ten seconds) and CO2 laser (1 W, cw, one second) application alone or in combination with 2 % NaF gel corroborated the clinical findings mentioned above. A
melted appearance along with the occlusion of the
dentinal tubules could be found in all irradiated
groups, but in terms of number and diameter of open
tubules, no significant differences between the laser
only and the combination group were found (Cakar et
al. 2008)._
Editorial note: To be continued in our next issue of laser. A
complete list of references is available from the publisher.

_contact

laser

Dr Ute Botzenhart
Department of Orthodontics
Centre of Dentistry and Oral Health
Ernst Moritz Arndt University of Greifswald
Germany
Dr Andreas Braun/Prof Matthias Frentzen
Department of Periodontology, Operative
and Preventive Dentistry
University of Bonn
Germany

Scan QR-Code for part I
of this article with
your smart phone.

laser
2
I 27
_ 2012

[28] =>

I case report

A novel technique of
Er:YAG laser-enhanced
early implant stability
Author_Dr Kenneth Luk & Dr Ryan S. K. Seto, China

_Introduction
Over the years, developments in implant dentistry
have concentrated on implant design and surface
treatment of titanium,1–11 and successful osseointegration12 is now considered the minimum standard for all
implants.
To avoid bone necrosis, preparation of the osteotomy site is commonly achieved with a series of
drills and copious water irrigation. Studies show that
erbium lasers with water spray can also be used to prepare the site.13–17 However, little attention has been paid
to the possibilities of laser conditioning after drill
preparation of the implant site.

Fig. 1_IO360 tip. (Courtesy of
elexxion AG)
Fig. 2_Representation of the beam
profile of the IO360 tip at 1 W
emission. (Courtesy of elexxion AG)
Fig. 3_SEM image of sample 1,
the SDS-prepared site, showing
smear layer in bovine bone.

Fig. 1

The Er:YAG laser has a wavelength of 2,940 nm. It
falls within the mid-infra-red region (invisible to the
human eye) and is well absorbed by water molecules
and hydroxyapatite. Since water is one of the main constituents of all oral hard and soft tissues, the Er:YAG
laser is therefore used in the ablation of tooth, bone and
dental soft tissue.18–33
Er:YAG laser osteotomy and drill osteotomy have
been compared in animal studies.16, 17, 34, 35 In these in-

Fig. 2

28 I laser
2_ 2012

vestigations, laser osteotomy yielded comparable or
better results than drill osteotomy in terms of bone
healing, and some of these studies14, 16, 35 showed
favourable laser results for bone-to-implant contact.
Romanos et al.13 demonstrate that Er:YAG laser irradiation appears to stimulate the secretion of platelet-derived growth factor when preparing osteotomy sites in
a rat model. The study postulates that laser irradiation
could improve the healing of those sites. Aleksic et al.36
demonstrate the low-level laser effect of Er:YAG laser
irradiation with the enhancement of osteoblast proliferation.

_Objective
The authors thus instituted a study to investigate
the possibility of using an Er:YAG laser to condition an
osteotomy site prepared according to a standard
drilling sequence (SDS). They utilised a newly designed
tip, performed a simple in vitro experiment, and then
proceeded to test the technique with two clinical
cases. The aim of this study was to compare the stability values of implant placement with and without
Er:YAG laser conditioning of the bone surface following an SDS. The maxillary region was chosen for both
patients.

Fig. 3

[29] =>

implants
_Materials and methods

international magazine of oral implantology

Tip design
A modified wedge-shaped design, 1,200 m diameter IO360 sapphire tip was used (elexxion AG; Fig. 1).
A 1 W emission of Er:YAG laser energy was analysed. The
beam profile (Fig. 2) demonstrates both side- and endfiring components, although the power is not evenly
dispersed. Ideally, the tip should provide an even 360degree emission to allow complete irradiation of the
osseous surface, but such a tip is not currently available
from the company.
In vitro experiment
Three samples of bovine bone were used. Sample 1
was prepared according to an SDS to produce an osteotomy site (4 mm x 9 mm), and served as the control.
Sample 2 was prepared by Er:YAG laser (elexxion Duros)
using a 1,000 µm conventional tip with parameters of
200 mJ, 10 Hz, 2 W, 100 µs pulse duration, with water
spray, irradiated for approximately 15 minutes. Sample
3 was prepared according to an SDS, similar to sample
1, followed by Er:YAG irradiation with parameters of
100 mJ, 20 Hz, 2 W, 100 µs pulse duration, with water
spray, and with a vertical movement of the IO360 tip
along the entire length of the site for 30 seconds. Scanning electron microscope images of the samples were
taken at 1,000x magnification by Prof. W.K. Leung at the
University of Hong Kong (Figs. 3–5).

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_Clinical cases
Two patients were selected for this pilot study, and
each was to have four implants (BioHorizons) placed in
the maxillary posterior region. Osteotomies were prepared according to an SDS. One site was used as a control and the other three sites were conditioned according to the same Er:YAG laser protocol described above
for sample 3 (100 mJ, 20 Hz, 2 W, 100 µs pulse duration,
with water spray). The authors have named their technique the Laser-enhanced Early Implant Stability Technique (LEIST), which uses two different movements for
conditioning.

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The first technique, termed LEIST-v (Fig. 6), entails a
15-second vertical withdrawal movement of the IO360
tip, placed in the centre of the osteotomy site, starting
1 mm above the apical floor and finishing at the ridge
surface of the site. Then the tip is rotated one-quarter
turn, placed 1 mm above the apical floor, and again
withdrawn vertically over a 15-second period.

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laser 2/12

The other technique, termed LEIST-s (Fig. 7), entails
a spiral withdrawal movement of the IO360 tip, starting 1 mm away from the apical floor and finishing at
the ridge surface of the site. As the tip is withdrawn, it
passes very close to the wall of the preparation, but
does not touch it. The movement takes 30 seconds.

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Holbeinstraße 29, 04229 Leipzig
Tel.: +49 341 48474-0
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[30] =>

I case report

Fig. 4

Fig. 5

Fig. 4_SEM image of sample 2,
the Er:YAG laser-prepared site with
conventional tip, showing
minimal smear layer.
Fig. 5_SEM image of sample 3,
the SDS-prepared site followed by
Er:YAG laser irradiation using the
IO360 tip, showing minimal
smear layer.
Fig. 6_Diagram of the LEIST-v
withdrawal movement of
the IO360 tip.

Fig. 7_Diagram of the LEIST-s
withdrawal movement of the
IO360 tip.
Fig. 8_Graphic representation of ISQ
values over time as osseointegration
progresses. Note the initial decrease
in stability, followed by an increase
as the implant becomes biologically
stable. (Courtesy of Osstell AB)
Fig. 9_Graphic plot of the ISQ values
of each implant in Case I over a
12-week period.

Fig. 7

Implant Stability Quotient (ISQ) values were
recorded immediately after implant placement and
subsequently at one-week intervals for 12 weeks, using
the Osstell Mentor. This instrument measures resistance to lateral movement of the implant by using resonance frequency analysis, which employs the principles of a tuning fork. The stiffer the interface between
the bone and implant, the higher the resultant frequency, which is converted into a number from 1 to 100
(ISQ value). The higher the stability, the larger the ISQ
value. This type of device has a mean ISQ value in the
range of 60 to 75.37 As shown in Figure 8, initial mechanical stability is supplemented and then replaced by
biological stability as osseointegration progresses.
Case I
The first patient was a 57-year-old male patient
with a long-standing history of diabetes and heart disease. He had been taking various medications including aspirin, metformin HCl, simvastatin, metoprolol
and gliclazide for the past ten years. He presented with
a type 3 bone quality, which is described as thin cortical bone with underlying dense trabecular bone.38 All of
the implant fixtures were internal hex and the implant
for site #27 also had the Laser-Lok feature, which is the
manufacturer’s proprietary implant surface treatment.
Site #27 was prepared according to an SDS and LEISTs, and an implant of 5.8 mm x 9 mm was placed. Site #26
was prepared according to an SDS and LEIST-v, and an
implant of 4.0 mm x 10.5 mm was placed. Site #14 was
prepared according to an SDS and LEIST-v, and an implant of 4.0 mm x 12 mm was placed. Site #15 was prepared according to an SDS only, and an implant of 4 mm
x 10.5 mm was placed.

