laser international No. 1, 2016

Cover / Editorial / Content / Fluorescence-guided caries excavation of decayed teeth: An ex vivo study / Evaluation of a self-adhesive composite in dentin surfaces: Preparation with Er - Cr:YSGG laser / Smear layer removal with laser in drilled implant holes: A pilot study / Non-ablative melanin depigmentation of gingiva / Histologica®l effects of NightLase in the soft palate of rats: A pilot study / Introducing LASOTRONIX— lasers for generations / Probing for alternatives: The prevention of dental fear / Nachgebohrt – Zahnarztangst Auf der Suche nach Alternativen / Eleven tips for success in your dental clinic Part III: CASCO and PEC / Laser education at its best AALZ Mastership courses in Greece / Manufacturer news / News international / Editorial (German) / News Germany / Imprint

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Vol. 8 • Issue 1/2016

issn 2193-4665

laser
international magazine of

1

2016

research
Fluorescence-guided caries
excavation of decayed teeth

special
Probing for alternatives

events
Laser education at its best

laser dentistry

[2] =>

Master of Science (M.Sc.) in
Lasers in Dentistry
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Aachen, Germany
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Kackertstraße 10 I 52072 Aachen I Germany
phone +49 241 80 23543 I fax +49 241 80 92525
info@academy.rwth-aachen.de
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phone +49 241 47 57 13 10 I fax +49 241 47 57 13 29
info@aalz.de
www.aalz.de

[3] =>

editorial

Light to brighten
the future

Kenji Yoshida

Dear readers of laser international magazine of laser dentistry,
We sincerely welcome all of you to Nagoya, Japan, on the occasion of the 15th Congress of the World
Federation for Laser Dentistry from July 17 to 19 2016 in Nagoya, Japan.
The WFLD is held every two years, and this is the third World Congress held in Japan, following the
first congress in 1988 in Tokyo under the presidency of Professor Hajime Yamamoto, and the second
congress in 2002 in Yokohama, hosted by Professor Isao Ishikawa.
Themed “Light to Brighten the Future”, the congress aims at moving forward from existing laser dentistry and dental care as well as seeking the new developments through extensively incorporating light
into diagnosis and treatment of patients. The congress features a varied programme, including lectures,
a symposium, workshops, oral and poster sessions, exhibitions and seminars. Each programme will bring
light to the future laser specialists in engineering and various medical fields, including dentistry. Presenters from all around the world will deliver their latest findings and scientific knowledge. It is our deepest
aspiration that the congress will also be an opportunity for further advancement of academic research
activities and clinical improvement, as well as herald the beginning of a new development of medical
devices and expansion of the industry in Japan.
Apart from the scientific programme, opportunities for social activities, including a welcome-drink
reception, Japan night and banquet during the congress. We hope the congress will be a place to acquire
the latest information and knowledge and to extend your scientific networks for your future careers and
research.
We are sincerely looking forward to seeing all of you at the WFLD2016 in Japan.
Kenji Yoshida
Chairperson, WFLD2016

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1 2016

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| content

page 12

page 24

page 40

editorial

practice management

03 Light to brighten the future

36 Eleven tips for success in your dental clinic

research

events

06 Fluorescence-guided caries excavation
of decayed teeth

40 Laser education at its best

12 Evaluation of a self-adhesive composite
in dentin surfaces

news

18 Smear layer removal with laser
in drilled implant holes

44 news international

Kenji Yoshida

Dr Anna Maria Yiannikos

Dr Dimitris Strakas

ZA Martin Augenstein & Prof. Dr Matthias Frentzen

Dr. Ana Catarina Nogueira da Silva et al.

Dr Alireza Mirzaee

case report
24 Non-ablative melanin depigmentation of gingiva
Dr Kenneth Luk

42 manufacturer news international

DGL
47 Mit Laser die Zukunft ausleuchten
Kenji Yoshida

48 news germany

industry

about the publisher

28 Histological effects of NightLase®
in the soft palate of rats

50 imprint

Aslıhan Üsümez et al.

32 Introducing LASOTRONIX—
lasers for generations

special
34 Probing for alternatives
Dr Anton Kasenbacher

35 Nachgebohrt – Zahnarztangst
Dr. Anton Kasenbacher

04

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1 2016

Cover image courtesy of LASOTRONIX
www.lasotronix.com

[5] =>

The universe at your fingertips.
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TwinLight Peri-implantitis
Treatment
A simple and effective procedure that offers the power to treat
peri-implantitis – an increasing threat to oral health.

Peri-implantitis treatment video

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• Minimally-invasive technique
• Fast regeneration/healing
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• No antibiotics needed

[6] =>

| research

Fluorescence-guided
caries excavation of
decayed teeth
An ex vivo study

Authors: ZA Martin Augenstein & Prof. Dr Matthias Frentzen, Germany

Introduction

Fig. 1: SIROInspect® with filter
glasses, accessory parts
and charging station
(Sirona Homepage, 2014).

Studies with dye solutions, which are supposed
to mark infected dentin, do not show unambiguous results either, since hypomineralised dentin
areas and porosities are stained as well.4 This often results in an overexcavation under clinical
conditions, since even non-infected hypomineralised areas such as the dentino-enamel junction
or healthy areas near the pulp are stained.5, 6
A fluorescence-based optical method may
be considered an alternative.7 Optical phenomena
in the tooth structure damaged by caries or
the spectroscopic detection of metabolic pro
ducts of a microbial infection of the dentin are
used.8, 9 
E xamples for this procedure are the
DIAGNOdent®-system,10 intraoral camera systems with blue light excitation11 as well as feedback controlled Er:YAG laser systems.12 The previously-mentioned systems are difficult to implement in practice. The technology is very complex.
Devices which stimulate the dentin with a
blue-light diode (405 nm) present an alternative;
the examiner gives an evaluation with the help of
filter glasses, making the fluorescence visible
during the treatment of caries excavation. This
treatment technique is called the FACE®
method (Fluorescence Aided Caries Excavation).7 The present study attempts to examine
histologically under ex vivo conditions whether

Fig. 1

06

The goal of caries excavation is the elimination
of bacterially infected dentin to give the maximal
conservation of healthy dental hard tissue as well
as to maintain the vitality of the dental pulp.1
Dentin layers near the pulp which can be remineralised—affected dentin—should be preserved
in terms of an atraumatic therapy.2, 3 There are
several techniques to determine the endpoint of
the excavation clinically. One of these techniques
is the examination of the hardness of the cavity
floor using a dental probe. For this type of test,
the dental probe must not infiltrate the material
further; the “Crie dentaire“ must be audible. However, this test is not objectifiable and does not

correlate with bacterially infected dentin.2 Additionally, Fusayama et al. observed that dentin
areas close to the pulp show a significantly lower
hardness than dentin of a chronical carious
lesion.2

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[7] =>

research

Fig. 2a

Fig. 2b

Fig. 2c

Fig. 2d

Fig. 2f
x

Fig. 2g

Fig. 2h

Fig. 2i

|

Fig. 2e

Fig. 2 a–i: Case example I—Documentation of a tooth sample in process of the examination; before excavation a daylight shot and a fluorescene shot (through a high-pass filter
> 500 nm) of the cavitated decayed lesion were taken; intermediate steps (b), (e) as well as the complete excavation (c), (f) using the SIROInspect® were documented; additionally
X-rays were taken after extraction and after the complete treatment (g), (h); the histological examination of the thin sections was evaluated microscopically (i).

an atraumatic, complete excavation of bacterially infected dentin is possible.

Material and methods
In this study, 31 human teeth with carious lesions were examined. The indication for the extraction of the teeth was made independently
from this trial. Patients gave their informed consent for the scientific use of the samples. All in all,

27 teeth were treated with the FACE®-System
(SIROInspect®, Sirona, Bensheim, Germany) directly within two hours after extraction (Fig. 1);
four untreated teeth served as reference for the
histological evaluation.
The initial state was recorded by a photo as well
as X-ray. After that, the teeth were fixed in a
stage. Then the cavity was illuminated using the
SIROInspect®-light probe (405 nm, 60–250 mW)

Oemus_Autorenanzeige_LE_210x99_en_Layout 1 29.03.16 10:44 Seite 1

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issn 2193-4665

international magazine of

Vol. 8 • Issue 1/2016

laser dentistry

1

2016

research

Fluorescence-guided caries
excavation of decayed teeth

special

Probing for alternatives

events

Laser education at its best

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Become an author for laser—
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1 2016

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03

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| research

Fig. 3a

Fig. 3b

Fig. 3c

Fig. 3d

Fig. 3f

Fig. 3g

Fig. 3h

Fig. 3i

Fig. 3 a–i: Case example II—
Documentation of a tooth sample
in process of the examination;
before excavation a daylight shot
and a fluorescene shot (through a
high-pass filter > 500 nm) of the
cavitated decayed lesion were taken;
intermediate steps (b), (e) as well
as the complete excavation (c),
(f) using the SIROInspect® were
documented; additionally X-rays
were taken after extraction and
after the complete treatment (g),
(h); the histological examination
of the thin sections was evaluated
microscopically (i).

and was photographed through a high-pass filter
which had the same properties as the filter glasses
of the goggles (Figs. 2a, d, g and 3a, d, g). This filter
system only lets waves with a wavelength larger
than 500 nm pass. Subsequently, an access cavity
was prepared with a diamond bur and the carious
changed tissues were excavated with a carbide
bur with 1,600 rpm using the laser system accord
ing to the manufacturer information until no
more red fluorescent dentin was visible. The examiner used magnifying glasses to control the
treatment. An X-ray and photographic documentation as well as a fluorescence image of the tooth
were made according to the initial photographs
(Figs. 2c, f, h and 3). The teeth were stored in isotonic saline solution during all steps of the examination. Before histological thin-section preparations were made, the teeth were stored in formalin solution (4 %) and stained with rhodamine
fuchsine fast green. Overview pictures were made
of all dental probes with a magnification of six
times (Figs. 2i and 3i). The identification of histological caries zones (Fig. 4), until which an excavation was performed under the control of the
laser system, was carried out at a magnification
of 12 times and 18 times respectively. Untreated
teeth with cavitated decayed lesions served as
histological reference.

Results
In 93 % of the teeth with cavitated caries
lesions, red fluorescence were detected in the

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1 2016

Fig. 3e

area of the lesion. Two samples did not show red
fluorescent features, but only fluoresced in the
brownish spectral range. These two teeth were
also excavated until there was no more brownish
fluorescence. The sections of these teeth did not
show any abnormalities of structure in the periphery of the carious lesions.
The X-rays revealed a complete excavation for
all teeth. 96 % of the teeth were identified histologically free from bacteria (Figs. 2 and 3). In 37 %
of the samples, parts of sclerotic dentin were
preserved. After the excavation using the laser
system, carious dentin (microbiological contamination) was identified histologically only in one
sample.

Discussion
In 2002, Lennon et al. already examined whether
red fluorescence corresponds to bacterially infected dental hard tissue.7 In his study, the FACE®
method was compared to other methods of excavation. DNA labeling of the samples was assessed
by means of CLSM (Confocal Laser Scanning Microscopy) as objective evidence. The study showed
a sensitivity of 94 % and a specificity of 83 % for
the FACE® method. The results of a conventional
excavation method were distinctly below those
values and the excavation method using carious
detector dye were rated the worst with 65 % for
sensitivity and a were only 17 % for specificity.7
Another significant finding is that if there was a

[9] =>

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Maximale Schneidleistung trifft
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[10] =>

| research
other treatment methods were often completed
when the hard, healthy dentin was reached,
in this study the FACE® method made it possible
to selectively excavate bacterially infected
dentin. These results coincide with the findings
of the present study. After laser excavation,
96 % of the teeth were histologically caries-free
and in 37 % of the samples, sclerotic dentin
could be detected indicating a gentle excavation.
Due to the small layer thickness of the sclerotic
dentin in extended cavities, its conservation
provides evidence of the method being tooth
conserving.

Conclusion
Fig. 4
Fig. 4: 18x magnification;
extended cavitation; histological
image which served as reference
for the determination of histological
layers of caries.

lack of red fluorescence on the dental hard tissue,
95% of the tooth samples were documented clear
from bacteria. This study confirms these results
for the fluorescence guided carious excavation
using SIROInspect®.
In addition, excavation using FACE® could be
completed in a shorter period of time than the
chemomechanical excavation or the use of Caries
Detector®.13 The cavity size did not increase and
the number of remaining bacteria was significantly lower for the use of FACE®.14
In a comparative study, the FACE® method using
a VistaProof camera was examined in contrast to
the conventional excavation with a probe and
the excavation using Caries Detector®.15 While

The SIROInspect®-tool offers an easy, practicable system for the examiner to visualise carious hard tissue during the excavation. In addition, the easy handling of the system allows for
a time-optimised excavation while minimising
the risk of increasing cavity size under clinical
conditions._

contact
Prof. Dr Matthias Frentzen
Welschnonnenstraße 17
53111 Bonn, Germany
Tel.: +49 228 287-22470
Fax: +49 228 287-22694
frentzen@uni-bonn.de

Kurz & bündig
Das Ziel der Kariesexkavation ist die Eliminierung des durch Bakterien infizierten Dentins; gesundes Hartgewebe
soll in größtmöglichem Umfang erhalten werden, um die Vitalität der Pulpa zu bewahren. Es gibt verschiedene
Methoden, um den Endpunkt der Exkavation klinisch zu bestimmen. Dazu zählt u. a. die Untersuchung der Härte des
Kavitätenbodens mithilfe einer Dentalsonde. Bei vollständiger Exkavation sollte der „Crie dentaire“ deutlich hörbar
sein. Alternativ wird die Möglichkeit einer Farbkodierung des Dentins beschrieben. Diese Tests sind jedoch nicht
objektivierbar und zeigen nicht an, ob infiziertes Dentin vollständig entfernt wurde bzw. ob bereits eine Überexkavation
im gesunden Gewebe vorliegt.
In der vorliegenden Studie wurden 31 menschliche Zähne untersucht, die kavitierte kariöse Läsionen aufwiesen.
Die Indikation zur Zahnextraktion wurde unabhängig von dieser Studie gestellt; die Patienten stimmten der wissen
schaftlichen Untersuchung der Zähne zu. Insgesamt 27 der 31 Zähne wurden mit Unterstützung des FACE®-System
(SIROInspect®, Sirona/Bensheim) innerhalb von zwei Stunden nach der Extraktion exkaviert, vier der Zähne blieben unbehandelt und dienten als Referenzzähne für die histologische Evaluierung.
Nach Exkavation mit Unterstützung des FACE®-Systems konnten 96 Prozent der Zähne histologisch als kariesfrei
eingestuft werden, bei 37 Prozent der Zähne wurde die Zone des sklerotischen Dentins im Rahmen der Kariesentfernung
belassen, was auf ein schonendes Vorgehen hindeutet.

