laser international No. 2, 2015

Cover / Editorial / Content / Preventive approach in paediatric dentistry using Er:YAG laser / Conservative management of a large salivary calculus in the submandibular gland / Laser-assisted osseointegration with a diode laser in Type I implant placement / Treatment of mucocele with the Er:YAGlaser: A case report / Manufacturer News / Industry / Gain power at your laser clinics! / Events / News International / Editorial (German) / Manufacturer News (German) / Events (German) / News Germany / About the publisher / Magazine Subscription

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Table of contents

issn 2193-4665

Vol. 7 • Issue 2/2015

laser

international magazine of

laser dentistry

2

2015

| research
Preventive approach in paediatric dentistry
using Er:YAG laser

| case report
Conservative management of a large salivary
calculus in the submandibular gland

| industry
The new BIOLASE: Practice growth ‘assured’

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editorial

Wavelengths

Prof. Dr Norbert Gutknecht
Editor-in-Chief

Dear readers,
As sunlight consists of different wavelengths and can only in this composition of wavelengths serve the vital
biological requirements, future-oriented laser users have to learn that, although the application of a wavelength
is important and good, the same wavelength cannot fulfil all biological and therapeutic demands. Based on this
insight, the future of laser dentistry will be associated with the combination of specific wavelengths.
Success or failure of a laser treatment is inseparable from the selection of the correct wavelength. The better
the biophysical knowledge of the laser user, the better he or she would be able to select the wavelength to target
the intended tissue, triggering the desired interaction. Since there are different tissue types in the oral cavity—in
areas of little space, such as in periodontal pockets—it may be necessary to involve two different wavelengths in
the treatment planning. This knowledge is increasingly used by manufacturers of laser devices not only to extend
the indication spectrum of their devices, but also to optimise specific treatment procedures by combining two or
more wavelengths. The combination and application of different wavelengths will thus be one of the main themes
at this year’s international annual congress of the Deutsche Gesellschaft für Laserzahnheilkunde (German Society for Laser Dentistry) and will be reflected in lectures and workshops, as well as in the dental exhibition.
For the summer months ahead, I wish you much pleasure in enjoying the different wavelengths of sunlight.

Kind regards,

Prof. Norbert Gutknecht
Editor-in-Chief

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I content

page 6

page 20

I editorial

I events

03

34

Wavelengths

06

Biggest IDS of all time in Cologne
| Koelnmesse

| Prof. Dr Norbert Gutknecht

38

I research

page 28

The DGL invites to its
24th International Annual Meeting

Preventive approach in paediatric dentistry
using Er:YAG laser

I news

| Ani Belcheva et al.

26

Manufacturer News international

I case report

40

News international

16

I DGL

Conservative management of a large salivary calculus in
the submandibular gland
| Dr Habib Zarifeh et al.

20

24

Wellenlängen
| Prof. Dr. Norbert Gutknecht

Laser-assisted osseointegration with a diode laser in
Type I implant placement

44

Manufacturer News germany

| Dr Maziar Mir et al.

36

Die DGL lädt ein zur 24. Internationalen Jahrestagung

Treatment of mucocele with the Er:YAG laser

48

News germany

| Foteini Papanastasopoulou

I about the publisher

I industry
28

43

50

| imprint

The new BIOLASE: Practice growth ‘assured’
| Sierra Rendon

I practice management
30

Cover image courtesy of BIOLASE Europe GmbH,
www.biolase.com
Original Background: ©oriontrail
Artwork by Sarah Fuhrmann, OEMUS MEDIA AG.

Gain power at your laser clinics!
Process
| Dr Anna Maria Yiannikos

page 30

04 I laser
2_ 2015

page 34

page 38

[5] =>

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[6] =>

I research

Preventive approach in
paediatric dentistry
using Er:YAG laser
Author_Ani Belcheva, Maria Shindova & Georgi Tomov, Bulgaria

Figs. 1a & b_Acid etching of
hypoplastic enamel showed patchy
loss of surface tooth structure
without evidence of uniform etching
patterns (a). The laser treated
surfaces showed that Er:YAG
radiation caused an uniform
roughness of the enamel for HE
(b) teeth (magnification x 3,000).

Fig. 1a

_Modern dentistry has focused on preventive
methods and conservative techniques to apply less-invasive procedures to tooth structure.1 Awareness towards the importance of preserving tooth tissue combined with a patient-friendly approach is becoming
self-evident. It has been shown that operative dental
treatment often leads to an increasing scale of more
surgical and invasive treatments. Whenever possible,
tissue should be preserved, and invasive treatment
should be kept to a minimum. The best way to ensure
maximum life for the natural tooth is to respect the
healthy tissue and protect it from being damaged by using minimally-invasive techniques in restorative dentistry.2

that prevent the occurrence of oral diseases or retard
their further progression. There are three levels of preventions:

_Preventive dentistry

Level 3: Tertiary prevention
At this level, prevention employs measures that are
necessary to replace much tissue and to rehabilitate patients to the point that functionality resembles its natural condition, as much as possible, after the failure of
the secondary preventions.

Preventive dentistry is a branch of dentistry that
deals with the preservation of healthy teeth and gingiva
and the prevention of dental and oral disease. The field
involves dental procedures, materials and programmes

Fig. 1b

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Level 1: Primary prevention
The pre-pathogenic stage employs measures that
forestall the onset of the disease to reverse the progress
of the initial stage, or to arrest the disease process before treatments becomes necessary.
Level 2: Secondary prevention
The pathogenic stage employs treatments methods,
to terminate a disease process and to restore tissues as
near normal as possible.

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In recent years, the development of new technologies made it possible to prevent complications and to
conduct treatments with minimal intervention. Laser
treatment with its considerable variety of biological actions and high therapeutic effectiveness is used widely
both in medicine and dentistry. Erbium lasers could be
used in large array of both hard and soft tissue procedures performed in paediatric dentistry.3 Many of these
procedures may be treatments that require a specialist.
However, when Er:YAG lasers are being used their efficacy and special characteristics allow general practitioners to perform and complete a wide range of these
procedures. The advantages of Er:YAG laser are associated with a process of ablation, decontamination, minimal invasion and analgesia, thus providing clinical solutions to what once was attribute solely to experts. The
purpose of this study is to describe the scientific approaches to prevention by using Er:YAG lasers.

Fig. 2a

_Er:YAG laser characteristics
and advantages
Ablation
Er:YAG laser has a wavelength of 2.94 µm, which
matches exactly the absorption peak of water and
which is also absorbed by hydroxyapatite. Erbium laser
radiation is very efficient in removing both dentin and
enamel, limiting the laser effect on these tissues to a superficial layer of a few micrometres. The overheated
water abruptly vaporises and the so released vapour
carries away surrounding broken tissue fragments in a
thermo-mechanical ablation process.4, 5

Fig. 2b

In general, there is a linear relationship between
crater depth or removed volume and applied energy
density.15 Water mist is needed to avoid thermal side effects and for pain control.6 The way to remove hard tissues with Er:YAG without overheating prevents the
pulp. Er:YAG laser ablation works in a minimally-invasive way, removing only the damaged tissues. It prevents destruction of sound structures and gives opportunity for a fast healing process.
Decontamination
The bactericidal effect of laser light was advanced to
be one of its beneficial effects. The wavelengths wellabsorbed in water have a good bactericidal effect even
at low-energy density output levels, starting at
0.3 J/cm2, without excessive temperature elevation.7
Due to its bactericidal effect combined with the reduced
pain sensation during its application, the Er:YAG laser
was a very promising tool for cavity preparation in Paediatric Dentistry and in Dentistry in general. Antimicrobial resistance or drug resistance is a problem spread
and discussed worldwide. It is a major concern of the
WHO. The ability of Er:YAG laser to establish decontamination is a solution for effective treatment and prevention of future complications.

Fig. 2c

Analgetic effect and pain perception
As Er:YAG lasers can be used to prepare cavities without thermal damage and the systems availability on the
market offers a high ablation efficiency, it was of interest to investigate the patients’ subjective perception of
this treatment method: Cavity preparation with the
help of Er:YAG laser was found to be more comfortable
in the patients perception than mechanical treatment
in at least 80 per cent of the cases.10, 11

Figs. 2a–c_Maxillary frenectomy
with LiteTouch, Er:YAG laser.

One of the parameters partly explaining the absence
of pain perception is the difference in tooth vibration

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status. Postponement of dental care can result in unnecessary pain, discomfort, increased treatment needs
and costs, unfavourable treatment experiences, and diminished oral health outcomes. Using Er:YAG laser in
patients with fear or phobia of dental treatment is a real
opportunity to treat them and show an alternative wellaccepted method to overcome the barrier of dental care.
With the help of Er:YAG laser, patients realise that there
is a way to preserve their teeth without pain, which will
encourage them to take care of their oral health more
frequently and at the end only for prevention.

_Application of Er:YAG laser in
hard tissues
Fig. 3a

Primary Caries Prevention
Laser is becoming common in clinical dental care and
is one of the promising new modalities used for caries
management. In many studies was investigated the possibility of sub-ablative energies to increase the acid resistance and the micro-hardness of enamel surface and
to reduce enamel solubility by increasing caries resistance without severe alterations of the enamel.13
Laser–fluoride effect on enamel found that low-energy
Er:YAG laser irradiation coupled with fluoride treatment
could inhibit enamel demineralisation through increased fluoride deposition on the surface and formation of fluoridated hydroxyapatite.14 In one recent study,
silver diamine fluoride (SDF ) application followed by
sub-ablative low-energy Er:YAG laser irradiation on
dentine rendered the dentine surfaces more resistant to
caries development, both chemically and mechanically.15 Lasers have also been used to prevent the enamel
demineralization caused by dental caries and have
shown good results.16,17 The Er:YAG laser has been shown
to reduce or prevent the demineralization of tooth
enamel.18 In some studies, when associated with fluoride, it leads to a reduction in mineral surface loss.19, 20

Fig. 3b

Fig. 3c

Figs. 3a–c_Lingual frenectomy of
7-year-old boy with Lite Touch,
Er:YAG laser.

speed caused by Er:YAG laser versus high-speed drill.
Mean vibration speed during laser cavity preparation
reaches 166 +/- 28 µm/second, at a characteristic frequency of 230 Hz, whereas the high-speed drill induces
a 100 times higher vibration speed of 65 +/- 48 mm/second, at 5 kHz. In addition, this much higher frequency
has its spectrum near the peak sensitivity of hearing, as
a potential factor of discomfort and pain provocation.12
A patient may suffer progression of oral disease if
treatment is not provided on time because of age, behaviour, inability to co-operate, disability, or medical

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Sealants reduce the risk of caries in susceptible pits
and fissures of primary and permanent teeth.13 The
enamel surface prior to the placement of the sealant
can be pre-treated in different ways. Non-invasive
techniques include only etching with 37 per cent orthophosphoric acid or air abrasion and acid etching. Invasive techniques use burs for opening the deep and
narrow fissures and then acid etching. Preparing the
enamel surface with Er:YAG laser with subsequent acid
etching is considered as non-invasive technique for
pre-treatment of pits and fissures. This laser wavelength has special uses in the domain of primary and
secondary prevention which include sealing of pits and
fissures and cavity preparation.14 This technology
makes the enamel more resistant to caries attack, and
also the need to acid etching procedure is eliminated, or
reduced.14,15 The use of laser gives the dentist the ability
to clean and sterilise enamel fissures. The bactericidal
effect of Er:YAG laser irradiation could boost the inter-

[9] =>

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I research
est in the already widely accepted pits and fissures sealing procedures. A simultaneous cleaning, conditioning
and decontamination in hardly accessible depths of fissures would open a new perspective to this preventive
treatment. Er:YAG pre-treatment and subsequent acid
etching with highly concentrated phosphoric acid was
equivalent to etching only.1 The long-term success rate
of a fissure sealant depends on its resistance to microleakage, its retention and micromechanical adhesion to the enamel surface, that is remaining completely
intact.16, 17
No significant difference in microleakage was reported between extended fissure sealing with a bur and
phosphoric acid-etching or Er:YAG and phosphoric
acid-etching. Laser irradiation did not eliminate the
need for etching enamel.18 Sealing the sound fissures
reduces the risk of caries and the use of Er:YAG laser for
conditioning and enamel sterilisation preserves the
tooth surface for a long time. There were some important differences between the results of various studies
in evaluation of the bond strength of restorative material bonded to teeth surfaces etched or conditioned with
Erbium laser family and with acid etch technique. These
differences could be the results of laser parameters (energy and frequency) and the type of restorative material
used. The obtained SEM images showed an increase in
retention of restorative material for the surfaces irradiated by laser and a decrease in bacteria in the pits and
fissures, the sterilisation property of laser on irradiated
surfaces is seen. In general, the best results have been
obtained in simultaneous use of laser and acid.1, 19, 20
Etching pattern of defective enamel is vague and has
no resemblance to that of normal enamel.21 This could
be due to difference in structure and composition of defective enamel. Seow W.K. and Amaratunge suggested
that variation of etching patterns could be due to differences in orientation of crystallites relative to the direction of attack together with differences in chemical
composition between central and peripheral parts of
enamel prisms.22 This explanation may highlight the
variation in enamel structure that can occur not only between normal and defective enamel but also from tooth
to tooth, or site to site, on a single tooth surface.23 Also,
variation of etching patterns for defective enamel could
be a result of different aetiology of the enamel defects
in different teeth which is unknown.22 These variations
may result in problems in bond strength.21 Hypoplastic
enamel surfaces prepared with Er:YAG laser LiteTouch
are characterised by a rough and regular topography
without presence of smear layer in contrast with the
surfaces treated with acid (Figs. 1a & b). The acid etching
of a less organised hypoplastic enamel structure may
result in a pattern that is not the classic etched pattern,
which may have a detrimental effect on bonding between the adhesive materials and the affected enamel.
Laser ablation procedures change enamel and the sur-

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faces appeared strong retentive and suitable for adhesive restorations.24, 25 Preparation of hypoplastic or hypomineralised enamel with Er:YAG laser is a way to reconstruct the surface for achievement of better adhesion. If the surface is not retentive enough, the adhesion
will be poor and this can compromise the restorations.
Laser treatment with Er:YAG laser proposes effective
bond strength.25

_Restorative dentistry
Er:YAG laser wavelength of 2,940 nm is strongly absorbed by water. It is thus effective and efficient in dental hard tissue ablation. Er:YAG laser has been studied in
periodontics29, restorative30 and surgical treatments31.
A great advantage of Er:YAG is that it has little chance
of pulpal damage if used under sufficient water cooling.
Minimal pain has been reported with its use, and it is
thus used without local anaesthesia. During cavity
preparation, the procedure begins with the use of very
low-energy settings of the laser in order to achieve an
analgesic effect on the tooth involved. Then the higherpower setting of the laser is used in order to remove the
enamel and expose the infected dentin. Subsequently,
the low-power setting is used once again to remove decayed dentin.26 Different ablation rates for carious and
sound tissue lead to selective removal of carious lesions.14 No smear layer is formed with the application of
laser, which results in an increase in bond strengths.14
Er:YAG lasers are selective for carious tissue and
comfortable in use. The introduction of a new generation of Er:YAG lasers in 2007 finally made it possible to
enjoy a device that automatically balances high energy
output with a wide range of frequency ranges that free
from conducting settings calculations while treating
their patients—saving them time and worries. There is a
laser in the market from the Er:YAG family including
pre-set options, with perfectly balanced high energy
output with a wide frequency range along with the precision control of pulse duration that fits the selected
procedure. Thus, the dentist is concentrated in his work
with no need for complicated calculations. The array of
indications covers almost every possible treatment of
dental hard tissue from simple fissure sealing to cavity
preparation. It is important to point out the positive and
preventive clinical dental care that is one of the promising new modalities used for caries management. The
combined fluoride-laser-treatment makes enamel
more resistant to acid than do either laser or fluoride
treatments alone.27, 28 Er:YAG laser can also transform
enamel hydroxyapatite into fluoridated hydroxyapatite
to reduce enamel solubility as a preventive treatment
for enamel caries.27
Compared to the smooth appearance of the cavity
walls after bur preparation, cavity margins and walls are
irregular but without any smear layer after ablative

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Er:YAG irradiation.32 Conservative dentistry as its name
says is a part of dentistry that uses more conservative
or minimally-invasive approaches to fulfil its goals. That
is why preparing the hard tooth structures with Er:YAG
proposes minimal intervention and prevention with respect to the sound tissues. The minimal penetration and
lack of thermal changes in the pulp prevent the occurrence of complications.

