laser international No. 3, 2016

Cover / Editorial / Content / A novel blue light diode laser (445 nm) for dental application / Er - Cr:YSGG laser and Internal Root Resorptions - Case report of an endodontic treatment using radial firing fips / New treatment protocol for periodontal pocket treatment - Combination of Er:YAG and Nd:YAG lasers / Pedonomics: lasers in paediatric dentistry / Eleven tips for success in your dental clinic - Part V: VIP Seminars and Scripting / Manufacturer News / News international / 25. Internationale Jahrestagung der DGL / News Germany / Imprint / Jahrbuch Laserzahnmedizin 2017

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Vol. 8 • Issue 3/2016

issn 2193-4665

laser
international magazine of

laser dentistry

3

2016

research
A novel blue light diode laser (445 nm)
for dental application

case report
Er,Cr:YSGG laser and
Internal Root Resorptions

practice management
Pedonomics: lasers in
paediatric dentistry

[2] =>

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[3] =>

editorial

25 years of DGL!

Prof. Dr Norbert Gutknecht

Dear DGL members and fans of laser technology,
Be aware: while leafing through this issue of laser international magazine of laser dentistry you will encounter
indications and laser systems that, 25 years ago, the DGL founding fathers would not even have dreamt of.
These include blue-light diode lasers in dental surgery, radial firing tips in endodontics, the combination of
wavelengths of the near and medium infrared range in periodontology as well as special treatment concepts
in paediatric dentistry and modern marketing strategies for adapting laser economically to the dental practice.
When the first DGL Congress was held in Stuttgart/Germany in 1991, speakers and participants only discussed one specific wavelength, the Nd:YAG laser. People were fascinated by the possibility that laser light was
transported via quartz fibre to the root canal and periodontal pockets. Those were the days of dental pioneers,
going from trial and error to success and failure in quick succession.
The development of laser technology, the discovery of new wavelengths, the establishment of training programmes and the integration in the German Society for Dental and Oral Medicine (DGZMK) prompted the DGL
to become today’s society for laser dentistry. We now feature high academic standards, distinct treatment
concepts for laser application in the dental practice and, most importantly in my opinion, a congress platform
which discusses all available laser systems and indications objectively.
For all of the above reasons, I hope you will enjoy both reading our current issue of laser international
magazine of laser dentistry as well as attending our anniversary congress in Munich.
Yours faithfully,

Prof. Dr Norbert Gutknecht

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3 2016

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© Annareichel/Shutterstock.com

| content

page 6

page 14

| editorial

| news

03 25 years of DGL!

34 manufacturer news

Prof. Dr Norbert Gutknecht

| research
06 A novel blue light diode laser (445 nm)
for dental application
Prof. Dr Matthias Frentzen et al.

36 news international
| DGL
39 25 Jahre DGL!

Prof. Dr. Norbert Gutknecht

| case report

40 Abstracts zur 25. Internationalen
Jahrestagung der DGL

14 Er,Cr:YSGG laser and
Internal Root Resorptions

48 news germany

Dr Miguel Rodrigues Martins et al.

| industry

| about the publisher
50 Imprint

20 New treatment protocol for
periodontal pocket treatment
Kinga Grzech-Lesniak

| practice management
26 Pedonomics: lasers in paediatric dentistry
Dr Imneet Madan

30 Eleven tips for success in your dental clinic
Dr Anna Maria Yiannikos

laser
issn 2193-4665

international magazine of

Vol. 8 • Issue 3/2016

laser dentistry

3

2016

research

A novel blue light diode laser (445 nm)
for dental application

case report

Er,Cr:YSGG laser and
Internal Root Resorptions

practice management
Pedonomics: lasers in
paediatric dentistry

04

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3 2016

Cover image courtesy of LASOTRONIX
www.lasotronix.com
Original Background: © Gun/Shutterstock.com

page 20

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The universe at your fingertips.
®

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Want to expand your practie with periodontal laser treatments?

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• No scalpels, no sutures
• High success rates with no need to repeat procedures
• Minimal or no-pain procedure

[6] =>

| research

A novel blue light
diode laser (445 nm)
for dental application
Biomedical testing and clinical aspects

Authors: Prof. Dr Matthias Frentzen, Dr Dominik Kraus, Dr Joana Reichelt, Dr Christoph Engelbach,
Dr Claudia Dehn & PD Dr Jörg Meister, Germany

The 445 nm laser represents an innovative extension to the already established diode laser systems.
Improved cutting performance at a lower power level
while retaining the advantages of the use of diode lasers for the treatment of oral soft tissue means that
this is a further development in addition to the infrared systems with no apparent disadvantages.

Introduction
In the last ten years, diode lasers—primarily in the
near infrared spectrum (NIR, 800–1,000 nm)—have
become established in dentistry on evidence-based
fundamentals for surgical indications.1 They are used
primarily for the cutting and removal of oral soft tissue but also for the disinfection of gingival pockets2, 3
and root canals.4 From a technical point of view, this
technology is not particularly error-prone or expensive compared to gas or solid-state lasers and, when
used correctly, the side effects can be easily assessed
from the clinician’s perspective.5 The further development of laser diodes has enabled an expanded
emission spectrum. As a result, laser application systems that emit in the blue light region are technically
feasible nowadays.6 From a biomedical point of view,
these wavelengths provide significant advantages
while maintaining an established technology. Blue
light is already used clinically in a large number of
medical indications.7, 8 As a result of the radiation

Fig. 1

Fig. 1: Overview of absorption constants for different biological
materials at different wavelengths. – Fig. 2: Absorption constants
in the range of 500 up to 1,000 nm of soft tissue structures (according to 25).

Fig. 2

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research

Fig. 3a

Fig. 3b

Fig. 3c

Fig. 3d

o utput available up to now, surgical applications of
the blue light lasers have not yet been realised to a
significant extent. However, approaches to this have
already been available in literature for a number of
years.6, 9

ily well perfused gingival tissues of the oral mucosa
including the subepithelial connective tissue. Examples are the free gingiva, attached gingiva, alveolar
mucosa, buccal mucosa, palatal mucosa, and mucosa
of the tongue.

The modification of diode laser technology in
dentistry towards systems with emission in the blue
light spectrum can open a large number of advantages in comparison to the established diode laser
technology in the NIR as a result of the biophysical
properties. This includes, among others, a huge
working effectiveness at considerably lower power
settings. Because of this, for instance the side effects can be reduced considerably. Furthermore,
there is a favourable effect on wound healing.10 Antimicrobial effects are highly exceeded in comparison with infrared radiation and promote an effective disinfection of contaminated tissue areas.11-13 In
this way, the blue light may prevent wound infections. Clinical experience with radiation in the region of 450 nm is already available in many disciplines of medicine without any disadvantages of
these wavelengths.14-16

The absorption constant for a wavelength of
445 nm shows a high level of absorption in melanin
and haemoglobin (Fig. 1). Furthermore, the absorption in collagen also increases significantly in the
wavelength range of blue light (Fig. 2). Absorption in
water, however, is lower compared to conventional
NIR surgical diode lasers. In addition, scattering in the
blue light spectrum also increases (Fig. 1). These biophysical effects mean that, in comparison to the infrared diode lasers, the working effectiveness may be
considerably higher at the same power settings as a
result of the huge increased absorption in the tissues.
With regard to tissue vaporisation, intensive absorption may improve cutting effects. The increased level
of absorption in comparison with conventional diode
lasers could lead to a reduction of the thermal side effects outside the work area. The specific absorption
constants related to blue light are therefore a basis for
an effective limiting of biological side effects outside
the radiation field.

Biophysical properties of
445 nm laser radiation
The possible use of a laser application system with
an emission wavelength of 445 nm for surgical procedures on oral soft tissues (incision/excision as well
as bacterial decontamination and haemostasis) requires a high level of absorption of the radiation used
in these tissues to work effectively. These are primar-

Figs. 3a–d: Test setup for the
implementation of standardised
gingiva incisions:
a) gingiva sample (mandibula, soft
tissue and bone/pig);
b) sample fixed on the optical bench;
c) example of irradiated sample
(HF versus 980 nm, 3 W cw, 5 mm/s);
d) histological section of Fig. 3c
(HE-staining), 1: HF surgery, 2 & 3:
laser 980 nm, 3 W, cw.

The absorption of light at 445 nm in water is low.
This means that, during surgical procedures, the radiation energy is almost completely transmitted
through the non-pigmented mucin layer. Therefore,
the cutting procedure starts immediately; there is no
need for a so-called initialisation of the incision
needed in cases by using diode lasers in the NIR.

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| research
The biophysical effects of blue laser radiation
therefore favour the effective ablation of tissue from
the beginning. Transmission properties and thermographic investigations confirm these observations:
Transmission through agar layers of 3 mm thickness
is approximately 80 % at 445 nm, independent of the
laser power from 100 mW to 1 W for irradiation periods between 5 and 20 seconds. The increase in temperature in this layer cannot be measured when the
laser power is 100 mW, with a laser power of 1 W, a
temperature increase of T = 2 °C could be observed.
In contrary, in blood agar, high absorption (> 98 %)
and temperatures were measured. The comparison of
the biophysical properties of laser radiation between
diode lasers with wavelengths of 445 nm and
810–980 nm shows that in both cases photothermal
effects are responsible for the laser-tissue interaction. On the basis of the laser settings that are technically possible, no non-linear effects, for example the
formation of plasma, are assumed. The different absorption constants, however, support the vaporisa-

In vitro investigations using a
445 nm diode lasers
Preparations from pig jawbones are particularly
suitable as a model system for the investigation of the
effects after laser irradiation under in vitro conditions. The macroscopic structure, the dimensions and
the histological structure are very similar to human
tissue so that valid statements can be made.17-22 Gingiva preparations obtained from the vestibular mandibles of freshly slaughtered pigs were used for the
investigation of the cutting effectiveness and histologically analysis of side effects during tissue preparation. They consisted of a rectangular segment of bone
covered with gingival tissue (Fig. 3a). These samples
were stored in physiological saline solution and were
fixed to an optical bench immediately after removal
(Fig. 3b). This bench was equipped with a linear microFig. 4: Ex vivo sample from pig gingiva after 445 nm laser incision
(2 W, cw). The high resolution photo collage shows that, starting
from the surface, the morphology of the tissue has been preserved
with a thin carbonisation film. No vacuolar structures and bleeding into the connecting tissue were detected. The incision edge
is covered by a very small carbonisation layer. – Fig. 5: Detailed
images of the subepithelial connective tissue after incision with
445 nm/2 W, cw. An undermined blistering (tissue destruction) in
the area of the lamina propria as is known with the 980 nm is only
very slightly pronounced. The micromorphology of the tissue is
preserved underneath the cutting level despite increased staining;
no tissue haemorrhage was detected. – Fig. 6: Histological thin
section after irradiation of a pig jawbone specimen using a 980 nm
diode laser (2 W, cw, left) and using a 445 nm diode laser (2 W,
cw, right), undecalcified thin section, staining: toluidine blue. With
980 nm, wide carbonisation zone with surrounding necrosis; with
445 nm, narrow carbonisation and necrosis zones.

Fig. 4

Fig. 5

tion of oral soft tissue at 445 nm in comparison with
IR lasers at 810 nm and 980 nm.

Fig. 6

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| research
Figs. 7a–c: Test setup and examples
of the monolayer culture as well
as the fluorescence detection of
cytoskeletal changes and DNA
double strand breaks:
a) sample mounted on a
xyz-translation stage;
b) sample holder with coverslip;
c) laser incision of the monolayer
with a 445 nm diode laser (2W, cw),
thermal effects at the central
irradiation zone (staining HE);
d) staining of the cytoskeleton
after 445 nm laser irradiation with
fluorophore conjugated phalloidine;
no adverse effects (Alexa Fluor
phalloidin, DAPI);
e) immunofluorescence microscopy:
DNA double strand breaks
characterised by red fluorescent
foci (p-H2aX) occurs only after
UV-irradiation as positive control.

Fig. 7a

Fig. 7b

Fig. 7c

Fig. 7d

Fig. 7e

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positioner that had been set to a feed rate of 1 and
5 mm/s to simulate constant cutting speeds. These
cutting speeds were chosen to cover the spectrum of
conventional laser applications. The specimens were
irradiated using the same laser application system (diameter 320 μm) both with a wavelength of 445 nm and
also with a 980 nm diode laser in contact mode. Linear
incisions were carried out starting from the starting
line that had been marked beforehand. The incisions
were carried out with a 445 nm laser with a power of
1.5 and 2 W continuously and with a 980 nm laser with
a power of 3 W in the same mode. Incisions that had
been made additionally with a scalpel and with HF surgery served as references (Fig. 3c). From the gingiva of
this sample, after removal of the soft tissue from the
bone substrate, paraffin sections in HE-staining were
examined under a light microscope (Fig. 3d).
The comparative histological evaluation of the
specimens led to the following results:
1. The histological changes in the cutting area at
wavelengths 445 nm and 980 nm are qualitatively
identical.
2. The width of the coagulation zone and the cutting
depth depends on the cutting speed (for both
wavelengths and their parameters).
3. The width of the coagulation zone is, at the same
cutting speed, larger at 980 nm compared to the
445 nm. With 445 nm, the width of the coagulation
zone increases with rising power, in particular at a
low cutting speed.
4. At a high cutting speed, the cutting depth is the
same for 445 nm at 2 W and 980 nm at 3 W (output
power).
5. The width of the coagulation zone is smaller with all
445 nm parameters than with 980 nm.
6. The HF surgical procedure led to histological results
that are comparable with 980 nm.
With regards to “freehand” ex vivo procedures in
pigs, 445 nm incisions (2 W, cw) demonstrated good
cutting effectiveness and haemostasis for incisions
of different depths (Fig. 4). Tissue vaporisation begins
immediately after activating the laser. The working
area remained clear due to haemostasis. The histological analysis (Fig. 4) shows three surgical incisions
with differing depths. No mechanical effects (clefts/
tissue deformation) were observed. The carbonising
layer on the tissue surface treated is very narrow (approx. 1 μm). Around the incision, a zone of increased
staining, which was clearly differentiated from the
unchanged tissue, appeared. No undermining blistering was noted in the epithelium in the area of the cutting edge. The morphological structure of the tissue
beneath the incision area is preserved despite the increased discolouration. Vessels in this area display no
ruptures (Fig. 5). No red blood cells were detected
outside of the vessels in the tissue.

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research

Fig. 8

In summary, it can be stated that, under “freehand”
conditions ex vivo, only minimal carbonisation of the
tissue was detected. Although the structures beneath
this layer showed stronger histological staining, the
tissue morphology was completely preserved. There
is no detectable evidence of ruptures in the tissue or
in the vessels. The results from these experiments indicate that the cutting efficiency at 980 nm with 3 W
output power is at most about the same compared to
the 445 nm at 2 W output power. The thermal damage
zones and the proportion of carbonised tissue in the
region of the cut appear more extensive when using
980 nm. In addition, the area of destruction of the epithelium (detachment of sub-epithelial connective
tissue) lateral to the incision is larger when using
980 nm. The histological results correspond with the
available literature when using 980 nm.
Irradiation of bone samples also show a considerably more pronounced carbonisation and necrosis
zone with 980 nm compared to 445 nm (980 nm at
2 W, cw; 445 nm at 2 W, cw; Fig. 6). With NIR radiation,
there is incineration on the surface with a pronounced carbonisation layer. It is connected to a wide
necrosis zone. When comparing with the same
cross-section specimen with 445 nm, there was a
narrow carbonisation zone on the surface with an
equally narrow necrosis zone beneath it.

