laser international No. 1, 2013

Cover / Editorial / Content / Laser versus conventional therapies / Photodynamic therapies – Blue versus Green / Becoming kissable: Laser-assisted haemangioma removal / Industry report / Manufacturer news / 1st International Congress of WALED and GLOBAL2013 in Istanbul / The next chapter in the IDS success story / News / Imprint

Open PDF View E-paper Edit Epaper Edit Epaper ads save

Table of contents

Open Link

Open Link

Open Link

) ) [pdf_filetime] => 1729567073 [s3_key] => 60045-da75fbd9 [pdf] => laser0113.pdf [pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/60045/laser0113.pdf [pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/60045/laser0113.pdf [should_regen_pages] => 1 [pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/60045-da75fbd9/epaper.pdf [pages_text] => Array ( [1] =>

issn 2193-4665

Vol. 5 • Issue 1/2013

laser

international magazine of

laser dentistry

1

2013

| overview
Laser versus conventional therapies

| research
Photodynamic therapies – Blue versus Green

| industry report
Long-term treatment of peri-implant lesions in
geriatric dentistry

[2] =>

[3] =>

editorial

Cologne in the
eyes of laser
dentistry

I

Dr Georg Bach

Dear readers of laser international magazine of laser dentistry,
I must confess that the headline of this editorial is a little presumptuous—and of course, not
only is Cologne in the focus of the dental community, but the whole dental family is watching
the city on the Rhine. This time, for sure, it is not because of the carnival, but because of IDS,
International Dental Show, which starts only shortly after.
Although we have experienced this dental trade show for decades, it still radiates a hard-todescribe mixture of curiosity, thirst for knowledge and fascination.
IDS has always been a special event for laser dentistry, if not even the motor of this incredible and sometimes turbulent development this dental specialty has undergone since the early
1990s.
Judging from the hype triggered by the first Nd:YAG lasers presented in Cologne as well as
the “all new” area of laser-supported hard tissue therapies and photodynamic therapy, laser dentistry has brought about a multitude of both new and aspiring laser users: IDS has always proved
to be the perfect place for laser dentistry!
As the dental laser industry is well aware of this fact, all important manufacturers and distributors are represented with stands, staff and equipment and even with an entertaining programme.
Of course, dear reader, I am not yet able to predict if the time-honoured Cologne exhibition
halls will witness a new laser hype, but you will certainly encounter state-of-the-art dental lasers
at IDS. Therefore, I wish you as well as our editorial team much fun at IDS 2013!
Independently from whether or not you will be able to visit Cologne, I hope that all readers of
laser international magazine of laser dentistry will enjoy this issue!

Warm regards,

Georg Bach

laser
1
I 03
_ 2013

[4] =>

I content _ laser

page 06

page 10

I editorial

I education

03

44

Cologne in the eyes of laser dentistry

| AALZ Germany

I overview
Laser versus conventional therapies
| Cristiane Meira Assunção et al.

I meetings
46

The next chapter in the IDS success story
| Koelnmesse

I research
10

1st International Congress of WALED and
GLOBAL 2013 in Istanbul

| Dr Georg Bach

06

page 26

Photodynamic therapies – Blue versus Green

I news
42

Manufacturer News

I case report

48

News

26

I about the publisher

| Dr Michael Hopp et al.

Becoming kissable:
Laser-assisted haemangioma removal

50

| imprint

| Dr Darius Moghtader

I industry report
30

Er:YAG Garnet in laser-assisted crown lengthening
| Dr Avi Reyhanian

34

Long-term treatment of peri-implant lesions in
geriatric dentistry
| Dr Georg Bach

38

X-Runner Er:YAG dental laser application

Cover image courtesy of Fotona,
www.fotona.com

| Prof. Dr Carlo Fornaini

page 34

04 I laser
1_ 2013

page 44

page 46

[5] =>

www.lightwalkerlaser.com

After endodontic laser
treatment there is no smear
layer around the opening
of the lateral canal.

www.fotona.com

The universe at your ﬁngertips.

Introducing the highest technology dental laser system
Supreme clinical results in:
TM

TwinLight Perio Treatments (TPT)
TwinLightTM Endo Treatments (TET)
Effective oral implant surgery
Gentle TouchWhiteTM bleaching
Patient-friendly conservative dentistry

Unmatched simplicity of use:
Pre-sets for over 40 applications
Intuitive user navigation
Balanced and weightless OPTOflex arm
Nd:YAG handpiece detection system
Er:YAG scanner ready

88897/21.0

Journey into a new dental experience with speed, precision and great results.
Visit www.lightwalkerlaser.com today!

[6] =>

I overview

Laser versus
conventional therapies
Authors_Cristiane Meira Assunção, Joanna Tatith Pereira, Renata Schlesner Oliveira &
Dr Jonas de Almeida Rodrigues, Brazil

be considered: safety, efficacy and effectiveness.
From an ethical standpoint, it is important to use the
best available evidence when making clinical decisions.2

_Diagnostic laser applications

Fig. 1a
Fig. 1a_DIAGNOdent 2095.

_Introduction
In recent years, several studies have been conducted on the clinical applications of laser in dentistry. At the same time, there has been a marked
emergence of organisations in support of the use of
laser in dentistry. In the last decades, laser therapy
has been used in dentistry as an adjunct or alternative to conventional approaches. In this paper, the
following topics will be reviewed: the application of
laser in caries prevention and diagnosis, hard- and
soft-tissue treatments, and periodontal and endodontic procedures. There is a large research effort
into new indications for laser in dentistry. It is expected that laser will become an essential component of the dentist’s armamentarium.
While the technology was regarded as complex
and of limited use in clinical dentistry in the past, a
growing awareness of the usefulness of laser in the
modern dental practice has been observed. Laser can
be used as an adjunct or alternative to conventional
approaches.1 When comparing the use of laser with
conventional therapies, three important areas must

06 I laser
1_ 2013

The most common methods for caries detection
are visual and radiographic examination.3 However,
visual examination is a subjective method that depends on the knowledge and clinical experience of
the examiner.3-6 Several studies have demonstrated
that radiographic examination demonstrates poor
sensitivity to non-cavitated lesions.3, 7-9 For this reason, fluorescence-based methods have been developed, aiming at the detection of occlusal and approximal carious lesions, for example DIAGNOdent
2095 (KaVo; LF; Figs. 1a-c) and DIAGNOdent 2190
(LF pen; Figs. 2a & b). They rely on the same principle:
a laser diode emits red light at 655 nm and a photodetector quantifies the reflected fluorescence
from bacterial metabolites (fluorophores) in carious
lesions, showing values ranging from 0 to 99.3,9
A study that assessed the performance of a visual
method, radiographic examination and fluorescence-based methods in detecting occlusal caries in
primary teeth found that the visual method and
VistaProof fluorescence camera (Dürr Dental; FC)
exhibited better accuracy in detecting enamel and
dentine carious lesions, whereas the visual method
combined with LF, LF pen and FC better detected dentine lesions on occlusal surfaces in primary teeth,
with no statistically significant difference among
them.3
Another study compared the performance of
fluorescence-based methods (FC, LF and LF pen), radiographic examination, and another visual

[7] =>

Let there be light!
4th Congress
of the
European Division

Brussels, July 11–12, 2013
www.wfldbrussels2013.com
You are cordially invited to participate
For information, please visit our website

Congress President:

Honorary Presidents:

Pr S. Nammour

Pr Lynn Powel; Pr Isao Ishikawa ,
Pr Hong Sai Loh, Pr Jean Paul Rocca,
Pr Norbert Gutknecht

International Organizing Committee
Chairman: Pr Roly Kornblit
Dr Boris Gaspirc (Slovenia)
Dr Peter Fahlstedt (Sweden)
Pr Anton Sculean (Switzerland)
Dr Miguel Vock (Switzerland)
Pr Ferda Tasar (Turkey)
Pr Sevil Gurgan (Turkey)
Pr Christopher Mercer (UK)
Dr Miguel Martins (Portugal)
Dr Marina Vitale (Italy)
Dr Sharonit Sahar-Helft (Israel)
Pr Lajos Gaspar (Hungary)
Dr Dimitris Strakas (Greece)
Dr Kallis Antonis (Greece)
Pr Matthias Frentzen (Germany)
Dr Frederick Gaultier (France)
Dr Gérard Navarro (France)
Pr Marita Luomanen (Finland)
Dr Peter Steen Hansen (Denmark)
Pr Julia Kamenova (Bulgaria)
Dr Emina Ibrahimi (Austria)
Dr Anna Maria Yiannikou (Cyprus)
Pr Igor Shugailov (Russia)
Dr. Oleg Tysoma (Ukraine)
Pr Assem Soueidan (France)

International Scientific Committee
Chairman: Pr Carlo Fornaini (Italy)
Pr Jean Paul Rocca (France)
Pr Norbert Gutknecht (Germany)
Pr Paolo Vescovi (Italy)
Pr Umberto Romeo (Italy)
Pr Antoni J. Espana Tost (Spain)
Pr Josep Arnabat (Spain)
Pr Carmen Todea (Romania)
Pr Adam Stabholz (Israel)
Dr Thierry Selli (France)

Local Organizing Committee:
Chairman: Pr Roeland De Moor
Marc Tielemans
Daniel Heysselaer
Amaury Namour
Secretariat: Cristina Barrella Penna
Chairman for commercial relations & Promotion:
Pr Roly Kornblit

www.wfldbrussels2013.com

[8] =>

I overview
method called the International Caries Detection
and Assessment System (ICDAS) II on occlusal surfaces. This study demonstrated that the combination of ICDAS and bite-wing radiographs yielded
the best performance for detecting caries on occlusal surfaces.9

_Caries prevention:
Enhancing enamel resistance
In the past, several in vitro studies have shown
that enhancing enamel demineralisation resistance
can be achieved by irradiation with lasers. In a blind
in vitro study, Ana et al. 20121 compared the effect of
professional fluoride application with that of laser irradiation with regard to the demineralisation of
enamel and fluoride formation and retention. The
study found that both methods enhanced enamel resistance, and no side-effects were found. A greater
concentration of retained calcium fluoride-like material was found in the laser group. Formation and retention of calcium fluoride were also improved with
laser irradiation.
The wavelengths absorbed most strongly by dental enamel are the 9.3 and 9.6 µm carbon dioxide laser
wavelengths. The reduction in acid dissolution of
enamel is said to be caused by a loss of the carbonate
phase of enamel crystals due to the heat of irradiation. Rechmann et al. 201110 demonstrated that
short-pulsed 9.6 µm carbon dioxide laser irradiation
successfully inhibited enamel caries without any
harm to the pulpal tissue of the teeth irradiated. The
efficacy of carbon C02 laser irradiation regarding its
long-term effect on caries resistances can be verified
by further studies.

_Hard-tissue applications:
Caries removal

Fig. 1b_Tip A for occlusal surfaces.
Fig. 1c_Tip B for smooth surfaces.

Fig. 1b

There is limited evidence to support the effectiveness of dental lasers in the removal of caries compared with rotary burs. In order to evaluate this, a systematic review of seven studies with adequate
methodologies was performed.8 Two of the studies

Fig. 1c

08 I laser
1_ 2013

found that there was no difference with regard to
time taken for caries removal and cavity preparation.
Four of the studies found that the laser took up to
three times longer to perform these procedures. Four
of the studies found that there were no differences
between lasers and rotary burs with regard to pulpal
effects. One of the studies found that dentists preferred the bur to the laser, and all the studies found
that patients favoured the laser with respect to comfort. The studies found that adult patients prefer the
laser, although the response from children was inconclusive. The results are not surprising, considering that local anaesthesia is often not needed when
using a laser, making the overall dental experience
more pleasant for the patient.10

_Endodontic laser procedures
(disinfection)
The main causes of endodontic treatment failure
are the presence of persistent micro-organisms and
recontamination of the root canal owing to inadequate sealing.11 The long-term success rate of conventional endodontic treatment depends on several
factors, such as the diverse and complex anatomy of
the root-canal system that consists of small canals
diverging from the main canal. This complex system
does not allow direct access during biomechanical
preparation because of the canals’ positioning and
diameter.6 New antimicrobial approaches to disinfecting root canals have been proposed; these include the use of high-power lasers and photodynamic therapy, which works by dose-dependent
heat generation. However, in addition to killing bacteria, they have the potential to cause collateral
damage such as charred dentine, ankylosed roots,
melted cementum, root resorption and periradicular
necrosis.2
In order to compare the effectiveness of antimicrobial photodynamic therapy with standard endodontic treatment and combined treatment to
eliminate bacterial biofilms present in infected root
canals, a study was conducted on ten single-rooted
freshly extracted human teeth inoculated with stable bioluminescent Gram-negative bacteria. It
found that endodontic therapy alone reduced bacterial bioluminescence by 90 %, while photodynamic therapy alone reduced bioluminescence by
95 %. The combination reduced bioluminescence by
up to 98 %, and, importantly, the bacterial regrowth
observed 24 hours after treatment was much less for
the combination group than for the treatment
groups individually.12
Alternatives to conventional therapies to improve the disinfection of root canals are Nd:YAG and
Er:YAG lasers. One study evaluated the bactericidal

[9] =>

overview

efficacy of Nd:YAG and Er:YAG lasers in experimentally infected curved root canals and concluded that
in the straight root canals the Er:YAG laser had a
bactericidal effect of 6.4 to 10.8 % higher than that
of the Nd:YAG laser. Conversely, the bactericidal effect of the Er:YAG laser in the curved root canals was
1.5 to 3.1 % higher than that of the Nd:YAG laser.13
These results suggest that further development of
the endodontic laser tip and techniques are required
to ensure its success.
Fig. 2a

_Periodontal laser procedures
(disinfection)
Conventional periodontal therapy procedures
include mechanical scaling and root planing, which
has some limitations, especially in reducing bacteria
inside deep pockets. In order to overcome the limitations of conventional mechanical therapy, several
adjunctive protocols have been developed. Among
these, laser has been proposed for its bactericidal
and detoxification effects and for its ability to reach
sites that conventional mechanical instrumentation
cannot.14
Different lasers could be used in periodontal
therapy for calculus removal, periodontal pocket
disinfection, photoactivated dye disinfection of
pockets and de-epithelialisation to assist regeneration.15
Several studies have indicated that the diode
laser, with a wavelength of between 655 and 980 nm,
can accelerate wound healing through the facilitation of collagen synthesis, promotion of angiogenesis, and augmentation of growth factor release. Furthermore, the diode laser has in vitro bactericidal
and detoxification effects and can prevent ablation
of the root surface, which theoretically reduces the
risk of removal of normal root tissue.13
Sgolastra et al. 201214 did not observe significant
differences for any investigated outcome (clinical
attachment level, probing depth, and changes in the
plaque and gingival indices) in their systematic review. These findings suggest that the use of the
diode laser as an adjunctive therapy to conventional
non-surgical periodontal therapy did not provide
additional clinical benefit. However, given that few
studies were included in the analysis, the results
should be interpreted with caution. Important issues
that remain to be clarified include the influence of
smoking on clinical outcomes, the effectiveness of
the adjunctive use of the diode laser on microbiological outcomes, and the effect of adverse events.
Future studies are required to assess the effectiveness of the adjunctive use of the diode laser, as well
as the appropriate dosimetry and laser settings.

