laser international No. 2, 2017

Cover / Editorial / Content / Dual-wavelength laser application / Diode-laser assisted vital pulp therapy / Treatment of black hairy tongue / Laser in soft tissue treatment / Laser-assisted herpes labialis therapy / Sealer placement in lateral/accessory canals / Successful communication in your daily practice / Marketing dentistry in a global economy / This year’s IDS sets new record in attendees / 4th International SGOLA Congress / Bringing laser to sunlight - 6th WFLD-ED Congress / Manufacturer News / News international / Editorial / Events / News Germany / Imprint

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Vol. 9 • Issue 2/2017

issn 2193-4665

laser
international magazine of

2

laser dentistry

2017

case report
Diode-laser assisted
vital pulp therapy

case report
Treatment of black hairy tongue

industry
Laser in soft tissue treatment

[2] =>

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[3] =>

editorial

Sense & sensibility

Prof. Dr Norbert Gutknecht

Dear colleagues,
When I walked the exhibition grounds of the IDS two and a half months ago, two aspects of the world’s
largest dental exhibition were especially touching to me. Firstly, the number of participants and exhibitors
has increased significantly over the years. And secondly, innovations and digital technologies have gained
more presence in dentistry. While originally a merely mechanical type of work, the profession of the dentist
has turned into handling a command centre surrounded by various technologies, including the latest laser
devices. If you thought that you would find hardly more than four or five laser manufacturers at the IDS only
a few years ago, a look into this year’s list of exhibitors will have shown otherwise. Not only were there more
than 40 laser exhibitors and manufacturers present at the IDS 2017, but the technical development of the
laser devices was impressive.
The devices’ performance and efficiency, the increasing variability of the laser applicators and the
above-mentioned further development of the software presented by many manufacturers demands a
higher level of insight in these technologies from the users when treating patients. The laser industry’s response to a yet palpable knowledge deficit in this regard covers elaborate treatment animations and extensive default settings for special therapies. A sensible balance of high-tech laser and extensive insights into
its appropriate handling will make laser-assisted therapies in dentistry even more effective in the future.
Yours,

Prof. Dr Norbert Gutknecht

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[4] =>

| content

page 14

page 18

page 38

| editorial

| events

03 Sense & sensibility

35 This year’s IDS sets new record in attendees

Prof. Dr Norbert Gutknecht

| case report
06 Dual-wavelength laser application
Dr Imneet Madan

10 Diode-laser assisted vital pulp therapy
Dr Masoud Shabani et al.

14 Treatment of black hairy tongue
Prof. Georgi T. Tomov et al.

| industry
18 Laser in soft tissue treatment
Hans-Joachim Koort

22 Laser-assisted herpes labialis therapy
Dr Darius Moghtader

26 Sealer placement in lateral/accessory canals
Dr He-Kyong Kang & Dr John Palanci

| practice management

36 4th International SGOLA Congress
Timo Krause

38 Bringing laser to sunlight
| news
41 manufacturer news
42 news international
| DGL
45 Effizienz & Innovation

Prof. Dr. Norbert Gutknecht

46 Laserzahnheilkunde –
Was geht und was nicht
48 news germany
| about the publisher
50 imprint

30 Successful communication in your
daily practice
Dr Anna Maria Yiannikos

32 Marketing dentistry in
a global economy
Chris Barrow

laser
issn 2193-4665

international magazine of

2

laser dentistry

2017

case report

Diode-laser assisted
vital pulp therapy

case report

Treatment of black hairy tongue

industry

Laser in soft tissue treatment

04

laser

2 2017

Vol. 9 • Issue 2/2017

Cover image courtesy of Biolase Technology Inc.
www.biolase.com
Original Background: © Samarets/Shutterstock.com

[5] =>

th

6 European Division Congress
of the World Federation for Laser Dentistry
Aachen Dental Laser Center – AALZ
Pauwelsstraße 17 · 52074 Aachen · Germany
Tel.: +49 241 4757130 · info@aalz.de

Official Media Partner

[6] =>

| case report

Dual-wavelength
laser application

Dental-fistula in a primary anterior tooth
Author: Dr Imneet Madan, UAE

Primary teeth play a vital role in setting the
healthy pathway towards permanent dentition. The
treatment modalities for primary teeth should
therefore be in best favour of preserving these
teeth until they exfoliate naturally. Chronic dental
caries in primary teeth are the most common cause
of premature extractions. The best mode of management is to prevent the onset, nevertheless, when
the decay does occur and reach the stage where
there is chronic infection leading to periapical
areas, laser therapy can be used effectively to save
the tooth.
The current case report emphasises on the successful effect of laser in the treatment of fistula in
primary upper anterior tooth in a four-year-old female. Laser-assisted endodontic treatment resulted
in success and this helped to retain the anterior
primary tooth until the permanent tooth will eventually replace it at the age of six to seven years. The
child is under periodic follow-up and has had no
clinical or radiographic signs of reinfection since
the last two years.

Introduction
Primary teeth functions extend far beyond
enhancing the smile of the child. They act as the
natural space maintainers that can be the best
guide in the eruption of permanent teeth in accurate alignment. Primary teeth contribute to the development of jaws, maintain the speech of the child
and avoid the development of any parafunctional
habits such as tongue thrusting.1
Considering these vital functions of the primary
teeth, it is important that under any given conditions, it should be prioritised to save them and avoid
premature extraction. One of the most common
reasons for the primary teeth to undergo extraction

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2 2017

is chronic untreated dental caries. Chronic dental
carious lesions lead to necrosed pulpal changes and
treatment for this is very complex in primary teeth.2
Both anatomical and physiological nature of primary teeth does not allow complete elimination of
root canal infection. There has been no reported
endodontic concept for the treatment of primary
teeth so far.3
The microbiology of endodontic infections is
complicated. Enterococcus faecalis has been reported in high prevalence in primary root canal infections.4 However, lasers, by virtue of their deeper
permeability help in sterilising the affected and infected canals leading to better success rates with
compromised teeth.

Case report
A four-year-old female child reported to the dental clinic after referral from their general practitioner. The child came in with her mom in January,
2015 after a traumatic fall on the upper front teeth
a few weeks back. No antibiotics were taken. The
upper front tooth had been mobile ever since the
fall. The mom took the child to her dentist and they
were then referred to consult for an opinion other
than extraction.
On intraoral examination
Tooth number 61 presented with grade II mobility
and a periapical fistula. An intraoral periapical X-ray
showed widening of the periodontal ligament in the
periapical area. There were no signs of tenderness to
percussion, although the child was in discomfort
due to infection and swelling in the gum (Fig. 1).
Discussion prior to the treatment
Based on radiographic and clinical examination,
two options of the treatment were given as follows:

[7] =>

case report

Fig. 1: Primary upper anterior
tooth 61 with fistula.
Fig. 2 & 3: Zinc oxide eugenol
obturation was done followed by
GC Fuji IX base fill and composite
fill on top.
Fig. 4: Primary upper anterior teeth
after treatment.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Option 1: Extraction followed by fixed
space maintainer.
Option 2: Root canal treatment with
uncertain prognosis.

Cotton role: Tooth pillow
Irrigation of canals: Wash the sugar bugs
Obturation: Putting cream in the tooth
Filling: Close the hole

The child’s mom was informed that after the
endodontic treatment of tooth #61, the tooth will be
observed for three months and an X-ray will be
repeated in order to check the healing of the periapical region. In case that the tooth does not take the
treatment successfully and there is a recurrence of
the infection, an extraction followed by space maintainer should be planned. The mom understood
both of the options and decided to go with option
two.

Certain behaviour modelling tools of neuro-linguistic programming were used in order to get the
child’s attention and cooperation. Since the child was
able to listen and agree in the best manner; the steps
for next visit were informed. She was very fond of
Barbie princess stories, so we agreed on telling the
princess stories and watching the same in the next
visit. The child then left the surgery with a small
reward as a positive reinforcement of good behaviour
and good listening.

Dental behaviour
The child was young, thereby, apprehensive and
fearful towards the dental treatment. The Dental
Behaviour Management was as following: It was
suggested to use the conscious sedation with
nitrous oxide. On the first visit, no treatment was
performed. The child was acquainted with the
dental chair, basic dental tools, water, air syringe,
nasal mask and laser.

Before leaving, the “Next Time Behaviour” message
was given and reinforced with small stickers. This was
done to serve as a reminder for the child to be brave
next time as well.

Euphemisms involved in the treatment were
explained as follows:
Nasal Mask: Happy air
Laser: Popping light
Dental caries: Sugar bugs
Dental cavity: Hole
Water: Washing the sugar bugs

Nitrous oxide sedation
Nitrous oxide is a friendly gas that helps to relax the
receptors in the way that the child acts more receptive
to the instructions during the dental procedure. It
does have an analgesic or anxiolytic effect that
causes temporary depression of the central nervous
system with very little effect on the respiratory
system. It gets absorbed rapidly but stays relatively
insoluble into any tissues in the body. At the end of the
procedure, 100 per cent oxygen is used to flush out
nitrous oxide. There is minimal impairment of any
reflexes, thus cough reflex is protected.5

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2 2017

[8] =>

| case report
Fig. 5: X-ray of the primary upper
anterior teeth after treatment.
Fig. 6: X-ray, follow-up after
four months.
Fig. 7: X-ray, follow-up after
nine months.
Fig. 8: X-ray, follow-up after
eighteen months.

Fig. 5

Fig. 6

periapical area. Since the canals had no bleeding and
were completely dry, zinc oxide eugenol obturation
was done followed by GC Fuji IX base fill and the
composite fill on the top (Figs. 2-5).

Procedure
As the child was seated in the chair, basic neuro-linguistic programming techniques were used to get her
attention to follow the instructions of deep breathing.
One of the introductory techniques is to ask the child
to “imagine”. As she began to imagine her own creations such as clouds, butterflies, flower garden, she
was guided into deep breathing. Further continuation
of stories and metaphors helped to place the mask.

The follow-up after nine and eighteen months
shows no clinical or radiographic changes (Figs. 7
& 8). The child has been completely asymptomatic
and the tooth showed normal signs of physiological
resorption (Fig. 9).

After three days, the tooth was reintervened. The
temporary fill was removed and the canals were re-irrigated with saline and chlorhexidine. Both erbium
and diode laser were used to sterilise the radicular and

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2 2017

Fig. 8

Informed consent
Due to the nature of pathology, uncertain prognosis for the treatment was suggested. The child’s mom
understood that in case of failure of treatment,
retreatment is not recommended. The tooth would be
extracted in such a scenario. Cost estimates for both
options were given. The mom chose the treatment
plan with laser under conscious sedation. Written
consents for the agreed treatment, nitrous oxide
sedation and costs were taken.

Nitrous oxide was slowly increased to 50 per cent
and then finally settled at 55 per cent. During this euphoric state, the child chose to watch a movie on the
overhead screen. She was allowed to relax in this state
for five minutes before the procedure was started.
After that, an erbium laser access from the palatal
surface was done with following settings: Er,Cr:YSGG
2,780 nm, MX7 tip, 3.75 W, 25 Hz, 80 water, Air 60. Rotary instruments, TCM prep, were used to enlarge the
canals until ISO #35. Intermittent irrigation with
saline and chlorhexidine was done. The erbium laser
was used for initial sterilisation of the canals with
following settings: Er,Cr:YSGG 2,780 nm, RFT2,
1.25 W, 50 Hz, Air 34, Water 24. Paper points were then
used to dry the canals. A diode laser 940 nm, 1.5 W,
continuous wave, 2 mm/sec, 4–5 turns in circular motion was used. An interim temporary filling was placed
in order to allow the fistula to heal before the final
obturation.

Fig. 7

After four months, the child presented with no
clinical signs or symptoms. An intraoral periapical
X-ray showed no abnormal changes (Fig. 6). The child
was able to eat, chew and there had been no recurrence of infection since the completion of treatment.

Discussion
Primary teeth act as the natural blue print for the
eruption of permanent teeth. They facilitate vital
functions:
–– Act as a natural space maintainers for the teeth.
–– Support proper chewing and digestion of the food.
–– Help in normal development of speech.
–– Add to self-esteem and confidence of the child.
Early loss of primary teeth can interrupt a proper
development of the speech. It can also lead to tongue
interposition and development of parafunctional oral
habits. Keeping the above functions in mind, it is ideal
not to decide to savage the primary tooth until it is
time for the new permanent teeth to erupt.
The microbiology of fistula
The microbiology of fistula has been reported to be
quite complex. Even though, the details of the same
are scarce. The deep areas of periapical region
and around do not provide oxygen to feed the
bacteria; hence, it is mainly the anaerobic population
that dwells here quite well. These bacteria can result
in pain, swelling, tenderness and exudation of pus.
A high prevalence of Enterococcus species and
P. gingivalis has been observed in the necrotic pulp of

[9] =>

case report

2 to 5 years old. Since E. faecalis is very resistant to
antimicrobials, this makes the endodontic treatment
of primary teeth a bit more challenging.4 P. gingivalis
has been found to affect about 27 per cent of primary
teeth.6,7 P. nigrescens, P. intermedia and P. endo
dontalis also contribute to the infectious process of
the pulp.3 Other bacteria that are found to contribute
as well are Fusobacterium nucleatum.8 Bacterial
associations such as Porphyromonas/Prevotella species and P. gingivalis/Enterococcus species had been
found in primary teeth as per few studies done on the
microbiology of the deciduous teeth with periapical
abscess and fistula.9 Spirochaetes such as Treponema
denticola are also profound.7 Enterococcus faecalis,
P. gingivalis and F. nucleatum were found in extensive
numbers especially in the fistula related to primary
teeth.3 It is the complex nature of the primary root
canal microbiology that renders the conventional
treatment supported only with antimicrobial not
100 per cent successful.
Complex microbiology that demands laser
There are predominantly two factors that
complicate the success of primary teeth root canals:
1. Anatomical root configuration
2. Complex resident bacterial flora10
The presence of lateral canals and a predominant
number of canal openings in the apical delta is a
specific anatomical variation of baby teeth. Blind ending canals called Diverticles pass through the root
dentin.10 Additionally, dentinal tubules run through
the entire dentine in complex manner and store the
bacteria at the depth of up to 1,000 µm.11,12 At this
depth, the microbes are able to sustain against the
body’s own defences and conventional pulpectomy
procedures.11,12
The conventional irrigants used in pulpectomy can
penetrate to the depth of about 100 µm.13 Lasers of
different wavelengths have been used in the root
canals and have shown the depth of penetration
between 500 µm to less than 1,000 µm.10 Laser light

Fig. 9: The child has been
completely asymptomatic and tooth
showed normal signs of physiological
resorption.