_Laser Application in soft tissues
Maxillary frenectomy
The abnormal junction of the frenum on the maxilla
results in diastema between teeth, weak hygiene, gingival retraction, and repetitive trauma during tooth
brushing. The best laser for the treatment of such a condition is the Erbium laser that is used simultaneously
with water spray. This intervention is performed without the need of suturing, scar tissue formation and any
problems in healing. Usually, frequencies between
30–45 Hz and an energy between 35–55 mJ are used.
On the other hand, with the use of laser, limitation of
the amount of hemorrhage during the surgery helps to
provide a better field view for surgeon. Furthermore,
patient’s comfort after surgery is without doubts one of
the biggest advantages for patients.54-56

Fig. 4a

Figures 2a-c show a case of a 6-year-old boy with a
revision of the maxillary frenum. When the labial
frenum is penetrating the palate or papilla it will have
the potential for developing orthodontic abnormalities,
discomfort, difficult articulation or even carious lesions
from poor hygiene. That’s why an early frenectomy of
such a harmful frenum could prevent the development
of the mentioned pathology.
Lingual frenectomy in ankyloglossia
Ankyloglossia is a frequent finding in newborns that
can cause significant problems in terms of breast feeding, nutrition and speech if the adhesion is severe. For
the treatment of this condition Erbium laser with topical anaesthesia or little needle anaesthetic are used
(Figs. 3a–c).57 The lingual frenum is incised with low energy 50 mJ, 10–15 Hz. The parameters must be changed
if more fibrotic tissue is present or haemostatic effect is
necessary. Laser frenectomy of the lingual frenum prevents speech disorders, as the correct phonetic, that are
formed during the first ages of life. When there is mechanical reason such as thick and tight lingual frenum
that limits the mobility of the tongue the feeding will
also be disturbed. Restoration of the normal tongue
mobility makes easier the clinical work on the rest of the
dentition.
Exposure of unerupted teeth during
orthodontic treatment
For soft tissue removal and exposure of unerupted
permanent teeth for orthodontic objectives it is possi-

Fig. 4b

Fig. 4c

ble to use different wavelengths of lasers, including
Er;Cr:YSGG, Nd:YAG, Er:YAG and Diode laser. Erbium
laser has the ability to remove soft and hard tissues.
When using this laser, one should pay close attention to
the enamel in the surgical point surroundings. This risk
doesn’t exist when using diode and Nd:YAG since their
wavelengths do not interact with hard tissues. For tooth
exposure, only soft tissue removal is necessary. Most of
the time the surgery can be performed without the need
of a local anaesthesia but with the application of topical anaesthetic only, which is a big advantage in the
treatment of small patients. The parameters should be

Figs. 4a–c_Exposure of unerupted
tooth 45 with LiteTouch,
Er:YAG laser.

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I research
Figs. 5a–c_Laser gingivectomy of
lower left quadrant with LiteTouch,
Er:YAG laser.

Fig. 5a

Fig. 5b

programmed to 50–75 mJ with a frequency of 10 to
30Hz. To reinforce the hemostasis, the Erbium laser with
energy of 65 mJ is used, frequency of 20 Hz and pulse
duration of 600 µs.3 Figures 4a–c demonstrates a case
with exposure of interrupting premolar.

tained for 15 s on the lesion and then it is moved in a rotation pattern above the lesion. The treatment is prolonged to a 1mm margin outside the lesion.59, 60 The idea
is to detoxify and dehydrate the ulcer as well as to induce bio-stimulating effect.59

Er:YAG laser is very effective when the impacted
tooth is located intra-bony, because it can work on mucosa, gingival and bone at different parameters. The Erbium laser with energy more than 100 mJ and frequency
of 20 Hz is used for soft tissue cutting and bone removal.

Herpetic gingivostomatitis is the most frequent
oral pathology in small children. A laser treatment with
mid-infrared lasers like Erbium laser, allow the evolution of the lesions and consequently instant dehydration. Er:YAG laser effectively stops the pain and makes
the treatment procedures shorter in time and less in
number. Minimal energy at a low frequency must be
used at the beginning of a treatment around the lesion
and then towards the centre of the lesion. The white
appearance is an indication for a complete dehydration. The procedure it asymptomatic and has a lasting
relief.

Gingival remodelling and gingivectomy
In children with gingival hypertrophy, we can use
various lasers for gingival remodelling. Gingival hypertrophy can be caused by some hydantoin anticonvulsants or other medications.58 It can be induced during
different stages of orthodontic treatment and especially when there is poor oral hygiene. Also, in cases of
tooth decay that goes under the gingiva, it’s possible to
use a laser to remove gingival tissue and proceed
through repair stages without gingival haemorrhage. In
gingivectomy, Erbium laser can be used at low energy of
55–80 mJ and frequency of 10–20 Hz (Figs. 5a–c). The
use of water spray reduces pain and helps tissue cooling. The procedure is usually accompanied by controllable bleeding. A gingivectomy during an orthodontic
treatment brings the natural contour of the gingival
margin. It makes treatment easier and comfortable both
for the patient and the clinician. If the overgrown gingival tissue covers the brackets, it will prolong and trouble
the treatment. Gingival remodelling improves the smile
line. It is important to preserve the biologic width of the
periodontal tissue. The procedure is performed under
anaesthesia and the parameters for Er:YAG laser must
be reduced to 50 mJ, 10–20 Hz.
Laser therapy offers minimally painful treatment
that will not leave negative emotions. The technique is
safe, fast and easy to reproduce. The decreased operating time leads to patient’s acceptance and early treatment without waiting for further complications.
Treatment of aphthous ulcers and herpetic lesions
Aphthous ulcers are very common in children. One
of the easiest and most appropriate ways to treat these
lesions is the application of a low power laser like the Erbium laser without using local anaesthesia. It is possible
to use Erbium laser with frequency of 15 Hz and energy
of 35mJ in a non-contact way. First, the laser is main-

12 I laser
2_ 2015

Fig. 5c

Medically compromised conditions
To provide thorough and safe treatment for medically compromised patients, who cannot tolerate
care, dentists must carry out more complex dental
treatments for the safety and comfort of the patients.
Physically and emotionally exhausting treatments
cannot be tolerated by such patients. Naturally, systemically compromised patients quickly discover that
they cannot withstand the stress of routine treatment
used in conventional dentistry. Therefore, after some
unpleasant experiences, patients will only seek dental
support when there is an emergency or when they
have aesthetic concerns, and they abandon elective
complete treatment.61 The treatment of oral diseases
that individuals with systemic conditions receive has
a direct impact on their overall health and/or medical
therapy, and includes care to control and mitigate pain
and infection and the restoration of function. Oral
health care is an integral part of systemic treatment.

_Patient emotional impact-based
situations
The terms dental fear, dental anxiety and dental
phobia are currently being used interchangeably in
dental literature when referring to negative feelings
related to dental treatment. Dental fear represents a
normal emotional reaction to a specific external
threatening stimulus in a dental situation. Dental anx-

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research

iety represents a state where the patient is evoked and
prepared for something unpleasant, unknown and
negative to happen. Dental phobia represents a severe
type of dental anxiety, which is characterised by persistent fear of clearly discernible objects and situations
and results in avoidance of necessary dental treatment
or enduring treatment only with dread.33
These psychological reactions interfere significantly with daily life. They are problems
suffered by many patients worldwide and
remain a significant challenge in providing adequate dental care. The aetiology of
dental fear and anxiety is multifactorial.
The idea of a “vicious cycle of dental fear
and anxiety” has been promulgated by several studies to explain the mechanism of their
appearance and development. Some researchers posit
a role of psychological variables such as embarrassment and feelings of shame culminating in avoidance
of dental treatment and deterioration of oral
health34–36 (Fig. 6), whereas Bauma et al. propose that
anxiety plays a crucial role in the “vicious cycle of dental fear”.37

Fig. 6_Vicious cycle of dental fear
according to Berggren.

Fear/anxiety

Feelings of
shame and
inferiority

Several studies among Australian dental patients
present the role of dental fear as a component in the
cycle of dental disadvantages with dentally anxious
individuals avoiding dental care. It results in worsening their dental problems and increasing the likelihood
that subsequent dental visits will be for emergency
reasons. So dental fear feeds back itself as a result of a
number of repercussions of the fear. These conceptualisations are described in another model of the socalled “vicious cycle of dental fear” (Fig. 7).38, 39
A recent study by van Wijk and Hoogstraten investigated the interaction between anxiety and dental
pain. They suggest that people who respond fearfully
to pain are at increased risk of ending up in the “vicious
cycle of dental anxiety” (Fig. 8).40 If this cycle is not broken, a severe form of dental anxiety, dental phobia,
might develop. So they propose a modification of the
“vicious cycle” emphasizing the leading role of the fear
of pain in the mechanism of the development of dental anxiety. In view of the above mentioned, it is suggested that dental fear and anxiety result in a delayed
and symptom-driven treatment culminating in an
avoidance of necessary dental care and deterioration
of both oral health and overall health. This linked chain
feeds back into the experiences of dental fear and anxiety. Overall, these studies highlight the need for alternative methods in dentistry that will weaken the impact of the main components that nourish and empower the “vicious cycle”. Consequently, the proven
connection between dental anxiety and pain41, 42,
keeps patients away from the dental practice and thus
may frequently result in acute symptoms and complications. The 21st century calls for a different treatment

Avoidance

Deterioration
of dental
state
atmosphere and conditions that eliminate the elements constructing the “vicious cycle” of dental fear.

_Decreasing dental anxiety
Several studies have shown that the most potent
triggers for dental anxiety are the sight of the anaesthetic needle and the sight, sound, smell and vibration
of dental handpieces and rotary dental drills, which are
pain-associated with dental treatment.43-45 It has been
suggested that reducing these stress-triggers is an effective procedure for managing anxious patients.41, 42
For this reason, anxious patients who must undergo
restorative procedures are often managed using the
“4S” rule or the so called “4S” principle. It is based on removing four of the major primary sensory triggers for
dental anxiety in the dental setting—sight (air turbine
drill, needles), sounds (drilling), sensations (high frequency vibrations—the annoyance factor), smells—
and it is used in conjunction with other measures and
alternative methods to mitigate anxious behaviours
and their consequences.41 A therapy with Er:YAG laser
in paediatric dentistry has known advantages, especially for the safety of its use and for its gentle approach
with patients.46 Dental laser treatment reduces the
need for injected local anaesthesia and obtains very
low to null likelihood of odontoblastic pain and the annoyance factor during carious removal. There is no
smell or dentine ablation vapour in case of inadequate
suction during cavity preparation. The dominant physical sensation is popping (shock waves) and ablation
sound. This new technology offers new possibilities to
the paediatric dentists’ to completely change restorative treatments and thereby help to decrease dental
anxiety of patients.

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[14] =>

I research
the comfort registered during the treatment contributes to a decrease of dental anxiety and makes
laser techniques a very effective method in paediatric
dentistry and a good treatment option for anxious patients. Fear of pain has been strongly linked to the development of dental anxiety and avoidance of
dental treatment.50

Fig. 7_Vicious cycle of anxiety,
modified by van Wijk and
Hoogstraten.

Anxiety

More fear

The application of Er:YAG lasers leads to a
decrease of dental anxiety by eliminating the
main component of the “vicious cycle of dental anxiety” which is pain, and the major stress
trigger observing the “4S” rule which are high
frequency vibrations. Thus, this technology offers new possibilities for an improved service of
anxious patients in both children and their parents.
Because nowadays many children may experience
laser treatment as their first contact with dentistry,
there is a possibility that a new generation of patients
will grow up with a different attitude towards dentistry.
Parents are also enthusiastic about being able to offer
their children the advantages of laser care.51

Fear of pain
Avoidance
of dental
treatment

_Phobic Patients
Numerous studies have been designed to determine
the subjective acceptance and pain perception of an
Er:YAG laser for soft and hard tissue therapy and to
consider the influence of this new technology in case
of dental anxiety. As results of several studies on patient
acceptance of different methods for cavity preparation
have shown, Er:YAG lasers have an acceptable efficiency compared to the conventional mechanical
preparation and patients aged ten years and older prefer the alternative method.47-49
The analysis of the obtained results from the use of
pain assessment scales indicates that patients have
been reported no or low pain perception during laser
preparation in contrast to the high pain levels during
the conventional mechanical preparation. The significant decrease of patient discomfort and dental anxiety have been found to be caused by the painless nature, elimination of the high frequency vibrations
generated by the rotary conventional instruments
and noncontact mode of lasers. Due to its versatility,
Er:YAG is the most frequently used laser by paediatric
dentists to treat both hard and soft tissues in the oral
cavity. Genovese et al. have been investigated the subjective tolerance and acceptance of laser therapy in
children needing both dental and soft tissue treatments.46 The results show that the hard tissue therapy
have been carried out without anaesthesia and with
good collaboration of the patients in 90 per cent of
the cases. While in the soft tissue therapy the acceptance has been presented in 62 per cent of the treated
patients because of the more invasive nature of the
procedure. The findings of this study show a total acceptance of 75 per cent of the treated cases. Hence,

14 I laser
2_ 2015

Dental phobia represents a severe type of dental anxiety, which is characterised by persistent fear of clearly
discernible objects and situations and results in avoidance of necessary dental treatment or enduring treatment only with dread.33 Several studies report that 6-15
per cent of people avoid regular dental care because of
dental anxiety and phobia.52
The prevalence of general and specific phobias reduces with age.52 The concept of the “vicious cycle” as
mentioned previously is valid for adults and children
and adolescents with dental phobia. Surprisingly,
among different subtypes of phobias, the dental phobia is the most prevalent (3.7 per cent).52 These findings should alert both researchers and dental practitioners with the objective to seek for ways of improving this condition. The Diagnostic and Statistical
Manual of Mental Disorders distinguishes phobia
from fear on the basis of the feared stimulus being
avoided or endured with intense distress. Precisely
those people report high dental fear, avoidance of visiting the dentist and significant social and functional
impacts who meet the criteria for a dental phobia.38
Er:YAG lasers can also be used in different paediatric soft tissue procedures, such as frenectomy, operculectomy, exposure of unerupted teeth, some oral
pathological conditions including mucocele, fibroma,
haemangioma, herpes labialis and aphthous ulcers.3, 14, 53

