laser international No. 2, 2014
Cover
/ Editorial
/ Content
/ Diclofenac - dexamethasone or laser phototherapy? Part I
/ Laser activated irrigation Part I: The power of the bubble
/ Er - Cr:YSGG in laser-assisted aesthetic rehabilitation: A case report.
/ Periodontal decontamination in microsurgery
/ Innovative pathways for extensive and efficient tissue removal with Er:YAG laser
/ Laser dentistry course for dental students in Thailand
/ Gain power at your laser clinics!
/ Strong against bacteria – gentle to teeth and gingiva
/ Interview: “We still have a long way to go”
/ Laser Dentistry in the City of Light - Welcome to Paris
/ Rimini show confirms that the future of dentistry is digital
/ News
/ About the publisher
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[1] =>
issn 2193-4665
Vol. 6 • Issue 2/2014
laser
international magazine of
laser dentistry
2
2014
| research
Diclofenac, dexamethasone or
laser phototherapy?
| case report
Er,Cr:YSGG in laser-assisted
aesthetic rehabilitation: A case report
| industry report
Innovative pathways for extensive and efficient
tissue removal with Er:YAG laser
[2] =>
Have you heard?
There’s something new in pediatric dentistry.
YOUR PEDIATRIC NEEDS ARE AS UNIQUE AS YOUR PATIENTS.
The WaterLase Pediatric Package from BIOLASE gives you both the technology and support
to enhance your practice growth for kids of all ages. Mom Approved. Kid-friendly technology
- no shot, no drill* - that moms appreciate and talk about with other moms.
NO SHOT, NO DRILL DENTISTRY.*
Pedro Morales • BIOLASE Europe GmbH • Biolase.com
+34 679 986 593 • info@biolase-europe.com
*Individual sensitivity to pain may vary. No shot in most cases. © 2014, BIOLASE, Inc. All rights reserved.
[3] =>
editorial
Preview on the
th
14 WFLD Congress
in Paris
I
Prof. Dr Norbert Gutknecht
Editor-in-Chief
Dear colleagues,
Today, meeting all expectations participants and companies hold towards a congress has become a difficult task. Whereas in previous years, one would have attended a congress in order to
expand one’s knowledge with new findings, expectations towards congresses today are dominated more and more by its status as an event rather than its educational properties. Of course,
both WFLD and the French organisers are open to this idea, but we also want to make sure that
the congress features a programme in which the latest laser technologies and many documented case studies are presented and discussed. Of course, problems with regard to the competent integration and amortisation of laser applications in the dental practice are discussed as
well.
As the upcoming WFLD Congress and the Congress held by the OIWC take place at the same
time and place, we came up with special topics including laser applications in implantology and
periimplantitis therapy.
Last but not least: Of course, participants will meet other modern, future-oriented colleagues
at the WFLD Congress in Paris. Looking forward to seeing you there!
Warm regards,
Prof. Dr Norbert Gutknecht
Editor and CEO WFLD
laser
2
I 03
_ 2014
[4] =>
I content
page 6
I editorial
03
page 18
page 32
I economy
Preview on the 14th WFLD Congress in Paris
40
Gain power at your laser clinics!
| Dr Anna Maria Yiannikos
| Prof. Dr Norbert Gutknecht
I research
I interview
06
Diclofenac, dexamethasone or laser phototherapy?
42
Strong against bacteria—gentle to teeth and gingiva
| Jan Tunér
44
“We still have a long way to go”
| Daniel Zimmermann
I overview
12
Laser activated irrigation—Part I
I meetings
| Roeland Jozef Gentil De Moor et al.
46
| Katrin Maiterth
I case report
18
Laser Dentistry in the City of Light
Er,Cr:YSGG in laser-assisted aesthetic rehabilitation:
A case report.
| Dr Christina Boutsiouki et al.
48
Rimini show confirms that the future of dentistry
is digital
I news
I industry report
49
26
I about the publisher
Periodontal decontamination in microsurgery
| Dr Fabrice Baudot
32
50
News
| imprint
Innovative pathways for extensive and efficient tissue
removal with Er:YAG laser
| Dr Kresimir Simunovic
I education
38
Cover image courtesy of Biolase,
www.biolase.com
background image: ©SmallAtomWorks
Artwork by Sarah Fuhrmann, OEMUS MEDIA AG.
Laser dentistry course for dental students in Thailand
| Associate Prof. Dr Sajee Sattayut et al.
page 40
04 I laser
2_ 2014
page 44
page 46
[5] =>
Education. Technology. Family.
Join the Syneron Dental Lasers Family at the WFLD 14 th World Congress
Come and see the LiteTouch™ in action
The unique Er:YAG laser that has changed the face of laser dentistry
LI-PB77691EN
Live presentations every hour at our booth in the WFLD 14 th World Congress
July 2-4 2014 – “Maison de la Chimie” – 28, rue Saint-Dominique - Paris, France
Reserve your personal consultation at dental@syneron.com
WWW.SYNERONDENTAL.FR
WWW.SYNERONDENTAL.COM
EMEA 2011 Winner
[6] =>
I research
Diclofenac, dexamethasone
or laser phototherapy?
Part II
Author_Jan Tunér, Sweden
[PICTURE: ©ROBERT KNESCHKE]
_Introduction
In part I, the author informed about studies
which investigated the effects of diclofenac and LPT.
In the second part, they continue their investigation
into the vast literature and studies on this topic and
give their conclusion.
In the May 2013 edition of Photomedicine and
Laser Surgery, the editorial written by Prof. Tina Karu
is titled “Is it time to consider photobiomodulation
as a drug equivalent?” Well, is it? Let us have a look
and see what the literature has to say about two very
popular drugs. Although the previously-mentioned
studies indicate that LPT is as effective, or more effective as diclofenac, a potentiation of the effect of
diclofenac by adding LPT is suggested in the following study:
The aim of the study by Markovic11 was twofold:
(1) to evaluate the postoperative analgesic efficacy,
comparing long-acting and intermediate-acting
local anaesthetics; and (2) to compare the use of
laser irradiation and the non-steroid anti-inflammatory drug diclofenac, which are claimed to be
among the most successful aids in postoperative
pain control. A twofold study of 102 patients of
both sexes undergoing surgical extraction of LTM
06 I laser
2_ 2014
was conducted. In the first part of the study, twelve
patients with bilaterally impacted lower molars
were treated in a double-blind crossover fashion;
local anaesthesia was achieved with 0.5 % bupivacaine plain or 2 % lidocaine with 1: 80,000 epinephrine. In the second part of the study, 90 patients undergoing lower molar surgical extraction
with local anaesthesia received postoperative laser
irradiation (30 patients) and a preoperative single
dose of 100 mg diclofenac (30 patients), or only regular postoperative recommendations (30 patients).
The results of the first part of the study showed a
strikingly better postoperative analgesic effect of
bupivacaine than lidocaine/epinephrine (eleven
out of twelve; four out of twelve, respectively, patients without postoperative pain). In the second
part of the study, LPT irradiation significantly reduced postoperative pain intensity in patients premedicated with diclofenac, compared with the
controls. Provided that basic principles of surgical
practice have been achieved, the use of long-acting
local anaesthetics and LPT irradiation enables the
best postoperative analgesic effect and the most
comfortable postoperative course after the surgical extraction of lower molars.
Dexamethasone is a corticosteroid, thus not an
NSAID, but the issue of replacing pharmaceuticals
[7] =>
research
I
treat S. epidermidis endophthalmitis, LPT has an
anti-inflammatory effect similar to that of dexamethasone.
Castano13 tested LPT on rats that had zymosan
injected into their knee joints to induce inflammatory arthritis. The author compared illumination
regimens consisting of a high and low fluence (3 and
30 J/cm2), delivered at high and low irradiance (5 and
50 mW/cm2) using 810 nm daily for five days, with
the positive control of conventional corticosteroid
(dexamethasone) therapy. Illumination with a
810 nm laser was highly effective (almost as good as
dexamethasone) at reducing swelling, and a longer
illumination time (10 or 100 minutes compared to 1
minute) was more important in determining effectiveness than either the total fluence delivered or
the irradiance. LPT induced reduction of joint
swelling correlated with reduction in the inflammatory marker serum prostaglandin E2 (PGE2).
with long-term negative effects to a treatment with
no side effect is urgent here as well.
A rabbit model of endophthalmitis was established by Ma12 to evaluate the anti-inflammatory effect of LPT as an adjunct to treatment for Staphylococcus epidermidis endophthalmitis. Rabbits were
randomly divided into three groups to receive intravitreal injections into their left eye: group A received 0.5 mg vancomycin (100 mcl), group B received 0.5 mg vancomycin + 0.2 mg dexamethasone
(100 mcl), and group C received 0.5 mg vancomycin
(100 mcl) and laser irradiation (10 mW, 632 nm) focused on the pupil. Slit lamp examination and Bmode ultrasonography were conducted to evaluate
the symptoms of endophthalmitis. Polymorphonuclear cells and tumour necrosis factor alpha (TNF-alpha) in aqueous fluid were measured at 0 h, and one,
two, three, seven and 15 days. A histology test was
conducted at 15 days. B-mode ultrasonography and
histology revealed that groups B and C had less inflammation than group A at 15 days. Groups B and
C had fewer polymorphonuclear cells and lower levels of TNF-alpha in aqueous fluid than group A at
two, three and seven days. There was no significant
difference between groups B and C. There was no
significant difference between groups A, B and C at
15 days. As an adjunct to vancomycin therapy to
Reis14 investigated the role of extracellular matrix elements and cells during the wound healing
phases following the use of LPT and anti-inflammatory drugs. Thirty-two rats were submitted to a
wound inflicted by a 6-mm-diameter punch. The
animals were divided into four groups: sham
treated, those treated with the LPT (4 J/cm2, 9 mW,
670 nm), those treated with dexamethasone
(2 mg/kg), and those treated with both LPT and dexamethasone. After three and five days, the cutaneous wounds were assessed by histopathology using polarised light and ultrastructural assessments
by transmission electron microscopy. Changes seen
in polymorphonuclear inflammatory cells, oedema,
mononuclear cells, and collagen fibre deposition
were semi-quantitatively evaluated. The lasertreated group demonstrated increased collagen
content and better arrangement of the extracellular
matrix. Fibroblasts in these tissues increased in
number and were more synthetically active. In the
dexamethasone group, the collagen was shown to
be non-homogenous and disorganised, with a
scarcity of fibroblasts. In the group treated with
both types of therapy, fibroblasts were more common and they exhibited vigorous rough endoplasmic reticulum, but they had less collagen production compared to those seen in the laser group. Thus,
LPT alone accelerated post-surgical tissue repair
and reduced oedema and the polymorphonuclear
infiltrate, even in the presence of dexamethasone.