Fig. 9

causes permanent destruction of the microbial cell
membrane and thereby stops their further growth.10

Conclusion
Primary tooth endodontics has gained utmost
importance in the past few decades, where parents
come seeking root canal treatments for the chronically affected primary teeth. Those who are not
aware of the same are educated about the importance of baby teeth at the first appointment. Parents
feel more assured when a successful alternative to
extraction is given.
Even if teeth are in grossly decayed shapes,
laser-assisted endodontics proves successful in the
lasting success of the treatment until the tooth
exfoliates on its own._

contact
Author details

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
Das Milchzahngebiss setzt die Grundlage für die bleibenden Zähne. Daher sollte bei einer Behandlung die Bewahrung der Milchzähne im Vordergrund stehen, solange, bis diese von alleine ausfallen. Die beste Behandlungsstrategie
ist Prävention. Sollte es doch einmal zu einem vorzeitigen Verfall und einer chronischen Infektion kommen, die bis
in den periapikalen Bereich vordringt, kann eine Lasertherapie effektiv sein und zur Rettung des Zahns beitragen.
Im Fallbericht schildert die Autorin den erfolgreichen Einsatz des Lasers bei der Behandlung einer Fistel im oberen
Frontzahn einer vier Jahre alten Patientin. Die laserunterstützte, endodontische Behandlung führte zum Erfolg und
trug dazu dabei, den Oberkieferfrontzahn im Milchzahngebiss bis zum Zahnwechsel im Alter von sechs bis sieben
Jahren zu bewahren. Das Kind kommt zu regelmäßigen Kontrollterminen in die Praxis und zeigt seit zwei Jahren keine
klinischen oder radiologischen Anzeichen einer erneuten Infektion.

Literature

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2 2017

[10] =>

| case report

Diode-laser assisted
vital pulp therapy
Authors: Dr Maziar Mir, Prof. Dr Norbert Gutknecht, Dr Masoud Mojahedi, Dr Jan Tunér &
Dr Masoud Shabani, Germany, Iran, Sweden

Introduction

Fig. 1: Immediately after pulpotomy
with high-speed handpiece and good
coagulation with diode laser and then
LLLT treatment.
Fig. 2: After CEM cement placement.
Fig. 3: Immediately after interim
restorative treatment (IRT) with Glass
Ionomer cement (GC Fuji IX).

Fig. 2

Fig. 1

10

The preservation of pulp vitality is one of the most
challenging approaches in endodontics. In Vital Pulp
Therapy (VPT), after pulp exposure due to extensive
dental caries, tooth injuries and iatrogenic events,
the intact portion and uninflamed dental pulp is
preserved with a suitable dressing at the exposure
area. The dressing materials are biocompatible or bioactive.1–3 At the moment, different methods for VPT
are used, including: (1) direct pulp capping, (2) indirect
pulp capping, (3) partial pulpotomy and (4) full pulpotomy. Pulp dressing in these methods is performed
using mineral trioxide aggregate (MTA), calcium-enriched material (CEM), calcium hydroxide and biodentin.4–6 Bleeding control and pain reduction are the
most common complications in partial or full pulpotomy.7 Lasers have several benefits in endodontic
treatment, for example: (1) pulp diagnosis, (2) dental
hypersensitivity reduction, (3) pulp capping, (4) pulpotomy, (5) disinfection of root canals, (6) root canal
shaping, (7) root canal obturation, (8) apicectomy and
(9) root canal photodynamic therapy.8 Dental lasers
are either Class 3B (< 500 mW) or Class 4 (< 500 to
5,000 mW). The former lasers are used for biostimulation (Low Level Laser Therapy—LLLT), whereas the
latter are used for evaporisation, coagulation, cutting, etc. Most lasers in both groups are based on diodes, but the 500+ mW lasers are often called “diode

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lasers”. Although particularly used for such procedures, they can also be set at their lowest output and
be used as biostimulators in a defocused mode. In the
current case, a Class 4 laser in defocused mode was
used for biostimulatory purposes in a case of VPT.8–9

Case report
An 18-year-old female patient with complaints
due to a right permanent molar tooth with deep caries
was referred for treatment.
Medical history
The patient’s medical history showed neither systemic medical problems nor any allergic reaction,
pharmaceuticals or history of past surgical procedures. Thus, the patient did not need to be referred for
medical consultation.
Dental history
Oral and maxillofacial examination of the patient
revealed no TMJ or myofascial disturbances, no
functional or parafunctional habits, Class I occlusion, but a relatively poor oral hygiene.
Clinical findings
Intermittent pain during the last 24 hours, binding
of explorer at the occlusal surface was obvious, thermal and cold vitality pulp tests were positive.

Fig. 3

[11] =>

case report

Figs. 4a & b: X-ray examination
immediately after VPT.

Fig. 4a

Fig. 4b

X-ray examination
X-ray examination showed a radiolucent lesion
near the dental pulp.

Interim restorative treatment (IRT) was applied
with Glass Ionomer GC Fuji IX according to the manufacturer’s instruction without finger pressure
(Fig. 3). Permanent filing was postponed for one
month.

Diagnosis
A reversible pulpitis was diagnosed.

Laser-assisted VPT procedure
Treatment delivery sequence
After fulfillment of the consent form, the operation area was anaesthetised by infiltration method
and 2 % lidocaine with Epi 1:80,000, 1.8 ml (Darou
Pakhsh, Tehran, Iran). The controlled area and proper
placing of the laser warning signs were defined to secure the operating room. The protective goggles for
patient, operator and assistant were checked. Furthermore, the patient's information (examination
sheet and X-ray, consent form, etc.) was reviewed.
Mouth rinsing was done by 0.2 % chlorhexidine
oral rinse (Shahre Daru, Tehran, Iran) for one
minute and then the surface of the tooth was
cleaned by a swab wetted by the same chlorhexidine solution.
Cavity preparation was performed by fissure
diamond burs and then round stainless-steel burs.
After caries removal, the pulpal bleeding was ob
vious and a partial pulpotomy was indicated.
Partial pulpotomy was started with sterile round
diamond bur on a high-speed handpiece to remove
the inflamed pulp tissue gently via normal saline
irrigation. Haemostasis was obtained by cotton
pellet soaked in normal saline for five minutes and
then followed by diode laser irradiation.
CEM cement dressing was applied with a base of
2 mm CEM cement paste according to the manufacturer’s instruction (Biunique Dent, Tehran, Iran)
using a sterile plastic instrument and then the dry
sterile cotton pellet was used for more adaptation
of CEM cement to the cavity wall (Fig. 2).

Laser parameters
The laser parameters were as follows:
–– For bleeding control: 980 nm (diode laser, Wuhan
Gigaa, Wuhan, China), power 0.8 W, 8 Joule, fibre
400 µm, non-initiated fibre, CW, non-contact
mode, 10 seconds in scanning mode (Fig. 1)
–– For pain reduction: 980 nm, output power 0.3 W,
irradiation time 10 s, 3 Joule, spot size 3 mm,
power density 4, 246 W/cm2 at the end of lowlevel handpiece. The cavity diameter was 4 mm,
irradiation area 0.1256 cm2, power density at the
target surface 2.388 W/cm2, dose 23, 88 J/cm2,
non-contact (5 mm away from the exposure
area), scanning mode, single dose

Final result
Excellent VPT was observed with no bleeding, no
carbonisation and no char. The patient did not
experience any discomfort and was satisfied. Radiographic examination was taken in order to follow
the result of laser-assisted pulpotomy based on
radiographic changes (Figs. 4a & b).

Follow-up
The first visit after VPT was one day after the procedure. There was no pain, therefore, a second LLLT
was not deemed necessary. The next visit was determined two days after the procedure via telephone conversation in order to check on the pain
degree based on VAS scaling (Visual Analogue
Scale). Since there were no symptoms, the final visit
was determined to be one month after the procedure. Finally, after one month follow-up, a successful treatment was observed clinically (positive
thermal pulp vitality test) and with radiographic
examination (Figs. 5a & b).

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[12] =>

| case report
Figs. 5a & b: X-ray examination
five weeks after VPT. A successful
treatment was observed clinically
(positive thermal pulp vitality test)
and with radiographic examination.

Author details

Fig. 5a

Fig. 5b

Discussion

pulpotomy can be twofold. In this case, higher power
was first used for good coagulation and LLLT was then
used in for pain reduction and anti-inflammatory
purposes.

Diode laser is extensively used in many dental practices.9 Laser-tissue interaction with high power diode
lasers is based on photothermal effects contrary to
LLLT, where there is no photothermal effect, but
based on photochemical mechanisms.10,11 Since LLLT
is dose-dependent,12 the laser parameters have to be
respected carefully.13,14 The precise molecular mechanisms for LLLT are not too clear, but the clinical effects
on pain control, inflammation reduction and wound
healing are well investigated.15–17 Gupta et al. reported
that laser pulpotomy showed clinical and radiographical results superior to those of electro-surgery and
ferric sulfate pulpotomy in human primary molars,
using high power diode laser in order to achieve good
coagulation.18 Uloopi et al. applied LLLT in pulpotomy
and noted that this treatment modality can be considered for primary teeth pulpotomy and its success
was comparable to MTA pulpotomy technique.19 It is
obvious that the use of diode laser application in

Conclusion
Diode laser based on the protocol applied in this
study can successfully be used in Vital Pulp Therapy._

contact
Dr Masoud Shabani
Deputy for Research, Ardabil University of Medical
Sciences, Ardabil, Iran
Conservative Dentistry, RWTH International Academy,
Aachen, Germany
m.shabani@arums.ac.ir

Kurz & bündig
Im Rahmen der VPT (Vital Pulp Therapy) wird der Erhalt der intakten, nicht entzündlichen Pulpa nach Kariesinfektion,
Zahntrauma oder iatrogenen Vorfällen durch einen entsprechenden Verband im Expositionsbereich erzielt. Die hierfür
verwendeten Materialien sind biokompatibel oder bioaktiv.1–3 Die aktuellen VPT-Verfahren schließen ein: (1) direkte Überkappung der Pulpa, (2) indirekte Überkappung der Pulpa, (3) teilweise Pulpotomie und (4) vollständige Pulpotomie.
Die Blutungskontrolle sowie die Schmerzlinderung zählen zu den häufigsten Komplikationen der teilweisen oder
vollständigen Pulpotomie.7 In diesem Zusammenhang können sich die Vorteile der Laseranwendung positiv auf das
Komplikationsmanagement der Pulpotomie sowie des Erhalts der Pulpa auswirken und kommen bei folgenden Behandlungsabschnitten zum Einsatz: (1) Pulpadiagnose, (2) Reduktion dentaler Hypersensitivität, (3) Überkappung der Pulpa,
(4) Pulpotomie, (5) Desinfektion des Wurzelkanals, (6) Wurzelkanalerweiterung, (7) Obturation, (8) Wurzelspitzenresektion
und (9) photodynamische Therapie.8 Diodenlaser können dabei auch als Biostimulatoren fungieren, wenn sie mit geringster Leistung und im nicht fokussierten Modus eingesetzt werden. So wurde im vorliegenden Fall ein Klasse IV-Laser
im nicht fokussierten Modus zur Biostimulation im Rahmen der VPT eingesetzt.8,9
Literature

Die Behandlungsergebnisse zeigten weder Blutung, noch Karbonisation, Vernarbung, Nebenwirkungen, jedoch eine
hohe Patientenzufriedenheit. Das Follow-up nach einem Monat bestätigte klinisch (positiver thermaler Pulpa-Vitalitätstest) sowie radiologisch den Behandlungserfolg. Die Autoren fassen daher zusammen, dass der Diodenlaser gemäß dem
im Artikel vorgestellten Behandlungsprotokoll erfolgreich im Rahmen der VPT eingesetzt werden kann.

12

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[13] =>

Master of Science (M.Sc.) in Laser in Dentistry
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[14] =>

| case report

Treatment of black
hairy tongue
Authors: Prof. Georgi T. Tomov, Michail Batilas & Pavlos Spyrantis, Bulgaria

Black hairy tongue (BHT) is a benign medical condition characterised by elongated filiform papillae
with typical appearance of the dorsum of the
tongue.1 Its prevalence varies ranging from 0.6 to
11.3 per cent.2–4 Known predisposing factors include
smoking, excessive coffee/black tea consumption,
poor oral hygiene, xerostomia, and antibiotics use.5,6
Complications of BHT (burning mouth syndrome,
halitosis, dysgeusia) respond poorly to conventional
therapy.1,7 The treatment of BHT involves the identification and discontinuation of the offending agent,
modifications of chronic predisposing factors, patient’s reassurance to the benign nature of the con-

dition, and maintenance of adequate oral hygiene
with gentle debridement to promote desquamation.
The use of antimicrobial therapies, topical triamcinolone acetonide, gentian violet, salicylic acid, vitamin B complex, thymol, and topical or oral retinoids, as well as keratinolytics (podophyllin), topical
30 per cent urea solution, and trichloroacetic acid
have been reported in the literature, although potential side effects from local irritation and possible systemic absorption are important factors to consider.1,7
In the available literature, lasers are not reported as
therapeutic modality for the treatment of BHT.
The aim of this article is to report about a new approach applied in the treatment of BHT, using a combination of laser ablation with Er:YAG laser and toluidine blue-mediated photodynamic therapy (PDT)
with diode laser.

Fig. 1: Appearance of patient’s
tongue on initial presentation.
Fig. 2a: The “chisel” tip is positioned
parallel to the dorsal plane in order
to cut the papillae without
damaging the tongue.
Fig. 2b: Visible borderline between
ablated and no ablated area.