Fig. 8

30 I laser
2_ 2012

Fig. 6

Figure 9 shows a graphic representation of the ISQ
values. Implant #15, the control, showed a decrease in
ISQ value from week 2 but gradually returned to initial
stability at week 9. Implants #14 and 26, conditioned
with LEIST-v, showed a very small decrease in ISQ value.
Unlike other sites, implant #27, conditioned with
LEIST-s, demonstrated an increase in ISQ value from
week 1. The actual numerical readings from the device
are given in Figure 10.
Case II
The second patient was a 69-year-old male patient
with a non-contributory medical history who also had
a type 3 bone quality. However, because of the location
of the maxillary sinuses, three of the four sites required
sinus floor elevation by osteotome. All of the implant
fixtures were internal hex with Laser-Lok.
Site #27 was prepared through sinus elevation, an
SDS and LEIST-s, and an implant of 5.8 mm x 7.5 mm was
placed. Site #26 was prepared through sinus elevation,
an SDS and LEIST-s, and an implant of 4.5 mm x 7.5 mm
implant was placed. Site #15 was prepared according to
an SDS and LEIST-v, and an implant of 4.5 mm x 7.5 mm
was placed. Site #17 was prepared through sinus elevation and an SDS, and an implant of 5.8 mm x 7.5 mm was
placed. This also served as the control.
Figure 11 shows a graphic representation of the ISQ
values. Implant #17, the control, showed a 20 % increase from the initial ISQ value. Implant #26, conditioned with LEIST-v, maintained an ISQ value above
initial stability throughout the period. Implant #27
showed a minimal dip in ISQ value between weeks 2 and

Fig. 9

[31] =>

case report

Fig. 10

4, but had recovered by week 5. Implant #15, conditioned with LEIST-v, but without sinus elevation
achieved a 10 % steady rise in ISQ value by week 4, while
implants #26 and 27 required nine weeks or more to
reach the 10% increase in ISQ value. The actual numerical readings from the device are given in Figure 12.

Fig. 11

Fig. 12

plants. The ISQ results are promising but not statistically significant. Animal and histological studies with
this technique will be the next step to confirming the
progressive level of osseointegration, and more clinical
cases utilising LEIST are underway.

_Acknowledgements
_Discussion
In Case I, the control showed an expected ISQ progression with a decrease in week 2 and a re-establishment of initial stability by week 9. The 20 % drop in ISQ
value was most severe at week 4, which may be related
to the patient’s diabetic condition. Implants conditioned with LEIST-v did not show a significant drop in
ISQ value, and the LEIST-s-treated site showed a constant rise in ISQ value from the first day.

The authors would like to thank elexxion AG for their
support and the design of the IO360 tip. Prof W. K.
Leung at the Prince Philip Dental Hospital, University of
Hong Kong, is acknowledged for his support with the in
vitrostudy. The authors would also like to thank Dr Douglas Chong, who performed the implant surgery for
Case II. Lastly, they would like to thank Drs Frank Yung
and Don Coluzzi for their guidance.

Fig. 10_Numerical values of
each implant in Case I over
a 12-week period.
Fig. 11_Graphic plot of the ISQ
values of each implant in Case II over
a 12-week period.
Fig. 12_Numerical values of
each implant in Case II over
a 12-week period.

_Disclosures
In Case II, the control started with an ISQ value of 57
at week 1 and the stability gradually increased by 20 %
over six weeks. Implant #26 showed an immediate increase in ISQ value, while implant #27 showed a 3 % dip
at week 2 and returned to above the initial ISQ value at
week 5. Lai et al.39 reported good initial primary stability with sinus floor elevation and a decrease in stability
between weeks 2 and 6, but ultimately a high stability
at week 20. The authors had similar but slightly higher
values in their smaller study.
Barewal et al.40 found that the greatest change in
stability was between weeks 3 and 10. The control in
Case I showed similar findings, but the sites conditioned
with LEIST showed very small drops in ISQ value between
weeks 3 and 10 or immediate increases in ISQ value.
Bornstein et al.41 demonstrated successful early loading
with provisional prostheses 21 days after implant placement using modified-surface implants. The authors
would be interested to see whether adding the LEIST
protocol to these modified-surface implants could
achieve any improvement in stability and early loading.

_Conclusion
The results of this very small clinical study indicate
that the Er:YAG laser with a special tip design and the
LEIST protocol could improve the early stability of im-

The authors received no financial support from
elexxion AG, BioHorizons or Osstell AB for this study.
Dr Luk is a presenter for elexxion and receives honoraria
for his services. Dr Seto has no relationships to disclose._
Editorial note: The article was first published as K. Luk & R.S.K.
Seto, A novel technique of Er:YAG laser-enhanced early implant stability for implant dentistry: A pilot clinical case report, Journal of Laser Dentistry, 19/1 (2011): 162–167, and is
reprinted here with kind permission of the Academy of Laser
Dentistry. Copyright 2011 by the Academy of Laser Dentistry.
All rights reserved.
A complete list of references is available from the publisher.

_contact

laser

Kenneth Luk
301, No.50 Queen's Rd Central,
Hong Kong
China
drkluk@mac.com

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[32] =>

I case report

Laser therapy of oral
haemangiomas
A case report
Author_Friedrich Müller & Dr Maximilian Schmidt-Breitung, Germany

Fig. 1

Fig. 2

Figs. 1 & 2_Haemangiomas prior to
treatment.
Figs. 3 & 4_Immediately after
treatment.

_Introduction
Owing to demographic changes, eruptive or socalled senile haemangiomas have become more frequent among our patients. Haemangiomas are benign
endothelial tumours found more often in women than
men. Congenital capillary or cavernous haemangiomas are characterised by remission in more than
50 %. Eruptive haemangiomas occur spontaneously in
patients of 60 or older, especially on the lips, but they
can also be found elsewhere. Remission of eruptive
haemangiomas is observed more seldom than in capillary or cavernous haemangiomas. Owing to their localisation and the fact that older patients have more
serious general health problems, non-surgical and
non-invasive modalities for haemangioma treatments are favoured in order to minimise the risk of
prolonged bleeding and scarring. Therefore, the use of
lasers is nowadays the best option for removing haemangiomas easily. This article demonstrates the removal of three oral eruptive haemangiomas using an
Nd:YAG laser with a wavelength of 1,064 nm.