In a study by Jajarm15 thirty patients with erosive-atrophic OLP were randomly allocated into two
groups. The experimental group consisted of patients treated with the 630 nm laser. The control
group consisted of patients who used dexamethasone mouth wash. The response rate was defined
laser
2
I 07
_ 2014
[8] =>
I research
[PICTURE: ©DTKUTOO]
based on changes in the appearance score and pain
score (VAS) of the lesions before and after each
treatment. Appearance score, pain score, and lesion
severity was reduced in both groups. No significant
differences were found between the treatment
groups regarding the response rate and relapse. The
study demonstrated that LPT was as effective as
topical corticosteroid therapy without any adverse
effects and it may be considered as an alternative
treatment for erosive-atrophic OLP in the future.
The aim of a study by Aimbire16 was to investigate
if LPT can modulate the formation of haemorrhagic
lesions induced by immune complex, since there is a
lack of information on LPT effects in haemorrhagic
injuries of high perfusion organs, and the relative
efficacy of LPT compared to anti-inflammatory
drugs. A controlled animal study was undertaken
with 49 rats, randomly divided into seven groups.
Bovine serum albumin i.v. was injected through the
trachea to induce an immune complex lung injury.
The study compared the effect of irradiation by a
650 nm laser with doses of 2.6 J/cm2 to celecoxib,
dexamethasone, and control groups for haemorrhagic index (HI) and myeloperoxide activity (MPO)
at 24 h after injury. The HI for the control group was
4.0. Celecoxib, laser, and dexamethasone all induced
significantly lower HI than in the control animals at
2.5, 1.8 and 1.5, respectively. Dexamethasone, but
not celecoxib, induced a slightly, but significantly
lower HI than laser. MPO activity was significantly
decreased at 1.6 in groups receiving celecoxib at
0.87, dexamethasone at 0.50, and laser at 0.7 when
compared to the control group, but there were no
significant differences between any of the active
treatments. In conclusion, LPT at a dose of 2.6 J/cm2
induces a reduction of HI levels and MPO activity in
haemorrhagic injury, which is not significantly different from that obtained by celecoxib. Dexamethasone is slightly more effective than LPT in reducing
HI, but not MPO activity.
08 I laser
2_ 2014
In an effort to clarify the molecular based mechanism of the anti-inflammatory effects of laser irradiation, Abiko17 used a rheumatoid arthritis (RA) rat
model with human rheumatoid synoviocytes
(MH-7) challenged with IL-1, treated with laser or
dexamethasone (DEX), monitored by gene expressions and analysed by the signal pathway database.
RA rats were generated by the immunisation of
type-II collagen, after which foot paws and knee
joints became significantly swollen. The animals
were laser treated and the swelling rates measured.
MH-7 was challenged with IL-1 and gene expression levels monitored, using the Affymetrix Gene
Chip system, and the signal pathway database
analysed using the Ingenuity Pathway Analysis (IPA)
tool. LPT significantly reduced swellings in the rats'
foot paws and knee joints and made it possible for
them to walk on their hind legs. LPT altered many
gene expressions of cytokines, chemokines, growth
factors and signal transduction factors in IL- induced MH-7. IPA revealed that LPT as well as DEX
kept the MH7A at a normal state to suppress mRNA
levels of IL-8, IL-1, CXC1, NFkB1 and FGF13, which
were enhanced by IL-1 treatment. However, certain gene expression of inflammatory factors were
reduced by LPT, but were enhanced by DEX. LPT reduced inflammatory factors through altering signal
pathways by gene expression levels. Interestingly,
LPT altered useful targeted gene expressions,
whereas DEX randomly altered many gene expressions, including the unwanted genes for anti-inflammation. Dexomethasone is a steroid known for
having a long range of serious side effects. Thus,
genome-based gene expression monitored by the
Gene Chip system together with a signal pathway
based database provide unprecedented access to
elucidate the mechanism of the biostimulatory effects of LPT.
It has been suggested that LPT acts on pulmonary
inflammation. Thus, Mafra de Lima18 investigated in
a work if LPT (650 nm, 2.5 mW, 31.2 mW/cm2,
1.3 J/cm2, spot size of 0.08 cm2 and irradiation time
of 42 s) can attenuate oedema, neutrophil recruitment and inflammatory mediators in acute lung inflammation. Thirty-five male Wistar rats (n = 7 per
group) were distributed in the following experimental groups: control, laser, LPS, LPS+laser and dexamethasone+LPS. Airway inflammation was measured 4 h post-LPS challenge. Pulmonary microvascular leakage was used for measuring pulmonary
oedema. Bronchoalveolar lavage fluid (BALF) cellularity and myeloperoxidase (MPO) were used for
measuring neutrophil recruitment and activation.
RT-PCR was performed in lung tissue to assess
mRNA expression of tumour necrosis factor-alpha
(TNF-alpha), interleukin-1 (IL-1), interleukin
(IL-10), cytokine-induced neutrophil chemoattrac-
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[10] =>
I research
with a larger collagen deposition as well as a decrease in both the inflammatory infiltrated and in
the delay on the wound healing process. Laser accelerated healing, delayed by the steroids, acting as
a biostimulative coadjutant agent, balancing the
undesirable effects of the steroids on the tissue's
healing process. The effect of LPT is almost as potent
as dexametasone but, again, without side effects.
[PICTURE: ©NIKOLAY LITOV]
tant-1 (CINC-1), macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule-1 (ICAM-1). Protein levels in both BALF and
lung were determined by ELISA. LPT inhibited pulmonary oedema and endothelial cytoskeleton damage, as well as neutrophil influx and activation. Similarly, LPT reduced the TNF-alpha and IL-1, in lung
and BALF. LPT prevented lung ICAM-1 up-regulation. The rise of CINC-1 and MIP-2 protein levels in
both lung and BALF, and the lung mRNA expressions
for IL-10, were unaffected. Data suggest that the LPT
effect is due to the inhibition of ICAM-1 via the inhibition of TNF-alpha and IL-1.
Steroids are frequently used to treat inflammation. Some studies report a reduced effect of LPT in
the presence of steroids, while others have found
positive results of LPT even in the presence of
steroids. However, steroids are known to delay
wound healing through a reduction of leukocyte
migration and a suppression of interleukins, while
LPT is known to stimulate wound healing. In a study
by Pessoa19, 48 rats were used, and after the execution of a wound on the dorsal region of each animal,
they were divided into four groups (n = 12), receiving the following treatments: G1 (control), wounds
and animals received no treatment; G2, wounds
were treated with laser; G3, animals received an intraperitoneal injection of sodium phosphate of dexamethasone, dosage 2 mg/kg of body weight; G4,
animals received steroids and wounds were treated
with laser. The laser emission device used was a
904 nm unit, in a contact mode, with 2.75 mW gated
with 2,900 Hz during 120 sec. After a period of three,
seven and 14 days, the animals were sacrificed. The
results showed that the wounds treated with steroid
had a delay in healing, while laser accelerated the
wound healing process. Additionally, wounds
treated with laser in the animals, also treated with
steroids, presented a differentiated healing process
10 I laser
2_ 2014
In a study by Lara20, 44 rats were treated with fluorouracil and, in order to mimic the clinical effect of
chronic irritation, the palatal mucosa was irritated
by superficial scratching with an 18-gauge needle.
When all of the rats presented oral ulcers of mucositis, they were randomly allocated to one of three
groups: group I was treated with laser (GaAlAs),
group II was treated with topical dexamethasone,
and group III was not treated. Excisional biopsies of
the palatal mucosa were then performed, and the
rats were killed. Tissue sections were stained with
haematoxylin and eosin for morphological analyses,
and with toluidine blue for mast-cell counts. Group
I specimens showed higher prevalence of ulcers,
bacterial biofilm, necrosis and vascularisation,
while group II specimens showed higher prevalence
of granulation tissue formation. There were no significant statistical differences in the numbers of
mast cells and epithelial thickness between groups.
For the present model of mucositis, rats with palatal
mucositis treated with laser showed characteristics
compatible with the ulcerative phase of oral mucositis, and rats treated with topical dexamethasone
showed characteristics compatible with the healing
phase of mucositis. Topical dexamethasone was
more efficient in the treatment of rats' oral mucositis than the laser.
It has been suggested that LPT and dexamethasone (DEX) in combination do not bring about any
advantages. But the following study suggests that
LPT works even in an environment with DEX.
The study by Marchionni21 aimed to assess the effect of LPT associated with and without dexamethasone on inflammation and wound healing in cutaneous surgical wounds. Limited studies are directed
at the possible interference of laser photobiomodulation on the formation of myofibroblasts, associated with an anti-inflammatory drug. Standard skin
wounds were performed on 80 Wistar rats, distributed into four groups: no treatment (sham group),
laser only (670 nm, 9 mW, 0.031 W/cm2, 4 J/cm2,
single dose after surgery), dexamethasone only
(2 mg/kg 1 h before surgery), and laser with dexamethasone. Tissue was examined histologically to
evaluate oedema, presence of polymorphonuclear,
mononuclear cells, and collagen. The analysis of
myofibroblasts was assessed by immunohisto-
[11] =>
research
chemistry and transmission electron microscopy.
The intensity was rated semi-quantitatively. The results showed that laser and dexamethasone acted in
a similar pattern to reduce acute inflammation. Collagen synthesis and myofibroblasts were more intense in the laser group, whereas animals treated
with dexamethasone showed lower results for these
variables. In a combination of therapies, the synthesis of collagen and actin as well as desmin-positive
cells was less than laser group. Laser was effective in
reducing swelling and polymorphonuclear cells and
accelerated tissue repair, even in the presence of
dexamethasone.
The aim of a study by Garcia22 was to compare LPT
as adjuvant treatment for induced periodontitis
with scaling and root planing (SRP) in dexamethasone-treated rats. One-hundred twenty rats were
divided into groups: D group (n = 60), treated with
dexamethasone; ND group (n = 60) treated with
saline solution. In both groups, periodontal disease
was induced by ligature at the left first mandibular
molar. After seven days, the ligature was removed
and all animals were subjected to SRP. They were divided according to the following treatments: SRP,
irrigation with saline solution (SS); SRP + LPT, SS and
laser irradiation (660 nm; 24 J; 0.428 W/cm2). Ten
animals in each treatment were killed after seven
days, 15 days and 30 days. The radiographic and his-
I
tometric values were statistically analysed. In all
groups, radiographic and histometric analysis
showed less bone loss in animals treated with SRP +
LPT in all experimental periods. SRP + LPT was an effective adjuvant conventional treatment for periodontitis in rats treated with dexamethasone.
_Conclusion
From the above papers it is clear that LPT has an
effect similar to that of dexamethasone. It is possibly not as strong as dexamethasone, but without the
side effects. Thus, it is a promising alternative, especially for long term use. What still remains is a careful analysis about the optimal dosage windows for
LPT._
Editorial note: A list of references is available from the
publisher.