Case report
A 37-year-old female patient complained about an
abnormal appearance of her tongue of seven months
duration. The patient noted a bad taste in her mouth.
Shortly before the oral complaint onset she was prescribed antibiotics for sinusitis. Additionally, the paFig. 1

Fig. 2a

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2 2017

Fig. 2b

[15] =>

case report

Fig. 3a

Fig. 3b

tient smoked more than one pack of cigarettes per
day. Physical examination demonstrated a light
brown, “furry” dorsal surface on the tongue (Fig. 1).
The patient was diagnosed with black hairy tongue.
After obtaining a written consent by the patient, a
new approach was applied to treat the condition using a combination of laser ablation with Er:YAG laser
and methylene blue-mediated photodynamic therapy (PDT) with diode laser.
Ablation therapy
During the first treatment session, the elongated
papillae were ablated with Er:YAG laser (LiteTouch,
Light Instruments, Israel) using “chisel” tip at the following parameters: 200 mJ/18 Hz (3.6 W) with water
cooling. Only topical anaesthesia with 10 per cent lidocaine spray was performed prior to the procedure
(Figs. 2a &b). The removed papillae were microbiologically tested and evaluated under SEM (Fig. 3).
Toluidine blue-mediated photodynamic therapy
The laser ablation of the elongated papillae of the
tongue enhanced the consequent PDT (one day after)
due to the better penetration of laser light and spread-

Fig. 3c

ing of the photosensitiser over the affected area. Five
sessions of PDT were performed with the toluidine
blue photosensitiser at a concentration of 0.5 per cent
applied on the dorsum of the tongue. After five minutes of pre-irradiation time for photosensitiser penetration, the excess was removed and laser activation
was done with infrared (890 nm and wavelength of
aiming beam 635 ± 10 nm) diode laser (LITEMEDICS
dental laser, LAMBDA SpA, Italy) using a bleaching
handpiece at 0.5 W (cw) for 60 seconds (Fig. 4).

Fig. 3: The removed “hairs” (a)
observed under SEM (b) are highly
elongated cornified spines that result
from delayed desquamation of the
cells in the central column of filiform
papillae and marked retention
of secondary papillary cells. The
microbiological tests revealed
Candida albicans infection (c).

Results
Follow-up examinations one month as well as
three, six and twelve months later revealed significant improvement of the condition with no signs of
relapse (Fig. 5).

Discussion
The pathophysiology of BHT has not been fully
elucidated.1,7 Defective desquamation of the dorsal
surface of the tongue is described in a SEM study.8
Our findings confirmed these conclusions. This morphology prevents normal debridement, leading to an
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case report

Treatment of black hairy tongue

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[16] =>

| case report
Fig. 4: Toluidine blue-mediated
photodynamic therapy (PDT)
with diode laser.
Fig. 5: Appearance of patient’s
tongue after six months of therapy.

posed combined laser therapy include mechanical
removal of the papillae by ablation with Er:YAG laser
and consequent local photodynamic therapy. Photodynamic therapy (PDT) has been investigated as a potential antimicrobial therapy and an alternative tool
against some infectious diseases in the oral cavity.9
The toluidine blue photosensitiser used in this study
is absorbed well by the aiming beam of 635 nm.
Similarly to methylene blue, toluidine blue has a low
antiseptic effect.

Conclusion
Fig. 4

There are many possible causes of BHT. It is important for the clinician to take an accurate and detailed
history in order to determine the most likely causal
agents. The treatment should be individualised,
based on the clinician’s assessment of the aetiologic
agents. This case demonstrated a successful resolution of the condition using combined laser therapy.
This new modality offers possibilities for both removal of the papillae by ablation and consequent
local photodynamic therapy with pronounced antifungal effect._

Fig. 5

accumulation of keratinised layers so the elongated
papillae secondarily collect fungi and bacteria. Our
patient was also positive for Candida albicans that
is easily harboured in this retentive niche. For these
reasons, the therapy effectiveness depends on the
ability to remove the hyperkeratinised layer for a
better antifungal therapy.
In the available literature, many treatment modalities exist, which generally means that the existing
methods are ineffective.1,7 The efficacy of tongue
scraping is also questionable. The benefits of the pro-

contact

Author details

Prof. Georgi T. Tomov
DDS, MS, PhD
Associate Professor and Chair of
the Department of Oral Pathology,
Faculty of Dental Medicine
Medical University of Plovdiv, Bulgaria
dr.g.tomov@gmail.com

Kurz & bündig

Literature

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2 2017

Die schwarze Haarzunge (engl. black hairy tongue; BHT) ist eine harmlose Erkrankung, die gekennzeichnet ist
durch eine Verlängerung der Papillae filiformes, mit einem haarigen und dunklen Belag auf dem Zungenrücken.1 Die
Prävalenz zur Entwicklung von BHT liegt zwischen 0,6 und 11,3 Prozent.2–4 Begünstigt wird die Erkrankung durch
Faktoren wie Rauchen, übermäßiger Kaffeekonsum, schlechte Mundhygiene sowie die Einnahme von Antibiotika.5,6
Bei der Therapie geht es vor allem darum, die krank machenden Erreger zu beseitigen. Ein neuer Ansatz in der Behandlung von BHT ist dabei die Kombination aus Laserablation mit dem Er:YAG-Laser und Toluidinblau-vermittelter
photodynamischer Therapie (PDT) mit dem Diodenlaser. Im Falle einer 37-jährigen, weiblichen Patientin konnte die
schwarze Haarzunge durch einerseits Beseitigung der Papillen mittels Laserablation und andererseits konsequent
lokaler photodynamischer Therapie mit stark antimykotischer Wirkung erfolgreich behandelt werden.

[17] =>

[18] =>

| industry

Laser in
soft tissue treatment
Author: Hans-Joachim Koort, Germany

Fig. 1: Cutting of tissue with laser:
The tissue is removed layer-by-layer;
the deeper the cut, the greater the
heat damage at the lesion base.
Since the emitted laser radiation
also heats the fibre end, the tissue is
exposed to additional stress.
Fig. 2: Cutting of tissue with radio
frequency: The tissue is removed by
only one precise, uniform section in
the entire length of the inserted
electrode. The metal electrode
remains cold at 2.2 MHz.
Fig. 3: Histological section of standardised gingiva sample (HE-staining)
with radio frequency at 2.2 MHz,
20 W permanent.
Fig. 4: Histological section of standardised gingiva sample (HE-staining)
with laser at 975 nm, 3 W cw.

Fig. 3

The combination of a 975 nm diode laser and a
2.2 MHz radio frequency generator in one device
(LaserHF; MedLas Medical) has proven to be a
unique and valuable solution for the dental soft
tissue management. In search for optimal instruments for dental soft tissue treatment both laser
and radio frequency devices have shown a satisfying performance. In both technologies, the rapid
and locally precise heating of soft tissue is used for
cutting as well as for coagulating.

Laser vs. radio frequency

Fig. 1

Fig. 2

Fig. 4

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2 2017

The well-known advantages of laser light
become obvious in superficial applications, as for
example in the elimination of bacteria in periodontic and endodontic treatments, to expose overgrown implants or trim gingival tissue. However,
there are differences in the use of laser. Especially
in surgical procedures when a higher power is
requested such as in the removal of fibroma and

[19] =>

industry

Fig. 5: Removal of fibroma with radio
frequency 20 W and loop electrode.
Fig. 6: Implant recovery with laser
975 nm at 3 W cw.
Fig. 7: Frenectomy with 975 nm laser
at 4 W cw.
Fig. 8: Wound edges after frenectomy
are closed using the bipolar radio
frequency forceps.

Fig. 5

Fig. 6

Fig. 7

Fig. 8

haemangioma or while performing a frenectomy
or in need of a larger and invasive surgical application, laser is time consuming since the cutting
speed of the laser beam is always limited by the
fact that tissue can be removed only in superficial
layers (Fig. 1). Neither increasing laser power nor
changing laser wavelengths or using laser pulses
can eliminate this physical fact.

cutting. In addition, bleeding is controlled effectively by the adjustable coagulation. Compared to
laser, the cutting efficiency of radio frequency is
much higher; because of the rigid metal electrodes
the cut can be made in its full length and be done
in one strike. From the view of histometry, the thermal modification in the area of the incision flanks
shows a comparable thermal interaction of 125 to
150 µm in both methods. The depth of the cut with
radio frequency (Fig. 3) is 0.8 to 1.0 mm, while the
cut with laser (Fig. 4) is limited to 0.17 to 0.20 mm.1

The oral tissue is very thin, delicate and has a
complex structure. In addition, it is in close proximity to the jaw bone and tooth structure. Laser
radiation is strongly absorbed in the tissue and
converted into heat, but it is also partially transmitted through the tissue without interaction. It
may thus cause unpredictable and undesired side
effects in adjacent healthy areas. By contrast, with
radio frequency technology the tissue is heated
and cut simultaneously, homogeneously and
rapidly in the entire length of the inserted metal
electrode (Fig. 2). Serious damages at a working
frequency of 2.2 MHz to adjacent healthy areas are
unlikely to occur and if they do occur, they are
predictable and can be planned.
Using very thin and flexible electrodes made of
special metal alloys, the electromagnetic waves are
passed into the tissue. This approach allows fast,
deep, precise, pressure-free and nearly athermal

Examples of application
Due to their certain characteristics and application possibilities, laser and radio frequency can be
used in different treatment settings. For the treatment of a fibroma, for example, a radio frequency
device can be used to quickly remove the swelling
in one strike in just five seconds with a power of
20 W and loop electrode (Fig. 5). In this setting,
speed and quality of a radio frequency application
has been proven.2 On the contrary, implant recovery is at best performed with a 975 nm laser at 3 W
cw (Fig. 6). In this application, laser shows its perfect superficial power in the gentle and precise
opening of the implant.3 A very special application
is shown in Figures 7 and 8. After having performed a frenectomy with laser, the edges of the

laser
2 2017

[20] =>

| industry

Fig. 9

Fig. 10

Fig. 9: The combination of a diode
laser and radio frequency technology
offers a wide range of applications in
soft tissue management.
Fig. 10: LaserHF (MedLas Medical),
combination device with two lasers
(975 and 660 nm) plus m
onopolar
and bipolar radio frequency
(2.2 MHz).

cut are “welded” together with forceps with radio
frequency in the bipolar mode.4
The unique combination of a diode laser and
radio frequency technology offers a wide range of
application possibilities in the soft tissue management (Fig. 9). The fast and precise cutting ability of
the radio frequency unit and the smooth surface
coagulation and ablation of the laser complete
each other very well. The use of photodynamic
therapy, e.g. in Low Level Laser Therapy (LLLT) and
tooth bleaching, is an additional feature and can
be performed with laser only.

f requency generator with a power of 50 W. A low
power laser at 660 nm laser (100 mW) is an
additional therapy laser for PDT (photodynamic
therapy) and LLLT (Low Level Laser Therapy)._

A list of references is available from the author.

Conclusion

contact

With regard to its application possibility, the
combination of a diode laser with a radio frequency device meets the desire for a perfect
system to perform a complete soft tissue management. Figure 10 shows this combination device. It
consists of a 975 nm laser with a power of 8 W
(cw and pulsed), combined with a 2.2 MHz radio

Hans-Joachim Koort
MedLas Medical GmbH
An St. Josef 25
53225 Bonn, Germany
Tel.: +49 228 42290352
ceo@medlas.com
www.medlas.com

Author details

Kurz & bündig
Auf der Suche nach geeigneten Instrumenten für ein optimales Weichgewebsmanagement hat sich eine
Kombination aus Laserlicht und Hochfrequenztechnologie in einem einzigen Gerät bewährt. Dank schneller und
präziser Erhitzung des Weichgewebes eignen sich beide Technologien für ein optimales Schneiden mit Koagulation zur Blutstillung. Das Gerät LaserHF (MedLas Medical) kombiniert einen 975 nm Diodenlaser und HF-Gene
rator mit 2,2 MHz. Zur Behandlung oberflächlicher Läsionen, wie der Beseitigung paropathogener Bakterien oder
zur Beschneidung von Zahnfleischgewebe, eignet sich der Laser hervorragend. Andere Anwendungen, wie die
Beseitigung von Fibromen oder die Durchführung einer Frenektomie, können besser mittels Hochfrequenztherapie
ausgeführt werden. Die Kombination beider Technologien ermöglicht eine schnelle und einfache Handhabung für ein
optimales Weichgewebsmanagement.

laser

2 2017

[21] =>

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[22] =>

| industry

Laser-assisted herpes
labialis therapy
Simple, fast and long-lasting
Author: Dr Darius Moghtader, Germany

“Quae medicamenta non sanant, ferrum sanat,
quae ferrum non sanat, ignis sanat” (What medicines
cannot cure, iron cures; what iron cannot cure, fire
cures)—When Hippocrates uttered these words
around 400 BC, he must have thought of skin diseases, amongst others. What else can be cured by fire
when iron and medicine fail? Readers will learn from
the following description that the therapy described
by Hippocrates can prove successful in the treatment
of herpes simplex. And of course we will also reveal
the meaning behind his statement, from which
both doctor and patient can benefit even more than
2,400 years later.
The term “herpes” is originated in Old Greek and
actually described skin ulcers—an idea to which any

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2 2017

person who has suffered from this viral disease,
whose symptoms are often located in the lip area,
can relate. When untreated, herpes labialis can be
acute for up to ten days and undergoes seven phases
in its course of disease. Those phase differ widely in
their duration and severity.
The first phase is the prodrome. Symptoms are
pain, a tingling or burning sensation and sometimes
an unpleasant feeling of tension in the yet intact areas of the skin. Not all herpes labialis patients undergo this phase. The second phase, which is called
erythema phase, the skin starts to redden. This is
followed by painful papules (papula phase). In the
vesicle phase, the papula transform into liquid-filled
blisters. This liquid contains viruses and bears a great

[23] =>

industry

potential for infection on contact. The blisters burst
and form painful ulcers and oozing wounds in the ulceration phase. In the encrustation phase, crusts or
scab form and are often accompanied by severe itching. In the last phase, the reddish areas and swellings
heal, usually without leaving any scar tissue.
Severe symptoms can be prevented if herpes labialis is treated by an antiviral cream up the beginning
of the papula phase. Unfortunately, this disease often
seems to break out abruptly without any previous
symptoms, in which case the topical treatment with
antiviral creams only helps alleviate the symptoms
and reduce the risk of infection.
A large portion of the population supposedly carries herpes simplex virus type 1. Often, acute episodes of herpes occur when the immune system is
weekend or in phases of severe stress, but also under
strong sun exposure. Once manifested, herpes labialis may co-occur with bacterial superinfections
which can affect both clinical symptoms and pain.
The HSV-1 virus is easily transferred via saliva or
smear infection. Multiple relapses occur mostly in
young adults, often at the vermillion border (Fig. 1).
These are the patients who usually present at the
dermatologist or dentist. The herpes virus often develops a resistance against antiviral creams and does
not respond to the treatment. Allergies, burning or
itching sensations or headaches (in oral therapy) are
common side effects of these medicines. As they are
potential mutagens, their application is not recommended during pregnancy.
Fortunately, these patients can be helped in finding alleviation and fast recovery by laser therapy.
However, the soft laser—which is usually recommended for these purposes—alone may lead to
frustrating results, as it accelerates the healing process, but this is often neither noticed nor honoured
by the patient, who will leave the dental practice with
the same results as when he entered it. For this rea-