_Conclusion

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research

The clinical work with Erbium laser is minimallyinvasive. Compared to the routine bur drilling where
healthy tissue can also be removed, Erbium laser ablation has minimal penetration in hard dental structures. It prevents healthy hard tissues. It reassures
bactericidal environment of the treated surfaces and
prevents further carious development. Er:YAG is one
of the best suited laser types for cavity preparation
because of its efficiency, especially in dentin. In addition, important pain reduction in comparison to burassisted preparation has clearly been demonstrated
to make it possible working without local anaesthesia
in most cases. Cavity preparation with Erbium laser
has no smear layer and by using it a perfect marginal
quality of the sealing material can be realised. Erbium
laser can be used successfully in medically compromised children with special needs. As for the emotional side, Erbium laser has good acceptance and
gives the opportunity for an attitude transformance,
providing right behaviour for prevention. Laser seems
to be a promising solution for treatment on time and
prevention. Reducing dental anxiety and forms of
phobia by using laser therapy sometimes is the only
possible way to prevent and treat paediatric patients.
The LiteTouch Er:YAG laser is suitable for minimally-invasive dentistry, and is an ideal tool for cavity preparation in both primary and permanent teeth
and in soft tissue management in the field of paediatric dentistry._
Editorial note: A list of references is available from the
publisher.

contact
Ani Belcheva, DDS, MSc, PhD
Associate Professor
Department of Pediatric Dentistry
Faculty of Dental Medicine
Medical University, Plovdiv
3 Hristo Botev Blvd.
4000 Plovdiv, Bulgaria
abeltcheva@yahoo.com

Kurz & bündig
Bei der Anwendung weniger invasiver Prozeduren an der Zahnstruktur hat sich die moderne Zahnmedizin lange Zeit auf präventive Methoden und konservative Techniken konzentriert. Das Bewusstsein über die Notwendigkeit, Zahngewebe zu erhalten und eine
patientenfreundliche Behandlung durchzuführen, ist mittlerweile selbstverständlich geworden. Eine operative Zahnbehandlung zieht
weitere chirurgische und invasive Behandlungen nach sich.Wann immer möglich sollte jedoch Gewebe bewahrt und eine invasive Behandlung auf ein Minimum reduziert werden.
Für eine minimal-invasive Vorgehensweise eignet sich der Erbium-Laser. Verglichen mit dem routinemäßigen Bohrer, mit dem
auch gesundes Gewebe entfernt werden kann, wird bei einer Erbium-Laser-Ablation nur minimal in die Hartzahnstruktur eingedrungen. Damit wird gesundes Hartgewebe bewahrt, das bakterizide Umfeld der behandelten Oberfläche sichergestellt und ein Schutz vor
einer weiteren Kariesentwicklung gewährleistet. Verglichen mit einer bohrergestützten Präparation konnte bei der Laseranwendung
eine deutliche Schmerzreduzierung beobachtet werden, was in den meisten Fällen eine lokale Anästhesie überflüssig macht.
Der Erbium-Laser lässt sich erfolgreich bei der Behandlung von Kindern mit „special needs“ anwenden und auch aus psychologischer Sicht stößt er auf große Akzeptanz. Der Er:YAG-Laser ist somit ein ideales Werkzeug für die minimal-invasive Zahnheilkunde
und die Kavitätenpräparation sowohl bei Milchzähnen als auch im dauerhaften Gebiss und eignet sich hervorragend für das Weichgewebsmanagement im Bereich der Kinderzahnmedizin.

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I case report

Conservative management of
a large salivary calculus in the
submandibular gland
Authors_Dr Habib Zarifeh, Dr Najwa Karam & Dr Nada el Osta, Lebanon

_Surgical management of salivary gland diseases
has always been challenging because it carries a considerable risk of nerve damage, pain and complications.
This case report presents an innovative ambulatory
laser-assisted technique with the use of the
Erbium laser (Er;Cr:YSGG, 2,780 nm) that could be an alternative method for removal of sialolithiasis.

_Introduction

Fig. 1_Mass in the floor of the mouth.
Fig. 2_Mandibular occlusal
radiograph shows a submandibular
salivary calculus.

Sialolithiasis is the most common disease of the major salivary glands. It affects 12 in 1,000 in the adult population. The great majority of salivary calculi (80 per
cent) occur in the submandibular gland, mainly in the
duct; 10 per cent occur in the parotid gland and the remaining 10 per cent in the sublingual and the minor salivary glands.1 Calculi may be located in different positions along the salivary duct and gland. Submandibular
stones close to the hilum of the gland tend to become
large before they become symptomatic. Sialolithiasis
occurs evenly on the right and left sides.2 Males are affected twice more than females and there is a slight
predilection for occurrence in males above the age of 40
years. Salivary calculi are usually unilateral and do not
cause a dry mouth period.3 Clinically, salivary calculi are
round or ovoid in shape with a rough or smooth surface
and of a yellowish colour. They consist of mainly calcium, phosphate with smaller amounts of carbonates in
form of hydroxyapatite, with minimal amounts of mag-

nesium, potassium and ammonia. This mix is distributed
evenly throughout the calculus.4
Sialolithiasis typically causes pain, discomfort and
swelling of the involved salivary gland by obstructing
the food related surge of salivary secretion. Calculi may
cause stasis of saliva, leading to bacterial ascent into the
parenchyma of the gland and therefore infection, pain
and swelling of the gland. Long-term obstruction in the
absence of infection can lead to atrophy of the gland
with resultant lack of secretory function and ultimately
fibrosis.4 Some may be asymptomatic until the stone
passes forward and can be palpated in the duct or seen
at the duct orifice. These can be managed conservatively
by gentle message. It may be possible that obstruction
caused by large calculi is sometimes asymptomatic as
obstruction is not complete and some saliva manages
to seep through or around the calculus.5 Larger
sialolithiasis may need to be managed by surgical removal of the stone itself when possible but if there is significant inflammation, the entire gland may need to be
excised.6 Surgical management of salivary gland diseases has always been challenging because it carries a
considerable risk of nerve damage, pain and complications. The development of additional conservative management techniques would be beneficial. This case report presents an innovative ambulatory laser-assisted
technique with the use of the Erbium laser (Er;Cr;YSGG,
2,780 nm) that could be an alternative method for removal of Sialolithiasis.7, 8, 9

_Patient

Fig. 1

Fig. 2

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A fifty-year-old man consulted for possible implant
placement in the left mandibular region. His medical
history was unremarkable, his blood pressure and pulse
rate were within normal limits, chest radiographs, electrocardiography, total blood count, urine sediment,
liver and kidney function tests were also normal. Extraoral examination revealed a palpable right sub-

[17] =>

November 27–28, 2015
Berlin, Germany
Hotel Palace

th

24 Annual Meeting of the DGL
LASER START UP 2015

dgl-jahrestagung.de

startup-laser.de

Fax Reply

Name & email address

+49 341 48474-290

Practice Stamp

I would like to receive further information on the

❏

24th Annual Congress of the DGL e.V.

on November 27–28, 2015 in Berlin, Germany.

❏ LASER START UP 2015
laser 2/15

[18] =>

I case report

Fig. 3a

Fig. 3b

Fig. 4a

Fig. 4b

Figs. 3a & b_Laser incision in the
floor of the mouth and removal of
sialolithiasis.
Figs. 4a & b_Laser bandage and
post-op wound.

mandibular gland and bimanual intra-oral palpation of
the floor of the mouth, in a posterior to anterior direction revealed a large, firm, non-tender swelling in the
right anterior floor of mouth in the region of the submandibular duct. Intraorally, there was a large, asymptomatic, firm and non-tender swelling in the right anterior floor of mouth in the region of the submandibular duct (Fig. 1) The patient was unaware of swelling and
only noticed it when it was pointed out by the dentist. A
mandibular occlusal film and panoramic projection radiograph confirmed the diagnostic and showed a radiopaque structure in the right premolar region (Fig. 2).
It measured approximately 1.5 cm along its greatest
length.

_Intervention

Fig. 5_The calculus shown
to scale (1.5 cm).
Fig. 6_The laser bandage.
Fig. 7_One week post-operative.

A diagnosis of the submandibular duct calculus was
established and the decision to remove the stone using
the Erbium laser (Er;Cr:YSGG, 2,780 nm)10 was made. The
Er;Cr:YSGG, 2,780 nm has the possibility to be used in
hard tissue and soft tissue by using long pulse duration
of up to 600 ms with an appropriate amount of energy
and an appropriate distance between the laser beam
and the surface of the tissue. Thereby, the presence of

Fig. 6

Fig. 5

18 I laser
2_ 2015

water particles layer of at least 1 mm can help with the
selectivity of tissue ablation due to the explosive vaporisation phenomena. With pulse durations longer than
the relaxation time of tissue, energy is lost to the interior of the tissue by conduction, increasing the energy
needed to cause ablation. Topical anaesthetic gel (EMLA)
was applied at site for five minutes and no injections
were administered. The procedure consisted of locating
the stone, isolating the duct from the surrounding tissues, introducing a button probe, ductal incision above
the stone, sialolithotomy, and checking duct patency
(Figs. 3a & b). The duct, together with the oral mucosa,
was incised until the stone localised within the distal
part of the Wharton duct in the floor of the mouth was
visible using the Waterlase MD Er;Cr:YSGG laser at 2.5
W, 30 pps, S mode using the gold handpiece with the Z
tip.11 It was then removed and no bleeding occurred during this procedure due to laser hydrokinetic energy ablation. The closing of the connective tissue was controlled using the same 2,780 nm laser at 1.0 W, 0 per cent
air, 0 per cent water, S mode (600 ms), using the gold
handpiece with the Z tip, achieving the homeostatic effect12 (also called laser bandage; Figs. 4a & b), no sutures
were needed in this procedure eliminating by consequence the post-operative discomfort of the sutures in
this particular sensitive site. The oral pathology report
confirmed the pre-surgical clinical diagnosis (Fig. 5). No
analgesics or antibiotics were required after the procedure. The patient was seen one week postoperatively to
check salivary function of the gland (Figs. 6 & 7). The
healing was uneventful and without any usual postoperative side effects such as scar formation, injury to the
lingual nerves, swelling, pain, or inflammation since the
Er,Cr:YSGG laser only cuts 5 to 10 cell layers deep and
does not produce any histamine release, effectively
blocking any inflammatory reaction.13 Wound healing
was excellent and achieved rapidly.12 Five years post-operative, no further abnormalities could be observed
(Figs. 8a & b). On review, the right submandibular gland
was palpable and clear saliva could be expressed from
the duct. Patients should be seen in almost every six
months to monitor the absence of recurrent lithiasis.

_Discussion
There are various methods available for the management of salivary stones, depending on the gland

Fig. 7

[19] =>

case report

Fig. 8a & b_Five years
post-operative.

Fig. 8a

Fig. 8b

affected and the stone location.6 Surgical removal of
the calculi is performed when located in the excretory
duct near the opening. Er,Cr:YSGG laser has been
widely used and replaced surgical interventions in selected patients. Its advantages are the relative absence
of pain and the elimination of the need for an operation with its surgical risks. Er,Cr:YSGG laser use is a
modern approach for the management of salivary calculi and treatment oral soft tissue lesions and should
be considered as an alternative to conventional scalpel
surgery. If the calculi are located in the gland itself,
fragmentation can be performed by extracorporal or
endoscopic laser lithotripsy.

maintaining control over them by emphasising the
value of hydration and excellent oral hygiene, which
lessens the severity of the attacks and prevents dental
complications. Once the diagnosis of a salivary gland
stone is established attempts at removal by minimally
invasive techniques should be considered._

_Conclusion
Patients should be educated regarding the mechanism of their underlying pathology and methods of

Editorial note: A list of references is available from the
publisher.

contact
Dr Habib Zarifeh
Clemenceau Medical Center, Beirut, Lebanon
Tel.: +961 70 567444
info@habibzarifeh.com

Kurz & bündig
Sialolithiasis ist eine der häufigsten Erkrankungen in der großen Speicheldrüse, betroffen sind 12 von 1.000 Erwachsenen.
Die Mehrheit der Speichelsteine (80 Prozent) treten in der Unterkieferspeicheldrüse auf, 10 Prozent in der Ohrspeicheldrüse
und weitere 10 Prozent in Drüsen unter der Zunge und kleinen Speicheldrüsen.1
Im Artikel wird der Fall eines 50-jährigen Mannes beschrieben, der eigentlich wegen einer möglichen Implantatplatzierung
vorstellig wurde. Seine medizinische Geschichte war unauffällig, eine extraorale Untersuchung offenbarte jedoch eine spürbare Unterkieferdrüse auf der rechten Seite. Die beidhändige intraorale Abtastung des Mundbodens offenbarte eine große,
feste, unempfindliche Schwellung auf der vorderen rechten Seite im Bereich des submandibulären Duktus (Abb. 1). Eine Aufnahme mandibulär okklusal und eine Panoramaschichtaufnahme zeigten eine radiopake Struktur im rechten Prämolarbereich
(Abb. 2) mit einer Länge von 1,5 cm. Der diagnostizierte Speichelstein sollte mittels einer neuartigen, ambulanten lasergestützten Technik entfernt werden. Zur Entfernung der Sialolithiasis wurde der Erbium-Laser (Er;Cr;YSGG, 2.780 nm)10 verwendet.7, 8, 9
Während der Behandlung wurde der Stein zunächst lokalisiert und der Duktus vom umgebenden Gewebe isoliert. Danach
wurde eine Tastsonde eingeführt, ein duktaler Schnitt über dem Stein gemacht und eine Sialolithotomie sowie eine Überprüfung der Duktusdurchgängigkeit durchgeführt (Abb. 3). Der Duktus zusammen mit der Mundschleimhaut wurde aufgeschnitten, bis der Stein sichtbar und dann entfernt wurde. Der Verschluss des Gewebes erfolgte ebenfalls mit dem Erbium-Laser
(Abb. 4). Analgetika oder Antibiotika waren zur Nachbehandlung nicht mehr nötig. Der Bericht zur oralen Pathologie bestätigte
die vorangegangene klinische Diagnose (Abb. 5). Eine Woche nach der Operation wurde die Funktion der Speicheldrüse überprüft (Abb. 6). Die Wundheilung erfolgte problemlos (Abb. 7 & 8). Insgesamt zeigt der Fallbericht, dass eine lasergestützte Behandlung einer Sialolithiasis eine Alternative zur konventionellen Chirurgie darstellt.

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I case report

Laser-assisted osseointegration
with a diode laser in Type I
implant placement
Authors_Dr Maziar Mir, Prof. Norbert Gutknecht, Dr Masoud Mojahedi, Dr Jan Tunér, Prof. Ramin Mosharraf &
Dr Masoud Shabani, Germany, Sweden & Iran

_Implant placement is conventionally performed after healing of the extraction socket. However,
with this method, undesirable outcomes can occur
owing to the substantial period that elapses before clinicians can continue treatment, for example a reduction in bone level and the collapse of soft tissue. These
unwanted results can compromise aesthetics in the
anterior region significantly. Therefore, immediate
(Type I) implant placement can be a golden opportunity to preserve the aesthetics. Fear of failure, especially in the case of an infected socket, is the greatest
barrier to selecting Type I implant placement.1–5

_Laser in implantology
Lasers have several applications in implantology,
for example:6
Fig. 1_Crown–root fracture.
Fig. 2_Diagnostic impression.