_contact
laser
Jan Tunér
Spjutvagen 11
772 32 Grängesberg
Sweden
jan.tuner@swipnet.se
AD
[PICTURE: ©SERGEY NIVENS]
Hand in your article.
Please contact:
Editorial manager
Georg Isbaner
g.isbaner@oemus-media.de
Editor
Katrin Maiterth
k.maiterth@oemus-media.de
laser
2
I 11
_ 2014
[12] =>
I overview
Laser activated
irrigation
Part I: The power of the bubble
Authors_Roeland Jozef Gentil De Moor, Maarten Meire, Belgium
[PICTURE: ©VECTOR ILLUSTRATION]
_Introduction
Endodontic success is determined by the removal
of remnants of vital and necrotic tissues, microorganisms and their microbial toxins from the root
canal system.1 Today, cleaning and shaping of the
root canal is based on a sodium hypochlorite
(NaOCl) supported root canal preparation followed
by final rinsing with EDTA.2 It is important that these
irrigants come into contact with the root canal wall
and biofilm (if present), especially in the apical third
of the root canal system. Therefore, a number of mechanical devices have been introduced to improve
the penetration and effectiveness of irrigation.3
_Laser fibre in dry root canal
In endodontics three types of investigations
were performed with fibre lasers on the effect of direct irradiation of the root canal wall:
– Type I: Water absorption increases significantly at
1,450 nm. With the potential of near-IR lasers with
wavelengths larger than 1,450 nm in removal of
dental hard tissues, investigations were conducted on their use in the instrumentation of root
canals.
– Type II: Investigations were also performed with
wavelengths below 1,450 nm such as Nd:YAG
12 I laser
2_ 2014
(1,032 nm), diodes (810, 830, 940, 980 nm) and KTP
(532 nm) for the modification and cleaning of the
root canal wall.
– Type III: Investigations examining the effect of direct irradiation with a laser fibre of the root canal
wall on the eradication of bacteria.
Up to 2006/2007, all these studies with high
power lasers were performed with flat ending fibres.
The studies had in common that a spiral motion of
the laser fibre was needed in order to expose the root
canal wall to the laser light. The findings were not always encouraging:
– In the type I studies,1 canals treated with Erbium
lasers resulted in significantly more debris than
canals that were prepared with NiTi-rotaries,2
laser instrumentation required twice as much
time,3 and there was also a risk for creation of
ledges and root canal wall irregularities.4 At the
end, these type of lasers were considered to be adjuncts to mechanical instrumentation.
– The Nd:YAG laser is one of the most extensively investigated lasers in endodontics. Up to the end of
the 1990s, it was also the most widely used laser in
endodontics. Studies have demonstrated that the
smear layer could be modified and typical aspects
of glazing were described in these Type II studies.5
With the introduction of EDTA as a rinsing solution
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[14] =>
I overview
interacting with the smear layer, the need for the
use of this wavelength for this type of laser-target
interaction disappeared.6
– In type III studies, much of the work has been conducted with the Nd:YAG followed by the diodes. A
study in 2010 by Hibst et al. demonstrated that
high-power NIR laser bacterial killing is not
caused by the light itself (photochemical effect).7
The exception are black pigmented bacteria when
irradiation is performed with Nd:YAG.8 They found
that the most important parameter was the maximum temperature, meaning that killing was the
result of a photo thermal process. Hence, irradiation of the bacteria at low temperature does not
result in killing.9 Furthermore, the spiral motion of
the fibre did not allow for complete exposure of
the root canal wall to the laser light.
Erbium lasers have also been investigated for this
purpose (Type III studies). In general, when relying
on a spiral motion of the fibre, the Nd:YAG proved to
be more effective at reducing the number of CFU
and at eradicating the bacteria in a biofilm when
compared to Erbium lasers.10 However, when it was
possible to expose the biofilm directly to the laser
light, Er:YAG was significantly more effective in bacterial killing.9 With the introduction of radial firing
tips, a better coverage of the root canal was expected.10 An increase of the disinfection effectiveness of the root canal with the Er,Cr:YSGG laser remained limited.10,11
_The era of the bubble
Limitations of the Erbium laser fibres
One of the problems with the Erbium lasers during disinfection of the root canal was the need to
achieve a balance between sufficient power output
for effective sterilization and avoidance of excessive
morphological alterations or damage to root canal
[PICTURE: ©ASHARKYU]
wall dentine. The use of both Er:YAG and Er,Cr:YSGG
may result in the creation of ledges due to their ablative nature. Effective sterilization could not be obtained at the lower power outputs.10-12 Although
Nd:YAG has a lower penetration depth in dentine
and dentinal tubules than NaOCl,13 and taking into
account that a direct exposure of the root canal wall
to Erbium lasers for root canal disinfection is not
possible yet, the 3-D sterilization of the root canal
system with its anatomic aberrations remains impossible.
Free liquid environment
Of all IR lasers, the Er:YAG has the highest absorption in water.14 As the laser light can be delivered through a small-diameter fibre tip, this wavelength has already been used in a wide range of
laser-assisted medical applications since the beginning of the century.15,16 The Erbium radiation delivered into liquid water through a submerged fibre tip
is completely absorbed right beside the fibre tip due
to the high absorption coefficient.17-20
At the beginning of the laser pulse (0 to 50 µs),
the energy is absorbed in a 2 µm layer that instantly
heats over the boiling point and is turned into
vapour. The time of the vapour formation depends
on the pulse energy and the pulse duration.17 This
vapour at high pressure starts expanding at high
speed and provides an opening for the Erbium light
in front of the fibre. As the laser continues to emit
energy, the light passes through the bubble and
evaporates the water surface at the front of the bubble. In this way, it drills a channel through the liquid
until the pulse ends.18 This mechanism has been referred to as “the Moses effect in the microsecond region”.20
From the moment the emission of energy stops,
the vapour cools and starts condensing. The internal pressure decreases and becomes lower than the
pressure in the surrounding liquid. The result is the
implosion of the bubble. The collapse of the bubble
follows immediately. The implosion occurs near the
tip of the fibre and results in the separation of the
bubble from the fibre. During the collapse, a portion
of energy stored in the bubble is converted into
acoustic energy. This results in the emission of
acoustic transients and shock waves.17 The cavitation generated pressure waves travel at supersonic
speed (shock waves) in the beginning and at sonic
speed (acoustic waves) later.21, 22 Also a high-speed
liquid jet is formed23 and fluid surrounding the bubble quickly flows inside the decompressed vapour
gap.
After the first large vapour bubble disappears,
the shock wave abruptly and extensively changes
14 I laser
2_ 2014
[15] =>
th
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LASER DENTISTRY
PARIS, July 2nd, 3th & 4th, 2014
ZIOG#FOTJURXSFRP
www.dental-laser-academy.com
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[16] =>
I overview
ble and the direction of the energy emission. The
conventional laser tips are flat and end-firing generating a channel-like bubble, whereas conical fibre
tips induce spherical bubbles (Fig. 1). There is also the
optodynamic energy-conversion efficiency which
refers to the ratio between the mechanical energy of
the liquid medium and the pulse energy. When a
conical tip is used, the efficiency is significantly
larger and it increases with increasing pulse energy
and decreasing pulse duration.17
Conventional laser-activated irrigation (C-LAI)
High-speed recordings of laser generated cavitation bubbles in glass models demonstrated that
vapour bubbles were created at the end of the fibre.
During these experiments, the fibre was positioned
in the root canal. The form of the cavitation bubbles
was identical to the ones in free liquid environment:
the flat tip resulted in a cavitation bubble appearing
as an elongated bubble with diffuse surface or the
previously described channel like bubble. The conical tip resulted in the formation of a spherical bubble.18
Fig. 1
Fig. 2
Fig. 1_Frames captured at the beginning (a and b) and at the maximum
size (c and d) of a vapour bubble.
With the flat tip (BioLase MZ4 Ziptip)
an elongated bubble is created (a and
c). The radiation with the conical tip
(BioLase MZ4 tip) results in a
spherical bubble (b and d). Irradiation
was performed with an Er,Cr:YSGG
laser (Biolase) at 0.5 W – 20 Hz –
400 µm fibre.
Fig. 2_The frames are captured in
three different liquids: Distilled water
(H2O), Sodium hypochlorite (NaOCl)
and Ethylenediaminetatraacetic acid
(EDTA). Radiation is performed with a
flat tip (BioLase MZ4 Ziptip) (a, b and
c) and with a conical tip (BioLase MZ4
tip) (d, e and f). Irradiation
was performed with an
Er,Cr:YSGG laser (Biolase) at 0.5 W –
20 Hz – 400 µm fibre.
16 I laser
2_ 2014
the pressure of water around the laser tip, resulting
in the nucleation of a number of new cavitation
bubbles. This phenomenon is generally referred to as
rebound. In this respect, Gibson described the socalled secondary cavitation which was generated
around a primary cavity rebounding relatively far
from a free surface, owing to the low pressure below
the threshold value in the region of concern.24 The
low-pressure generation was reasonably explained
as the result of the superimposed effect of the surrounding static pressure, decreasing as the cavity
re-expanded, with the tension waves coming from
the free surface. The second cavitation bubbles are
much smaller compared with the first vapour bubble. When these second cavitation bubbles collapse,
even smaller bubbles form and disappear repeatedly
in decreasing numbers.
Important parameters that influence the bubble
formation are pulse energy, pulse duration17 and
pulse frequency (the latter more from the perspective that the pulse duration cannot always be
changed). There is also the effect of tip design which
may influence the shape of the laser-induced bub-
In the study of de Groot et al., using an Er:YAG
laser with a flat-ending fibre, the bubble grew with
a velocity of the order of 1 m/s during the pulse duration. When the laser pulse ended, the bubble collapsed with a velocity of the order of 1 m/s.25 When
the bubble collapsed, secondary cavitation was seen
with a relatively large bubble near the collapse site.
The cycle of expansion and collapse of the cavitation
bubble repeated for a number of times, until it was
damped out within a few milliseconds. The laser
bubble also grew predominantly in the coronal direction. For laser energy exceeding 120 mJ per pulse
it was observed that some fluid was ejected from the
root canal, leaving less irrigant in the root canal.25
In the study of Blanken et al., using an Er,Cr:YSGG
laser with a flat-ending fibre, bubbles up to a length
of 3 to 3.5 mm were observed.18 The small canal prevented the vapour from expanding freely laterally,
pushing the water both forward and backward in
the canal. Since the water obstructs the expansion
of vapour in the forward direction, the bubble also
grows backwards along the fibre. The pressure inside the bubble remains high for a long time, since it
has to fight against the resistance of the irrigant
which has to be displaced in the small canal. The
presence of secondary cavitation bubbles was also
noted. In this study, it was emphasized that the creation of cavitation bubbles of this size in a root canal
may result in the absence of irrigation solution between fibre and canal wall. Hence, there is a risk that
the emitted energy can be absorbed by hydroxyapatite in the canal wall and may result in the damage
of the root canal wall.