Cell culture trials
Diode lasers primarily induce thermal effects.
However, regarding to a wavelength of 445 nm, only
a few reports of the effect of laser radiation at the cellular level are available. The goal of cell culture studies
therefore was to investigate the interaction effects of
this radiation in comparison with the established IR
infrared lasers. First, it was to be investigated whether
the wound healing behaviour after laser application
of 445 nm and 980 nm differed from that from mechanical interventions. Furthermore, it was to be in-

Fig. 9

vestigated whether this laser radiation leads to specific cell damaging effects.23

Fig. 8: Temperature increase T
(°C) after irradiation of cultures of
E. faecalis and S. salivarius in agar

For the simulation of oral soft tissues, HaCaT and
MG-63 cells as monolayer cultures on cover slips were
irradiated by diode lasers of wavelengths of 445 nm
and 980 nm with power settings of 2 and 3 W in continuous wave operation (Figs. 7a–d). For the simulation of
a surgical incision, linear irradiation with a defined
traverse speed (3 mm/s) and a defined distance to the
monolayer culture (1 mm) was applied. As reference, a
mechanical wound was made with the laser application
tip without the laser being activated (Figs. 7a–d). After
irradiation, the morphology of the cells was documented using HE staining and the wound healing behaviour was assessed by light microscopy. The occurrence of cytoskeleton alterations and DNA double
strand breaks after irradiation was analysed by using
fluorescence staining (phalloidin, p-H2AX; Figs. 7a–d).

plates at identical conditions with
a 445 nm laser and a 980 nm laser
in cw mode. The 980 nm laser
causes a significantly higher
temperature increase.
Fig. 9: Haemostatic effects of
445 nm laser irradiation.
Coagulation of porcine whole blood
(0.1 W, cw/non-contact mode, fiber
to object distance 10 mm).

Using the 445 nm wavelength, thermal coupling
occured already at a power of 2 W, whereas at 980 nm
this effect required a minimum output power of 3 W
and a pigmented marking. Thermographic analysis indicated a considerably higher temperature increase
on the monolayer surface during irradiation with
445 nm (> 400 °C) in comparison with 980 nm caused
by the increased absorption of cells at 445 nm. The
healing process of the lesions for both laser wavelengths in the monolayer are comparable to the mechanical injury (Figs. 7a–d). There was no evidence of
an increased occurrence of double-strand breaks for
both laser systems.23 In contrast to UV irradiation as a
reference, laser irradiation with both wavelengths did
not increase the risk of DNA damages as an indicator
for genetic risk (Figs. 7a–d).

Antimicrobial effects
For many indications, an antimicrobial effect has
also been attributed to laser irradiation of differing

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wavelengths. The basis for these effects are thermal
and photochemical effects, e.g. known from aPDT
(antimicrobial photodynamic therapy). This effect
has been recognised for a number of years for NIR laser irradiation.
Studies in basic medical research have shown that
blue light also has an antimicrobial effect.11 As a result,
a laser system with a wavelength of 445 nm has a significant potential for antimicrobial effects if such a
laser is used within the scope of surgical indications.

Figs. 10a–c: Deep crown fracture
45 in a multi-morbid patient;
gingivectomy using 445 nm
(1,5 W, cw, 320 µm Ø);
a) OP situs before surgery;
b) one week post-op;
c) three months post-op.
Figs. 11a–d: Caries lesion up to the
furcation area; adhesive restauration
including endodontic treatment using
445 nm (1,5 W, cw, 320 µm Ø);
a) location of the caries lesion,
b) extensive excision of soft tissue,
no bleeding after gingivectomy;
c) adhesive restauration after
finishing the margin of the cavity
(removing of the carbonised layer
with hand instrument);
d) situation four weeks after vestibular composite restauration and
endodontic treatment.

Comparative studies were carried out whether the
antimicrobial effect of a surgical blue light laser was
comparable with the antimicrobial effects of infrared
laser irradiation with a wavelength of 980 nm.24 In
particular, it was to be investigated whether decontamination of the surgical field with low thermal effects is basically possible. To test this, agar plates
were coated with test bacteria (E. faecalis and S. salivarius) and irradiated with laser light at 445 nm and
980 nm. Identical application systems were used for
this purpose. After laser irradiation, the agar was
coated with an overlay agar that contained the specific nutrient components for the bacterial growth.
Furthermore, the temperature of the irradiated area
was measured using a thermographic camera during
irradiation. Concerning the temperature change
during the irradiation phase, only a small temperature increase had been observed when the laser radiation in the blue light spectrum was used. By contrast, there were significant temperature increases
during irradiation with the 980 nm laser (Fig. 8). Under identical test conditions, bactericidal effects
were demonstrated in the culture trials by the use of
a 320 μm fibre diameter at 445 nm wavelength even
at low output power (0.1 W) in non-contact mode.

Fig. 10a

Fig. 10b

Fig. 11a

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Fig. 11b

At 980 nm irradiation, bacterial growth was firstly
affected at 2 W output power. The effects were independent from the test species (E. faecalis and S. salivarius) that were used for this investigation. The results show a very high potential for a possible
antibiotic treatment that can be achieved with only
low-level stress to the region adjacent to the irradiated area—a maximum 3°C temperature increase in
these investigations—in comparison to infrared laser
irradiation. These results concur with a number of basic studies that assume a sustained antimicrobial effect of blue light.11-13 This concomitant effect provides clinically relevant support for the use of a
445 nm laser for surgical indications.10

Haemostasis
Due to the strong adsorption of blue laser light in
haemoglobin, pronounced coagulation effects were
expected. To investigate coagulation, porcine whole
blood in test samples with a thickness of 150 μm were
examined (Fig 9). During irradiation with blue laser
light, even with an output power of 0.1 W in cw mode,
applied via a fibre with a diameter of 320 μm at an object distance of 10 mm, clearly visible coagulation effects occurred suddenly (Fig. 9).24 These experimental
results confirmed the prediction regarding the high
haemostatic potency of the new blue light diode laser
system (Fig. 1). This effect provides sustainable support to incision and excision procedures, in particular
for patients with anticoagulation therapy.

Case report of surgical applications
Based on the existing in vitro investigations, a clinical study was required to prove the particular properties of blue light laser radiation in clinical situations.

Fig. 10c

Fig. 11c

Fig. 11d

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For this, a monocentric, prospective, randomised,
two-arm, observer-blinded study was initiated, in
which the effect of blue laser irradiation is compared
with the established IR lasers with a wavelength of
980 nm (approval by the Ethics Committee of the
Medical Faculty of the University of Bonn, No.
095/15). As part of these investigations, the clinical
healing process after laser-based preprosthetic gingivectomies will be evaluated on the basis of a number
of clinical assessment parameters. Among these parameters are bleeding on probing (BOP), sulcus fluid
flow rate (SFFR), modified gingiva index (MGI), modified early wound healing index (mEHI) and attachment status. The laser parameters for the blue light
laser were 2 W, cw and 3 W, cw for the 980 nm laser as
these both power settings demonstrated comparable
cutting efficiencies in pre-experiments. An identical
handpiece with a 320 μm fibre was used for both lasers. Figures 10a–c shows examples of a gingivectomy after a crown fracture in a multimorbid patient
(anticoagulants/diabetes). Figures 11a–d demonstrates the exposure of the marginal cavity margin in
a patient with extended vestibular caries before root
canal treatment. Figure 12 illustrates a comprehensive gingivectomy in a patient with idiopathic gingival
hyperplasia.
Preliminary results from this study show that no
adverse effects occurred either after the use of the
445 nm laser or after the use of the 980 nm laser.
Wound healing was good with both lasers. In all of the
cases that have been treated so far, no pain medication was necessary after the surgery. However, the
445 nm laser showed a higher level of cutting effectiveness that led to shorter operation times. Unlike
the 980 nm laser, no fibre conditioning is necessary
for the 445 nm laser wavelength. Furthermore, working in non-contact mode and periodic cleaning of the
application tip improves the treatment outcome. In
particular, it was determined that haemostasis was
better with the 445 nm laser.

Conclusion
The wavelength of 445 nm displays a high level of
direct coupling to tissue during incision or excision
that is achieved by the favourable biophysical properties of this radiation. Comparison of the cutting ef-

Fig. 12: Gingivectomy in the lower
jaw (idiopathic hyperplasia) using a
445 nm laser (1,5 W, cw, 320 µm Ø)
and a 980 nm laser (3 W, cw,
320 µm Ø) in a split-mouth design.
Surgical procedure using 445 nm
was less time consuming.

Fig. 12

fectiveness shows advantage effects with 445 nm in
comparison to 980 nm. The consistent results from
the histological investigations and the cell culture
tests show that with both lasers tested, damage in the
sense of an unspecific thermal interaction occurs.
Therefore, modification of the emission wavelength
of the diode laser does not shift the risk of application.
No disadvantages in comparison to the already established IR diode lasers were found. Modifying the
wavelength thus represents an advancement with
clinical relevance regarding a desired range of indications (incision/excision/disinfection)._

contact
Center for Dental, Oral and Maxillofacial Dentistry
(Zentrum für ZMK) Bonn/AG Laser in der Zahnheilkunde
(Lasers in Dentistry working group)
Welschnonnenstraße 17
53111 Bonn, Germany
www.amlarebo.uni-bonn.de

Kurz & bündig
Literature

Der 445 nm-Laser stellt eine innovative Alternative zu den bisher etablierten Diodenlasersystemen dar. Eine verbesserte Schnittleistung bei geringerem Leistungseinsatz unter Beibehaltung der Vorteile der Anwendung von Diodenlasern im Rahmen oraltherapeutischer Maßnahmen am Weichgewebe bedeutet eine Weiterentwicklung der Infrarotsysteme, ohne dass Nachteile erkennbar sind.

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| case report

Er,Cr:YSGG laser
and Internal Root
Resorptions

Case report of an endodontic treatment
using radial ﬁring ﬁps
Authors: Dr Miguel Rodrigues Martins, Prof. Dr Manuel Fontes Carvalho, Prof. Dr Irene Pina-Vaz,
Prof. Dr Miguel André Martins & Prof. Dr Norbert Gutknecht, Portugal/Germany

Introduction
Endodontic therapy is the treatment of choice for
teeth with apical periodontitis and Internal Root Resorptions (IRR) as it aims to eliminate bacterial contamination, granulation tissue and blood supply of
the clastic cells that are commonly reported to be involved with the process.1, 2

Sodium hypochlorite (NaOCl) is arguably chosen as
primary endodontic disinfection solution. Nevertheless, the ideal concentration, temperature, contact
period and extent of clinical effectiveness of NaOCl
remains under discussion.3–6 Moreover, several clinical factors (e.g. root perforations, absence of apical
constriction etc.) may accidently induce NaOCl extrusion into periapical tissues with potentially severe and
hazardous consequences.7–9

© Annareichel/Shutterstock.com

In spite of this, several clinical strategies were reported with regards to the management of root resorptions,10 their scientific evidence is limited to case
reports and few present alternative disinfection
techniques.11–14 Lasers have long been presented as
promising alternatives to conventional endodontic
procedures.15 Each laser wavelength has a specific
absorption coefficient for every tissue16 and erbium
lasers demonstrate a high absorption coefficient for
both water/aqueous solutions and hydroxyapatite.17, 18 Thus, the rationale for using erbium lasers in
endodontics may be briefly described as: (1) the ability of infrared light to interact with aqueous solutions and produce cavitation effects capable to
remove smear layer, dentinal debris and filling materials from the root canal walls19–21 and (2) the ability
of infrared light to propagate into the dentinal
tubules, achieving significant bactericidal effects
deeper than conventional chemical solutions.22, 23
Accordingly, the 2,780 nm Er,Cr:YSGG laser has
been reported as an effective method for smear layer

14

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[15] =>

case report

and debris removal in comparison with EDTA irrigation, hand activation or even ultrasonic activated irrigation,19, 24, 24–27 resulting in a significant clearance
of canals/isthmuses prior obturation28 and less microleakage of root canal filling materials.29 Moreover,
it has also been shown to be suitable for deep root
canal system disinfection and to allow irrigation
solutions to travel apically.22, 30–32 In addition,
Er,Cr:YSGG laser irradiation has been shown to produce clinically safe temperature increments along
the root canal walls,32–35 together with absence of
molecular dentine changes, signs of melting or carbonisation.18, 34, 36
Previously, laser-assisted endodontic protocols
consisted of using plain fibres (with a straightforward
emission beam profile). Generally, these fibres were
placed in the main canal and withdrawn from apical
to coronal in a rotating motion. However, such technique is known to be sensitive and to produce inconsistent results.18, 35, 37
Designed to overcome such limitations, radial firing tips (RFT) present a beam expansion pattern—
promoted by the tip geometry—that favours a homogeneous energy distribution along the root canal

|

wall. In contrast with plain fibres, RFT have been
shown to produce consistently relevant in vitro results. They are known to spread their energy in the
direction of the dentinal tubules,22 to produce lower
temperature increments,27 to increase cavitation effects towards the root canal walls without harming
periapical tissues,38 to be highly efficient in bacterial
and biofilm reduction39, 40 and to allow irrigating
solutions to travel apically by overcoming the airlock
effect.41
Although some clinical studies have demonstrated
the potential benefits and long-term outcomes after
laser-assisted treatments,42, 43 there is no mention of
any IRR case treated with a laser-assisted technique.
The report of distinct clinical cases with long-term
follow-ups may be an additional support for an evidence-based proof of concept.

Case report
A 31-year-old female patient presented for consultation, complaining of recurrent swelling and
painful episodes related to tooth 11, which had been
treated with antibiotic prescriptions over the past
few years. The patient’s medical history was not conAD

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laser dentistry

3

2016

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research

A novel blue light diode laser (445 nm)
for dental application

case report

Er,Cr:YSGG laser and
Internal Root Resorptions

practice management
Pedonomics: lasers in
paediatric dentistry

Please contact: Georg Isbaner · Editorial manager
g.isbaner@oemus-media.de

laser
OEMUS MEDIA AG · Holbeinstraße 29 · 04229 Leipzig · Germany · Phone: +49 341 48474-308 · grasse@oemus-media.de

3 2016

15

[16] =>

| case report
Fig. 1: Clinical picture
demonstrating aesthetic initial
appearance of tooth 11.
Fig. 2: Initial radiographic
appearance of tooth 11
demonstrating an extensive apical
radiolucency and internal
root resorption.
Fig. 3: Immediate post-operative
radiograph of tooth 11.

instrument. Root canal irrigation was performed
between each file with 3 ml of sterile saline solution (Monoject 27G, Kendall-Covidien, USA). No
chemical irrigants or inter-appointment dressings
were used.