Fig. 1

– Atraumatic uncovering of submerged implants to
prevent crestal bone loss

Fig. 2

20 I laser
2_ 2015

– Recontouring of peri-implant soft tissue
– Sculpting of the emergence profile for prosthetic
components
– Rising of surgical flaps
– Osseous recontouring
– Creation of parabolic tissue architecture
– Bone harvesting of block grafts
– Window preparation in sinus lift procedures
– Ridge splitting
– Debridement of extraction sockets for immediate
implant placement.
Research reports show that the mineralisation of
the socket may not be adequate after three months.
Therefore, additional support to achieve the best bone
density and better osseointegration after implant
placement is needed, specifically in Type I implant
placement.7 It appears that diode lasers have some
potential benefits in helping clinicians to obtain the
best results in implant placement into a fresh socket.

[21] =>

case report

Fig. 3

On the one hand, the high intensity of a diode laser
can remove epithelial cells for 2 or 3 mm at the gingival crest and delay epithelial cell migration to the implant surface, preventing pocket formation around
the implant and creating a sterile area for implant
placement. On the other hand, a diode laser can often
be set at a low output to perform biostimulation (lowlevel laser therapy, LLLT), accelerating the healing
process. Laser-assisted osseointegration without the
use of any bone substitutes is presented in this article.

_Anamnesis and diagnosis
A 25-year-old female patient with the complaint
of a right incisor fracture presented for treatment. The
patient’s medical history showed no systemic medical
problems, no allergic reaction, no medicaments and
no history of past surgical procedures, and thus it was
not necessary to refer the patient for medical consultation.
An oral and maxillofacial examination of the patient found no temporomandibular joint or myofascial disturbances, as well as no functional or parafunctional habits, but a Class I occlusion and poor oral
hygiene. As shown by the clinical findings, the tooth
was infected and a crown–root fracture was obvious
(Fig. 1). The apical area showed the orifice of a fistula,
but there was no pain or swelling.
The radiographic examination showed a radiolucent lesion at the apical part of the involved teeth. The
tooth was diagnosed as not worth preserving and thus
the final decision was to perform an atraumatic extraction followed by dental implant placement (Fig. 2).
The consent form was completed and the patient’s
information was reviewed (examination sheet and radiograph, consent form, etc.). Thereafter, antibiotic
prophylaxis was prescribed (penicillin V 500 mg, q.i.d.,
orally, starting one day before extraction).

_Initial treatment
After the diagnosis, the treatment plan was to first
extract the tooth and then accelerate wound healing

Fig. 4

Fig. 5

Fig. 6

Fig. 7

using a laser device. The surgical area was anaesthetised with infiltration of 1.8 ml of 2 per cent lidocaine with 1:100,000 epinephrine in order to perform
an atraumatic tooth extraction. The controlled area
was then defined and the laser warning signs placed
properly to secure the operating room. Furthermore,
eye protection was provided for the patient, as well as
for the patient’s guardian and the assistant.

Fig. 3_Clinical view.
Fig. 4_Atraumatic extraction.
Fig. 5_De-epithelialization and
implant site preparation.
Fig. 6_Implant placement without
any bone substitutes.
Fig. 7 & 8_Two months after implant
placement.

Having extracted the tooth (Figs. 3 & 4), socket debridement and irrigation with normal saline were performed. The laser system was then calibrated in order
to irradiate the treated area with a low-intensity laser
(LLLT) for acceleration of wound healing. The laser parameters were as follows: wavelength of 980 nm, output power of 1 W, irradiation time of 20 s, spot size of
3 mm, power density of 1.41 W/cm2 at the end of the
low-level handpiece, socket diameter of 8 mm, irradiation area of πr2 = 0.502.4 cm2, power density of
0.199 W/cm2 at the target surface, dose of 3.98 J/cm2,
non-contact mode (1 mm from the orifice) and rotating at the orifice of the socket, single dose.
After the treatment, the patient was advised to
keep the area clean and plaque free with gentle brushing, continue using the antibiotic and take over-thecounter analgesics as needed. The next visit was
scheduled for one week after the initial treatment in
order to perform the implant placement.

_Implant placement
One week after the initial treatment, the implant
was placed. After revision of the consent form and establishing safe laser delivery conditions, the surgical
area was anaesthetised with infiltration of 1.8 ml of
2 per cent lidocaine with 1:100,000 epinephrine.

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I case report

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Fig. 9_Healing implant site two
months after implant placement.
Fig. 10_Immediately after crown
seating (ten weeks after implant
placement).
Fig. 11_Six months after implant
placement.

First, the laser system was recalibrated, which entailed cleaving of the fibre, aiming of the beam, and
initiation of the fibre with articulating paper and testfire of the laser, in order to create a hole at the socket
orifice for starting the drilling and for de-epithelialisation of the attached gingiva for approximately
3 mm around the socket orifice. During the treatment,
high-volume suction was used to evacuate the
vapour plume and objectionable odours at the site of
operation. The carbonised tissue was then removed
with a micro-applicator brush soaked in a 3 per cent
hydrogen peroxide solution.
The hole creation and gingival de-epithelialisation
(Fig. 5) were performed with a 980 nm diode laser,
with a power of 1 W, fibre of 400 µ, initiated fibre,
continuous wave and in contact mode. After this
procedure, the implant placement was performed
(Fig. 6).
The laser parameters for the acceleration of the
osseointegration were as follows: wavelength of
980 nm, output power of 0.1 W, irradiation time of
20 s, spot size of 3 mm, power density of 1.41 W/cm2
at the end of the low-level handpiece, socket diameter of 8 mm, irradiation area of πr2 = 0.502.4 cm2,
power density of 0.199 W/cm2 at the target surface,
dose of 3.98 J/cm2, non-contact mode (1 mm from
the orifice) and rotating at the orifice of the socket.

22 I laser
2_ 2015

Both the labial and palatal surfaces of the socket
were irradiated at the same dose immediately after
implant placement (the total dose for three sites in
the first session was 11.94 J/cm²) and then twice
weekly with the same protocol, but with an irradiation time of 15 s, consequently with a dose of
2.985 J/cm² (the total dose for three sites per session
was 8.955 J/cm²). The LLLT was performed at intervals
for two weeks.
Finally, a temporary bridge made of composite materials was fabricated and seated in order to preserve
the aesthetics.

_Final result and follow-up
Excellent implant placement was observed with no
bleeding, carbonisation or char. The primary stability
of the implant was excellent. The patient did not experience any discomfort and was satisfied with the
treatment.
The first visit after Type I implant placement was
scheduled for two days after the procedure. The healing process was as expected in that the healing was
progressing well and without any swelling or pain.
LLLT was performed and the next visit was determined
after two days for the next LLLT session two weeks
later. Finally, after two months of follow-up, a suc-

[23] =>

case report

cessful treatment outcome was observed with excellent osseointegration and sufficient soft tissue to ensure the aesthetics at the site (Figs. 7–11).

_Discussion
LLLT is used extensively in many dental practices.8, 9
Laser–tissue interaction in LLLT is not photo-thermal.10, 11 This treatment is dose dependent12, 13 which
means that the laser parameters have to be respected.14 The precise molecular mechanisms of LLLT
are not well understood, but its clinical effects on pain
control, inflammation reduction and wound healing
have been well researched.15–17

LLLT can promote implant stability and improve
healing around the surgical site through increasing
ATP synthesis and angiogenesis, reducing inflammation and increasing osteoblast proliferation.21–23
Furthermore, LLLT can improve the attachment of
the fibroblast to implant surfaces24 and promote
osteoblast activity.25

_Conclusion
Based on the laser protocol applied in this study, the
diode laser can be used in Type I implant placement
with or without bone substitutes in order to achieve
better osseointegration and implant stability._

Diode lasers can be used for soft-tissue management in implantology.18 Our results in this case
demonstrate that a diode laser can be applied in Type
I implant placement in order to establish osseointegration successfully.

contact

Gomes et al. have shown that LLLT enhances periimplant bone repair, thereby improving stability and
bone formation.19 De Vasconcellos et al. have reported
that infrared LLLT may improve the osseointegration
process in osteopenic and normal bone, particularly
based on its effects in the initial phase of bone formation.20

Dr Masoud Shabani
Oral Health Department, Official Complex of Ardebil
University of Medical Sciences, Daneshgah Street
5618985991 Ardebil, Iran
Tel.: +98 451 5521417
Fax: +98 451 5522196
m.shabani@arums.ac.ir

Editorial note: A list of references is available from the publisher.

Kurz & bündig
Konventionell wird eine Implantatplatzierung nach der Heilung der Extraktionsalveole vorgenommen. Mit dieser Methode
kann es jedoch zu unerwünschten Resultaten kommen, wie einer Reduzierung des Knochenniveaus und einem Zusammenbruch
von Weichgewebe, was auch die Frontästhetik sehr stark beeinträchtigen kann. Eine sofortige Implantatplatzierung (Typ I) kann
dabei eine gute Möglichkeit sein, die Ästhetik zu bewahren.
Im Fallbeispiel wurde eine 25-jährige Frau mit einer Fraktur des rechten Schneidezahns vorstellig. Die Anamnese offenbarte
eine Okklusion der Klasse I sowie eine schlechte Mundhygiene. Der Zahn war infiziert und zeigte eine Krone-Wurzel-Fraktur (Abb.
1). Apikal war eine Fistelöffnung zu sehen, jedoch gab es keine Schmerzen oder Schwellungen. Eine radiologische Untersuchung
zeigte eine strahlendurchlässige Verletzung im apikalen Bereich des betroffenen Zahns. Der Zahn wurde als nicht erhaltungswürdig diagnostiziert, und daher fiel die Entscheidung auf eine atraumatische Extraktion mit anschließender Implantatplatzierung (Abb. 2).
Nach der Zahnextraktion (Abb. 3 & 4) wurde die Wunde gesäubert und mit Kochsalzlösung ausgespült. Das Lasersystem
wurde dann kalibriert, um den behandelten Bereich zur Beschleunigung der Wundheilung mit niedriger Intensität (LLLT) zu bestrahlen. Eine Woche später wurde das Implantat inseriert. Die Erstellung des Lochs und die gingivale Epithelisierung (Abb. 5)
wurden mit einem 980 nm Diodenlaser durchgeführt. Im Anschluss wurde das Implantat platziert (Abb. 6). Abschließend wurde
eine temporäre Kompositbrücke aufgesetzt, um die Ästhetik zu bewahren.
Nach einer zweimonatigen Follow-up-Periode mit regelmäßiger LLLT konnte ein erfolgreiches Behandlungsergebnis beobachtet werden mit einer exzellenten Osseointegration und ausreichendem Weichgewebe (Abb. 7–11).
Wie diese Studie zeigt, eignet sich ein Diodenlaser für eine Typ I-Implantatplatzierung mit oder ohne Knochenersatzmaterialien zur Erreichung einer besseren Osseointegration und Implantatstabilität.

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[24] =>

I case report

Treatment of mucocele
with the Er:YAG laser
A case report
Author_Foteini Papanastasopoulou, Greece

_Mucocele is a mucosal swelling due to a rupture
of a salivary gland duct and accumulation of mucin in
the surrounding soft tissue. It is a common lesion of the
oral mucosa in children and young adults and often
caused by local trauma. The size of the mucocele can
range from 1 mm to a few centimetres and is asymptomatic. The most common area of appearance is the
lower lip. Some mucoceles heal spontaneously after
rupture. However, chronic lesions are treated by local
surgical excision, cryotherapy and laser surgery.

lip. The lesion was painless, fluctuant and round. The
aetiology was an accidental bite of the lower lip three
months ago. The presence of the swelling was causing difficulties in speaking and chewing for the patient. The medical and dental history was taken and
the patient was examined clinically. The lesion was diagnosed as a mucocele (Fig. 1). The treatment of the
mucocele was removal of the lesion. Removal with
the use of an Er:YAG laser was the choice of treatment.

_Case report
A 13-year-old male patient visited the dental
clinic with the complaint of a swelling on the lower

A local infiltrative anaesthetic was administered
(Ubistesin Forte 1 ml, 3M ESPE). An Er:YAG laser
(2,940 nm, LiteTouch, Syneron Dental Lasers) was
used with the power settings of 200 mJ, 20 Hz, 4 W,

Fig. 1a

Fig. 1b

Fig. 2a

Fig. 2b

Figs. 1a & b_Clinical diagnosis.
Figs. 2a & b_Immediately after laser
treatment.

24 I laser
2_ 2015

[25] =>

case report

Fig. 3b

Fig. 3a

and a pulse duration of < 800 µs in soft-tissue mode,
with a water spray (Level 5). The tip was 0.6 mm in diameter and 17 mm in length and was placed in contact with the tissue at a 50-degree angle. The procedure lasted for 3–5 minutes and no sutures were required (Fig. 2). Once the lesion had been removed, the
incision site was pressed with sterile gauze and instructions were given to the patient to avoid acidic
foods. No antibiotics were prescribed.

_Clinical results
Postoperative clinical examination was performed a week later. The patient reported no postoperative pain or discomfort and had not used any analgesic medication. The wound healing of the lesion
was good and without complications (Fig. 3). After a
four-month follow-up, no recurrence or scar formation was observed (Fig. 4).

_Conclusion
Laser surgery combines safety and effectiveness,
which are beneficial for both patient and dentist. The
comfortable and easy procedure without the need
for sutures minimises patient anxiety and increases
laser familiarisation in everyday clinical praxis. Additionally, the excellent wound healing and aesthetic
outcome ensure the best treatment option for patients._

Fig. 4

Figs. 3a & b_Healing after one
month.
Fig. 4_Healing after four months.

contact
Dr Foteini Papanastasopoulou
L. Kalamakiou 73
174 55 Alimos
Greece
foteinel@yahoo.gr

Kurz & bündig
Unter einer Mukozele versteht man eine Schleimhautschwellung, die durch einen Riss des Speicheldrüsenkanals und eine
Ansammlung von Mucin um das umgebende Weichgewebe verursacht wird. Eine solche Verletzung der Mundschleimhaut tritt
besonders häufig bei Kindern und jungen Erwachsenen auf und kann oftmals auf ein lokales Trauma zurückgeführt werden.
Einige Mukozelen heilen von alleine, bei chronischen Verletzungen kann eine lokale chirurgische Entfernung, Kältetherapie und
Laserchirurgie Abhilfe schaffen.
Im vorliegenden Fall wurde eine 13-jährige Patientin behandelt, die mit einer Mukozele in der Unterlippe vorstellig wurde. Die
Patientin hatte sich drei Monate zuvor auf die Unterlippe gebissen und die daraufhin resultierende Schwellung verursachte
Schwierigkeiten beim Sprechen und Kauen. In einer drei- bis fünfminütigen Prozedur wurde die Verletzung unter Verwendung
eines Er:YAG-Lasers entfernt. Das Nähen der Wunde oder eine Gabe von Antibiotika im Anschluss an die Behandlung waren nicht
mehr nötig.
Die Untersuchung eine Woche nach der Operation zeigte eine gute Wundheilung ohne nennenswerte Komplikationen. Auch
beim Follow-up nach vier Monaten wurde weder ein Rückfall noch eine Narbenbildung festgestellt.
Gerade solche kleineren Eingriffe sind eine gute Gelegenheit, den Laser in den Praxisalltag einzuführen. Die Laserchirurgie
kombiniert Sicherheit und Effektivität, was sowohl für den Patienten als auch für den Zahnarzt von Vorteil ist. Die komfortable und
einfache Prozedur macht eine Nahtlegung überflüssig und verringert Ängste aufseiten der Patienten. Zusätzlich stellt eine Laseranwendung durch die exzellente Wundheilung und das ästhetische Ergebnis eine gute Behandlungsoption für den Patienten
dar.

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[26] =>

I manufacturer news_international

Manufacturer News
Schneider Dental

Cutting-edge technology with comfort
could be developed through extensive studies,
which offers a high efficiency of laser wavelength
of 810 nm. The focus in PDT lies on the endodontia, periimplantitis and periodontitis.