[17] =>
overview
In the study of Matsumoto et al., using an
Er:YAG laser with a conical tip with top angle degree of 84 degrees, large vapour bubbles were created.21 The maximum bubble length was 4.5 mm
and the bubble expanded in vertical direction. The
registrations were in line with the study of de
Groot et al. and Blanken et al. The three studies also
had in common that there were considerations
with regards to safety to the patient and it was recommended not to position the fibre end too close
to the apex (Blanken et al. recommend 5 mm from
the most apical point of the preparation, Matsumoto et al. also used the fibre 5 mm short of the
most apical end).
George and Walsh examined the extrusion of
fluid through the apex following laser activation of
irrigant with the Er:YAG and the Er,Cr:YSGGG, and
with an end-firing and a radial firing tip placed 5 mm
or 10 mm short from the most apical end.26 Neither
laser type nor tip design appeared to be significant
variables. The amount of dye extrusion was higher
in the laser groups than in the group with manual
syringe irrigation. Also the position of the laser tip
did not result in significantly different extrusion distances (the 5 mm group, however, had a generally
greater amount of extrusion). One important parameter that was not taken into account was the
presence of an intact periodontal ligament. Nevertheless, the risk of apical extrusion was brought to
attention. The studies in the glass models also
demonstrated that the form of the cavitation bubbles was identical to the ones in water. In this respect, Meire et al. demonstrated that the transmission spectra of endodontic irrigation solutions (a.o.
NaOCl and EDTA) proved to follow the spectrum of
pure water to a large extent.27 A pilot study performed by the authors on the influence of fibre tip
design and endodontic irrigant solutions on laseractivated cavitation with Er,Cr:YSGG demonstrated
that there was no influence of the form of the cavitation bubble (Fig. 2).28
Conventional LAI was reported to result in a significantly better debridement of artificial root canal
wall grooves filled with artificially prepared dentin
debris when comparing the use of PUI during 20
seconds with the use of C-LAI during 20 seconds
(Er:YAG25 – Er,Cr:YSGG29). When comparing C-LAI
during 20 seconds with PUI for 3 x 20 seconds, there
was no statistically significant difference (however,
there was a trend for better debridement scores for
C-LAI with both Er:YAG and Er,Cr:YSGG).30 A comparison between C-LAI (Er:YAG flat tip) during 20
seconds with LAI performed with the tip hovering
over the entrance of the canal (H-LAI) (Er:YAG conical) and PUI during 20 seconds demonstrated significantly higher debridement scores for both C-LAI
I
and PUI than for H-LAI.31 There were no statistically
significant differences between PUI and C-LAI.
In vitro studies investigating the bactericidal effect of C-LAI with the two types of fibre tips have not
been published. At present, there is only a blind randomized controlled clinical trial with six month
evaluation, where Er,Cr:YSGG was used with a radial
firing tip combining C-LAI in distilled water (two
times) and the spiral motion of the fibre in the dried
canal (two times) in necrotic teeth with chronical
apical periodontitis. This protocol was compared
with the concomitant use of 3 % NaOCl and interim
calcium hydroxide paste.32 There were no significant
differences in terms of periapical healing between
the two groups, however, they exhibited statistically
significant decreases in PAI scores in favour of the
laser protocol.
A comparison between the use of lasers for laseractivated irrigation with the fibre in the canal
(C-LAI) versus fibre in the pulp chamber (H-LAI) will
be made in Part II of this article in laser 3/2014.
_Conclusion
Conventional Laser Activated Irrigation (C-LAI)
with Erbium lasers, i.e. placement of the fibre tip in
the proximity of the most apical end of the prepared
root canal, used stationary or retracting until reaching the most coronal part of the root canal has the
potential of better debridement of dentinal plugs
along the root canal wall when compared to Passive
Ultrasonic Irrigation. Investigations of the bactericidal effect of C-LAI have not yet been performed._
Editorial note: A list of references is available from the publisher.
_contact
laser
Prof. Dr Roeland De Moor
Ghent University Hospital
Dental School
De Pintelaan 185/P8
B-9000 Ghent, Belgium
Tel.: +32 9332 4003
roeland.demoor@ugent.be
laser
2
I 17
_ 2014
[18] =>
I case report
Er,Cr:YSGG in laser-assisted
aesthetic rehabilitation:
A case report.
Authors_Dr Christina Boutsiouki & Dr Dimitris Strakas, Greece
_Introduction
The Er,Cr:YSGG laser is beyond doubt a very helpful tool in the hands of a trained practitioner in
everyday practice. It can be used safely both for
hard- and soft-tissue treatment, with minimal or
no use of anaesthetic. Patients are always positive
about and eager to undergo laser treatment owing
to the comfort they enjoy compared to classical
treatments.
The following case report details the case of a
young female patient aged 28 who visited the postgraduate dental clinic at the Department of Operative Dentistry of the Aristotle University of Thessaloniki in Greece complaining about the colour of her
teeth. After obtaining the medical and dental
anamnesis of the patient, clinical and radiographic
examination was performed to address any therapeutic (caries, periodontal or endodontic) problems.
dental office three to four years ago, but observed
that the whitening result had not lasted. Clinical examination revealed old Class IV restorations with
visible discolouration. The patient was informed
that composite restorations cannot be whitened
and replacement after tooth whitening would be
necessary. It was also observed that the patient’s
smile extended up to the first premolars in both the
maxillae and mandible. Moreover, soft-tissue
melanchrosis was visible in several areas of patient’s
gingivae. Clinical and radiographic examination
found no problems concerning the posterior teeth.
_Er,Cr:YSGG-assisted tooth whitening
During anamnesis, it was mentioned that the
patient had undergone tooth whitening in a private
Discoloured teeth are a common concern of patients in modern society, as aesthetic demands rise
constantly and people dream of a bright white
smile. In order for dentists to keep up with these
needs, aesthetic dentistry is constantly evolving, as
new materials and techniques are introduced, giving us the opportunity to implement them in our
offices. These range from conservative to invasive
and include composite veneers, porcelain veneers,
all-ceramic crowns and tooth whitening. Since
Fig. 1
Fig. 2
Fig. 1_The initial situation.
Fig. 2_The gingival barrier.
18 I laser
2_ 2014
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[20] =>
I case report
Fig. 3_The whitening agent.
Fig. 4_Laser whitening.
Fig. 5_The silicone key.
Fig. 6_The final situation after laser
treatment.
Fig. 7_Laser treatment of the softtissue melanchrosis.
Fig. 8_Soft-tissue melanchrosis in
the mandible.
Fig. 9_Rubber dam placement.
Fig. 10_Silicone key adjustment.
Fig. 11_Additional etching with 37%
phosphoric acid.
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
20 I laser
2_ 2014
[21] =>
case report
I
Fig. 12_The etched enamel.
Fig. 13_The palatal enamel shade.
Fig. 14_The dentine shade lobes.
Fig. 15_The final restorations.
Fig. 12
Fig. 13
Fig. 14
Fig. 15
dental tissue is unable to regenerate, dentists
should suggest the most conservative treatment
that meets the patient’s needs, allowing for procedures that are more invasive in the future.
patient and minimal to no post-treatment discomfort and sensitivity, which are often encountered in
light-activated tooth whitening with incoherent
light sources (e.g. plasma lamps). In a pulsed-mode
operated laser, these advantages are more apparent
owing to the fact that bursts of energy are directed
to the whitening agent in a very short period, thus
giving enough time for heat dissipation in the tissue
and relief for the patient.
Tooth whitening is the process through which a
dentist alters the colour of the patient’s teeth to appear whiter and brighter, and is considered one of
the most conservative procedures in the field of
aesthetic dentistry. This is made possible using various techniques and oxidising whitening agents to
eliminate tooth discolouration. The main oxidising
agents used are hydrogen peroxide in concentrations of 30–35 % and carbamide peroxide in concentrations of 10–22 %. The decomposition of these
agents produces hydroperoxyl free radicals with a
high whitening capability.
It is known that heating hydroxyl or carbamide
peroxide accelerates its decomposition rate. By increasing the whitening agent’s temperature by
10 °C, the speed of the decomposition is doubled. At
this point, more hydroperoxyl free radicals are released and then the free radicals penetrate the
porosities in the rodlike crystal structure of enamel
and oxidise the inter-prismatic stain deposits.
Many different light sources, both coherent and
incoherent, have been used to increase temperature
during tooth whitening (e.g. plasma arc lamps, halogen lamps, light-emitting diodes and lasers). The advantages of the use of laser in tooth whitening include the speed of the procedure, the comfort of the
In order to achieve the best clinical results without harming teeth, it is crucial to follow the procedure carefully and to take all safety measures. Before starting the first session, the patient was informed that the result of the procedure is not permanent and is dependent on the age of the patient,
the use of tobacco and extrinsic staining by the deposition of tannins found in coffee, red wine, tea and
cola beverages. The average duration expectancy is
three to four years for non-smokers. The patient was
also informed that, if tooth sensitivity or pain was
felt during tooth whitening, treatment could be
paused or stopped.
Prophylaxis and tooth cleaning had been performed at a private dental office before the patient
presented to our clinic. Before starting with the
tooth whitening, it was checked that the teeth were
free of plaque, calculus and extrinsic staining (Fig.
1). In order to prevent unwanted proteins interfering with the whitening agent, a mild polishing of the
teeth to be whitened was performed with Hawe
Cleanic Prophy paste (Kerr Corporation).
laser
2
I 21
_ 2014
[22] =>
I case report
Fig. 16_The final restorations under
a polarising filter.
Fig. 17_The final smile under a
polarising filter.
Fig. 16
Fig. 17
A review of the literature on Er:YAG laser
whitening indicates that there is a significant difference between laser-assisted and conventional
whitening in terms of the speed of the procedure.
We consequently expected faster activation of the
whitening gel with an Er,Cr:YSGG laser device
compared with other laser devices. Owing to the
similarities of the two wavelengths in terms of absorption in water, we expected to achieve the
same results as those observed in Gutknecht’s
study.1
on for 15 minutes and then removed from the
teeth with high-power dry suction. The procedure
was repeated twice during the same appointment.
After completion of the procedure, soft-tissue irritation was noticed in the area of tooth 42, but the
patient reported that she did not feel pain or tenderness.