_Case presentation
Prior to treatment, differential diagnostic aspects
must be investigated. Lymphangiomas, retentions,

32 I laser
2_ 2012

Fig. 3

cysts and tumours of the salivary glands sometimes
have a similar appearance to haemangiomas. Even
haematomas can be mistaken for haemangiomas. The
diagnosis is based on clinical parameters and can be
confirmed by the use of a small glass plate that renders
the haemangioma anaemic. Aspiration can also be
helpful. Angiographic investigations have no clinical
relevance in dentistry because of their poor
benefit–cost ratio.
A 67-year-old male patient presented with three
eruptive haemangiomas. He was treated with an
Nd:YAG laser with a wavelength of 1,064 nm. The irradiation time applied was two minutes and the power
output was 1.75 W and 15 Hz in non-contact mode.
Three eruptive haemangiomas in the lower lip regions
34 and 45 with a diameter of 3 mm were treated in one
appointment. The treatment was stopped when the
surface of the haemangiomas turned whitish.
Figures 1 & 2 show the haemangiomas in regions
34 and 45 before the treatment. In order to enhance
patient comfort, a local anaesthetic was administered. Figures 3 & 4 give an impression of the three
haemangiomas immediately after laser treatment.
One week after laser irradiation, a central induration
with a marginal bulge was observed. This can be seen

[33] =>

case report

Fig. 4

from figure 5. The complete removal of the haemangiomas was followed up 11 weeks after treatment. As
can be seen from figure 6, neither differences in the
colour of the lip mucosa occurred, nor in its texture.
Although our patient reported stinging pain during
laser irradiation, no complications or pain arose during the healing process.

_Conclusion
This case report demonstrates that the removal of
haemangiomas can be done with very little effort
even in the dental practice. We suggest that this procedure can also be used for coagulation of intra-oral
lesions of hereditary telangiectasis like morbus Osler-

I

Fig. 5

Fig. 6

Rendu-Weber to reduce the risk of spontaneous
bleeding.
The authors declare no conflict of interest.

_contact

Fig. 5_One week after laser
irradiation.
Fig. 6_11 weeks after laser
irradiation.

laser

Friedrich Müller
Tannenring 76
65207 Wiesbaden (Auringen)
Germany
praxis@muellerzahnaerzte.de
www.muellerzahnaerzte.de

[PICTURE: ©SUKIYAKI]

AD

Please contact Claudia Jahn
c.jahn@oemus-media.de

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[34] =>

I industry report

Lasers in oral
implantology
Author_Drs Ilay Maden & Zafer Kazak, Turkey

[BACKGROUND: ©EVV; FEMALE DENTIST: ©FRANCK BOSTON]

_Introduction

_Removal of granulation tissue

Both lasers and implantology are considered to
be the fashionable treatments of modern dentistry,
and combining them seems to represent best practice from a number of perspectives. Implantology is
one of the many dental indications for the use of
lasers, and it is one from which patients can benefit
significantly.

One of the most important uses of lasers in implantology is the removal of granulation tissue and
disinfection of the surgical area after extraction.

_The ideal scenario
Ideally, the soft tissue surrounding the implant
should be prepared before starting an implant procedure. The vestibular sulcus depth and frenulum
should be examined and prepared accordingly. This
can also be performed during the second stage of
surgery (Fig. 1). Different laser wavelengths can be
used for this kind of surgery. Er:YAG lasers cause less
pain, as they do not heat the tissue surface, unlike
diode, Nd:YAG and CO2 lasers, and the patient heals
more quickly for the same reason.1, 2

34 I laser
2_ 2012

Erbium lasers can be used for this purpose, especially if there was chronic infection before the extraction, regardless of whether implants or bone
grafts are being placed (Fig. 2). It has even been suggested that implants can be placed at pre-infected
sites, although the site has to be cleaned thoroughly.3
Owing to significant differences in water content,
the erbium laser can be used to only remove soft tissue by setting the parameters correctly (energy density, pulse duration, etc.). This is done without thermal side-effects on the bone,4 and with greater comfort to the patient while disinfecting the surface,5
since no force is applied, unlike with curettes. The
non-contact or pseudo-contact procedure enables
safe cleaning of very fragile bone that may even be in
a bridge form if there is a fenestration.6

[35] =>

industry report

_Laser ablation
If the coronal part of the crest is too thin, and a
plateau is desired, ablating the bone in order to
achieve the desired thickness is advantageous, since,
without a thermal effect, exposure of the implant
neck can be avoided. This same safety benefit also applies when angulated implants are placed and distal
neighbouring bone needs to be removed. Also, a laser
can be used to make an indent to mark the location of
the first drilling site because it will not slip and cause
iatrogenic damage (especially helpful for novice implantologists). Lasers can also be used when the procedure involves an osteotomy sinus lift, obtaining a
bone block or bone splitting (Figs. 3a & b).9, 10

_Preparation of the implant bed
The Er:YAG laser can be used for the preparation of
an implant bed in special cases, such as when the bone
is very thin and soft. Thin contact tips can be used to
remove the minimum amount of bone (Fig. 4), as they
are thinner than pilot drills. Then the implant bed can
be prepared using bone condensers. For other cases,
it may also be beneficial to prepare the implant bed
with a laser to achieve longer stability.11 Ultimately, if
scanner systems are combined with high-powered
lasers for the purpose of shaping cavities of predetermined dimensions in the bone without the thermal
side-effects of drills, it could be speculated that the
results would improve even further: in addition to the
disinfection of the site, the smear layer would be re-

Fig. 1

_Bio-modulation
After the removal of granulation tissue and superficial disinfection, a diode or Nd:YAG laser can be
used for deep disinfection. The penetration of laser
energy of these wavelengths in hydroxyapatite and
absorption by bacterial pigments are advantageous
in this case.7 These wavelengths also have a biomodulation effect, which aids healing, leading to less
oedema and pain.8 Bio-modulation is mostly effective during the initial healing phase, which is why it
should be repeated every second day for the first few
weeks.8

Fig. 2

moved from the surface, activating osteoblastic activity.12

_Uncovering the implant
The most comfortable, patient-friendly use of the
Er:YAG laser is during the second stage of implant
placement: uncovering the implant (Fig. 5). Using a reduced water spray in order to decrease bleeding, it is
possible to uncover the implant with diminished pain,
even if bone is covering the implant. Using longer
pulses causes haemostasis in the soft tissue, while
shorter pulses enable the removal of bone without

Fig. 3a

Fig. 1_Frenectomy with a diode laser
after placement of full-arch
implant-supported prostheses.
Fig. 2_Cleaning and disinfecting the
socket with an Er:YAG laser after
extraction.
Figs. 3a & b_Bone splitting (a). Sinus
window preparation (b).

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[36] =>

I industry report

Fig. 3b

Fig. 4

Fig. 6a

Fig. 6b

Fig. 4_Bone ablation for the
implant bed.
Fig. 5_Uncovering the implant.
Figs. 6 a & b_De-epithelialisation of
the crestal gingival to make a
roll flap.
Figs. 7a & b_Peri-implantitis before
treatment (a). After cleaning,
disinfection and augmentation (b).

Fig. 5

Fig. 7a

thermal side-effects. This is achieved without causing pain to the patient and without raising a flap. This
is possible, of course, if there is sufficient attached
gingiva and the crestal attached gingiva does not need
to be replaced apically. When there is no harmful heating of the soft tissue, there is no retraction of tissue, so
the impressions can be taken as soon as possible without delay. Another use is the de-epithelialisation of
the crestal gingiva to make a roll flap in order to optimise vestibular soft-tissue thickness (Fig. 6).