Diode lasers in dentistry are more capable than
most practitioners might think. However, the most
important fact is that using the gadget should be
intuitive and easy—despite multiple therapy possibilities. For little surgical interventions, the BluLase Mini by BluLase is the best way to perform.

BluLase opines that even the best gadget cannot
show its advantages without a professional instruction. Therefore, the sales and services were
spun off exclusively to the dental company
Schneider Dental in Pilsach, Germany. So instead
of a mail sending the device is delivered personally and assembled locally, an extensive briefing
by doctor and staff generally takes place before
the handover. Additionally, the BluLase Academy
by Schneider Dental offers trainings at regular
intervals.

The handy, pencil-shaped tool is light-weighted
but full of energy: it has a maximum output power
of 2.5 W in pulse mode, lower services of 0.7 W and
1.7 W are available as a continuous wave (CW) as
well as 300 mW especially for photodynamic therapy. Only two buttons are sufficient to run the BluLase Mini, the feedback of the device takes place
via a multi-coloured light-emitting diode, which
informs the user about the set power. Thanks to the
quick-change battery with a charging station, the
BluLase Mini is continuously ready for use. Beside
the classic diode laser indications, both BluLase
810 PDT and BluLase Mini were designed for the
Photodynamic Therapy (PDT). A TBO-based dye

Schneider Dental/BluLase
Muscherstraße 8
92367 Pilsach, Germany
www.schneiderblulase.com

Fotona

Erbium laser with patented technologies

laser

ur
o
y
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s
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Publ se!
i
expert

2015

26 I laser
2_ 2015

Fotona’s booth at IDS allowed visitors to get a
first-hand look at the company’s award-winning
LightWalker AT S dental laser.
Renowned international dental
laser experts were on hand
around the clock at the company’s booth to answer questions and demonstrate the laser’s
advanced capabilities, especially
with difficult-to-treat conditions
such as peri-implantitis.

The dental laser’s state-of-the-art design,
engineering and patented technologies
have made it one of the world's fastestcutting Erbium laser, outperforming even
rotary burs in terms of speed and precision, while simultaneously offering a wide
range of highly effective hard- and softtissue treatments. Typical procedures

with this laser are faster, easier to perform,
less painful and require shorter healing times
compared to conventional treatments.
The LightWalker AT system includes high-performance Er:YAG and Nd:YAG lasers, 20 W of
power and Fotona's patented VSP and
QSP pulse technologies for best possible
performance and control during over a
wide range of applications, from simple
cavity preps to implantology and endodontics. LightWalker AT is also the first
Erbium dental laser on the market with
digitally controlled handpiece technology
(X-Runner®), offering dentists new treatment possibilities and higher levels of
precision.
Fotona d.d.
Stegne 7
1000 Ljubljana, Slovenia
www.fotona.com

[27] =>

[28] =>

I industry

The new BIOLASE:
Practice growth
‘assured’
Author_Sierra Rendon, USA

[PICTURE: ©SHUTTER_M]

_“The new BIOLASE.”
You may hear or see that phrase this year and wonder, what exactly does that mean? In 2015, BIOLASE, a
leader in the dental laser industry, has a new focus on
placing customers first; new and improved products,
such as the WaterLase iPlus and Epic X; and a new industry-first, ground-breaking Practice Growth Guarantee.
Orlando Rodrigues, Vice President and Chief Marketing Officer at BIOLASE, and Bill Brown, Marketing
Director, spoke about the new products, concepts and
future developments of the company.

_Lasers can make
differences
Lasers can make a profound difference in the practice
of dentistry. It is a market in need of improved clinical benefits, patient preference in terms of significant pain reduction and practice-growth opportunities
for the company's primary audience,
which is dentists. One of the first things down

28 I laser
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its focus on any segment other than dental lasers. “We
are essentially refocusing the direction of the company almost 180 degrees, one of our objectives we
have now placed is that a minimum of 30 per cent of
our revenue every year will come from new or improved products," Orlando Rodrigues, Vice President
and Chief Marketing Officer, said.
This goes along with the company’s new re-focus on
placing customers first. “BIOLASE is not a business
where we sell boxes and move onto the next customer,”
Rodrigues said. “Our commitment to the dental professional is the most important thing that we do.”
New and improved products for the company include both the EPICTMX and the WaterLase iPlus 2.0.
“We just introduced a new diode laser, EPICTMX, back
in November, that is the result of a total focus on quality,” Bill Brown, Marketing Director, said. “And [in February] in Chicago, we introduced the new WaterLase
2.0, which is a product upgrade offering significant
improvements to uptime and functionality.”
The other new concept BIOLASE is introducing is
the Practice Growth Guarantee, which has never before been done in dentistry, Brown said.

[29] =>

industry

M]
.CO
YPIC
L
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A
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TUR
IC
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[

_The Practice Growth Guarantee
“The Practice Growth Assurance commits to the
dentists that we are going to guarantee them that
they will grow their practice by focusing on the seven
core procedures that dentists have identified as the
most important,” Brown said. “We assure them that
we are going to work with them by providing practicemarketing materials and more training assistance,
and with the increased ease of use of the WaterLase,
it all works together to address that No. 1 need that
we hear from dentists: growing their business. That is
not to diminish the dentists’ focus on clinical outcomes and patient needs, but they are business people, and they want to build their practice.”
Practice growth could mean a number of different
things, Brown said. It might mean more patients, it
might mean more referrals or it might mean being
able to treat many patients that before would’ve been

The Practice Growth Assurance
commits to the dentists that we
are going to guarantee them that
they will grow their practice.

sent elsewhere. “We are partnering with the dentist
and, in six months, if you have not grown your practice, we are going to come in and do an analysis and figure out why. And we will come
back and give you more resources.”
BIOLASE believes that by enhancing
patient experience, clinicians will automatically generate practice growth. “One
of the things we are really focused on is
making sure that dentists retain more of
their patients and do not have to refer out
anymore or not nearly as many as they did
before because they are now capable of
handling those procedures,” Rodrigues
said.
For more information on the EPICTMX,
the WaterLase iPlus 2.0 or BIOLASE’s Practice Growth Guarantee, visit BIOLASE.com_

Kurz & bündig
2015 erfindet sich BIOLASE, einer der führenden Anbieter in der zahnärztlichen Laserindustrie, neu. Neu ist der Fokus des Unternehmens, der sich nun zuerst auf die Kunden richtet; neu und verbessert sind die Produkte, wie der WaterLase iPlus und der EPICTMX
Diodenlaser; und neu ist eine noch nie vorher dagewesene Practice Growth Guarantee. Orlando Rodrigues, Vizepräsident und Chief
Marketing Officer von BIOLASE, und Bill Brown, Marketing Director, sprachen über die neuen Produkte, Konzepte und die zukünftige Entwicklung des Unternehmens.
Das Unternehmen ist überzeugt, dass die Laseranwendung gerade auch für die Zahnmedizin viele Vorteile in der täglichen Anwendung bietet. Deshalb konzentriert sich das amerikanische Unternehmen nun ganz auf dentale Laser und den Zahnarzt selbst.
Eines der Ziele ist es, mindesten 30 Prozent der jährlichen Gewinne aus neuen oder verbesserten Produkten zu generieren. Erst im
November hat BIOLASE den Diodenlaser EPICTMX eingeführt und im Februar den WaterLase iPlus 2.0. Ein weiteres neues Konzept
stellt das Unternehmen mit der Practice Growth Guarantee vor.
Mit dieser Garantie sichert BIOLASE seinen Kunden ein Praxiswachstum zu bei Konzentration auf sieben Prozeduren, die Zahnärzte als am wichtigsten identifiziert haben. Bei der Erreichung des jeweils individuellen Ziels zum Praxiswachstum unterstützt das
Unternehmen die jeweilige Zahnarztpraxis mit Praxismarketingmaterial und Schulungshilfen sowie der erhöhten Benutzerfreundlichkeit des WaterLase. Die Garantie: Wenn sich nach sechs Monaten kein Erfolg eingestellt hat, führt das Unternehmen mit dem
Kunden eine Analyse durch und stellt diesem weitere Ressourcen zur Verfügung.

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_ 2015

[30] =>

I practice management

Gain power at
your laser clinics!
Process
Author_Dr Anna Maria Yiannikos, Germany & Cyprus

_Today, as a sequel of our previous articles we
will introduce you to the last P of our 7 P’s of Marketing Mix. With these series of articles my ultimate goal is to give dentists and dental professionals a basic guideline of the marketing options
available which they can directly implement to
their clinical routine. Starting with this easy strategy, I will teach you how you can implement these
methods at your own clinic as well as understand
their value and power and thus change your professional life.
The last P of the 7P’s of Marketing Mix is Process.
Actually, this refers to the process that our patients
undergo before, during and after the treatment.
Our ultimate goal is to add value to all the above
three stages.

_Five factors
The above mentioned three stages are influenced by five crucial factors. The first factor is the
culture of our patients. For example, Americans are
more convinced about aesthetic dentistry than
Cypriots and thus are more likely to undergo an aes-

30 I laser
2_ 2015

thetic treatment. The second factor refers to our patients’ social class. A patient from an upper social
class might be more interested in a whitening treatment than a patient from a lower social class.
The third factor is the reference group. This
means that our patients’ decision to accept a treatment is influenced not only by psychological factors, personality and lifestyle, but also by the people around them, with whom they are interacting,
and the various social groups to which they belong.
The groups with whom they interact directly or indirectly influence our patients’ decisions. If a patient for example knows a friend or a relative who
has been treated with laser, he or she would be
more attracted to do such kind of treatment than a
patient who has no previous reference group.
The fourth factor refers to opinion leaders. There
are three types of opinion leaders that are most
commonly used: celebrities, experts and the ‘common man’. For example, a patient might visit us
because a famous star is one of our patients
(celebrity), his GP referred him or her to us (expert)
or he or she saw a testimonial from one of our pa-

[31] =>

practice management

services or products based on the need or on emotions—the so called internal motivation. On the
other hand, we have the external motivation that
we as dentists can offer to our patients by openly
communicating the benefits of the laser treatment,
for instance.

_Decision making process
[PICTURE: ©OLIVIER LE MOAL]

As I mentioned above, there are three stages that
our patients go through during their decision making process to accept the treatment.
The first phase is the pre-purchase stage. In
this phase, the patients are aware of their needs,
they start to search for more information,
through the internet, by asking friends or relatives and possibly visiting other colleagues of us.
In this phase, our external marketing plays a very
important role.
The next stage is the service-encounter stage.
This second stage represents the moment when
we are in direct contact with the patient; this has
been termed as the ‘moment of truth’, which is our
opportunity to influence the patient’s perception
of the service quality through our internal mar-

[PICTURE: ©EDYTA PAWLOWSKA]

tients on our website / testimonial book (‘common
man’). Last but not least, there are psychological
factors that determine our patients’ behaviours. If
they need the treatment, we have to ask ourselves:
What is their perception, their attitude towards the
treatment and finally, what are the patients’ motives? Based on the Freudian theory, there is an existence of unconscious motives in the selection of

keting. The third and final stage is the post-purchase stage. It is the stage when the patients go to
their houses, think about their treatment and evaluate us. In this stage, the patients’ loyalty and intentions for referrals are created. They decide
whether they are going to continue visiting us or
not, whether we have met their expectations. They
are either satisfied or we have not succeeded and

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_ 2015

[32] =>

I practice management
they are dissatisfied. Additionally,
in this third stage cognitive dissonance might occur, a very
normal situation in people,
which is also known as doubt.

[PICTURE: ©MATHEE SAENGKAEW]

For example, let’s assume that Mrs. Smith has
made ten veneers. She had chosen us after an extensive pre-purchase search and evaluation of alternatives. When she saw her new smile she was so
excited! However, when she went home her next
door neighbour said: “What on earth have you done!
You have spent so much money just for your smile
during this economic crisis!” So, Mrs Smith’s level of
dissonance could be very substantial indeed.
And then Mrs Smith comes to us full of anxiety
about her decision. Some of which we can do in this
moment is to reassure her of the success of the
method she has chosen and that there are war-

ranties. Furthermore, we can assure her
that we would be next to her in the exceptional case of failure. Another possible
way to reduce the cognitive dissonance is to
remember our patient of the reference
groups, e.g. people that have already
been treated and are satisfied with us.
In the next issue of this magazine I
will introduce a new series named “11
TIPS to gain desirable success in our
dental clinics”. Till then, you can always
send me your questions and request
further information and guidance at
dba@yiannikosdental.com or via our Facebook Account. Looking forward to our next trip of business
growth and educational development!_

contact
Dr Anna Maria Yiannikos
Adjunct Faculty Member of AALZ
at RWTH Aachen University
Campus, Germany
DDS, LSO, MSc, MBA
dba@yianniksodental.com
www.dba-aalz.com

Kurz & bündig
Im finalen Teil dieser Serie wird das letzte P im 7 P’s of Marketing Mix vorgestellt: der Prozess. Dieser beschreibt die Entscheidungsfindung des Patienten für oder gegen eine weiterführende Behandlung und umfasst drei Phasen, nämlich vor, während und nach der Behandlung.
Diese Phasen werden von fünf Faktoren beeinflusst. Erstens dem kulturellen Hintergrund des Patienten: Ein Amerikaner ist
für eine ästhetische Zahnbehandlung beispielweise zugänglicher als ein Zypriot. Der zweite Faktor bezieht sich auf den sozialen
Status: So interessiert sich ein Patient aus einer höheren sozialen Schicht vielleicht mehr für eine Zahnaufhellung als ein Patient
aus einer niedrigeren. Ein dritter Faktor stellt die Referenzgruppe dar: Ein Patient, der bereits auf die Erfahrung von Bekannten
oder Freunden zurückgreifen kann, wird sich eher für beispielsweise eine Laserbehandlung entscheiden als jemand, der keine
solche Referenzgruppe hat. Der vierte Faktor umfasst die Meinungsbildner. Hier sind drei Gruppen zu nennen, die eine Patientenentscheidung beeinflussen: prominente Persönlichkeiten, Experten und der „Normalbürger“, letzterer trägt zur Meinungsbildung durch Bewertungen auf der Praxiswebsite oder mündliche Empfehlungen bei. Zu guter Letzt bestimmt auch noch die
Psychologie über das Patientenverhalten. Hier können unbewusste Motive des Patienten zur Entscheidungsfindung beitragen.
Diese fünf Faktoren spielen eine wichtige Rolle im dreistufigen Entscheidungsprozess. In der ersten Stufe – vor der Behandlung – ist das externe Marketing der Praxis entscheidend; der Patient holt sich Informationen beispielsweise über das Internet
oder durch Empfehlungen ein. In der nächsten Stufe entsteht der direkte Kontakt zwischen Patient und Behandler. Hier lässt sich
der Entscheidungsprozess des Patienten durch internes Marketing, d.h. Servicequalität, beeinflussen. Die letzte Stufe beschreibt
die Zeit nach der Behandlung, wenn der Patient die Praxis verlässt, über die Behandlung nachdenkt und entscheidet, ob er wiederkommt oder nicht. In dieser Stufe können Zweifel aufkommen. Hier kann der Behandler die Ängste des Patienten durch Zusicherung von Hilfe bei evtl. Problemen nach der Behandlung etc. und durch positive Referenzen beseitigen.
In der nächsten Ausgabe beginnt eine neue Serie. Hier wird die Autorin 11 Tipps geben, wie sich wünschenswerter Erfolg in
der Zahnarztpraxis erzielen lässt.