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[11] =>

[12] =>

| research

Evaluation of a
self-adhesive composite
in dentin surfaces
Preparation with Er,Cr:YSGG laser

Authors: Dr Ana Catarina Nogueira da Silva, Prof. Paulo Ribeiro Melo, Prof. Sofia Arantes Oliveira &
Prof. Norbert Gutknecht, Portugal, Germany

Introduction
Flowable resin composites appeared in the late
1990s, and they have properties like low modulus
of elasticity and high wettability, which are very
desirable for the clinical work.1, 2 The development
of dentistry has eventually led to minimal invasive
dentistry, with smaller preparations, giving the
flowable resin composite an important role due to
its flow characteristics and easy application.3
Self-adhesive flowable resin composites combine a bonding system and a flowable composite.
This kind of material is an adequate tool to use in
more difficult patients and children, because it allows a restorative procedure with less steps and
less time in the dentist chair. The self-adhesive
flowable resin composite used in this study was the
Vertise™ Flow (VF) from Kerr, was released in the
market in 1992, and has the OptiBond™ bonding
mechanism to dentine.4 This material has the characteristics described in the Table 1.
The GPDM (phosphate functional group) forms
a chemical bond with the calcium ions on the
tooth, and the prepolymerized filler present in the
VF minimises the shrinkage and enhance properTable 1: Self-adhesive flowable resin
composite used in this study.

12

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1 2016

ties of clinical handling. The VF does a micromechanical adhesion with the formation of a hybrid
layer, which consists in resin impregnation with
collagen fibres and dentin smear layer.4
Dentin is a mineralised subtract of the tooth
which has an intricate three-dimensional frame,
with tubules extending from the pulp to the dentino-enamel junction, intratubular and peritubular
dentin. It has 70 % (by weight) of mineral, 20 % of
organic component and 10 % of fluid. The composition of the organic matrix is 90 % of fibrillar type I
collagen and 10 % of noncollagenous proteins like
phosphoproteins and proteoglycans. Because of
this complex structure, only a few structure-property relationships can be performed.5, 6
Actually, the formation of a hybrid layer, with the
monomers impregnation into the dentin partially demineralised, and its subsequent polymerisation
seems to be the most successful method.7, 8 Erbium
lasers cavity preparation results in the absence of
smear layer, opened dentinal tubules and micro irregularities on the dentin in result of the removal of the
intertubular dentin, outcoming in a dentin surface
more suitable to adhesive procedures. The effect of
laser on the collagen network is still not completely

Self-adhesive flowable resin composite
ID

Material

Manufacturer

Compositions

VF

Vertise™ Flow

Kerr

GPDM, HEMA, prepolymerized filler, 1-µm barium glass
filler, nanosized colloidal silica, nanosized Ytterbium fluoride

[13] =>

research

The Er,Cr:YSGG laser has a wavelength of 2.79 μm.
The ablation threshold in human dentin is 2.69 to
3.66 J/cm2.11 The laser frequency is the number of
laser pulses per second.12 Theoretically, an increase
of the laser frequency would result in a smoother
surface, which could reduce the gaps between the
composite and the dental surface.
The main objective of this study was to evaluate
the bond strength of self-adhesive flowable composite Vertise™ Flow in dentin surfaces prepared
with Er,Cr:YSGG laser with two different settings.
The null hypotheses to test were: (a) the microshear bond strength of the restorations with
Vertise™ Flow self-adhesive flowable composite is
the same, in dentin surfaces prepared with bur and
Er,Cr:YSGG laser; (b) micro-shear bond strength of
the restorations with Vertise™ Flow self-adhesive
flowable composite is the same, in dentin surfaces
prepared with Er,Cr:YSGG laser with the settings
4.5 W, 50 Hz, 50 μs, 70 % air, 90 % water and with
the settings 4.5 W, 75 Hz, 50 μs, 70 % air, 90 % water.

Materials and methods
The sample consisted of 15 non carious molars
extracted by periodontal or orthodontic reasons.
After extraction, the teeth were cleaned and stored
in 0.5 % chloramine T at a temperature of about 4 °C
to carry out the disinfection and preventing bacterial growth for no longer than three months until
used in the experiment. Afterwards, the teeth were
numbered by a person assigned, and distributed to
the three groups (n=5) by another person assigned.
To obtain the samples for the electron microscopy, two from each group, the coronal occlusal
third of the teeth and the roots were removed by
bisecting the tooth transversely with a low speed
diamond saw and copious supply of water. It resulted in approximately 2 mm thick dentin discs.
To obtain the samples to the Tensile Bond Strength
(TBS) test, three teeth from each group were longi
tudinally sectioned into two parts where the proximal
enamel was removed by a disk to expose the dentin.

Groups
The laser samples were submitted to an
Er,Cr:YSGG laser (Waterlase iPlus—Biolase Tech-

10,000

Mean Shear Bond Strength

clear, but it is known that laser irradiation can develop
microstructural alterations and micro rupture of collagen fibres.9 The reported bond strengths of composite resin to dentine substrate prepared by erbium
lasers have often been confusing and contradictory.10

Error bars: ± 1 SD

7,500

5,000

2,500

,000

Control
Fig. 1

Group 2

Group 3

Surface Treatment

nology Inc., Irvine, CA, USA), with two different
settings , with the MZ8 tip, using the beam with
an angle of 45° to the surface, with smooth movements in the horizontal and vertical, during twelve
seconds in the dentin discs, and eight seconds in
the teeth’s proximal surface, where the area was
smaller than the discs. The dentin samples from
the control group were not submitted to any laser
treatment:

Fig. 1: Mean and standard deviation
of the Shear Bond Strength (MPa) in
the three groups.

Group 1: Control Group (n=10) Material: Vertise™ Flow (Kerr, Orange, CA, USA) (without laser
surface treatment).
Group 2: Settings 4.5 W, 50 Hz, 50 μs, 70 % air,
90 % water (n=10) (Fig. 7) Material: Vertise™ Flow
(Kerr, Orange, CA, USA).
Group 3: Settings 4.5 W, 75 Hz, 50 μs, 70 % air,
90 % water (n=10) (Fig. 8) Material: Vertise™ Flow
(Kerr, Orange, CA, USA).
The Vertise™ Flow self-adhesive flowable composite was applied in the dentin surface from each
sample, about 3 mm delimited by a tape of poly
ester (Mylar) and a silicone mold with 3 mm of
diameter and 4 mm of high to the samples to the
SBS test, directly to dentin in the discs used in
the SEM, and lighted cured for 20 seconds with a
LED curing light Bluephase C8 (Ivoclar Vivadent)
800 mW/cm2.
Subsequently, the samples were placed in an incubator at 37 °C with 100 % humidity for 24 hours.
Next, they were thermocycled 500 times in baths
of 5 °C and 55 °C for 20 seconds at each temperature, to simulate the in vivo conditions in the oral
cavity. At the end of thermocycling, the samples
returned to the incubator for more than 24 hours.

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1 2016

[14] =>

| research
Fig. 2: SEM of the dentin surface
without laser preparation (Control),
showing the micromorphological
aspects of the bonding region
produced by Vertise Flow™. Note the
regular surface and the wide dentinal
tubules with resin tags (x 1,500).
Fig. 3: SEM of the dentin surface
without laser preparation (Control),
showing the micromorphological
aspects of the bonding region
produced by Vertise Flow™. Note
the sectioned resin tags in the
dentin surface (x 1,500).

Fig. 2

Fig. 3

Preparation of samples for scanning
electron microscopy

Games-Howell post-hoc test was used to compare
pairwise, with a confidence interval of 95 %.

The samples discs were split in half (MD) with a
diamond blade mounted on the handpiece resulting
in restored hemi-discs. The hemi-discs were prepared to be observed on the SEM. The observations
were made using the electron microscope scanning—FE SEM (JEOL JSM 6301F) at 10–15 kV and were
focussed in the area resin-dentin interdiffusion. The
electron microscopy photomicrographs were taken
in a variation of 300 x and 5,000 x magnifications.

Results

Shear Bond Strength (SBS) test
The Shear Bond Strength was performed using
the Instron device connected to a computer, (system developed at the University of California, San
Francisco). Shear Bond Strength was tested at
1 mm/min.

Statistical analysis
The Shear Bond Strength values were analysed
using the Shapiro-Wilk test to control the normality assumptions, because the number of the sample was lower than thirty. The homogeneity assumptions were controlled by the Levene test. Although
the data were normally distributed, the Levene
test rejected the homogeneity of the variances.
Therefore, the Welch test was applied and the
Fig. 4: SEM of the dentin surface
pre-treated with Er,Cr:YSGG laser
from Group 2, showing long resin
tags with lateral branches (x 1,500).
Fig. 5: SEM of the dentin surface
pre-treated with Er,Cr:YSGG
laser from Group 2, showing long
resin tags with lateral branches.
The formation of a gap along the
interface was observed (x 5,000).

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1 2016

Fig. 4

Shear Bond Strength test (SBS test)
All statistical analyses were performed using
SPSS version 21.0 (SPSS Inc., Chicago, IL, USA).
Group 2 was the one with the highest Shear Bond
Strength mean (4.76 ± 3.99 MPa), although the
standard deviation is the highest, and the Group
3 had the lowest Shear Bond Strength mean
(0.81 ± 0.93 MPa), as we can see in the graph
(Fig. 1). This means of the Shear Bond Strength
of the Control Group (1.87 ± 1.61 MPa), of Group 2
(4.76 ± 3.99 MPa) and of the Group 3 (0.81 ±
0.93 MPa), were not statistically different between each other (p > 0.05).
Scanning electron microscopy
Control Group
In these dentin samples we saw a regular surface, with resin tags in the surface of the dentin
going through the open dentinal tubules. The resin
tags appeared to be sectioned, showing an adhesive failure (Figs. 2 and 3).
Group 2
In the analysis of the samples of Group 2, a
rougher dentin surface was noted, with several
resin tags. It was possible to see a hybrid layer forFig. 5

[15] =>

research

Fig. 6

Fig. 7

mation in all the samples and the presence of resin
tags with lateral branches. A gap along the interface between the VF and the dentin surface was
seen in two of the samples (Figs. 4 and 5).

better SBS with the first system.16 The application
of acid in the dental surface prepared with laser
dissolves the intertubular dentin, altering the surface produced by laser, and leading to unknown
dentin-demineralised depths, which could interfere with the monomers diffusion.17–19

Group 3
In the dentin surface of the samples of Group 3,
it was possible to observe what seems to be melted
dentin, with a few open dentinal tubules, and a gap
along the interface (Fig. 6). In a sample, it was not
possible to observe resin tags in the dentinal tubules, there was almost no hybrid layer and a big
gap along the interface between the VF and the
dentin surface was observed (Fig. 7). The samples
of this group seemed to have a smoother dentin
surface than those in Group 2, but rougher than
the samples of the Control Group (Figs. 6 and 7).

Discussion
There are already several studies about adhesion
in dental surfaces prepared with laser, but mostly
with Er:YAG and enamel, and fewer about self-adhesive flowable in dentin, especially with Er,Cr:YSGG
laser. Several factors can influence the adhesion to
dentin, such as the dentin substrate itself, the
treatment and the dentin conditioning.13,14 The adhesion to dentin was always a greater challenge
because of the water and collagen content.15 The
dentin hybridisation is the accepted mechanism to
explain the resin-dentin bond, which consists in
demineralised dentin with infiltrated monomers
and its polymerization.8
Several articles showed that dentin surfaces prepared with Er,Cr:YSGG laser appear with open dentinal tubules looking cuff-like, irregular and rough,
and are without smear layer.9 These features of
lased dentin theoretically should have better conditions for adhesion.15 The comparison presented
by Beer et al., between dentin surface prepared
with Er,Cr:YSGG laser and self-etch system and a
dentin surface also prepared with Er,Cr:YSGG laser
and etched with 37 % phosphoric acid, showed

Fig. 6: SEM of the dentin surface
pre-treated with Er,Cr:YSGG
laser from Group 3, showing the
micromorphological aspects of
the bonding region produced by
Vertise™ Flow. The formation
of a gap along the interface was
observed (x 500).
Fig. 7: SEM of the dentin surface
pre-treated with Er,Cr:YSGG laser
from Group 3, showing the formation
of a gap along the interface (x 500).