_Peri-implantitis
The most efficient use of the Er:YAG laser is in the
treatment of peri-implantitis.14 With Er:YAG, it is possible to clean the granulation tissue both on the bone
surface and implant surface (Figs. 7a & b). This is done
through decontamination of the site, which is the
main purpose of peri-implantitis treatment.15, 16 Similar to the cleaning of the surgical area after extraction, it is possible to leave the highly fragile surrounding bone intact. The effect of the laser energy
on the implant surface is dependent on the amount
of energy density, power and possibly also pulse duration.17, 18 The parameters should be chosen cautiously, however. Lowering the settings may make the
procedure slower but safer for re-osseointegration.
Non-surgical use of Er:YAG and diode lasers is also
possible if the problem is not extensive.
The most prevalent reason for peri-implantitis appears to be poor occlusal load distribution, with either
primary contacts or cantilever bridges in implantsupported prostheses. Good oral hygiene on the patient’s part is mandatory. The position and design of
prostheses that are difficult to manage may limit the

36 I laser
2_ 2012

Fig. 7b

effectiveness of mechanical cleaning. Once the underlying reason has been determined and recurrence
is prevented, the Er:YAG laser can help treat periimplantitis. Finally, lasers are also used to enhance the
aesthetics of implant-supported prostheses. Gingival levelling by crown lengthening and depigmentation are the most common procedures performed for
this purpose.

_Conclusion
From this range of laser applications, it is evident
that the use of lasers in modern dentistry is only limited by the dentist’s imagination. Ultimately, lasers
are not miracle machines that can improve the quality of implantology overnight in cases in which the
practitioner has limited knowledge and experience in
implantology. However, they are indeed a major aid in
doing what is needed, always enabling increased
comfort, both for the operator and the patient. Education is certainly the key in implantology and laser
dentistry in general._
Editorial note: The complete list of references is available
from the author.

_contact
Dr Ilay Maden PhD, MSc, BDS
Mühürdar Caddesi 69
34710 Istanbul, Turkey
ilaymaden@gmail.com

laser

[37] =>

October 5-6, 2012//Hamburg, Germany//Elysee Hotel
Congress President//Prof. Dr. Dr. Frank Palm/DE
Scientific Director//Dr. Roland Hille/DE

International annual

congress of the dgzi
Quality driven implantology –
On the way to long term success

Speakers
Prof. Dr. Dr. Kai-Olaf HenkelDE
Prof. Dr. Dr. George Khoury/DE
Prof. Dr. Dr. Albert Mehl/CH
Prof. Dr. Herbert Deppe/DE
Prof. Dr. Werner Götz/DE
Prof. Dr. Shoji Hayashi/JP
Prof. Dr. Andrea Mombelli/CH
Prof. Dr. Dr. Frank Palm/DE
Prof. Dr. Suheil Boutros/US
Prof. Dr. Peter Rammelsberg/DE
Prof. Dr. Anton Sculean/CH
Prof. Dr. Dr. Jörg R. Strub/DE

Gold Sponsor:

Silver Sponsor:

Prof. Dr. Hans-Peter Weber/US
Prof. Dr. Thomas Weischer/DE
Priv.-Doz. Dr. Andreas Bindl/CH
Dr. Tomohiro Ezaki/JP
Dr. Daniel Ferrari, M.Sc./DE
Dr. Sami Jade/LB
Dr. Ramy Fahmy Rezkallah/EG
Dr. Osamu Yamashita/JP
ZTM Andreas Kunz/DE
ZTM Tom Lassen/DE
ZTM Christian Müller/DE
Mohamed Moataz M. Khamis
B.D.S., M.S., Ph.D./EG

Bronze Sponsor:

FAX REPLY
+49 341 48474-390
Please send me further information on the
42nd International annual congress
of the DGZI October 5–6, 2012, in Hamburg, Germany.

Office Stamp

laser 2/12

[38] =>

I manufacturer _ news

Manufacturer News
FOTONA

Primcogent Solutions

"red dot design award 2012" for LightWalker

Erchonia Europe
renamed as
Primcogent Solutions

Fotona's latest dental laser, LightWalker, was
awarded one of the world's most distinguished design awards, the “red dot
award: product design 2012”, being
recognized for combining innovation,
technological perfection and excellent
design.
LightWalker's technologically advanced, modern and functional design offers ease-of-use and improved
ergonomics: A state of the art color
touch screen with an adjustable tilt,
interchangeable optics for
new technologically advanced
hand pieces, and a modern,
durable and lightweight system housing allow userfriendly handling. An easy-toaccess water reservoir and the
unique and patented OPTOflex articulated arm,
which allows a full range of motion, provide further

comfort. The system enables gentle and
precise cavity preparation, sutureless softtissue surgery, effective periodontal treatments, safe and efficient endodontic treatment
and numerous cosmetic procedures.
The red dot award is LightWalker’s third
prestigious international quality recognition. In 2011, the Pride Institute awarded
the laser system the "Best of Class Technology Award", and Dentistry Today,
America’s leading clinical news magazine for dentists, recognized LightWalker
as one of the “TOP 100 dental products of
the year”.
Fotona d.d.
Stegne 7
1000 Ljubljana, Slovenia
www.lightwalkerlaser.com
info@lightwalkerlaser.com

Henry Schein

Henry Schein regains top position on Fortune
companies list
Henry Schein is once again No. 1 on Fortune magazine's 2012 list of the most admired companies in the
wholesale healthcare sector. This is the first time since
2011 that the company has ranked first in this category. In the two previous years, the top position was
held by McKesson, a pharmaceutical corporation
based in San Francisco.
According to Fortune, Henry Schein not only outdid
competitors in business-related categories like global
competiveness and longterm investment but also
scored best in the social responsibility category, driven
by Henry Schein Cares, a program launched in 2001 with
the aim of providing medical

38 I laser
2_ 2012

supplies and logistic support to underserved communities around the world. In 2011, the program provided
medical relief to the victims of Hurricane Irene in North
America and the New Zealand earthquake, among others. Nasdaq-listed Henry Schein scored record sales of
$ 8.5 billion worldwide last year. In addition to its US
businesses, the company currently maintains operations in 25 countries.

Erchonia Europe, the provider of Low Level Laser Technology (LLLT) for medical applications, has been renamed Primcogent Solutions, and now holds exclusive
North American and Western European distribution
rights to the ZERONA® non-invasive body contouring
laser. Primcogent Solutions is a privately-held medical
company with offices strategically located in New York
City, Dallas, the United Kingdom and Germany, whose
products and services are backed by a clear, logical
and convincing scientific and clinical foundation. With extensive knowledge and
success in the sales, marketing and financing of
healthcare products and
services, Primcogent Solutions is ideally placed to fully
support and grow the ZERONA®
provider network. Mike McDonald, President of Primcogent
Solutions, said the new move will
benefit physicians, consumers and employees alike: “Our primary goal has always been to continuously evolve
and provide better
products and services to
our customers. We are proud to have taken the next
step in the evolution of our company.” David Boris,
Chairman of Primcogent Solutions, added:“We are extremely excited to be able to provide the Erchonia
Europe management team with the resources needed
to help them grow the ZERONA provider network and
add new products into the North American and Western European portfolios.”

Henry Schein Dental
Deutschland GmbH
Monzastraße 2a
63225 Langen, Germany

Primcogent Solutions
The Innovation Centre
99 Milton Park, Abingdon,
Oxon, OX14 4RY, United Kingdom

info@henryschein.de
www.henryschein-dental.de

sales@primcogent.com
www.primcogent.com

[39] =>

manufacturer _ news

Biolase

A.R.C. Laser

Biolase concludes transaction
with Henry Schein
Biolase Technology,
Californian-based
dental laser manufacturer and distributor,
has repurchased 159 of its
Waterlase MD Turbo laser systems from Henry
Schein, supplier of dental and medical equipment.
The equipment is expected to be used primarily as a
source of parts to service the large number of installed MD Turbo laser systems and for dental
schools in order to promote Waterlase technology in
the academic sector.
According to the manufacturer, the Waterlase MD
Turbo, first launched in 2006, is the most successful all-tissue laser in the history of dental lasers, with
approximately 6,500 units sold worldwide.
Biolase purchased the MD Turbos at a very advantageous price and the entire purchase price was offset by monies owed by Henry Schein to Biolase from
sales made in the normal course of business mainly
during the first quarter of 2012 and, to a much lesser

extent, the year ended Dec. 31, 2011. None of the
monies used to offset the purchase price were related to the original sales of the MD Turbos to Schein.
Federico Pignatelli, Chairman and CEO of Biolase,
commented, “Closing this transaction is a very important step for Biolase, as it eliminates the overhang in the marketplace that equaled approximately 440 units at the end of 2010 and significantly
impacted our sales in 2011, releases all liens on our
patent and intellectual properties portfolio and frees
us of any present and future obligations to Schein. It
is also a very advantageous transaction, as the remaining inventory was purchased at a very convenient price and will mainly be used as parts to service
our vast install base of MD Turbos.”