32 I laser
2_ 2015

[33] =>

[34] =>

I events

Biggest IDS of all time
in Cologne
Growth in the number of visitors, exhibitors and exhibition space
Author_Koelnmesse

_After achieving a record result, the 36th International Dental Show (IDS) that was characterised by an
excellent atmosphere closed its doors in Cologne after
five days. Around 138,500 trade visitors from 151
countries attended the world's leading trade fair of the
dental industry, which corresponded to an increase of
almost eleven per cent compared to the previous
event. IDS also achieved new records in terms of the
number of exhibitors and the exhibition space sold.
2,201 companies (+6.9 pe rcent) from 56 countries
presented a wealth of innovations, product developments and services on exhibition space covering
157,000 square meters (+6.2 per cent). With an over
70 per cent share of foreign exhibitors (2013:
68 per cent) and a 17 per cent increase in the number
of trade visitors from abroad the level of internationality of the event was once again significantly increased. At the same time, the number of trade visitors

34 I laser
2_ 2015

from Germany also increased markedly in comparison
to 2013 (+4.3 per cent).
"We succeeded in making the International Dental
Show in Cologne even more attractive, on both a national and international basis. It is thus the most successful IDS of all time," summed up Dr Martin Rickert,
Chairman of the Association of German Dental Manufacturers (VDDI). "The quality of the business contacts
between the industry and the trade as well as between
the industry, dentists and dental technicians was extremely high. The number of orders placed at IDS rose
once again and we are reckoning with sustainable impulses for the post-fair follow-up business," added
Katharina C. Hamma, Chief Operating Officer of Koelnmesse GmbH. Furthermore she said: "In addition to the
growth in the number of German trade visitors, the high
international response once again underlines the char-

[35] =>

events

acter of IDS as the world's leading trade fair of the dental industry. The International Dental Show particularly
recorded strong growth in the number of visitors from
the Near and Middle East, the United States and
Canada, Brazil as well as from China, Japan and Korea.
The business in the South East European market, especially Italy and Spain, has also increased noticeably."

_Strong interest in innovations
The trade and the users were extremely interested
in innovative products and technologies. "In this respect, staged every two years, IDS fits in perfectly with
the innovation cycles of the industry regarding the development and further development of products, materials and services," emphasised Dr Markus Heibach,
Executive Director of VDDI. "This applies for both
breakthrough innovations and further developments
of existing products, but also for development
progress in smaller phases that are however significant in terms of quality."
IDS 2015 focused on the intelligent networking of
components for computer-controlled dentistry. Today, the world of digital systems in diagnostics and
production encompasses the entire workflow from the
practise through to the laboratory. The computer-controlled process chains are in the meantime complete
and are putting their enormous flexibility to use.

_Fantastic outcome of the trade fair and
excellent mood
The hustle and bustle in the halls made the high attendance at IDS very apparent. By all accounts, representatives from all relevant professional groups—from
dentists' surgeries, dental laboratories, from the dental trade, but also from the higher education sector—
from all over the world had visited the exhibition
stands. The exhibitors were especially pleased about
the high level of internationality of the trade visitors.
In terms of business, IDS was very successful for many
companies, because orders were placed—by both national and international customers. Numerous companies were pleased to announce full order books. Aspects such as grooming contacts, customer bonding,
winning over new customers or penetrating new foreign markets were at least equally important for the
exhibitors. These goals were also achieved to complete
satisfaction at the 36th International Dental Show. The
exhibitors evaluated the quality of the visitors very
positively. This finding is confirmed by the initial results
of an independent visitor survey: 83 per cent of all of
the visitors are involved in purchasing decisions at
their company.

Meisinger GmbH. "More international customer contacts visited our stand this year than in 2013. Visitors
from Latin America were particularly well represented,
but also from Asia. "We were able to establish countless new contacts at IDS and also met up with our existing customers." Martin Dürrstein, Chairman of Dürr
Dental AG, was also extremely satisfied: "The trade fair
went very well for us, it was fantastic. We received a
high number of particularly qualified trade visitors. We
are totally satisfied with the fair, because we were able
to welcome many new customers from Asia, Arabia,
Latin America and South Africa."
Christian Scheu, Executive Director of Scheu-Dental GmbH also praised the further increased internationality of IDS: "In comparison to 2013, we were able
to further increase the number of visitors at our stand,
in particular visitors from abroad. The Asiatic region,
for instance China and Korea, were especially well represented, but we also registered an increase in the
number of customers from Southern Europe." As well
as the high frequency of visitors at his stand, Axel

"The world meets up at IDS in Cologne," summed
up Sebastian Voss, managing partner of Hager &

laser
2
I 35
_ 2015

[36] =>

I events
establish many new customer contacts. This is why the
International Dental Show is an absolute must for every
American manufacturer from the dental industry."
IDS 2015 was also a success for Andrew Parker, CEO
of Mydent International: "We met up with our international customers here in Cologne and were additionally able to make over 100 interesting new contacts to dental dealers. No other event in the world has
such international appeal."

_Satisfied visitors all round

Klarmeyer, Executive Director of BEGO, also reported,
"that the customers were well informed and that they
showed great interest in new technologies."
Walter Petersohn, Vice President Sales of Sirona
Dental Systems, was also pleased "about the vast numbers of international visitors, the buying interest and as
always about the large number of attending German
dentists and dental technicians." Michael Tuber, Executive Director of A. Titan also awarded IDS 2015 top
marks. "This is the seventh time we have exhibited at IDS
and we have optimally achieved the goal we set ourselves, namely further expanding our international
sales network. The trade fair offers us the perfect platform for meeting up with our existing customers from
all over the world, but at the same time, we were able to

The visitor survey revealed that over 75 per cent of
the respondents were (very) satisfied with IDS. The
fair's comprehensive spectrum of products and new
products ensured that 81 per cent of visitors rated the
product range as being (very) good. 74 per cent of the
exhibitors were (very) satisfied in terms of reaching the
goals they had set themselves for the fair. Overall, 95
per cent of the visitors questioned would recommend
visiting IDS to business partners and 77 per cent also
intend to visit IDS 2017. The International Dental Show
(IDS) takes place in Cologne every two years and is organised by the GFDI Gesellschaft zur Förderung der
Dental-Industrie mbH, the commercial enterprise of
the Association of German Dental Manufacturers
(VDDI) and is staged by Koelnmesse GmbH, Cologne.
The next IDS—the 37th International Dental Show—
is scheduled to take place from 21 to 25 March 2017._
www.ids-cologne.de

Kurz & bündig
2015 war ein Rekordjahr für die nunmehr 36. Internationale Dental-Schau (IDS) in Köln: Rund 138.500 Fachbesucher aus
151 Ländern besuchten die Weltleitmesse der Dentalbranche, was einer Steigerung von fast elf Prozent im Vergleich zur Vorveranstaltung entspricht. 2.201 Unternehmen (+ 6,9 Prozent) aus 56 Ländern präsentierten auf 157.000 Quadratmetern (+ 6,2
Prozent) eine Vielzahl an Innovationen, Produktweiterentwicklungen und Services.
„Es ist uns gelungen, die Internationale Dental-Schau in Köln sowohl national als auch international noch attraktiver zu machen. Damit ist sie die erfolgreichste IDS aller Zeiten“, bilanzierte Dr. Martin Rickert, Vorstandsvorsitzender des Verbandes der
Deutschen Dental-Industrie (VDDI). „Die Geschäftskontakte zwischen Industrie und Handel sowie zwischen Industrie, Zahnärzten und Zahntechnikern waren von hoher Qualität geprägt. Die Ordertätigkeiten auf der IDS sind erneut gestiegen und auch für
das Nachmessegeschäft rechnen wir mit nachhaltigen Impulsen“, ergänzte Katharina C. Hamma, Geschäftsführerin der Koelnmesse GmbH.
Im Vordergrund der IDS 2015 stand die intelligente Vernetzung von Komponenten für die computergestützte Zahnheilkunde.
Die Welt der digitalen Systeme in Diagnostik und Fertigung umspannen heute den gesamten Workflow von der Praxis bis ins Labor. Die computergestützten Prozessketten sind inzwischen komplettiert und spielen nun ihre enorme Flexibilität aus. Eine Besucherbefragung ergab, dass mehr als 75 Prozent der Befragten mit der IDS (sehr) zufrieden waren. Das umfassende Produktspektrum und zahlreiche Produktneuheiten sorgten dafür, dass 81 Prozent das Ausstellungsangebot mit (sehr) gut bewerteten.
Mit der Erreichung ihre Messeziele zeigten sich 74 Prozent (sehr) zufrieden. Insgesamt würden 95 Prozent der befragten Besucher Geschäftspartnern den Besuch der IDS empfehlen und 77 Prozent planen, die IDS auch 2017 zu besuchen. Der Termin für
die nächste Veranstaltung steht bereits fest: Die 37. Internationale Dental-Schau findet vom 21. bis 25. März 2017 in Köln statt.

36 I laser
2_ 2015

[37] =>

Return address
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
c/o Universitätsklinikum Aachen
Klinik für Zahnerhaltung
Pauwelsstraße 30
52074 Aachen, Germany

Tel.: +49 241 8088164
Fax: +49 241 803388164
Credit institute: Sparkasse Aachen
IBAN: DE56 3905 0000 0042 0339 44
BIC.: AACSDE 33

Membership application form
Name/title:
Surname:
Date of birth:
Approbation:
Status:

self-employed

employed

civil servant

student

dental assistant

Address: Practice/office/institute (delete as applicable)
ZIP/city:

Street:

Phone/fax:

Email:

Private/place:

Street:

Due to an association agreement of DGL and DGZMK, an additional reduced annual fee for DGZMK is charged (85 EUR
p.a. if you are not yet a member of DGZMK). The contribution collection is made by the DGMZK office, Liesegangstr. 17a,
40211 Düsseldorf. You will be addressed hereby.
With the application for membership I ensure that
I am owing an own practice since

and are working with the laser type
(exact name)

I am employed at the practice
I am employed at the University
I apply for membership in the German Association of Laser Dentistry (Deutsche Gesellschaft für Laserzahnheilkunde e.V.)

Place, date

Signature

Annual fee: for voting members with direct debit € 150
In case of no direct debit authorisation, an administration charge of € 31 p/a. becomes due.
DIRECT DEBIT AUTHORISATION
I agree that the members fee is debited from my bank account
Name:

IBAN:

BIC:

Credit institute:

Signature of account holder

This declaration is valid until written notice of its revocation

[38] =>

I events

from 27 to 28 November 2015 in the Hotel Palace in
the city of Berlin. The event is held in collaboration
with the 3rd Oral Hygiene Day, the 12th Annual Meeting of the DGKZ, and the 7th International Congress
of Aesthetic Surgery and Cosmetic Dentistry (IGÄM)
and the 4th Nose, Sinus & Implants.
The programme schedule enables the involved
companies to offer active participation in the congress, i.e. in the form of workshops. By combining
the various meetings, the request of many exhibitors
will be met by providing access to a high number of
participants. The expected attendance is around
400 participants.
The congress president and scientific director of
the 24th International Congress of the DGL and
LASER START UP is Prof. Dr Norbert Gutknecht of the
RWTH Aachen University Hospital.

38 I laser
2_ 2015

_The laser market can currently be viewed as
very positive—this is reflected in a wide range of
modern and highly efficient new laser systems. The
effort to further integrate laser dentistry into the
individual disciplines, such as implantology, periodontics or endodontics, the acceptance of lasers in
dentistry will be even more successful.

The objective of the LASER START UP Congress is
to introduce dentists to the use of lasers in dentistry
and in this context to give an overview of the relevant lasers for dental applications and the respective manufacturers. The focus group of the annual
meeting of the DGL is expert users of laser technology from at home and abroad, from the dental offices and the universities._

The joint conference of the 24th International
Annual Meeting of the DGL and LASER START UP is

For further information please visit www.dgl-online.de and www.oemus-media.de

[39] =>

Call for papers
DGL | German Society for Laser Dentistry
24th International Annual Congress
27 to 28 November 2015 in Berlin, Hotel Palace, Germany
Title

Author

Institute(s)
Address
Tel./Fax/E-Mail

/

/

Abstract (max. 250 words in Times New Roman, 11 pt.)

Session:
(1) Scientific session
(2) Case presentation

Presentation:
(1) Lecture
(2) Poster presentation
(3) Video presentation

Abstract:
Please arrange the text in the order of:
• Purpose: Give a brief overview of the topic and in this
context state the main objective of the study.
• Material and Methods: Describe the basic design, subjects
and scientific methods.
• Results: Give main results of the study including confidence
intervals and exact level of statistical significance, whenever
appropriate.
• Conclusion: State only those conclusions supported by the
data obtained and whenever appropriate, the direct clinical
application of the findings (avoid speculations).

Authors:
The name of the person presenting the paper should be marked by an asterisk.
Please include a copy on CD!

Please send in your abstract until 30 June 2015

Presentation:
Only via computer/beamer
For more information:
Prof. Dr Norbert Gutknecht, Universitätsklinikum Aachen,
Klinik für ZPP/DGL, Pauwelsstraße 30, 52074 Aachen, Germany
Tel.: +49 241 8088164, Fax: +49 241 803388164
E-Mail: sekretariat@dgl-online.de

[40] =>

NEWS

international

Er:YAG laser irradiation

Dental plaque can be used for

Effects on bacteria communication

Disease prediction
and treatment

The Biofilm Research Laboratory, Institute of Dental Sciences in collaboration
with the Department of Endodontics
at the Hebrew University-Hadassah
School of Dental Medicine in Jerusalem,
Israel, has being researching “Laser
irradiation effects on cell-to-cell
communication” since the incorporation of the LiteTouch Er:YAG laser
in the University. The research
findings suggests a possible effect of laser irradiation on bacteria’s quorum sensing cascade,
essentially disrupting cell-to-cell
communication and bio-film formation. As far as has been known
yet this is a novel discovery,
which had not been documented before. The research
team is leaded by renown Key
opinion leaders and users of
the LiteTouch Er:YAG laser
such as Idan Redenski, BSc,

Sharonit Sahar-Helft, DMD, Adam Stabholz, DMD, Reuven Aharoni, PhD,
and Doron Steinberg, PhD.
“This previously undetected interaction between Er:YAG laser
and bacteria opens a new field of
clinical applications for the LiteTouch,“ Claudia Yoel, Marketing
projects Manager at Syneron
Dental Lasers, said.
Following a presentation of this
research at IADR, the Hebrew
University team won in the first
place of the European IADR
Robert Frank Award. The International Association for
Dental Research (IADR), headquartered in Alexandria, Virginia, US, is a non-profit organisation with nearly 11,000
members worldwide.