Therefore, theoretically we do not need acid
etching prior the adhesive to accomplish an adequate adhesion in lased surfaces. Despite the advantages of the dentin surfaces prepared with
Er,Cr:YSGG in adhesion,15 several studies have
demonstrated a lower SBS when compared with
surfaces treated with conventional methods.9, 15, 20, 21
However, this subject is still treated controversially.22, 23
Group 2 presented higher mean values of bond
strength (4.76 ± 3.99 MPa), followed by the Control
Group (1.87 ± 1.61 MPa). A lower adhesion result
was observed in Group 3 (0.81 ± 0.93 MPa). The
high standard deviation presenting in Group 2
shows that probably there was more variability in
the sample than expected. The age of the dentin
samples could be a factor with an impact on the
Shear Bond Strength,24 that was not controlled in
this study, and also the sample probably should be
higher. None of the SBS differences between the
three groups were statistically significant (p > 0.05),
so neither of the null hypothesises were rejected.
The settings used in Group 2 resulted in a surface
without smear layer, which was rougher than the
Control Group. The absence of smear layer and open
dentinal tubules promotes a better surface for adhesion, leading to a better infiltration of the resin
tags, which were observed in the SEM micrographs
of this study.25 A study performed by Yazici et al.,
comparing the Shear Bond Strength of the VF in
human dentin lased with Er:YAG and unlased surfaces, also showed better results in the lased ones.3
Moreover, the manufacturer of VF claims that
the acidic phosphate group etches the dental sur-

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1 2016

[16] =>

| research
face, creating a chemical bond with the calcium,
probably enhancing the adhesion. According to Visuri et al., the main presence of peritubular dentin
in the dentin surface treated with laser can explain
why the SBS was better than that of the Control
Group.26 This surface results from a higher content
of water in the intertubular dentin, leading to more
ablation of this substract.9 The mean of the SBS of
the VF in Group 2 (4.76 ± 3.99 MPa) was lower
compared to other studies performed by Altunsoy
et al., and Yazici et al. in lased dentin with Er:YAG.1, 3
One of the main reasons that could explain this
difference is the use Er:YAG laser in these studies,
and the different settings applied.1,3 In all samples
of Group 3, and in one of Group 2, a gap in the interface of the dentin surface and the VF was seen,
probably due to thermocycling. According to
El-Marhomy et al., the thermocycling influences
the marginal gap of composite restorations,27 because the hot water can accelerate the hydrolysis
of the interface components and induce stress between the composite and the dental surface.28 Despite these findings, the effect of thermocycling is
still controversial because some studies showed no
influence of thermocycling on gap formation.29
One of the objectives of this study was to compare the influence of the laser frequency on the
SBS of the VF. The results showed that even if you
get a smoother surface with the increasing of the
laser frequency, as we can see in the SEM micrographs, the SBS is lower (0.81 ± 0.93 MPa) compared to Group 2 (4.76 ± 3.99 MPa) and Control
Group (1.87 ± 1.61 MPa). These results concur with
a study performed by Samad-Zadeh et al., in which
the authors concluded that the SBS was higher in
the laser-textured dentin substrate, with greater
spacing patterns.30

Comparing the results of this study with other
studies is always a challenge because different lasers
and parameters influence the laser-tissue inter
action, leading to different outcomes. All dental
products on the market were produced to work in
dental surfaces prepared by conventional methods
like the bur. This study and all the studies referred to
in this article tested those materials available in the
market. The results should be used to develop new
products, with a laser-treated dental surface in mind.

Conclusion
Although the bond strength of the Vertise™ Flow
was influenced by the type of dentin surface and
the laser parameters, the results of each group
were not statistically different between each other
(p > 0.05), showing no significant difference concerning dentin-surface treatment. The increase of
only the laser frequency resulted in lower SBS. Additional studies should be carried out in order to
reach a better adhesion of self-etch flowable composites in dentin surfaces prepared with Er,Cr:YSGG
laser, possibly trying new laser settings._
Editorial note: A list of references is available from
the publisher.

contact
Ana Catarina Nogueira
da Silva, DMD, MSc
Conservative Dentistry Department,
Faculdade de Medicina Dentária,
Universidade do Porto, Portugal
Rua Dr. Manuel Pereira da Silva,
4200–393 Porto, Portugal
anacatns@gmail.com

Kurz & bündig
Selbstklebende, fließfähige Harz-Composites verbinden ein Bondingsystem mit einem fließfähigen Composite. Diese
Art Material ist ideal für den Einsatz bei schwierigen Patienten sowie Kindern, da es eine Restauration in wenigen Schritten mit einer kürzeren Behandlungsdauer begünstigt. In der vorliegenden Studie wurde das selbstklebende, fließfähige
Harz-Composite Vertise™ Flow (VF) der Firma Kerr verwendet.
Das Hauptziel dieser Studie war es, die Bondingstärke des selbstklebenden, fließfähigen Composites Vertise™ Flow an
Dentinoberflächen zu ermitteln, welche mithilfe eines Er,Cr:YSGG-Lasers in zwei verschiedenen Voreinstellungen präpariert
wurden. Obwohl die Bondingstärke des verwendeten Composites durch die Dentinoberfläche und die Laserparameter
beeinflusst wurde, unterschieden sich die Ergebnisse der verschiedenen Versuchsgruppen statistisch nicht voneinander
(p > 0.05), sodass kein signifikanter Unterschied hinsichtlich der Behandlung der Dentinoberfläche festgestellt werden
konnte. Ein Erhöhen der Laserfrequenz bewirkte eine niedrigere SBS (Shear Bonding Strength). Weitere Studien sollten
durchgeführt werden, um eine verbesserte Adhäsion der selbstätzenden, fließfähigen Composites an Dentinoberflächen zu
erreichen, welche durch Er,Cr:YSGG-Laser präpariert wurden. Dabei könnten weitere Laser-Einstellungen getestet werden.

16

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1 2016

[17] =>

25th International Annual
Congress of the DGL
LASER START UP 2016
30 September – 1 October 2016
Munich | The Westin Grand Hotel

Anniversary
congress

Fax Reply

Name & email address

+49 341 48474-290

Practice Stamp

I would like to receive further information on the

❏

25th Annual Congress of the DGL e.V.

❏ LASER START UP 2016

30 September – 1 October 2016 in Munich, Germany.

laser 1/16

[18] =>

| research

Smear layer removal
with laser in drilled
implant holes
A pilot study

Author: Dr Alireza Mirzaee, Iran

Introduction
Dental implants form a new opportunity window
for individuals who have lost their teeth due to various reasons such as trauma, dental caries and
periodontal diseases.1, 2 According to published papers, less than 8 % of dental implantation surgeries
have failed.3, 4 Formation of smear layer after usage
of dentistry tools or by bacterial flora surrounding
the implant cavity may, however, result in implant
fracture.5–7
Smear layer refers to a remainder of bone tissue
after usage of dentistry tools which may challenge
the success of relief, joints and penetration of materials to bottom layers such as the root canal. This
layer includes different materials like bone and soft
tissue lesions, blood cells and microorganisms.
These lesions are not limited to inter-dental or
bone septum, but may penetrate to bone tubules
and do not solve related negative effects.5, 8 Forma
tion of this layer defects the sealing process and
creates an environment for growth of microorganisms and bacteria to bone tissue which may decrease the probability of deep cleansing and result
in fracture of the implant.5 Therefore, it is highly
required to discover safe and inexpensive methods
to remove this layer.
Laser is abbreviated from “Light Amplification by
Stimulated Emission of Radiation” and is effectively used in dentistry interventions.9 Various
types of lasers have different impacts on bacteria,
depending on type of radiation, conditions of ra
diation and bacterial density. Vercruyssen et al.
conducted a study in which they applied pulsed

18

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1 2016

Nd:YAG laser radiation on teeth root in in-vitro
environment. The results indicated that density of
E. coli and Staphylococcus aureus was significantly
reduced and when the application of sodium hypochlorite was added to the treatment, the bactericidal effect was increased.10 Meral et al. reported
that Nd:YAG laser radiation exhibits various levels
of lethality rates for different bacteria. As their results shown, the lethality rate for Staphylococcus
alpha hemolytic was higher compared to Staphylococcus nicira.11 In another study conducted by
Lee et al. with diode laser applied on Staphylococcus mutans colonies with a thickness of 500 microns, a lethality rate of 97.7 % was observed. With
increase in thickness of the bacteria colony, the lethality rate was reduced.12
Many types and categories of laser instruments are being introduced to the worlds of dentistry and medicine, but their application and effectiveness are yet to be evaluated and studied.
Among these instrument, Er,Cr:YSGG laser is
widely used for bone incisions and soft tissues
surgeries in dentistry.13 Compared to conventional mechanical drills, this particular type of laser exhibits minimised tissue damage and does
not increase the tissue temperature to intolerable
ranges.14 The bactericidal effects of Er,Cr:YSGG
laser is another important aspect of this type of
laser. Schoop et al. observed in their research that
Er,Cr:YSGG laser managed to remove the layer of
bacteria from smear layer on the root.15 Miller
et al. stated that this type of laser has an appropriate impact in disinfecting the dental implant
surface.16 Since this type of laser has been accepted as a conventional disinfecting instrument,

[19] =>

research

operations for removing the smear layer show
better results.17
As our researches indicated, none of the studies
carried out an evaluation of the effects of radiation
conditions of Er,Cr:YSGG laser on removing the
smear layer of the bone cavity for dental implants
that report optimum radiation conditions. Hence,
the objective of the current study is to evaluate
various conditions of radiation of this particular
laser for the removal of smear layer from bone cavity in in-vitro conditions.

Materials and methods
This is a semi-experimental in-vitro study performed on bone cavities drilled on the femur of a
bovine calf.

Bone preparation
Initially, the femur bone of recently a slaughtered bovine calf was removed and kept in water of
a temperature of 4 °C. Prior to the commencement

|

of the tests, the bone surface was placed in ambient temperature for twelve hours to be completely
dried and then all residues were removed from the
bone surface using sand paper, then washed by tab
water and again placed in ambient temperature for
the next twelve hours. In the next stage, 102 holes
were drilled with a depth of 15 mm on the femur
bone on the basis of NEOSS system implant protocol for Pro Active Tapered implants with a diameter
of 4.5 Ø, using Pilot Drill 2.2 Ø and a speed of 1,000 to
1,200 rpm.18 The space between the holes is 2 centimeters. Then the holes were categorised in 17
six-member groups which include 16 direct radiation groups and one control group. Then the holes
were washed with water and placed in ambient
temperature for twelve hours to be used in the
laser intervention.

Laser instrument
In this study we applied a radiation of an
Er,Cr:YSGG laser instrument configured with 16
settings (Figs. 1–6) on the bone cavity. The exposure conditions include power configuration rage

Table 1: Number of drilled cavities
with smear layer in 16 studied
groups.

No.

Power (W)

Frequency (Hz)

Mode (H/S)

Air (%)

Water (%)

Tip

Time (S)

1

4.5

50

H

10

80

RFTP5

60

2

4.5

50

H

10

80

RFTP5

120

3

4.5

40

H

10

80

RFTP5

60

4

4.5

40

H

10

80

RFTP5

120

5

4.5

30

H

10

80

RFTP5

60

6

4.5

40

H

10

80

RFTP5

180

7

3

15

H

10

90

RFTP5

20

8

3

15

H

10

90

RFTP5

40

9

1.5

30

H

10

90

RFTP5

20

10

1.5

30

H

10

90

RFTP5

40

11

1.5

30

H

10

70

RFTP5

60

12

1.5

30

H

10

70

RFTP5

120

13

1.25

50

H

10

50

RFT2

60

14

1.25

50

H

10

50

RFT2

120

15

0.75

20

H

10

50

RFT2

60

16

0.75

20

H

10

50

RFT2

120

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[20] =>

| research
Figs. 1–6: SEM images of settings
13 to 16 and control group before
intervention.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

of 0.75 to 4.5 Watts with frequencies of 20 to 50
Hertz, an air percentage of 10 % and water cooling
percentage of 50 to 90 with a radiation time ranged
from 20 to 180 seconds. Before radiation on each
cavity, the other cavities were covered with aluminum paper. Radiation was commenced by locating
the laser fibre in each cavity. Time was also measured by watch on the basis of different settings.
Laser radiation was accompanied with water spray
as abolisher. Samples of the control group were
also rinsed with tab water using a 10 cc syringe after drilling the related cavities.

SEM imaging
For provision of the SEM images, initially all
cavities were cut in half and prepared according to
the study conducted by Freitas et al.18 In summary,
after cutting the cavities, samples were submersed
in 2.5 % glutaraldehyde solution in combination
with 0.1 molar sodium cacodylate buffer solution
with acidity degree of 7.4 for 12 hours and
at a temperature of 4 °C. Then all samples were
dehydrated using 25 % to 100 % ethanol solution; hexamethyldilslazane solution was used for
10 minutes for drying the samples. Paper filters
were used at the time of airbrushing the samples;
then samples were mounted in aluminum tubes
using a silver-gold colloid adhesive. Cavities were
imaged using SEM before and after exposure to radiation to evaluate the condition of smear layer
qualitatively.