Fig. 1

Fig. 2

son, the author has developed a modified treatment
protocol in his practice, which leads to an instant pain
relief of at least 90 % and a Wow-moment for the
patient.
For this purpose, we use the programme „Soothing
of the pockets” of our elexxion claros laser and the
soft-laser handpiece T4 with a diameter of 4 mm. A
pulse power of 1.5 W and a frequency of 1,500 Hz as
well as a pulse duration of 444 µS result in an average
performance of 1 W (Fig. 2).
As a first step, we inform the patient that treatment
may result in a light warming of the tissues, asking
him to give notice when the sensation should become
too hot. Then, we decrease the distance to the source
of infection under continuous suction, starting from
1 cm and up to 0.2 to 0.5 cm, and palpating it following a grit pattern under constant movement for 30
seconds. Afterwards, we check with the patient and
inspect the treated tissue areas. After treatment, the
skin may not exhibit any damages caused by laser and
the patient should report an unsuspicious temperature sensation. If these standards are not met—in our
experience, this happens in approx. 5 % of the patients, please reduce the pulse performance to a level
the patient can accept and prolong the treatment
time accordingly. Afterwards, you can ask the patient
to describe the intensity of his complaints compared
to his original complaints on a scale from 1 to 10. This
way, we continue therapy until we achieve a pain reduction of 90 % or often 100 % which corresponds to
a 0 or 1 on the pain scale. This may lead to a treatment
time of up to three minutes. In about 15 % of the
cases, increasing the pulse performance to 1.95 W
may be recommended. This should be done when the
patient does not report any improvements of the
symptoms after one minute of treatment time. Afterwards, we use the soft laser with the programme
“Wound Healing” of our laser or at 100 mW for at least
one minute. When doing this, an energy level of 5 to
7 Joules should be applied to the tissue. On the next
day, the patient will present at our practice for his
check-up (Fig. 3) and another soft-laser therapy

Fig. 1: The HSV-1 virus is easily
transferred via saliva or smear
infection. Multiple relapses occur
mostly in young adults, often at the
vermillion border.
Fig. 2: A pulse power of 1.5 W and
a frequency of 1,500 Hz as well as a
pulse duration of 444 µS result in an
average performance of 1 W.
Fig. 3: Check-up after 24 hours. The
patient is free from pain.

Fig. 3

laser
2 2017

[24] =>

| industry
s ession. If the patient is not yet completely free of
pain, another repetition of the protocol is indicated.

described long-lasting effects and reduction of
relapses.

Following Hippokrates, we may interpret this therapy protocol the following way: If medicine will not
cure, the iron (the scalpel) will, if the scalpel will not
cure, fire (the laser) will.

In conclusion, it can be stated that laser treatment
provides instant relief in cases of herpes labialis. If the
laser is applied in time, instant pain relief can be
achieved. Often, a proliferation of the herpes blisters
can be prevented and the duration of the symptoms
may be reduced. This form of therapy is pain free
and also recommended for children and during
pregnancy. Its effects are long lasting._

Laser can provide a therapy of herpes labialis which
is free from pain or side effects, effective and efficient. Its instant pain relief of at least 90 % (tension
and itching sensation) and the no longer necessary
topical therapy with creams leads to a high acceptance in the patients and an increase demand. Our
clinical experience supports the findings of a study
by the University of Vienna which reports that laser
therapy leads to a significant decrease of relapses in
cases of aphthae or herpes when compared to conventional treatment with medication.1
The best-possible time to start this treatment protocol are prodrome or erythema phase. Most patients, however, present at our practice during the
vesicle phase. We inform these patients that if their
herpes should reoccur, they most react fast and visit
our practice during prodrome or erythema phase.
Accordingly, practice organisation must be adapted.
Our receptionists are informed and give sameday appointments to these patients. Only if these
prerequisites are met we can profit from the above-

contact
Dr Darius Moghtader
In den Weingärten 47
55276 Oppenheim, Germany
Deutschland
Tel.: +49 6133 2371
dr-moghtader@hotmail.de
www.laser-zahn-arzt.de

Author details

Kurz & bündig
Vielen ist unbekannt, dass davon ausgegangen wird, dass ein Großteil der Bevölkerung das Herpes simplex-Virus
Typ 1 bereits in sich trägt. Oft tritt ein Herpesschub in einer Phase der geschwächten Immunabwehr, bei Stress oder
bei starker Sonneneinstrahlung auf. Diese Patienten werden dann meist entweder beim Dermatologen oder beim
Zahnarzt vorstellig. Gegen die oft verschriebenen virustatischen Cremes entwickeln sich schnell Resistenzen des Herpesvirus, der dann nicht mehr auf diese Therapie anspricht. Zudem sind bekannte Nebenwirkungen dieser Arzneimittel
Allergien, Brennen oder Reizungen der Haut, bei der oralen Therapie auch Kopfschmerzen. Da diese Medikamente
potenziell mutagen sind, wird darüber hinaus von einer Anwendung in der Schwangerschaft abgeraten.
Mithilfe der Lasertherapie kann diesen Patienten jedoch auf einem anderen Weg zu Linderung und schneller Heilung verholfen werden. Der immer wieder für diesen Zweck angepriesene Softlaser allein führt allerdings mitunter zu
frustrierenden Ergebnissen. Zwar schreitet der Heilungsprozess schneller voran, dies wird jedoch vom Patienten kaum
bemerkt oder honoriert, da er die Praxis mit den gleichen Beschwerden verlässt, wegen derer er sie aufgesucht hat.
Deshalb haben wir in unserer Praxis ein modifiziertes Verfahren entwickelt, das sofort zu einer erheblichen Schmerzlinderung und zu einem Aha-Erlebnis beim Patienten führt.

Literature

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2 2017

In einer Studie der Universität Wien wurde festgestellt, dass Aphthen und Herpes nach einer Laserbehandlung
signifikant weniger häufig wieder auftreten, als bei einer Therapie mit Medikamenten.1 Diesen Effekt können wir aus
unseren klinischen Erfahrungen eindeutig bestätigen. Zusammenfassend lässt sich darüber hinaus festhalten, dass
die Lasertherapie in den meisten Fällen sofort bei Herpes hilft. Wird der Laser frühzeitig eingesetzt, erreicht man unmittelbare Schmerzfreiheit. Zudem kann oft das Ausbrechen der Herpesbläschen verhindert oder die Krankheitsdauer
deutlich reduziert werden. Diese Therapie ist absolut schmerzfrei, natürlich auch für Kinder oder Schwangere geeignet
und zeigt nachhaltige Wirkung.

[25] =>

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[26] =>

| industry

Sealer placement in
lateral/accessory canals
Utilising the Nd:YAP laser
Authors: Dr He-Kyong Kang & Dr John Palanci, USA

In 1967, Schilder1 had postulated that the final objective of endodontic procedures should be the total
three-dimensional filling of the root canals and all accessory canals, in addition to the elimination of all organic debris, bacteria, and bacterial toxin. Therefore,
the ability of filling lateral canals has been regarded as
a measure of the endodontic treatment quality.

Fig. 1: 320 µm (red) and
220 µm (black) laser optic fibres.

Since it is unlikely to kill all pathogens in entire root
canals, Buchanan9 suggested that the embedding of
remaining bacteria with filling materials can achieve
the same results as from complete disinfection in
the canal systems. Thermo-plasticised gutta-percha
filling techniques have been considered preferable
means to achieve this goal due to remarkable frequency of lateral canal filling based on case reports
and in vitro studies.9–11 Two major concerns for using
thermoplastic techniques would be the periodontium
damage by temperature increase and overextension
of root canal filling materials, especially gutta-percha.
The application of lasers in endodontic treatment is
an attempt to minimise these potential risks.
The investigation of laser applications in endodontics was first reported in the early 1970s.12 Among a
variety of conceivable uses, most researches emphasised the efficiency of debridement and the possibility
of shaping the root canal by laser.12–14 It seems that the
disinfection and cleaning of the root canals would be
the most practical use of laser devices in endodontic
treatment.12,15–22 The maximum disinfecting effects in

Fig. 1

26

Nevertheless, the substantive need for filling lateral and accessory canals is still a controversial issue
among clinicians. Kasahara et al.2 reported the incidence of accessory canals in the maxillary central incisors to be over 60%, and Dammaschke et al. showed
79% of molars had lateral/accessory canals.3 Large
numbers of lateral/accessory canals exist in the roots,
but the frequency of periapical lesions related with
these ramifications is not as high as anticipated.4,5 The
answers for these clinical observations are still not
clarified. The differences in size between main apical

foramen and lateral/accessory foramen might explain why the apical lesions were observed more frequently than lateral lesions.3 The amount of bacteria
existing in the small ramifications might not be sufficient to raise inflammation which can be detectable
on radiographs. Occasionally, the lateral lesion is
healed without lateral canal filling because simple
canal treatment could stop the diffusion of bacterial
products from the main canal which might reach periodontal ligaments through lateral/accessory canals
maintaining vitality.6 However, if periapical lesions
originate from bacteria surviving in some spaces
derived from lateral canals and irregularities of root
canals, such as isthmuses, ramifications, deltas,6–8
then the treatment seems to be particularly chal
lenging for clinicians.

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root canals can be achieved by laser-
activated irrigation with NaOCl solution due to the pulsation of laser
output and the easy access to root
canals by an optical fibre.22 The acoustic streaming, caused by the collapse
of laser-induced bubbles, was identified as an effective mechanism for
dentin debridement in the apical portion of root canals.21 The pressure produced by the pulsation of laser beam
in a narrow space like a root canal is a
unique feature of laser devices.
No study addresses the application
of laser pulsation on canal filling so
far. This report documents three cases
of traditional endodontic treatment
that were supplemented with the use
of the Nd:YAP laser which resulted
in the radiographic identification of
sealer in apical ramifications.

Fig. 2a

Fig. 2c

Material and methods
Three patients of this case report received root canal treatment necessitated by carious exposure of the
pulp or apical periodontitis. Endodontic treatment
consisted of the following procedures: access opening, canal preparation by hand and rotary instruments, canal irrigation, and canal filling. The canals
were enlarged conservatively providing adequate
proximation of the optic fibre to the apical third of the
root canal. Three-percentage NaOCl solution and
EDTA paste (RC-Prep, Premier, USA) were used during
instrumentation; saline was used between application of NaOCl and EDTA. Gutta-percha cones (Gutta
Percha Points, Meta Biomed, Korea) and zinc-oxide
eugenol-based sealer (ZOB Seal, Meta Biomed, Korea)
were used for canal obturation.
The exposure to the Nd:YAP laser (Lokki YAP, Lokki,
France), using 220 µm optical fibre (Fig. 1) with
160 mJ/pulse and 30 Hz, was conducted during canal
irrigation. The optical fibre was put into a root canal
2–3 mm short of working length as a starting point for
pulsed radiation. Radiation of the laser was followed
with upward movement of the optical fibre against
the canal wall and stopped when the optic fibre was
close to the orifice. Laser irradiation was repeated
throughout all canals as mimicking circumferential
filing until no debris was noted in the pulp chamber
followed by drying of the canals with paper points.
The 220 µm optical fibre with the mode of 180mJ/
pulse and 5 Hz was chosen for canal filling. After root
canals were filled with sealer by using a lentulo spiral,
a single pulse of laser beam was radiated at a position
2–3 mm short of working length at first, and then an-

Fig. 2b

Fig. 2d

other two single pulses of laser beam were emitted in
the middle of the root and at a location 2–3 mm below
the orifice consecutively. Cold lateral condensation
was accomplished with the placement of a master
gutta-percha cone followed by accessory cones for
complete obturation. Periapical X-ray films were
taken to evaluate the quality of the root canal ob
turation. No medications were prescribed during
treatment or postoperatively for patients.

Case presentation
Case 1 (Figs. 2a–e)
A 45-year-old woman sought treatment for severe
pain associated with a mandibular left canine. Clinically there was severe vertical mobility and cuspal
interference existed when the patient moved her
mandible in lateral excursion. Radiographic examination revealed a radiolucent lesion extending along the
mesial aspect of the root. Before beginning access
opening, the canine was splinted to the mandibular
left, lateral incisor and first premolar, and the occlusion was adjusted to eliminate lateral interference.
Purulent exudate was drained not only from the
periodontal pocket, but also from the canal orifice
after the chamber was opened. An accessory canal
mimicking a bifurcated apical canal was sealed. At
the ten-month recall, bone density was increased
around the root and no inflammatory signs were
observed in the periodontal pocket.

Fig. 2e
Fig. 2: Comparison of intraoral
photos and periapical radiographs
before treatment (a and c) and
post treatment (b, d and e).
a) Purulent exudate was drained
from the mesiolabial periodontal
sulcus. b) Intraoral photo: 10-month
post treatment. Periodontal abscess
subsided with gingival recession.
c) Periapical radiograph before
treatment. A significant radiolucency
was observed around the root of
mandibular left first premolar.
d) Periapical radiograph immediately
after treatment. e) Periapical radiograph: 10-month post treatment.
The increase in bone density was
noted around the root of mandibular
left first premolar even though
excess of sealer was remained out of
the root apex.

Case 2 (Figs. 3a & b)
A 46-year-old woman with missing restorations
on the mandibular right first and second premolars

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Discussion

Fig. 3a

Fig. 3b

Fig. 3: Comparison of periapical
radiographs before (a) and post
treatment (b). a) Dental restorations
of mandibular right first and second
premolars were lost due to secondary
caries. Periapical radiolucency
around the root of mandibular right
first was seen. b) One-month post
treatment. Accessory canals were
identified by sealer.

c omplained of toothache. The fracture of the crowns
was a result of secondary caries at the cervical portion
of premolars. A large apical lesion was observed
around the root of the first premolar. A prosthdontic
treatment of splinted crowns on the mandibular right
first and second premolars with crown lengthening
and cast posts was planned due to the patient’s desire
to retain teeth. All symptoms subsided after endodontic treatment was completed. There was radiographic evidence of sealer in the apical ramifications.
Case 3 (Figs. 4a–c)
A 40-year-old woman sought treatment for a labial
sinus tract related to the maxillary right first premolar.
Extensive pulpal calcification was noticed on the periapical radiograph. The gutta-percha cone indicated
that the labial sinus tract which appears to originate
from a lateral canal. A dilaceration of the apical third
and calcification of the canal made access difficult,
resulting in a perforation on the mesial aspect of the
root. The working length was adjusted and the canal
was obturated to this point. A lateral canal was filled
with sealer on the distal aspect of the root. The patient
returned for follow-up in two weeks. The sinus tract
healed and she was asymptomatic.