Researchers from Canada have suggested that dental plaque, a bacterial biofilm formed on dental surfaces, can be used to predict, identify and treat diseases. In a recently established laboratory, they collect and analyse plaque samples to screen for biomarkers that correlate with certain oral and systemic
conditions, such as diabetes.
In particular, the researchers scan for the 16S rRNA
gene, which is unique to each bacterial type, yet
present in all bacteria and can thus be used to distinguish individual species. Plaque analysis only
takes a few hours, and the results help the scientists
determine disease risk and shed light on the effectiveness of a specific treatment rapidly. The research
is being conducted at the recently formed Oral Microbiome and Metagenomics Research Laboratory
at the University of Toronto's Faculty of Dentistry. It is
[PICTURE: ©POP PAUL-CATALIN]

Growing and ageing population drives

Australian’s dental industry
IBISWorld, an independent research firm, [PICTURE: ©RUSLAN GUZOV]
has recently updated its report on the dental service industry in Australia. It found
that ageing and the country’s growing
population have driven the industry over
the past five years, particularly as the oral
care of older people has increasingly improved and they have retained their natural teeth. The report further indicates that
the dental services industry has grown
over the past five years owing to a considerable increase in individual expenditure
on dental services.According to IBISWorld
industry analyst David Whytcross, growing private private health insurance extras to subsidise out-ofhealth insurance coverage has also benefited the in- pocket dental costs. Furthermore, policy interventions
dustry, as patients are willing to visit their dentist more have affected the industry. Whytcross explained that
regularly and undergo procedures that are more ex- initiatives such as the Medicare Chronic Disease Denpensive.Therefore, industry revenue is expected to rise tal Scheme and the Medicare Teen Dental Plan enabled
through the 2014–2015 period to reach A$9.4 billion. many patients who could not afford to pay for dental
Similar trends are expected over the next five years, as care to maintain their oral health by entitling them to
a growing number of older Australians will require den- dental visits to public clinics and the provision of vouchtal work and owing to a greater willingness to take up ers for private clinics.

40 I laser
2_ 2015

currently focused on plaque as a source of microbiological biomarkers for disease, but aims to study
biomarkers for inflammation, for example. In the future, the laboratory's work could also benefit head
and neck cancer patients undergoing radiation therapy, which often damages oral mucosa and salivary
glands, the researchers believe. With the development of plaque transplantation therapies, for instance, healthy plaque samples could help stabilise
bacterial content in the mouth and effectively protect
teeth without the use of chemicals, operations or
other invasive procedures.

[41] =>

After 50 years US need to

Lower fluoride
in drinking water

Healthy Growth for
the medical laser
market

US health authorities have updated their guidelines for fluoride in drinking water and now recommend an optimal fluoride concentration of
0.7 mg/l. As Americans today have greater access
to fluoride in the form of toothpaste and
mouthrinse and owing to the increasing incidence
of fluorosis due to excess fluoride, the Department
of Health and Human Services sought to replace its
recommendations that were issued in 1962.
Since the early 1960s, the practice of adding fluoride to public drinking water systems has grown
steadily in the US. Nearly all water fluoridation systems in the US have used fluoride concentrations
ranging from 0.8 to 1.2 mg/l. With the recent update, however, this will be reduced by
0.1–0.5 mg/l, and fluoride intake from drinking
water alone will decline by approximately 25 per
cent. The total fluoride intake will be reduced by
about 14 per cent. According to the department's
report issued on April 27, the new optimal concen-

BBC Research reports

During the next five years, the medical laser market should enjoy healthy growth, bolstered by
growing consumer demand for elective laser procedures. Combined with advances in medical
laser technology, along with development of new
applicators and tool holders that will widen the
range of applications, this industry should rebound impressively from the economic downturn.
tration of 0.7 mg/l was chosen to maintain caries
prevention benefits, but reduce the risk of dental
fluorosis. Today, nearly 75 per cent of Americans
who are served by public water systems receive
fluoridated water. In 2012, the Centres for Disease
Control and Prevention estimated that approximately 200 million people in the US were served
by 12,341 community water systems that added
fluoride to water or purchased water with added
fluoride from other systems.

Dental researchers to complete

After having achieved promising results in the first
test phase, researchers in New York, USA, have received a new grant from the National Institutes of
Health to complete the development of a rapid blood
and saliva test for HIV/AIDS. They believe that the
time- and cost-saving device will particularly benefit people in remote geographic areas with only limited access to advanced diagnostics. In total, the

project received a $1.5 million Small Business Innovation Research Phase II grant, which will be used to
develop a commercial-ready fully automated system that can simultaneously detect HIV/AIDS antibodies and viral RNA from the AIDS virus in a single
specimen.
The primary aim of the project is to simplify HIV testing and eliminate the need for multiple patient visits
to health providers. The grant was awarded to
Rheonix, a New York-based company specializing in
the design of automated, customizable molecular diagnostic devices. In collaboration with dental experts at the New York University College of Dentistry,
the company successfully performed an initial test of
its Rheonix CARD cartridge system. The system,
which is the size of a smartphone, is a disposable
card that acts as a receptacle for blood or saliva samples. The card is then placed on an instrument that
carries out all of the required steps in processing the
sample. According to the researchers, the entire
testing process takes less than one hour and the device is mobile and can be battery operated.

The global market for medical laser devices was at
nearly $3.7 billion in 2013. This market is expected
to increase from more than $4.1 billion in 2014 to
nearly $7.8 billion in 2019, with compound annual
growth rate (CAGR) of 13.6 per cent over the fiveyear period from 2014 to 2019.
BCC Research examines the medical laser devices
industry in its report, Global Markets and Technologies for Medical Lasers. The report addresses
the global market for lasers used in diagnostic,
therapeutic, and cosmetic applications during the
period from 2013 through 2019. It addresses the
market in its entirety as well as in selected regional
and country markets.

laser
2
I 41
_ 2015

[42] =>

27. und 28. November 2015
in Berlin
Hotel Palace

24. JAHRESTAGUNG DER DGL
LASER START UP 2015

dgl-jahrestagung.de

startup-laser.de

Faxantwort
+49 341 48474-290

Name/E-Mail-Adresse

Praxisstempel

Bitte senden Sie mir das Programm zur/zum

❏ 24. JAHRESTAGUNG DER DGL

❏

LASER START UP 2015

am 27. und 28. November 2015 in Berlin zu.

laser 2/15

[43] =>

editorial

Wellenlängen

Prof. Dr Norbert Gutknecht
Editor-in-Chief

Liebe Kolleginnen und Kollegen,
so wie das Sonnenlicht aus den unterschiedlichsten Wellenlängen besteht und auch nur in dieser Zusammensetzung unterschiedlicher Wellenlängen die vitalen biologischen Anforderungen bedienen kann, so müssen auch
zukunftsorientierte Laseranwender verstehen lernen, dass die Anwendung einer Wellenlänge zwar sehr wichtig und
gut sein kann, dieselbe Länge aber nicht alle biologischen und therapeutischen Anforderungen erfüllt. Die Laserzahnheilkunde der Zukunft wird deshalb mit der gezielten Kombination von Wellenlängen assoziiert sein.
Mit der Auswahl der richtigen Wellenlänge ist der Erfolg oder Misserfolg einer Laserbehandlung untrennbar verbunden. Je besser die biophysikalischen Kenntnisse des Laseranwenders sind, desto gezielter wird er diejenige Wellenlänge auswählen, mit der die beste Gewebeinteraktion ausgelöst werden kann. Da wir in unserer Mundhöhle mit
den unterschiedlichsten Gewebetypen konfrontiert sind, und dies zum Teil auf engstem Raum, wie beispielsweise in
der parodontalen Tasche, kann es notwendig werden, zwei voneinander verschiedene Wellenlängen in die Behandlungsplanung einzubeziehen.
Das Wissen um die Wirkungsweisen verschiedener Wellenlängen wird zunehmend von Lasergeräteherstellern
aufgenommen, um nicht nur das Indikationsspektrum ihrer Geräte zu vergrößern, sondern auch bestimmte Behandlungsabläufe durch die Kombination zweier oder mehrere unterschiedlicher Wellenlängen zu optimieren. Aus
diesem Grund wird die Kombination und Anwendung unterschiedlicher Wellenlängen eines der Schwerpunktthemen des diesjährigen internationalen Jahreskongresses der Deutschen Gesellschaft für Laserzahnheilkunde e.V.
(DGL) sein und sowohl in Vorträgen, Workshops als auch in der Industrieausstellung ihren Niederschlag finden.
Für die vor Ihnen liegenden Sommermonate wünsche ich Ihnen jedoch erst einmal viel Freude bei dem Genuss
der unterschiedlichen Wellenlänge des Sonnenlichts.
Herzlichst Ihr

Prof. Dr Norbert Gutknecht
Präsident der DGL

laser
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_ 2015

[44] =>

I manufacturer news_germany

Manufacturer News
Schneider Dental

Spitzentechnik mit Komfort
Diodenlaser in der Zahnmedizin können oft mehr, als der erste Eindruck vermittelt. Dabei muss die Bedienung des Geräts intuitiv und
einfach sein, trotz zahlreicher möglicher Therapien. Für kleinere
Eingriffe bietet BluLase ganz aktuell den BluLase Mini an. Das
handliche Gerät im Stiftformat lässt sich bequem mitführen,
bietet jedoch trotz seines geringen Gewichts eine maximale
Ausgangsleistung von 2,5 W im Pulsbetrieb, niedrigere Leistungen von 0,7 W und 1,7 W stehen als Dauerstrich (CW) zur Verfügung sowie 300 mW speziell für die photodynamische Therapie. Die Bedienung des BluLase Mini wird mit zwei Tasten vorgenommen, die Rückmeldung des Geräts erfolgt über eine mehrfarbige Leuchtdiode, welche den Anwender über die
eingestellte Leistung informiert. Durch die SchnellwechselAkkus mit Tischladestation ist der BluLase Mini permanent
einsatzbereit.

pie (PDT) konzipiert. Durch umfangreiche Studien konnte ein Farbstoff auf TBOBasis entwickelt werden, welcher bei der Laserwellenlänge von 810 nm eine
hohe Effizienz bietet. Schwerpunkte der PDT sind die Endodontitis, Periimplantitis sowie Parodontitis.
BluLase vertritt die Auffassung, dass auch das beste Gerät ohne professionelle
Unterweisung nicht seine ganzen Vorteile ausspielen kann. Aus diesem Grund
wurde der Vertrieb sowie der Service exklusiv an die Firma Schneider Dental in Pilsach ausgegliedert. Anstelle eines Postversands wird das Gerät in der Regel persönlich in die Praxis geliefert und vor Ort montiert, eine umfangreiche
Einweisung von Arzt und Personal erfolgt grundsätzlich vor der Übergabe. Darüber hinaus werden im Rahmen der BluLase-Academy durch
Schneider Dental in regelmäßigen Abständen Schulungen angeboten.

Neben den klassischen Diodenlaser-Indikationen ist der
BluLase Mini insbesondere für die Photodynamische TheraAD

Schneider Dental/BluLase
Muscherstraße 8
92367 Pilsach, Deutschland
www.schneiderblulase.com

Fotona

Erbium-Laser mit patentierten Technologien

laser

2015

n
e
h
c
i
l
t
n
e
f
f
ö
r
Ve
Sie Ihr issen
Fachw

44 I laser
2_ 2015

Während der IDS konnten sich Besucher am Stand
von Fotona einen eigenen Eindruck vom preisgekrönten dentalen Laser LightWalker AT S
machen. Internationale Experten aus dem Bereich der Laserzahnmedizin standen rund um
die Uhr zur Beantwortung von
Fragen zur Verfügung und demonstrierten die erweiterten
Funktionen des Lasers – besonders bei schwer zu behandelnden Erkrankungen wie Periimplantitis.
Das state-of-the-art Design, die Bauweise und patentierten Technologien
haben den Laser zu einem weltweit am
schnellsten schneidenden Erbium-Laser
gemacht. In puncto Schnelligkeit und Präzision übertrifft er damit sogar rotierende
Bohrer. Gleichzeitig bietet das Gerät ein
großes Spektrum effektiver Hart- und
Weichgewebsbehandlungen. Typische
Prozeduren mit diesem Laser sind schneller, einfacher auszuführen, weniger
schmerzvoll und benötigen eine kürzere

Heilungszeit, verglichen mit konventionellen Behandlungen.
Das LightWalker AT-System enthält leistungsstarke Er:YAG- und Nd:YAG-Laser,
20 W und Fotonas patentierte VSP- und
QSP-Pulstechnologien für eine bestmögliche Leistung und Kontrolle während einer Vielzahl von Anwendungen, beginnend bei einfacher
Kavitätenpräparation bis zur Implantologie und Endodontie. LightWalker AT ist auch der erste
Erbium-Laser auf dem zahnmedizinischen Markt mit einer digital
kontrollierten Handstück-Technologie (X-Runner®), der den Zahnärzten neue Behandlungsmöglichkeiten und eine bessere Präzision
ermöglicht.
Fotona d.d.
Stegne 7
1000 Ljubljana, Slowenien
www.fotona.com

[45] =>

Antwort:
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
c/o Universitätsklinikum Aachen
Klinik für Zahnerhaltung
Pauwelsstraße 30
52074 Aachen

Tel.: 0241 8088164
Fax: 0241 803388164
E-Mail: sekretariat@dgl-online.de
Bank: Sparkasse Aachen
IBAN: DE56 3905 0000 0042 0339 44
BIC: AACSDE33

Aufnahmeantrag
Name/Titel:
Vorname:
Geb.-Datum:
Approbation:
Status:

selbstständig

angestellt

Beamter

Student

ZMF/ZAH

Adresse: Praxis/Dienststelle/Institut (Unzutreffendes bitte streichen)
PLZ/Ort:

Straße:

Telefon/Fax:

E-Mail:

Privat/Ort:

Straße:

Aufgrund des bestehenden Assoziationsvertrages zwischen der DGL und der DGZMK fällt zusätzlich ein reduzierter Jahresbeitrag für die DGZMK an (85 € p.a., falls Sie noch nicht Mitglied der DGZMK sind). Der Beitragseinzug erfolgt durch die
DGZMK-Geschäftsstelle, Liesegangstr. 17a, 40211 Düsseldorf. Sie werden hierfür angeschrieben.
Mit der Stellung dieses Aufnahmeantrages versichere ich, dass ich
seit dem

in der eigenen Praxis mit einem Laser des Typs
arbeite. (genaue Bezeichnung)

in der Praxis

beschäftigt bin.

in der Abt. der Universität

beschäftigt bin.

Ich beantrage die Aufnahme in die Deutsche Gesellschaft für Laserzahnheilkunde e.V.

Ort, Datum

vollständige Unterschrift

Jahresbeitrag: Für stimmberechtigte Mitglieder bei Bankeinzug 150,00 €.
Sofern keine Einzugsermächtigung gewünscht wird, wird ein Verwaltungsbeitrag von 31,00 € p.a. fällig.
EINZUGSERMÄCHTIGUNG
Ich bin einverstanden, dass der DGL-Mitgliedsbeitrag von meinem Konto abgebucht wird.
Name:

IBAN:

BIC:

Geldinstitut:

Unterschrift des Kto.-Inhabers

Diese Erklärung gilt bis auf schriftlichen Widerruf

[46] =>

I events

Die DGL lädt ein
zur 24. Internationalen
Jahrestagung

_Der Lasermarkt kann derzeit in vielerlei
Hinsicht auf eine außerordentlich positive Bilanz verweisen. Nicht zuletzt spiegelt sich dies
in einem breiten Angebot an modernen und
sehr effizienten Lasern wieder. Mit dem
Bestreben, die Laserzahnmedizin künftig
stärker in die einzelnen Fachgebiete wie
Implantologie, Parodontologie oder
Endodontologie zu integrieren, wird es
noch besser gelingen, dem Laser den
ihm gebührenden Platz innerhalb der
modernen Zahnmedizin zu erkämpfen.
Der Gemeinschaftskongress, bestehend
aus der 24. Internationalen Jahrestagung der DGL
und LASER START UP, wird vom 27. bis zum 28. November 2015 im Hotel Palace in Berlin gemeinsam mit
dem 3. Mundhygienetag, der 12. Jahrestagung der
DGKZ, dem 7. Internationalen Kongress für Ästhetische Chirurgie und Kosmetische Zahnmedizin (IGÄM)
und dem 4. Nose, Sinus & Implants stattfinden.
Die Programmstruktur bietet den beteiligten Firmen aktive Mitwirkungsmöglichkeiten, z. B. in Form
von Workshops. Mit der Zusammenlegung verschie-

46 I laser
2_ 2015

dener Kongresse wird dem Wunsch
vieler Aussteller nach Bündelung
der Aktivitäten im Interesse hoher
Teilnehmerzahlen entsprochen. Es
werden insgesamt rund 400 Teilnehmer erwartet.
Die Kongresspräsidentschaft und
Wissenschaftliche Leitung der 24.
Internationalen Jahrestagung der DGL
und des LASER START UPs liegt in den
Händen von Prof. Dr. Norbert Gutknecht,
Uniklinik Aachen.
Ziel des LASER START UP-Kongresses ist
es, Zahnärzte an den Einsatz des Lasers in
der Zahnmedizin heranzuführen und in diesem Zusammenhang einen Überblick über die für den
Dentalbereich relevanten Laser und die entsprechenden Anbieter zu geben. Im Fokus der DGL-Jahrestagung stehen versierte Laseranwender aus dem Inund Ausland, aus der Praxis und den Universitätskliniken._
Weitere Infos gibt es unter www.dgl-online.de
oder www.oemus-media.de.