Fig. 1

Fig. 2

Fig. 3

tributory. The patient reported trauma to her upper
teeth when she was 20 years old. After performing
clinical and radiographic examinations, tooth 11 was
diagnosed with pulp necrosis with internal root resorption and apical periodontitis. The tooth was
slightly tender to percussion, periodontal probing
depths were considered normal (< 3 mm), and there
was no discoloration (Figs. 1 & 2).
Approval for the study protocol (N_682/068) was
obtained. Treatment options were discussed and the
required consent obtained (Helsinki Declaration, revised in Edinburgh 2000). No financial incentive was
offered (i.e., patient was responsible for the usual
root canal treatment fee).
Under local anaesthesia (2 % lidocaine with
1:100,000 epinephrine, Scandonest, Saint Maur
des Fossés, France) and rubber-dam isolation (Hygenic Non-Latex Rubber Dam, Coltène/Whaledent,
Germany), an access cavity was prepared with a
high-speed carbide bur (SS White, Lakewood, NJ)
and Z ekrya Endo burs (DENTSPLY Maillefer, Ballaigues, Switzerland). The working length (WL) was
electronically established (Root Zx mini, Morita,
USA) as 1 mm short of the biological apex of the root
and confirmed by radiography. No bleeding was
noted from the root canal. Patency was confirmed
with an ISO#20 K-file and root canal preparation was
performed with the Protaper system (DENTSPLY
Maillefer, Ballaigues Switzerland) up to an F5 (#50.05)

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3 2016

For smear layer removal and root canal disinfection, a previously reported laser-assisted protocol
was adopted.42, 43 Following root canal preparation,
the main canal was filled with distilled water and
laser irradiation was performed with the 2,780 nm
Er,Cr:YSGG laser (Waterlase MD; Biolase Technology, San Clement, CA) and radial firing Tip (RFT2
Endolase, Biolase Technology; calibration factor of
0.55) which was 270 µm in diameter, with panel settings of 0.75 W, 20 Hz (37,5 mJ), 140 µs pulse, 0 %
water and 0 % air. The tip was placed at the working
length and irradiation was performed, approximately, at the speed of 2 mm/s until it reached the
most coronal part of the canal. The irradiation procedure was repeated four times: 2x with the canal
filled with distilled water (for smear layer and granulation/pulp tissue removal) followed by 2x in dry
conditions (to achieve deep dentine penetration
and disinfection), with approximately 15 seconds
between each irradiation. Afterward, a sterile cotton pellet was placed in the pulp chamber, and the
access cavity was sealed with a reinforced zinc-oxide eugenol intermediate restorative material (IRM,
DENTSPLY).
At the second appointment after seven days, the
patient reported pain, tenderness to percussion
and swelling upon questioning. Under local anaesthesia and rubber dam isolation, the canal was
re-accessed. The main canal was filled with distilled
water and laser irradiation was performed using a
320 µm radial firing tip (RFT3 Endolase, Biolase
Technology: calibration factor of 0.85), with panel
settings of 1.25 W, 20 Hz (62.5 mJ), 140 µs pulse,
0 % water and 0 % air. The irradiation protocol was
identical to the first appointment. After irradiation,
a final rinsing of sterile saline solution (3 ml) was
performed, and the canal was dried with sterile paper points, checking for the absence of any suppuration or exudate. Filling was performed with a
#50.05 auto-fit gutta-percha cone (DENTSPLY
Maillefer, Ballaigues Switzerland) using a down
pack-backfill technique (Calamus, DENTSPLY
Maillefer) and a resin-based endodontic sealer
(Topseal, DENTSPLY Maillefer). Both down pack motion and gutta-percha injection were performed
with low pressure and extreme caution due to the
root weakness. Radiographic images were taken
immediately (Fig. 3) and after one (Fig. 4), two
(Fig. 5) and three years (Figs. 6 & 7). Over this
follow-up period, the tooth remained completely
asymptomatic and periapical healing was noticed.

[17] =>

case report

Discussion
Due to its insidious pathology, the following clinical
findings enabled the establishment of the diagnosis
of IRR:44 initial absence of bleeding from the root canal confirming a necrotic pulp, normal probing depth
(< 3 mm) and the complete resolution of apical radiolucency after endodontic treatment, followed by the
cessation of the progression of resorption.
Given that there is insufficient clinical data supporting the superiority of any chemical irrigation regimen and no guidelines for the management of
low-occurrence pathologies such as IRR, case reports
may be of special relevance while adequately reporting new disinfection techniques and their clinical
outcomes.3, 45
The present protocol adopted the use of an
Er,Cr:YSGG laser and innocuous irrigants (e.g. saline
solution as irrigation and distilled water for laser activation). The decision was primordially based on the
assumption that IRR lesions may perforate external
root surfaces without being detectable on conventional radiographic images,46 and that anatomic variations are known to significantly contribute to the
occurrence of sodium hypochlorite accidents.47
While trying to achieve significant bacterial reductions, our protocol contrast with that recently reported by Christo et al. which used low concentrations of NaOCl and a Er,Cr:YSGG laser-activation
technique. In fact, this protocol has been shown not
to improve the antibacterial effects of NaOCl48 and,
therefore, the activation of NaOCl may seem inadequate for the management of such conditions. In
accordance, it was shown that the use of Er,Cr:YSGG
laser with relatively high output powers to activate
irrigants such as NaOCl or EDTA may result in a high
magnitude of pressure changes capable to induce irrigants extrusion during laser-activated irrigation.49

Fig. 4

Fig. 5

In order to obtain adequate microbial control calcium hydroxide (CH) is often recommended for the
management of IRR lesions.50–52 However, the use of
CH as an intra-canal medication consistently fails to
present improved clinical outcomes.53–55 In the present report we may support that CH medication should
not be considered crucial as antimicrobial agent and
neither as essential to stop the IRR progression.
In fact, the decision process for not using CH as
intra-canal medication during the endodontic treatment of IRR was also supported by the following criteria: (1) no irrigation technique is completely able to
remove CH from simulated internal root resorption
cavities14 and (2) the long-term exposure to CH can
cause a significant reduction in the mechanical properties of radicular dentine.56
Due to their biophysical properties, lasers have
long been seen as a promising disinfection tool in
endodontics. However, each wavelength demonstrates different biophysical interactions with the
main radicular dentine components.15 The high absorption coefficients in both water and hydroxyapatite may justify the selection of the Er,Cr:YSGG laser (=2,780 nm) for both smear layer removal and
disinfection purposes.18 Conflicting evidence while
using other wavelengths can be found consistently.57, 58
In the present report, the laser protocol consisted
in two irradiations with distilled water in the main
canal followed by two irradiations in dry conditions,
respectively for smear layer removal and disinfection purposes.42 The rationale was that in wet conditions the Er,Cr:YSGG laser can promote beneficial
cavitation effects inside the main canal without increasing the extrusion of irrigants.38 Moreover, water-mediated cavitation has been shown to be highly
effective for the removal of dentin debris in comparison with conventional or passive ultrasonic irriga-

Fig. 6

Fig. 4: Twelve-month follow-up.
Fig. 5: Two-year follow-up.
Fig. 6: Three-year follow-up from
the mesial direction.
Fig. 7: Three-year follow-up from
the distal direction.

Fig. 7

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3 2016

[18] =>

| case report
tion.19, 38 Then, to achieve its maximum bactericidal
properties, the Er,Cr:YSGG laser should work on a dry
canal, allowing the energy to be transmitted deep
into the dentinal tubules22 and to instantaneously
interact with the water molecules trapped into the
bacterial membrane and within endodontic biofilms.39
RFT have been shown to overcome several limitations attributed to bare fibres, distributing the emitted laser energy in a uniform ring-shaped pattern.33, 59
In similarity with any other innovative root canal
treatment strategies, there are few reports demonstrating the prospective, long-term clinical outcomes associated with the use of Er,Cr:YSGG laser,
namely with RFT. However, Martins et al. have shown
that RFT can be considered predictable as the concomitant use of 3 % NaOCl and CH for the endodontic treatment of single-rooted teeth with apical periodontitis.42, 43 Our findings may provide further
evidence that RFT can be considered safe in cases of
teeth with wide apical foramina while being adequate to effectively reach all the contours of the resorption lesion.
The prognosis for the conservative treatment of
IRR should increase due to the report of alternative
endodontic techniques along with the use of new
technologies (Al-Momani & Nixon 2013, Khojastepour et al. 2015, Nilsson et al. 2013).2, 44, 46 Therefore,
clinicians may consider this laser-assisted technique

while selecting an appropriate endodontic disinfection strategy for the management of IRR.

Conclusion
Despite their intrinsic methodological limitations,
the adequate report of single clinical cases may either
help the understanding of unusual presentations of
common diseases or assist in guiding new treatment
concepts into clinical practice.45 This case report presents potential benefits towards the use of Er,Cr:YSGG
laser and radial firing tips in endodontics. Further randomised clinical trials should be conducted to clearly
demonstrate its effectiveness._

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

contact
Dr Miguel Rodrigues Martins, DDS, MSc, PhD
Endodontic Department, Faculty of Dental Medicine,
Universidade do Porto, Portugal
Rua Dr. Manuel Pereira da Silva,
4200-393 Porto, Portugal
Tel.: +351 914610046
miguel.ar.martins@gmail.com

Kurz & bündig
Im Gegensatz zur konventionellen, lasergestützten Wurzelkanalbehandlung mithilfe einfacher Laserfasern mit einem geraden Emissionsprofil stellt die RFT-Therapie mithilfe radial abstrahlender Faserspitzen eine vorhersagbare und
sichere Alternative dar. Die spezielle Geometrie der Faserspitze ermöglicht eine homogene Energieverteilung entlang
der Wurzelkanalwand in Richtung der Dentintubuli. Der entstehende Temperaturanstieg fällt geringer aus und die
Kavitationseffekte entlang der Wurzelkanalwand werden verstärkt, ohne dass periapikale Gewebe beschädigt werden.
Dabei zeigt sich die RFT-Therapie hocheffizient hinsichtlich der Reduktion von Bakterien und Biofilm und ermöglicht
es, dass Spüllösungen sich apikal verteilen können.
Diese Eigenschaften der RFT-Therapie belegen die Autoren ausführlich anhand der aktuellen Literatur und stellen
zudem selbst einen Patientenfall vor, bei dem diese für die Therapie einer internen Wurzelresorption angewendet
wurden. Dies wurde in der vorliegenden Literatur bisher nicht dokumentiert.
Beschrieben wird diese Behandlung bei einer 31-jährigen Patientin ohne auffällige Vorgeschichte. Nach einem
Zahntrauma elf Jahre zuvor litt sie unter wiederkehrenden Schwellungen und Schmerzen im Bereich von Zahn 11,
bei welchem wir nach klinischer Untersuchung und Röntgenbefund eine Pulpanekrose mit interner Wurzelresorption
und apikaler Parodontitis feststellten. Der Zahn war leicht empfindlich gegenüber Perkussion und die parodontalen
Sondierungstiefen waren normal (< 3 mm). Verfärbungen wurden nicht festgestellt. Direkt nach der Behandlung sowie
nach einem, zwei und drei Jahren wurden Röntgenaufnahmen angefertigt. Innerhalb dieses Zeitraums blieb der Zahn
symptomfrei und eine periapikale Heilung setzte ein. Obwohl der vorliegende Fallbericht damit die potenziellen Vorteile
der Anwendung des Er,Cr:YSGG-Lasers und radial abstrahlender Faserspitzen in der Endodontie bestätigt, empfehlen
die Autoren weitere randomisierte klinische Studien, um diese eindeutig zu belegen.

laser

3 2016

[19] =>

IA

16

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Deutsche Gesellschaft für Laserzahnheilkunde e.V.
Klinik für Zahnerhaltung, Parodontologie und
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Pauwelsstraße 30 | 52074 Aachen | Germany
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[20] =>

| industry

New treatment
protocol for periodontal
pocket treatment
Combination of Er:YAG and Nd:YAG lasers
Author: Kinga Grzech-Lesniak, Poland

Periodontitis is the most common chronic inflammatory disease in adults of European populations.
Eight out of ten over 35-year-olds suffer from some
kind of gum complaint. It is associated with systemic
diseases including type 2 diabetes, cardiovascular
disease and stroke. Although they are so common,
periodontal diseases are not very well acknowledged.1, 2
To date, mechanical therapy has been the general
treatment for plaque-induced periodontal disease. A
lot of studies have shown that mechanical treatment
itself does not lead to a complete healing because it
does not eliminate the periopathogenes.3

Laser therapy may constitute an efficient alternative to surgical treatment. Based on research, data
and experience of many practitioners, we can enumerate potential advantages of laser therapy, such as
bactericidal, detoxification and homeostatic effects
and biostimulation. It is also easy to use, provides
good access to anatomically difficult areas and makes
a comfortable treatment for patients. Laser treatment provides for eradication of bacteria and better
wound healing.4, 5
High-energy lasers are applied in periodontal procedures as adjunctive therapy or alternative conventional procedures have become standard treatment

Figs. 1a–d: a) initial state;
b) the situation of the
gingival-tooth in the jaw;
c) orthopantomographic image;
d) the dental-gingival situation
in the mandible.

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3 2016

Fig. 1a

Fig. 1b

Fig. 1c

Fig. 1d

[21] =>

industry

Fig. 2a

Fig. 2e

Figs. 2a–f: a) Clinical improvement
of the gum after hygienisation,
reduction of swelling, bleeding and
bacterial plaque;
b) Clinical view of the periodontal
treatment, electronic probe testing
(pa-on, Orangedental);
c) electronic probe, pa-on view and
molecular-biological test;
d) the result of pocket-depth probing
(PD) and clinical attachment level
(CAL), Bleeding on Probing (BOP),
mean value of PD = 38; RC = 1.19;
AT = 3.57; BOP = 33%;
e) Plaque Index (PI), PI = 11%;
f) baseline values of molecular-
biological test (PET Plus test,
MIP Pharma, Germany).

Fig. 2b

Fig. 2c

|

Fig. 2d

Fig. 2f

of periodontal pockets. Their effectiveness in eliminating periodontal pathogens and decreasing pocket
depth is widely documented. Neodymium: Yttrium–
Aluminum: Garnet (Nd:YAG) laser with a wavelength
of 1,064 nm can decontaminate periodontal pocket
without causing necrosing or carbonization of the
underlaying connective tissue.6 Periodontopathogens can persist within cells outside the pocket epithelium after mechanical conventional mechanical
periodontal debridement, and Gianelli et al. reported
that the Nd:YAG is capable of eradicating periodontopathogenic bacteria trapped within gingival epithelial
cells.7
Erbium:YAG (Er:YAG) with a wavelength of 2,940 nm
has been applied for effective elimination of granulation tissue, gingival melanin pigmentation and gingival discoloration. This laser is also used for contouring
and cutting of bone with minimal damage and enhances healing.8 In addition, irradiation with the
Er:YAG laser has a bactericidal effect with reduction
of lipopolysaccharide, is efficient in calculus removal,
with the effect limited to a very thin layer of the surface and is effective for implant maintenance.