Fig. 4: Comparison of periapical
radiographs before treatment (a, b)
and two-week post treatment (c).
a) Severe canal calcification with
apical root dilaceration of maxillary
right first premolar was observed.
b) Insertion of a gutta-percha
cone into the labial sinus tract for
diagnosis. The tip of the gutta-percha
cone pointed to the lateral surface of
the root instead of the root apex.
c) A lateral canal was identified
by sealer.

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Fig. 4a

Fig. 4b

Microbial infection is considered a major cause of
endodontic failure. Several studies reported that periapical lesions did not develop without bacteria, although pulp tissue had been devitalised6,23; therefore,
thorough disinfection is strongly recommended before obturation is performed. The complexity and
variability of the root canal system make it difficult to
achieve ideal goals of endodontic treatment. A laser
system which transmits energy through a flexible and
small-diameter optical fibre can provide convenient
access to root canals. Consequently, direct and indirect disinfection by laser possibly takes place while
irradiating the inside of root canals. De Andrade AK
et al.24 reported laser disinfection is an effective way
to decrease bacterial colonies when the mean power
of laser exposure was over 3 Watts. The energy of
the Nd:YAP laser is powerful enough to eliminate
microbes because the average output of the Nd:YAP
laser is 10 Watts and the peak power may reach
2.6 kW. Only 0.00015 seconds of laser energy is emitted for every pulsed irradiation,25 so the fleeting moment of emission minimises the risk of overheating
surrounding tissues and has bactericidal effects by
direct contact. Two possibilities may explain the indirect disinfection of laser. When the mode of 30 Hz is
used in narrow space such as a root canal filled with
irrigation solution, shock waves may occur repeatedly
and be transmitted into dentinal tubules to kill bacteria. Pulsed irradiation causes vibrations in narrow
spaces similar to ultrasonic devices.25 This laser
energy caused by high frequency emission of the
Nd:YAP laser help maintain the integrity of the root
because it is not necessary to eliminate excessive
contaminated dentin of canal wall. Minimal enlargement is sufficient, if the space can allow 220 µm optical fibre to move passively through the canal. The laser
energy also causes temperature of the NaOCl solution
to rise resulting in increased efficiency of dissolving
organic debris and disinfection in canals.26 This
enhanced cleanliness gains space in apical ramifi
cations for sealer placement.

Fig. 4c

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In the clinical practice, the warm vertical condensation technique is widely used to obturate the canal,
but keeping a gutta-percha cone warm enough to
obtain favorable sealing in the ramifications may
cause lasting discomfort because of thermal damage
to periodontal tissues.27,28 On the other hand, the
mechanism of sealer placement by the Nd:YAP laser
is different from thermoplastic techniques. Sealer is
placed in the canal with a lentulo spiral followed by
application of the Nd:YAP laser to disperse the sealer
into ramifications by the fleeting pressure of laser
beam. Although the pressure causes slight discomfort, the post-filled sensation is not overt and dissipates clinically within a few hours. In most cases,
there was radiographic evidence of sealer being
forced into lateral/accessory canals. Puffs of sealer
from the periapical foramen are considered an evidence of tight seal.1 Zinc-oxide and eugenol-based
sealer was chosen in this case report because working
and setting time are conducive to completion of the
entire obturation process before the sealer sets. The
heat from laser irradiation induces fast setting and
burning of epoxy resin-based sealer; these types of
sealers are not recommended with this technique.
Taking periapical films during obturation is recommended to confirm whether the sealer is placed into
canal adequately.
Another advantage of using the Nd:YAP laser is that
the need for analgesics/antibiotics after treatment
can be decreased. The Nd:YAP laser has a strong antibacterial effect and an excellent potential for promoting tissue healing induced without a more invasive
procedure29,30; therefore, using the Nd:YAP laser may
be more efficient in disinfection and obturation of the
root canal system resulting in a higher success rate of
non-surgical root canal treatment. Based upon personal experience and observation for four years in
laser application, Nd:YAP laser-assistant endodontic
treatment is less technique sensitive and easy for

general practitioners to acquire the skill and follow
this method.
Further histological analysis is needed to verify the
significance of laser disinfection and sealer placement with the use of the Nd:YAP laser. These additional investigations will hopefully add to the store
of knowledge relative to canal disinfection and the
benefits of adequate obturation of auxiliary canals.

Conclusion
Obturation of lateral canals and apical ramifications were observed on postoperative radiographs.
This indicates enhanced canal cleanliness and sealing
of these small ramifications. The Nd:YAP laser can be
utilised as adjuncts to disinfection, canal irrigation
and canal filling to improve the quality of obturation
in the canal system. The efficiency of Nd:YAP laser-
assistant endodontic treatment could simplify the
procedure of root canal treatment without purchasing additional equipment to provide an advanced
level of treatment._
Acknowledgement: The authors are grateful to
Eric Jacobs, a media specialist, from University of
Detroit Mercy School of Dentistry for image edition.

contact
Dr John Palanci
Clinical assistant professor
Department of Oral Health and
Integrated Care,
University of Detroit Mercy
2700 Martin Luther King Jr. Blvd.
Detroit, MI 48208, USA
Tel.: +1 313 4946863
palancjg@udmercy.edu

Author details

Kurz & bündig
Ausgehend von der Aussage Schilders (1967), dass die finale Zielvorgabe einer jeden endodontischen Behandlung
die komplette, dreidimensionale Füllung der Wurzel- und Nebenkanäle sei, einschließlich der Entfernung aller organischer Ablagerungen, Bakterien und Bakteriengifte, erheben die Autoren dieses Artikels diese Maßgabe zum ultimativen
Qualitätskriterium der endodontischen Behandlung. Im Bewusstsein, dass diese These auch heute noch von Behandlern
kritisch diskutiert wird, stellen die Autoren eine lasergestützte endodontische Behandlungsalternative anhand dreier
Fallbeispiele vor. Dabei kam der Nd:YAP-Laser bei der Einbringung des Sealers zum Einsatz. Auf den anschließend
angefertigten Röntgenaufnahmen konnte die Aufbereitung der Nebenkanäle und apikalen Verzweigungen sichtbar gemacht werden, sodass aus Sicht der Autoren auch diese bestmöglich gereinigt und versiegelt werden konnten.

Literature

Abschließend kommen sie daher zu dem Schluss, dass der Nd:YAP-Laser eine geeignete Behandlungsalternative
für die Desinfektion, Spülung und Füllung der Wurzelkanäle darstelle und die Qualität der Wurzelkanalaufbereitung
signifikant erhöhe.

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Successful
communication
in your daily practice
Part II: Curious patients
Author: Dr Anna Maria Yiannikos, Germany & Cyprus

the solutions for daily communication problems you
are facing with your patients that bring you into a
difficult situation, make you lose your sleep or even
trust to your own self!
Let’s face it! We are not only dentists—we have a
business to run! Are you ready to find solutions to all
these problems? Let’s start with today’s amazing
brain-melting topic which is: How to shush patients
that have too many questions? Five steps to solve
the problem with courtesy and caring!

How to shush curious patients

Welcome to the 2nd part of the new communication
series; the series that includes the most popular and
challenging scenarios that might occur in your dental
practice with helpful tips of how you can deal with
them so your patients always leave your practice
feeling: “My dentist is THE BEST!” Each individual article of this series will teach you a new specialized
protocol that you can use easily, customise and adapt
from the same day on to your own dental clinic’s
requirements and needs. I am here to teach you all

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How many times have you been delayed by a patient that is constantly asking questions? Maybe it
is because he wants to feel that he is in control or
maybe he is afraid of the treatment or even he does
not trust you enough.
Whatever the reason is, you cannot spend the
whole day answering his questions! And this is a real
fact! On the other hand, you do not want to be perceived as rude. So, my gift for you today is a protocol
to deal with this annoying patient habit nicely and at
the same time effectively!

5 steps for a successful communication
Here is how it goes:
Step 1: Be in charge of the conversation
Before you start the treatment, spend five to ten
minutes sitting with your patient at your office area
and explain the proposed or upcoming treatment.

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Important tip: Explain already beforehand the
available time and reason for this meeting. For example, you could say: “George, I would love to sit with
you today and spend five minutes of our time to
explain the treatment that will follow in detail.”
Step 2: Ensure him
Tell him the format of contact. In case he has questions, he can ask them either during the meeting at
your office, or after the treatment, or he can call your
well-trained and qualified assistant or even e-mail
you at own convenience for further details.
Step 3: Keep in mind the following
If during treatment, he wants to interrupt you and
ask you more questions, just use the following
phrase: “I am all ears, but believe me it is better if we
now concentrate on the selected treatment. Me and
my staff will give you more time after the completion
to ask for more information about the treatment, so
let’s proceed…”

Just do it!
It is not so hard to apply the above presented
5 steps for successful communication in your daily
practice. I encourage you to start doing it from today
on, as part of your clinic’s script! I am sure, it will give
you greater peace of mind as well as more time and
energy for your next patient!
In the next issue of laser magazine, I will present
to you the third part of this unique new series of
communication concepts that will teach you with
7 simple steps how to attract, communicate and retain millennial patients—who are our present and
future patients. Until then, remember that you are
not only the dentist of your clinic, but 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 website www.dbamastership.com. Looking
forward to our next trip of business growth and
educational development!_

The above said words will relax him a bit, so you
will be able to do your job, which is: treat him!
Step 4: After the treatment
You can shortly explain your findings and how you
are going to proceed, ask him if he wants anything
else from you and simultaneously bring your assistant in. You must continue the show…! Go into the
treatment room and serve the next patient!
Step 5: Necessary documents and info
Your assistant will provide the patient with the
follow-up instructions, your clinic’s e-mail, etc. It is
better, for your peace of mind, to not give him your
private cell phone number, for obvious reasons: You
do not want him calling you for unnecessary reasons
(whether it is the appropriate time to take his lunch,
or when he should change the gauge, etc. Correct?).

contact
Dr Anna Maria Yiannikos
Adjunct Faculty Member of AALZ
at RWTH Aachen
University C
ampus, Germany
DDS, LSO, MSc, MBA
dba@yiannikosdental.com
www.dbamastership.com

Author details

Kurz & bündig
Im zweiten Teil der Serie „Erfolgreiche Kommunikation im Praxisalltag“ gibt unsere Autorin fünf Tipps, wie Zahnärzte
mit allzu wissbegierigen Patienten umgehen können. Denn ein Patient, der ständig Fragen stellt, hält den Praxisbetrieb
auf und strapaziert die Nerven seines Behandlers. Schritt 1 ist daher, dem Patienten bereits im Vorhinein in fünf bis
zehn Minuten im Empfangsbereich die nachfolgende Behandlung zu erklären. Im zweiten Schritt vereinbaren Sie mit
ihm, dass er aufkommende Fragen entweder vor oder nach der Behandlung klären kann. Wenn er während der Behandlung weitere Fragen stellt, versichern Sie ihm im dritten Schritt, dass diese im Nachhinein eingehend beantwortet
werden und Sie sich erstmal ganz auf die Therapie konzentrieren möchten. Nach der Sitzung erklären Sie Ihrem Patienten in Schritt 4 kurz die Befunde und das weitere Vorgehen. Bringen Sie gleichzeitig Ihre Assistentin in den Raum
und gehen Sie dann in den nächsten Termin. Ihre Assistentin wird Ihrem Patienten im letzten Schritt alle notwendigen
Dokumente und Informationen geben. Auf diese Weise vermeiden Sie unnötige Fragen und geben Ihrem Patienten
trotzdem das Gefühl, in guten Händen zu sein. Im nächsten Heft gibt die Autorin sieben Tipps, wie Sie Millennials als
Patienten gewinnen können.

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Marketing dentistry
in a global economy
Author: Chris Barrow, UK

“In an information-rich world, the wealth of information means a dearth of something else: a scarcity
of whatever it is that information consumes. What
information consumes is rather obvious: it consumes the attention of its recipients. Hence a wealth
of information creates a poverty of attention.” These
prophetic lines were shared by Nobel laureate and
social scientist Dr Herbert Simon in 1971. It seems
incredible to think that his words predate the
Internet by 20 years.

From bill-board to blog post
Simon lived in a world in which advertisers tried
to gain our attention with bill-boards, newspaper
advertisements and television commercials. At the
same time, the local ma-and-pa business prospered
through convenience and human interest. The connected economy and growth in population have
created statistics that are beyond our comprehension. There were 60 trillion websites at the last count

© Jesus San/Shutterstock.com

32

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and every year the Internet grows by eight million
new songs, two million new books, 16,000 new
films, 30 billion blog posts and 182 billion Tweets.
Google handles 35 billion e-mails every day alone,
and 1.8 billion photographs are uploaded to the
Cloud from everywhere around the globe. I speculate as to how many of those photographs are of
happy, smiling faces.

ners in the race to attract that poverty of attention
first mentioned in 1971. So where does this place the
independently owned dental practice? You are a
mouse, wandering between the legs of a herd of bull
elephants, all trumpeting their mating call. No matter how loudly you squeak, at best your sound will be
drowned out and at worst you may be trampled in
the rush.

IBM tells us that we are “a world awash in data”,
80 % of which is currently invisible to our computers;
however, with the IBM Watson project, the company
intends to use cognitive computing to bring that
data into a useable domain. With global health-care
data expected to grow by 99 % in the next twelve
months, the search is on to find a new unified theory
that will bring all of this information to the fingertips
of government, business and individuals.