[47] =>

Call for papers
DGL | Deutsche Gesellschaft für Laserzahnheilkunde
24. Internationaler Jahreskongress
27. – 28. November 2015 in Berlin, Hotel Palace
Titel

Autor(en)
Name, Vorname, Titel
Institut(e)
Anschrift
Telefon/Fax/E-Mail

/

/

Abstract (max. 250 Wörter in Times New Roman, Schriftgröße 11)

Sitzung:
(1) Wissenschaftliche Sitzung
(2) Klinische Fallpräsentation

Art der Präsentation:
(1) Vortrag
(2) Poster-Präsentation
(3) Video-Präsentation

Klassifikation:
(1) Wiss. Grundlagen
(2) Kavitätenpräparation
(3) Kariesentfernung
(4) Klinische Anwendung
(5) Klinische Studien
(6) Diagnostik
(7) Endodontie
(8) Parodontologie
(9) Kariesprävention
(10) Lasersicherheit
(11) Chirurgie, Weichgewebe
(12) Sonstige ____________

Titel:
Der Titel muss kurz und deutlich den Inhalt der Arbeit wiedergeben.
Autoren:
Die Nachnamen bitte in Großbuchstaben schreiben.
Markieren Sie den Namen des Vortragenden mit einem Sternchen.
Inhalt:
Ziel der Arbeit, Material und Methode, Ergebnisse, Diskussion
Bitte fügen Sie eine Kopie auf CD bei!
Präsentationstechnik:
Computerprojektor (PowerPoint)

Weitere Informationen erhalten Sie unter:
Prof. Dr. Norbert Gutknecht, Universitätsklinikum Aachen, Klinik für ZPP/DGL, Pauwelsstraße 30, 52074 Aachen
Tel.: 0241 8088164, Fax: 0241 803388164, E-Mail: sekretariat@dgl-online.de

Bitte bis spätestens 30. Juni 2015

[48] =>

NEWS

germany

Er:YAG-Laserbestrahlung beeinﬂusst

Umfrage belegt:

Kommunikation zwischen Bakterien

Fast jeder dritte
Patient bucht
Arzttermine online

Wissenschaftler des Biofilm Research Laboratoriums am Institut für Zahnwissenschaft und des Endodontologischen Instituts der Hebrew University-Hadassah, School of Dental Medicine in Jerusalem, Israel,
haben eine bemerkenswerte Entdeckung gemacht: Die Bestrahlung
mit einem Er:YAG-Laser wirkt sich nicht nur wesentlich auf die Kommunikation zwischen Zellen einer Population aus, sondern scheint
auch einen Effekt auf die Kommunikation innerhalb von Bakterien zu
haben, welche die Zellkommunikation sowie die Anordnung des
Biofilms wesentlich stören. Für die Untersuchungen wurde der LiteTouch Er:YAG-Laser der Firma Syneron Dental Lasers verwendet.
„Diese bisher unbekannte Interaktion zwischen Er:YAG-Laser und
Bakterien eröffnet ein neues Feld in der klinischen Anwendung des
LiteTouch-Lasers“, sagte Claudia Yoel, Marketingmanagerin von
Syneron Dental Lasers.

Patienten schätzen die Möglichkeit,Arzttermine online
zu buchen. Fast jeder dritte Internetnutzer hat dies in
der Vergangenheit bereits getan (29 Prozent). 84 Prozent derjenigen, die noch keinen Arzttermin online gebucht haben, können sich dies jedoch künftig vorstellen. Dies sind die zentralen Ergebnisse einer online-repräsentativen Umfrage unter 1.000 Internetnutzern
des Marktforschungsinstituts Research Now im Auftrag von jameda.
[PICTURE: ©SYDA PRODUCTIONS]

Für ihre Forschungsergebnisse wurde das Team der Hebrew University mit dem Robert Frank Award der europäischen International Association for Dental Research (IADR) ausgezeichnet. Die
IADR mit Hauptsitz in Alexandria (Virginia), USA, fördert und unterstützt weltweite Forschungen in der oralen Gesundheit.

Quelle: Syneron Dental Lasers

Studie belegt:

Kaugummi könnte Ohrwurm unterbinden
90 Prozent der Bevölkerung hat mindestens ein Mal in der Woche ein Lied im Ohr
– den typischen Ohrwurm. Doch 15 Prozent davon empfinden den dauerhaften
Rhythmus als unangenehm und sogar störend. Eine neue Studie der University of Reading fand nun heraus, dass Kaugummi dabei helfen könnte, die
ungewollten Töne loszuwerden. Denn von den insgesamt 98 Probanden
dachten diejenigen, die nach dem Hören der gängigen Lieder Kaugummi
kauten, weniger oft an den Song als die Gruppe, der keiner zur Verfügung
stand. Darüber hinaus reduzierte der Kaugummi außerdem die Häufigkeit,
mit der die Teilnehmer den Song „hörten“ um ein Drittel. Frühere Forschungen haben bereits bewiesen, dass sich allein das lautlose Singen
oder das Bewegen der Kiefer auf das Kurzzeitgedächtnis sowie die Melodie in der Erinnerung auswirken. Dr. Philip Beaman, Studienleiter
an der University’s School of Psychology and Clinical Language
Sciences, sieht im Kaugummi zusätzliches Potenzial, unerwünschte oder aufdringliche Gedanken zu reduzieren.
„Unseren „inneren Monolog“ durch einen komplexeren Ansatz des Kaugummikauens zu zerstreuen,
könnte auch anderweitig eingesetzt werden.“ Um
zu prüfen, ob er gegen Symptome wie Zwangsstörungen oder ähnliche Erkrankungen helfen könnte, seien aber laut Beaman weitere
[PICTURE: ©AARON AMAT]
Forschungen nötig.

48 I laser
2_ 2015

Die Möglichkeit, Arzttermine online zu buchen, wird
von Männern und Frauen gleichermaßen genutzt (jeweils 29 Prozent). Unterschiede gibt es jedoch hinsichtlich des Alters. Am größten ist der Anteil derjenigen, die Arzttermine bereits im Internet gebucht haben,
mit 38 bzw. 33 Prozent unter den 26- bis 35-Jährigen
und den 36- bis 45-Jährigen. Am geringsten ist er unter den über 56-Jährigen. Von ihnen hat immerhin jeder Fünfte bereits online einen Termin vereinbart (19
Prozent).
Die Zufriedenheit mit der Online-Terminbuchung ist
überaus groß, wie die Ergebnisse belegen. Fast alle, die
bereits einen Arzttermin im Internet vereinbart haben,
würden dies auch künftig wahrscheinlich oder auf jeden Fall wieder machen (98 Prozent).
Als häufigsten Grund für die Online-Terminbuchung
gaben Patienten an, dass sie so auch abends oder am
Wochenende einen Arzttermin vereinbaren könnten
und daher nicht auf Sprechstundenzeiten angewiesen
wären (60 Prozent). Zudem schätzt jeder Zweite die
Möglichkeit, die Warteschleife am Telefon dadurch
umgehen zu können (46 Prozent).

[49] =>

Medizinisch notwendige

ZWP-Redaktion sucht

Zahnaufhellung ist umsatzsteuerfrei

„Deutschlands
schönste Zahnarztpraxis“

]
SK
OR

das Urteil jedoch nicht anerkennen und
ging in Revision, sodass der Fall
schließlich vor den Bundesfinanzhof landete. Dieser gab
dem Zahnarzt in letzter Instanz Recht.
K
[PICTURE: ©TRIFONEN

.
AN
O IV

Der Bundesfinanzhof (BFH) hat in einem
aktuellen Urteil bestätigt, dass Zahnaufhellungen (Bleaching), die
ein Zahnarzt zur Beseitigung
krankheitsbedingter Zahnverdunkelungen vornimmt, umsatzsteuerfreie Heilbehandlungen sind. Im konkreten Fall
hatte sich eine Plöner Zahnarztpraxis mit Unterstützung der
Zahnärztekammer Schleswig-Holstein gegen den Bescheid des zuständigen Finanzamtes gewehrt. Darin waren sämtliche Bleaching-Leistungen der Praxis im Rahmen einer
Umsatzsteuer-Sonderprüfung auch für zurückliegende Fälle als umsatzsteuerpflichtig eingestuft worden. Die Finanzbehörde hatte nicht unterschieden, ob
es sich um rein kosmetische Aufhellungen oder die
Beseitigung krankheitsbedingter Verfärbungen handelte. Da sich das Finanzamt auch von den Stellungnahmen der Zahnärztekammer wenig beeindruckt
zeigte, klagte der Zahnarzt vor dem schleswig-holsteinischen Finanzgericht. Trotz dezidierter und fachlich
fundierter Urteilsbegründung mochte das Finanzamt

Das Urteil: Die Zahnbehandlungen, die jeweils eine Verdunkelung des behandelten
Zahnes zur Folge hatten, waren
medizinisch indiziert und damit umsatzsteuerfrei. Die als Folge dieser Zahnbehandlung notwendig gewordenen ZahnaufhellungsBehandlungen waren ästhetischer Natur, aber – im
konkreten Streitfall belegt – auch medizinisch erforderlich.
Die Steuerbefreiung gilt also nicht nur für Leistungen,
die unmittelbar der Diagnose, Behandlung oder Heilung einer Krankheit oder Verletzung dienen, sie umfasst auch Leistungen, die erst als (spätere) Folge solcher Behandlungen erforderlich werden, auch wenn
sie ästhetischer Natur sind.

Patienten weiterhin

Zufrieden mit den Zahnärzten
Patienten vertrauen ihren Zahnärzten im Vergleich zu
anderen Facharztgruppen am meisten. Dies ist eines
der Ergebnisse des jameda-Patientenbarometers
1/2015, das jameda zweimal im Jahr erhebt. Die Zahnärzte erhalten von ihren Patienten auf einer Schulnotenskala von 1 bis 6 für die Kategorie „Vertrauensverhältnis“ die sehr gute Note 1 (1,46). Damit befinden sie
sich in dieser Kategorie wie auch schon im Vorjahr
(1,45) auf dem ersten Platz im Fachärztevergleich.
Durchschnittlich benoten die Patienten das Vertrauensverhältnis zu ihren Ärzten mit der guten Note 1,93.
Großes Vertrauen bringen die Patienten neben den
Zahnärzten auch ihren Urologen (1,78) und ihren Allgemein- und Hausärzten (1,92) entgegen. Das Vertrauensverhältnis zu den Augenärzten bewerten die
Patienten hingehen mit einer nur befriedigenden 2,52,
das zu den Hautärzten mit einer 2,55.
Die Gesamtzufriedenheit, in die auch die Kategorie
„Vertrauensverhältnis“ mit einfließt, mit Deutschlands

Sie sind Praxisinhaber, Architekt, Designer, Möbelhersteller oder Dentaldepot? Dann zeigen Sie, was
Sie haben: Die Zahnarztpraxis mit einer besonderen
Architektursprache, mit dem perfekten Zusammenspiel von Farbe, Form, Licht und Material. Überzeugen Sie mit Ideen und Stil. Präsentieren Sie sich, am
besten im Licht eines professionellen Fotografen.

WIR VERDERBEN
IHM NUR UNGERN
DIE SHOW!

WWW.DESIGNPREIS.ORG
Einsendeschluss 1. Juli 2015

„Deutschlands schönste Zahnarztpraxis“ 2015 erhält eine exklusive 360grad-Praxistour der OEMUS
MEDIA AG für den modernen Webauftritt. Der virtuelle Rundgang bietet per Mausklick die einzigartige Chance, Räumlichkeiten, Praxisteam und -kompetenzen informativ, kompakt und unterhaltsam
vorzustellen, aus jeder Perspektive. Die 360gradPraxistour ist bequem abrufbar mit allen PCs, Smartphones und Tablets, browserunabhängig und von
überall. Einsendeschluss für den diesjährigen ZWP
Designpreis ist der 1. Juli 2015. Die Teilnahmebedingungen und -unterlagen sowie alle Bewerber der
vergangenen Jahre finden Sie auf www.designpreis.org.
Wann bewerben auch Sie sich?
Wir freuen uns darauf.

Zahnärzten bleibt weiterhin sehr hoch. Im ersten Halbjahr 2015 erhalten die Zahnärzte eine Durchschnittsnote von 1,4 (2013: 1,4, 2014: 1,39) und liegen demnach mit Abstand auf dem ersten Platz. Wie schon in
den Vorjahren folgen auf Platz 2 die Urologen (1,73) und
auf Platz 3 die Allgemein- und Hausärzte (1,88).
Schlusslicht bilden wie schon im letzten Jahr die Hautärzte mit 2,48.

OEMUS MEDIA AG
Stichwort: ZWP Designpreis 2014
Holbeinstr. 29
04229 Leipzig
Tel.: 0341 48474-120
zwp-redaktion@oemus-media.de
www.designpreis.org
www.oemus.com

laser
2
I 49
_ 2015

[50] =>

I about the publisher

laser

international magazine of

laser dentistry

Publisher
Torsten R. Oemus
oemus@oemus-media.de
CEO
Ingolf Döbbecke
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Members of the Board
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Lutz V. Hiller
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Editor in Chief
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Coeditors in Chief
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Matthias Frentzen
Managing Editors
Georg Bach
Leon Vanweersch
Division Editors
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European Division

Ambrose Chan
Asia & Pacific Division
Senior Editors
Aldo Brugneira Junior
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Editorial Board
Peter Steen Hansen, Aisha Sultan, Ahmed A Hassan, Antonis Kallis, Dimitris Strakas, Kenneth Luk,
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Printed by
Silber Druck oHG
Am Waldstrauch 1, 34266 Niestetal, Germany

laser international magazine of laser dentistry
is published in cooperation with the World
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WFLD Headquarters

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Editorial Office
Georg Isbaner
g.isbaner@oemus-media.de

University of Aachen Medical Faculty
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www.laser-magazine.com

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Copyright Regulations
_laser international magazine of laser dentistry is published by OEMUS MEDIA AG and will appear in 2015 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
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assumed 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_ 2015

[51] =>

laser
international magazine of

"

laser dentistry

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[52] =>

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[cover] => laser international No. 2, 2015

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Table of contents

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