A case report
A 47-year-old female patient was diagnosed with
advanced generalised periodontal disease, numerous missing teeth, lack of prosthetic supplements in
the posterior region, periapical lesions, and an incomplete endodontic treatment. The patient required
a comprehensive dental treatment. To create a preliminary treatment plan, it is necessary to implement
initial treatment (hygienisation) to check the patient's motivation to continue the highly specialised
treatment and assess the prognosis of her teeth.
Detailed clinical examination should include,
among others, data on the periodontal pocket depth
(PD), bleeding on probing (BOP) and plaque index (PI).
In the case of a significantly severe disease, high tooth
mobility, numerous missing teeth, it is recommended
to carry out a molecular-biological test to assess
periopathogens quantitatively and qualitatively.
Before the treatment the patient underwent supragingival hygienic procedures done with ultra-

laser
3 2016

21

[22] =>

| industry
Figs. 3–7: Sterilisation of
the periodontal pockets
and decontamination.
Figs. 8–12: Removal of
subgingival stone.
Figs. 13 & 14: Bleeding stop.

Fig. 3

Fig. 5

Fig. 4

Fig. 6

Fig. 7

Fig. 9

22

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3 2016

Fig. 8

Fig. 10

Fig. 11

Fig. 12

Fig. 13

Fig. 14

[23] =>

industry

Fig. 15

Fig. 16b

Fig.16a

|

Fig. 15: Situation immediately
after surgery, subgingival plaque
removal and sterilisation of the
periodontal pocket.
Figs. 16a–c: Clinical view during
inspection after three and six
months.
Fig. 17: Comparison of the clinical
condition at microbiological/
molecular baseline and
after six months.
Figs. 18a–f: Clinical situation
after 16 months.

Fig. 16c

Fig. 17

Fig. 18a

Fig.18b

Fig. 18c

Fig.18d

sound scaler (EMS, Piezon). After hygienisation, the
clinical condition of the patient improved. Additional
examination was carried out to determine the stage
of the periodontal disease. Then, an Nd:YAG laser
was applied for periodontal pocket sterilisation and
decontamination (Figs. 3–7) and Er:YAG laser to re-

move subgingival calculus (Figs. 8–12). For final decontamination and stabilization of the fibrin clot, the
Nd:YAG laser was applied again (Figs. 13 & 14). Figure
15 shows the situation immediately after surgery by
Er:YAG and decontamination of the periodontal
pocket by Nd:YAG (LightWalker, Fotona).

laser
3 2016

23

[24] =>

| industry
Fig. 19: Molecular-biological test
results after 16 months
(PET plus, MIP Pharma Germany)

Fig. 18e

Fig. 18f

Fig. 19

Summary
Er:YAG and Nd:YAG lasers have become the tool
of choice in the treatment of periodontal diseases.
They effectively reduce bleeding (BOP) and a
pocket depth (PD) and are less time-consuming in
comparison to conventional methods. Another
advantage is the increased access of laser light to
anatomically difficult areas compared to conventional hand tools, such as deep narrow pockets or
furcations.
Lasers broaden the range of treatments offered
in the dental office, increasing precision, enabling
minimally-invasive treatments and better wound
healing. The introduction of laser methods to the
dental practice compels us to further learning, im-

proving professional qualifications and specialisation in the field. This in turn extends the range of
non-surgical treatments of periodontal diseases._
Editorial note: A list of references is available from
the publisher

contact
Kinga Grzech-Lesniak DDS, PhD
Oral Surgery Department,
Medical University of Wroclaw, Poland
Specialist Periodontist
President of the Polish Society of Laser Dentistry, PTSL
ptsl@laser.org.pl
kgl@periocare.pl

Kurz & bündig
Vorgestellt wird ein Fallbericht zur Anwendung des Er:YAG-Lasers in der Behandlung von Zahnﬂeischtaschen.
Eine 47-jährige Patientin stellte sich in der Praxis der Autorin mit fortgeschrittener Parodontitis, einigen verlorenen
Zähnen, mangelnder prothetischer Versorgung im Seitenzahnbereich, periapikalen Läsionen sowie einer unvollständigen endodontischen Behandlung vor. Sie wünschte sich eine umfassende Behandlung. Für die Erstellung eines
ersten Behandlungsplans wurde mit einer gründlichen Prophylaxe begonnen, um eine exakte Prognose zu erhalten
sowie Einblick über die Motivation der Patientin zu gelangen, sich konsequent auch komplexeren Behandlungen zu
unterziehen. Weiterhin wurden Daten zur Taschentiefe, dem BOP-Index (Bleeding on Probing) und dem Umfang von
Zahnbelag und Zahnstein (PLI) erhoben. Auch die molekular-biologischen Eigenschaften des Bioﬁlms wurden getestet,
um die Parodontalkeime qualitativ und quantitativ ermessen zu können. Nach der laserbasierten Reinigung speziell der
Taschentiefe zeigte sich eine deutliche Verbesserung der klinischen Situation der Patientin. Sowohl Nd:YAG-Laser als
auch Er:YAG-Laser kamen zum Einsatz. Die Autorin zeigt sich überzeugt, dass der Einsatz von Dentallasern in schweren Fällen, wie dem hier vorgestellten, das mögliche Behandlungsspektrum sowie den Patientenkomfort erweitert.

laser

3 2016

[25] =>

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international magazine of

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Vol. 8 • Issue 3/2016

research
A novel blue light diode laser (445 nm)
for dental application
case report
Er,CR:YSGG laser and
Internal Root Resorptions

laser dentistry

2016

practice management
Pedonomics: lasers in
paediatric dentistry

research

A novel blue light diode laser (445 nm)
for dental application

case report

Er,Cr:YSGG laser and
Internal Root Resorptions

practice management
laser 3/16

Pedonomics: lasers in
paediatric dentistry

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[26] =>

| practice management

Pedonomics: lasers in
paediatric dentistry
Author: Dr Imneet Madan, UAE

We live in an era in which time is the basis for many
decisions: what saves time is what gets chosen. Introducing better technology helps to work with time
economics in paediatric dentistry. The recent term
coined for this perspective of expanded thinking is
“Pedonomics”. Pedonomics refers to the impact of the
changing world of paediatric dentistry in the dental
practice.1

Time economics goes hand in hand with pedonomics. The selective niches of dentistry are expanding far
more today than in the past years. Few reasons that
account for the need of this level of advanced healthcare are:2
1. Some parents who have their children later in life
are referred to as drone parents. These parents
self-educate a lot via social networks and extensive
internet research. With less inherent trust in
healthcare providers, they generally form a strong
opinion about the dental care of their children and
are most demanding of their paediatric dentist.
2. This category of parents are often techno-savvy
and are quite updated with latest technologies.
They appreciate a “no pain, no drill, no memory”
dentistry.
3. Caries rate in dentistry is ever-increasing, with a
heightened frequency of cariogenic diet and a decline in caries prevention.

laser

3 2016

4. There are more and more general dentists that
would “do the job” and only if it is mismanaged,
would they refer the child to the specialist. Increased availability of advanced technology can
put an end to this trial practice.

Lasers as game changers
Lasers are introduced as excellent instruments in
everyday dentistry. However, the idea of dentistry is
generally connected to discomfort and pain in children’s minds. Any treatment trend that can help our
practice to remove this connection by the use of contemporary technologies can increase patient referrals
and treatment acceptance.
Although the hand piece does remove the dental
decay, it may also cause abrasion of the tooth structure and a significant amount of discomfort that may
not be taken very well by the children. In addition, the
vibration and noise of the drill could be unpleasant to
young ears, thereby lasers can prove a better tool as
they do overcome all these fears of drill dentistry.3
Additional benefits must far supersede the costs and
investments when it comes to completing the laser
requirements of any practice.
Patients’ perception of laser dentistry
Generally, the treatment approach in paediatric
dentistry is much different from adults. With Lasers bringing the additional benefits of no contact,
no pressure, no drill, no anaesthesia and thereby
a less negative perception of dentistry, higher
success rates are likely to be seen. This is certainly
because of an increased degree of satisfaction of
the patients.
Marketing protocols help us to see a larger number
of patients per day, but to have these patients accept
the proposed treatments better, it is advisable to
introduce to them tools that can truly help. As applicable in any field, an experience that exceeds the expectations will motivate the patients to keep appoint-

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practice management

ments, accept recommended care and hence allow to
build up positive clientele.
Laser indications in dentistry
Medicine began to integrate lasers in the mid-1970s
for soft tissue procedures. The first laser specifically for
dental use was a neodymium-doped y ttrium aluminium garnet developed in 1987 and a pproved by the
Food and Drug Administration in 1990.4
Benefits
–– Less thermal necrosis of adjacent tissues is produced with lasers than with electrosurgical instruments.5, 6
–– Haemostasis can be obtained without the need for
sutures in most cases.7, 8
–– Little or no local anaesthesia is required for most
soft tissue treatments.9–13
–– Reduced operator chair time has been observed
when soft tissue procedures have been completed
using lasers.
–– Lasers feature decontaminating and bactericidal
properties on tissues, requiring less prescriptions
of antibiotics post operatively.9, 10
–– Lasers provide relief from pain and inflammation
associated with aphthous ulcers and herpetic lesions without pharmacological intervention.13
–– Erbium lasers can remove caries effectively with
minimal involvement of the surrounding tooth
structure because caries-affected tissue has a
higher water content than healthy tissue.5, 7
–– As erbium lasers have no direct contact with hard
tissue, the vibratory effects of conventional high
speed handpieces are eliminated, allowing tooth
preparations to be comfortable. As a consequence,
anxiety in both children and adolescents is reduced.9, 11, 14, 15
Lasers and profits in dentistry
Lasers allow the dental practice to balance well
between business and dentistry. Offices that in
corporate lasers in their practice have a unique
psychological and promotional advantage over
those who fail short to offer such services. Lasers
are definitely the foundation of creating a referral-based practice.16
Benefits that add to the practice are always important, but how actually does one convince oneself to
accept the resulting expenses for the practice. Usually, lasers are considered high investments and any
high investment must prove reasonable enough to be
accommodated in the practice. Return on investments with lasers can be easily pre-calculated. In general, laser treatments can cost 35 to 40 per cent more
than the usual appliance, this calculation done for a
return period of two to three years can yield on the
investment.

Laser Filling

Conventional Filling

One Surface

785

577

Two Surface

895

706

Three Surface

976

784

More than three surface

1082

847

Mathematics in pedonomics
The introduction of lasers into the practice should
be made in an orderly and precalculated manner.
Proper financial planning will help ensure the successful introduction of laser and help to yield its benefits better. Calculation of economics used in paediatric dentistry and thus making decisions in favour
of economic benefits to the practice are the basis of
pedonomics. The concept of pedonomics and the
time-economics model are based upon the profitability per unit of chair time which is the most important factor in determining the fi
nancial future of
the practice. Pedonomics work on the presumption
that the profit matters, not the income.16

Table 1

Table 1: Number of patients treated
with laser vs. conventional approach.

Laser costs
Cost is the primary determinant in any acquisition.
In the most common manner, it is defined as the
amount or equivalent paid or charged for something.
It is termed as price in the economic language. Another important factor here is the opportunity cost. It
is the added cost of using resources (as for production
or speculative investment) forms the difference between the actual value resulting of using this opportunity and that of its alternative.
Opportunity costs is a major determinant as it describes the following:
1. Cost of the acquisition of a laser.
2. Costs incurred when not having the laser, which include: loss of income due to loss of high-end, cutting edge dentistry, loss of referrals.
The final decision to purchase is worked out after
looking at both financial and the opportunity costs.16
Laser as a profit centre
There are many ways that can help us calculate the
profits based on Laser procedures. In any private
practice, time is money. This can be best determined
on the basis of the average hourly income. There
should be a certain specific amount that needs to be
earned per hour that can keep the practice flourishing. Apart from this basic income, any additional ability to perform the procedure more efficiently means
extra income. The average amount of one hour chair
time should be able to yield approximately 500–
750 US Dollars. This is not the fixed amount but an

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3 2016

[28] =>

| practice management
Table 2: Cost comparison in
UAE Dirhams between laser and
conventional treatment.

new terminology used in pedonomics is KPIs which
stands for key performance indicators.

Other procedures
1

Laser Cosmodent

Cosmodent

2250

1800

Laser Frenectomy

Frenectomy

3100

2500

Laser Sealant

Sealant

550

450

Laser Pulpectomy

Pulpectomy

2100

1850

If KPIs seem to increase or even remain at a good
level, this indicates that break-even and the much
awaited ROI will not be far off.
Table 2

approximate average that can keep the practice on
profitable ends.
The procedures that can be effectively and efficiently performed by using laser in the paediatric dental office are:
1. Restorative laser dentistry
2. Laser-assisted endodontics
3. Frenectomy
4. Sealants
5. Minor surgical procedures
6. Tooth desensitisation
7. Lingual fraenum removal
8. Exposure of unerupted teeth
9. Laser tooth whitening
10. Treatment of orthodontic or drug-induced hypertrophy.
Return on Investment16
Once the laser is bought, pedonomics suggests
that there should be a fair return on the investment
made. Just to break even, the income generated by
laser must include covering the price of the laser,
maintenance, supplies as well as an additional
amount to cover the income lost from the money
used to purchase the equipment and not otherwise
generating its own income. The profit that exceeds
the break-even point is called the return on investment (ROI).
Some of the items that should be included in ROI
would entail the profit from the following:
1. Novelty of procedures with lasers.
2. Reduced out-referrals, caused by the new laser
procedures.
3. In-referrals due to the uniqueness of laser-assisted
paediatric dentistry.
Tracking
To actually calculate the accurate financial return
of introducing the laser to the practice, the income
derived from laser must be monitored over time. A

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3 2016

These are the factors that are used in evaluating
the success of the profit centre as follows:
1. Laser-assisted procedures.
2. In-referrals for laser procedures.
3. New patients that come asking for laser.

Unique selling preposition
The USP is the unique cutting edge of any practice.
When it comes to paediatric dentistry, lasers are indeed a unique selling preposition due to their contemporary benefits. In the field of marketing and management, USP is defined as the factor or consideration
presented by a seller as the reason that the product or
service is different from and better than that of the
competition. The USP of lasers are as f ollows:
1. Non-surgical minor procedures.
2. No drill.
3. No anaesthesia.
4. No pressure on or contact with the tooth.
5. Easier healing.
6. Less need of analgesics and antibiotics.
Six Sigma approach of pedonomics
Six Sigma is defined as the set of techniques and
tools for process improvement. It was introduced by
Engineer Will Smith in 1986 while working at Motorola. Jack Welch centralised this as a business strategy in 1995 at General Motors. The main implication
of the Six Sigma approach in any industry is to be
flawless and error-free. It uses a set of quality-management methods, mainly empirical or statistical, and
creates a spatial infrastructure of people within the
organisation that are aware of this method.
A Six Sigma process is one in which 99.99966 % of
all opportunities to produce some feature of a part
are statistically expected to be free of defects
(3.4 defective features per million opportunities).
When applied to medical or healthcare systems, the
most important dimensions of the quality of the
medical act are:
–– Safety
–– Professional competence
–– Acceptability
–– Efficacy and Relevance
–– Efficiency 17 ref.
–– Accessibility
–– Continuity
–– Interpersonal relations
–– The patient’s satisfaction
–– Patient compliance.