Fig. 2b

Fig. 3

Fig. 2a_Cylindrical tip for occlusal
surfaces.
Fig. 2b_Wedge-shaped tip for
proximal surfaces.
Fig. 3_Infra-red laser therapy for
treatment of a primary herpetic
infection in an adolescent patient
undergoing chemotherapy
(Therapy XT, DMC).

_Soft-tissue applications
There are numerous soft-tissue procedures that
can be performed with laser. Two key advantages of
this are reduced intra-operative bleeding and less
post-operative pain compared with conventional
techniques, such as electrosurgery. Certain procedures in patients with bleeding disorders are better
suited to lasers with greater haemostatic capabilities.5

_Conclusion
Although the results of laser therapy are similar
(in safety, efficacy and effectiveness) to those obtained with conventional methods, new techniques
and devices have been developed. Laser could thus be
an evidence-based and well-supported treatment
option for the dentist in daily dental practice._
Editorial note: A list of references is available from the publisher.

_contact

laser

Dr Jonas de Almeida Rodrigues
School of Dentistry
Federal University of Rio Grande do Sul
Av. Paulo Gama, 110
Porto Alegre – RGS
90000-000
Brazil
jorodrigues@hotmail.com

laser
1
I 09
_ 2013

[10] =>

I research

Photodynamic therapies –
Blue versus Green
Author_Dr Michael Hopp & Prof. Dr Reiner Biffar, Germany

_Introduction
After the successful introduction of antimicrobial
photodynamic therapy based on methylene and toluidine blue, a green medical colouring agent which is activated at 810 nm has become available. The following
article illustrates its indication, range of effects and
therapy efficiency in comparison to the classical blue
agents. Photodynamic therapy (PDT) as a minimally invasive oncological method performed with injected
photosensitisers has been advanced to a non-invasive,
surface-oriented therapy in dentistry. Its main indications are bacteria, which is why it has been marked “antibacterial”: antimicrobial photodynamic therapy
(aPDT). aPDT entails a light-induced inactivation of cells,
microorganisms or molecules without destroying the
tissue. Therefore, aPDT or PDT in periodontology, endodontology, professional tooth cleaning, as well as
periimplantitis and mucosa treatment must be differentiated from invasive therapies such as hard-tissue
treatments in enamel, dentine and bone, surgery, periodontal treatment, endodontology and invasive periimplantitis therapy.
Fig. 1_Structural formula of
methylene blue (MB).
Fig. 2_Structural formula of
toluidine blue (TBO).
Fig. 3_Structural formula of
indocyanine green (ICG).

Fig. 1

Fig. 2

In aPDT, two effects are brought together: the lowlevel, highly pervasive laser energy with the photodynamic effect resulting in high tissue efficiency and the
colouring agent activation resulting in a bactericidal effect via singlet and triplet oxygen, which harms the unsaturated fatty acids in the colour-marked membranes
and their organelles. In addition, they initiate the disintegration of the bacterial membranes and therefore
cause the bacteria to die. These two effects are linked inseparably in aPDT. Parallelly to reducing bacteria, laser
light which has not been absorbed promotes healing.
Even the application of laser light alone will reduce dental plaque1, thus leading to a reduced healing time. In
previous years, aPDT has been associated with a multitude of synonyms: PACT—photoactivated chemotherapy, PDD—photodynamic disinfection, LAD—light-activated disinfection, PAD—photoactivated disinfection,
among others. These terms signify a principle rather
than actually contributing to an enhanced insight into
the concept. They can therefore be seen as marketingoriented neologisms.
Laser-, LED- und colouring agent systems have become available in larger quantities and can be integrated to other therapies. Possible combinations are:
– LED 630 nm—toluidine blue O—Fotosan/Fotosan 630
– Laser 635—toluidine blue O—PACT system, R+J,
Two in one, MDL 10, among others
– Laser 670 nm—methylene blue, HELBO system,
Periowave, among others
– Laser 810 nm—methylene blue derivative—Photolase
system
– Laser 810 nm—indocyanine green—EmunDo,
PerioGreen

_aPDT/PDT application in dentistry

Fig. 3

10 I laser
1_ 2013

Periodontology
Periodontology is the most prominent field of application for aPDT/PDT in dentistry to date. aPDT can be applied specifically to target infected and contaminated
tissues or organic structures (periodontitis, periimplan-

[11] =>

Master of Science (M.Sc.) in
Lasers in Dentistry
Next Start:

23 September 2013
Aachen, Germany
4 semesters

Become part of the International Dental Elite

RWTH International Academy
Kackertstraße 10 I 52072 Aachen I Germany
phone +49 241 80 23543 I fax +49 241 80 92525
info@academy.rwth-aachen.de
www.academy rwth-aachen.de

PROFESSIONAL EDUCATION PROGRAMMES

t

Create new economic potential for your practice

t

Two year career-accompanying postgraduate programme at the University of Excellence RWTH Aachen

t

Combination of lectures, skill training sessions, live ops,
tutorials, and practical workshops

t

Internationally accepted and accredited by the German
Governent, the European Union, the Washington Accord
and the Bologna Process

t

Science-based and practice-orientated on highest national and international level

t

Increased patient satisfaction: minimal contact reduced
vibration and pain

AALZ GmbH
Pauwelsstraße 17 I 52074 Aachen I Germany
phone +49 241 47 57 13 10 I fax +49 241 47 57 13 29
info@aalz.de
www.aalz.de

[12] =>

I research
Fig. 4_Intensity differences between
methylene blue (Blue Sensitizer,
HELBO, on the left) and toluidine
blue O (PACT, Cumdente,
on the right).
Case 1
Fig. 5_ Blue Sensitizer (HELBO)
applied to the sulcus.
Fig. 6_Laser light application
to the sulcus.

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Fig. 13

Case 2
Fig. 7_Measuring of progressing
bone resorption.
Fig. 8_Selective laser application
according to protocol.
Fig. 9_Inflammation-free condition
after 30 days.
Case 3
Fig. 10_Entrance to the inflamed
bone cavity after pus removal.
Fig. 11_Application of Blue
Sensitizer to the cavity.
Fig. 12_ TeraLite laser application.
Fig. 13_Removal of a bone
sequestrum from a bone cavity which
is almost completely epithelialised.

12 I laser
1_ 2013

[13] =>

research

titis, infected mucosa or other areas of the patient’s
skin).2-4 De Olivera et al.5 have reached comparable clinical results in their split-mouth investigations of aPDT in
comparison to scaling and root planing (SRP). Wilson et
al.6,7 have introduced the basics of low-level laser application with photosensitive substances in bacteria.
PDT treatment can be applied in dentition damaged
by periodontitis:
1. As an immediate measure in acute gingivitis or periodontitis.
2. As a consecutive conventional periodontitis therapy
in intervals of three days up to two weeks.
3. In unspecific prophylactic bacterial reduction in extended professional tooth cleaning in intervals of
one to two years.3,8
aPDT applications have provided good results and a
significant reduction of the microbial load.9 In periodontitis caused by Porphyromonas gingivalis, a reduced bone resorption in comparison to the control
group was observed in animal studies after colouring
agent-activated laser treatment with toluidine blue.10
Comparing different laser systems with regard to their
adjuvant application, Brink and Romanos11,12 showed
that mechanical cleansing combined with aPDT resulted in the highest possible reduction of microbes in
the dental pockets. The highest reduction was verified
after three months. Actinobacillus actinomycetemcomitans, now named Aggregatibacter actinomycetemcomitans, was eliminated after treatment
with one of the systems (aPDT, 1,064 nm laser, 980 nm
laser). Investigations in patients of an open dental practice showed a microbial reduction of 80,11 % after four
weeks and 91,37 % after twelve weeks compared to the
initial findings of aPDT in comparison to the abovementioned laser systems. Sulcus bleeding index, pocket
depths and mobility of the teeth were significantly reduced after treatment. In cases of minimal pocket
depths of three to four millimetres, aPDT can be the sole
therapy. A fast recolonialisation of the periodontic tissue was minimised by PDT after two days.13 They showed
in their study that roughly 95 % of A. actinomycetemcomitans and F. nucleatum and 99–100 % of the blackpigmented bacteria, such as P. gingivalis and P. intermedius and S. sanguis were eliminated. Rühling et al.14
did not note any advantages in PDT with regard to conventional treatment, but they admit that it can be an alternative. The initial treatment of periodontitis with
amoxicillin and metronidazole (Winckelhoff cocktail) is
favoured by Griffiths et al.15 over an invasive treatment.
An initial administration of antibiotics achieved better
results than did subsequent treatment. A critical discussion on the administration of metronidazole was
conducted only reluctantly. Procedures which are
specifically tropical (aPDT) and of a high selectivity are
more favourable in the aftercare of periodontally dam-

aged patients than broad-spectrum antibiotic treatments, which have various side effects and are often accompanied with a limited compliance of the patients.16
Hägi & Sculean17 do not consider aPDT which is free
from side effects and bactericidal a significant improvement over antibiotic therapies, with the exception
of severe and aggressive periodontitis.
The importance of pulpal temperature rise in periodontal treatments is described by El Yazami et al.18 with
an average temperature rise of roughly 0,5°C at
5,46 J/cm2 for 60 s with a diode laser of 660 nm (output:
20 mW). Another advantage of aPDT is that it can be performed by a trained assistant if the patient has been
treated accordingly before. This kind of laser treatment
(class 3B) is a physical, non-invasive therapy19 which can
be delegated. Whereas the doctor is in charge of supervision, control and overall responsibility of delegated
tasks with respect to a commission with single allocation defined in concrete terms, he does not have to execute the delegated tasks. Treatment is free of pain and
non-destructive on the tissues. However, its application
in the bleeding dental pocket would neutralise its effect
almost completely. Therefore, a time-shift is recommended in this treatment. The activation of epithelia
and bone growth, vascularisation and an increase in
phosphorylation are important for the production of
ATP in the healing phase and their effects on mitochondria and enzymes of the respiratory chain have long
been assumed.20,21 Bosatra22 showed that low-energy
laser light induces the synthesis of fibres in the tissue in
1984. Tocco et al.23 and Boulton et al.24 proved an increase in fibroblast growth by HeNe (630 nm) and
IR laser application.
Implantology
In implantology, aPDT is applied in mucositis or manifested periimplantitis as a closed therapy or as an open
therapy in combination with surgical measures. An important advantage of athermal laser applications is the
lack of superficial changes of the titan and of ruptures.
Oral and maxillofacial surgery
In oral and maxillofacial surgery, photodynamic disinfection of bone or soft tissue defects during the final
surgical phase is an additional means of prevention. Local or systemic toxicity of the photosensitiser as well as
damage by the source of light can be excluded because
of the low energy level. Lingohr et al.25 have described
advantages with regard to apicoectomies. Neugebauer
et al.26 have observed positive effects on the prevention
of alveolar ostitis and the dolor post extractionem and
Conrad27 on the augmentation of infected alveoli. Nagayoshi et al.28 have proved a complete sterilisation of
the bone cavity via ICG with radiation for more than 60
seconds at 810 nm in the periapical defect model. PDT
can be an alternative to lengthy and highly-dosed antibiotic therapies in the treatment and post treatment

laser
1
I 13
_ 2013

[14] =>

I research

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Case 4
Fig. 14_Injection of a surplus of TBO (Fotosan)
in the periodontal pockets.
Fig. 15_High transillumination in palatinal laser application.
Fig. 16_Laser light application in the mandible.
Case 5
Fig. 17_PDT disinfection of the tissue surfaces after periodontal
surgery.

14 I laser
1_ 2013

Case 6
Fig. 18_Application of ICG solution.
Fig. 19_Transgingival laser application
with bare fibre.
Fig. 20_Laser application of the periodontal
pockets with bulb fibre.
Fig. 21_Removal of the inflamed pocket epithelium
at 300 mW.

[15] =>

research

of bone defects induced by diphosphate. It can also be
combined with surgery in the open operating site. A crucial side effect in laser therapy, however, is the stimulation of bone healing by photobiological effects of the
laser radiation. Guzzardella et al.29 have shown a significant effect on bone defect healing by laser light of a
wavelength of 780 nm in their experiments. Laser irradiation resulted in bone growth twice or three times the
amount as compared to conventional treatment. These
findings have been confirmed by other studies30, which
have also been published on red wavelengths of HeNe
lasers of low performance.31,32
Endodontics
Various low-consistent sensitisers and long slim applicators are offered for the disinfection of the root
canal. In addition to a possible discolouration of the root
dentine, there is the danger of a lack in in-depth moistening of the dentinal tubuli, which would limit the
effect on the prepared pulp cavity. The application of
type-4 lasers must be considered with regard to safety
as well as material and time saving.
Cariology (dentine hardening)
In cariology, PDT procedures for dentine hardening
usually are time-dependent processes with blue colouring agents. Multiple applications are sensible and gen-

tle on the dentine, since carious dentine is disinfected
and removed layer-by-layer. Disinfection of the occlusal
fissures is another possibility. A pulpal increase in temperature in the photodynamic treatment of deep carious lesions results in a rise in temperature of 0,8 – 1°C
after 30 seconds of irradiation.33 While a blue colouring
agent only permits a disinfection of the carious dentine,
ICG can also result in dentine removal. ICG-based caries
removal was examined by Rodrigues de Sant’anna et
al.34, who proved significant removal on the hard tissue.
McNally et al.35 also describe erosive processes without
any ruptures in the substance, whereas the temperature
rise in the pulpal area of extracted teeth depends on the
ICG concentration as well as the laser performance.
Caries removal via ICG is more invasive and has hardly
been examined to date. However, it suffices with one
single application. It remains to be seen whether it poses
a real alternative to Er:YAG and Er,Cr:YSGG lasers.
Skin und mucosa infections
Infections of mucosa or skin are a common oral or
periodontal phenomenon, resulting from bacterial or
viral infections. Here, PDT can be performed by the dentist as well as the dermatologist and other specialists.
Zolfaghari et al.36 have proved a photodynamic effect on
Staph. aureus by the combination of methylene blue
and laser light. In recent years, mycoses of the oral cavAD

Please visit us at:
trade fair hall 10.1
booth J030/K031

1. BodenseeLaser-Symposium
7 – 8 June 2013 |
Überlingen

Now that´s
something
to get my
teeth into.
Perio Green® effectively destroys bacteria in bioﬁlm, periodontal
pockets and dental implants, using photodynamic therapy (PDT).
For more information: www.periogreen.com

[16] =>

I research

Fig. 22

Fig. 23

Fig. 24

Fig. 25

Fig. 26

Fig. 27

Fig. 28

Fig. 29

Case 7
Fig. 22_Transgingival laser
application.
Fig. 23_Laser application in the
dental pockets with bulb fibre.
Fig. 24_Application of the ICG
solution in the periodontal pockets.
Fig. 25_Intrasulcular laser
application in the mandible.
Fig. 26_PDT/PTT treatment.