Healthy teeth =
Healthy patients
Bacterial inflammation in periodontal pockets can
lead to bleeding gums, pocket formation, reformation of gums with loosening and eventual loss of
teeth. Furthermore, scientific evidence indicates
that there is an increased risk of infections developing in the rest of the body, eventually resulting in vascular diseases in the heart and arteries.
EmunDo® PDT therapy is safe and effective for
removing harmful bacteria, regardless of the Gram
stain and including Gram-positive/-negative bacteria, as well as Gram-variable and Gram-undetermined species. By comparison, mechanical cleaning
cannot reach and remove bacteria in all areas. Other
laser-based therapies cannot be said to be clinically
effective on all types of germs.

Biolase Europe GmbH
Paintweg 10
92685 Floss, Germany
info@biolase-europe.com
www.biolase.de

elexxion

elexxion signs distributor for Asian markets
Dental laser specialist elexxion has reported that
it has signed a new distribution agreement with
Global Dental Supplies in Hong Kong. The five-year
contract will give the dental distributor the exclusive rights to distribute elexxion’s laser technology
for use in dentistry in several Asian countries.

pand our sales and marketing activities in Asia,”
commented elexxion CEO Per Liljenqvist. He said
that his company could particularly benefit from
the agreement in terms of product registration and
exhausting new distribution channels in the region.

Currently, the German company sells its products
through its subsidiaries and dealers in selected
markets, such as India and
Japan. The distribution rights
for Hong Kong and Macau were
previously held by Healthcare
Dental, which did not renew its
contract with elexxion after
2009, company officials told
Dental Tribune Asia Pacific. Besides elexxion dental lasers,
Global Dental Supplies also
distributes products from the
German implant company
BEGO, Sunstar, Bisco and GC, among others. “With
Global Dental Supplies we have a strong partner
that gives us the opportunity to systematically ex-

The latest elexxion product offering includes the
delos 3.0, a novel combined Er:YAG/diode laser indicated for a wide range of dental
applications. In addition, the company distributes the pico mobile
diode laser and duros, an Er:YAG
dental laser claimed to facilitate
efficient hard-tissue preparation
and bone ablation tasks.

PDT has the ability to treat exposed areas without
thermal effect. EmunDo® has a selective, localized
effect because it accumulates only in the inflamed
areas and can be irradiated immediately without
waiting period. Furthermore, the bacteria contained
in plaque or biofilm is less affected by antibiotics, because they are shielded by the organic matrix in the
film and may be absorbed by or adhere to the tooth
and epithel cells. While PDT has the advantage of
achieving excellent cosmetic results with minimal
risk of scarring, it is also a welcome alternative treatment for periimplantitis to save the implant by maintaining the protective function of the mucosa.

elexxion AG
Schützenstraße 84
78315 Radolfzell, Germany

A.R.C. Laser GmbH
Bessemerstraße 14
90411 Nuremberg, Germany

info@elexxion.com

info@arclaser.de

www.elexxion.de

www.arclaser.de

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_ 2012

[40] =>

I education

“Laser Supported
Dentistry” in Turkey
AALZ and Bezmialem Vakif University Istanbul cooperate
Author_Prof Dr Aslihan Usumez, DDS, PhD/Turkey, Leon Vanweersch, MBA/Germany

_“Laser Supported Dentistry”attracts more attention in dentistry, day by day. Dental laser training and education are necessary to start laser-assisted dental
therapy in order to execute dental laser applications in
the most accurate and safe way.
On 5 December 2011, in accordance to a collaboration protocol for post-graduation education, signed by
AALZ and Bezmialem Vakif University, the first one-year
mastership certification course “Laser Supported Dentistry” was started at Istanbul Bezmialem Vakif University.
A well-attended opening ceremony was arranged in
the university on 3 February 2012, which was also the
starting date of the first course. University Director Prof
Dr Adnan Yüksel, AALZ Director Prof Dr Norbert
Gutknecht, the Bezmialem Vakif University Dental Faculty Dean Prof Dr Serdar Üsümez, other deans of the university and university academicians, dental laser distributors in Turkey, agents of visual and print media,
mastership students and university students attended
the ceremony. Bezmialem Vakif University Rector Prof
Dr Adnan Yüksel was the first to address the audience.
Rector Yüksel emphasized that the University is open for
innovations and highlighted the importance of the collaboration with AALZ in his speech. AALZ Director Prof
Dr Norbert Gutknecht expressed in his speech that the
AALZ network is growing every day and that AALZ has

40 I laser
2_ 2012

cooperations with lots of universities all over the world.
Prof Gutknecht also introduced the scientific co-worker
group for the courses at Bezmialem, formed by Prof Dr
Usumez, PhD Dr Maden, Dr Kazak, and Dr Berk, who hold
Master of Science degrees and mastership certificates
from RWTH Aachen University. Dentistry Faculty Dean
Prof Dr Serdar Üsümez introduced the young academic
permanent staff of the Dentistry Faculty, expressing
that the aims of the new Bezmialem Dental Faculty are
a rapid growth and to become an important scientific
and academic institution.
The first module of the first mastership course
started with 18 participants and took place on 4 to 5 February 2012 at Bezmialem Vakif University. Prof Dr Jörg
Meister lectured the Laser Safety Officer training on the
first day. On 5 February, a lecture and skill training about
the construction and properties of lasers were conducted. The second mastership module was executed
from 16 to 19 May 2012. The lecturer here was Prof
Gutknecht himself, assisted by Dr Maden, Dr Kazak and
Prof Usumez. Because of the high interest in this mastership program, a second batch will already start their
first module from 28 to 29 June 2012. The “Master of Science in Lasers in Dentistry” course, which will start after
receiving the approval of the Turkish Council of Higher
Education, is being planned to start in September 2013._
Detailed information can be found at
http://aalz.bezmialem.edu.tr.