In the postgraduate dental clinic, we use an
Er,Cr:YSGG laser (2,780 nm, Waterlase MD Turbo,
BIOLASE) and a yellow whitening agent for in-office whitening with a concentration of 38 % hydrogen peroxide (POWER WHITENING, WHITEsmile).
The tip used is a Z-type glass tip (MZ8) of 800 µm in
diameter and 6 mm in length, used with the gold
handpiece of the laser system. The power settings
that we used for this case were an output power of
1.25 W, a pulse duration of 700 µs (S-mode) and a
pulse repetition rate of 10 Hz.
The dentist, dental assistant and patient evaluated the initial tooth colour. In our case, the patient’s initial colour was evaluated as Shade A3 in
the VITA classical shade guide (Vident; Fig. 2). Safety
goggles must be worn by the patient and by all staff
in the laser working area. Lip protection cream was
applied and the working area was isolated with a
cheek and lip retractor. After drying the teeth and
gingiva with a gentle air stream, a liquid gingival
barrier was carefully applied to both the maxillary
and mandibular teeth and was polymerised with a
fanning motion for 40 seconds.
The whitening agent was applied in a layer of
1–2 mm in thickness to each tooth (Fig. 3), starting
with the maxillary teeth. With the power settings
mentioned above, we activated the whitening
agent for two intervals of 10 seconds for each
tooth (Fig. 4), keeping the laser handpiece at a distance of 2.5 cm from the teeth. After the end of the
procedure, the activated whitening agent was left
22 I laser
2_ 2014
The final colour evaluation was conducted by
the dentist, dental assistant and patient. After two
repetitions of the process during the same appointment, the colour of the teeth had been
changed to Shade B1 according to the VITA classical shade guide. The patient was satisfied with the
colour of her teeth and was advised to re-evaluate
the colour after two to three days to allow for rehydration of her teeth. The patient informed us that
she was satisfied with the final colour and a second
appointment was arranged in order to replace the
Class IV composite restorations on the mesial and
labial areas of her central incisors.
_Class IV restorations
Class IV restorations were scheduled to be performed after four weeks in order to allow for longterm colour evaluation by the patient. Colour differences were non-existent, as can be seen in the
photograph of the restorations with a polarising
filter. The restorations were performed with the silicone key technique, for which a palatal impression
of the existing restorations was taken with a
polyvinyl siloxane and trimmed to the incisal edges
(Fig. 5).
Subsequently, the old composite was removed
using an Er,Cr:YSGG laser (2,780 nm, Waterlase
MD). The output power was set to 4.5 W, with a pulse
duration of 140 µs (H-mode) and a pulse repetition
rate of 20 Hz using an MZ6 tip under a water spray.
Since there was no evidence of secondary caries or
any other defect apart from colour and marginal integrity, it was decided to maintain the inner bulk
volume of the old composite. However, all margins
were placed on enamel (Fig. 6). Laser treatment of
[23] =>
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[24] =>
I case report
Fig. 18_A photograph of the
situation seven days post-op.
Fig. 19_A photograph of the final
situation.
Fig. 18
Fig. 19
the aesthetic zone was finished with the elimination of the brownish-black pigments on the gingiva
between the central incisors and in the areas of
teeth 32 and 33 (Figs. 7 & 8).
air, had caused her discomfort. During depigmentation, no side-effects were reported. The Class IV
restorations were built up incrementally to
achieve better aesthetics. A silicone key was used
to reproduce the rough shape of the old restorations and final adjustments were made during
polishing to enhance the natural effect. A polarising filter was used to detect minor colour mismatches.
A restorative procedure was performed after
placement of a rubber dam (Fig. 9). The silicone key
was tried in (Fig. 10) and the adjacent teeth were
protected with PTFE tape before etching the
enamel margins with 37 % phosphoric acid (Figs.
11 & 12). The resin composite bond to enamel benefits from both laser etching and acid etching. The
restorations were built up incrementally, starting
with the palatal enamel surface with a translucent
enamel shade, Shade E (CLEARFIL MAJESTY Esthetic, Kuraray; Fig. 13). The dentine shade, Shade
OA2, was then placed, forming the internal dentinal lobes (Fig. 14). A final labial enamel layer in
Shade A2 was placed and was anatomically
formed to recreate the macrostructure. A small
quantity of Shade E was placed at the incisal edge
to increase the biomimetic effect of the restorations.
The microstructure was created by polishing
with fine and ultra-fine diamond burs, polishing
discs of decreasing roughness, silicone points and
brushes coated with diamond paste for the final
gloss (Fig. 15). The colour match was checked under the polarising filter (Figs. 16 & 17). The patient
was recalled seven days post-operatively in order
to check the aesthetic appearance of the restorations and the healing of the soft tissue in the areas
of depigmentation (Figs. 18 & 19).
_Results
The aesthetic rehabilitation of the case was
performed entirely with the use of an Er,Cr:YSGG
laser. Laser treatment was performed with no
anaesthetic. The patient reported only minor sensitivity during whitening and when the composite
was removed, adding that the low temperature of
the whitening agent and of the water ejected from
the laser handpiece, in conjunction with the cold
24 I laser
2_ 2014
_Discussion
The properties of the Er,Cr:YSGG wavelength
(2,780 nm) are well known. Its characteristic absorption in water makes it an excellent tool not
only for hard-tissue removal but also for soft-tissue and other aesthetic procedures.
One of the main components of a whitening gel
is water. It can be found in percentages of up to
50 % in any whitening gel. The advantage of using
a laser system from the erbium family is obvious.
The laser energy is fully absorbed by the water
molecules in the whitening gel, thus increasing its
temperature rapidly. This will result in rapid decomposition of the hydrogen peroxide and more
hydroperoxyl free radicals will be produced. Consequently, the same expected result in terms of the
final outcome of the whitening procedure is
reached in minimal time compared with non-activated whitening gel treatment.
The laser’s pulsed operation delivers bursts of
high energy to the gel over a relatively small area.
Its high energy density is a prominent advantage
over other light sources used for laser whitening
in terms of heat dissipation and safety of the pulp.
As Er,Cr:YSGG is also absorbed by hydroxylapatite, it is of great importance to select the power
settings carefully in order not to ablate the enamel
of the teeth to be whitened. For that reason,
we kept the laser system parameters at a laser energy density (fluence) of every pulse well below
the enamel ablation threshold. Our setting was
[25] =>
case report
0.4 J/cm2 and the ablation threshold for enamel is
close to 3.5 J/cm2.
_Conclusion
The Er,Cr:YSGG laser can be very useful as an activation medium of the whitening agent during the
tooth-whitening process. The whole procedure is
faster, the results are excellent and the patient feels
comfortable throughout the appointment. No
harmful side-effects have been recorded. Of
course, more studies are needed to corroborate
these preliminary results. Future developments are
encouraging and we can expect better-designed
handpieces for whitening and wavelength-specific
whitening agents.
Besides aesthetic dentistry, lasers have been
successfully used for restorations in operative
dentistry, providing pain-free treatment. The
Er,Cr:YSGG laser is a powerful tool in the hands of a
trained dentist for performing both hard- and softtissue treatment, sometimes even during the same
appointment. In conclusion, it is important for the
clinician to take all safety measures during the pro-
I
cedure, to comply with the manufacturer’s guidelines, and to use the correct wavelength and the
proper parameters of the laser device, depending
on the therapy selected, in order to achieve the best
results for the benefit of the patient._
_contact
laser
Dr Dimitris Strakas
DDS, MSc, PhD cand. Department of Operative
Dentistry, Aristotle University of Thessaloniki
dimitris.strakas@gmail.com
Dr Christina Boutsiouki
DDS, MSc, Department of Operative Dentistry,
Aristotle University of Thessaloniki
christinaboutsiouki@gmail.com
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[26] =>
I industry report
Periodontal
decontamination in
microsurgery
Author_Dr Fabrice Baudot, France
_Introduction
We are witnessing today an upsurge in the use of
minimally invasive techniques in the medical field.
Dentistry has not escaped this rapidly expanding
trend. In all the specialties of our discipline, we see
the appearance of micro-dentistry operating instruments and protocols. The search for better operating
comfort, greater effectiveness and better results
lead us in this direction.
Fig. 1_This strongly magnified view
of the periodontium shows the
abundance of the anatomic
structures.
Periodontology also became part of this process
several years ago with the development of periodontal microsurgery. This approach is based on an
adapted technological platform and new operating
protocols. The object of this article is to present a new
surgical technique made possible by the synergy of
LiteTouch Erbium:YAG laser (Syneron Dental Lasers,
Israel) and optical aids.
_Basic aspects of the microsurgery
Why microsurgery? This is a legitimate question.
Preserving vascularisation
Burkhardt & Lang in 2005 clearly showed that a
microsurgical technique led to better healing than
the classical technique.1 The key to the success of microsurgery is maintaining the integrity of the tissues
and in particular their vascularisation—so much so
that a surgical technique can be qualified as minimally invasive when it safeguards tissue vascularisation.
Plane-by-plane surgery
In this type of surgery, attention must be paid to
the thinness of the anatomic structures, namely of
the different tissue planes being operated on. Just as
plastic surgeons treat skin tissues plane by plane, the
periodontist should handle the periodontium in the
same way, taking account of the anatomic and functional specificity of each plane. The thinness of the
structures to be operated on calls for a microsurgical approach.
Avoiding tissue tension
With plane-by-plane surgery it is possible to respect the various anatomic structures, as well as to
manage possible tissue tensions that could be harmful to the revascularisation of the surgery site, as brilliantly demonstrated in Mammoto’s article published in the well-known Nature review in 2009.2 The
development of endothelial cells, seat of the vascularisation process, is influenced by tension receivers
Fig. 1
26 I laser
2_ 2014
[27] =>
Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry
www.dental-tribune.com
[28] =>
I industry report
ing, but he must also have tools that can meet the requirements of more precise movements.
The synergy created between optical aids and Erbium:YAG laser advantageously meets this dual requirement. Thanks to optical aids (minimum x3.5),
the surgeon acquires a finer analysis of the tissues
on which he is operating and the accuracy of the
therapeutic effects of the LiteTouch Erbium:YAG
laser allows him the optimal precision required for a
minimally invasive surgical approach.
Fig. 2_The synergy of two
instruments used in periodontal
microsurgery.
which guide the tissue morphology in particular
during tissue healing.
Fine suturing or no suturing
This is yet another surgical parameter in respect
of the surgically treated tissues. Fine sutures have
physical and biological properties. They avoid excessive tissue tensions, therefore ensuring better healing,3 and they limit microbial infiltration of the operated areas.4 With the microsurgical use of the LiteTouch Erbium:YAG laser it is possible to operate
without need of sutures, which is even less traumatic.