16 I laser
1_ 2013

Fig. 27_Condition free from
inflammation and swelling
after two weeks.
Case 8
Fig. 28_Insertion of the ICG colouring agent
(EmunDo, ARC).
Fig. 29_Laser application with bulb fibre.
Fig. 30_Healing of the acute episode after
three weeks.

Fig. 30

[17] =>

research

ity have become a focal point of dental treatment. Here,
photodynamic therapies are a new aspect in treating superficial mycotic infections. The target, which is the mycotic cell, as well as other microorganisms are eliminated, since the colouring agents are unspecific. In dermatology and mycotic therapy, activation via conventional or LED light systems have been favoured so far,
since they are simple, reasonably priced and easy to apply on extensive surfaces. Malachite green, which is a
triphenylmethan-based colouring agent activated at
810 nm, has been used against Candida spp., whereas
blue photosensitisers have been successfully applied in
mycoses of mice in animal studies.37 The colouring agent
Green 2 W, activated at 630 nm, has provided good results in an in vitro study on Aspergillus fumingatus.38
Mucosa changes
The selective treatment of malign or semi-malign
mucosa changes is often bound to special photosensitisers which are activated by differing wavelengths. Porphyrin and its derivatives are often used for PDT in cancer cells. 5-aminolaevuline acid (5-ALA) is applied in
fluorescence diagnostics in urology, gynaecology and
dermatology as well as in the therapy of malign degenerations, such as urethral carcinomas in their initial
stage. Methylene blue is applied as well, but its low insertion depth of less than 20 µm minimizes its effect.
Extended prophylaxis
PDT can prove an effective measure for an extensive
prophylaxis to maintain healthy, but reduced gingiva
which is unresponsive to further treatment after periodontitis.8 Generally speaking, low-level lasers are applied more and more by trained assistants, especially in
the area of prophylaxis. If required, prophylaxis assistants can inform the patient on their own and perform
the relevant tasks according to the therapy chosen by
the dentist. In addition to an increase in treatment efficiency, delegating these tasks will result in a motivation
boost for the assistant, who can now work more autonomously.

_Photodynamic disinfection
Photodynamic disinfection auf prosthetics and impressions has been investigated in experiments. Vlahova et al.39 have tested various Phthalocyanine photosensitisers, activated with an LED light at 635 nm, with
regard to their performance in disinfection of MRSA,
Staph. aeruginosa and C. albicans. The disinfection of
silicones and composites by Ga-Phthalocyanine was
100 % and 40 % in Alginates. Therefore, Phthalocyanine
can be seen as an alternative to other, specialised disinfection methods.
Veterinary Medicine
In addition to human medicine and dentistry, veterinary medicine is another field in which photodynamic

therapies have proved to be successful treatment methods. Toth et al.40 have given convincing results for the
gentle treatment of infected extensive surface wounds,
for instance eosinophil ulcerated dermatitis in horses.

_Photosensitisers in dentistry
In dental procedures, four photosensitisers are currently applied. These are indocyanine green and three
kinds of phenotiazines: methylene blue, toluidine blue,
methylene blue derivatives. Whereas the effect of these
colouring agents on bacteria can vary, their charge—anionic or cationic—seems to play a vital role in their binding to bacteria (gram positive or negative), as do
preparatory medications or trypsinisation.41
1. Methylene blue
Methylene blue (MB), 3,7-bis(Dimethylamino)-phenothiazin-5-ium chloride (Fig. 1), was synthesised by
chemist Henrich Caro (BASF, Germany) in 1876. Already
in 1885 did Paul Ehrlich realise its advantages with regard to selective colouring in histology. Methylene blue
can be applied as a vital colouring agent in the vital
staining of live tissues. In the past, it was seen as an important antidote in nitrite or aniline poisoning. Its application as an antiseptic, for example in malaria, enteritis
and pyelitis cases, has become obsolete. Methylene blue
today is used as an antirheumatic and as a means of diagnosis. It has been considered a treatment option for
Alzheimer’s disease for some time and several investigations were conducted. Its low toxicity makes it an unproblematic substance in medicine, which can be seen
from its MAC (maximum workplace concentration)
value of 1,180 mg/kg (rat, perorally). If larger quantities
(0.5 ml and above) of methylene blue are swallowed,
urine will assume a green colour.42 Its absorption of max
661 nm makes this cationic colouring agent an ideal
sensitiser for red laser applications.
2. Toluidine blue O
Toluidine blue O (TBO), also known as tolonium chloride (Fig. 2), is a blue colouring agent (3-amino-7-[dimethylamino]-2-methylphenothiazine) which is used
for histological and intravital dyeing or as an antidote
in methemoglobin generator poisonings. In dentistry
and maxillofacial medicine, it is used as a test to differentiate between benign and malign precancerous
leukoplakia. However, the specificity of this test is too
low.
Similarly to methylene blue, toluidine blue has a low
antiseptic effect. Its low toxicity renders it an unproblematic medical substance: its LD50 in rats when administered intraperitoneally is 215 mg kg-1. If larger
quantities of toluidine blue O are swallowed, urine will
assume a green colour. An absorption of max 635
makes this colouring agent ideal for red lasers of this
wavelength.43

laser
1
I 17
_ 2013

[18] =>

I research
3. Methylene blue derivatives
Methylene blue derivatives are applied with wavelengths of 810 nm. There are only a few case descriptions
in the literature. Balboaca et al.44 have proved a shift in
the activation wavelength to 810 nm in methylene blue
derivatives. However, no exact description of the molecule applied in the Photolase system (Photolase Europe,
Ltd., Hamburg), based on 810 nm lasers, was found.
There was an attempt to explain the process by “changes
in the colouring agent molecules based on phenothiazine causing a ‘long-waved flank’ which results in
optical activation and irradiation of 810 nm”. Since the
necessary light dose can be achieved faster, treatment
time is said to be shortened considerably. In addition, an
increase in the output of reactive oxygen radicals (ROS)
is said to result from the undiluted solution.45 Other derivatives, such as New Methylene blue (NMB, 5564161G; Sigma) can reduce the activation wavelength similarly to toluidine blue O.37
4. Indocyanine green
Indocyanine green (ICG, Fig. 3), 1,7-Bis(1,1-dimethyl-3-[4-sulfobutyl]-1H-benz[e]indol-2-yl)heptamethinium-betain-Na, well-known in liver function
tests, ophthalmology and onkology46, is new in dentistry
but seems promising for periodontology.
Indocyanine green is an anionic photosensitiser
which is activated at 810 nm and leads to photo-oxidation. Here, the intra- and extracellular ICG concentration is vital and must comprise a temporal component.47
Its absorption depends on the dissolving medium,
bonds to the plasma proteins and its concentration.48
The overall effect of indocyanine green consists of 20
per cent photodynamics (PDT) as well as fluorescence
and, mainly, of its photothermal effect (PTT).49 The
thresholds in tissue coagulation are employed to make
use of photothermal effects free from side effects in
therapies of the ciliary body, which is a highly sensitive
tissue.50 For this, the dose-effect graph must be taken
into account precisely. ICG in the form of sodium salt is
combined with sodium iodide of up to 5 % to improve
solutions for medical treatment.51 In dentistry, the material used is free from iodide (EmunDo, ARC) or contains normal quantities of iodide (PerioGreen, elexxion).
There are no findings on how far material containing iodide can trigger allergies or anaphylactic reactions in
dentistry. Most of the medical treatments consider an
injection of ICG and its concentration in the target cells.
The photothermal effect of injected ICG has been applied in the therapy of telangiectatic leg veins in order
to obliterate tissue changes subcutaneously in an elegant manner.52 Laser energies of 100 – 110 J/cm2 are applied. Mathematical Modellation and comparison with
the results of scientific experiments, ICG concentration
and laser performance can be optimised with regard to
the tissue. Thus, excessive heating of the tissue can be

18 I laser
1_ 2013

prevented.53 The letal but selective effect of ICG on bacteria is a well-established fact. While Staphyloccocus
aureus and Strep. pyogenes are eliminated by the photodynamic effect, P. aerugenosaremains intact. The energy density applied was 411 J/cm2. An effective concentration was reached already at 25 µg/ml.54 ICG laser
systems can advance acne treatments significantly in
substituting or accompanying conventional therapies,
since the agents applied did not show any serious side
effects.55
Szeimies et al.56 observed excellent effects in the
treatment of AIDS-associated Kaposi sarcomas on the
outer skin, resulting in an almost complete remission of
the sarcomas. Laser welding of wounds as described by
Khosroshahi et al.57 can be performed with a relatively
low energy, avoiding in-depth tissues by topically applied ICG. The future will show if this technique can be
involved in welding neural tissue. An effective impact
of ICG on squamous cancer of the oral mucosa was
proved by Lim & Oh.58 The percentage of apoptotic cells
increased to 84 % six hours after ICG-PDT with 20 µM
ICG. The percentage of dead cells rose to 65 % in three
hours of applying a solution of 200 µM ICG. Contrarily
to other studies, they activated ICG via LED of a wavelength of 785 nm. This procedure can advance minimally invasive cancer therapy in the oral cavity significantly. Urbanska et al.59 observed a high effectiveness
of ICG in the pre-treatment of melanoma cells which
was five to ten times higher than the effects of conventional laser treatment with diode lasers of a wavelength
of 700 – 800 nm. Experts are currently working on the
implementation of polyurethane composites in the
production of intravenous catheters, since the antimicrobial activity against gram-positive bacteria results in
a reduction of 2 log10 units, such as methicillin-resistant Staphylococcus aureaus (MRSA) and Staphylococcus epidermidis after 15 minutes of exposure at an energy density of 31,83 J/cm2. Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) showed
only little reaction under the same conditions: they were
reduced by 0.5 log10-units.60
ICG is not resorbed by the intestinal mucosa, which
is why the danger of uncontrolled swallowing of the
material is non-existent. The metabolization of indocyanine green occurs microsomally in the liver and is excreted only via liver and the pancreatic ducts.61 ICG is of
a low toxicity. LD50 values in animals were 60 mg/kg in
mice and 87 mg/kg in rats.51 Restrictions of the visual
field with regard to the visual sense after intraocular ICG
application have further enhanced the discussion about
the toxicity of the material. Engel et al.49 proved in cellular experiments that the material which disintegrates
during photo oxidation obtains a cell-inhibiting effect
caused by its fission and decomposition products. ICG
is suitable for liver function diagnostics because of its
complete metabolization and excretion by the liver. In

[19] =>

research

addition, it can help differentiate between a normal,
healthy liver, liver dysfunctions and drug- or medicine
related liver anomalies because of its specific clearance
rate.62 ICG which is administered intravenously has a
half-life of three to four minutes, depending on the
liver performance. During pregnancy, its administration is not risk-free. Only few allergic reactions on ICG
containing iodine have been described in the literature.63

_Indocyanine green in dentistry
Only little published data is available on indocyanine
green in dentistry, mostly in vitro studies, figures based
on experience and case studies. Its application in periodontology has been postulated after successful in vitro
tests with regard to periodontally pathogen germs by
Boehm & Ciancio.64 This however has not yet been
proved by patient studies. More extensive studies are
currently being conducted.
From the practitioner’s point of view, the integration
of PDT and ICG in aftercare and the long-term stabilisation of periodontitis/periimplantitis have proved of
value.8 Combined with ICG photosensitisers, low laser
performance has a good effect on various bacteria of
the biofilm as well as the periodontal pockets. Therefore,

it can be used in support of conventional mechanical
methods.
McNally et al.35 evaluate the reduced hardware in
colourant-based laser ablation of carious enamel and
dentine as an advantage over Er:YAG lasers. In this regard, advantages postulated with respect to heat development, in-depth irradiation, pulpal damage, consumption of consumables and time must be discussed
critically, even if the authors conclude that the dentine
treated has no fissures and shows hardness similar to
healthy material. With regard to the colouring agent, it
can be argued that, in addition to various chemical
properties, a differing quality and highly varying concentration of active substances are currently being offered. Figure 4 gives a split-mouth depiction of MB
(Helbo) and TBO (Cumdente) photosensitisers. Some
manufacturers do not declare the concentration of active substances in their colouring agents. The consistency of the solution has to match its application. Low
consistencies are recommended for areas which are
hard to moisten, such as root canals, while high viscosities are more appropriate for surface defects or areas of
a long retention time such as the periodontal pockets.
Each package is of a different user-friendliness and applicability. While blue dyes are provided in a dissolved
form for direct application, the crystalline ICG has to be
AD

[20] =>

I research
dissolved in a puncture vial first. The reason for this is its
short shelf life of roughly four hours.48
Since photosensitisers are designed for one application (ICG) or one patient and thus are of a short shelf life
(blue colouring agents), the packing quantities are decisive. Packages of 0.5 to 1 ml are optimal, while quantities of more than 1 ml are too large and result in a high
proportion of waste and high costs. In addition, prices
differ significantly between the various providers and
active ingredients.

_Photoactivation
Light sources based on laser, LED or plasma lamps are
appropriate for photoactivation. Conversely, the physical and therapeutical differences resulting from the
variation in light sources are hardly known. Clinically,
there are no differences in the results of identical procedures, wavelengths and powers of the light sources.
There are no experiments with regard to the possible differences of the photobiological effects on healing and
stimulation of the tissues in the various light sources
(laser or LED). It seemed more important to find out
about optical fibres and applicators appropriate to lead
the light to its site of action effectively and without loss.
For this, the material of the optical fibre as well as the
quality of the optical coupling points play an important
role, as they decide about power losses and, finally, the
price. From a hygienic point of view, disposable applicators are preferable to permanent fibres.
In intrasulcular applications, the laser light reaches
the colouring agent immediately and thus is applied directly to its site of action. A small percentage of the light
is emitted to the depths where it can trigger photobiological effects. Mucosal thickness, blood circulation,
mucosal pigmentation, absorption in the tissue, light
parameters, remains of blood, secretions and colouring
agents as well as absorption variations during treatment influence transgingival irradiation. It remains to
be discussed whether the concentration of the sensitiser and exposure time are corresponding with the irradiation parameters and whether the graphs of the action time are extrapolated with regard to unfavourable
anatomic cases. Light plays a vital role in the photobiological effect. Fotosan (LOSER & CO, Leverkusen, Germany) is a system which works exclusively transgingivally. Due to the many still unknown components, the
current trend is directed towards intrasulcular light applications or combined intrasulcular transgingival applications.