[41] =>

[42] =>

I education

Innovation and
information at IDS 2013
Laser technology in the spotlight
Author_VDDI

_There is no such thing as a universal laser that
covers all indications equally well in the field of laser
dentistry. Instead, the sector offers a wide range of
different units for specific areas of application. Differentiating features include the respective characteristic wavelength, the medium and the form of signal produced by the laser. As far as wavelength is concerned, the spectrum of light emissions extends from
the ultraviolet over the visible region all the way into
the far infrared. When it comes to the search for the
right laser, interested dentists will find the concentrated expertise of the innovative dental industry and
the associated trading companies presented at IDS
2013 in Cologne.
The CO2 laser, a gas laser, opens up completely new
possibilities in soft-tissue surgery. Its applications include frenectomies, vestibuloplasties and hyperplasia
removals, where it is used as a minimally invasive
scalpel replacement. Furthermore, it can also be used
to smooth scars resulting from an apicectomy. Dentists looking for a laser for hard-tissue applications
will turn to an Er:YAG laser. This can be used both for
caries removal and enamel conditioning and for oral
surgery procedures. Such applications include, for example, incisal ridge defects, lesions due to cleaning
and multilayer constructions of dentin adhesives. The
erbium laser also represents a worthwhile investment
for a practice that is active in the field of paediatric

42 I laser
2_ 2012

dentistry, as it can be used for minimally invasive therapy of an incipient caries. What’s more, the laser
works without physical contact and with minimal discomfort to the patient.
Diode lasers can be used to carry out both gingival
surgical procedures and endodontic treatments.
Multimorbid patients in particular profit from this
form of therapy, which is why this technique provides
an additional benefit for a practice, especially in the
light of ongoing demographic change. Patients suffering from diabetes are much less frequently affected by wound-healing impairments after laser
therapy, and the majority of patients receiving Marcumar can also be treated without the need for the internist to make changes to the blood-thinning medication.
IDS takes place in Cologne every two years and is
organized by the Gesellschaft zur Förderung der Dental-Industrie mbH (GFDI), the commercial enterprise
of the Association of German Dental Manufacturers
(VDDI), and is staged by Koelnmesse GmbH, Cologne.
“Trade visitors from practices and laboratories will
have a unique opportunity during the International
Dental Show, the world's largest trade fair for dental
medicine and dental technology, in Cologne from 12
to 16 March 2013,” said Dr. Markus Heibach, Executive
Director of the VDDI._

[43] =>

meetings

I

International events
2012
Europerio 7
Vienna, Austria
6–12 June
www.europerio7.com

20th Pragodent Dental Fair
Prague, Czech Republic
11–13 October
www.pragodent.eu

FDI Annual World Dental Conference
Hong Kong, China
29 August–1 September
www.fdiworldental.org

DenTech China
Shanghai, China
24–27 October
www.dentech.com.cn

21st DGL Annual Conference
Leipzig, Germany
7–8 September
www.dgl2012.de
China Dental Show
Xi’an Qujiang, China
13–15 September
www.ChinaDentalShow.com
32nd Dental-Expo
Moscow, Russia
17–20 September
www.dental-expo.com
22nd Central European Dental Exhibition
Poznan, Poland
20–22 September
www.cede.pl
13th Slovak Dental Days
Bratislava, Slovakia
27–29 September
www.incheba.sk
42nd International Congress of DGZI
Hamburg, Germany
5–6 October
www.dgzi-jahreskongress.de

laser
2
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_ 2012

[44] =>

I meetings

DGL annual conference
in Leipzig, Germany
Author_Jürgen Isbaner, Germany
Translated by_Claudia Jahn, Germany

_The 21st annual conference of the German Society for Laser Dentistry (Deutsche Gesellschaft für
Laserzahnheilkunde e.V., DGL) will take place from 7
to 8 September, 2012, in Leipzig, Germany. Particular
focus is placed on laser as an integrative technology
in dentistry.
Only a few scientific events in dentistry pay as
much attention to laser and its various fields of clinical application as do the DGL annual conferences. The
facts that various lasers make soft tissue surgery possible, free of hemorrhage or with only little bleeding,
and that caries excavation and the preparation of cavities can be conducted free of pain via erbium lasers
have become standard knowledge, at least among the
members of the DGL. Other than the direct, visible and
demonstrable effects of various kinds of lasers, however, secondary reactions and tissue changes are another interesting and impressive fact to note when it
comes to laser dentistry. It is especially those interactions which are scientifically hard to follow and impossible to measure which have had a highly positive
impact on the success of laser-supported therapy.

44 I laser
2_ 2012

One of the internationally leading scientists, Prof
Dr Chukuka S. Enwemeka
from Milwaukee (USA) is going
to give a speech on this phenomenon at the upcoming DGL annual
conference. Under the topic “Biomodulation and Biostimulation”, Prof Dr
Enwemeka is going to illustrate how visible
infrared laser beams can have a positive influence on the surrounding tissues and especially single
cells even in small doses.
In addition to photodynamic therapy, almost every
field of laser application is put into focus at the conference, reaching from endodontology over periodontology to surgery. After all, laser applications
have undergone a significant revaluation in recent
years. Compared to conventional methods in dentistry, laser application often proves to be easier,
faster and thus more efficient. Participants of the DGL
annual conference will have the opportunity to catch
up on the latest developments on the laser market on

[45] =>

meetings

I

[EARTH: ©ANTON BALAZH]

the occasion of the accompanying dental trade fair in
Leipzig. Parallel to the annual conference, Laser Start
Up is designed to enable beginners in laser dentistry
to acquire a professional knowledge base in order to
enter this new field of expertise. In addition, workshops and hands-on courses will provide practical
training in getting to know the various kinds of lasers.
The DGL party is the festive occasion concluding
the DGL annual conference Saturday night at THE
WESTIN LEIPZIG hotel. The accomplished combination of professional exchange and friendly gathering
makes this year’s DGL annual conference an exceptional educational event._
BERLIN
LEIPZIG

_contact

laser

OEMUS MEDIA AG
Holbeinstraße 29
04229 Leipzig, Germany

[PICTURE: ©ORLA]

Tel.: +49 341 48474-308
Fax: +49 341 48474-390
event@oemus-media.de
www.oemus.com

laser
2
I 45
_ 2012

[46] =>

I meetings

“Scientifically, laser has
now reached its highest
standard”
Author_Dajana Mischke, Germany

On the occasion of the German Society for Laser
Dentistry (Deutsche Gesellschaft für Laserzahnheilkunde e.V.) annual conference 2012 in September in Leipzig, Germany, Prof Dr Norbert Gutknecht
of the University Hospital of RWTH Aachen, Germany, commented on the current situation of laser
dentistry, the key issues of the upcoming DGL annual conference as well as the future of laser therapy in dentistry and the activities of the DGL.

Prof Dr Norbert Gutknecht

_laser: Prof Dr Gutknecht, this year’s DGL annual
conference takes place in early September in Leipzig,
Germany. Can you tell us what the participants can expect from this event? What are the highlights of the
conference?
You can roughly attribute four key points to our upcoming congress in Leipzig. Firstly, we want to present
the latest scientific discoveries to our audience in an
easily accessible way. Secondly, we aim at emphasising
the significance of laser for a successful dental therapy by pointing out how laser technology has been
integrated in various medical and dental therapies.

46 I laser
2_ 2012

Thirdly, economic efficiency plays a crucial role in any
laser application. Therefore, another important aspect
of this year’s congress is the new German Scale of Fees
for Dentists (Gebührenordnung für Zahnärzte, GOZ).
And last but not least, there is the social aspect. The
success of last year’s DGL anniversary party has shown
once more how important social values and friendships are nowadays. Our DGL party on Saturday is dedicated to combining the scientific interest we all have
in common with a friendly and relaxed atmosphere.
_How would you assess the current situation of
laser dentistry? What are the main directions its development is going to take? What do you think will be the
status of laser dentistry in five years?
Scientifically, laser dentistry has now reached its
highest and most substantiated standard. Furthermore, laser is an integrative technology highly accepted by the professional organisations in medicine
and dentistry. In my opinion, this shows how laser
technology can take a decisive influence on the success of various therapies. Speaking of the main directions of the development of laser dentistry, we have
to take three essential aspects into account: Firstly,
there is the advancement of pico-second and femtosecond lasers with regard to hard tissue applications.
Secondly, laser-activated photodynamic therapy has
become both more specialised and developed.
Thirdly, therapy concepts for already existing laser
systems are constantly being developed, which will
lead to a significant growth in the sector of laser
technology within the coming five years. This perspective is especially relevant for periodontology,
endodontology, cariology, surgery, implantology and
pedodontics.
_DGL maintains a high profile, both nationally and
internationally. Can you name current activities initiated or supported by the DGL?