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practice management

Lasers as the Six Sigma in pedonomics
To make the delivery of the treatment best accepted by the family, it must be fit to comply with the
level of patient acceptance. The average amount that
can be generated by laser treatment quite exceeds
the amount generated by conventional treatments.
The approximate amounts ranging in our practice
which runs its costs parallel to the costs in the United
States can be seen from table 1 and 2 and the following numbers:
–– The average amount spent on purchasing as laser:
350,000 AED.
–– Equated monthly instalments calculated with interest: the purchase of laser was made with complete down payment.
–– Average cost per month over three years period:
10,000 AED.
–– Average increase in treatments with laser vs conventional approach: about 200 per type of treatment:
–– Fillings: approximately: 300 more with laser than
Conventional way; average 45 per month.
–– Pulpectomy: only lasers. Average 30 per month.
–– Laser sealants: average 30 per month.
–– Laser frenectomy: 2 per month.
–– Laser pulpotomy: 15 per month.
Based on the above numbers, the approximate
profit earned on laser vs. conventional approach:
–– Fillings: 50 x 300: 15,000 AED.
–– Pulpectomy: 30 x 300: 9,000 AED.
–– Frenctomy: 600 AED.
–– Seals: 30 x 200: 6,000 AED.
–– Sealants: 20 x 300: 6,000 AED.
–– Pulpotomy: 15 x 300: 4,500 AED.

Based on the above figures, the average amount
gained from laser approach of treatment: 41,000 AED.
–– Net profit: 41,000–10,000 (monthly investment on
laser over three years period)
= 31, 000 AED per month.
Break even was tentatively achieved at the end of
14 months. Profit started roughly after this period.

Conclusion
The Six Sigma approach with lasers teaches us to apply the zero-defects principal. This degree of excellence
is not just in a word, but there is a realistic possibility of
making it happen. It is an approach that can actually
accelerate the rhythm of development and of the distribution of new ideas within an organisation. Laser is a
tool that helps in the application of the Six Sigma principle in the dental office. In conclusion, it is statistically
proven that laser with all its attributes is quite efficient
in bringing “more dentistry” to a dental office._

contact
Dr Imneet Madan
Specialist Pediatric Dentist
MSC Lasers Dentistry (Germany)
MDS Pediatric Dentistry
MBA (Hospital Management)
Children's Dental Center, Dubai
Villa 1020 Al Wasl Road, Umm Suqeim 1, Dubai,
United Arab Emirates
Tel.: +971 506823462
imneet.madan@yahoo.com
www.drmichaels.com

Kurz & bündig
Im vorliegenden Artikel befasst sich die Autorin mit den wirtschaftlichen Aspekten der Kinderzahnheilkunde innerhalb
der zahnmedizinischen Praxis. Mit dem Begriff „Pedonomics“, einer Kopplung aus pediatric dentistry (AE für Kinderzahnheilkunde) und economics (Wirtschaft) fasst sie dabei die wesentlichen Inhalte zusammen und erläutert diese im Verlauf
des Beitrags ausführlich mit speziellem Hinblick auf die Laserzahnmedizin. Dabei sieht sie die steigende Nachfrage nach
Laserzahnbehandlungen in der Kinderzahnheilkunde u. a. durch den zunehmenden Fokus auf moderne Technologien in
allen Bereichen der Medizin begründet, aber auch durch die Ansprüche von besonders fürsorglichen Eltern (besonders
die sogenannten Helikopter- oder Dronen-Eltern) an eine umfassende und fortschrittliche Dentalbehandlung ihres Kindes.
Auch der kindlichen Perspektive werde die Lasertherapie gerecht, denn sie reduziert Schmerz und Beschwerden während
der Behandlung und kann damit effektiv der Angst vor dem Zahnarzt entgegenwirken. Als Folge sieht die Autorin steigende
Überweisungszahlen und eine generell höhere Akzeptanz der Therapie. Nach einer ausführlichen Kosten-Nutzen-Analyse
des Lasereinsatzes in der Kinderzahnmedizin, bei der die Autorin u. a. die Aspekte der Kapitalrendite, Kennzahlen, Alleinstellungsmerkmal und die Methoden der Six Sigma-Analyse berücksichtigt, kommt sie zu folgendem Fazit: Die Laserzahnmedizin könne ein Schlüsselmoment für die Anwendung des Six Sigma-Verfahrens zur positiven Entwicklung einer
Zahnarztpraxis darstellen. Dabei sei es statistisch erwiesen, dass Laseranwendungen ein effizientes Mittel seien, um den
Umsatz einer zahnmedizinischen und speziell kinderzahnmedizinischen Praxis zu erhöhen.

Literature

laser
3 2016

[30] =>

| practice management

Eleven tips for success
in your dental clinic
Part V: VIP Seminars and Scripting
Author: Dr Anna Maria Yiannikos, Germany & Cyprus

Welcome to the fifth part of the series ‘Eleven tips
for success in your dental clinic’. Today I will teach you
two new tips that I encourage you to use at your clinics in order to gain the power and control that you deserve. Let me introduce you to the concepts of VIP
Seminars and Scripting!

VIP seminars
Over the years, many of my students – fellow dentists—complain that the promotion of their clinics
costs them a lot of money. Today I will refute this
statement by introducing to you VIP seminars that
can reward your loyal patients, educate them and
position yourself as an expert all in one shot. I know
that this sounds a bit awkward, but I will explain this

o
xR

t
hu

k
oc

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3 2016

great promotion tool in detail so you can also apply
it in your dental clinic, without any serious cost. Let’s
start by describing the steps on how you can establish a successful and impactful way to promote your
clinic.
Before the seminars
1. Use your reception area and, depending on its
space, place 20–30 white plastic chairs. It is very
important to cover them with elegant white chair
covers (similar to the one that we see in wedding
receptions).
2. Make a list with 40 loyal patients of your clinic that
you feel you should reward and thank for the years
of coming and referring patients to you. Why 40?
My experience over the years says that if you want

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practice management

to get 20 at that day you should invite 40 to get 25
positive answers, although in the last couple of
days previous to the event, three to ﬁve of them will
cancel.
3. Send them an enticing e-mail invitation—like the
ones that we receive for special events and weddings with a unique and glamorous design.
4. Ask your assistant to call them and inform them
about the invitation as well as to conﬁrm whether
they have received it. You should call them again
after approximately one week so they can feel how
important their participation is to you. Two days
before the seminar, ask your assistant to send them
a text reminder.
5. Find a catering service that will prepare delicious
ﬁnger food for your event.
6. Ask a company (dental supplier) to sponsor the
event by offering a unique traveling dental kit for
example or a dentistry-related present useful to
your patients. Send each guest a warm note that is
unique and special to them (for example what part
of their character you admire).
During the seminars
Start on time! Choose topic relevant to your guests
and elaborate on it. This will establish you as the expert. The duration of your speech should not exceed
15-20 minutes. Before cocktails, award your loyal patients with the promotional present—call them one by
one, thank them for coming and give them their present.
After the seminars
Send them a warm personalised message (an
e-mail or SMS), thanking them for coming and for being your patients.

Isn’t that easy? I encourage you to use VIP seminars
at least two times a year. It is your opportunity to
thank your loyal patients, make them feel special but
also to position yourself as the expert.

Scripting
The next tip that we are going to discuss is the importance of knowing what to say and how to say different things to our patients in order to make them
increase our case acceptance. Let’s start by being assertive and not aggressive. Since people are attracted
to positive people, additionally this effect is contagious. To establish this, the key is the correct use of
words. A very important tool that we use in my clinic
and I encourage you to use it in yours as well, is a script
of words. How can you create that?
Sit with your team and together brainstorm words
with energy and passion that represent the philosophy of your own clinic. These will be the words that
you are going to use in your verbal communication
(face to face and phone) with your patients but also
in all your media communication, for example when
you make a presentation (VIP seminars) or for the
video playing on the TV screen at the reception area,
or in a Facebook post. Here are ten words of our script
so you can get an example and inspiration for designing your own:
Passionate—Faith—Gifted—Share—Unique—Feel
—Care—Pleasure—Creation—Enlighten
Isn’t that easy, too? I encourage you to use them
daily. It is your opportunity to increase patient loyalty,
referrals, and overall case acceptance. The reason?
People tend to place their trust in people they like.

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3 2016

[32] =>

| practice management

People are attracted to positive and enthusiastic
people. The words we use have tremendous impact on
others. Anyone can improve communication with a
few simple changes.
The above tools are a very small part of the tools,
ideas and protocols of the presentation skills module
which is one of the ten modules that I teach during the
DBA—Dental Business Administration Mastership
course. DBA is a mini MBA that will not only teach you
ten different modules in only ten days, but it will also
give you examples and exercises based on our routine
dental life. It is a unique educational programme that
can show you how to gain the business success that
you deserve.
In the next part of this useful series, we will discuss
more business concepts that as always will assist you
in revealing the opportunities and real potential of
your dental clinic and staff. Until then, remember that

you are not only the dentist of your clinic, but you are
also the manager and the leader. You can always send
me your questions and request for more 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@yiannikosdental.com
www.dbamastership.com

Kurz & bündig
Mittlerweile vier Teile der Serie “11 Tipps zum wünschenswerten Erfolg in Zahnkliniken” gehen dem Artikel dieser
Ausgabe voraus. In diesen beschäftigte sich die Autorin damit, wie sich Praxisinhaber intensiv mit ihren eigenen Stärken und Schwächen auseinandersetzen können, mit der Suche nach dem idealen Praxismitarbeiter, dem optimalen
Umgang mit Patienten und schließlich damit, wie man lohnenswerte Investitionen in die eigene Praxis ermittelt und
das Praxisumfeld analytisch bewerten kann.
Im heutigen Teil zu VIP-Seminaren und Skriptsprache geht es darum, Patienten durch exklusive Veranstaltungen
und eine durchdachte sowie individuelle Praxissprache an ihre Zahnarztpraxis zu binden. Die Autorin beschreibt,
wie ausgewählte Patienten zu speziellen VIP-Seminaren eingeladen und dort für ihre Treue belohnt werden könnten.
Hierbei können auch Dentalfirmen als Sponsoren fungieren. Darüber hinaus empfiehlt die Autorin, gemeinsam mit
dem Praxisteam Schlagworte zu finden, welche das Praxiskonzept ideal wiederspiegeln. Diese Skriptsprache solle
dann aktiv in der Kommunikation mit Patienten und Partnern angewendet werden, sodass sich diese stärker mit der
Zahnarztpraxis identifizieren und positive Assoziationen mit dieser knüpfen.
Auch in der kommenden Ausgabe der laser international magazine of laser dentistry erwartet Sie wieder ein Beitrag für
den wirtschaftlichen Erfolg Ihrer Praxis. Seien Sie gespannt!

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3 2016

[33] =>

[34] =>

manufacturer news
LASOTRONIX

SMARTM dental diode laser – Versatile and functional
like biostimulation and PAD (Photoactivated
Disinfection). Combining two wavelengths in one
device made SMARTM laser a unique and advanced application for all soft tissue procedures
in dentistry.
Thanks to thoughtful design that allows in
tegration with the dedicated workstation or a
dental unit, SMART M laser meets the needs of
every dental office and assures perfect operation comfort. In addition, accessories such as a
wide range of fiber delivery systems, application
end tips and a variety of surgical handpieces
provide maximum versatility. As a result, the
SMART M laser is suitable for a vast number of
therapies. If you want to join us and promote our
innovative products please kindly contact us via
E-Mail: mp@lasotronix.pl.
LASOTRONIX is proud to present the diode-based
laser platform especially designed for dentistry,
the SMARTM series. SMARTM laser is offered
as a combination of two lasers in one package:

10 W at 980 nm wavelength for a wide range of
applications in microsurgery, endodontics, perio
dontology, pain therapy and whitening as well as
400 mW at 635 nm wavelength for cold therapies

LASOTRONIX
˚ytnia 1 str.
05-500 Piaseczno, Poland
www.lasotronix.com

Light Instruments Ltd.

Sino-Lite Ltd. announces Acquisition
of Light Instruments Ltd.
Sino-Lite Ltd., an Israeli corporation, has announced the acquisition of Light Instruments Ltd,
a leading dental laser manufacturer, previously
owned by Syneron Medical Ltd.
Light Instruments Ltd. is famed for its flagship
product the LiteTouch™ Er:YAG laser. This product incorporates the innovative Laser-in-Handpiece technology, housing the entire laser mechanism within a small sized chamber, measuring
22 cm long by 2.6 cm diameter. Thanks to its
technological design LiteTouch™ mimics the
feel of the turbine drill and yet incorporates laser
benefits: micro surgery, faster healing, minimal
invasive treatments and higher acceptance of
patients to dental treatments.
Sino-Lite Ltd. specializes in the acquisitions, development and management of dental and medical companies worldwide. The company is backed
by strong Chinese groups headed by Sino-Ita International Trading Company, distributor of the

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3 2016

Italian brand NewTom Cone Beam 3D Imaging in
China and South East Asia. Sino-Ita integrates the
whole chain from research, sales to service.
According to Adv. Eric Ben Mayor, CEO of Sino-
Lite Ltd. and Light Instruments Ltd., the acquisition of Light Instruments Ltd. is the first step,
within a sequence of acquisitions of high technology companies and innovative companies
that the group intends to acquire in the Israeli
market. “Sino-Lite Ltd. will expand Light Instruments Ltd’s workforce, variety of high-end
dental lasers offering and add advanced technologies and solutions, increasing the company’s
position as a leading industrial innovator.”
Light Instruments Ltd.
Industrial Zone, Tavor Building,
P.O.B. 223
20692, Yokneam Israel
www.light-inst.com

Adv. Eric Ben Mayor, CEO of Sino-Lite Ltd. and Light
Instruments Ltd.