_Clinical cases
Therapies based on blue colouring agents are relatively simple. The sensitiser is applied to the periodontal pocket which must be free from bleeding after dis-

20 I laser
1_ 2013

infection. It is then put to effect by diffusion for a consistent colouration of the aquatic space and is finally
activated by laser. Most of these systems work with applicators which are injected in the periodontal pocket.
Transgingival activation has become more and more
prominent, in which case laser parameters must be in
accordance with anatomical and physiological properties.
Case 1: Consecutive periodontitis therapy
In the following case, a 49-year-old female patient
is treated by the PDT system HELBO (Bredent, Senden,
Germany). During her regular dental cleaning, a new
periodontal episode was noted after a successful laser
periodontitis treatment four years earlier. The system
used for this periodontal treatment included the
TheraLite laser (660 nm, 100 mW), HELBO® 3-D pocket
probe and the light absorbing colouring agents
HELBO® Blue Photosensitiser (methylene blue). A time
controller was used for an easy and controllable application of dye exposure and application times of the
laser light on the treatment site. aPDT should succeed
the professional dental cleansing after three to 14 days
with respect to the degree of inflammation and latent
bleeding tendency. A bleeding sulcus might have a reductive effect on the colouring agent penetration into
the pockets and thus on the final treatment result.
However, immediate treatment is still an option. Treatment starts with the application of the colouring agent
solution (Fig. 5) circular around the teeth. The distribution of the intensely blue colouring agent can be well
controlled. Exposure time is a minimum of three minutes, since this step is determined by diffusion and the
molecules of the colouring agent penetrate into the
biofilm, where they adsorb unspecifically and specifically to the bacteria via forces of attraction caused by
electric charges. After the exposure, the colouring
agent is sprayed off (Fig. 6) and the periodontal pockets are rinsed in order to avoid an unnecessary absorption loss of the laser light in the free colouring agents.
All steps of the procedure which depend on time are
paced by the time controller (Fig. 7). The tapered fibre
applicator of the activated laser can be injected easily
in the pockets and the activation energy (laser light) can
be applied (Fig. 8). Depending on the individual tooth,
four to six points of the pockets are irradiated. The
treatment success was monitored after about three
weeks, which showed a reduction in the depth of the
periodontal pockets of a minimum of three millimetres
(Fig. 9). In severe and therapy-resistant cases, treatment can be repeated on a weekly basis.
Case 2: Periimplantitis therapy in the acute phase
An acute periimplant inflammation can be a dramatic experience for the patient and a challenge for
his dentist. Inflammation, bleeding, pain, pocket formation and loss of the periimplant attachment defined the clinical picture of the 56-year old female pa-

[21] =>

NOVEMBER 15–16,
2013// BERLIN,
GERMANY//MARITIM HOTEL

LASER
START UP
2013
22nd
ANNUAL
CONGRESS
OF THE
DGL e.V.

impressions
DGL / / LASER
START UP 2013
Scan QR-Code with
your Smartphone
(Quick Scan, etc.)

PLEASE FAX THIS FORM

NAME/E-MAIL

+49 341 48474-390
OFFICE STAMP

Further information about:

❏ LASER START UP 2013

❏ 22nd ANNUAL CONGRESS OF THE DGL e.V

November 15–16, 2013, Berlin, Germany
laser 1/13

[22] =>

Call for papers
DGL | German Society for Laser Dentistry
22nd International Annual Congress
15 - 16 November 2013 in Berlin, Germany
Titel

Author(s)

Institute(s)
Adress
Phone/Fax/E-Mail

/

/

Abstract

Session:
(1) Scientific Session
(2) Case Presentation

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

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

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

Information for Authors:
Authors must register til 15. August 2013
Notification about acceptance will be given til 15. September 2013

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

[23] =>

research

tient (Fig. 10) who presented 10 years post-op with iliac crest bone which was applied via onlay procedure
after resorption. Probing depth (Fig. 11) and radiological bone loss are decisive parameters of the diagnosis. In order to assess the severity of the damage and
treatment options, the CIST system by Lang et al.65 is
an appropriate measure. The overall treatment procedure is conducted according to protocol: rinsing of
the periodontal pockets, injection of the colouring
agents (Fig. 12) and laser application according to the
perimeters for single-rooted teeth for 20 seconds in
all four sites (Fig. 13). Here, the applicator is placed on
the base of the pockets. After laser treatment, the
pockets are rinsed and then dried to instill the CHX gel
(Fig. 14) and insert the prosthesis. This procedure is repeated weekly. Home care includes cleansing of the
prosthesis and reciprocal instillation of CHX gel and
Durimplant. After only a short amount of time, an inflammation-free result was reached (Fig. 15).
Case 3: Osteonecrosis treatment after bisphosphonate therapy
The dramatic event of multiple osteonecrosis of
the maxilla occurred in a 86-year-old male patient after long-term bisphosphonate therapy. Bisphosphonates have been administered for more than 20 years
in multiple myelomas (plasmacytoma), mammary
carcinoma, kidney tumours, prostate carcinoma, osteoporosis and rheumatism. In this case, a multiple
myeloma was diagnosed, but it was not confirmed
later. The initial OPG of the patient (Fig. 16) showed a
remaining dentition in the maxilla, teeth 17, 22, were
situated in the devitalised bone and had to be removed. Markers of the devitalised bone are the lack in
bleeding and hardly any resistance against extraction
due to the destruction of the periodontium. A surgical revision of the maxilla was conducted INT with loss
of the alveolar ridge and the maxillary sinus. After
healing, the maxilla was fitted with a telescope obturator prosthesis (Fig. 17). Resulting from the following osteonecrosis episode, tooth 21 was lost and left
an persisting ulcerating defect in regio 22/23 (Fig. 18).
After deciding against another surgical therapy, a
conservative long-term treatment via PDT was preferred over highly dosed antibiotics. Upon pus removal and rinsing, the entrance to an inflamed bone
cavity with surrounding, highly reactive granulation
became visible (Fig. 19). Blue Sensitiser (HELBO) was
applied (Fig. 20) and left to take effect over a relatively
long amount of time of roughly ten minutes. The remains of the colouring agent were rinsed (Fig. 21) and
laser application (TeraLite laser, Fig. 22) followed. After several PDT applications during the following two
weeks and the reduction of inflammatory complications, exposed bone became visible. This was removed
as a bone sequestrum from an almost completely epithelialized bone cavity (Fig. 23). The defect was again
lased via PDT (Fig. 24) and then healed autonomously

(Fig. 25). Even three years later, an irritation-free alveolar ridge without any signs of a relapse was diagnosed (Fig. 26).
Case 4: Transgingival periodontitis treatment
A 68-year-old female patient presented with dentures in urgent need for restoration. Periodontal
treatment was conducted in the form of PDT with TBO
in the transgingival activation mode via the FotoSan
system. The special feature of this device is the light
source with a 15-Watts LED. Photosensitiser was inserted in the dental pockets after disinfection (Fig. 27)
and left to take effect. The surplus of photosensitiser
was removed before laser application. Since only a
shortened row of teeth existed, including the second
premolars, the photosensitiser was applied in one
step at all teeth. The laminar applicator of the device
is placed directly on the mucosa. The light is applied
segmentally and tooth-by-tooth for activation. Figures 28 and 29 show the high transillumination of the
tissue, which is why there is sufficient activation energy for the photosensitiser within the pockets. After
irradiation, the remains of the sensitiser are sprayed
of and CHX gel is placed in the pockets.
Case 5: Photodynamic Post treatment after periodontal
surgery
In the days following a surgical periodontal procedure, oral hygiene is limited. Pain, swelling, tendency towards bleeding and the danger of damage to the soft tissue structures are significant restrains to mechanical
cleansing. Some regenerative and augmentative procedures, such as the application of enamel matrix proteins
(Emdogain, Straumann) requires only chemical cleaning via a disinfecting rinsing in the first few days after
surgery. An efficient bactericidal method without any
mechanical intervention is the application of PDT on the
surfaces of mucosa, teeth and interdentally. Already in
the year 2000 did Frentzen et al.66 point out the possibility of a “laser tooth brush”. This principle was applied
successfully in the following case of a female patient
with progressed aggressive periodontitis after surgical
periodontal treatment via Emdogain. At the first followup two days after surgery, the postoperative condition
corresponded with the healing process and a photodynamic cleaning of the teeth was conducted. Figure 30
depicts the activation of the blue colouring agent with
a laser by R+J (Berlin, Germany) and a therapeutic approach which allows light application on the surface.
Case 6: Treatment of chronic periodontitis
A 46-year-old patient presented with chronic periodontitis caused by insufficient care. Bone loss and
crater-like irruptions became visible in the OPG. After
cleaning the tooth necks (SRP), a combined PDT and PTT
treatment was conducted in a separate session. Superficial anaesthesia with Oraqix is sufficient for light cases
of periodontitis. After rinsing the pockets with physio-

laser
1
I 23
_ 2013

[24] =>

I research
logical saline, an ICG solution (EmuDo, ARC) is applied
and the first laser application is performed transgingivally with bare fibre (400 mW, 810 nm, Q 810, Henry
Schein, Germany) for ten seconds per periodontal unit
from vestibular to palatinal/lingual. Alternatively to
bare fibres, the therapy, transgingival or bleaching hand
piece can be used. The second step consists of laser application at and in the dental pockets with bulb fibres
and, depending on the condition of the mucosa, with
200 up to 300 mW. Depending on size and undercut,
eight to twelve seconds of irradiation are estimated
time frames. Constant movement is necessary since the
photothermal effect is significant already in low powers and excessive burns must be avoided. The inflamed
inner epithelium of the periodontal pocket can only be
removed efficiently with a power of 300 mW. The same
procedure is conducted via a palatinal approach. Because of the therapeutic character of the minimally invasive approach, the same principles that are applied to
operative laser-surgical procedures are adopted to
PDTPTT with extended hygienic demands. For example,
protective glasses have to be worn in any applications
of type-4 lasers of a wavelength of 810 nm. When the
PDT/PTT treatment is finished, the sulcus is rinsed and
the treatment result will show that a minimally invasive
procedure was performed. After treating all five quadrants, and after the periodontium has finished healing,
only slight discolourations by the CHX rinsing solution
were visible after four weeks. The development of the
clinical parameters and the pocket depths indicate good
final results.
Case 7: Acute gingivitis/periodontitis treatment
Other than PDT with blue colouring agents, which
can be applied without any tissue damage, ICG-based
methods allow the selective removal of the inner epithelia of the periodontal pocket from the sulcus at
300 mW and via bulb fibre. This is usually the standard
in photothermal therapy (PTT).
The 64-year-old female patient presented with an
acute inflamed periodontitis episode and a massive mycotic infection by Candida albicans (CFU +++) in the
oral cavity and on the lips five years after restoration of
the dentures. The mycosis was treated with a combination of Amphotericin B and Mikonazol. The periodontal
treatment was conducted after surface anaesthesia
with Oraqix by successive mechanical cleansing followed by PDT/PTT. Laser application was conducted
with the Q810 laser (Henry Schein) with universal fibre
and disposable bare and bulb fibre attachments. After
rinsing and application of the EmunDo photosensitiser,
transgingival laser application with the bare fibre at
400 mW was performed. Afterwards, the periodontal
pockets were lasered with bulb fibre at 300 mW according to protocol. A light de-epithelialisation of the marginal periodontium at 400 mW and rinsing ensued.
Since only anterior dentures have remained, this case is

24 I laser
1_ 2013

treated jaw-by-jaw and not quadrant-by-quadrant. After rising, the ICG solution is inserted in the periodontal
pockets of the mandible. In addition, transgingival and
intrasulcular laser application and de-epithelialisation
are conducted. Finally, CHX gel is applied to the pockets
and the cone prosthesis as a reservoir. Only shortly after
PTT, the patient appears free from inflammation and
swelling. The periodontal pockets depths showed convincing results and there are no periodontal inflammations when the prosthesis is worn. Bleeding cannot be
provoked.
Case 8: Therapy of advanced periimplantitis
A 79-year-old patient presented with advanced
periimplantitis. In agreement with the patient, conservative, non-invasive maintenance measures are taken,
preferably without any antibiotics. Home care involves
mechanical tooth cleaning, rinsing for disinfection, instillation of CHX gel in the periimplant sulcus and
Durimplant application. Advanced bone loss became
visible on the X-ray and was proved by the measured
pocket depths. There was neither block nor infiltration
anaesthesia, but an intrasulcular surface anaesthesia
via Oraqix. After careful cleansing, the ICG photosensitiser (EmunDo, ARC) is inserted and activated transgingivally via bare fibre at 400 mW and 810 nm (Q810,
Henry Schein) as well as bulb fibre at 300 mW. A single
treatment already resulted in immediate remission of
the inflammation. A stable condition was achieved after healing. However, this success should not blind us to
the fact that this is only a symptomatic treatment which
hardly contributes to the formation of new bone und
must be evaluated clinically as a dormant state of periimplantitis.

_Economic aspects of PDT application
From an economic point of view, PDT methods are
more costly than laser treatments exclusively with type4 lasers, due to the fact the colouring agents (photosensitisers) and sometimes disposable applicators have
to be used. Therefore, possible applications have to be
examined with regard to more efficient methods which
can be used instead of photodynamic caries hardening,
which has to be repeated on consecutive treatment
days. Periodontal treatment of singular teeth which is
based solely on laser or selective caries removal via
Er:YAG laser is one possible alterantive.

_Conclusion
The integration of PDT has proved itself in the treatment and post-treatment with long-term stabilisation
of periodontitis/perioimplantitis.8 Low laser power
combined with photosensitisers on various bacteria of
the biofilm and in the periodontal pocket showed good
results and can therefore be used in addition to conventional mechanical cleansing. Thus, PDT can already

[25] =>

research

be found in a compilation of evidence-based laser-supported treatment methods.67
All light-activated procedures have been viewed as
comparable to PDT treatment and were said to differ
only in their colouring agents, their intrinsic effect and
the wavelength used for activation. This assessment,
however, cannot be supported when the real modes of
action are taken in consideration. Because of the good
adhesiveness of the colouring agents, depending on exposure time, photodynamic therapies with blue colouring agents encompass a photodynamic effect as well as
solely disinfecting properties of the dyes along with an
efficacy which exceeds the treatment. There is however
no intrinsic disinfecting effect in photodynamic therapies based on indocyanine green. The therapeutical effect is limited to the treatment time, which is the
amount of time in which the colouring agent is activated by laser. This effect consists of photodynamics
(PDT) with a percentage of 20 %, fluorescence and,
mainly, photothermal effects (PTT).49 These components of the therapeutical effect explain the limited destruction of the pocket epithelium and minimised
bleeding. Another sensible application of the wavelength of 810 nm was added when ICG was introduced.
In both of the two applications, a strict protocol which
includes the abidance to the exposure and activation
times of the colouring agents as well as rinsing and drying procedures and the level of laser energy applied is vital. While an extension of the activation time does not
result in tissue damages in PDT based on methylene or
toluidine blue, the specified treatment time must not be
exceed in ICG. Moreover, the intrinsic effect of the photosensitiser seems to be a philosophical problem, since
the treatment success does not depend on the question
if the effect of the photosensitiser occurs when activated or without activation. Both PDT and combined
PDT/PTT are gentle, yet efficient therapy methods for
acute and chronic periodontal and periimplant defects.
A separation between PDT und treatments with extensive bleeding are recommended, since the colouring
agent could be rinsed or diluted in an invalid level by the
bleeding. In addition, binding to plasma proteins or
blood cells can also minimize the effect of the photosensitisers. PDT and PDT/PTT have increased the range of
treatment modalities for bisphononate-reduced necrosis of the jaw and a multitude of infections. Economic
aspects have to be taken into account in PDT or PDT/PTT
application in single teeth, endodontics, caries hardening, and disinfection of the surgical site, among others.
Because of the high efficiency of PTT when ICG is applied, a singular therapy per cycle will be sufficient,
whereas phenotiazine-based colouring agents will necessitate the repetition of the treatment within short intervals. Both of the two procedures cannot necessarily
substitute antibiotics, but they can contribute significantly to reduced antibiotic applications. The bacterial
load in the periodontal pockets can be reduced consid-

erably, which is an advantage with regard to sluicing
bacteria in immediately following periodontal surgeries. ICG is more efficient because of its proved in-depth
effects which include PTT effects on microorganisms in
bordering tissues. PTT is followed by healing of the defect in case of laser light applications beyond a threshold level causing tissue damages. This healing usually
processes fast and does not cause retractions since the
defect is limited in size.
PDT and combined PDT/PTT cannot be compared
with or replace each other. Although both of the two
procedures can be applied equally, the wishes of patient
and dentist as well as therapy goals determine their usage. PDT alone cannot be applied in non-invasive delegation procedures, the treatment of tissue defects or
pain-free conservational therapies. A maximum power
of 0.2 Watts must not be exceeded in ICG-based therapies. Further investigations with regard to these treatment areas are necessary. If the treatment can be of an
invasive character or more extensive, combined PDT/PTT
treatment must be preferred. In most cases, this will be
performed by the dentist. Combined PDT/PTT indocyanine-green based treatment constitutes a new instrument for the dentist, which offers laser treatment at low
laser energy levels of 200 up to 400 mW as well as a low
photodynamic component for the sterilisation of periodontal pockets via oxygen radicals and a photobiological component to support the healing process. Therefore, PTT can result in an improved performance in modified mechanisms of action in periodontal treatment
when compared to blue-based PDT procedures._
Editorial note: A complete list of references is available
from the publisher.