The to-dos of digital dental marketing

I have watched the world of digital marketing in dentistry very carefully over the last five
years and have reached some conclusions that are
likely to land me in trouble with traditional digital marketers. However, I did not get where I am
today without stepping on the fenced-off grass
every now and then, running along the side of
the swimming pool and tearing up the rule book.
How to upgrade the human data system So, here is my recommended list of actions to be
taken by the independent dental practice in order
The question is, can we cope with this? In his to gain attention:
book “Homo Deus: A Brief History of Tomorrow”, 1. Use good search engine optimisation (SEO) to opIsraeli author Prof. Yuval Noah Harari visualises a
timise your position in Google’s organic search.
completely connected world in which “Data-ism”
SEO is a technical skill that has to be delivered by
dominates. There he writes: “Sapiens evolved in
experts. Google changes its own goalposts reguthe savannah thousands of years ago and their allarly and the savvy SEO guru will know that and
st
gorithms are not built to handle 21 century data
take appropriate action quickly.
flows. We might try to upgrade the human data- 2. Massively encourage the collection of Google reprocessing system, but this may not be enough.
views, user reviews via Facebook and critic reThe Internet of all Things may create such huge and
views via proprietorial sites. In September 2016,
rapid data flows that even upgraded human alGoogle changed the rules twice, first by including
gorithms won’t handle it. When cars replaced the
external reviews alongside its own in searches
horse-drawn carriage, we didn’t upgrade horses—
and second by altering its own search criteria to
we retired them. Perhaps it is time to do the same
favour businesses with in excess of 100 Google
with Homo sapiens.”
reviews. It is necessary that your marketing
activity be adjusted to reflect such changes.
A rather grim and ominous suggestion perhaps, 3. Connect to your patients through a well-mainbut by jolting our sensibilities, Harari makes us pause
tained social media channel like Facebook or Twitfor thought. Let us narrow our field of vision from
ter (and deliver daily human interest content). Rethese impossible numbers and facts. Pundits sugmember that those 1.8 billion photograph uploads
gest that you and I are interrupted by advertising and
per day include the inevitable selfies. Many of my
brand exposures 5,000 times in an average day and
clients now take a patient selfie at the end of a
mentally register around 350 of these. We note 150,
course of aesthetic dental treatment. To quote
think briefly about 80 and pause at 12 to think about
again from Harari’s new book: “If you experience
whether they are relevant to us at this time. Thus,
something—record it. If you record something—
the challenge facing the dental marketer is how to
upload it. If you upload something—share it.”
become one of 12 out of 5,000 at the right time, on 4. Build a website that engages the visitor through
the right day, for the right person.
video and visual testimonials. Your most powerful marketing collateral is the stories that your
Big data—big money
patients can tell about the difference that you
have made to their lives.
Big business has a simple solution to this problem; 5. Collect visitors’ e-mail addresses and consent (to
it is called big money. Whether it is a Super Bowl telee-mail) via white paper marketing. A coffee shop,
vision commercial, a giant bill-board on a motorway
hotel or airport exchanges free Wi-Fi access
or, nowadays, massive expenditure on Internet visifor an e-mail address and permission to keep
bility via paid media, those with the deepest pockets
one informed. You can do the same by exchanging
offering the best products and services are the winuseful information (free guides).

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Conclusion: to advertise or
not to advertise
I have given you nine marketing actions designed
especially for the smaller business. Actions that
should be avoided by the independent dental practice are seeking to gain attention by paying through
the nose for Google or Facebook advertising, broadcasting non-human interest material or selling services on price, discount or special offer. This is because every week I hear from dentists and their
marketing teams that advertising to strangers, using
jargon and cutting prices at best attract nobody and
at worst attract bargain-hunters, price-shoppers
and messers.

“A wealth of information creates a poverty of attention.” We end where we began. The challenge is
for the mouse to gain attention without competing
with the bull elephants. You can only do that by stepping away from the herd of elephants and delivering
your story in a different way and a different place.
For me, that means human interest, personal service
and recommendation, and so when I am working
with clients on their marketing plans, we focus on
and mobilise their most valuable asset: the goodwill
of their existing patients._
6. Nurture long-term relationships with patients and
prospects by publishing a monthly human interest
e-mail newsletter.
7. Deal with initial enquiries directed through the
Internet, by telephone or in person in a polished
manner.
8. Create a memorable new patient experience from
initial consultation all the way through to treatment delivery.
9. Employ a strict end-of-treatment protocol to capture reviews, testimonials and social connections
(as well as plan membership).

contact
Chris Barrow
7connections
27 Clements Lane
London, EC4N 7AE, United Kingdom
Tel.: +44 20 33191709
hello@7connections.com
www.7connections.com

Author details

Kurz & bündig
Ausgehend von den Theorien der „Attention economy“ des US-amerikanischen Sozialwissenschaftlers Herbert
Simon beschreibt Business-Coach Chris Barrow in seinem Artikel die Entwicklungen des (dentalen) Marketings von der
händisch beschriebenen Anzeigentafel des 19. Jahrhunderts bis zu den Möglichkeiten digital und global angelegter
Marketingstrategien des 21. Jahrhunderts. Damals wie heute ginge es darum, in einem Meer von Informationen die
eigene Botschaft, das eigene Produkt oder die eigene Marke für das Zielpublikum präsent und relevant zu gestalten.
Für das dentale Marketing erstellt Chris Barrow abschließend eine praxisnahe To-do-Liste, in der er in Kürze das digitale Praxismarketing von der Suchmaschinenoptimierung über die Gestaltung von Web- und E-Mail-Adressen bis hin
zur individuellen Gestaltung von Patientenbindung und Behandlungserfahrung beschreibt.
Sein Fazit: Die Einzelpraxis kann sich in einer Welt digitaler Giganten nur behaupten, wenn Sie stets an ihrer eigenen Geschichte und ihren Alleinstellungsmerkmalen festhält und dafür individuelle Marketingstrategien entwickelt. In
der Zusammenarbeit mit seinen Klienten habe sich dabei vor allem eins bewährt: der Fokus auf den „Goodwill“ der
Bestandspatienten.

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©Koelnmesse

events

This year’s IDS sets
new record in attendees
More than 155,000 people from 157 countries visited the International Dental Show (IDS) this year, according to final figures released by organiser Koelnmesse. This is an increase of 12 per cent compared
with IDS 2015. Furthermore, the number of international attendees rose by almost 20 per cent to around
60 per cent. There was also a slight increase in
national visitors.
There was a significant increase in visitor numbers
from almost all regions: the Americas (+ 52.9 per
cent), eastern Europe (+ 43.0 per cent), the Middle
East (+ 31.9 per cent), Africa (+ 31.7 per cent) and Asia
(+ 28.0 per cent). The number of attendees from
North America (+ 15.7 per cent) and the rest of
Europe (+ 12.6 per cent) also rose significantly.
In a visitor survey, about three-quarters of respondents were very satisfied or satisfied with IDS 2017,
as well as with achieving their targets for the exhibition. The majority of those surveyed (90 per cent)
would recommend IDS to business partners, and
70 per cent said they plan to visit IDS in 2019.

At the fair, 2,305 companies from 59 countries
(compared with 2,182 companies from 56 countries
in 2015) exhibited in an overall area of 163,000 m²
(158,200 m² in 2015). These included 624 exhibitors
and 20 additionally represented companies from
Germany (636 and 19, respectively, in 2015), as well
as 1,617 exhibitors and 44 additionally represented
companies from abroad (1,480 and 44, respectively,
in 2015). The proportion of foreign companies was
72 per cent (70 per cent in 2015). Of the more than
155,000 visitors from 157 countries (138,500 visitors
from 151 countries in 2015), around 60 per cent
(compared with 51 per cent in 2015) came from
abroad.
IDS 2017 focused on digital production and diagnostics, intelligent networking solutions for practices and laboratories, smart services for dentists and
dental technicians, as well as the further improvement of patient care and thus oral health worldwide.
The next IDS will take place from 12 to 16 March
2019._

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| events

© canadastock/Shutterstock.com

4 International
SGOLA Congress
th

Author: Timo Krause, Germany

On 1 April 2017, fortbildungROSENBERG and
SGOLA (Swiss Society for Oral Laser Applications)
held their 4th International Congress at the Marriott
Hotel in Zurich/Switzerland. The congress title was
“Laser in the Dental Practice: Focussing on Innovation and Evidence”.
Dr Kresimir Simunovic, MSc, President of SGOLA,
had gathered renowned speakers from Switzerland,
Germany, Italy and Slowenia and 150 international
Fig. 1: From left to right:
SGOLA President Prof. Dr Kresimir
Simunovic, Dr Jörg Meister, Prof. Dr
Matthias Frentzen, Prof. Dr Giovanni
Olivi, Dr David Dovšak,
Dr Michel Vock.

Fig. 1

36

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2 2017

participants. The congress aim was to present new
approaches in laser dentistry and thereby substantiate traditional laser-based treatment and therapy
concepts. As laser applications are almost unlimited,
they open further opportunities for all other dental
disciplines, for example photothermal and photodynamic protocols in the treatment of periodontitis and
periimplantitis or laser applications in endodontology—participants thus received an update from the
practice for the practice.

[37] =>

events

Fig. 2

Fig. 3

After the congress was opened by SGOLA President
Dr Simunovic, Dr Jörg Meister (Aachen/Germany)
started the scientific presentations. With his speech
“Laser Technology—Dos and Don’ts”, he gave insights
in the range of options for laser applications in the
dental practice. His speech was followed by Prof.
Dr Matthias Frentzen’s (Bonn/Germany) “News in
Laser Research” and Prof. Dr Giovanni Olivi’s (Rome/
Italy) “Lasers-Assisted Dentistry & PIPS”. Dr Claude
Andreoni (Zurich/Switzerland) gave interesting tips
for the “Laser-Assisted Treatment of Periimplantitis”
with his closing speech of the first session.
The afternoon programme started with Dr Michael
Hopp (Berlin/Germany) who spoke about the current
status of the universality of diode lasers. Prof. Dr Olivi

followed with his second speech on “445 nm—A New
Wavelength in Laser Dentistry”. Dr David Dovšak (Ljubljana/Slowenia) opened an all-new perspective on
dentistry with his speech “Laser-Assisted Snoring
Therapy”.
Dr Alex Kelsch (Karlsruhe/Germany) gave the first
presentation after the coffee break, which was titled
„Photothermal Periodontal Therapy with Emundo“.
He was followed by Dr Michel Vock’s, MSc, (Seuzach/
Switzerland) review on “The Past 17 Years of Laser
Treatment in the Private Practice”. SGOLA President
Dr Simunovic himself held the final speech “The
Potential of the Er:YAG Wavelength”.

Fig. 2: Participants enjoyed the
relaxed atmosphere at the Zurich
Marriott Hotel.
Fig. 3: From left to right: Participants
Dr Marco Stocker, Dr. Chantal Riva
(Switzerland) and Claude Andreoni.
Fig. 4: The congress took place on
1 April 2017 at the Marriott Hotel in
Zurich/Switzerland.

Traditionally, Dr Meister’s laser safety course was
held on the day before the congress. Participants
learned the basics of laser applications and the interactions of light and tissues. They were rewarded with
the certificate “Expert in Laser Saftey SGOLA”.

Conclusion

Fig. 4

Participants were equally interested in the scientific approaches towards laser application in the
dental practice and the associated industry exhibition
of renowned manufacturers and distributors. Once
more, the 4th International SGOLA Congress highlighted the potential of laser applications in the dental
practice and their high esteem among users._

contact
SGOLA
Seefeldstr. 128
8008 Zurich, Switzerland
Tel.: +41 443834070
info@sgola.ch
www.sgola.ch

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| events

Bringing laser
to sunlight
6th WFLD-ED Congress

Source: WFLD-ED 2017

Save the date: September 2017 will bring laser to
sunlight with the joint event of the 6th WFLD-ED
Congress and the 5th WALED Congress being held
in sunny Thessaloniki, Greece. Organising Committee Chairman Dr Dimitris Strakas, Scientific
Committee Chairman Prof. Dr Norbert Gutknecht
and AALZ Business Development Manager Leon
Vanweersch took the time to shine a light on the
exclusive features of this special congress in the
following interview.
Fig. 1: From left to right: Leon
Vanweersch (Manager of WALED),
Dr Dimitris Strakas (WFLD-ED
Organising Committee Chairman),
laser authors Dr Hubert Stieve and
Augustus Crocker, Prof. Dr Norbert
Gutknecht (CEO WFLD).

You have already visited Thessaloniki and also
supervised the preparations. Tell us a few words
about the location and the organisation so far.
The location is very attractive. Not only is it a
good place for the scientific programme, but also
for a lot of social activities. This city is an extraordinary place. The local organisation is led by a person
with a very high dedication to our Federation and
to the use of lasers, thus his engagement is extremely high. Also his connection to the authorities
of the University and to its professors is very helpful
and beneficial for the preparation of the congress.
You will be also hosting the major event of the
16th World Federation Congress in Berlin next
year, which coincides with the 30 year anniversary of ISLD (International Congress for Laser in
Dentistry). Can you please update our readers on
this very important meeting?
I am very happy that you have brought up this
question. Indeed, it will be an extraordinary meeting in Berlin, not only because it is the World Congress, but also because we are celebrating it in the
city of Albert Einstein—the father of the laser idea.
I am sure that a large number of participants will
come to Berlin and we are very dedicated and motivated to prepare a scientific programme of excellence. But due to the fact that we will celebrate the
30th anniversary of ISLD, we will also host a special
party for our participants which will be a remarkable social event. I think it is a positive must to join
this congress if you are a real laser enthusiast.

Fig. 1

Professor Gutknecht, as CEO of WFLD, what is
your opinion about laser dentistry improvements and how will this 6th European Laser
Congress help to promote the use of laser even
further amongst dentists?
During the last five years, we have seen a lot of
improvements in the field of laser dentistry. New

lasers have entered the market and treatment
concepts have been established to improve the
success of dental treatment. I expect from the upcoming 6th WFLD-ED Congress in Thessaloniki that
a large number of dentists will come in contact with
the use of lasers and its benefits. This will create a
growing interest in this technology.