[35] =>

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:
Street:

Phone:

ZIP/city:		

Fax:		

Country:

E-Mail:

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

[36] =>

news

international

Reduced carbohydrates may

Student develops

Alleviate periodontal
inflammation

Artificial dental plaque

©g

re b
ch

a/

Sh
ut

te
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to
om
k.c

© kaisorn/Shutterstock.com

Alongside her studies, Flad works at the
ORMED—Institute for Oral Medicine at the university, a research and development organisation for scientific services with the focus on oral
hygiene, robotic simulation of toothbrushing and
medical plaque control. Flad’s trip to Seoul was
funded by the Fördergemeinschaft Zahnmedizin,
a non-profit association of dentists.

rs

Aiming to test the hypothesis that diet helps reduce inflammation lead author Dr Johan Wölber
from the University of Freiburg and his colleagues
designed a study to investigated the impact of an
oral health-optimised diet on periodontal health in
a group of patients with a history of gingivitis.
Of the 15 participants, ten were asked to follow
a list of restricted and recommended foods and
meals, such as omega-3 fatty acids, vitamins C
and D, antioxidants and fibre. Five participants
continued with their typical eating patterns. Apart

As part of a research project, a dentistry student from Germany has developed a new formula to synthesise dental plaque, which could
help facilitate research on oral biofilm significantly in the future. As the first dental student
ever to speak at the congress, she presented
her findings at the 94th General Session and
Exhibition of the International Association for
Dental Research, which took place from 22
to 25 June in Seoul in South Korea. “Currently, researchers have to find study participants
who are not allowed to brush their teeth for
days,” explained Ann-Kathrin Flad, who is an
eighth-semester dental student at Witten/
Herdecke University in Germany and has
been involved in the project for three years
already. “With the new formula for artificial dental plaque, however, this can be
avoided, as it adheres to teeth like natural
dental biofilm. It can be coloured in order to
measure how much is being removed using
manual and electric toothbrushes, as well as
other oral hygiene tools.”

Teeth reveal

Vitamin D deficiency
from not using interdental cleaners, participants
were advised not to change their oral health routines throughout the study period.
After four weeks, participants in the low-carb
group showed significantly reduced gingival and
periodontal inflammation compared with the control group. According to the researchers, reducing
carbohydrates in particular led to a significant improvement in the gingival index, bleeding on probing and the periodontal inflamed surface area.
Although the study had its limitations, the results
support the assumption that modern Western
eating habits, including consumption of refined
carbohydrates and a high omega-6 to omega-3
fatty acid ratio, promote inflammatory processes.
The study, titled “An oral health optimized diet can
reduce gingival and periodontal inflammation in
humans—A randomized controlled pilot study”,
was published online on 26 July in the BMC Oral
Health journal.

36

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3 2016

By analysing life traces in the teeth of six individuals who died hundreds of years ago, Canadian
researchers have now been able to accurately backtrack episodes of vitamin D deficiency
during these people’s lifetime.
However, these episodes of abnormalities do not
disappear in teeth, but are evident in the formation
of characteristic interglobular dentin spaces. In
the study, researchers from McMaster University
in Hamilton examined a total of 12 teeth in individuals with skeletal evidence of a vitamin D deficiency. The teeth came from four women buried

in a French cemetery between 1225 and 1798 and
two people buried in rural Quebec between 1771
and 1860, a child believed to be 3 years old and
a 24-year-old man. Based on the defects in the
dentin, the analysis showed that all of the subjects
had a vitamin D deficiency or rickets, a common
childhood disorder caused by the condition that
results in weakening of the bone and is often characterized by bowed legs and deformed hips. The
study, titled “The rachitic tooth: A histological examination,” was published online ahead of print on
30 June in the Journal of Archaeological Science.
© bitt24/Shutterstock.com

[37] =>

SIROLaser Blue wins

Genetics affecting obesity’s impact on

Red Dot Award

Periodontal disease
progression

has been awarded to products, design concepts
and communication designs since 1954. This
year, 41 jury members (made up of independent
designers), design professors and specialist
journalists assessed a record number of 5,214
products from 57 nations in 31 categories. The
award ceremony was held on 4 July 2016, at
the Red Dot Gala in the Aalto Theater in Essen,
Germany.

y/S

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m

The SIROLaser Blue handpiece has once again
won over international design experts. It was
presented the Red Dot Award in the category
“Life Science and Medicine” for, according to the
jury, “the elegant feel of its flowing, elongated
shape and stainless steel finish”. This is the second design prize this year for the Dentsply Sirona
Instruments laser for surgical dentistry. In February, the SIROLaser Blue handpiece was presented with the iF Design Award. The Red Dot Award
is an internationally recognized quality seal that

Studies have indicated that individuals with a
high body mass index are more prone to developing periodontal disease than other people are.
Being overweight or obese might also negatively
affect one’s response to nonsurgical periodontal
therapy. In order to evaluate whether specific
patterns of interleukin-1 (IL-1) gene variants,
which are known to affect periodontitis severity,
influenced the association between obesity and
subsequent periodontitis progression, DNA was
collected from 292 men (aged 29–64 at entry) in
a recently published study. The participants had
dental and anthropometric endpoints collected
over multiple examinations, approximately every
three years for up to 27 years.

Source: Dentsply Sirona

Frequent dental scaling to reduce

Infection risk after knee replacement
Oral bacteria that enter and spread through the of periprosthetic infection following total knee arbloodstream have been found to cause about 10 throplasty: A nationwide population-based nested
per cent of peri-prosthetic joint infections after case–control study”, was published online in the
total knee arthroplasty (TKA).
PLOS ONE journal on 23 June.
A team of Asian researchers analysed 1,291
patients who had undergone TKA between
1999 and 2002 and needed revision surgery within five years after the initial operation owing to a peri-prosthetic infection.
They compared these cases to a control
group of age- and sex-matched TKA patients who had not had any peri-prosthetic infection. The researchers concluded
that regular dental scaling can improve
oral health and thereby reduce the risk of
transient bacteraemia caused by oral bacteria. The study, titled “Frequent dental
© Ocskay Mark/Shutterstock.com
scaling is associated with a reduced risk

The analysis showed significant interactions
between IL-1 genetic variations and obesity-related traits in predicting periodontal disease
progression. Participants who were both obese
and IL-1-positive were 70 per cent more likely
to experience periodontal disease progression
than those without these risk factors. The study
was conducted at the Boston University Henry M.
Goldman School of Dental Medicine in collaboration with Interleukin Genetics. The study, titled
“Influence of obesity on periodontitis progression
is conditional on IL-1 inflammatory genetic variation,” was published online on 19 August in the
Journal of Periodontology, an official publication
of the American Academy of Periodontology.

laser
3 2016

[38] =>

E

KT

16

T

LDU GSPU
N

N

FOR

BI

Faszination Laser in München




25. INTERNATIONALE JAHRESTAGUNG DER DGL
LASER START UP 2016
30. September und 1. Oktober 2016
München | The Westin Grand München

VERANSTALTER / WISSENSCHAFTLICHE LEITUNG
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
Klinik für Zahnerhaltung, Parodontologie und
Präventive Zahnheilkunde
Universitätsklinikum der RWTH Aachen
Pauwelsstraße 30 | 52074 Aachen
Tel.: 0241 8088-164 | Fax: 0241 803388-164
sekreteriat@dgl-online.de | www.dgl-online.de
ORGANISATION
OEMUS MEDIA AG
Holbeinstraße 29 | 04229 Leipzig
Tel.: 0341 48474-308 | Fax: 0341 48474-290
www.oemus.com | event@oemus-media.de
ANMELDUNG
www.dgl-jahrestagung.de | www.startup-laser.de

Faxantwort an 0341 48474-290
Bitte senden Sie mir folgendes Programm zu (Bitte ankreuzen):


25. Internationale Jahrestagung der DGL		
 LASER START UP 2016

Praxisstempel

Titel, Name, Vorname

E-Mail-Adresse (Für die digitale Zusendung des Programmes.)

laser 3/16

[39] =>

editorial

25 Jahre DGL!

Prof. Dr. Norbert Gutknecht

Liebe DGL-Mitglieder,
liebe Freunde der Lasertechnologie,
wenn Sie durch diese Ausgabe des laser international magazine of laser dentistry blättern, werden Sie mit Indikationen und Lasersystemen konfrontiert, von denen wir, die Gründungsmitglieder der DGL, uns vor 25 Jahren noch nicht einmal im Traum etwas hätten vorstellen können.
Wir sprechen heute sowohl von Blue-Light-Diodenlaser in der Chirurgie, von Radial Firing Tips in der Endodontie, von der Kombination von Wellenlängen aus dem nahen und mittleren Infrarotbereich in der Paro
dontologie sowie von speziellen Behandlungskonzepten in der Kinderzahnheilkunde als auch einer modernen Marketingstrategie für die wirtschaftliche Integration von Lasern in der zahnärztlichen Praxis.
Anlässlich unseres ersten DGL-Laserkongresses 1991 in Stuttgart hatten sich Referenten und Teilnehmer
ausschließlich mit einer Wellenlänge beschäftigt, dem Nd:YAG-Laser. Man war fasziniert, dass Laserlicht von
einer Quarzfaser transportiert in den Wurzelkanal und die parodontale Tasche geleitet werden konnte. Es war
die Zeit der Pioniere, in der sich Versuch und Irrtum, Erfolg und Misserfolg rasch abwechselten. Die Weiterentwicklung der Lasertechnologie, die Entdeckung neuer Laserwellenlängen, die Schaffung von Ausbildungsprogrammen und die Integration in die DGZMK haben uns zu dem gemacht, was wir heute sind: eine
Laserfachgesellschaft mit hohen akademischen Ansprüchen, mit klaren Behandlungskonzepten für die
Anwendung von Lasern in der zahnärztlichen Praxis und – für mich ganz besonders bedeutungsvoll – ein
Kongressforum, das sich objektiv mit allen verfügbaren Lasersystemen und Indikationen auseinandersetzt.
Deshalb wünsche ich Ihnen beim Lesen unserer Fachzeitschrift, und natürlich für all diejenigen, die unseren Jubiläumskongress besuchen, viel Freude und hoffentlich viele neue Erkenntnisse beim Vertiefen in die
dargebotenen Themen.
Ihr

Prof. Dr. Norbert Gutknecht

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3 2016

[40] =>

25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


SEM surface observations of titanium implants irradiated
by Er.Cr:YSGG laser (2,780 nm)
Prof. Dr Norbert Gutknecht, Dr Peter Fahlstedt
RWTH Aachen University, Department of Operative Dentistry and Periodontology, Germany
Unintended alteration of oral implant surfaces i.e. micro fractures,
melting and ablation has been reported as a consequence of incorrect settings and handling of erbium-laser and diode laser of different
wavelength. The aim of this pilot study was to compare the 2-dimensional surface structure by SEM (Scanning Electron Microscope)
of an untreated and by different settings of dual wavelength laser
irradiated oxidized titanium oral implant surface.

Laser parameters
0,75 W; 1,0 W; 1,25 W; 50Hz; Water 80 %; Air 20 %; Fluency
6.25 J/cm2

Material and methods
NobelBiocare titanium dental implant representing an oxidized surface

Results
SEM results after irradiations following adjusted protocol: laser irradiation parameters at 1 mm distance and Er;Cr:YSGG settings of
0,75 W and 1,0 W no signs of alteration of TiU surfaces was observed. The surfaces seemed similar to non-irradiated control areas.
After distance increasing from 1 to 2 mm the same observations was
made for 1,25 W.

Laser equipment
Er,Cr:YSGG 2,780 nm laser; Hand piece for fibre tip: MZ8, 6 mm
length, Diameter of fibre tip-end: 800 micrometer. Distance between fibre tip end and implant surface: 0,8–1,2 mm.

Analysis
Field emission Scanning electron microscope (SEM) Jeol JSM7400F was used for 2-dimensional surface observations.

Kurzpulslaser in der Zahnheilkunde: vom Excimer-Laser bis zur UKPL-Technologie
Prof. Dr. Matthias Frentzen, Priv.-Doz. Dr. rer. nat. Jörg Meister, Bonn/Germany
Voraussetzung für die Abtragung von Zahnhartgeweben und Knochen sind gepulste Lasersysteme, um thermische Schädigungen der
Gewebe zu vermeiden. Die Laserforschung hat sich hierbei neben
Wellenlängen im 3 µm- und 10 µm-Bereich auch mit Nanosekunden-,
Pikosekunden- und Femtosekunden-Lasertechnologien seit Ende
der 80er-Jahre auseinandergesetzt.
Excimer-Laser (193 nm und 308 nm/Pulslänge im ns-Bereich), die
primär für die Ophthalmologie entwickelt wurden, zeigten Möglichkeiten auf, Zahnhartgewebe und Kochen atraumatisch und formgebend
zu bearbeiten. Die Materialbearbeitung konnte mit spektroskopischen Analysensystemen im Sinne einer Feedbacksteuerung gekoppelt werden. Aufgrund mangelnder Effizienz und hohem technischen
Aufwand wurde dieser Weg zugunsten moderner UKPL-Systeme
(Faserlaser gekoppelt mit Scannersystemen, ns- bis fs-Bereich) ver-

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3 2016

lassen. Die Möglichkeiten der neuen, standfesten Technologie mit
kompakten Laserquellen stellen eine signifikante Weiterentwicklung
gegenüber den UV-Gaslasern vor 25 Jahren dar. Die Technologie der
heutigen UKP-Laser schreitet voran, sodass in Zukunft – vergleichbar der Entwicklung der Diodenlaser – auch leistungsstarke, miniaturisierte Kurzpulslaserquellen zu erwarten sind, die eine klinische
Realisierbarkeit von Feedback-gesteuerten All-in-One-Systemen im
Sinne einer Theragnostik ermöglichen können. Die bereits gewonnenen wissenschaftlichen Erkenntnisse dieser Forschung haben auch
Einfluss auf die Weiterentwicklung von Erbium- und CO2-Laser zur
Hartgewebebearbeitung.
Die Grundzüge dieser Entwicklung zur Bearbeitung von mineralisiertem Gewebe im Laufe der letzten 25 Jahre sollen resümiert werden
und Zukunftsperspektiven aufgezeichnet werden.

[41] =>

Auf neuen Wegen – Der 445 nm-Halbleiterlaser in der klinischen Anwendung
Prof. Dr. Andreas Braun, Marburg/Germany
Lasersysteme werden in einer Vielzahl von zahnmedizinischen Behandlungsverfahren vor allem in den Bereichen Chirurgie, Zahnerhaltung, Endodontie und Parodontologie eingesetzt, um sowohl
den Komfort des Patienten als auch das Behandlungsergebnis zu
verbessern. Die Wirksamkeit des Lasers hängt dabei entscheidend
davon ab, wie die elektromagnetische Strahlung vom Zielgewebe
absorbiert wird.
Die Entwicklung eines neuartigen Diodenlasers im blauen Wellenlängenbereich (445 nm) verspricht eine gute Energiekopplung an
pigmentierte Zellen und Gewebe. Kombiniert mit einer geringen
Absorption in Wasser resultiert eine im Vergleich zu herkömmlichen
Halbleiterlasern im Wellenlängenbereich 810–980 nm verbesserte
Schneidleistung für chirurgische Eingriffe. Aufgrund seiner kürzeren
Wellenlänge dringt blaues Laserlicht weniger tief in ein Zielgewebe
ein, sodass durch die geringere Penetrationstiefe die Gefahr von unbeabsichtigten Verletzungen tiefliegender Schichten verringert und
die Strahlführung präzisiert werden kann. Der thermische Energie-

eintrag des Lasers in das umliegende Gewebe ist durch die geringe Absorption in Wasser verringert, sodass blutungsarme Schnitte
mit räumlich begrenzter Hitzewirkung beobachtet werden. Darüber
hinaus eignet sich blaues Laserlicht, herkömmliche Maßnahmen
zur Keimreduktion in parodontalen Läsionen oder Wurzelkanäle zu
verbessern. Nicht zuletzt deuten Ergebnisse erster diesbezüglicher
Studien an, dass die blaue Wellenlänge Effekte der Low-Level-LaserTherapie (LLLT) induzieren kann, um Wundheilungsprozesse zu unterstützen.
Auf Lasertechnik basierende Behandlungsverfahren alleine scheinen in vielen Fällen oftmals zu Ergebnissen zu führen, die auch
mit konventionellen Methoden erreicht werden können. Betrachtet
man laserbasierte Behandlungsmaßnahmen wie den Einsatz des
445 nm-Lasers allerdings unter dem Aspekt einer adjuvanten Therapie, kann der Einsatz von Lasern die Ergebnisse konventioneller Behandlungsprotokolle verbessern und den Therapieerfolg insgesamt
positiv beeinflussen.