_contact

laser

Dr Michael Hopp
Zahnarztpraxis am Kranoldplatz
Kranoldplatz 5
12209 Berlin-Lichterfelde, Germany
mdr.hopp@t-online.de
www.dr-michael-hopp.de
Prof. Dr Reiner Biffar
Ernst-Moritz-Arndt-Universität Greifswald
Zentrum für Zahn-, Mund- und Kieferheilkunde
Abteilung für Zahnärztliche Prothetik und
Werkstoffkunde
Direktor: Professor Dr. Reiner Biffar
Rotgerberstraße 8
17489 Greifswald, Germany
Tel.: +49 3834 865000
biffar@uni-greifswald.de

Scan for the German version of
this article, including a more
extensive image gallery.

laser
1
I 25
_ 2013

[26] =>

I case report

Becoming kissable:
Laser-assisted
haemangioma removal
Author_Dr Darius Moghtader, Germany

[PICTURE: ©DIEGO CERVO]

Figs. 1a & b_Treatment example
with the 980 nm diode laser at 2.5 W
(continuous wave);
(a) Typical presentation of a
haemangioma;
(b) Six weeks after the third session.

Fig. 1a

Fig. 1b

_Introduction

ready guessed—goes by the name of haemangioma.
Haemangiomas are benign blood-vessel tumours
that are usually prominent and localised, and range
from crimson to greyish-blue in colour. The blood
filling can often be pressed out (spatula test).

This is the story of how an attractive young
woman became kissable once again, thanks to laser
therapy.
There are a surprisingly high number of patients
with growths mostly in the area of the lip vermilion, and virtually every person affected by this condition reports suffering under it. Strangely, we
dentists are hardly ever asked by patients what
these growths could be or how they can be treated.
The reasons for this will be discussed later on in this
article—I can certainly promise that it will be worth
your while to read on.
The lesion has a bluish colour, occurs in differing
sizes and especially on the lip, but also on the mucosa of the cheek or on the tongue and—as you al-

26 I laser
1_ 2013

In this article, I will discuss the various non-invasive, minimally invasive and invasive laser treatment methods for haemangiomas and how a
rather rare exophytic haemangioma can be treated
quickly, painlessly and aesthetically.

_The proper addressee
We should first address the interesting issue of
why dentists are rarely asked about treatment options for these unsightly lip spots. The answer is as
simple as it is surprising: the patients have already
asked someone else: their GP. Generally their fam-

[27] =>

case report

_The methods—
From non-invasive to invasive
Non-invasive therapy
First, let’s talk about the non-invasive haemangioma therapy developed by the laser pioneer, Prof.
Georgios E. Romanos. The haemangioma is treated
by means of a contact-free diode laser through a
very thin ice wafer. The cooling effect of the ice preserves the texture of the lip.
Place an extremely thin ice wafer on the vascular tumour (Fig. 1a) and, after administering local anaesthetic, irradiate the tumour through the
ice using the preset haemangioma programme of
the elexxion claros or 2.5 W (continuous wave)
until coagulation is achieved. As the ice wafer
melts, the laser must constantly be moved in order to prevent direct contact between laser and
tissue.
The blue spot shrinks and success of the therapy
is evident by the greyish-white colour of the tissue.
The constant cooling protects the surface of the
tissue, and the lip structure is fully preserved. As a
rule, this therapy must be repeated several times
until the haemangioma has been completely eliminated (Fig. 1b).
ily doctor, or perhaps their dermatologist, or another doctor who does not normally work with
lasers will, correctly, tell the patient that it is a benign tumour and that he or she would recommend
leaving it well alone, as removal can lead to copious bleeding and potentially to ugly and disfiguring scars after removal of the sutures. And of
course, the doctor is right. It is better to leave the
scalpel alone and refer the patient to a specialised
colleague, who ideally also has experience in plastic surgery, or even better to a laser specialist!
If this last description applies to you anyway,
first obtain the patient’s informed consent, then
furnish the patient with a quotation and—after the
statutorily prescribed reflection period—perform
the treatment using your diode laser in less than
five minutes. The next section will detail this
method and other more invasive methods.

Fig. 2a

Romanos originally described this procedure in
the Atlas of Laser Applications in Dentistry1 with
reference to the Nd:YAG laser, which is the ideal
wavelength for this method owing to its greater
depth of penetration compared with the diode
laser.
How does it work? Laser light of the abovementioned wavelengths has a high selective absorption in haemoglobin and in certain pigments.
This results in energy bundling in the tumour tissue and leads to coagulation and destruction of the
vascular tumour.
What laser types are suitable? Lasers with a
greater depth of penetration and high haemoglobin absorption are more advantageous for this
application: argon, Nd:YAG, 980 nm diode and
810 nm diode lasers.

Fig. 2b

Figs. 2a–d_Minimally invasive
therapy (Photographs courtesy of
Dr Bach).

Fig. 2c

Fig. 2d

laser
1
I 27
_ 2013

[28] =>

I case report

Fig. 3a

Fig. 3b

Fig. 3c

Fig. 3d

Fig. 3e

Fig. 3f

Figs. 3a–f_(a & b) Invasive therapy,
(c) one, (d) two, (e) six and (f) twelve
weeks post-op.

Minimally invasive therapy
In Laser (German edition), Dr Georg Bach2 presented a modified method to optimise this procedure for the 810 nm diode laser. With the new
method, the haemangioma is treated directly and
in a minimally invasive manner (Fig. 2a) using a
cannula embedded in an ice block (Figs. 2b & c). The
advantages of this method are good results while
protecting the lip structure by means of cooling
with ice, as well as the possibility of completing
the treatment in just one session (Fig. 2d).

uation was seen after just two weeks (Fig. 3d).
Slow and constant self-optimisation was observed in the further wound-healing process after
six weeks (Fig. 3e) up to the desired final result at
the end of 12 weeks (Fig. 3f).

Invasive therapy
This female patient consulted me about her lip
problem. She told me how unhappy she was that
she was no longer being kissed because of the
growth on her lip. Her lip texture and structure had
been affected (Fig. 3a). In this case, invasive therapy was able to provide a good aesthetic result for
the exophytic haemangioma on her lip.

This case report has demonstrated that invasive laser therapy can, in selected indications, lead
to good aesthetic results with exophytic haemangiomas of the lip quickly, safely and efficiently.

After administration of local anaesthetic, onetime, direct, contact-free irradiation was performed with the preset haemangioma programme
of the elexxion claros with the 600 µm fibre up to
complete coagulation (Fig. 3b). In this programme,
the elexxion claros operates at 25 W high peak
power with pulses of 15,000 Hz and a duration of
10 µs and an average output of 3.75 W.
After one week (Fig. 3c), we saw wound healing
without any complications. At every follow-up
visit, the elexxion claros was applied using the
low-level laser programme for one minute at
100 mW with the glass rod in order to optimise
wound healing. A distinct improvement in the sit-

28 I laser
1_ 2013

If one has performed the treatment correctly,
there will be no bleeding, and the patient will have
no pain or discomfort. Only two weeks later, this
patient was kissable once again as she reported
with a big smile on her lips.

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

_contact
Dr Darius Moghtader
In den Weingärten 47
55276 Oppenheim
Germany
dr-moghtader@hotmail.de
www.oppenheim-zahnarzt.de

laser

[29] =>

st

1 International Congress
of WALED and GLOBAL
June 14-15, 2013
Istanbul, Turkey, Point Hotel Taksim
Fees: 250 EUR, inclusive full day catering and 2 evening events
Congress Presidents: Prof Norbert Gutknecht, Dr Zafer Kazak

Enjoy dental science and fun in Istanbul!

More Information: info@aalz.de

Copyright © Sadik Gulec

Preliminary List of Speakers:
Prof Norbert Gutknecht

Prof Aslihan Üsümez

Prof Matthias Frentzen

Prof Gerd Volland

Ass.-Prof Ilay Maden

Ass.-Prof Jörg Meister

Dr Iris Brader

Dr Masoud Mojahedi

Dr Miguel Martins

Dr Peter Fahlstedt

Dr Zafer Kazak

Dr Merita Bardoshi

Dr Stefan Grümer

Dr René Franzen

Dr Nasrin Kianimanesh

Dr Alireza Fallah

Dr Dimitris Strakas

Dr Gabriele Schindler-Hultzsch

[30] =>

I industry report

Er:YAG Garnet in
laser-assisted crown
lengthening
Author_Dr Avi Reyhanian, Israel

Fig. 1

Fig. 2

Fig. 1_Patient presentation.
Fig. 2_Insertion of five implants.

_Introduction
This article describes and demonstrates the use
of the Erbium:YAG 2,940 nm laser system (LiteTouch, Syneron Medical Ltd.) as a central tool in the
treatment of osseous crown lengthening, and the
advantages this wavelength offers versus the use
of conventional methods.

Fig. 3_Teeth #14 and 15
in occlusion.
Fig. 4_Use of the diode laser to mark
the border for incision of the
soft tissue.
Fig. 5_Incision border.

Fig. 3

_Objectives and methods
Crown lengthening is a surgical procedure employed for the removal of periodontal tissue, in order to increase the clinical crown height. It is the

Fig. 4

30 I laser
1_ 2013

most frequently used and valuable periodontal
surgical procedure related to restorative treatment.1-4
The objectives of clinical crown lengthening include
– Removal of subgingival caries
– Preservation and maintenance of restorations
– Cosmetic improvement
– Enabling restorative treatment without impinging on biologic width
– Correction of the occlusal plane
– Facilitation of improved oral hygiene

Fig. 5

[31] =>

industry report

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

There are two methods of crown lengthening:
– Orthodontic—coronal extension
– Surgical—apical extension.
Clinical considerations
– Importance of the tooth
– Subgingival caries
– Clinical crown/root ratio
– Root length and morphology
– Residual amount of bone support
– Furcation involvement
– Tooth mobility
– Aesthetic demands
– Post-op maintenance and plaque control.

_Biologic width and
aesthetic dentistry
The clinician must create a symmetrical and
harmonious relationship between lips, gingival architecture and positions of the natural dentate
forms. Spear et al.5 have referred to this diagnostic
methodology as facially generated treatment
planning, where the maxillary central incisal edges
determine where the soft tissue, i.e., gingiva, and
bone should be positioned.6
To utilize crown lengthening, it is important for
the restorative dentist to understand the concept
of biologic width, indications, technique and other
principles.7-9 To maintain healthy periodontal tissue, the attached gingival and biologic width must
be considered. Biologic width is measured from the
bottom of the gingival sulcus to the alveolar crest
and is maintained by homeostasis.10,11 This width
consists of the epithelial attachment to the tooth

surface and its connective tissue. The average
width is 2.04 mm. Impinging biologic width may
cause periodontal tissue destruction; therefore, in
crown lengthening, the position of the margin is
important.

Fig. 6_Incision.
Fig. 7_Lifting the mucoperiosteal.
Fig. 8_Bone ablation.
Fig. 9_Bone level after ablation.
Fig. 10_Immediately post-op.
Fig. 11_One week post-op.

_Methods of
clinical crown lengthening
As mentioned above, there are two methods to
lengthen a crown: coronal extension and apical extension. Apical extension of the crown is achieved
by surgery, with or without osseous resection. In
apical extension there are two methods:
– Open technique—patients who exhibit asymmetrical gingival levels, those with greater than
3 to 5 mm of maxillary gingival display, or both
may be candidates for surgical gingival and/or
alveolar bone repositioning to improve their aesthetics.
– Closed technique—for minor localized biologic
width and/or aesthetic gingival zenith corrections. Can be used in lieu of a flap procedure to
make the correction and complete the restorative process without the necessary healing time
required for open crown lengthening surgeries.12

_Case presentation
This clinical report describes a situation in
which a crown lengthening procedure was successfully performed with the Er:YAG laser (LiteTouch, Syneron Medical Ltd.) as a principal auxiliary tool, and the advantages of the 2,940 nm
wavelength versus conventional methods.

laser
1
I 31
_ 2013

[32] =>

I industry report

Fig. 12

Fig. 13

Fig. 12_Four months post-op.
Fig. 13_Nine months post-op.
Fig. 14_Nine months post-op X-ray
image.