Avoiding periosteum detachment
The periosteum is a fundamental vascular source
for the periodontium. Full thickness flaps, or even
partial thickness flaps, induce a delay in healing and
bone resorptions, as noted in the recent study by Fickl
et al.5 Flapless surgery or surgery using partial thickness techniques considerably improves the healing
process: this has long been studied6-8 and is made
possible precisely by microsurgical techniques.
Fig. 3_Laser absorption curves.
The main feature of the energy released by the
laser beam at a wavelength of 2,940 nm is its massive absorption by water and hydroxylapatite. This
physical property gives this laser its great versatility
in dental surgery and especially in periodontology.
The energy absorbed in the targeted tissues leads
to their vaporisation: visually, a tissue micro-ablation process is observed. The laser becomes a microsurgical instrument that allows precise sculpting of
the tissues. The micro-ablation results depend on the
water load of the targeted tissues. The greater the
water load, the more intense the vaporisation. The
water load of the various tissue planes is not constant. For purposes of clarity, two types of situations
can be distinguished:
Increasing water load
Hard tissues against soft tissues: in such a situation, the Erbium:YAG laser is more delicate to use,
with high risk of injuring the soft tissues. In these
clinical cases, piezosurgery (complementary to laser)
seems to be more adapted.
_Advantage of the LiteTouch
Erbium:YAG laser in periodontal
microsurgery
– Opening of the sinus flaps
– Root haemisection
– Bone grafting
As can be seen, the dental practitioner must improve his view of the tissues on which he is operat-
Decreasing water load
Soft tissues against hard tissues: This is the optimal field of application of the Erbium:YAG laser. Radiation acts on the soft tissues (which contain more
water) without affecting the hard tissues (which
contain less water). The appropriate clinical situations are for example:
– Gingivectomy against the root
– Tissue degranulation against the bone and the
roots
– Inflammatory tissues inlaid on the healthy gum
These concepts define the field of application and
mode of operation of the Erbium:YAG laser in periodontology. Laser treatment of periodontal tissues
differs from surgery with conventional instruments.
No more cutting or drilling of the tissues, but very ac-
Fig. 3
28 I laser
2_ 2014
[29] =>
industry report
Fig. 4a
Fig. 4b
Fig. 4c
Fig. 5
curate sculpting. The beam is used as a sort of optical curette with selective action on the inflammatory tissues, leaving the surrounding tissues undamaged, and particularly preserving vascularisation.
– Pulse duration
– Distance between the energy emitting source and
the tissues
– Beam angulation
_Erbium:YAG laser setting parameters
Here is not the place for explanations of laser
physics; it should be noted only that the Erbium:YAG
laser operates in pulse mode. Energy is released by
pulses with water irrigation.
NB: the irrigation can be suspended, but thermal
effects appear rapidly. This allows coagulation with
the Erbium:YAG laser which, in principle, is not intended for this. The practitioner has five parameters
at his disposal to adjust the therapeutic laser effect.
Two parameters set on the device
To simplify the clinical use, the manufacturers
have limited the device setting to two parameters to
be defined by the practitioner in order to determine
the characteristics of the beam emitted: pulse frequency (in Hertz) and pulse intensity (in millijoules).
The result of these two parameters is a pulse power
measured in watts.
Three variable parameters in the practitioner’s
hands
To adjust the energy delivered to the targeted tissues, the practitioner will utilise the following parameters:
I
Fig. 4_a) intra-operative view with
microsurgical access to the deep
periodontium: aggressive
periodontitis. Note the tissue
stability at two months;
b) post-operative view after two
months; c) Post-operative view
(two months) of an aggressive
periodontitis treated by
microsurgical protocol and flapless
PRF. Note the access to oral hygiene
and the tissue stability.
Fig. 5_Pre-operative X-ray of an
aggressive periodontitis, in smoker
patient, 45-years-old with
Vitamin D deficiency.
By regulation of these parameters, the practitioner takes full advantage of the “magic” effect of
the instrument. With visual control, he will be able to
sculpt the tissues with an accuracy of some tens of
microns.
_Microsurgical decontamination
protocol
The use of such microsurgical instruments, the
improvement of optical aids and the development of
our knowledge of the importance of micro-vascularisation in the healing process provide us today
with a third way between the surgical approach advocated by the Americans, especially by Widman,9
Fig. 6_After cleaning of the deep
periodontium, a very light polish of
the root surfaces may be performed
under visual control.
Fig. 6
laser
2
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_ 2014
[30] =>
I industry report
Fig. 7_Defocussing effect of the tip.
and the completely non-surgical techniques proposed by the Swedes from
the 1990s.10 Both approaches are efficient, but their limits have been shown
in the treatment of periodontitis:
– The surgical approach is invasive, the
surgical protocols are complicated and
the long treatment periods expose to
risks of reinfection. While the aim is to
reduce the periodontal pockets, the periodontal decontamination surgery does
not obviate the need for a strict maintenance programme.
shape) or with a laser in the most delicate areas. The object is to provide access to the deep periodontium (a sort of
access cavity). Through this 1 mm space,
it is possible to see up to 10–12 mm with
high performance optical aids. Therefore, it is possible to operate with visual
control without needing to detach a flap.
– Cleaning the deep periodontium is
conventionally done using fine ultrasound to remove tartar. Inflammatory
tissues are laser treated by selective vaporisation. The fine laser insert gives
access through a widened sulcus,
which will allow accurate tissue degranulation like a very high performance curette.
– The non-surgical approach follows a
microbiological rationale. Acting on the
aetiology of the pathology and respecting the periodontal tissues, it has
achieved good results. However, the
– At this stage, the operation is over. The
surgical technique results in a large
surgical protocol is short, minimally
number of residual periodontal pockinvasive and the post-operative manets and the non-surgical treatment of
agement light.
periodontitis entails an ultra-strict
Fig. 7
maintenance programme that few
Treatment of the whole mouth is
patients and members of the medical staff are able proposed in two sessions, 48 hours to one week apart
to maintain in the long term (especially in France at most in order to limit the risks of cross contamiwhere there are no dental hygienists). The way nation. Each half-mouth (top and bottom) surgical
opened by the microsurgical approach is expected session takes between 45 minutes and 1h30 accordto combine the advantages of both techniques ing to the extent of the lesions. Oral hygiene teachwhile smoothing out their disadvantages. This way ing sessions are given on a decontaminated periderives from the technique pioneered by Yukna odontium.
(1978) who published "E.N.A.P: Excisional for New
Two months after surgery, the patient pays a folAttachment Procedure".11
low-up visit for reassessment. At this stage, the
Finally, the most important element in periodon- adapted periodontal maintenance programme will
titis treatment is periodontal maintenance. The pa- be established and begin. It will be reassessed yearly
tient must have access to all the dental surfaces in according to the evolution of the clinical parameorder to maintain a level of hygiene adapted to his ters.
physiological profile. The critical point lies in the
The periodontitis treatment in such a protocol is
number of periodontal pockets. The initial phase
aims at reaching the deep periodontium in order to simple. The periodontal maintenance is rapidly iniclean these pockets (non-surgical approach) and to tiated on a periodontium that has been treated
deeply and efficiently. The microsurgical protocol is
some extent to reduce them (surgical approach).
halfway between the surgical and non-surgical apThe microsurgical approach proposed will meet proaches.
both criteria in a simple, quick surgical protocol.
_Selective tissue vaporisation with
The practitioner works with optical aids and
Erbium:YAG laser and therapeutic
therefore with visual control, with an ultra-fine surproperties
gical instrument which allows him to operate in a
non-invasive, flapless way, while preserving tissue
vascularisation and integrity.
Three-step surgical protocol
– Internal bevel sulcular incision (more or less
shifted) to access the deep periodontium. This incision may be done with a fine diamond drill (flame
30 I laser
2_ 2014
As already shown, one of the special features of
this surgical protocol is the use of the Erbium:YAG
laser which provides therapeutic efficiency in a restricted space. The characteristic of tissue microablation according to the water load of the tissues
allows fine and selective degranulation of the tissues, plane by plane, thus respecting the principles
[31] =>
industry report
of microsurgery. Inside the periodontal pocket, the
laser pulses vaporise the inflammatory tissues. The
first vaporised tissue planes are moisturised and
infiltrated most. Under the effect of laser irrigation, the surgical site clearly emerges and the practitioner, with optical aids, can see the surfaces he
or she is treating. There is no coagulation and
therefore no micro-vascular lesion, but the removal of inflammatory tissues reduces bleeding
and makes the surgical site clearer.
Once the inflammatory tissues are removed, the
practitioner has a precise view of the pocket inside
and can treat the second plane, the healthy tissues.
At this stage, soft tissue plasty of the pocket may
be considered to reduce depth in the sectors where
this is possible. Then, the practitioner may carry
out micro bone remodelling directly from inside
the pocket, by tissue micro-ablation: flapless bone
modelling. Laser beam angulation using the defocusing cone allows low-energy treatment of the
side walls of the pocket: ligament and bone. These
walls will be decontaminated and bio-stimulated
according to the LLT laser principles: low level therapy. The Erbium:YAG laser absorption by the hydroxylapatite gives this radiation excellent properties for the cleaning of the bone surfaces, removing the smear layer caused by alveolysis.
beam angulation are the variables at the practitioner’s disposal to express his treatment expertise.
_Conclusion
More than ten years ago, the scientific literature proved the physical and biological properties
of the Erbium:YAG laser: it is a high performance,
safe surgical instrument. The main advantage of
this radiation lies in its high absorption by water.
This is what makes it safe since it limits the collateral thermal effects. Its clinical performance can be
attributed to its tissue micro-ablation properties.
It is a versatile instrument allowing sculpting of
enamel at the highest energy levels, and surface
decontamination through its bactericidal effects
on microbial biofilms, at lower energy levels.
We have described here the application of the
Erbium:YAG laser in periodontal decontamination,
but its field of application is not limited to periodontics. The Erbium:YAG laser is also used in plastic surgery. It allows performing of surgery, no
longer by cutting or drilling tissues, but by sculpting them. Micro-plastic procedures can thus be
carried out on soft tissues in mucogingival surgery,
flapless crown lengthening and other minimally
invasive, guided bone regeneration surgeries.
The periodontal debridement by laser is performed with water irrigation. We benefit from the
agitation of the irrigation solutions, as is the case
in endodontic applications of the laser. The lasertriggered microcavitation of the irrigation cleans
the walls of the space thus treated.
The LiteTouch Erbium:YAG laser is not a treatment, but a microsurgical instrument which, combined with optical aids, offers an additional advantage to dental surgeons who wish to offer minimally invasive treatment._
_The Erbium:YAG laser in the clinical
practice
Editorial note: A list of references is available from the
publisher.