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1 2016

Statistical analysis
The data were qualified according to presence/
absence of smear layer which were analysed using
Mann-Whitney U-Test and SPSS 17 software.

Findings
The SEM images captured from cavities exposed
to 16 settings of Er,Cr:YSGG laser are presented in
Figs. 1–6. The images are captured from four settings after 100 % removal of smear layer.1 Images
are demonstrated on the basis of different settings.
Series (a) of images are taken prior to application
of radiation and series (b) show the results of application. Among the mentioned 16 settings, only
the numbers 13 to 16 (Figs. 1–6) revealed an appropriate removal of smear layer. SEM images of
settings 13 to 16 and control group are illustrated
here.

Discussion
The main objective of this study is to evaluate
the bactericidal effect of various settings of
Er,Cr:YSGG laser radiation. According to the
findings of the research, from a total of 16 settings, 1.5 and 3 Watt radiation condition, frequencies of 15 and 30 Hz and time of 20 and
40 seconds, a smear layer removal efficiency of
up to 100 % was achieved in comparison to the
control group.

[21] =>

research

Er,Cr:YSGG laser is a safe instrument with a high
level of tissue adaptive capability; compared to conventional drills used for preparation of the bone bed
of the implant, application of this instrument results
in a much smaller temperature raise in the tissue,
which is within the tolerance range of the tissue.19 It
seems that the application of this particular type of
laser imposes mitochondrial osteoblastic function
with no significant impact;20 in other words, the osteoblastic function necessary for bone formation
around the implant area is preserved using this
method. Additionally, according to the findings of
Secilmis et al., using power configurations of 1 and
2 Watts imposes minerals of hard tissue with not
significantly change and superficial strength, connectivity capability is not reduced.21 Additionally,
histo-pathological evaluations indicate that various
radiations of this laser with lesser powers do not
trigger inflammatory response; the application of
laser radiation does not elevate inflammatory response to ranges that affect the tissue healing process with negative effects.22 Few studies are conducted on disinfection capabilities of Er,Cr:YSGG
laser. Ishizaka et al. found that lower power used in
Er,Cr:YSGG laser radiation preserved the smear

|

layer removal performance. In their study, all three
power configurations of 1, 3 and 5 Watts removed
the smear layer properly; also, the performance was
related to the diameter of the tip of the fibre and
flatter tips proved to be more efficient in disinfection.23 Yamakazi et al. did not find significant differences in the smear layer removal performance using
power configurations of 1 to 6 Watts; however, in
contrast to dry radiation, cooling the target at the
time of radiation resulted in better performance of
smear layer removal.24
Microorganisms are an important part of the
smear layer that may have a specific role in reducing the success rate of dental implants. Several
studies were focussed on the bactericidal effects
of the Er,Cr:YSGG laser radiation. Generally, these
studies did not focus on different settings of laser
radiation, bur investigated tooth root canal and
implant surface. Moreover, specific germs that participate in implant infection are similar to oral
microbial flora and pathogens.24,26 Gordon et al.
studied 15 settings of Er,Cr:YSGG laser (175 to
325 mW and exposure times of 15 to 340 seconds)
and their results were compared to the results of

Oemus_JB_laser_2016_210x148_Layout 1 23.03.16 12:25 Seite 1

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21

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[22] =>

| research
application of 2.5 % hypochlorite solution for the
removal of Enterococcus faecalis colonies from
root canals. Their findings showed that the disinfection capability of the laser radiation is increased
through the elevation of power and exposure time;
as for their study, the best result was achieved
by a power of 325 mW with an application time of
120 seconds without using water cooling. This setting managed to achieve a 99.7 % success in disinfection; disinfection processes using water showed
better results compared to dry disinfection.64
Arnabat et al. evaluated the effects of laser radiation with power configurations of 1 and 2 Watts
for application times of 30 and 60 seconds; they reported similar results in relation with power and
time of the application in the removal of Enterococcus faecalis. In their study, 5 % sodium hypochlorite
solution treatment had the best disinfection performance and 2 Watts for 60 seconds, and 1 Watt for
120 seconds respectively showed second and third
best disinfection performances.27 Various conventional chemical treatments are used as mouthwashes, dryer or disinfectants that sometimes are
used as bactericides for the implant cavity. The most
common agents are EDTA, Chlorhexidine and sodium hypochlorite. Difference in disinfection capability, restriction to some particular bacteria and cytotoxicity are among the limitations of such chemicals.17, 28, 29 However, application of laser radiation
can be considered as an alternative means for the
removal of bacteria or a supplementary method
used with chemical disinfectant agents.

Conclusion
In this study, findings were interpreted qualitatively to introduce best radiation condition. Despite the potential relation between application

power and time to effectiveness, the removal of
smear layer by laser showed no regular pattern. In
our study, power configurations ranged from 0.75
to 4.5 Watts with various application times were
studies featuring an application of 1.5 and 3 Watts
of power achieved better results.
However, research was subject to some limitations; in the study we did not evaluate bacterial or
fungus germs that contaminated the cavities.
Other negative aspects of the study were in-vitro
environment and lack of comparison of effects of
laser application and effects of mentioned chemical treatment. Addressing such defects in future
studies can result in more comprehensive results.
In the end, our findings indicated that the application of Er,Cr:YSGG laser with power configurations of 1.5 and 3 Watts accompanied by air brushing and water cooling, with application times of 20
and 40 seconds, result in the most effective removal of smear layer. These conditions lead to better results in comparison with higher powers and
exposure times; as the exposure time is reduced,
the probability of tissue damage diminishes._
Editorial note: A list of references is available from
the publisher.

contact
Dr Alireza Mirzaee
No. 5 parvaneh St. Gisha Bridge
Tehran, Iran 1439914141
Tel.:+98 9125169865
alirezamirzaee56@gmail.com

Kurz & bündig
Im vorliegenden Artikel vergleicht der Autor eine Vielzahl von Studien zur Reduktion der Schmierschicht in Implantatbohrungen durch Laserbestrahlung sowie konventionelle Desinfektionsmethoden mit den Ergebnissen seiner eigenen
Forschung. Im Anschluss an die Auswertung von fast 70 Quellen der zeitgenössischen Literatur zum Thema sowie der
eigenen Studienergebnisse gelangt der Autor zu dem Fazit, dass die Entfernung der Schmierschicht durch den Dentallaser keine regulären Muster aufweise. Obwohl potenziell eine Abhängigkeit zwischen Applikationszeitpunkt, -dauer und
Effektivität bestünde, konnte in der vorliegenden Studie keine Relation zwischen diesen Faktoren nachgewiesen werden.
Der Autor weist jedoch darauf hin, dass umfassendere Ergebnisse erreicht werden könnten, wenn zukünftige Studien
weitere Faktoren in die Auswertung einschlössen. Hierzu zählen Bakterien- und Pilzkeime in den Kavitäten sowie das
in-vitro Umfeld und Vergleiche zu verschiedenen Laseranwendungen und der chemisch-basierten Schmierschichtentfernung. Die Ergebnisse der vorliegenden Studie legen abschließend nahe, dass die Anwendung eines Er,Cr:YSGG-Lasers
bei 1,5 und 3 Watt, in Kombination mit Airbrush und Wasserkühlung für eine Dauer von 20 bis 40 Sekunden am effektivsten sei. Mit der Reduktion der Anwendungsdauer verringere sich dabei die Wahrscheinlichkeit für Gewebeschäden.

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1 2016

[23] =>

Call for papers
DGL | German Society for Laser Dentistry
25th International Annual Congress
September 30 to October 01, 2016, in Munich, The Westin Grand Hotel, Germany
Title
Author
Institute(s)
Address
Tel./Fax/E-Mail

/

/

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

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

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

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

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

Please send in your abstract until 30 June 2016

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

[24] =>

| case report

Non-ablative melanin
depigmentation of
gingiva
Author: Dr Kenneth Luk, Hong Kong

Introduction
Fig. 1: Depigmentation by ablation.
Fig. 2: Depigmentation by absorption
of melanin and haemoglobin.

Melanin depigmentation of gingiva using various laser wavelengths have been reported for over
ten years.1–5 Layer by layer, the mucosa is ablated

to the basal layer of the epithelium where the melanocytes are located. The use of lasers have been
compared with the use of scalpel and diamond bur
(Fig. 1).6–9 By incorporating the optical properties
and absorption characteristics of 810 nm together
with specific power parameters, a non ablative
technique was developed (Fig. 2).10, 11
Another similar non-ablative technique described as microcoagulation was also reported
using a 20 W 980 nm diode laser.12 The 445 nm
blue wavelength was introduced in the dental
market in 2015. By using 320 μm uninitiated fiber
delivering 1 W continuous wave of 445 nm, the
same non-ablative procedure and result can also
be realized.

Background with non-ablative technique
Diode laser at 810 nm is poorly absorbed in
water, but it is well absorbed by pigment such as
haemoglobin and melanin. The use of high power,
short pulse duration concentrated the thermal
energy on the surface over deep tissue thermal
conduction with lower power and long pulse.13, 14

Fig. 1

The author has used the 810 nm wavelength
(elexxion Claros 810 nm diode laser, elexxion AG,
Singen, Germany) with the power parameters of
30 W, 20 kHz, 16 μsec giving an average power of
10 W. Under local anaesthesia, a non-initiated
600 μm fiber was used. The fiber was placed at a
distance of 2 mm to 5 mm from the pigmented
mucosa. Coagulation can be observed with immediate effect upon irradiation.
A constant movement must be performed in
order to avoid thermal damage deep into the tissue. Water irrigation can be used as coolant

Fig. 2

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1 2016

[25] =>

case report

Fig. 3

Fig. 4

Fig. 5

Fig. 6

during the treatment. There is no surface ablation
of the pigmented mucosa but rather the haemoglobin and melanin absorbing the laser energy
(Fig. 2). This technique (Figs. 3–6) showed a
treatment time of two minutes compared to the
ablative technique time up to 30 minutes in an
area of first premolar to first premolar of one
dental arch.
The wavelength of 445 nm is much better absorbed by melanin and haemoglobin than 810 nm
(Fig. 7). Hence, a much lower power density may
be used to produce the same effect.

Material and method
SIROLaser Blue (Dentsply Sirona) with an emission wavelength of 445 nm was used at 1 W, CW
delivered through a 320 µm fiber.

Procedure
Depigmentation technique is the same as
described with the 810 nm wavelength (above).
Under local anaesthesia, a non-initiated 320 μm
fiber delivers the energy at a distance of 2 mm to
the pigmented area with constant movement.

Figs. 3–6: Depigmentation on upper
arch using 810 nm at 30 W, 20 kHz,
16 μsec, pre-op (Fig. 3), immediate
coagulation (Fig. 4), three weeks
post-op (Fig. 5), eight years post-op
(Fig. 6).

Figs. 7: Absorption Spectra
of biological materials.
(Courtesy of J. Meister)

Case outline
A 26-year-old female patient of Chinese ancestry presented with melanin pigmentation in 2007.
Congenital melanin pigmentation of the labial gingiva was diagnosed. Depigmentation on the upper
arch using 810 nm at 30 W, 20 kHz, 16 μsec was
carried out. Eight years post-op showed mild relapse of pigmentation, but the patient was satisfied with the cosmetic appearance (Figs. 3–6). She
now wanted the melanin pigment on her lower
anterior segment to be removed (Fig. 8).

Purpose
Pigment removal in the requested sites was discussed using 445 nm diode laser. The same technique would be used and the patient consented to
the treatment.

Fig. 7

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1 2016

[26] =>

| case report

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Figs. 8–11: Depigmentation of
lower arch using 445 nm at 1 W CW,
pre-op (Fig. 8), immediate post-op
(Fig. 9), one day post-op (Fig. 10),
one day post-op laser peel between
31, 41 (Fig. 11).

Immediate change to pink colour without surface
ablation of the pigmented mucosa was observed.
The procedure took approximately 40 seconds
to complete between lower left and right canine
region.

Results
In this case, the mucosa turns pink without any
signs of surface mucosal ablation except one spot
between teeth 41, 42 (Fig. 9). Sub-surface coagula
tion of blood vessels gave a pink coloured appearance. There was very mild post-op discomfort for
about one hour after loss of the anaesthetic effect.
No analgesics were required as the discomfort
feeling disappeared fast.

Fig. 12: Three days post-op
(photo taken by patient on holiday).
Fig. 13: Two weeks post-op.

Fig. 12

Laser peeling of mucosa between 31 and 41 was
noted during photograph taking at one day post-op

Fig. 13

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1 2016

review (Figs. 10 and 11). The three day post-op
photo taken by the patient showed that the laser
peel disappeared with new gingival mucosa formation (Fig. 12). Two weeks post-op showed complete recovery of the gingival mucosa without melanin pigmentation (Fig. 13).

Discussion
There has not been much information on this
new wavelength. From Fig. 7, the absorption coefficient for haemoglobin is estimated at 7x10²/cm-1
and 10³/cm-1 for melanin. Penetration depth for
haemoglobin is calculated at 140 μm and 10 μm for
melanin. The penetration depth of haemoglobin
and melanin with 810 nm are 2 mm and 0.1 mm respectively. Furthermore, scattering curve showed
less tissue scattering effect with 445 nm than
810 nm.