Examination
Clinical examination of a 57-year-old male revealed missing teeth at the locations #17, 36, 44,
45 and 46 with overeruption of teeth # 14 and 15
(Fig. 1). Radiographic examination of the area
showed overeruption of teeth 14 and 15 with the
alveolar bone.
Treatment options
The treatment options available in this case
were:
– Insertion of implants and metal-ceramic crowns
at the locations of teeth #17, 36, 44, 45 and 46.
– In addition to option one above: crown lengthening for teeth #14 and 15 and covering them
with metal-ceramic crowns.
Following discussion with the patient and evaluation of the possibilities for success, it was decided to perform crown lengthening. Treatment
would involve the use of the Er:YAG laser to perform the following steps, based upon accepted research:
– Flap incision13-15
– Ablation of soft tissue around the teeth after
raising a flap16-18
– Remodelling, shaping and ablating of the
bone.13,15,19,20
Treatment
All five implants were placed in one sitting (Fig.
2). Crown lengthening was performed three weeks
postop (Fig. 3). Laser operating parameters employed for the various surgical stages were as follows:
– Flap Access: Wavelength: 2,940 nm (Er:YAG),
600-micron sapphire tip, contact mode; 200 mJ
per pulse at 35 Hz. Total power: 7 Watts.
– Soft Tissue Removal: Wavelength: 2,940 nm
(Er:YAG), 1,300-micron sapphire tip, non-contact mode; 400 mJ per pulse at 20 Hz. Total
power: 8 Watts.
– Bone Surgery: Wavelength: 2,940 nm (Er:YAG),

32 I laser
1_ 2013

Fig. 14

1,300-micron sapphire tip, non-contact mode;
300 mJ per pulse at 20 Hz. Total power: 6 Watts.
With the assistance of a diode laser operating
at a power setting of 2.4 W in contact mode, the
location of the incision was marked (Figs. 4 and 5).
An incision was made with the laser (after anaesthesia) at the buccal and palatal side of teeth #14
and 15 (Fig. 6) and a vertical incision was not required. The buccal and palatal flaps were lifted and
the area was explored (Fig. 7); there was soft tissue around the neck of the teeth. The soft tissue
was ablated using the laser. Vaporization of
soft/granulation tissue (if any exists) after raising
a flap is efficient with the Er:YAG laser, offering a
lower risk of overheating the bone than that posed
by the diode or CO2 lasers23 and often obviates the
need for hand instruments. Results from both
controlled clinical and basic studies have pointed
to the high potential of the Er:YAG laser and its
excellent ability to effectively ablate soft tissue
without producing major thermal side effects to
adjacent tissue have been demonstrated in numerous studies.16-18
The Er:YAG laser was aimed at the surface of the
exposed bone which was ablated in non-contact
mode (Fig. 8). Studies have shown that Er:YAG
laser energy effects on bone include bacterial reduction.22 Following this, all accessible bone surfaces were exposed to laser energy to ablate
necrotic bone and to shape and remodel the surface in accordance with established clinical protocols.13,15,20
The bone level around teeth #14 and 15 fits to
the bone level of teeth #13 and 16 (Fig. 9). The mucoperiosteal flap was re-positioned and sutured
with silk 3-0, paying particular attention to primary closure of the flap (Fig. 10).
Postoperative instructions
The patient was prescribed antibiotics to avoid
infection and painkillers for pain. Instructions were
given to rinse with Chlorhexidine 0.2 %, starting
the next day for two weeks, three times per day.

[33] =>

Management of complications and follow-up
The following day the patient reported moderate pain and moderate swelling. There was no tissue bleeding and the site was closed. The flap was
showing signs of attachment and was healing
nicely. At seven days post-op, the patient returned
for inspection and removal of sutures. The swelling
had resolved and healing was progressing well (Fig.
11). After five months, the soft tissue was healed
completely without complications (Fig. 12). The
soft issue had healed over the bone and there were
no bony projections observed under the soft tissue.
The prognosis is excellent. An impression for two
metal-ceramic crowns was taken five months
post-op (Fig. 10). An aesthetic result was achieved
(Figs. 13 & 14).

_Conclusion
The Er:YAG laser system (LiteTouch, Syneron
Medical, 2,940 nm) can be employed as an auxiliary
tool for the purpose of crown lengthening and has
been shown to be effective and safe. The use of the
LiteTouch wavelength for these procedures presents many advantages as opposed to conventional
methods, including enhancement of the surgical
site and less bleeding during the operation, providing the surgeon with a better field of visibility and
reducing patient discomfort during use. In addition, anecdotal claims have been made that postoperative effects such as pain and swelling are less
pronounced. Finally, the laser offers the dental surgeon enhanced ease of use with the hand piece's
360° swivel capability._
Editorial note: A complete list of references is available
from the publisher.

_contact
Dr Avi Reyhanian
Private Clinic
1 Shaar Haemek St.
Netanya 42292, Israel
Tel.: +972 9 8338825
Fax: +972 9 8339890
avi5000rey@gmail.com
www.dentallaser.co

laser

[34] =>

I industry report

Long-term treatment
of peri-implant lesions
in geriatric dentistry
Author_Dr Georg Bach, Germany

[PICTURE: ©PRIVILEGE]

_Introduction
In recent years, photodynamic therapy has
gained many new users in laser dentistry, giving it an
enormous push forward. This therapy is minimally
invasive and long-lasting. A multitude of scientific
studies on the therapy have been conducted and it
has a uniform nomenclature, established during the
last meeting of the DGL (German Association for
Laser Dentistry). During this meeting, the difference
between “real” photodynamic therapy and one
whose sensitiser has its own (antibacterial) properties was established. The following case report describes the minimally invasive use of a photodynamic therapy system with a green sensitiser in
geriatric dentistry (treatment of peri-implant lesions).

_Real photodynamic therapy:
Sensitiser with intrinsic effect
In treatments with real photodynamic therapy,
cell death of the pathogenic bacteria is achieved exclusively by the interaction between sensitiser and
laser light, which generates oxygen, resulting in destruction of the pathogenic cell. A further differentiation can be made with regard to sensitisers that
use blue (usually with antibacterial properties) and
those that use green (usually without antibacterial
properties) dyes. Systems with green sensitisers are
undoubtedly the focal point of current interest. They
are generally indocyanine green (ICG) based and activated with an 810 nm (diode) laser (near infrared).

34 I laser
1_ 2013

_Indocyanine green-based sensitisers
for photodynamic therapy
ICG is a recognised active substance that has
been standard in ophthalmology, as well as in oncology, dermatology and veterinary medicine, for
years. If irradiated with a low-energy laser of a
wavelength of 810 nm, it promises a successful
therapy for periodontitis and peri-implantitis.

_Case report
Eleven years ago, the now 79-year-old female
patient had received implants in the mandible. After several years of total satisfaction with the implant provision, she experienced the first complications. While initially limited to the superstructure (small chips on the ceramic and loosening of
the superstructure), problems with the actual implants had increased in the past three years and recurring infections, sometimes painful, and bleeding when brushing her teeth, etc. arose. Local and
systemic antibiotics only yielded short-lived improvement, and she was then referred to our practice.
The first superficial intra-oral examination revealed clinical findings clearly indicative of a diagnosis of peri-implantitis:
– massive peri-implant bone loss;
– bowl-shaped defect; and
– pain on probing the soft-tissue sleeve.

[35] =>

industry report

I

Fig. 1_Within the scope of a
full-mouth disinfection, both of the
implants affected by peri-implantitis
and the remaining teeth of the
mandible were treated with
ICG-based photodynamic therapy.

Fig. 1a

Fig. 1b

Fig. 1c

Fig. 1d

Fig. 1e

Fig. 1f

Fig. 1g

Fig. 1h

Fig. 1i

Fig. 1j

laser
1
I 35
_ 2013

[36] =>

I industry report

Fig. 2a

Fig. 2b

Fig. 2c

Fig. 2d

Fig. 2e

Fig. 2f

Fig. 2g

Fig. 2h

Fig. 2i

Fig. 2j

Fig. 2k

Fig. 2l

Fig. 2m

Fig. 2n

Fig. 2_Mixing of sensitiser: the kit contains all the
components required for preparing the sensitiser solution
by dissolving the dye tablet in the liquid provided,
which can then be used for approximately 30 minutes
and is applied intra-orally.

36 I laser
1_ 2013

[37] =>

industry report

The X-ray confirmed the initial clinical diagnosis:
it was a case of full peri-implantitis. One implant in
the left half of the mandible had loosened from the
bone to the extent that no more than half of the titanium surface that had originally been covered by
the implant was still osseointegrated. An explantation with subsequent augmentation and re-implantation later could have been considered for this artificial abutment tooth.

Pretreatment
Aim: reduction of the
inflammation parameters

Information
Individual decision

(Perio Green motivation)

Already at this early stage of decision-making,
the family doctor and internal medicine specialist
vetoed any procedures with increased risk of bleeding, increased risk of bacteraemia and a high degree
of invasiveness owing to the patient’s highly compromised physical condition. With these justified
restrictions, photodynamic therapy was the obvious
choice for treatment.
An ICG-based sensitiser (Perio Green, elexxion) in
combination with an 810 nm diode laser (100 mW,
pulsed) was used (Fig. 1). This is a photodynamic
therapy system with matched components. The
sensitiser is made up immediately prior to treatment
by dissolving a dye tablet in the liquid included in the
kit and then applied intra-orally (Fig. 2). The application of a low-viscosity light-green sensitiser,
which requires a directed droplet-flow technique, is
quite demanding compared with high-viscosity
blue sensitisers. After application and a period of exposure, the laser fibre is inserted into the target area
and the tissue is then irradiated with a low-energy
diode laser (810 nm). The persistent colouring of the
gingiva that is often observed when using other
sensitisers does not occur after completion of treatment. No residue of the dye is visible intra-orally after rinsing several times.
An intra-oral follow-up examination was carried
out at one and four weeks. The patient was, and is to
date, without any symptoms. To maintain this situation, she is scheduled for recalls every three
months, with every recall entailing a professional
cleaning and photodynamic therapy for every second recall (Fig. 3).
Since, the patient is now almost completely
without symptoms for the first time in years, but no
improvement is to be expected with regard to her
general health, we decided on this minimally invasive maintenance therapy. Regarding the commitments associated with it, the patient concluded very
matter-of-factly, “To me, it is worth it”.

_Conclusion
In my opinion, photodynamic therapy is a minimally invasive option compared with conventional

Application of
Perio Green

Success
monitoring

Decision on
No effect?

further measures

YES
Aim achieved?

YES

Decision on
further measures

Recall
phase

methods. It is ideally and most effectively used with
a verified treatment protocol and a sensitiser without an intrinsic effect. Photodynamic therapy has
become my treatment of choice for patients with
compromised health, for whom more invasive therapy options would be more difficult or impossible to
implement, and for patients with a risk of bacteraemia._

_contact

Fig. 3_Treatment regimen of
ICG-based photodynamic therapy
using Perio Green.

laser

Dr Georg Bach
Rathausgasse 36
79098 Freiburg/Breisgau
Germany
doc.bach@t-online.de

laser
1
I 37
_ 2013

[38] =>

I industry report

X-Runner
Er:YAG dental laser
application
Author_Prof. Dr Carlo Fornaini, Italy

the use of conventional rotating instruments.3-5 The
dentin surface treated by laser appears clean, without
a smear-layer, and with the tubules open and clear.6

Fig. 1

Fig. 2

Fig. 4

Fig. 3
Fig. 1_Tooth sample for optical
microscope and SEM observation.
Fig. 2_LightWalker AT dental laser.
Fig. 3_X-Runner handpiece.
Fig. 4_X-Runner settings screen.

38 I laser
1_ 2013

_Introduction
The notion of utilising laser technology in conservative dentistry was proposed in 1990 by Hibst and
Keller, who introduced the possibility of using an
Er:YAG laser as alternative to conventional instruments such as the turbine and micro-motor.1,2 Widespread interest in employing this new technology
stems from a number of significant advantages, as described in several scientific studies. Thanks to the
affinity of the Er:YAG laser wavelength to water and
hydroxyapatite, laser technology allows for efficient
ablation of hard dental tissues without the risk of micro- and macro-fractures, as have been observed with

Thermal elevation in the pulp, recorded during
Er:YAG laser irradiation, is lower than that recorded by
using a turbine and micro-motor with the same conditions of air/water spray.7,8 This wavelength also has
an antimicrobial decontamination effect on the
treated tissue, which destroys both aerobic and anaerobic bacteria.9 The most interesting aspects of this new
technology are related to the goals of modern conservative dentistry, i.e. minimally invasive treatments and
adhesive dentistry. Er:YAG lasers can reach spot dimensions smaller than 1 mm, which enables a selective ablation of the affected dentin while preserving
the surrounding sound tissue to produce highly efficient restorations.10 Several in vitro studies have
demonstrated that the preparation of enamel and
dentine by Er:YAG laser, followed by orthophosphoric
acid-etching, enhances the effectiveness in terms of
reduced microleakage and increased bond strength.11
To understand the role that a scanner can perform
in dental treatments, it is useful to take a comparative
look at the field of aesthetic medicine. The Er:YAG laser
has been used for many years in the field of dermatology, where it is employed for the vaporisation of lesions such as condyloma, naevi, warts, mollusca contagiosa, as well as for the treatment of keloid scars and
wrinkles with so-called laser “resurfacing”.12 For many
years, scanners have proven highly effective in dermatological treatments, enabling high-precision surface
treatments without overlapping or under-coverage of
the laser treatment area.
The aim of our study, which began several years ago,
has been to evaluate the possibility of transferring the
same type of scanner technology that is widely utilised

[39] =>

industry report

Fig. 5a

in dermatology to the dental field. The firstin vitro tests
were performed on extracted teeth by using a scanner
and a dermatological Er:YAG laser. Because of the fact
that this particular dermatological device operates
without water, it was necessary to modify it by adding
a double external pipeline in order to deliver an air/water spray at the point of the laser’s impact on the tooth.
The results of this first sequence of tests were very
promising and convinced the manufacturer Fotona to
invest in a major research and development effort to
construct a scanner handpiece of reduced size, able to
be employed intra-orally. Once developed, the new
dental-optimised scanner was given another series of
“in vitro” tests, and after the safety of its utilisation was
demonstrated via K-thermocouple records, optical
microscope (Fig. 1) and SEM observation, it was subsequently applied to in vivo tests on human subjects.

_Material and method
The laser appliance used was a LightWalker (Fotona, Fig. 2). The scanner handpiece is similar to the
usual non-contact Er:YAG laser handpiece. The scanning mechanism is integrated inside an ergonomic box
that lies on the operator’s hand, with a supplementary
electrical cable delivering the digital information from
the laser device to the scanning mirrors (Fig. 3). Its application is the same as with the usual non-contact
handpiece; the only difference is that it covers a bigger area than the standard handpiece. However, it is
useful because it can cover a larger area, or, by pressing the button on the screen, it can be used as a classical one-spot laser handpiece. The scanner handpiece
can thus be used for all kinds of treatments by switching from the scanner modality to classic handpiece
modality, without swapping handpieces.
The following settings are available for the scanner
handpiece on the touch screen (Fig. 4):
– scanning of the area shape (circular, rectangular,
hexagonal),
– size of the scanning area (width and length of the
rectangle, diameter of circle and hexagon),
– number of scan passages (a function of the requested ablation depth),

Fig. 5b

– delay between consecutive scans (duration of the
pause between scans).
Moreover, all parameters available with the classic
handpiece (energy, frequency, mode, spray) are also
used with the scanner handpiece. By reducing one of
the sides of the rectangular shape, it is possible to obtain a linear cut without moving the handpiece, for instance to cut the root apex during endodontic surgery
or to perform an incision in soft tissues surgery.

Fig. 5c

Fig. 5_a) During laser-scanner
conditioning; b) After the enamel
preparation for brackets with the
scanner; c) Brackets bonding
completed.

In this preliminary study, clinical applications are
shown below which illustrate this new Er:YAG laser
technology.