[47] =>

meetings

Nationally, the DGL boards are intensively engaged in establishing statements and clinical treatment guidelines for the German Society for Dental
and Oral Medicne (Deutsche Gesellschaft für Zahn-,
Mund- und Kieferheilkunde, DGZMK). Furthermore,
subgroups of the executive board and advisory
boards are currently discussing the problem of interpreting and billing certain laser treatment options
according to the new GOZ. Internationally, DGL is
represented both in European and international laser
societies. Moreover, not only are members of the DGL
much sought-for speakers, but they also are entrusted with different additional tasks in their respective organisations.
_Photodynamic therapy is going to be among the
key topics of this year’s DGL conference. What is the
current status of photodynamic therapy in laser dentistry and how relevant is it for the daily dental practice?
In the past, photodynamic therapy only played a
secondary role or the role of the outsider, both in scientific research and in clinical applications. However,
we have noticed a grown interest in this therapeutic
branch since 2006, which has even more increased

within the past two years. By now we can rely on different wavelengths and photosensitisers which have
been scientifically tested and applied in clinical therapies. Nevertheless, the range of possible dental applications of lasers is still very limited, with the highest clinical relevance in periodontology: photodynamic therapy has proven a successful integrative
method for the standardised procedures of periodontological treatment.
Prof Dr Gutknecht, thank you very much for this
interview!

_contact

laser

Prof Dr Norbert Gutknecht
DGL—Deutsche Gesellschaft für
Laserzahnheilkunde e.V.
Pauwelsstraße 30
52074 Aachen, Germany
speck@dgl-online.de
www.dgl-online.de

laser
2
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_ 2012

[48] =>

NEWS
From the use of lasers to aesthetic implants

Compostable toothbrush

by Javier Martínez de Pisón

Produced by German
manufacturer

The third day of lectures of the Dental Tribune Study
Club Symposia introduced on Tuesday a good variety
of speakers and topics at the Greater New York Dental
Meeting. A total of six speakers of different backgrounds spoke at these well-known series of lectures,
which are part of the educational arm of Dental Tribune
International. Among them were Dr Gregori Kurtzman,

Dr George Freedman and Dr Fay Goldstep, who gave an
explanation of the clinical advantages of the now affordable laser therapy, entitled “The Diode Laser: The
Essential Soft Tissue Handpiece”.
The 4-day series of lectures of Dental Tribune Study
Club attracted a large number of dentists interested in
learning about these topics. The Tuesday lectures offered six hours of ADA-CEP Continuing Education credits.
Dr Pedro Lázaro, a Spain-based specialist in periodontics and dental implants, said that what is really difficult is to get results that are perfect from an aesthetic
point of view, or as close to perfect as possible.

who talked about “Core
Buildups, Post & Cores and
Understanding Ferrule”;
Dr Paul Goodman, who disserted on how to “Capitalize
on the Hidden Implant Production in Your Practice”;

“It’s like when you see a professional tennis player
and the game looks very easy, but you know that
there are only a few real top level champions like
Rafa Nadal or Roger Federer,” said Lázaro in an interview after his lecture. “Not using the appropriate
technique could worsen the results of treatment,” he
warned.

Australian survey ﬁnds

Dental mid-life crisis in women
Middle-aged women are most likely to suffer from
fear of the dentist, a new study found. Clinical observation of patients taking part in a multi-year clinical
trial conducted at the Dental Phobia Clinic in Westmead, Sydney, has indicated that the level of dental
anxiety is highest among women in their forties.
According to the researchers, this demographic was
also found to have perceived a traumatic dental experience, including orofacial trauma, in the past and
to be more prone to stress or mental disorders like
depression. The results are intended to help investigate the relationship between dental anxiety and the

48 I laser
2_ 2012

perception of and coping with pain, as well as to develop strategies for managing the condition successfully.
In addition, the study could confirm findings of earlier research that found that cognitive processing of
dental phobia in women differs significantly from
that in men.
Forty per cent of people in the developed world are
estimated to have some form of dental anxiety. Surveys have shown that compared with the general
population, phobic patients wait more than five
times longer to make a dental appointment, co-ordinator of the study and special needs dentist Dr Avanti
Karve said. She added that the key strategy for managing dental phobia is to help the patient develop the
skills for coping with or overcoming the condition.
“Dental anxiety is very real and complex and it
should never be downplayed,” she said. The anxiety
study has been running in association with clinical
psychologists for five years.

Engineers have developed a cardboard toothbrush that could replace not only disposable
toothbrushes in hotels and aeroplanes but also
conventional household toothbrushes. The materials used in manufacturing this toothbrush are
bio-based, renewable and fully recyclable.
According to the German Federal Environmental
Agency, experts agree that plastic products
decompose extremely slowly. Depending on
environmental conditions, they estimate that
plastic bags, for instance, take up to 500 years to
decompose.

In a collaborative research
project, the Zahoransky engineering
corporation and the West Saxon University of
Applied Sciences of Zwickau developed an innovative injection-moulding process, which made it
possible to produce a toothbrush using renewable
raw materials. This invention could be an alternative to disposable toothbrushes, which are also
given regularly to patients at dental practices.
According to Zahoransky, the new toothbrush is
manufactured from a biodegradable, fibre-filled
composite, which is made by first pressing waste
paper fibre into free-flowing bulk solids and
thereafter processing the solids into injectable
granulate using a biopolymer matrix.
Given the rising oil price, which affects the price of
synthetic oil-based plastics, and increasing
public awareness of ecologically safe products
and processes, the designers wanted to create a
disposable toothbrush that is environmentally
friendly at the same time. The production of the
newly developed toothbrush does not involve
any fossil fuel because it is made solely from
bio-based synthetic materials. After use, the
toothbrush can be disposed of in the composting
bin.

[49] =>

Survey ﬁnds

Most unattractive oral problems
A survey conducted by the British Dental Health
Foundation (BDHF) ahead of its annual oral health
campaign, National Smile Month, demonstrated
that an imperfect smile usually makes a bad impression. National Smile Month from 20 May to 20
June, is the largest oral health campaign in the UK.
The survey of more than 1,000 people aimed to determine which oral health problems are generally
considered the least desirable to one’s appearance. Missing teeth was considered to be the least
desirable problem by 57 per cent of respondents,
and stained teeth turned off nearly one in five respondents (18 per cent). Surprisingly, only six per
cent of the respondents were most put off by
braces, and only two per cent of people thought fillings were the least desirable feature. Opinions

were also sought on cracked teeth, uneven teeth
and receding gums, problems that put off a combined total of roughly one in five respondents (18
per cent).
According to Dr Nigel Carter, Chief Executive
of the BDHF, the findings do not come as
a great surprise: “Images portrayed in

[PICTURE: ©IOFOTO]

the media of celebrities have led to a society where
image and the way we look is an important facet of
daily life. Young people particularly associate
celebrities with attractiveness, achievement and
affluence, so it is only natural they will seek to
mimic what they see on TV and in print.”
Carter added, “It is great to see oral health
in the country improving over the
years of the campaign, but there
are still improvements to be
made. By taking responsibility for
your oral health, your teeth and
your mouth, it’s clear from the
survey desirability can improve
too.”

Novel portable probe
YouTube’s value

for dentists established
by study

Detects early oral
cancer
In order to reduce the time taken to diagnose oral cancer, researchers have developed the first prototype of
a handheld detection device capable of fast imaging
with a large field of view.