Effect of varying pulse duration of Er:YAG laser on the microstructure of titanium
implant surface
Dr Kenneth Luk, Aachen/Germany, Hong Kong
The irradiation of 10.6 J/cm2 at 200 µs of Er:YAG energy density
has been reported to be safe on implant surfaces. Varying the
pulse durations with the same energy density may be a parameter which affects the RBT surface microstructure. An implant
motor is employed at a speed of rotation in the implant placement
mode. 40 µs, 100 µs and 300 µs pulse durations were chosen.
For each sample, three threads were chosen for laser irradiation.

The samples were irradiated at the parameters set. The samples
were observed under SEM. In all samples, there were melting, resolidification and micro-crack formations under SEM observation.
Er:YAG laser with articulated arm transmission at pulse durations
of 40 µs and 100 µs and 300 µs at an energy density of 10.6 J/cm2
in near contact mode are not suitable on preservation of implants
with RBT microstructure.

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3 2016

[42] =>

25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


Comparison of diode lasers in soft-tissue surgery using cw- and
superpulsed mode—An in vivo study
Dr Ralf Borchers, Bünde/Germany
Dental soft-tissue surgery by diode lasers in cw-mode often causes
carbonisation of the tissues with following necrosis and a delay of
wound healing. In vitro studies have already shown that superpulsed
diode-laser surgery has much less disadvantages for the tissues in
an histological approach.
The purpose of this study was to investigate in vivo if the superpulsed
mode of operation can realise an improvement for surgeon and patient in soft-tissue surgery. 26 patients were treated by diode lasers
in different modes of operation for soft-tissue surgery.
Twelve patients were treated by the superpulsed elexxion claros
diode laser: 810 nm; 10–50 W peak; 10–20 µs pulse duration;
12,000–20,000 Hz; 400 µm fibre. 14 patients were treated by Vision
MDL-10 diode laser: 980 nm; 2.5 W; cw-mode and also a 400-µm
fibre. Clinical treatment was documented by photos and questionnaires for patients and surgeons. Questions concerned: carbonisa-

tion, coagulation, cutting speed, pain, swelling, bleeding, need for
drugs, functional reduction and fibrin layer on wounds—during treatment, directly after treatment, after one day, after three days and
after one week. Clinical observations and the questionnaires showed
significant differences between cw-mode and superpulsed diodelaser treatment in surgery in most cases. It was shown that superpulsed diode-laser surgery is superior to continuous-wave treatment.
Carbonisation and thermal damage of the tissues can be reduced
to a minimum, therefore healing is faster than in cw-mode surgery.
The generation of a soft-tissue cut is faster and more precise. Patients have less pain; in amount and duration. The need of drugs is
reduced. There are less functional restrictions and there is less swelling. The advantages of superpulsed mode of operation for soft-tissue
diode-laser surgery are evident. Continuous-wave mode should no
longer be implemented in diode-laser surgery.

Investigations of radicular dentin permeability and ultrastructural changes after
irradiation with dual wavelength (Er,Cr:YSGG and 940 nm diode laser)
Tamara Sardar Al-Karadaghi, Dr René Franzen, Hussein A. Jawad and Prof. Dr Norbert Gutknecht, Aachen/Germany
The aim of this study was to assess the effectiveness of dual wavelength (2,780 nm Er,Cr:YSGG, 940 nm diode) laser in the elimination
of smear layer, comparing it to Er,Cr:YSGG laser in terms of radicular
dentin permeability and ultrastructural changes of root canal walls.
51 sound single-rooted extracted teeth were instrumented up to size
F4 and divided into three groups: group Co (non-irradiated samples),
group A (irradiated with Er,Cr:YSGG laser), group B (irradiated with
the dual wavelength laser). Afterward, the roots were made externally
impermeable, filled with 2 % methylene blue dye, divided horizontally
into three segments, reflecting the cervical, middle, and apical thirds
then examined under microscope. Using analytical software, the root
section area and dye penetration area were measured, and then, the
percentage of the net-dye penetration area was calculated. Addi-

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3 2016

tionally, scanning electron microscope investigations were accomplished. Analysis of variance (ANOVA) showed significant differences
between all groups over the three root thirds. Dye permeation in the
dual wavelength laser group was significantly higher over the whole
root length, cervical, middle, and apical, compared to Er,Cr:YSGG
laser group and non-irradiated samples (p < 0.001). Scanning electron micrographs of dual wavelength irradiated samples showed a
distinctive removal of smear layer with preservation of the annular
structure of dentinal tubules. Er,Cr:YSGG laser root canal irradiation
produced an uneven removal of smear layer and inefficient cleanliness especially in the apical third. There was no sign of melting or
carbonisation. Within the studied parameters, root canal irradiation
with dual wavelength laser increased dentin permeability.

[43] =>

FÜR JEDE KLINISCHE INDIKATION
DAS OPTIMALE SYSTEM
LASER EINFACH, SICHER & SANFT

www.henryschein-dental.de

HENRY SCHEIN DENTAL – IHR PARTNER IN DER LASERZAHNHEILKUNDE
Wir bieten Ihnen ein breites und exklusives Sortiment marktführender
Lasermodelle verschiedener Hersteller an.
Unsere Laserspezialisten beraten Sie gern über die vielfältigen Möglichkeiten
und das für Sie individuell am besten geeignete System.
Laser ist nicht gleich Laser und genau hier liegt bei uns der Unterschied:
Sie, Ihre Patienten und Ihre gemeinsamen Bedürfnisse stehen bei uns
an erster Stelle.
Bei Henry Schein profitieren Sie vom Laserausbildungskonzept!
Von der Grundlagenvermittlung über hochqualifizierte Praxistrainings
und Workshops zu allen Wellenlängen bis hin zu Laseranwendertreffen.
Unsere Laser-Spezialisten in Ihrer Nähe beraten Sie gerne.
FreeTel: 0800–1400044 oder FreeFax: 08000–404444

[44] =>

25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


Einfluss der Lasertherapie auf die Regenerationszeit nach
erfolgter Gaumennahterweiterung –
Ein systematisches Review
Dr. Ambili Mundethu, Prof. Dr. Dr. Heinrich Wehrbein, Dr. Dr. Collin Jacobs, Mainz/Germany
Das Ziel der vorliegenden Untersuchung war die systematische Analyse der vorhandenen Evidenz in Bezug auf die Low-Level-LaserTherapie zur Knochenregeneration nach erfolgter Gaumennahterweiterung.
Im Zeitraum von September 2015 bis Januar 2016 wurde eine systematische Recherche der vorhandenen Literatur (Web of Science,
PubMed, Cochrane Libary, Handsuche) vorgenommen, welche sich
mit dem Effekt der Low-Level-Laser-Therapie auf den Knochenstoffwechsel nach erfolgter Gaumennahterweiterung beschäftigte. Die
Recherche erfolgte mittels der Suchbegriffe „laser“, „orthodontics“,
„tooth movement“, „pain reduction“, „enamel debonding“, „gingiva“,
„periodontal“ und „rapid maxillary expansion“. Hierzu wurden sowohl
Cochrane- als auch Prisma-Richtlinien berücksichtigt.
Insgesamt erzielte die Recherche 1.522 Treffer bezüglich der Lasertherapie in der Kieferorthopädie. Hiervon blieben nach Anwendung der

Ausschlusskriterien 144 relevante Studien über. Nach Durchlaufen des
Selektionsprozesses ergaben sich 13 Studien, welche in einem systematischen Review zusammengefasst wurden. Hierbei handelte es
sich um elf Tierstudien und zwei prospektive, kontrollierte Patientenstudien. Die Knochenregeneration wurde entweder histologisch oder
radiologisch analysiert. Alle 13 Studien konnten eine beschleunigte
Knochenregeneration nach der Gaumennahterweiterung durch die
Anwendung einer Low-Level-Laser-Therapie, verglichen mit der Kontrollgruppe, nachweisen.
Die vorliegende Übersichtsarbeit belegt, dass mittels der Low-LevelLaser-Therapie die Knochenregenation nach erfolgter Gaumennahterweiterung beschleunigt werden kann. Hieraus könnten sich eine
verkürzte Retentionszeit und eine verringerte Relapserate nach erfolgter Gaumennahterweiterung ergeben. Zu diesem interessanten
Therapieansatz sind weitere klinische Studien erforderlich.

Surface layer erosion of artificial caries lesions using
Er,Cr:YSGG laser in preparation for resin infiltration
Dr Berchem Kalender, Julian Lausch, Jale Gorucua, Prof. Dr Norbert Gutknecht, Ankara/Turkey, Aachen/Germany
The aim of this study was to compare four different pretreatments (15 % hydrochloric acid, 37 % phosphoric acid, 3.5 W, 4 W
Er,Cr:YSGG laser) regarding their ability to erode the surface layer
of artificial enamel lesions in preparation for resin infiltration in vitro.
88 bovine enamel samples (5 x 5 x 4 mm) were demineralised for 21
days to create artificial lesions. After demineralisation, the samples
were randomly allocated to four groups according to the pretreatment
procedures (n = 22). In the H3PO4-group, lesions were etched with 37 %
phosphoric acid gel (H3PO4-gel) (iBOND Etch, Heraeus Kulzer) for 5 s.
In the HCl-group, lesions were etched with 15 % hydrochloric acid gel
(HCl-gel) (ICON etch, DMG) for 5 s. The two laser groups included
the irradiation of the enamel surface layer using a Er,Cr:YSGG laser
(2,780 nm wavelength, 140 m pulse duration, 80 % water, 60 % air)
with sapphire tip (MZ#8), focused mode at 3.5 W/100 Hz (Laser 3.5 W)
and 4 W/100 Hz (Laser 4 W). After preparation, two samples from each
group were selected to determine the morphology of the treated enamel
surfaces with Scanning Electron Microscopy (n = 2). After preparation,
all lesions were infiltrated (Icon, DMG) for 10 s (n = 20). Subsequently,
light curing was performed for 60 s. Samples cut perpendicular to the

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3 2016

lesion surfaces, polished and analysed using Confocal Laser Scanning
Microscopy. Lesion depths (LD), the depth of erosion (ED) and penetration depths (PD) were measured. The percentage penetration was
calculated as PP = PD ÷ LD x 100. Statistical analyses were performed
using the Kruskal-Wallis test and Mann-Whitney test.
The ED was significantly increased in lesions etched with HCl-gel
or irradiated with Er,Cr:YSGG laser compared to those etched with
H3PO4 (p < 0.05). The percentage penetration of the infiltrant was
significantly higher in the HCl-group and laser groups than in the
H3PO4-gel group (p < 0.05). The use of the laser at 3.5 W and 4 W
revealed similar results. Using the laser at 3.5 W and 4 W created
similar micromorphological etching patterns on enamel surfaces like
conventional acid etching procedures.
It can be concluded that the pre-treatment using an Er,Cr:YSGG laser
results in a deeper erosion of the surface of artificial enamel lesions
compared with 37 % H3PO4-gel and similar erosion compared with
the use of conventional 15 % HCl-gel. Thus, the use of an Er,Cr:YSGG
laser seems to be suitable as a pre-treatment of artificial lesions in
preparation for resin penetration.

[45] =>

Welchen Laser in der Kieferorthopädie? – Die Weisheit der Wahl
Dr. Peter Kleemann, M.Sc., Grevenmacher/Luxemburg
Eine Systematik der Laseranwendungen in der Kieferorthopädie entwickeln und daraus eine Methode zur Auswahl der passenden Laserwellenlänge/n und des geeigneten Lasergerätes ableiten.
Nd:YAG/Er:YAG, 2-Nd:YAG und Diodenlaser mit 810, 970, 660 und
445 nm wurden bei ca. 3.000 kieferorthopädischen Patienten zwischen
2003 und 2016 eingesetzt, um Weich- und Hartgewebsprobleme zu
lösen. Entsprechend der klinischen Hauptindikationen konnten vier Indikationsgruppen unterschieden und diese analog einer „Baumstruktur“
unterklassifiziert werden in Art des Zielgewebes (Hart- versus Weichgewebe) und weiter in Modus Ablation versus Nonablation. Am Ende
steht die Laserapplikation, eindeutig beschrieben mit Protokollname,
Konzept, Wirkungsweise und zu erwartendem Resultat.
Es wird eine Systematik der Laseranwendungen in der Kieferorthopädie präsentiert mit den Mengen: 1. Orthodontisch indizierte,
2. Ästhetisch, 3. Kariespräventiv indizierte, 4. Assoziierte Laseranwendungen. Aus diesen werden Schnittmengen gebildet mit den

Applikationsmöglichkeiten der getesteten Lasergeräte und daraus deren Leistungsprofil bestimmt.
Die Systematik enthält einen geordneten Überblick aller Laseranwendungen in der Kieferorthopädie. Wünschenswerte und häufige Laseranwendungen können identifiziert und den getesteten Laserwellenlängen und -geräten zugeordnet werden. In umgekehrter Weise kann
das „Leistungsprofil“ eines Gerätes über das „Gesamtraster“ gelegt
und die Grundsatzentscheidung für oder gegen das Gerät erleichtert
werden. Externe Faktoren wie Bedienungskomfort, Design und Preis
fließen in eine Bewertung mit ein. Am Beispiel eines hochgepulsten
Diodenlasers 810 nm und eines niedriggepulsten Multiwave-Diodenlasers (970/660/445 nm) soll die Vorgehensweise bei der Bewertung und Auswahl erläutert werden. Die evidenzbasierte Systematik
stellt sich als ein wissenschaftlich sinnvoller und praktischer Wegweiser in der Vielzahl kieferorthopädischer Laserapplikationen und
der Auswahl passender Lasergeräte dar.