_Case 1: Enamel laser conditioning for
orthodontic bracket bonding
The employment of an Er:YAG laser to prepare the
enamel for improving the strength of adhesion of
composite resins has been proposed by several authors in conservative dentistry as well as for bracket
bonding in orthodontics.13 Several studies, based both
on traction and microleakage tests, have shown that
the best values were obtained with samples irradiated
by an Er:YAG beam before acid etching.14 Additionally,
an “in vitro” study on extracted human teeth demon-

Fig. 6_a) Enamel lesions in the right
upper lateral incisor, canine, and the
first premolar; b) During scanner
treatment; c) After the scanner
ablation of enamel lesions;
d) After the complete treatment.

Fig. 6a

Fig. 6b

Fig. 6c

Fig. 6d

laser
1
I 39
_ 2013

[40] =>

I industry report
Fig. 7_a) Damaged frontal teeth
crowns; b) During scanner ablation
of enamel; c) After the scanner
ablation of dental tissue; d) After
bonding a coat of composite resin.

Fig. 7a

Fig. 7b

Fig. 7c

Fig. 7d

strated that preparation by Er:YAG laser alone also
gives a stronger adhesion than orthophosphoric acid
alone.15 Moreover, other authors have underscored
these results when using lasers to prepare enamel
surfaces to make them more resistant to decay.16 This
is possible because of the modification of hydroxyapatite crystals, which is important in the prevention
of decalcification zones around brackets, particularly
in patients with scanty oral hygiene.17 Another advantage of laser utilisation is the ability to prepare a
very small surface area of enamel, exactly of the same
dimension of the bracket. We initially proposed a
technique based on the use of a plastic template with
rectangular windows designed to limit the irradiated
area. Now, by using the scanner handpiece, the procedure is faster, easier and more precise.

easily detachable enamel, while in the hypoplastic
type, the enamel is well mineralised but the amount is
reduced.19

The case described presents a 14-year-old female
receiving orthodontic fixed treatment of the upper
arch. The parameters used were determined by SEM
observation in order to give the best enamel conditioning coupled with the minimal ablation: 55 mJ, 8 Hz,
MSP mode, 4/6 air/water spray. The dimension of the
ablation area was 2.5 x 3 mm and the number of passes
was 10, once for each tooth.

The case presented concerns an 18-year-old
male who had enamel lesions in the right upper lateral incisor, canine, and the first premolar. The treatment was performed without anaesthetics, with a
total laser irradiation time of 186 sec. For this case we
used the following parameters: 250 mJ, 10 Hz,
MSP mode, 4/6 air/water spray. The ablation area was
a 3.5 mm diameter circle and the number of passes
was 15.

_Case 2: Treatment of amelogenesis
imperfecta spots on permanent incisors
The term amelogenesis imperfecta is defined as a
diverse group of hereditary disorders that primarily affects the quantity, structure, and composition of
enamel.18 In the hypomature type, the affected teeth
exhibit mottled, opaque white-brown or yellowish
discoloured enamel, which is softer than normal. The
hypocalcified type shows pigmented, softened, and

40 I laser
1_ 2013

In our daily practice, we have worked with several
young patients exhibiting zones of discoloration in their
frontal teeth and who needed treatment to improve the
aesthetics of their smile. Due to the impossibility of
treating these cases with classical bleaching techniques, it was necessary to ablate the affected zones and
to fill the cavities produced with composite resins. We
have already described the use of the Er:YAG laser in this
type of case as a good example of minimally invasive
dentistry20 but the use of the scanner improves the precision of the ablation even further by programming the
extent and depth of the zone in advance.

_Case 3: Direct composite veneering of
permanent incisors
In cases concerning damage to the frontal teeth
crowns from a number of possible causes, i.e. traumas
or bruxism, and if the patient does not wish to choose
a prosthetic option, the solution is to ablate a portion
of the enamel and to directly bond a coat of composite resin. The role of the Er:YAG laser in improving the

[41] =>

industry report

Fig. 8_a) Old composite on tooth 34;
b) During scanner ablation; c) Immediately after scanner treatment;
d) After the complete treatment.

Fig. 8a

Fig. 8b

Fig. 8c

Fig. 8d

adhesion of resin to enamel has been well demonstrated21,22 and the advantage with the use of a scanner handpiece is the possibility to limit the volume of
ablated dental tissue. The case presented regards a 64year-old male who needed repair of his upper incisors.
The treatment was performed without anaesthetics,
with a total laser irradiation time of 253 sec. The parameters used were: 300 mJ, 10 Hz, MSP mode, 4/6
air/water spray. The ablation area was a 4.5 mm diameter circle, the number of passes was 15.

lation area was a 4 mm diameter circle and the number of passes was 15 for two times.

_Case 4: Aesthetic re-treatment of an
aging composite restoration
In some cases, composite restorations may present
discolorations and spots after a number of years, particularly in patients who do not observe an adequate
level of oral hygiene. The vestibular face of the frontal
teeth or the cervical area of the premolars may pose a
problem, from an aesthetical point of view, and this is
the reason why several patients have come to our offices to regain a pleasant smile. The Er:YAG laser may
be very helpful in this situation; in fact, because of its
wavelength (2,940 nm) it is well absorbed by Glycidyl
methacrylate (GMA) and Silicon Dioxide, two important components of composite. It is very effective in
the ablation of old restorations without thermal elevation23 and can produce a rough surface, very difficult to obtain with orthophosphoric acid, which is able
to bond the new coat of resin.
The case presented here involves a 55-year-old female with an aging infiltrated and spotted cervical
restoration on tooth 34. The treatment was performed
without anaesthetic. The parameters used were:
250 mJ, 10 HZ, MSP mode, 4/6 air/water spray. The ab-

_Discussion and Conclusion
Laser technology was introduced in dentistry by
Goldman in 1967.24 Since that time, a continuing effort has been made by clinicians, researchers and companies to improve the results of clinical treatments.
The introduction of Er:YAG in 1990 provided the option to also treat hard tissues, and this technology was
further improved through greater control of pulse duration (VSP—variable square pulse technology).
The recent introduction of a scanner handpiece enabled a higher precision of irradiation and depth of ablation as well as reduced treatment time, allowing laser
technology to more fully realise the vision of “minimally invasive” conservative dentistry._
Editorial note: A list of references is available from the
author.

_contact

laser

Prof. Dr Carlo Fornaini
MD DMD MSc
Via Varini, 10
29017 Fiorenzuola d'Arda, PC, Italy
Tel.: +39 0523 982667
Fax: +39 0523 242109
info@fornainident.it
www.fornainident.it

laser
1
I 41
_ 2013

[42] =>

I manufacturer _ news

Manufacturer News
GIGAA LASER

Biolase

Professional medical diode laser
systems supplier

Laser training and
new diode laser

CHEESE dental laser is a good assistance for dentists
in the treatment of periodontics, conservative dentistry, endodontics, oral surgery as well as teeth
whitening. The good performance of laser technology
comprising with conventional treatments makes the
patients smile, it sounds like “CHEESE”. With the advantage of battery-operated design, the fully charged
battery can support about three hours of treatment in
CW mode.
GBOX dental laser with repetition rate up to
20 kHz makes the pulse-pauseratio (PPR technology) available.
PPR technology is a treatment for
soft tissue cutting and coagulation in a high repetition rate with
less or no carbonization. As a
result, the patients will feel less
pain and recover quickly. Gigaa is
a leading developer and manu-

facturer of diode
laser systems for
the dental area
as well as other
surgery areas,
such as vascular surgery,
ENT surgery, lipolysis, and urology surgery and laser
therapy. It is our mission to provide reliable diode laser
systems to increase patients’ health.
Wuhan Gigaa
Optronics Technology Co., Ltd
5-6/F, Unit A-B, Building B8, Hi-Tech Medical Device Industrial Park,
#818 Gaoxin Avenue, East Lake Development Zone, Wuhan 430206, China
info@gigaalaser.com
www.gigaalaser.com

elexxion

Antimicrobial periodontal and peri-implantitis
treatment
With the new photodynamic active ingredient Perio
Green, elexxion AG based in Radolfzell, Germany, is
bringing colour into laser-assisted periodontal and
peri-implantitis treatment.
The new class IIa medical
device, which is based on
the clinically proven PDT
dye indocyanine green and
reacts specifically to the
light frequency of elexxion
lasers, provides highly effective and painless adjuvant
treatment of periodontitis and peri-implantitis –
with no risk to hard dental and soft tissue and without causing discolouration or systemic effects.
If the active ingredient is irradiated by a diode laser
with a wavelength of 810 nm, active oxygen is released. This singlet oxygen changes the micro-organisms so that they are no longer able to
metabolise and are killed. The treatment is virtually
painless for patients because it causes no thermal

42 I laser
1_ 2013

or mechanical effects; anaesthesia is usually unnecessary.
The actual Perio Green treatment,
which can be repeated any time
in recall appointments, takes
about an hour. If the method is
used during a professional oral
hygiene session, the time is reduced to only about 30 minutes.
Furthermore, as this type of
laser-assisted therapy is non-invasive, it
can be delegated to a suitably trained dental nurse.

Informing themselves about the latest developments and methods in laser applications and taking part in the respective trainings is mandatory
for all laser users. Therefore, Biolase has been
supporting WCLI (World Clinical Laser Institute) for
many years, thus operating in laser education on
an international scale. In order to be able to offer
certified high-level courses worldwide, Biolase
has also recently started a new cooperation with
AALZ (Aachen Dental Laser Center) in Aachen,
Germany, presided by Prof. Norbert Gutknecht.
In addition, train-the-trainer seminars will be held
for international training practices. For the first
time, a workshop will be conducted which combines periodontology and aesthetic surgery/dermatology. Every laser user can gain further qualification in a certification course starting January
2013.
Moreover, the release of the new 10-Watts diode
laser Epic is eagerly awaited by laser users. A good
price-performance ratio, its appealing design and
easy handling have already led to such a high demand that it has become hard
keep pace with on the production side, resulting
in delivery delays.
Now, finally, the
modern diode-laser
system Epic with 25
years of Biolase experience in development is
made available worldwide.
All training activities in the German-speaking
countries can be found atwww.nmt-muc.de.

elexxion AG
Schützenstraße 84
78315 Radolfzell, Germany

Biolase Europe GmbH
Paintweg 10
92685 Floss, Germany

info@elexxion.com
www.periogreen.com/en

info@biolase-europe.com
www.biolase.de

IDS: Hall 10.1, booths J030-K031

IDS: Hall 4.2, botth N060

[43] =>

Henry Schein

AD

Henry’s Angels brighten EllenorLions
Hospices’ charity shop
A team of office workers from Henry
Schein UK, subsidiary of the US-based
Henry Schein, Inc. (NASDAQ: HSIC),
the world’s largest provider of
health care products and services
to office-based dental, medical
and animal health practitioners,
swapped their pens for paintbrushes
to give one of EllenorLions Hospices’
local charity shops a make-over.
Henry’s Angels—a troupe of volunteers from Henry Schein in Gillingham, UK—took time out of their busy
schedules to give Gravesend’s Kings
Street store a face life. Armed with paint
[PICTURE: ©BOULE]
pots and oodles of enthusiasm, the dedicated team set to work on Thursday, 23 August 2012.
The Angels brightened the walls with lashings of
white emulsion and gave the woodwork a beautiful
glossy finish. All of the materials were also paid for
donations raised by the Angels at a car-wash project
held at a local car wash centre in July. The team also
brought in donations of pre-loved clothes, household

items and other goodies, to be sold in the
shop. Henry’s Angels was formed in January 2011 with the goal of providing
Henry Schein employees an opportunity to help local causes in practical
ways. Henry Schein’s global corporate social responsibility programme,
Henry Schein Cares, stands on four pillars: engaging Team Schein Members to
reach their potential, ensuring accountability by extending ethical business
practices to all levels, promoting environmental sustainability, and expanding access to health care for underserved and at-risk communities.
Henry Schein UK
Centurion Close
Gillingham Business Park
Gillingham ME8 0SB, England
www.henryschein.co.uk
IDS: Hall 10.2, booths M048-N049

Syneron Dental Lasers

Syneron Dental Lasers, provider of innovative dental
laser technologies, is pleased to announce the
launch of its global LiteTouch™ Training Academy,
with a new concept that opens more than eight academic institutions around the globe offering practical LiteTouch™ training and insight into the Laserin-the-Handpiece™ technology.

sity “Goce Delcev” Stip, R. Macedonia, the University
of Geneva and the Asia Pacific Laser Institute. The
LiteTouch™ training programs include instructorled classroom lectures as well as hands-on sessions. The Academy offers training programs led by
key opinion leaders and targets two main groups:
new entrants to laser dentistry and practitioners
looking to extend their clinical knowledge. In addition, the program will provide a first-of-its-kind education program for specialists seeking to understand best practices and clinical solutions for specific procedures in their area of specialty (e.g.,
endodontics, periodontics, paediatric dentistry,
restorative and oral Surgery, aesthetic dentistry).

Syneron Dental Lasers has partnered in education
with world-class leading laser dentistry institutions,
including the International Society for Oral Laser Applications (SOLA) in Vienna, the University of
Barcelona, the Hebrew University and Hadassah
Medical Center in Jerusalem, the University of NiceSophia Antipolis, the University of Plovdiv, the faculty
of Medical Sciences, General Stomatology Univer-

Syneron Dental Lasers
Tavor Building, Industrial Zone
20692 Yokneam Illit, Israel
dental@syneron.com
www.synerondental.com

[PICTURE: ©SUKIYAKI]

LiteTouch™ Training Academy Goes Global

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

IDS: Hall 4.2, booth N050

laser
1
I 43
_ 2013

[44] =>

I education

1 International
Congress of WALED and
GLOBAL 2013 in Istanbul
Source_AALZ Germany

From 14-15 June 2013, the 1st International Congress of WALED and GLOBAL 2013 will be held at Point
Hotel Taksim in Istanbul, Turkey. We are planning an exciting programme with evidence-based and state-ofthe art laser dentistry. Meet international experts in their
fields, e.g. laser diagnostics, paediatric dentistry, aesthetics and oral surgery.
[PICTURE: ©ILKER CANIKLIGIL]

The programme is separated between the two organisers on the first day. The WALED programme is reserved only for WALED members. Members of this academy are Master of Science and Mastership/ Fellowship
graduates from the Aachen Dental Laser Center (AALZ)
and RWTH Aachen University. WALED (World Academy
for Laser Education in Dentistry) is the academic and educational worldwide network of AALZ and has been established to realise an international academy of excellence for postgraduate education and research in laser
dentistry. The goal of WALED is to standardise education
concepts based on evidence-based research as well as

44 I laser
1_ 2013

treatment protocols based on evidence-based preclinical and clinical research.
On the second day, the programme is open for everybody. Simultaneous translation in Turkish will be provided. Workshops will complete the lecture and the congress will be closed by the great “International Night”.
The Congress Fees are 250 Euro and include, in addition
to the scientific sessions, the full day catering as well as
the evening events!
We also established a WALED page on www.facebook.com/groups/123005997774948/
Please have a look from time to time for any updates
and news. We sincerely hope you will be able to attend
our congress, that your visit will be an enriching experience both academically and culturally, and that, above
all, you will have fun! We look forward to welcoming you
at our congress and to Istanbul. _

[45] =>

[46] =>

I meetings

The next chapter in the
IDS success story
Source_Koelnmesse

tions from abroad in March 2013. These are organised
in conjunction with state or private export promotion
organisations and associations. At present, 13 joint
participation groups have registered. These come
from Argentina, Brazil, Bulgaria, The People’s Republic of China, Great Britain, Israel, Italy, Japan, the
Republic of Korea, Pakistan, Russia, Taiwan and the
USA.