[PICTURE: ©LICHTMEISTER]

Researchers investigating YouTube have suggested
that the potential of the online video-sharing platform
and similar social media sites as means of dental education is highly underdeveloped. In a study, they
found that it could hold important implications for dental professionals, as well as dental education staff.
Owing to an increasing integration of multimedia
sources into professional and academic education,
Dr Michael Knösel, an orthodontic specialist, and his
team from the University of Göttingen, assessed the
value of videos on YouTube related to dentistry.Two assessors with an academic background evaluated 60
videos in the general category “All” and 60 videos in
the “Education” category.The results were first sorted
“by relevance” and later by “most viewed”. Videos in
the educational category were mostly uploaded by
practitioners but also by academic institutions and
dental companies. The majority of videos in the general category, which were aimed at entertainment
generally, were mostly posted by patients and laypersons, but there was also a significant percentage of

videos with a commercial purpose and posted by dental manufacturers. The assessors said that videos in
the educational category depicted an optimistic view
on dentistry, whereas those in the general category
tended to be rather negative.They found that between
68 and 93 per cent of the videos represented dentistry
accurately, and videos in the general category were
inaccurate in this regard.
The researchers recommended that more academic
institutions acknowledge YouTube as an effective
supplementary medium for education: “YouTube and
similar social media websites offer new educational
possibilities for dentistry, but are currently both underdeveloped and underestimated regarding their potential value. Dentists should also recognise the importance of such websites in relation to the formation
of public opinion about their profession,” the researchers stated. “We would therefore like to encourage educators to make greater use of this medium, to
work to improve the quality of videos, and to demand
that contents are updated on a regular basis.”

"To achieve a higher survival rate, early and on-site
diagnostic methods are much needed in oral health
programs. The compact
handheld confocal imaging system shows
great promise for clinical
early oral cancer diagnosis and treatment," the
researchers from the
University of Texas at
Austin's Department of
Biomedical Engineering [PICTURE: ©LIGHTSPRING]
concluded. The probe
uses a laser to illuminate the examination area and a
micro-mirror,an instrument also used in barcode scanners. The micro-mirror is controlled by micro-electromechanical systems, enabling the laser beam to scan
the area as programmed. Preclinical trials showed
good correspondence with control images from conventional laboratory microscopes and clinical trials are
currently being planned. The paper was published online on April 27 in the Journal of Micromechanics and
Microengineering ahead of print.

laser
2
I 49
_ 2012

[50] =>

I about the publisher _ imprint

laser
international magazine of

laser dentistry

Publisher
Torsten R. Oemus
oemus@oemus-media.de

Loh Hong Sai
Asia & Pacific Division

Editorial Office
Dajana Mischke
d.mischke@oemus-media.de

Senior Editors
CEO
Ingolf Döbbecke
doebbecke@oemus-media.de
Members of the Board
Jürgen Isbaner
isbaner@oemus-media.de
Lutz V. Hiller
hiller@oemus-media.de
Chief Editorial Manager
Norbert Gutknecht
ngutknecht@ukaachen.de
Co-Editors-in-Chief
Samir Nammour
Jean Paul Rocca
Managing Editors
Georg Bach
Leon Vanweersch
Division Editors
Matthias Frenzen
European Division
George Romanos
North America Division
Carlos de Paula Eduardo
South America Division
Toni Zeinoun
Middle East & Africa Division

Aldo Brugneira Junior
Yoshimitsu Abiko
Lynn Powell
John Featherstone
Adam Stabholz
Jan Tuner
Anton Sculean

Claudia Jahn
c.jahn@oemus-media.de

Editorial Board

Sarah Fuhrmann
s.fuhrmann@oemus-media.de

Marcia Martins Marques, Leonardo Silberman,
Emina Ibrahimi, Igor Cernavin, Daniel Heysselaer,
Roeland de Moor, Julia Kamenova, T. Dostalova,
Christliebe Pasini, Peter Steen Hansen, Aisha Sultan,
Ahmed A Hassan, Marita Luomanen, Patrick Maher,
Marie France Bertrand, Frederic Gaultier, Antonis
Kallis, Dimitris Strakas, Kenneth Luk, Mukul Jain,
Reza Fekrazad, Sharonit Sahar-Helft, Lajos Gaspar,
Paolo Vescovi, Marina Vitale, Carlo Fornaini, Kenji
Yoshida, Hideaki Suda, Ki-Suk Kim, Liang Ling Seow,
Shaymant Singh Makhan, Enrique Trevino, Ahmed
Kabir, Blanca de Grande, José Correia de Campos,
Carmen Todea, Saleh Ghabban Stephen Hsu, Antoni
Espana Tost, Josep Arnabat, Ahmed Abdullah, Boris
Gaspirc, Peter Fahlstedt, Claes Larsson, Michel Vock,
Hsin-Cheng Liu, Sajee Sattayut, Ferda Tasar, Sevil
Gurgan, Cem Sener, Christopher Mercer, Valentin
Preve, Ali Obeidi, Anna-Maria Yannikou, Suchetan
Pradhan, Ryan Seto, Joyce Fong, Ingmar Ingenegeren, Peter Kleemann, Iris Brader, Masoud Mojahedi,
Gerd Volland, Gabriele Schindler, Ralf Borchers,
Stefan Grümer, Joachim Schiffer, Detlef Klotz,
Herbert Deppe, Friedrich Lampert, Jörg Meister,
Rene Franzen, Andreas Braun, Sabine SennhennKirchner, Siegfried Jänicke, Olaf Oberhofer,
Thorsten Kleinert

Executive Producer
Gernot Meyer
meyer@oemus-media.de
Designer

Customer Service
Marius Mezger
m.mezger@oemus-media.de

Published by
OEMUS MEDIA AG
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Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de
www.oemus.com
Printed by
Messedruck Leipzig GmbH
An der Hebemärchte 6
04316 Leipzig, Germany

laser
international magazine of laser dentistry
is published in cooperation with the World Federation for Laser Dentistry (WFLD).

Copyright Regulations
_laser international magazine of laser dentistry is published by Oemus Media AG and will appear in 2012 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 inadmissible 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 the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
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for 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.

50 I laser
2_ 2012

[51] =>

laser
international magazine of

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laser dentistry

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[52] =>

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[cover] => laser international No. 2, 2012

[toc] => Array ( [0] => Array ( [title] => Cover [page] => 01 ) [1] => Array ( [title] => Editorial [page] => 03 ) [2] => Array ( [title] => Content [page] => 04 ) [3] => Array ( [title] => Laser in oral surgery and medicine—Part II [page] => 06 ) [4] => Array ( [title] => Evaluation of combined Nd:YAG laser treatment of moderate periodontitis [page] => 12 ) [5] => Array ( [title] => The antibacterial effects of lasers in endodontics [page] => 16 ) [6] => Array ( [title] => Laser treatment of dentine hypersensitivity [page] => 24 ) [7] => Array ( [title] => A novel technique of Er:YAG laser-enhanced early implant stability [page] => 28 ) [8] => Array ( [title] => Laser therapy of oral haemangiomas [page] => 32 ) [9] => Array ( [title] => Lasers in oral implantology [page] => 34 ) [10] => Array ( [title] => Manufacturer News [page] => 38 ) [11] => Array ( [title] => “Laser Supported Dentistry” in Turkey [page] => 40 ) [12] => Array ( [title] => Innovation and information at IDS 2013 [page] => 42 ) [13] => Array ( [title] => Meetings [page] => 43 ) [14] => Array ( [title] => News [page] => 48 ) [15] => Array ( [title] => Imprint [page] => 50 ) ) [toc_html] =>

Table of contents

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