[27] =>

case report

Fig. 14

Fig. 15

In view of the low scattering effect together with
high absorption of haemoglobin and melanin to
445 nm, 1 W CW was used. Power density of
88 W/cm² (Fig. 14) delivering at 88 J/cm² fluence
at 2 mm distance was calculated. Although the
power density of 1,697 W/cm² (Fig. 15) delivering
543 J/cm² fluence used by 810 nm is higher than
445 nm delivered, the eight years post-op showed
stable gingival contour with no recession (Fig. 6).
The understanding of the optical properties of the
wavelength, power parameters and laser tissue
interaction are important information for the clinician to achieve the desired treatment outcome.

mediate aesthetic result with very short procedure
time. To the author’s knowledge, this is the first
case presented using 445 nm for melanin depigmentation._

Conclusion

Dr Kenneth Luk
502, Winway Building,
No. 50 Wellington Street, Central, Hong Kong
Tel.: +852 2530 2837
laserdontic@me.com

The use of 1 W CW 445 nm blue diode laser is
effective in non-ablative depigmentation of oral
mucosa. This non ablative technique provide im-

Fig. 14: Diagram 3.
Fig. 15: Diagram 4.

Editorial note: A list of references is available from
the publisher.
Dr Luk reports no potential conflicts of interest.

contact

Kurz & bündig
Seit mehr als zehn Jahren wurde bereits über eine Melanin-Depigmentierung durch Laser verschiedener Wellen
längen berichtet.1–5 Schicht für Schicht wird die Mukosa bis hin zur Basalschicht des Epitheliums abgetragen, wo
sich die Melanozyten befinden. Für diesen Prozess liegen Vergleiche zwischen Laser, Skalpell und Diamantbohrer vor (Abb. 1).6–9 Durch die Nutzung der optischen Eigenschaften und Absorptionscharakteristiken der Wellenlänge 810 nm gemeinsam mit spezifischen Parametern wurde eine nicht-ablative Technik entwickelt, die als Mikro
koagulation beschrieben wurde.12 Im Jahr 2015 wurde die Wellenlänge 445 nm auf dem Dentalmarkt vorgestellt.
Durch Anwendung einer nicht initiierten 320 μm-Faser wird kontinuierlich eine Wellenlänge von 445 nm und 1 W
abgegeben, sodass bei gleichem Vorgehen wie bei den konventionellen Methoden dieselben Ergebnisse erzielt werden können. Der SIROLaser Blue (Dentsply Sirona) mit einer Wellenlänge von 445 nm wurde im vorliegenden Fall mit
1 W CW und einer 320 μm-Faser verwendet. Die Depigmentationstechnik ist die gleiche, wie sie für eine Wellenlänge von 810 nm beschrieben wird. Unter Lokalbetäubung wurde die Bestrahlung, wie beschrieben, aus einer Entfernung von 2 mm zur pigmentierten Fläche mit konstanter Bewegung ausgeführt. Dabei wurde ein sofortiger Koagula
tionseffekt beobachtet. Die pigmentierte Mukosa wurde nicht direkt bestrahlt, und die gesamte Prozedur dauerte etwa
40 Sekunden, bis sie bei 1 W CW in der unteren linken und rechten Eckzahnregion beendet wurde (Abb. 8–11). Die Anwendung des blauen 445 nm-Diodenlasers bei 1 W CW ist eine effektive, nicht-ablative Depigmentationstechnik für die orale
Mukosa. Sie ermöglicht sofortige ästhetische Ergebnisse bei einer kurzen Behandlungsdauer. Nach aktuellem Kenntnisstand des Autors handelt es sich beim vorgestellten Fall um den ersten Bericht zur Melanin-Depigmentation bei 445 nm.

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1 2016

[28] =>

| industry report

Histological effects of
®
NightLase in the soft
palate of rats
A pilot study

Authors: Aslıhan Üsümez, Tugba Unver, Emre Aytugar & Tugçe Kıran, Turkey

Introduction
Snoring is a common problem in adults that affects between 20–50 % of the population.1–3 Although there is no exact definition of snoring, the
term indicates a breathing sound that arises during
nighttime or daytime sleep.4 The sound of snoring
is usually a consequence of the vibration of pharyngeal soft tissue (most commonly soft palate),
so treatment focuses on reducing these vibrations.4, 5

Fig. 1: Application of the
PS04 handpiece to the
soft palate of the rat.

There are many types of surgical treatment procedures that have been defined up to now.5–9 In
addition to these surgical treatments, some nonsurgical procedures are available.10, 11 Among the

treatment options, the main goal is to find a simple, safe and effective procedure that benefits a
speedy recovery and return to normal daily life.
In the past, Nd:YAG laser irradiation was used
for stiffening the soft palate using a low energy
method as a less invasive alternative. Nd:YAG laser
stiffening of the soft palate was reported to be
simple, safe and effective for reducing the length
of the soft palate in the canine model.3 Recently
a new laser irradiation tool was introduced in the
market known as NightLase®, which claims to be
a non-invasive and effective method for the treatment of snoring and sleep apnea. This treatment is
reported to be a fast, safe and efficient method for
decreasing the amplitude of snoring through the
use of superficial Er:YAG laser light.10 However,
there is no information in the literature about the
histological effects of this treatment model on living tissues. Therefore, this study aims to assess the
effects of Er:YAG laser irradiation on the histological structures of the soft palate in rat models.

Materials and methods
Twenty adult female Wistar albino rats weighing
200 to 250 g were used in this study. Rats were
randomised into two groups as an experimental
(n=10) and a control group (n=10) following the
approval of an animal use protocol by the Bezmialem Vakif University Animal Care Committee.
The rats were anaesthetised and Er:YAG laser
energy (LightWalker AT, Fotona, Slovenia) was delivered with a snoring handpiece (PS04, Light-

Fig. 1

28

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1 2016

[29] =>

industry report

Fig. 2

Fig. 3

Walker AT, Fotona, Slovenia) in non-contact mode
(1.15 W, 2 Hz, 1.57 J/cm2, SMOOTH mode, Fig. 1).
The surface of the soft palate of each rat in the
experimental group was irradiated for two minutes. The laser beam was manually guided across
the soft palate horizontally. The control group did
not receive any treatment (Fig. 2).

After the first 24 hours, contraction of the tissue
was labeled as level 2.5. Shrinkage decreased
gradually and was scored as 1.6 at the first week,
1.3 at the third week, but was still present at the
end of fifth week at level 1.

The animals were sacrificed after 24 hours, one
week, three weeks or five weeks. The soft palates
of each rat were removed by excisional biopsy.
The specimens underwent histological examination with an optical microscope (CX 31, Olympus,
Tokyo, Japan) used for the examination (X4 and
X10 zoom).

This study evaluated the contraction of the
soft palate of rats after Er:YAG laser irradiation.
Histologically, acute shrinkage was observed in
the experiment (Fig. 3). Snoring is a problem that
affects the majority of the population. A narrowed pharyngeal airway and extra vibratory
tissue are what cause snoring,5 and the general
aim of treatment options is to expand the airway
and eliminate the redundant vibratory structures. The optimal treatment would effectively
decrease the sound of snoring while being simple and safe.4

Sections were evaluated by an experienced
pathologist without any knowledge of the type
of animal group and inflammation; contraction
was reported as grading from 1+ to 3+. Statistical
analysis was done with Statistical Package for
Social Sciences (SPSS) for Windows 10 and,

where appropriate, Mann-Whitney U-Test and
Spearman’s rho, with P values less than 0.05 considered significant.

Results
The overlying mucosa of each rat in the experimental group was intact, with some superficial
blanching, but carbonisation of the tissue was not
observed. All animals recovered normally and tolerated normal intake of food and water within
1 ± 1.5 hours after reaction from the anaesthesia,
without any complications thereafter. There was
no exposed wound, bleeding or necrosis to be
found when the soft palate was observed macroscopically after sacrificing the animals.
A noticeable contraction of the soft palate occurred immediately after laser application (Fig. 3).

Fig. 2: Normal mucosa
of the control group.
Fig. 3: Acute shrinkage
of the soft palate.

Discussion

Research on surgical approaches of snoring and
sleep apnea has focused on causing less tissue
damage. Haytaoglu et al. compared the effects
of palatal implants and uvulopalatal flaps on
snoring and sleep apnea management.7 They reported that hospitalisation, preoperative laboratory studies and loss of labor make uvulopalatal
flaps an expensive and non-preferred method for
snoring and sleep apnea treatment, while palatal
implants could be placed in shorter time under
local anaesthesia with a lower rate of morbidity.
Wang et al. used Nd:YAG laser as an alternative
to uvulopalatopharyngoplasty (UPPP) on an animal model and demonstrated the stiffening and
elevation of the soft palate.3 They reported that
Nd:YAG laser seemed to be effective in palate
shortening and stiffness of the canine, but it remained to be determined if it would produce the
same effects in human subjects.

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1 2016

[30] =>

| industry report
Traditional surgical and non-surgical treatments do not provide satisfactory consequences,
and surgical methods are also associated with
some significant risks such as pain, haemorrhage,
infection and malfunction.3, 4 Er:YAG laser irradiation, on the other hand, is reported to be a non-invasive and more effective method available for
treating snoring and sleep apnea.10, 14 The method
uses Er:YAG laser energy, which causes a contraction of the collagen fibers and provides an opening
of the airway to decrease snoring and apnea with
a 90% success rate. No side effects have been reported after Er:YAG laser irradiation in the treatment of snoring.10 Similarly, Dovsak et al. showed
that Er:YAG laser treatment is a safe method and
is easily tolerated by patients.14
In this study, mucosal contraction can be seen
immediately after laser irradiation as a result of
the thermal effect on the tissue. Due to the contraction of the pharyngeal soft tissue, the airway
expanded and vibrations of the pharyngeal soft
tissue were eliminated. Meanwhile, the mucosa remained intact, with no evidence of bleeding, severe inflammation, carbonisation, necrosis or any
other complication.
Among the literature, this is the first study to
evaluate the contraction of the soft palate from a
histological basis after NightLase® application.
The limitations of the current study include using
a small number of animals because of animal-use
protocols, which unfortunately makes it difficult

to state predictive value. Another limitation is the
need for sacrification of the rats for histological
analysis, which made repetitive application of
NightLase® impossible. Future studies with higher
numbers of subjects and repetitive laser irradiation are needed to be able to draw more definitive
conclusions.

Conclusions
The present study indicates that Er:YAG laser irradiation with a snoring handpiece (PS04) causes
acute shrinkage of the mucosa. This contraction
decreases gradually but is still present at the end
of fifth week. This treatment option may be considered safe due to the absence of any carbonisation, necrosis or haemorrhage._
Editorial note: A list of references is available from
the publisher.

contact
Prof. Dr Aslıhan Üsümez
Department of Prosthodontics
Faculty of Dentistry, Bezmialem Vakif University
Istanbul, Turkey
Tel.: +90 212 4531700
Fax: +90 212 6217578
aslı_u@hotmail.com

Kurz & bündig
Schnarchen betrifft die Mehrheit der Bevölkerung. Verursacht wird es durch eine Verengung der Luftröhre und Vibrationen der umgebenden Gewebe. Schnarchbehandlungen zielen darauf ab, die Atemwege zu erweitern und Strukturen,
die wiederkehrende Vibrationen begünstigen, zu eliminieren. Vor Kurzem wurde ein neues Gerät zur Laserbestrahlung
vorgestellt (NightLase®, Fotona), welches eine nichtinvasive und effektive Methode zur Behandlung von Schnarchen und
Schlafapnoe darstellen soll.
Die vorliegende Studie ermittelt den Effekt einer Bestrahlung durch Er:YAG-Laser auf die histologischen Strukturen
des Gaumensegels bei Ratten. Insgesamt 20 ausgewachsene, weibliche Wistar-Albinoratten mit einem Gewicht zwischen
200 und 250 g wurden in dieser Studie untersucht. Die Ratten wurden randomisiert in zwei Gruppen (n = 10) eingeteilt,
wovon eine Gruppe die Kontrollgruppe darstellte und nicht behandelt wurde. Die Tiere der zweiten Gruppe erhielten nach
Anästhesie eine Laserbestrahlung (LightWalker AT, Fotona, Slovenia) durch ein spezielles Schnarch-Handstück (PS04,
LightWalker AT, Fotona, Slovenia) im Non-Kontakt-Modus (1,15 W, 2 Hz, 1,57 J/cm2, SMOOTH mode, Fig. 1). Dabei wurde
die Oberfläche des Gaumensegels für zwei Minuten bestrahlt und der Laserstrahl manuell horizontal über das Gaumensegel geführt.
Die Auswertung der histologischen Ergebnisse lässt den Schluss zu, dass eine Er:YAG-Bestrahlung durch ein
Schnarch-Handstück (PS04) ein starkes Zusammenziehen der Mukosa bewirkt. Dieses war auch fünf Wochen nach der
Laserbehandlung noch messbar, wenn auch stark abgeschwächt. Da keine Karbonisation, Nekrose oder Blutung fest
gestellt wurde, kann diese Behandlung als sicher bewertet werden.