The Erbium:YAG laser beam emission inside the
periodontal pocket is accompanied by physical and
biological phenomena with therapeutic effects
visible under high magnification. The laser is a surgical instrument with much higher performance
than conventional instruments which have only a
mechanical and relatively basic action in comparison with this radiation. In practice, it is all very
simple. The laser tip is inserted into the pocket just
like an optical curette, and the practitioner scans
the surfaces to be treated while the beam is emitted in order to limit the thermal effects and to carry
out a uniform and homogeneous treatment (similarly to a paint spray). The ergonomics of the insert
allow visual control of the therapeutic effects. The
tissue plasty requires applications in the scanning
movement. To increase the surfaces to be treated,
the practitioner defocuses radiation. The three parameters of time of exposure, focal distance and
I
_contact
laser
Dr Fabrice Baudot
dental@syneron.com
www.synerondental.fr
laser
2
I 31
_ 2014
[32] =>
I industry report
Innovative pathways for
extensive and efficient tissue
removal with Er:YAG laser
Author_Dr Kresimir Simunovic, Switzerland
_Introduction
The newest and most innovative handpiece for
oral hard- and soft-tissue removal from Fotona is the
X-Runner, an ideal accessory for the company’s LightWalker AT laser (Er:YAG & Nd:YAG). In our daily in-office applications, we notice many remarkable advantages in the preparation of veneers and partial or full
crowns, in oral surgery, especially for soft-tissue
management, and in implantology for implant release and certain specific steps during implant setting
procedures.
Figs. 1 & 2_Settings on the
LightWalker AT screen in advanced
mode: highlighted SX as the
X-Runner handpiece and the
standard settings for soft-tissue
ablation by very long pulses, which
enable an efficient coagulation due
to the adjustable pulse duration of
700 µs and more (only possible with
Fotona Er:YAG lasers). In this case,
the full area of a rectangle with a
6 x 1 mm surface is active. Two of the
three geometrical pre-settings
(circle, rectangle, hexagon) are
schematically shown as active on the
full surface or only at their margins.
Figs. 3 & 4_Extensive surface
preparation with the X-Runner using
the geometrical setting of a rectangle
with 6 x 3 mm of active area.
32 I laser
2_ 2014
The X-Runner allows for precise and extensive tissue removal, defined by the choice between three different geometrical shapes: circle, rectangle and hexagon. These can be highlighted as full ablational areas
or only active along the borders as a means to carve
out just the margins, maintaining the full integrity of
the inner area. The extent of ablation is gradually adjustable between 1 to 6 mm, depending on the geometry, with a variety of 1 single to 99 successive passes.
The corresponding basic and advanced settings for
soft- and hard-tissue management with the Light-
Fig. 1
Fig. 2
Fig. 3
Fig. 4
[33] =>
industry report
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
I
Figs. 5 & 6_Standard setting for
veneer preparation on the
LightWalker AT in QSP (Quantum
Square Pulse) Mode, which allows
for an efficient and fast ablation with
a highly precise margin.
Figs. 7 & 8_Final surface
modification, followed by the
adhesive in-office protocol
(Syntac Classic/Ivoclar).
Figs. 9 & 10_Before and after pics
of the veneer case on the upper
incisors.
Figs. 11 &12_LightWalker AT either
with the X-Runner handpiece in
non-contact mode or with the H14
handpiece using different sapphire
and quartz tips.
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_ 2014
[34] =>
I industry report
Figs. 13 & 14_Osseo-integrated
implant on X-ray and the
corresponding intraoral situation
after the mandatory healing period of
the implant in the area of the first
lower left molar (Nobel Biocare).
Figs. 15 & 16_X-Runner handpiece
in a fixed position with an active
circle diameter of 5.5 mm, and the
beginning of layer-by-layer
soft-tissue ablation through
multiple passes.
Figs. 17 & 18_Advanced ablation
with the X-Runner and simultaneous
release of the implant margins.
Figs. 19 & 20_Released implant
before the impression, and Er:YAG
settings in Advanced mode: SX for
X-Runner, long pulse duration and
circular active area of a diameter
of 5.5 mm.
Figs. 21 & 22_Geometrical layer-bylayer ablation (circle) of a fibroma
through multiple passes with the
X-Runner in a fixed position ...
34 I laser
2_ 2014
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
[35] =>
industry report
Walker AT can be directly adapted to procedures with
the X-Runner, allowing for highly predefined and noticeably facilitated removal of tissue over larger areas.
The Er:YAG wavelength is primarily absorbed by the
water content of every tissue in the human body, and
this basic nature of the Er:YAG wavelength allows for
a very safe and fully manageable surgery, offering
constant control of the progression of the laser-assisted ablation with no need for intervention.
To illustrate the idea, we would like to present two
different clinical cases with routine indications in
laser-assisted dentistry: first, a veneer preparation of
the upper-central and lateral incisors and second, an
implant release in the lower-left first molar area.
_Veneer preparation in the upper front
An extended and fast mode of preparation was
performed with the X-Runner using the predefined
veneer prep setting on the LightWalker AT panel, followed by a final surface modification. There was no
need for local anaesthesia.
At that time our tissue removal experience with
the X-Runner in marginal areas was somewhat lim-
I
ited, so consequently we performed the finish with
the cylindrical tips and the H14 handpiece. As an alternative, the X-Runner can be modified by a simple
and time-saving change of the output settings to perform as a regular non-contact H02 handpiece.
The finished surfaces were bonded instantly, the
impression taken, and a couple of days later the lab
veneers were integrated into the patient’s smile design dimension.
_Implant release in the first lower left
molar area
After the predefined healing period, the soft-tissue above an osseointegrated implant (Nobel Biocare)
was removed by multiple passes, following the preset
shape and extension of the ablation area. A healing
abutment was fixed on the fully uncovered implant
after the impression was taken for the lab. The surgery
was performed without need for local anaesthesia.
_Extended range of indications
Aside from the standardized indications in aesthetic and conservative dentistry and soft- and hardAD
implants
implants
Last Name, First Name
Company
Street
ZIP/City/Country
E-mail
Signature
Signature
[36] =>
I industry report
Figs. 23 & 24_...followed by flap
surgery with the Er:YAG Quartz tip
(Varian/Fotona) and laser-assisted
osteotomy during an implant bed
procedure in the lower-left jaw area.
Figs. 25 & 26_Intermediate depth
measurement with a perio probe to
a value of around 8 mm, followed by
a final classical drill by the
manufacturers protocol (Nobel
Biocare) and the implant in place
before suturing.
Figs. 27 & 28_Postoperative
photobiomodulation (PBM) of the
surgical area on the right lower jaw
with 810 nm diode (ARC, Nürnberg,
Germany), and the three implants
in place after laser-assisted
surgery with X-Runner
(LightWalker AT, Fotona).
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 28
tissue surgery, we also noticed some specific advantages as a support to specific steps of the implant setting procedures, with respect to other approaches developed by specialised clinical centres.
and innovative aspects of soft- and hard-tissue management that are now possible in the daily clinical
practice in Er:YAG laser-assisted dentistry._
We performed an initial implant bed preparation
using the X-Runner only, by choosing the geometry
and corresponding area and finalising the procedure
by the last step of the classical implant bed protocol.
The patient presented a very solid and healthy bone of
the lower jaw, so we were able to drill with the predefined shape to a depth of 8–9 mm, without the need
for any classical burr-based procedures.
Our first experiences with the X-Runner handpiece
used in combination with our in-office standard
LightWalker AT laser (Er:YAG & Nd:YAG; Fotona) provided us with fascinating insights into new, powerful
36 I laser
2_ 2014
_contact
Dr Kresimir Simunovic
Office for Laser-Assisted Dentistry
Seefeldstrasse 128
8008 Zurich, Switzerland
Tel : +41 44 383 4070
ksimunovic@smile.ch
www.simident.ch
laser
[37] =>
October 9-14, 2014 | San Antonio, Texas, USA
Education: October 9-12 | Exhibition: October 9-11
Education
Exhibition
Connections
Participate in challenging
CE courses that fit into your
schedule and budget
Research and purchase
dental products and services
at a discount
Mingle with colleagues
from across the world
To learn more, visit ADA.org/meeting.
[38] =>
I education
Laser dentistry course
for dental students
in Thailand
A classroom action research
Authors_ Associate Prof. Dr Sajee Sattayut, Assist Prof. Dr Piyachat Pacharanuchat &
Associate Prof. Suwit Undompanich, Thailand
[PICTURE: ©29OCTOBER]
_Introduction
Owing to the fact that dental students at the Khon
Kaen University (KKU) were interested in laser therapy, an intensive course for laser therapy in dentistry
was introduced to the final year students. The instructional design was based on transferring technology and translation research to practice. A classroom action research was conducted to evaluate this
course. The results showed favourable knowledge and
attitude of the learners. This article reveals a pattern
of instructing laser dentistry to dental students.
Laser dentistry was commenced in the faculty of
dentistry, Khon Kaen University (KKU) in 1993. Consequently, the lasers in dentistry research group, Khon
Kaen University, (LDRG KKU) was established in 2011.
The development of this discipline has continuously
been accomplished in basic research, clinical trial and
technical transferring. Besides this, the dental students, KKU were also interested in conducting research in laser dentistry and using laser for their general dental practices. Therefore, we introduced an in-
38 I laser
2_ 2014
tensive laser dentistry curriculum called “Laser Therapy in Dentistry” for the final-year dental students. A
classroom action research was undertaken to evaluate an instructional design for dental students learning laser dentistry.
_Methods
The principle of instructional design was modified
from the methods of technology transferring for professionals.1-3 This was based on transferring laser
technology by learning both context and skills in laser
dentistry in order to utilise laser dentistry for quality
of life (Fig. 1). The instructional design (Fig. 2) comprised a twelve-hour interactive lecture on the basic
and application of laser dentistry, a ten-hour related
laboratory with co-operative learning after lecturing
together with clinical demonstration from the dental
students who had experiences in using lasers and a
four-hour authentic evaluation and discussion using
experiential-based learning. The laser techniques
transferred to the students were as follows: soft tissue surgery4, tooth preparation, laser welding for
[39] =>
education
Fig. 1
I
self-assessments of the students’ knowledge and confidence in practice were 8.4 (95 % CI = 8.0 to 8.8) and
9.0 (95 % CI 8.5 to 9.5), respectively, with correlation at
0.496 (P value = 0.001). The students were satisfied
with this learning method at the mean VAS of 8.0 (95
% CI = 7.6 to 8.5). They thought that their skills were
improved by the instructors’ advices and the analytic
thinking at the mean VAS of 9.2 (95 % CI 9.0 to 9.5) and
9.2 (95 % CI 8.9 to 9.5), respectively. From qualitative
analysis, the students reflected their impressive experiences on the instructors and the team offering an intensively inspired learning, opportunities to expose a
new technology as laser therapy and the learning style.
This included student-centred learning, comprehensive knowledge, relaxed share of funny activities and
practical laser hand-on offering the possibility to apply the gained knowledge to real-life clinical practice.