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2 2017

[39] =>

events

Dr Strakas, as the Chairman of WFLD-ED, can
you please tell us your goals for the upcoming
6th European Laser Congress?
First of all, I want to thank OEMUS MEDIA AG and
laser: international magazine of laser dentistry for
their invaluable help. Coming to your question. I
am honoured to host the 6th WFLD-ED Congress in
my country and the city of Thessaloniki. My bonds
with this beautiful city go very deep since I have
lived here during my undergraduate studies, but
also now as we have established the first laser
clinic in Greece at the Aristotle University of
Thessaloniki.
This year we reach the ten-year anniversary after the first WFLD-ED Congress in Nice, France.
The goals of these congresses are always the
same: to gather and disseminate the current
knowledge in laser dentistry and provide the
highest possible scientific quality presentations.
From my side, I would like to achieve after many
years to have a great “laser party” both in terms of
science and social events. This will strengthen the
bonds between laser users worldwide and also the
dynamics of our European Division, which always
plays an important role in WFLD.
This is already happening: the registrations that
we have received so far are from a big variety of
countries, not only Greece and Europe, but globally
with countries such as Egypt, Iran, Israel, Brazil,
Colombia, Turkey and even Canada.
Finally, I am more than grateful to our sponsors.
It is a very rare occasion that a European Laser Congress will have such a large number of laser companies in the exhibition area, whilst all of them are
leaders in the field of dental laser system devices.

What was the inspiration for the congress
motto “Bringing Laser to Sunlight”?
We all know that lasers have a direct association
to electromagnetic radiation and light. It is also
widely known that our country is renowned for its
amount of sunshine and quality of light, both in
Europe and worldwide. So the motto was brought
up spontaneously by association. We want to
bring together the photons of the coherent,
monochromatic laser light with those of the
Greek sunlight. In the same manner, our congress
logo combined the famous artwork “Umbrellas”
by the great sculptor Giorgios Zoggolopoulos in
the awarded new promenade of Thessaloniki with
the colours representing the different wavelengths of the visible spectrum.
What are the subjects of the congress and how
can this be helpful for the laser user in his
everyday practice?
Our esteemed invited speakers are internationally renowned for their work and research in the
field of laser dentistry. The subjects of the scientific programme will cover the whole spectrum of
the wavelengths that are currently used in dentistry. That means that the participant will not
only discover the basic principles, but moreover
all indications of laser applications including periodontology, endodontics, operative dentistry,
oral surgery, paediatric dentistry, photodynamic
therapy, prosthetics and implantology.
With an abundance of oral and poster presentations we will cover the needs of colleagues that
are currently entering the fascinating world of
laser dentistry as well as the needs of advanced
laser users who want to follow up on new technological improvements and recent studies in this
field.

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© erveridis Vasilis/Shutterstock.com

Mr Vanweersch, as manager of WALED, can
you please tell us some things about the World
Academy and its goals?
WALED—the abbreviation of World Academy for
Laser Education in Dentistry—is the alumni club of the
Mastership/Fellowship and Master of Science programmes in Lasers in Dentistry of Aachen Dental
L aser Center (AALZ) at RWTH Aachen University, Germany. Membership of this association is exclusively
limited to students, graduates and alumni of these
programmes in the field of lasers in dentistry. With
WALED, we have established a worldwide academic
and educational network in dental laser therapy. With
respect to our vision of lifelong learning we provide
our members the unique possibility to upgrade their
knowledge every year with the newest developments
in basic and clinical research.
Why did you select Thessaloniki for this 5th WALED
Congress?
One of our closest and longest academic co-workers, Dr Dimitris Strakas, is the Organising Chairman
and the Chairman of the European Division of WFLD.
Due to the fact that our WALED members are spread
around the globe, we try every year to give our members the highest value for their participation in our
congress, and this is why we decided to organize a
joint congress of WALED and WFLD-ED. Furthermore,
the city of Thessaloniki definitively is a highly attractive motivation to participate in this congress, due to
the unique location at the seaside, the touristic possibilities, and the very nice weather during the conAbout Prof. Gutknecht

40

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2 2017

About Dr Strakas

About Mr Vanweersch

gress days in September. On top, the congress hotel
selected by us, the five-star Makedonia Palace Hotel,
will be one of the best locations ever for organising
such a congress, providing the best-possible background to the events we will offer our participants.
It seems to be a universal truth for the dentists
participating in your events that the programme
and social events related to it are of the highest
quality. What can a dentist expect when registering for the upcoming joined WALED/WFLD-ED
Congress in Thessaloniki?
In addition to the high quality of all presentations
in the WALED Congress and the two very interesting
congress days of WFLD-ED, we offer our participants
a unique, all-inclusive package, which also includes
our WALED Get-Together Party on 21 September, the
welcome cocktail reception on Friday, 22 September
and the Gala Dinner on Saturday, 23 September as
well as all coffee and lunch breaks during all three
congress days. When WALED members book before
1 June, they can enjoy all of this for an all-inclusive
registration fee of 350 Euro.
Thank you for the interview._

contact
Dr Dimitris Strakas
Chairman of WFLD-ED
DDS, MSc. in Lasers in Dentistry,
RWTH Aachen University
PhD Department of Operative Dentistry
Aristotle University of Thessaloniki
Spiridi 28
38221 Volos, Greece
Tel.: +30 24210 32525
www.wfld-thessaloniki2017.com

[41] =>

manufacturer news
Fotona

Enhancing laser endodontics
Fotona’s proprietary ASP (Adaptive Structured
Pulse) technology represents a step forward with
respect to controlling laser pulses in the temporal domain. By introducing a revolutionary new
SWEEPS™ (Shock Wave Enhanced Emission
Photoacoustic Streaming) mode, developed to
further improve the cleaning and disinfecting efficacy of LightWalker’s laser-assisted PIPS® endodontic procedures. Although the PIPS® irrigation
is very effective, its cavitation dynamics is still
much slower than what it could be if not slowed
down by the friction on the root canal walls. With
the specially adapted SWEEPS™ pulse structure,
a faster photoacoustic collapse can now be pro-

duced even in narrow root canals, resulting in the
emission of a large number of enhanced pressure
waves throughout the canal. This is a very exciting development. With SWEEPS™-supported
endodontics, you not only improve the streaming
of irrigants throughout the complex root canal
system, but also enhance the direct removal of
the smear layer and disinfection, potentially eliminating the need for the use of aggressive irrigants.
Fotona, d.o.o.
Stegne 7
1000 Ljubljana, Slovenia
www.fotona.com

BIOLASE

cumdente

Worldwide launch of new all-tissue
laser system

Contact-free incision

Biolase
4 Cromwell
Irvine, CA 92618, USA
www.biolase.com

Cumdente GmbH
Paul-Ehrlich-Straße 11
72076 Tuebingen, Germany
www.cumdente.com

High performance for dental surgery, parodontology and implantology—this
is possible with LASER blue® by cumdente. The blue light laser is superior
BIOLASE, the global leader to diode laser (infrared) due to its high effectiveness and incision efficiency
in dental lasers, announced at low energy parameters. One main advantage of the blue light laser is
today that its new, fifth- its property of being more tissue-conserving. Due to contact-free incision
generation Waterlase without touching any tissue and immediate entry into tissue ablation there is
Express™ all-tissue la- minimal tissue damage and no thermal tissue disruption or damage to conser system, having re- tiguous structures such as tooth or implants. Furthermore, no delay effects
ceived 510(k) clearance with simultaneously minimised fibre optic wear and tear appear. With L ASER
for commercial distri
- blue®, practitioners can rely on an optimised incision effectiveness and
bution from the U.S. haemostasis during the treatment with minimal biological side effects and
Food and Drug Admin- coagulation. The device’s antimicrobial effect and disinfection of contamiistration (FDA), is available nated tissue round off the picture. Currently, no disadvantages are known
for immediate sale to den- for the wavelength of this high performance
tists in the US as well as laser, which makes it a perfect alternative for
select international markets in scalpel or HF units. Thanks to the mobile
Europe, the Middle East and Asia.
equipment with integral battery pack, one
Waterlase Express was first unveiled interna- can immediately start using the blue light
tionally in Cologne, Germany, at the International Dental Show (IDS), which laser. The very simple touch screen conis the world's leading trade show for the dental industry.
trols allow 10 settings for each indicaWith extensive qualitative and quantitative research from a team of tion, which makes LASER blue® a perdentists around the world guiding the design of the system, Waterlase fect device for surgery, parodontology,
Express represents the new foundation of the Company’s strategy to implantology, endodontics, prosthetics
greatly expand all-tissue laser use in dentistry.
as well as aesthetics.

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2 2017

[42] =>

news

international

New laser applications at the

7th LA&HA Symposium
Fotona’s new SWEEPS™ endodontic treatment,
first announced at this year’s IDS, was one of
the highlights of the 7th Annual L aser & Health

Academy Symposium. SWEEPS™ uses the
power of the Er:YAG laser and Fotona’s revolutionary new ASP technology to create non-ther-

Supplements are only effective in

New cost-effective blue laser

Significant vitamin D
deficiency

Intraoral scanning technology

An international study of older adults has found
that mass, untargeted provision of vitamin D
supplements provides little clinical benefit to
many when it comes to the common bone disease, osteoporosis. Instead, the study recommends targeting vitamin D supplements at individuals whose levels of this vitamin are markedly
reduced. The results of the study—carried out
by researchers at the University of Auckland,
New Zealand, and Harvard Medical School,
Boston—were announced today by Professor

Ian R. Reid at ECTS 2017, the 44th European
Calcified Tissue Society Congress being held in
Salzburg, Austria.
Professor Reid concluded: “It was clear to us that
future trials of vitamin D supplements in older
adults should focus on those who have baseline
vitamin D levels equal to or below 30 nmol per
litre and that the findings represent a significant
step towards defining vitamin D deficiency for
bone health in older adults.”

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2 2017

Taiwan’s Metal Industries Research and Development Centre (MIRDC) has introduced a new
blue laser line intraoral scanning technology.
According to the developers, the device is built
with mostly Taiwanese electronic components
and will be significantly cheaper than similar
scanning devices from international competitors.
Through software, the device uses a triangular
measuring method to focus a high-coherence
laser light on to the object to be scanned. In this
manner, it is able to accurately construct a dental model, taking precise measurements within
an area of 22 x 18 mm, which reduces the margin
of error, the developers said.
Developed by the MIRDC, the blue laser line was
transferred to several Taiwanese companies,
Taiwan News reported online.
The scanner, which is currently being tested in
clinical trials, is to be introduced to the market
later this year. According to the MIRDC, similar oral scanning devices made in Germany,
Denmark and the US, for example, cost about
NT$1.2–1.6 million (US$39,900–53,200). The

mal photoacoustic shock waves for removing
the smear layer in root canals. Also of special
interest at the LA&HA Symposium were cases
utilising the innovative TwinLight ® approach for
treatments in periodontics, oral surgery and
even in NightLase®.
The 7th Annual Laser & Health Academy Symposium took place in May at the Slovenian Alpine
resort of Kranjska Gora. This year’s Symposium
attracted a record number of nearly 500 participants, with more than 50 clinical experts from
around the world presenting the latest innovations and applications in the field of medical
and dental laser technology. The annual LA&HA
Symposium is held to exchange research and
education among medical professionals in the
field of laser medicine, with a focus on practical
instruction and presentations of the latest laser
procedures and research. For further information, visit www.laserandhealthacademy.com.

MIRDC’s partners, however, hope that the commercialised product will sell for US$30,000 to
hospitals and dental clinics globally.

Screenshot (YouTube/solberg hu) of the newly developed
blue laser line intraoral scanning device (MIRDC Taiwan).

[43] =>

Obstructive Sleep Apnea causes

Complications in implant-borne prostheses
Researchers from OSI Araba University Hospital in Victoria, Spain, published
a study that investigated how Obstructive Sleep Apnea (OSA) affects implant-borne prostheses. The frequency with which a complication occurred
© one photo/Shutterstock.com

and the type of complication were studied in 67 patients. Contradictory to
their initial hypothesis, the researchers found a high instance of complications related to OSA.
Of the 67 patients included in the study, the researchers found that 16 experienced complications; 13 of which had OSA. Among these 16 patients
with complications, there were 22 prostheses with a total of 30 issues. The
researchers found these complications consisted of porcelain fracture, fracture of the screw/implant, loosening of the screw, and decementation. The
average time for a complication to occur was 73 months’ post-implantation.
During the study, the researchers also noted a strong relation between individuals who suffer from OSA and those who suffer from bruxism. Past studies revealed that those afflicted with bruxism had a higher instance (6/10) of
complications with implant prostheses than those without bruxism (13/75).
This shows that people suffering from OSA and/or bruxism have a more
difficult time with successful prosthetic implantation.
This study shows that 81 per cent of patients with OSA experienced complications with their prostheses. Given that the success rate of implants is
reported to be between 92 and 97 per cent, there is a strong correlation
between OSA and prosthetic complications.

Survey exposes truth about

Our oral health habits
FDI World Dental Federation is myth busting
what people around the world believe to be
good oral health practices, encouraging them
to become better informed and take action.
Oral health is integral to our general health and
well-being; impacting every aspect of our lives.
The results from a survey carried
out in 12 countries, by YouGov on
behalf of FDI, exposed a significant
gap between what people believe to
be good oral health practices, versus what they actually do. Eight of the
countries reported that 50 per cent or
more of the people surveyed think it is
important to brush your teeth straight after
every main meal. Brazil, Mexico, Egypt and
Poland were the worst offenders of this incorrect oral health practice (84 %, 81 %, 62 % and
60 % respectively). FDI recommends waiting
at least 30 minutes after eating to brush your
teeth to avoid weakening tooth enamel.
The majority of countries surveyed incorrectly believe that rinsing the mouth out with water
after brushing is important; Brazil, South Africa,

Mexico, India and Canada were found to practice
this myth the most (77 %, 75 %, 73 %, 67 % and
67 % respectively). It is actually recommended not
to rinse with water straight after brushing to allow
maximum exposure to
fluoride, which will
optimize the preventative effects.