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[31] =>

[32] =>

| industry

[ Pi
c tu
re :
©L
uk
as

Only recently, LASOTRONIX has launched its
new diode laser SMARTM, especially designed
for dentistry. Combining two laser wavelengths
(635 nm/200 mW and 980 nm/10 W) to achieve
high efficacy, this laser device makes use of fast
cutting via coagulation and the best-possible
“cold” stimulation and disinfection.
In addition, accessories such as the flexible, thin
quartz fibre and a variety of surgical handpieces
provide maximum versatility. As a result, SMARTM
is suitable for a vast range of applications and
therapy forms, including microsurgery, dermatosurgery, endodontics, periodontology, whitening,

laser

1 2016

The laser unit also features an expandable database covering a set of predefined therapy protocols, which can be modified and assigned to a
patient. It unique versatility makes SMARTM an essential asset to any modern medical office._

contact
LASOTRONIX
ul. ˚ytnia 1
05-500 Piaseczno, Poland
Tel.: +48 22 7363434
Fax: +48 22 7373435
med@lasotronix.com
www.lasotronix.com

]

Be smart…start treating at last!

c ik

biostimulation and PAD—photoactive disinfection
of root canals.

je r

With more than twenty years of experience
in laser technology, LASOTRONIX covers a
wide range of applications, including a variety
of therapy accessories. Cutting-edge technology is the trademark they all have in
common: one unit is set to equal five different devices, making the use of CO, Nd:YAG,
low-power diode lasers, PAD lamp or an
ozone system as well as teeth whitening
lamps. Applying the most powerful laser results in the shortest-possible treatment time
and low operating costs.

Introducing
LASOTRONIX—
lasers for generations

[33] =>

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

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

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

self-employed

employed

civil servant

student

dental assistant

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

Street:

Phone/fax:

Email:

Private/place:

Street:

Due to an association agreement of DGL and DGZMK, an additional reduced annual fee for DGZMK is charged (85 EUR p.a.
if you are not yet a member of DGZMK). The contribution collection is made by the DGMZK ofﬁce, Liesegangstr. 17a, 40211 Düsseldorf, Germany.
You will be addressed hereby.

With the application for membership I ensure that
I am owing an own practice since

and are working with the laser type
(exact name)

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

Signature

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

IBAN:

BIC:

Credit institute:

Signature of account holder

This declaration is valid until written notice of its revocation

[34] =>

| special

Probing for
alternatives

The prevention of dental fear
Author: Dr Anton Kasenbacher, Germany

The following video recently went
viral as it illustrates how dental fear
impacts both patient and dentist:

Literature
[1] Zahnarzt-Angst vor Behandlung:
Wie stark fürchten Sie sich vor den
folgenden zahnärztlichen Behandlungen? Statistische Erhebung der
Toluna Germany GmbH i. A. der
DEVK, April 2009.
[2] Kani, E.; Asimakopoulou, K.; Daly,
B.; Hare, J.; Lewis, J.; Scambler,
S.; Scott, S.; Newton, J. T.: Characteristics of patients attending
for cognitive behavioural therapy
at one UK specialist unit for dental
phobia and outcomes of treatment. British Dental Journal 2015;
219(10): 501–506.
[3] Walther, W.: Der Einfluss von
Präparationen mit Turbine und
Schnellaufwinkelstück auf die
menschliche Pulpa. Vergleichende
histologische Untersuchungen.
Inaugural-Dissertation, Albert-Lud
wigs-Universität, Freiburg i. Br.,
1984.
[4] Pantas, E.; Jöhren, H.P.: Zahnbehandlungsangst – eine prospektive
Studie zur anxiolytischen Wirkung
von Musik während der Zahnbehandlung. Deutsche Zahnärztliche
Zeitschrift 2013; 68(5):288–295.

laser

1 2016

After scientists from the University of São Paulo
have recently investigated a method to replace injection needles—one of the main triggers of dental
anxiety—by a technique entailing less potential for
dental fear, this article discusses the factor which
is seen as the most prominent cause for dental
phobia worldwide: the dental drill.1
In a study recently published by the British Dental Journal, 77 per cent of the patients surveyed
stated to be very afraid of upcoming dentaldrill
treatments.2 Although the electrical dental drill,
which was already patented in 1875 by US dentist
George F. Green (US-Patent No. 171121 A) is seen
as the gold standard for caries therapy and preparation procedures, most patient anxieties are related with this traditional dental tool, as its causing
pain and tissue damages seems to be an inherent
principle of its application.3 For this reason, anaesthetic injections prior to treatment are inevitable
in most cases.
Thus, in their prospective clinical investigation of
dental fear, authors Pantas and Jöhren refer to a
number of analyses which indicate that 75 per cent
of the adult population are batteling dental anxiety. In 5 to 12 per cent of the patients, dental phobia is so pronounced that they refuse to be treated.4
Moreover, some studies imply that about 95 per
cent of all dental offices do not offer any strategies
to prevent dental anxiety in the first place, according to Pantas and Jöhren.
Ultrashort pulsed lasers form an alternative to
both fear-inducing dental drills (turbine, highspeed engine) and all dental lasers on the market
so far. Applying pulse durations of less than 10 pico
seconds and pulse energies of less than 50 µJ stop
heat and shock waves from spreading towards the
dental pulp, resulting in a pain-free dental treatment without any tissue damages. After 141 years

of technical advances in dental therapy, the arrival
of ultrashort pulsed lasers has finally achieved
complying to the Hippocratic principal of "primum
non nocere" (First, do no harm)._

contact
Dr Anton Kasenbacher
Obere Hammerstraße 5
83278 Traunstein
Tel.: +49 861 4692
Fax: +49 861 12853
a.k@ts-net.de

[35] =>

special

Nachgebohrt –
Zahnarztangst

Auf der Suche nach Alternativen
Autor: Dr. Anton Kasenbacher, Deutschland

da er prinzipiell bedingt Schmerzen sowie Gewebeschäden verursacht,3 weshalb die Betäubungsspritze
in der Mehrzahl der Fälle unumgänglich ist.

Dass die Zahnarztangst ein hochaktuelles Thema ist, das Arzt und Patient
gleichermaßen betrifft, zeigt dieses
kürzlich viral gegangene Video:

So zitieren die Autoren Pantas und Jöhren in ihrer
prospektiven klinischen Untersuchung zur Zahnbehandlungsangst mehrere Analysen, die zu dem
Schluss kommen, dass 75 % der Erwachsenenbevölkerung mit einer mittleren bis starken Zahnarztangst
zu kämpfen haben, die bei 5 bis 12 % der Zahnarztpatienten so stark ausgeprägt ist, dass sie deshalb die
Behandlung ganz vermeiden.4 Darüber hinaus ginge,
so Pantas und Jöhren weiter, aus einigen Studien
hervor, dass etwa 95 % aller Zahnarztpraxen ihren
Patienten keinerlei Techniken zur Angstvermeidung
anbieten.

[Picture: © alphaspirit]

Nachdem Forscher der Universität São Paulo
jüngst eine Methode erforschten, um die von vielen Patienten gefürchtete Injektionsnadel, eine der
Hauptursachen der weit verbreiteten Zahnarztangst,
durch eine Technik mit weniger Angstpotenzial zu
ersetzen, beschäftigen wir uns im vorliegenden Ar
tikel mit der weltweit am häufigsten genannten Ursache für Zahnarztphobie: dem Dentalbohrer.1
In einer vor Kurzem im British Dental Journal veröffentlichten Studie gaben 77 % der befragten Patienten an, sehr ängstlich zu sein, wenn ihnen eine
Behandlung per „dental drill“ bevorstünde.2 Obwohl
der bereits 1875 vom amerikanischen Zahnarzt George F. Green patentierte elektrische Dentalbohrer
(US-Patent No. 171121 A) bis heute als Mittel der
Wahl für Kariestherapie und Zahnpräparation gilt,
sind die meisten Patientenängste mit ihm verknüpft,

Eine Angst eliminierende Alternative zum Dentalbohrer (Turbine, Schnellläufer) sowie zu allen bis dato
am Markt verfügbaren Dentallasern stellt erstmals
der Ultrakurzpulslaser dar. Die Verwendung von
Pulsdauern unter 10 Pikosekunden und Pulsenergien
unter 50 µJ haben zur Folge, dass sich Wärme- sowie
Schockwellen nicht mehr in Richtung Zahnpulpa
ausbreiten mit dem Resultat einer schmerzfreien
Zahnbehandlung ohne Gewebeschäden. Damit existiert nach 141-jähriger technischer Weiterentwicklung eine zahnmedizinische Therapie per Ultrakurzpulslaser, die endlich dem hippokratischen Grundsatz des „primum non nocere“ (d.h. zuerst einmal
nicht schaden) gerecht zu werden vermag._

Kontakt
Dr. Anton Kasenbacher
Obere Hammerstraße 5
83278 Traunstein
Tel.: +49 861 4692
Fax: +49 861 12853
a.k@ts-net.de

Literatur
[1] Zahnarzt-Angst vor Behandlung:
Wie stark fürchten Sie sich vor den
folgenden zahnärztlichen Behandlungen? Statistische Erhebung der
Toluna Germany GmbH i. A. der
DEVK, April 2009.
[2] Kani, E.; Asimakopoulou, K.; Daly,
B.; Hare, J.; Lewis, J.; Scambler,
S.; Scott, S.; Newton, J. T.: Characteristics of patients attending
for cognitive behavioural therapy
at one UK specialist unit for dental
phobia and outcomes of treatment. British Dental Journal 2015;
219(10): 501–506.
[3] Walther, W.: Der Einfluss von
Präparationen mit Turbine und
Schnellaufwinkelstück auf die
menschliche Pulpa. Vergleichende
histologische Untersuchungen. Inaugural-Dissertation, Albert-Ludwigs-Universität, Freiburg i. Br.,
1984.
[4] Pantas, E.; Jöhren, H.P.: Zahnbehandlungsangst – eine prospektive
Studie zur anxiolytischen Wirkung
von Musik während der Zahnbehandlung. Deutsche Zahnärztliche
Zeitschrift 2013; 68(5):288–295.

laser
1 2016

[36] =>

| practice management

Eleven tips for success
in your dental clinic
Part III: CASCO and PEC
Author: Dr Anna Maria Yiannikos, Germany & Cyprus

tant) how long exactly your next patient will
have to wait in case of delays, so she can
also inform him/her promptly and avoid
possible irritability.

2. Apologise

ic t
ur
e:

]

1 2016

lor

laser

v il

As dental practitioners, we work with patients
that have special needs and difficulties, therefore
sometimes we find ourselves in trouble due to inevitable delays. My question here is: How can we
deal with them? However, most essential is, how
can we control them? Be aware of the acronym
CASCO, which stands for control, apologise, solution, change, and offer.

ejo

We have already reached the
third part of our exceptional series on professional success and
personal growth, and this journey has the title Eleven tips for
success in your dental clinic. In this article, you are
going to get the critical knowledge and specific
tips that I promise you will help you deal with
delays and with conflict in a more professional
and efficient way! Now let’s start with delays!

Do not be afraid to say sorry to your patients,
this will show your humane side and they will
really appreciate it. You can do it in so many
ways, verbally (immediately when you face
them) or you can send them an email expressing your apologies. But please avoid
adding annoying excuses, like ‘Sorry
for being late, but I had a difficult
surgery’ or ‘I am so sorry, but it
is not my fault as the previous
appointment came 30 minutes late’. Do you think
that our patients should
care about our uncontrolled
schedule? Or worse, the previous
patient? Absolutely not! Please remember to avoid
any excuses that will make them more angry or
frustrated.

3. Solution
Give them a solution for their next appointment.
For example, you can say, “I suggest that next time
we can book you especially the first morning
appointment to ensure no delays.”

1. Control

4. Change

You can control your delays by assigning to your
assistant to remind you every five minutes for the
next appointment that awaits you. She can become your personal alarm clock that will wake you
up and remind you of your next appointment. You
should also inform your “alarm clock” (aka assis-

Do not be afraid to make the change—and
change the habit of having delays at your clinic and
create a clinic with no or limited delays. Trust me,
this will add value to your clinic’s image—be aware
that the best dentist is the one that respects his
patients by being punctual.

[37] =>

practice management

5. Offer
Be ready to give them a complimentary treatment to show your apologies once more, they
will really love that. Avoid phrases like “I will give
you a free treatment”, instead explain to them
that ’this treatment is a gift from us’. You can
combine two treatments without charging the
second one. In this way, you will raise the value
of the treatment for your patients. At the same
time, explain the separate cost of each treatment and the benefits you just gave to your
p atients without mentioning the word free. For
example, “I will now do a dental cleaning and in
addition we will do a polishing session with the
new air flow machine that would cost 50 Euros.
You will like the results much more than the ones
from the simple dental cleaning, your teeth will
shine more and the stains between your teeth
will disappear completely.”
Now let’s go to the sixth tip, which is as essential
as the previous one and concerns how we can deal
with conflicts. Unfortunately, there are times that
we have to face problematic patients or unpleasant
situations with our employees or our associates.

|

How can we face these conditions? Apply PEC to
successfully deal with them. PEC stands for:

1. Perception
Name it! Behave as an adult and get rid of fear
and just say the problem. Think what the worst
scenario is. By making this risk management
process, you immediately acknowledge the fact
that you could face it as well. Be ready to listen
to the other party, ask them about their opinion,
maybe their perception is completely different
from yours.

2. Emotions
Deal with them and then start the conversation.
You should not start a discussion in case you still
feel angry about the person or the issue. Be well
prepared and avoid to take anything personally.
Be ready to express your feelings, you might be
surprised with the other party’s unawareness of the
problem. Remember to show your empathy with
phrases like “I understand you”, instead of “You are
right”. It is a pity to miss the wood for the trees!