_IDS 2013 will continue a positive
tradition that began 90 years ago, when
the first dental show took place in Germany.
More than 1,900 exhibitors from over 55 countries
are expected to be in Cologne from 12–16 March 2013
for the world’s largest trade show for dentistry and
dental technology. Thanks to the tremendous demand for space, the fair will also occupy Hall 2.2 in addition to Halls 3, 4, 10 and 11. Altogether, 150,000 m²
of gross exhibition space will be covered.
The International Dental Show will once again be
the global meeting point for the international dental
sector in 2013. Around 68 per cent of the exhibiting
companies will come to Cologne from abroad. Following Germany, the nations that will be the most
strongly represented include Italy, the USA, the Republic of Korea, the People’s Republic of China,
Switzerland, France and Great Britain. In addition,
there will again be a large number of joint participa-

46 I laser
1_ 2013

Once again in 2013, the International Dental Show
will stick to its time-tested recipe for success. The concept of the event will continue to focus on business at
the stands and product information provided by the
exhibitors. Correspondingly and according to tradition, 12 March 2013, the first day of the show—also
referred to as Dealer’s Day—will concentrate on dental trade and importers. This special focus will provide
participants with an appropriate atmosphere for
undisturbed and intensive sales negotiations. Another well-established part of the
IDS programme—the Speakers’ Corner—
will take place in Hall 3.1, right next to the
Entrance South. Here, IDS exhibitors will
present new product information, services
and process techniques every day. In addition, speakers will report on the latest findings
from the worlds of science and research.
A number of digital services are available to help
visitors plan the optimal trade show visit. These services contribute to goal-oriented trade show preparations and help make the visit more effective. In order
to ensure optimal support, the update for the trade
show’s own IDS app for iPhone, Blackberry and other
operating systems is available since December. The
app can be downloaded free of charge from the IDS
website.
Travel arrangements, hotels and admission tickets
for the trade fair can be booked quickly and easily online, thanks to a number of services on the IDS website. Registration and ticket sales are available now
through the online ticket shop._

[47] =>

[48] =>

NEWS
New chip accelerates

Gingivitis bacteria

Detection of periodontal bacteria

Manipulate immune
system

Of the estimated 700 bacterial species found
in the oral cavity, only 11 are known to cause
periodontitis. The detection of the relevant
pathogens, however, has been very timeconsuming to date. Now scientists from Germany hope that a newly developed diagnostic device will allow dentists and medical labs
to conduct bacterial analysis in less than half
an hour.

New research from the US provides evidence that
Porphyromonas gingivalis, the main agent of the
chronic inflammatory disease periodontitis, also
manipulates the human immune system. In a number of laboratory tests, scientists observed that the
pathogen inhibits the body's defense processes
that would normally destroy it.

Conventionally, bacterial analyses are carried out in external contract laboratories using microbial cultures. This method bears the
risk of bacteria being killed as soon as they
come into contact with oxygen and the analysis can
take up to four to six hours. Therefore, ParoChip, an
initial lab-on-a-chip device, was designed by researchers at the Fraunhofer Institute for Cell Therapy and Immunology (IZI) to speed up the time
needed for identification.

Using ParoChip, many manual steps involved in
bacterial analysis can be avoided, Kuhlmeier said.
In addition, the synthetic disks can be produced
cheaply and are disposable, just like a single-use
glove, he added.

The new mobile diagnostic unit consists of a diskshaped microfluidic card that is about 6 cm in diameter. The card has eleven reaction chambers,
each containing the dried reagent for one of the
eleven periodontal pathogens.

To date, there is only a prototype of the device,
which will be tested in clinical laboratories first.
However, the researchers believe that it could also
be used by dentists to carry out in-house analyses
of patient samples in their practice in the future.

In order to determine the manner in which P. gingivalis influences the immune system, the researchers treated cells from mice with an inhibiting antibody against Interleukin-10 (IL-10), an antiinflammatory protein, while leaving a different portion of the same cells untreated. Afterwards, they
tested whether the cells produced interferongamma (IFN-γ), a protein that has an immunostimulatory and antiviral effect.

Oral Health Care

free oral health care event for 20 elementary aged
Queens children at the Colonial Church’s afterschool program in Bayside, NY, this past week.
Dr Fialkoff, founder of the Fialkoff Dental Study
Club, a dental educational group in Queens,
learned about the Partnership for Healthy Mouths,
Healthy Lives’ campaign earlier this year which the
Ad Council recently released to Capitol Hill and
American dentists.
Dr Fialkoff encouraged all dentist members to do
likewise at the group’s October meeting. Mike Calia
of Philips Oral Healthcare donated 20 “Sonicare for
Kids” electronic toothbrushes.

Councilman Dan Halloran, Philips, and Dr Bernard
Fialkoff DDS presented the Partnership for Healthy
Mouths, Healthy Lives and the Ad Council’s
“Healthy Mouths, Healthy Lives” campaign at a

48 I laser
1_ 2013

Victor Mimoni, staff representative of Councilman
Dan Halloran, instructed the children on proper
dental health.

According to the study, P. gingivalis stimulated the
production of IL-10, which in turn inhibited the activity of T-cells and macrophages, and repressed
the immune response. The researchers observed
increased production of IFN-γ in the treated cells,
while no such growth was seen in the untreated
cells.
The study highlighted the mechanism by which the
pathogen establishes a chronic infection. "These
bacteria go beyond merely evading our body's defense and actually manipulate our immune system
for their own survival," the researchers said. The
findings suggested that the damage done by the
bacterium occurs when the immune cells of the
host are first exposed to the pathogen. With regard
to successful treatment, the results demonstrated
the importance of a very early intervention.

[49] =>

Eco-Dentistry Association to hold

First Green Dentistry Conference

The conference will showcase the information and
products needed to create and maintain state-ofthe-art green practices. In this regard, it will feature a number of lectures about branding and marketing a green dental practice, as well as a presentation about how dental technologies can reduce waste and save energy. Participants may
earn continuing education credits, the EDA announced. During the meeting, panel discussions
will be held on various topics, from building and financing to creating a successful green hygiene
program. Participants will have the opportunity to
attend small-group hands-on courses for dental

technology such as laser and
CAD/CAM systems.
In order to promote the overall
health and well-being of the attendees, optional morning yoga
and meditation courses will be
held, in addition to presentations
focusing on the importance of
work-life balance. After the conference, participants can join a hiking tour
in the 6,000 acres of pristine wilderness
adjacent to the Sundance Resort on May 5.
Anyone interested can register for the event on the
EDA’s website, www.ecodentistry.org/conference. However, attendance is limited to the first
100 registrants, the association said.
The EDA was founded by Dr Fred Pockrass and his
wife Ina Pockrass, who created the model for eco-

The Eco-Dentistry Association, an international
association of dental professionals that promotes
earth-friendly dentistry, has announced that it will
be holding the first conference devoted to hightech, environmentally sound dental practices. The
event will take place on 3 and 4 May at the Redford
Conference Center in Provo, Utah.

friendly dentistry, which includes methods such as
reducing waste and pollution, as well as saving
energy, water and money. Their practice in Berkeley, CA, was the first in the country to be certified
as a green business.

Blackberries: possible treatment for

Complete tooth loss after

Oral bacterial diseases

Extensive consume
of soft drinks

New research has provided evidence that blackberry
extract could be used to control the growth of oral
pathogens on dental and mucosal surfaces. In a
number of tests, the researchers found
that it inhibited the metabolic activity of the causative agents of periodontal disease and dental caries in
particular.In the study,researchers from the
University of Kentucky tested the antimicrobial effects of blackberry extract on ten different oral bacteria. Among others, they observed
that the extract significantly reduced the metabolic
activity of Porphyromonas gingivalis and Fusobacterium nucleatum, two pathogens known to cause periodontal diseases, by about 40 per cent, and that it inhibited Streptococcus mutans, the primary agent of
dental caries, by approximately 30 per cent. In addition, they found that at higher concentrations the extract had the ability to kill oral bacteria.
To date, mouth rinse containing chlorhexidine, a
chemical antiseptic, has been one of the most effective antimicrobial agents against the colonization of
oral bacteria responsible for gingivitis and periodonti-

tis. However, its side effects, such as staining and
abrasion,limit its prolonged use as antimicrobial agent
by the general population. Thus, blackberry extract
might be a promising adjunct for prevention and treatment of periodontal infections, the scientists concluded.
Although the mechanisms underlying the antimicrobial effects are not fully understood, the researchers
suggested that berry-derived polyphenols, which can
be found in red wine, citrus and black tea too, could be
involved the process.The study will be published in the
February issue of the Journal of Periodontal Research.

According to recent news reports, Australian dentists
have had to remove all the teeth from the mouth of a
25-year-old owing to overindulgence in soft drinks.
The man had apparently drunk up to eight litres of soft
drink each day for the last three years. As reported by
online newspaper adelaidenow, William Kennewell is
highly addicted to sugary drinks and ignored dentists’
repeated warnings about the possible danger to his
oral health. He said he drank six to eight litres a day.
His addiction had not only led to severe tooth decay,
leaving him with only 13 teeth, but also caused blood
poisoning, which improved after his teeth were removed and replaced with dentures, the newspaper
reported. Only recently, a study among 16,500 Australian children revealed
that more than half of the
children in the country consume at least one soft drink
per day. Health experts have
consequently called for
tooth-decay warnings on
s u g a r- s w e e t e n e d
[PICTURE: ©BOULE]
beverages.

laser
1
I 49
_ 2013

[50] =>

I about the publisher _ 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
Chief Editorial Manager
Norbert Gutknecht
ngutknecht@ukaachen.de
Co-Editors-in-Chief
Samir Nammour
Jean Paul Rocca
Managing Editors
Georg Bach
Leon Vanweersch
Division Editors
Matthias Frentzen
European Division
George Romanos
North America Division
Carlos de Paula Eduardo
South America Division

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

Toni Zeinoun
Middle East & Africa Division
Loh Hong Sai
Asia & Pacific Division

Executive Producer
Gernot Meyer
meyer@oemus-media.de

Designer
Sarah Fuhrmann
s.fuhrmann@oemus-media.de
Customer Service
Marius Mezger
m.mezger@oemus-media.de

Published by
Oemus Media AG
Holbeinstraße 29
04229 Leipzig, Germany
Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de
www.oemus.com

Printed by
Silber Druck oHG
Am Waldstrauch 1
34266 Niestetal, Germany

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

Copyright Regulations
_laser international magazine of laser dentistry is published by Oemus Media AG and will appear in 2013 with one issue every quarter. The
magazine and all articles and illustrations therein are protected by copyright. Any utilization without the prior consent of editor and publisher is inadmissible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Oemus Media AG. Responsibility for such articles shall be borne by the author.
Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed
for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty
representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.

50 I laser
1_ 2013

[51] =>

laser
international magazine of



laser dentistry

Subscribe now!

I would like to subscribe to laser international magazine of
laser dentistry (4 issues per year) for € 44 including shipping
and VAT for German customers, € 46 including shipping and VAT
for customers outside Germany, unless a written cancellation is
sent within 14 days of the receipt of the trial subscription. The
subscription will be renewed automatically every year until a written cancellation is sent to OEMUS MEDIA AG, Holbeinstr. 29,
04229 Leipzig, Germany, six weeks prior to the renewal date.

You can also subscribe via
www.oemus.com/abo

Last Name, First Name
Company
Street
ZIP/City/County
E-mail

Signature

Reply via Fax +49 341 48474-290 to
OEMUS MEDIA AG or per E-mail to
grasse@oemus-media.de

Notice of revocation: I am able to revoke the subscription within 14 days after my order by sending a written
cancellation to OEMUS MEDIA AG, Holbeinstr. 29, 04229 Leipzig, Germany.

laser 1/13

Signature

OEMUS MEDIA AG
Holbeinstraße 29, 04229 Leipzig, Germany, Tel.: +49 341 48474-0, Fax: +49 341 48474-290, E-Mail: grasse@oemus-media.de

[52] =>

The Dual Wavelength Waterlase iPlus
Advancing Laser Technology to Its Ultimate

INTUITIVE & INTELLIGENT
GRAPHICAL USER INTERFACE
For example, performing a Class I Cavity Prep
with the iPlus™ is as easy as 1,2,3...
Select “Restorative” from the ﬁrst screen
Choose “Class I” from the next screen
that appears automatically
Specify any other concerns such as patient
sensitivity or bond strength
That’s it! Step on the foot pedal, and
start working.

Step 1
Step 2
Step 3

iLASE ™
940nm DIODE LASER
DOCKING STATION






BREAKS THE
SPEED BARRIER


ə5powered laser delivers 100 pulses/sec. for




superior soft-tissue cutting
Patented laser technology delivers 10 watts of power
Enables multi-quadrant same-day procedures

Adds dual wavelength versatility
and convenience
First totally wireless dental laser
5 Watts peak power with
ComfortPulse™
Battery operated with ﬁnger
switch activation
Exclusive bendable tips in many
diameters & lengths

PROVIDES
GREAT
RETURN ON
INVESTMENT




Increases treatment acceptance of
day-to-day restorative cases
Attracts new patients
Increases productivity and enables
new procedures

ENABLES BIOLOGICALLY
FRIENDLY DENTISTRY
R

R




No micro-fractures or thermal damage
More precise, minimally invasive

2011

TOP 50

Technology Products

©2012

| www.BIOLASE.com | Toll-free 888-424-6527

) [page_count] => 52 [pdf_ping_data] => Array ( [page_count] => 52 [format] => PDF [width] => 595 [height] => 842 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => laser international No. 1, 2013

[toc] => Array ( [0] => Array ( [title] => Cover [page] => 01 ) [1] => Array ( [title] => Editorial [page] => 03 ) [2] => Array ( [title] => Content [page] => 04 ) [3] => Array ( [title] => Laser versus conventional therapies [page] => 06 ) [4] => Array ( [title] => Photodynamic therapies – Blue versus Green [page] => 10 ) [5] => Array ( [title] => Becoming kissable: Laser-assisted haemangioma removal [page] => 26 ) [6] => Array ( [title] => Industry report [page] => 30 ) [7] => Array ( [title] => Manufacturer news [page] => 42 ) [8] => Array ( [title] => 1st International Congress of WALED and GLOBAL2013 in Istanbul [page] => 44 ) [9] => Array ( [title] => The next chapter in the IDS success story [page] => 46 ) [10] => Array ( [title] => News [page] => 48 ) [11] => Array ( [title] => Imprint [page] => 50 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

[cached] => true )