Nearly half the population surveyed in India, South
Africa, Brazil and Poland (52 %, 49 %, 48 % and
42 % respectively), felt that drinking fruit juice
rather than fizzy drinks was important for good
oral health. Fruit juice however, can also be high
in sugar which can cause tooth decay. FDI recommends keeping consumption of sugary drinks to a
minimum as part of a healthy, balanced diet.

laser
2 2017

[44] =>

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

[45] =>

editorial

Effizienz &
Innovation

Prof. Dr. Norbert Gutknecht

Liebe Kolleginnen und Kollegen,
als ich vor zweieinhalb Monaten über die Ausstellungsfläche der IDS gelaufen bin, haben mich zwei
A spekte besonders berührt. Zum einen ist die Zahl der Teilnehmer an der IDS und die Menge der Aussteller
gestiegen, zum anderen nehmen die Innovationen und digitalen Technologien einen immer breiteren Raum
ein. Der Beruf des Zahnarztes (vormals eine rein mechanische Arbeitsweise) wird zunehmend ein Kom
mandoplatz, umgeben von den unterschiedlichsten Technologien – so auch den neuen modernen Laser
geräten. Wenn man meinte, nur vier oder fünf Laserhersteller auf dieser Ausstellung anzutreffen, so musste
man sich bei dem Blick ins Ausstellerverzeichnis eines Besseren belehren lassen. Nicht nur, dass mehr
als 40 Laseraussteller und -hersteller vertreten waren, sondern die technische Weiterentwicklung der
L asergeräte war beeindruckend.
Die Leistungsfähigkeit der Geräte, die immer größer werdende Variabilität der Applikatoren und die, wie
schon oben angesprochen, technische Weiterentwicklung der Software vieler Hersteller erfordert vom
Benutzer ein immer größeres Maß an Verständnis dieser Technologie beim Einsatz am Patienten. Diesem
Defizit an Kenntnissen versucht die Industrie mit aufwendigen Behandlungsanimationen und umfang
reichen Voreinstellungen für bestimmte Therapien zu begegnen. Die Symbiose aus einem Hightech-Laser
und einem guten Verständnis der adäquaten Handhabung derselben wird die Anwendung von Lasergeräten
in Zukunft noch sinnvoller und effektiver machen.
Ihr

Prof. Dr. Norbert Gutknecht

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2 2017

[46] =>

| events

Laserzahnheilkunde –
Was geht und was nicht
Am 23. Juni 2017 findet der DGL-Kongress erstmalig in Form eines Workshops im Universitätsklinikum Aachen statt. Dieser Workshop-Kongress
soll alle interessierten Anwender im Bereich der
Laserzahnmedizin sowohl theoretisch als auch
praktisch mit den täglichen Herausforderungen des
Lasers konfrontieren.
Im Vordergrund der theoretischen und praktischen Einheiten werden dabei nachfolgende Fragen
und Themen stehen:
1. Welche neuen Wellenlängen stehen Anwendern
als Alternative zur Verfügung und wie unterscheiden sie sich?
2. Kann der Lasereinsatz in der Praxis optimiert
werden?
3. Ist es ethisch vertretbar, für eine Laserbehandlung ein höheres Honorar zu verlangen?

4. Warum ist Diodenlaser nicht gleich Diodenlaser?
5. Auf Knopfdruck die richtige Therapie?
6. Kann heute noch ein 3-Watt-Nd:YAG-Laser erfolgreich in die Behandlung integriert werden?
Zusätzliche Fragen der Teilnehmer werden in einer Podiumsdiskussion besprochen und können
der DGL bereits im Vorfeld zugesandt werden.
In den angebotenen Workshops sollen Schwerpunkte wie Endodontie, Parodontologie, Kinderzahnheilkunde, Implantologie und Periimplantitis,
minimalinvasive Kariologie und Kavitätenpräparation sowie Ästhetische Zahnheilkunde und Bleaching
diskutiert werden. Des Weiteren finden ein Marketing- und Abrechnungsworkshop statt. Die Teilnehmer erhalten ebenso einen Überblick über die
neuesten Änderungen im Bereich der Lasersicherheit (neue Verordnung OStrV & TROS)._

Einladung zur DGL-Mitgliederversammlung
Freitag, 23.06.2017, 11.30 – 12.30 Uhr
Aachen – Universitätsklinikum
WERDEN SIE
DGL-MITGLIED

Tagesordnung:
TOP 1
TOP 2
TOP 3
TOP 4
TOP 5
TOP 6

Genehmigung der Tagesordnung
Bericht des DGL-Vorstandes
Vorstandswahlen
WFLD/DGL-Weltkongress 2018 in Berlin
Anträge zur Mitgliederversammlung
Verschiedenes

Assoziierte Gesellschaft
der DGZMK

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

laser

2 2017

[47] =>

Freitag, 23.06.2017, 08.00 – 18.00 Uhr | Aachen – Universitätsklinikum
09.00 Uhr

Begrüßung und Eröffnungsansprache
Prof. Gutknecht, RWTH Aachen

09.30 Uhr

Klinisch relevante Indikationen für
den Einsatz des 455/660/970 nmDiodenlasers

10.00 Uhr

10.30 Uhr

Klinisch relevante Indikationen für
den Einsatz des 2.940 nm-Erbium
YAG Lasers

11.00 Uhr

Klinisch relevante Indikationen für
den Einsatz des 2.790 nm Er,Cr:YSGG
Lasers

11.30 Uhr

Klinisch relevante Indikationen für den
Einsatz des 810 nm-Diodenlasers

11.30 Uhr

DGL-Mitgliederversammlung

12.30 Uhr

Mittagspause

Klinisch relevante Indikationen für
den Einsatz des 940 nm-Diodenlasers

Workshop

Aussteller

Thema

Referent

1+2

Dentsply Sirona

Der Sirolaser – Eine Übersicht
über seine drei Wellenlängen,
445/660/970 nm // Hands-on

Dr. Johannes-Simon Wenzler

3

Biolase

Laserunterstützte Kinderzahnheilkunde / Von Kons bis Chirurgie

Dr. Gabi Schindler-Hultzsch

4

Biolase

Laserunterstützte Chirurgie /
Dioden- oder Er,Cr:YSGG-Laser?

Dr. Gabi Schindler-Hultzsch

5

Morita

Die Anwendung des Er:YAGLaser in der Praxis

Dr. Detlef Klotz

6

DGL

Neuerungen in der Lasersicherheit

Dr. René Franzen

7

DGL

Neuerungen in der Abrechnung

Dr. Detlef Klotz

Jeder Teilnehmer muss an mindestens drei unterschiedlichen Workshops teilgenommen haben, um sein
Zertifikat mit 8 Fortbildungspunkten erhalten zu können. Folgende Workshops werden angeboten, in die
Sie sich bitte vorab bei den Ausstellern eintragen.
Uhrzeit

Dentsply Sirona

Biolase

Morita

14.00 – 15.00 Uhr

1

2

4

15.00 – 16.00 Uhr

1

3

4

16.00 – 17.00 Uhr

1

2

4

17.00 – 18.00 Uhr

1

3

4

DGL

18.00 – 18.30 Uhr

5

18.30 – 19.00 Uhr

6

Änderungen vorbehalten

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

Assoziierte Gesellschaft
der DGZMK

[48] =>

news

germany

Laserzahnmedizin kompakt

Jahrbuch Laserzahnmedizin 2017
Das umfassend überarbeitete und aktualisierte Jahrbuch Laserzahnmedizin
in seiner 18. Auflage ist die einzige rein deutschsprachige Laserzahnmedizin-Publikation am Markt. In der Fülle an Fachartikeln, Grundlagenbeiträgen sowie den aktuellsten Lasermarktübersichten ermöglicht es einen fundierten Einblick für Einsteiger und erfahrene Anwender. Neben bewährten
Verfahren greift das neue Jahrbuch Laserzahnmedizin 2017 in mehreren
Artikeln auch die Ultrakurzpulslasertechnologie auf, welche entscheidende
Verbesserungen auf dem Gebiet der Laserzahnheilkunde ermöglichen
könnte. Zusätzlich stellen sich
erfahrene Industriepartner der
Laserzahnmedizin vor und führen
in ihre Produkte und Services auf
diesem Gebiet ein. Einen besseren und aktuelleren Überblick, als
es das Jahrbuch Laserzahnmedizin 2017 bietet, gibt es nicht.
Das Jahrbuch ist zum Preis
Zum OEMUS Onlineshop
von 49 Euro (zzgl. MwSt +
Versand) im OEMUS Onlineshop erhältlich oder kann über
grasse@oemus-media.de angefordert werden.
Quelle: OEMUS MEDIA AG

Zufriedenere Patienten dank

Online-Terminlösung
Das Angebot einer Online-Terminbuchung wirkt sich positiv auf die allgemeine Zufriedenheit von Patienten mit ihren Ärzten aus. Das zeigt eine Auswertung der Arztbewertungen auf www.jameda.de. Demnach erhalten Mediziner, die ihren Patienten eine Online-Terminbuchung anbieten, auf einer
Schulnotenskala von 1 bis 6 die Durchschnittsnote 1,28, womit sie deutlich
besser abschneiden als ihre Kollegen ohne Online-Terminbuchung. Letztere
werden von ihren Patienten mit der Durchschnittsnote 1,80 bewertet.
Patienten bewerten zahlreiche Aspekte ihres Arztbesuchs besser, wenn es
sich um eine Praxis mit Online-Terminbuchung handelt. So fällt zum Beispiel
die Wartezeit auf einen Termin (1,42) bei diesen Arztpraxen deutlich besser
aus als bei Medizinern, die keine Online-Terminbuchung anbieten (1,88).
Quelle: jameda

Henry Schein Gründer Camp

Das Gründerforum für Zahnärzte
Am 29. und 30. September 2017 findet eine
Veranstaltungspremiere statt: Das Gründer
Camp von dent.talents., eine Plattform für Austausch, Inspiration und Networking rund um die
Zukunft in der eigenen Praxis. Geboten wird ein
abwechslungsreiches Programm in der Union
Halle in Frankfurt am Main. Im östlichen Szeneviertel der Stadt gelegen, passt die Location
perfekt zur Atmosphäre, die das Gründer Camp
ausmacht: kreativ und inspirierend.
Das Gründer Camp bereitet interessierte Zahnärzte auf die Existenzgründung vor. Wenn es um
die Frage „Selbstständigkeit: Ja oder Nein?“
geht, bietet das Camp Inspiration und Entscheidungshilfe. Häufig lassen kleine Impulse Ideen
für die Zukunft in der eigenen Praxis entstehen.
Acht Praxisgründerinnen und -gründer mit
unterschiedlichen Praxiskonzepten und Gründungsgeschichten werden einen Teil des Pro-

laser

2 2017

gramms abdecken und machen das Gründer
Camp zu einem komplett neuen Veranstaltungsformat. Alle Gründungen liegen maximal fünf
Jahre zurück. Durch diese Vielfältigkeit ist für
jeden Zuhörer etwas dabei. Ergänzt wird das
Programm durch weitere Gründungsspezialis-

ten aus den Bereichen Businessplan, Marketing,
Führung und Kommunikation.
Die Anmeldung ist unter www.denttalents.de/
gruendercamp möglich.
Quelle: Henry Schein

[49] =>

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
www.dgl-online.de

26. DGL-Jahrestagung Workshop-Kongress
23. Juni 2017 im Universitätsklinikum Aachen



Hiermit melde ich mich verbindlich zur 26. Jahrestagung der DGL im Universitätsklinikum Aachen am Freitag,
dem 23. Juni 2017, von 9.00 bis 19.00 Uhr an (inkl. Kaffee, Kaltgetränke, Mittagessen).

Name:

Straße/Nr.:

Vorname:

PLZ/Ort:

Unterschrift:

Datum:

Status:  DGL-Mitglied 230,– €

 Nichtmitglied 280,– €

 Student/Assistent/Helferin 90,– €

Die Bestätigung Ihrer Anmeldung erfolgt nach dem Eingang Ihrer Kongressgebühren auf das Konto der DGL:
Sparkasse Aachen, IBAN: DE56 3905 0000 0042 0339 44, BIC: AACSDE33

Allgemeine Bedingungen
Anmeldeschluss ist der 31. Mai 2017. Anmeldungen nach diesem Zeitpunkt können nur noch vor Ort bearbeitet werden (bis zur max. Teilnehmerzahl). Nach Zugang der Anmeldung ist diese für den Teilnehmer verbindlich.Die Gestaltung und Durchführung des wissenschaftlichen Programms obliegt der Deutschen Gesellschaft für Laserzahnheilkunde
e.V. Für die Durchführung der Workshops während der Dentalausstellung übernimmt die Deutsche Gesellschaft für
Laserzahnheilkunde e.V. keine Verantwortung.

Bankverbindung: Sparkasse Aachen, IBAN: DE56 3905 0000 0042 0339 44, BIC: AACSDE33

[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,
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Liang Ling Seow, Shaymant Singh Makhan,
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Peter Fahlstedt, Ali Saad Alghamdi, Alireza Fallah,
Michel Vock, Hsin-Cheng Liu, Sajee Sattayut,
Anna-Maria Yannikos, Ryan Seto, Joyce Fong,
Iris Brader, Masoud Mojahedi, Gerd Volland,
Gabriele Schindler, Ralf Borchers, Stefan Grümer,
Joachim Schiffer, Detlef Klotz, Jörg Meister,
Rene Franzen, Andreas Braun,
Sabine Sennhenn-Kirchner, Siegfried Jänicke,
Olaf Oberhofer, Thorsten Kleinert
Editorial Office
Georg Isbaner
g.isbaner@oemus-media.de
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c.jahn@oemus-media.de
Product Manager
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t.krause@oemus-media.de

Executive Producer
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meyer@oemus-media.de
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Sandra Ehnert
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kontakt@oemus-media.de
www.oemus.com
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Silber Druck oHG
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laser international magazine of laser dentistry
is published in cooperation with the World
Federation for Laser Dentistry (WFLD).
WFLD Headquarters
University of Aachen Medical Faculty
Clinic of Conservative Dentistry
Pauwelsstr. 30, 52074 Aachen, Germany
Tel.: +49 241 808964
Fax: +49 241 803389644
ngutknecht@ukaachen.de
www.wfld-org.info

www.laser-magazine.com

Copyright Regulations

laser international magazine of laser dentistry is published by OEMUS MEDIA AG and will appear in 2017 with one issue every quarter. The

magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inad
missible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
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check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
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assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or
faulty r epresentation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.

50

laser

2 2017

[51] =>

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laser 2/17

www.oemus.com/abo

Vol. 18 • Issue 2/2017

issn 1868-3207

implants

Vol. 9 • Issue 2/2017

issn 2193-4665

laser
international magazine of

2

international magazine of

2

oral implantology

2017

laser dentistry

2017
research
Immediate restoration in the
digital workflow—Part I

case report
Sinus elevation with short implant

industry
Augmentation and defect filling
in oral surgery

ceramic

implants

international magazine of ceramic implant technology

case report
Diode-laser assisted
vital pulp therapy

case report

research

Treatment of black hairy tongue

How to successfully
place ceramic implants

event

industry

6th IAOCI World Congress
in Miami

Laser in soft tissue treatment

interview
“Metal-free restorations are
medically relevant”

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[52] =>

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[cover] => laser international No. 2, 2017

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Table of contents

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