[Pictur: ©Sergey Nivens]

laser
1 2016

37

[38] =>

| practice management
In the upcoming issue, we will analyze two brand
new tips and practical solutions that will help you
to reveal new opportunities and potential of your
dental clinics. Until then, remember that not only
you are the dentist in your clinic, but you are also
its manager and leader.
You can always send me your questions and
requests for more information and guidance via
dba@yiannikosdental.com or via our facebook
account. Looking forward to our next trip of business growth and educational development!_

[Picture: ©Pressmaster]

3. Communication
A constructive communication is essential to
build relationships. Therefore, speak your truth
without hurt feelings, ask questions to reveal the
issue, sit together to find a win-win solution and
make the gesture! This means you can make a
warm handshake, or you can hug the other party
(based on the type of your relationship) showing
your positive attitude to resolve the problem. Finally, always remember to be calm, express some
humor, and be humane!

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

Kurz & bündig
Im ersten Teil der Serie „11 Tipps zum wünschenswerten Erfolg in Zahnkliniken” ging es darum, sich als Praxisinhaber
intensiv mit den eigenen Fähigkeiten, Stärken und Schwächen auseinanderzusetzen. Der zweite Teil befasste sich im
Anschluss mit der Suche nach dem idealen Praxismitarbeiter: Vier Schlüsselqualifikationen helfen dabei, den geeigneten
Mitarbeiter auszuwählen, und fünf einfache Maßnahmen können dazu beitragen, diesen in der Praxis zu halten und zu
motivieren.
Im nun vorliegenden dritten Teil geht es ganz um den Umgang mit den Patienten. Die Autorin zeigt den Lesern in fünf
einfachen Schritten, wie sie ihr Terminmanagement optimieren können und auf unvermeidbare Verzögerungen und Wartezeiten reagieren: Dabei sollte die erste Maßnahme sein, die Terminabfolge stärker zu kontrollieren (control) und so Verzögerungen zu minimieren. Sollten diese trotzdem unvermeidlich sein, ist eine Entschuldigung beim Patienten (apologise)
unabdinglich, gefolgt von einem individuellen Lösungsangebot (solution). In der Zukunft sollten lange Wartezeiten vermieden werden (change), um die Patientenzufriedenheit zu steigern und die positive Wahrnehmung Ihrer Praxis zu verstärken.
Dazu können auch weitere Angebote an den Patienten beitragen (offer), wie zum Beispiel eine kostenlose Zahnreinigung.
Abschließend setzt die Autorin ihren Fokus auf den Umgang mit Konfliktsituationen: Hierbei zähle vor allem eine klare
und realistische Wahrnehmung (perception). Beide Seiten sollen die Möglichkeit haben, Probleme direkt zu benennen und
dabei auch gehört zu werden. Auch Emotionen (emotions) sollten offen geäußert werden, ohne jedoch aus der Diskussion
einen Streit werden zu lassen. Bei allem gilt: Eine konstruktive Kommunikation (communication) ist essenziell für jede
funktionierende Beziehung.
Seien Sie gespannt auf die nächste Ausgabe der laser international magazine of laser dentistry, in der Ihnen die Autorin
weitere praktische Tipps für ein optimales Erfolgspotenzial Ihrer Praxis geben wird.

laser

1 2016

[39] =>

laser
international magazine of

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laser dentistry

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[40] =>

| events

Laser education
at its best

AALZ Mastership courses in Greece
Author: Dr Dimitris Strakas, Greece

Since 1991, when AALZ was originally founded, a
vast number of dentists have been educated and
certified as laser experts. It was in 2010 that a new
branch of AALZ has opened its arms in Athens and
Thessaloniki, providing courses in laser dentistry
for Greek and foreign dentists.
Fig. 1: Leisure times and
Greek cuisine dinner.
Fig. 2: Prof. Norbert Gutknecht
in action.
Fig. 3: The mastership/fellowship
2015–2016 group photo.
Fig. 4: Hands-on workshop with
different wavelengths.

Entering its 6 year of operation, AALZ Greece
has already established its position as a leader in
certified education for laser dentistry. A dozen of
laser safety officer courses, many diode-orientated wavelength courses, four mastership/fellowship programmes and several one-day seminars
with a variety of lectures have been offered and
embraced by the Greek dental world.
th

Fig. 1

Fig. 2

Fig. 3

Fig. 4

laser

1 2016

Even in this difficult and challenging financial
period, especially in Greece, but also in Europe, we
are happy to say that this year’s mastership/fellowship course 2015–2016 is a big success, reaching a
number of 14 participants.
The course started on October 10 and 11, 2015, with
Module I, covering the laser safety officer certification, the laser construction and handling part and the
ILIAS system—introduction and understanding. Module I was repeated on January 23 and 24, 2016, since
several more dentists have enrolled.
We had the honour and pleasure in both circumstances to host Mr Leon Vanweersch, who wel-

[41] =>

events

comed the participants as the general manager of
the programme and gave them an introductory
speech in order to make them understand the history, qualities and advantages of AALZ’s educational programmes before introducing Module I’s
lecturers for AALZ Greece, Dr Dimitris Strakas and
Antonis Kallis. It was also the first time that Prof.
Norbert Gutknecht, although not present for these
modules, also welcomed the participants with a
video conference call.
Coming to Module II on February 7 to 10, 2016, the
group was happy and eager to listen and learn as
much as possible on diode lasers in dentistry by Prof.
Norbert Gutknecht himself, covering the whole
spectrum of therapeutic indications. Long and interactive days always included both fun and work,
which is by all means necessary in order to be more
productive. Module II ended with a hands-on course,
in which participants learned the handling of diode
lasers and the methodology behind each specific
treatment. Last but not least, we had the opportunity
to demonstrate diode and Nd:YAG laser therapies on
some patients in our clinic.
For the successful hands-on we have to thank the
companies that supported this and provided us with
their units, giving the participants the opportunity to
work with the full spectrum of diode wavelengths and
Nd:YAG (445 nm, 660 nm, 810 nm, 930 nm, 980 nm,
1,064 nm). In alphabetical order we would like to
thank: Biolase, Fotona, Sirona and Zolar.
All our participants are already impatient with
regard to Module III, which is scheduled for June 5
to 8, 2016, and Prof. Gutknecht’s lectures on Erbium family lasers. This year’s mastership course is
scheduled to be completed in Aachen on September 29 and 30, 2016.

AALZ Greece’s courses are taking place in the
renovated “Excelixi” Convention Center at “Domotel
Kastri Contemporary Hotel” in the Kastri district,
Athens. Our participants are catered throughout
the days of the courses and we will have dinner
nights with them and our AALZ stuff, enjoying the
weather and the famous Greek cuisine. For more
info on AALZ Greece’s courses, visit www.aalz.gr
or contact via email on aalzgreece@gmail.com_

contact
Dr Dimitris Strakas
PhD cand. Department of Operative Dentistry Aristotle
University of Thessaloniki
Spiridi 28, 38221
Volos, Greece
Tel./Fax: +30 24210 32525
dimitris.strakas@gmail.com

Kurz & bündig
Seit der Gründung des AALZ im Jahr 1991 hat eine große Anzahl von Zahnärzten die Ausbildung zum zertifizierten
Laser-Experten durchlaufen. Weitere Standorte des AALZ wurden 2010 in Athen und Thessaloniki eröffnet und ermöglichen
seitdem die Schulung griechischer Zahnärzte sowie Kollegen aus dem Ausland in der Laserzahnmedizin. In seinem sechsten Jahr hat sich das AALZ Griechenland mittlerweile als ein führender Anbieter für die Schulung von Laseranwendungen in
der Zahnmedizin etabliert. Kurse zum Arbeitsschutz und Veranstaltungen mit Fokus auf Diodenlaser sowie vier Mastership-/
Fellowship-Programme und verschiedene eintägige Seminare wurden von der griechischen Dentalwelt bisher sehr positiv
angenommen. Selbst angesichts der aktuellen finanziellen Herausforderungen, die sich besonders für Griechenland in den
letzten Jahren ergeben haben, hat sich auch in diesem Jahr die Mastership-/Fellowship-Kursreihe mit nunmehr 14 Teilneh
mern als großer Erfolg erwiesen. Mit Eröffnungsreden von Herr Leon Vanweersch im Januar und einer Videokonferenz mit
Prof. Norbert Gutknecht im Februar sowie einer gelungenen Mischung aus interaktiven, praxisnahen Veranstaltungen und
einem ansprechenden Freizeitangebot ist die Kursreihe gut ins neue Jahr gestartet. Modul III wird sich im Juni 2016 unter
der Leitung von Prof. Gutknecht auf Erbiumlaser konzentrieren. Die finale Veranstaltung der Reihe ist dann für den 29. und
30. September in Aachen geplant.

laser
1 2016

[42] =>

manufacturer news
LASOTRONIX

SMARTM dental diode
laser—Versatile and
ingenious
LASOTRONIX—a Polish manufacturer—is
launching a new diode based laser platform for
dentistry, the SMART M series with a variety of
most effective wavelengths increasing a number
of applications.
SMART M is offered as a combination of two lasers in one package: 10 W at 980 nm wavelength
for a wide range of applications in microsurgery,
endodontics, periodontology and whitening as
well as 400 mW at 635 nm wavelength for cold
therapies like biostimulation and photoactivated
disinfection.
Combining two wavelengths in one device made
our dental laser unique and one of the most advanced in the world for all soft tissue procedures.
SMART M is equipped with a wide range of fibers,
application end tips and an advanced user interface, which makes the unit one of the most

versatile dental lasers known so far. It is also
upgradeable in the field by other wavelengths if
needed. If you want to join us and promote our
unique innovation please kindly contact us.

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

Fotona

Mobile app for dentists now available
Fotona’s mobile app has recently experienced a
substantial growth of content, with more educational webinars and in-depth clinical reports

about the latest laser procedures (with actual
treatment settings). Users now enjoy access to
over 180 videos, 100+ product and treatment

presentations and 70 clinical cases by experts
in various fields.
Users can download everything for offline use
or alternatively bookmark selected content
according to their needs.
The app also makes it easy to catch up on the
latest news about industry events, see a calendar of upcoming trainings and workshops
around the world, and keep track of relevant
congresses and exhibitions where Fotona will
be present. Users of the app also enjoy free access to all Laser & Health Academy publications
(journals, magazines and compendiums).
All this is now available for the first time on the
iPhone. The mobile app can be downloaded
directly from either iTunes or the Google Play
store.
Fotona
Stegne 7
1000 Ljubljana, Slovenia
www.fotona.com

laser

1 2016

[43] =>

Henry Schein

Recognition for ethical and socially-minded business practices
Henry Schein, Inc. (NASDAQ: HSIC) today announced its recognition by the Ethisphere Institute, a global leader in defining and advancing
the standards of ethical business practices, as
a 2016 World’s Most Ethical Company®. This
year marks the tenth anniversary of Ethisphere
and the World's Most Ethical Companies designation. Henry Schein is one of 131 Ethisphere
honorees, representing 54 industry sectors, 21
countries, and five continents.

Henry Schein has been recognized for the fifth
consecutive year and is the only honoree in the
Healthcare Products category, underscoring the
Company’s longstanding commitment to leading
ethical business standards and practises.
“We are proud to be recognized by Ethisphere
as one of the World’s Most Ethical Companies
alongside many of the world’s most successful
businesses,” said Stanley M. Bergman, Chairman of the Board and Chief Executive Officer

of H
enry Schein, Inc. “Since 1932, our company has pursued the ideal of ‘doing well
by doing good’. As a result, we have created
long-term economic and social value by maintaining exceptional ethical standards in our
business practices and by cultivating a culture
of caring.”

academies as trainer, evaluated business opportunities for the promotion of laser usage in dayto-day dentistry.
The results of this analysis are displayed in his
newly founded company MEDENCY. “Our flagship
product PRIMO combines state-of-art diode laser
technology with innovation and the experience of
MEDENCY in the dental sector. Owing to its intuitive interface, the device is easy to use,” Boschi
said. In addition to its products, the company offers a full range of strategy and planning—from

product design development to clinical testing,
governmental regulatory approval, and manufacturing quality systems certification.

Henry Schein
Corporate Headquarters, USA
135 Duryea Road
Melville
NY 11747, USA
www.henryschein.com

MEDENCY

Debut at AEEDC 2016
Under the slogan “Technology, innovation,
passion”, this year’s AEEDC saw the launch of
MEDENCY, a recently founded Italian company
that was built upon profound global expertise in
the dental market, and dental lasers in particular.
Especially in dental surgery, lasers offer numerous benefits, accelerating treatment and leading
to significantly improved patient outcomes.
Over the past years, General Manager Alessandro Boschi, who is a distinguished laser dentistry
expert and has collaborated with several major

MEDENCY Srl
Piazza della Libertà 49
36077 Altavilla – Vicenza, Italy
www.medency.com

laser
1 2016

[44] =>

news

international

Laser technology explores

Nanostructures with
living cells

Laser vibrometry initiates

Breakthrough in scaler research
By recording a scaler operating under the microscope at 10,000 times the speed of regular filming,
they found tiny water bubbles forming at the end of
the scaler, a process known as cavitation. According to them, the area of cavitation near the free end
of the tips increased with greater power and with
the amplitudes of displacement at the tips.
The formation and collapse of water bubbles create significant forces that could disrupt biofilm
without touching the tooth’s surface, paving the
way for new instrument designs that are less in-

vasive, the researchers said in the paper. For the
study, a Satelec P5 Newtron Scaler with Satelec
tips 10P, 1 and 2 operating at medium and high
speeds was recorded at up to 250,000 frames per
second in a water tank. The tip displacement was
then recorded using scanning laser vibrometry. It
is the first time that both methods have been applied to study cavitation around ultrasonic scalers.
The study, titled "High speed imaging of cavitation
around dental ultrasonic scaler tips", was published online on March 2 in the PLOS One journal.