Der 445 nm Diodenlaser in der Endodontie. Erste In-vitro-Ergebnisse.
Dr René Franzen, Nour Al Hassan, Prof. Dr Georg Conrads, Prof. Dr. Norbert Gutknecht, Aachen/Germany
Aufgrund des Absorptions- und Transmissionsverhaltens in Hydroxylapatit, Wasser und Pigmenten ist von der 445-nm-Wellenlänge
eines Diodenlasers ein sinnvoller Einsatz in der Endodontie zu erwarten. An der RWTH Aachen wurden hierzu erste In-vitro-Untersuchungen durchgeführt. Hinsichtlich der sicheren Anwendung wurden Temperaturmessungen im stabilisierten Wasserbad (37 °C) an humanen
Zahnmodellen durchgeführt, die in ein Polyurethanresin mit vergleichbarer Wärmeleitfähigkeit humanen Knochens eingebettet wurden. Die
Messungen zeigen, ob die als kritisch geltende Grenze nach Eriksson

und Albrektsson von T=10 °C eingehalten wird. Hierzu erfolgte eine
zeitlich und räumlich aufgelöste Temperaturmessung mithilfe von
K-Type-Thermoelementen. Bakterizide Wirkungen wurden mit einem
computergesteuerten Verschiebetisch an humanen Dentinscheiben
der Dicken 300, 500 und 1.000 µm am endodontologischen Leitkeim
Enterococcus faecalis durchgeführt. Ergebnisse zur Temperaturentwicklung und bakteriziden Wirkung werden für Laserparameter von
0,4 W cw und 0,6 W cw sowie für 1,2 W, 10 Hz bei 50 % Tastverhältnis
bei Einsatz von 200-µm-Faserspitzen vorgestellt.

laser
3 2016

[46] =>

25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


Chirurgische Interventionen mit Laser im Weichgewebe im Vergleich zu anderen
schneidenden Verfahren – Beurteilung des Schädigungsvolumens
Dr. Michael Hopp, Dr. Alejandra Perez-Canto, Dr. Joachim Schiffer, Prof. Dr. Reiner Biffar, Berlin/Germany
Inzisionen an Schleimhäuten und Weichgeweben können mit Schneidinstrumenten, Instrumenten auf Basis von Hochfrequenz und Lasern
durchgeführt werden. Es ergibt sich eine typische Defektzone, die die
Art der Heilung beeinflusst. Zur Beurteilung kamen Exzisate aus dem
Mundbereich, die mittels Skalpell, Schere, Hochfrequenzchirurgiegerät
und verschiedener Laser (Diodenlaser – 445 nm, 810 nm, 980 nm,
Nd:YAG-Laser, Er:YAG-Laser und CO2-Laser) entnommen wurden. Es
wurden an den histologischen Proben das Schädigungsvolumen und
die Art der Schädigung eingeschätzt.
Bei Verwendung schneidender Instrumente treten glatte Trennungen
geringen Schädigungsvolumens im unteren Mikrometerbereich mit gelegentlichen Gewebsrissen auf (Skalpell) sowie Gewebsquetschungen
(Schere) auf. Gefäße werden nicht geschlossen. Bei Aneinanderlage-

rung der Schnittkanten führt dies zu einer primären Heilung. Hochfrequenzchirurgiegeräte führen in Abhängigkeit ihrer Frequenz und
Leistung zu einem unterschiedlich großen thermischen Schädigungsvolumen im unteren bis mittleren Mikrometerbereich, was den Übergang von der primären Heilung zur Defektheilung bedeutet.
Die weiteste Spanne des Schädigungsvolumens tritt bei Lasern auf.
Während 445 nm-Dioden-, Er:YAG- und CO2-Laser in Abhängigkeit
von der verwendeten Leistung ein eher geringes thermisches Schädigungsvolumen aufweisen, führen Diodenlaser im Bereich zwischen 810
bis 980 nm sowie Nd:YAG-Laser zu ausgeprägten Schädigungszonen
mit sistierender Blutung an den Schnitträndern. Die Heilung reicht von
überwiegend primärer Heilung bei Verwendung von Er:YAG-Lasern bis
zur ausgeprägten Defektheilung bei fast allen anderen Lasertypen.

Removal of failed dental implants using the Er,Cr:YSGG laser and the conventional
trephine bur: an in vitro comparative study
Dr Mohammad Hajji, Dr René Franzen, Dr Stefan Grümer, Dr Ali Modabber, Prof. Dr Norbert Gutknecht, Aachen/Germany
Objectives
To compare between the conventional trephine bur and the Erbium,
Chromium:Yttrium-Scandium-Gallium-Garnet (Er,Cr:YSGG) laser in
removing implants in terms of the volume of removed bone, duration
of the procedure and the morphological changes on the bone surface.
Materials and methods
Three human mandibles were utilised, four implants were inserted
in each mandible using a drilling handpiece and burs. The implants
were divided into two groups (n = 6), where two implants from each
mandible were removed using a trephine bur running at 1,200 rounds
per minute (rpm) with water irrigation. The remaining implants (n = 6)
were removed with Er,Cr:YSGG laser (power 6 W, frequency 20 Hz,
pulse duration 50 µs, Water 60, Air 30). The volume of bone loss was
calculated by filling the holes with Mercury and measuring its volume,

laser

3 2016

the preparation time was measured with a digital stopwatch and the
post-operative bone surfaces were examined under a scanning electron microscope.
Results
The laser group exhibited a smaller amount of bone loss than the trephine bur group, whereas the latter required a shorter time of preparation. The SEM revealed empty trabecular spaces with no signs of
carbonisation and well-defined edges in the laser group, while the
trephine group displayed a surface covered with a smear layer and
micro-cracks.
Conclusion
The Er,Cr:YSGG laser provides superior results over the trephine bur
in terms of bone preservation, thermal damage and cutting efficiency.

[47] =>

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:
Straße:

Telefon:

PLZ/Ort:

Fax:

Land:

E-Mail:

Aufgrund des bestehenden Assoziationsvertrages zwischen der DGL und der DGZMK fällt zusätzlich ein reduzierter Jahresbeitrag für die DGZMK
an (85,00 € 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

[48] =>

news

germany

SIROLaser Blue auf der

25. DGL Jahrestagung
Die Deutsche Gesellschaft für Laserzahnheilkunde zelebriert gemeinsam
mit dem LASER START UP 2016 vom 30. September bis 1. Oktober das
25-jährige Jubiläum der internationalen Jahrestagung. Unter dem Motto
„Von den Ursprüngen zu neuen Horizonten“ stellen Spezialisten aus aller
Welt in München Neuigkeiten aus dem Bereich Dentallaser in spannenden
Vorträgen und Workshops vor. Dentsply Sirona Instruments präsentiert vor
Ort den innovativen und bisher einzigen im blauen Wellenlängenbereich arbeitenden SIROLaser Blue mit seinen vielseitigen Einsatzmöglichkeiten.
Im Workshop von Dentsply Sirona „SIROLaser Blue – the use of multiple
wavelengths“ wird Dr. Carlo Francesco Sambri (Triest, Italien) die Viel
seitigkeit des Lasers demonstrieren. Auch wie der Anwender bei der Arbeit
mit CEREC vom SIROLaser Blue profitieren kann, wird ein Thema sein.
Anschließend haben Teilnehmer die Möglichkeit, sich selbst ein Bild vom
SIROLaser Blue zu machen und Hand anzulegen.
Dentsply Sirona Instruments bietet als Hauptsponsor der Jahrestagung der
Deutschen Gesellschaft für Laserzahnheilkunde Nicht-Mitgliedern die Möglichkeit, eine von 30 Eintrittskarten im Wert von bis zu 318 Euro für die Jah-

restagung zu erhalten. Interessierte Zahnärzte sind herzlich eingeladen, sich
dafür unter dem angegebenen Link zu registrieren: www.sirona.com/dgl.
Durch die Teilnahme ist der Erhalt von 16 Fortbildungspunkten möglich. Um
die blaue Wellenlänge in der eigenen Praxis anzuwenden, haben Teilnehmer zudem die Chance, einen SIROLaser Blue zu gewinnen: Voraussetzung
dafür ist die Teilnahme an einem der beiden Workshops oder der Besuch
der SIROLaser Blue-Vorführung am Stand 18.
Quelle: Dentsply Sirona

Power of Light beim

Henry Schein Laserkongress

Abb. 1

Abb. 2

Abb. 1: Marcus Dahlinger (links), Vertriebsmanager Laser & optische Systeme bei Henry Schein Dental Deutschland GmbH, und das Referententeam bei der Podiumsdiskussion. –
Abb. 2: Die Kombination aus Vorträgen und Workshops gewährte Interessenten einen Einblick in die Technologie und Anwendern vertiefende Informationen.

Am 17. und 18. Juni 2016 fand in Mörfelden-
Walldorf (bei Frankfurt am Main) der Kongress
„Power of Light“ statt. Im Fokus des Laserkongresses standen die Anwendung des Lasers in der
zahnärztlichen Praxis, die Abrechnung, die Imple
mentierung in den Behandlungsablauf und der
Erfahrungsaustausch.
Als erster Referent des Kongresses gab Dr. Michael Hopp (Berlin) – zertifizierter Spezialist für
Laserbehandlungen – einen Überblick zur Entwicklung der Lasertechnologie. Prof. Dr. Giovanni
Olivi (Genua, Italien) bezog sich in seinem Vortrag

laser

3 2016

auf die Kinderzahnheilkunde. Dr. med. dent. Kresi
mir Simunovic, M.Sc. (Zürich) nahm die Zuhörer
mit auf eine Reise durch die weite Indikationswelt
des Fotona Lightwalkers. Wie die photothermische
Therapie (PTT) in der Parodontologie mit dem
A.R.C. Q810 Diodenlaser in Kombination mit dem
Farbstoff EmunDo® angewendet werden kann,
zeigte Prof. Dr. Gerd Volland, M.Sc. (Heilbronn). Dr.
med. dent. Alexander Kelsch (Karlsruhe) sprach
über die Veränderungen im Praxisalltag. Jeanette
Deumer, M.Sc. (Berlin) stellte die photothermische
Therapie (aPTT) der photodynamischen Therapie

(aPDT) gegenüber. Dr. Thorsten Kuypers, M.Sc.
(Köln) sprach über die Antischnarchtherapie mit
dem Er:YAG-Laser und stellte die „NightLase“-
Therapie vor. Wie man mit dem Laser am besten rechnen kann, zeigte der Zahnarzt Thorsten
Wegner (Stadthagen). Die auf dem Laserkongress
angebotenen Workshops gingen auf praktische
Anwendungen ein. So stellte beispielsweise Dr.
Schlichting die laseraktivierte Spülung von Wurzelkanalsystemen mit PIPS® dar.
Quelle: Henry Schein

[49] =>

EINLADUNG ZUR DGLMITGLIEDERVERSAMMLUNG
DGL-KONGRESS 2016

ONLINE-ANMELDUNG/
KONGRESSPROGRAMM

30. September /1. Oktober 2016
München – The Westin Grand München
www.dgl-jahrestagung.de

T

Faszination Laser
in München
25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


30. September und 1. Oktober 2016
München | The Westin Grand München

KT

LDU GSPU
N

N

FOR

16

BI

E

Freitag 30.09.2016, 14.00 – 15.30 Uhr
Tagesordnung:
TOP 1

Genehmigung der Tagesordnung

TOP 2

Bericht des DGL-Vorstandes

TOP 3

Entlastung des amtierenden Vorstandes

TOP 4

Wahl des DGL-Vorstandes

TOP 5

25. Internationale Jahrestagung der DGL

TOP 6

WFLD-Weltkongress 2018/2020 in Deutschland

TOP 7

Anträge zur Mitgliederversammlung

TOP 8

Verschiedenes

Hauptsponsor

Assoziierte Gesellschaft
der DGZMK

DGL c/o Universitätsklinikum Aachen, Klinik für ZPP, Pauwelsstraße 30, 52074 Aachen

OEMUS MEDIA AG

Holbeinstraße 29 · 04229 Leipzig · Tel.: 0341 48474-308 · grasse@oemus-media.de

[50] =>

| imprint

laser
international magazine of

laser dentistry

Publisher
Torsten R. Oemus
oemus@oemus-media.de
CEO
Ingolf Döbbecke
doebbecke@oemus-media.de
Members of the Board
Jürgen Isbaner
isbaner@oemus-media.de
Lutz V. Hiller
hiller@oemus-media.de
Editor in Chief
Norbert Gutknecht
ngutknecht@ukaachen.de
Coeditors in Chief
Samir Nammour
Matthias Frentzen
Managing Editors
Georg Bach
Leon Vanweersch
Division Editors
Umberto Romeo
European Division
Melissa Marchesan
North American Division
Carlos de Paula Eduardo
South American Division
Toni Zeinoun
Middle East & Africa Division
Ambrose Chan
Asia & Pacific Division

Senior Editors
Aldo Brugneira Junior
Kenji Yoshida
Lynn Powell
Dimitris Strakas
Adam Stabholz
Marcia Martins Marques
Editorial Board
Peter Steen Hansen, Aisha Sultan,
Ahmed A Hassan, Antonis Kallis,
Dimitris Strakas, Kenneth Luk, Mukul Jain,
Reza Fekrazad, Sharonit Sahar-Helft,
Lajos Gaspar, Paolo Vescovi, Ilay Maden,
Jaana Sippus, Hideaki Suda, Ki-Suk Kim,
Miguel Martins, Aslihan Üsümez,
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Michel Vock, Hsin-Cheng Liu, Sajee Sattayut,
Anna-Maria Yannikou, Ryan Seto, Joyce Fong,
Iris Brader, Masoud Mojahedi, Gerd Volland,
Gabriele Schindler, Ralf Borchers, Stefan Grümer,
Joachim Schiffer, Detlef Klotz, Jörg Meister,
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laser international magazine of laser dentistry
is published in cooperation with the World
Federation for Laser Dentistry (WFLD).
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Clinic of Conservative Dentistry
Pauwelsstr. 30, 52074 Aachen, Germany
Tel.: +49 241 808964
Fax: +49 241 803389644
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laser international magazine of laser dentistry is published by OEMUS MEDIA AG and will appear in 2016 with one issue every quarter. The
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50

laser

3 2016

[51] =>

NEUERSCHEINUNG

BESTELLUNG AUCH
ONLINE MÖGLICH

Jahrbuch Laserzahnmedizin 2017
Interdisziplinär und nah am Markt

www.oemus.com/abo

Lesen Sie im aktuellen
Jahrbuch folgende Themen:
Klinische Fallberichte
Aktuelle Forschungslage
Gesamtübersicht Detallasermarkt
Vorstellung Dentallaser/
Photodynamische Systeme

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_______ Laserzahnmedizin 2017

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_______ Digitale Dentale Technologien 2016

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_______ Endodontie 2016

49,– Euro*

_______ Prävention & Mundgesundheit 2016

49,– Euro*

_______ Implantologie 2016

69,– Euro*

* Preise verstehen sich zzgl. MwSt. und Versandkosten. Entsiegelte Ware ist vom Umtausch ausgeschlossen.

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[52] =>

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[cover] => laser international No. 3, 2016

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