Using Laser Technology, Aleksandr Ovsianikov
from the Vienna University of Technology wants
to create microstructures with embedded living
cells. The behaviour of cells strongly depends on
their environment. If they are to be researched and
manipulated, it is crucial to embed them in suitable
surroundings. Aleksandr Ovsianikov is developing
a laser system, which allows living cells to be in-

[ Pi

ctu

re :

V
TU

ien

]

Fig. 1

Steady growth in the

Dental laser market
In addition to oral surgery, dental lasers are used
for a variety of applications. Owing to the increasing demand in this sector, among other inﬂuences, the worldwide market for the devices will grow
by a compound annual growth rate of 5.2 per cent
over the next five years and is expected to exceed
US$ 200 million (£ 144 million) by 2020, a new
report has predicted.
According to the report, this growth
will primarily be driven by the Asia
Pacific market as clinicians and patients in this region are increasingly
becoming aware of the benefits of
laser devices. Other developments
contributing to the growth of laser
use include the rise in the number of
aesthetic procedures on the continent
and the ageing population.
The report, which was conducted by
market research provider Marketsandmarkets and published by Re-

laser

1 2016

portBuyer in Charing, Kent, last week, analysed
industry trends and the market shares of top players in the field. It also provides insights into the
markets for dental lasers across various regions,
exploring new distribution channels, new client
bases and different pricing policies.
Source: www.dental-tribune.com
[Picture: ©everything possible]

Fig. 2
Fig. 1: A laser hardens the liquid material exactly at the focal
point. – Fig. 2: A three-dimensional grid can be produced,
which keeps the cell in place.

corporated into intricate taylor-made structures,
similar to biological tissue, in which cells are surrounded by the extracellular matrix. This technology is particularly important for artificially growing
biotissue, for finding new drugs or for stem cell
research. Ovsianikov has now been awarded the
ERC Starting Grant from the European Research
Council (ERC) of approximately 1.5 million Euros.
Interdisciplinary cooperation is crucial for this
project, which connects engineering, material
science, biology and chemistry. Born in Lithuania, Ovsianikov obtained his PhD in Hannover,
Germany. Now he has been working at the Vienna
University of Technology for two years.
Source: www.tuwien.ac.at

[45] =>

Hello from

Big Data tool to

The Dentist’s side

Test new medicines

Hardly ever is a visit at the
dentist’s seen as a fun
event. While many are
aware of the patient’s
side, only few take into
account the dentist’s
view. A dental clinic from
Houston, Texas, now endeav
ours to overcome this bias by
a very special music video:
they have adapted Adele’s super hit “Hello” in favour of dentists worldwide.
Friendly reminders remaining unheard, missed
check-up appointments and the omnipresent
danger of being bitten—as most people are
usually seated on rather than in front of the

dental chair, taking the den
tist’s perspective is difficult.
The dental clinics New
Teeth Dental Side has
now turned the tables by
recording a new version of
Adele’s “Hello”, which features all aspects of the daily
dental practise. The result is a funny
parody which illuminates the special relationship between dentist and
patient.
The following video recently went viral as it illustrates
how dental fear impacts both
patient and dentist:

Dentsply Sirona introduces

Online knowledge-sharing platform
The development of blue laser technology has
vastly increased the possible applications of diode
lasers in dentistry and, at the same time, created
greater awareness of laser dentistry. The international “Sirona Laser Platform” from Dentsply
Sirona, which was introduced at the beginning
of March, is meant to acquaint dentists with the
different areas of laser dentistry in a lively way.
Dentists who wish to take advantage of this opportunity can receive free access to the knowledge-sharing platform of the global market and

technology leader in the dental industry via the
link www.sirona.com/en/sirolaser.
The information available on the platform is very
diverse and encompasses the various types of
lasers in the market, the differences between
diode and traditional lasers and how they work.
Additionally, a corresponding forum is included
in this platform as well. This gives participants
a place to exchange knowledge and information
on all things related to laser dentistry with other
colleagues.

Australian scientists have developed a tool to
map the effects of new medicines already on
the market, potentially saving millions of health
practitioners from prescribing medicines with
lesser-known yet serious side effects. Lead researcher Dr Nicole Pratt, a senior research fellow at the University of South Australia's School
of Pharmacy and Medical Sciences, has been
working with the Asian Pharmacoepidemiology
Network (AsPEN) to develop a mathematical
algorithm that charts the temporal relationship
between a new medicine and reports of adverse
side effects around the globe. The rapid detection
tool is able to quickly analyse large population
datasets of up to 200 million people, containing
information about the time a patient is prescribed
a new medicine (captured at the point of purchase) and recorded hospitalisation events. “We
look at the link between starting a new medicine and a hospitalisation event and determine
whether there is an association between those
two events”, said Pratt. At the time a new medicine is first released onto the market less than
50 per cent of the side effects are known.
Source:
www.theleadsouthaustralia.com.au

laser
1 2016

[46] =>

25
Jahre
DGL

JUBILÄUMSKONGRESS DER DGL
LASER START UP 2016
30. September bis 1. Oktober 2016
München | The Westin Grand Hotel
VERANSTALTER
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
Klinik für Zahnerhaltung, Parodontologie und Präventive Zahnheilkunde
Universitätsklinikum der RWTH Aachen
Pauwelsstraße 30, 52074 Aachen
Tel.: 0241 8088-164 | Fax: 0241 803388-164
sekreteriat@dgl-online.de | www.dgl-online.de

ORGANISATION/ANMELDUNG
OEMUS MEDIA AG
Holbeinstraße 29, 04229 Leipzig
Tel.: 0341 48474-308 | Fax: 0341 48474-290
event@oemus-media.de | www.dgl-jahrestagung.de

Faxantwort

Name/E-Mail-Adresse

0341 48474-290
Praxisstempel

Bitte senden Sie mir das Programm zur/zum

❏ JUBILÄUMSKONGRESS DER DGL
❏

LASER START UP 2016

am 30. September und 1. Oktober 2016 in München zu.

laser 1/16

[47] =>

editorial

Mit Laser die
Zukunft ausleuchten

Kenji Yoshida

Liebe Leser von laser international magazine of laser dentistry,
wir heißen Sie alle herzlich zum 15. Kongress der World Federation for Laser Dentistry vom
17. bis 19. Juli 2016 in Nagoya, Japan, willkommen.
Der WFLD-Weltkongress findet alle zwei Jahre statt und wird nun zum dritten Mal in Japan gehalten.
Damit schließt sich der 16. WFLD-Kongress an die erste Veranstaltung im Jahr 1988 in Tokyo unter der
Präsidentschaft von Prof. Hajime Yamamoto und den zweiten Kongress 2002 in Yokohama unter Prof.
Isao Ishikawa an.
Unter dem Motto „Light to Brighten the Future“ (Licht, das die Zukunft erhellt), will der Kongress bestehende Kenntnisse in der Laserzahnmedizin und der Zahnheilkunde erweitern und neue Entwicklungen
begünstigen, indem Laserstrahlung konsequent in der Diagnose und Therapie angewendet wird. Dafür
wartet der Kongress mit einem abwechslungsreichen Programm auf, welches Vorträge, ein Symposium,
Workshops, Posterpräsentationen, Ausstellungen und Seminare beinhaltet. Jeder Programmbestandteil
wird die Laserspezialisten aus den verschiedenen technischen und medizinischen Bereichen, einschließlich
der Zahnmedizin, sprichwörtlich erleuchten. Internationale Referenten werden ihre neuesten wissenschaftlichen Erkenntnisse vortragen. Es ist uns ein ernstes Anliegen, den Kongress als ein fortschrittliches
Forum für wissenschaftliche Forschung, klinische Arbeit und der sowohl nationalen als auch internationalen Medizingeräteentwicklung zu begreifen.
Das wissenschaftliche Programm wird durch ausgewählte Veranstaltungen, einschließlich eines Willkommensempfangs sowie eines japanischen Abendessens und Banketts, ergänzt. Wir hoffen, dass der
Kongress damit nicht nur Raum für wissenschaftliche Weiterbildung, sondern auch für die Erweiterung
Ihres beruflichen Netzwerks und damit Ihrer Karriere- und Forschungsmöglichkeiten bietet.
Wir freuen uns darauf, Sie zu WFLD2016 in Japan begrüßen zu dürfen.
Kenji Yoshida
Chairperson, WFLD2016

laser
1 2016

[48] =>

news

germany

Laserfluoreszenzverfahren gegen

ZWP erscheint

Rückfälle bei Mundkrebs

Noch moderner und
noch besser

Diese hatten entweder ein Plattenepithelkarzinom
von bis zu vier Zentimeter oder eine hochgradige
Läsion. 154 Patienten wurde mit FV-Surgery behandelt, 92 „normal“ operiert. Es zeigte sich, das
bei den 92 Prozent der Patienten mit Plattenepithelkarzinom, die mit FV-Surgery behandelt
wurden, nach drei Jahren eine wesentlich niedrigere Rückfallrate vorlag – 6,5 Prozent gegenüber
40,6 Prozent bei den herkömmlich operierten
Personen. Diese Operationsmethode scheint dank
präziserer Resektion daher bedeutend Erfolg versprechender für die Patienten.
[Picture: ©Lightspring]

Wie in einer Studie festgestellt wurde, erleiden
Patienten, deren Mundkrebs mit einer fluoreszenzgestützten Tumorresektion (FV-Surgery) entfernt
wurde, seltener Rückfälle als Patienten, die auf
herkömmliche Art und Weise operiert wurden.
Für die Studie untersuchte ein Team der Universität
von British Columbia in Vancouver 246 Patienten.
1

Mit der ersten Ausgabe 2016 erscheint die ZWP
Zahnarzt Wirtschaft Praxis und das Supplement
ZWP spezial im 22. Erscheinungsjahr in einem
komplett neuen Layout:
Rot als Gestaltungsfarbe rückt noch stärker in den
Fokus. Gleichzeitig wurde das Magazin farblich
zurückgenommen, die Seiten sind klar und übersichtlich. Dabei steht Rot für Kraft, Leidenschaft,
Tatendrang, Mut und Durchsetzungsvermögen –
Kernwerte und Antrieb für unsere Arbeit in 21
Jahren ZWP Zahnarzt Wirtschaft Praxis.

[1] Fluorescence Visualization-Guided Surgery for EarlyStage Oral Cancer. Catherine F. Poh, Donald W. Anderson, J. Scott Durham, Jiahua Chen, Kenneth W.
Berean, Calum E. MacAulay, Miriam P. Rosin, JAMA
Otolaryngol Head Neck Surg. Published online January 14, 2016. doi:10.1001/jamaoto.2015.3211

Quelle: doctorslounge.com

Online-Plattform zum

Austausch über Laserzahnheilkunde
Die Entwicklung der blauen Lasertechnologie hat
die Einsatzmöglichkeiten von Diodenlasern in der
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te von Dentallasern mittels Bild- und Videomaterial verständlich aufgezeigt. Erfahrungsberichte
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[49] =>

Antwort:
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Mit der Stellung dieses Aufnahmeantrages versichere ich, dass ich
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mit einem Laser des Typs

in der eigenen Praxis
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in der Praxis

beschäftigt bin.

in der Abt. der Universität

beschäftigt bin.

Ich beantrage die Aufnahme in die Deutsche Gesellschaft für Laserzahnheilkunde e.V.
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Jahresbeitrag: Für stimmberechtigte Mitglieder bei Bankeinzug 150,00 €.
Sofern keine Einzugsermächtigung gewünscht wird, wird ein Verwaltungsbeitrag von 31,00 € p.a. fällig.
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[50] =>

| imprint

laser
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laser international magazine of laser dentistry is published by OEMUS MEDIA AG and will appear in 2016 with one issue every quarter. The
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[51] =>

1. LASERKONGRESS
FRANKFURT, 17. & 18. JUNI 2016

FÜR LASER-INTERESSIERTE UND LASER-ANWENDER IN DER ZAHNHEILKUNDE
DIE REFERENTEN
Dr. Michael Hopp, Berlin
Prof. Dr. Giovanni Olivi M. Sc., Rom
Dr. Kresimir Simunovic M. Sc., Zürich
Prof. Dr. Gerd Volland M. Sc., Heilsbronn
Dr. Alexander Kelsch, Karlsruhe
Thorsten Wegner, Stadthagen
Dr. Ralf Schlichting, Passau
Dr. Volker Beltz M. Sc., Dresden
Dr. Frank Herdach, Leonberg
Jeanette Deumer M. Sc., Berlin
Dr. Thorsten Kuypers M. Sc., Köln

DAS ERWARTET SIE
Viele spannende Vorträge und Workshops rund um das Thema Laser – von den
Einsatzmöglichkeiten über Behandlungsmethoden bis hin zu wirtschaftlichen Aspekten.
Kommen Sie zu informativem Austausch mit Experten zu unserem zentral gelegenen
Veranstaltungsort 10 km südlich von Frankfurt am Main in das NH Hotel Mörfelden-Walldorf.

FreeTel: 0800 –140 00 44 oder FreeFax: 08000 – 40 44 44
Anmeldung und weitere Informationen:
www.henryschein-dental.de/laserkongress

[52] =>

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[cover] => laser international No. 1, 2016

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