_Discussion
Fig. 2
chronic oral ulceration5, 6, photocoagulation4, 7 and
low intensity laser therapy.6, 8, 9 The laser regimes in
this course were founded on calibration and research
conducted by the LDRG KKU team. These were also
used routinely for treating patients at the faculty of
dentistry already.
This one-week intensive course called “Laser Therapy in Dentistry: Research transferring to practice”
(Fig. 3) was carried out with 45 final-year dental students, Khon Kaen University, 2013. For evaluation of
this programme, a combined quantitative analysis
and a qualitative reflection of the data from summative academic evaluation, the satisfaction of the students using questionnaires with a 10 cm visual analogue scale (VAS) and an open question were used.
_Results
The knowledge test ranges from 57 to 100 per cent
(mean = 81.9, 95 % CI = 79.2 to 84.6). The means of
The intensive laser course for undergraduate dental students that we introduced was able to provide
favourable knowledge, practical skills and attitude on
laser dentistry in the learners. The important factors
leading to this success were due to both
instructional design for transferring
technology and translation research to
practice.1, 2 Additionally, all of the laser
therapy techniques taught in this course
were created by LDRG KKU. The regimes of
laser therapy were set up in the ranges of
power and energy density. These allowed
the students to practise the adjusting of
lasers in detail and thereby to find out
which were suitable for a variety of situaFig. 3
tions in real practice.
_Conclusion
This integrated instructional design for technology transferring and translation research “Laser Therapy in Dentistry” provided the abilities and good attitudes on laser dentistry for dental students._
Editorial note: A list of references is available from the
publisher.
_contact
laser
Assoc. Prof. Dr Sajee Sattayut
Khon Kaen University
Khon Kaen City, 40002, Thailand
Tel: +66 9 45141644
Fax: +66 43348153
sajee@kku.ac.th
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[40] =>
I economy
Gain power at
your laser clinics!
Author_Dr Anna Maria Yiannikos, Germany & Cyprus
_In this article, I discuss the next very important component of the marketing mix: promotion.
There are two different kinds of promotion strategies: internal marketing, aimed at existing patients
and their families (an example of this kind is referrals); and external marketing, aimed at those outside of the clinic. Research has proved that the
most effective method to attract new patients is by
word of mouth through internal marketing and
that this approach attracts 80 per cent of new patients. External marketing, such as advertising or
public relations, however will create awareness of
the clinic among prospective patients, but very few
new patients will actually visit the clinic. The following are six areas of promotion relevant to dental practices.
_Logo
The clinic’s logo is its fingerprint; it is its identification. It should appear not only on the clinic’s business card and stationery, but also on its outdoor
signs, promotional items, uniforms and billing
statements. The logo should be so identifiable with
the clinic that people should be able to identify the
clinic just by looking at the logo and without reading the name of the clinic.
_Newsletters
Dentists should think of newsletters as an important means of informing others about the clinic
by communicating general information concerning
the clinic or the services offered, as well as providing
photographic material in order to communicate with
patients visually and confirm the written content.
Newsletters can be sent to patients by e-mail
monthly, quarterly or yearly. Newsletter content
could include the following for example:
– You could educate your patients about how you can
prepare a tooth using laser.
– You could inform them about an educational seminar or congress that you have attended.
–You could introduce a new treatment or service that
you have added to the clinic.
_Testimonial book
Clinics can have a testimonial book either on the
reception desk or in the waiting lounge. It is very comforting for new or existing patients of the clinic to
read about the experiences and feelings of other patients at the clinic, especially in cases in which patients feel afraid or anxious about dental treatment,
or mistrustful of the dentist.
_Business card
A business card provides a first impression of the
clinic; it hints at the clinic’s traits and what it stands
for. A clinic’s business card must make a powerful,
positive personal impression by offering something
out of the ordinary. For example, you could consider
achieving this by means of
– a high-quality paper;
– a beautiful logo; or
– the unique use of colour.
40 I laser
2_ 2014
A testimonial book is a very helpful marketing tool
for two reasons: it reinforces a positive image of the
clinic to the person writing the testimonial, and it encourages patients to accept the treatment recommended by the dentist and feel safer and more at ease.
_Web presence
A clinic’s website and social media sites may be the
first places a new or a prospective patient may visit to
establish information about the clinic. The clinic’s
[41] =>
economy
I
A clinic’s website and social
media sites may be the first
places a new or a prospective
patient may visit to establish
information about the clinic.
[PICTURE: ©JACK FROG]
competitive advantage should be clearly communicated on these sites in order to demonstrate instantly
the benefits of visiting the clinic.
_Presence in the dental field
and networking
In addition, it is very important to establish a general presence in the dental field by presenting dentistry-related seminars or by writing articles for a
journal or local newspaper, for example. In this manner, you can achieve recognition of your name and establish yourself as an expert. Such a presence acts as
reinforcement for existing and prospective patients.
Furthermore, you could
– network with other professionals;
– offer scholarships or sponsorships bearing the dental clinic’s logo;
– advertise or be invited to speak on television programmes or communicate via other media;
– be an active member of professional groups;
– volunteer for community activities;
– accept invitations to social functions;
– be present at political activities;
– present your hobbies and activities; or
– participate in a group form of a solo activity you enjoy, for example, if you like jogging, you could join
an amateur running club that participates in charity races. You could also join a networking group,
such as a social club, and attend at least two of its
events a month.
_Conclusion
Of course, you cannot adopt all of the above promotion strategies. Therefore, it is very important to
make an accurate evaluation and invest more time
and effort in those strategies that yield a greater return on your investment.
I would like to conclude with a powerful and inspirational quote from Kevin Roberts, CEO of global
advertising company Saatchi & Saatchi: “Our goal,
nowadays, is to create lovemarks not just brands.”
There is a difference between the two terms: brands
are owned by companies; lovemarks are owned by us,
dentists and professionals who love our jobs. Brands
deliver performance, respect and trust. Lovemarks infuse intimacy (empathy, commitment and passion)
and sensuality (triggers emotions). Our patients operate in terms of all five senses._
_contact
laser
Dr Anna Maria Yiannikos
Adjunct Faculty Member of
AALZ at RWTH Aachen University Campus, Germany
DDS, LSO, MSc, MBA
dba@aalz.de
www.dba-aalz.com
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[42] =>
I interview
Strong against bacteria –
gentle to teeth
and gingiva
Periodontitis and periimplantitis
therapy with perio green®
Source_elexxion
[PICTURE: ©LEONID AND ANNA DEDUKH]
With its new photodynamic agent perio green®,
elexxion AG (based in Radolfzell, Germany) brings
some colour to the realm of laser-supported periodontitis and periimplantitis therapy. In this interview, Dr Gordon John, scientific staff member of the
Poliklinik für Zahnärztliche Chirurgie, University
Hospital Düsseldorf, Germany, informs about this
innovative agent.
_Dr John, new technologies and materials usually
aren’t overnight inventions. How much time passed between the first idea until perio green®’s introduction to
the market, and what is this new product based on?
In principle, the path from the initial idea to the final
market approval of a product is long and tiring. Of
course, new products must be tested with regard to their
effects and, more importantly, unwanted counter effects as well as interactions with other medical products
or medications. This is an essential part of patient protection. In the case of perio green®, ten years have
passed from our initial idea until its application in periodontitis therapy, five years of which can be attributed
to the certification process.
_How does the photodynamic germ reduction with
indocyanine green work? Is there any possible discomfort for the patient? Is the treatment performed under
local or general anaesthesia?
42 I laser
2_ 2014
The operating principle of photodynamic germ reduction or photodynamic therapy is based on placing a
colouring agent in the periodontal pockets, which is activated by a light source and thus enfolds its bactericidal effects. After its placement, indocyanine green (perio green®) penetrates the base of the pockets as well
as small retention niches because of its very low viscosity, selectively colouring the bacterial cell walls. Endogenous cell components are not coloured.. Perio
green® is activated at a wavelength of 810 nm and a
power of only 300 mW. Its main effect is based on a very
high energy absorption of the light of the respective
wavelength, which is expressed on local, short heat
peaks. These result in the destruction of the bacterial
cell walls, thus developing its bactericidal effect. Heat
peaks are quite short and locally restricted. Therefore,
neither are they noticed by the patients nor do they influence the surrounding healthy tissues. The term
“photothermal therapy” would however be more accurate with regard to perio green®, as its effect relies on
the impact of the photosensitizer in the form of released oxygen radicals.
A general anaesthesia is not required for germ reduction with perio green®. In most cases, even local
anaesthesia is not necessary. In some cases, patients regard the insertion of the application or laser tip an unpleasant sensation. Here, local anaesthesia can be applied.
_Perio green® allows a highly effective and pain-free
adjuvant periodontitis and periimplantitis therapy. Are
[43] =>
interview
there any risks for hard and soft tissues or any side effects?
Side effects for the dental hard tissues or surrounding soft tissues as well as any risks for restorations or implants are unlikely because of the low laser power.
For example, indocyanine green is applied intravasally in ophthalmology, visceral surgery or cardiology. Intravasal application results in a very low half-life
period of indocyanine green of three to four minutes, a
low toxicity and a safe intraoral and topical application.
As perio green® is not resorbed by the intestinal mucosa,
there are no serious risks for the patient even if it is swallowed during the procedure.
Systemic side effects have not been reported to date,
and only a low number of allergic reactions have been
described. However, indocyanine green does contain
iodine and should thus be regarded cautiously in cases
of iodine allergies.
_Perio green® is distributed in the form of pills. How
is it applied and could any colour residues of the photosensitizer remain on the root and implant surfaces?
It is correct that perio green® is distributed in the
form of pills. This is necessary, since perio green®, in its
operational, dissolved form, maintains its activity for
only two hours. The photosensitizer is prepared chairside, individually for each patient. This process couldn’t
be simpler: all necessary materials are delivered in aseptic packages. After one pill is placed in a mixing vessel,
2 ml of sterile water are added. After one minute, the solution is homogenous. The solution is then drawn into
an aspiration cannula (red label), which is then exchanged with a thinner application syringe (green label). This is used to apply perio green® in the periodontal or periimplant pockets. After two minutes, the remaining colouring agent is rinsed off. In none of the previously treated cases, colouring residues were reported
at the dental hard and soft tissues or implant structures.
Afterwards, perio green® is activated via laser (810 nm
wavelength, 300 mW) for one minute. The final treatment step is the rinsing of the pockets.
_Does the photodynamic agent also remove mineralised plaque or does this require further measures?
Perio green® does not remove mineralised plaque.
However, it is also not intended to do so. The mineralised
biofilm should be removed mechanically, for example by
special curettes. There can be up to 60 per cent of residual biofilm after the decontamination of rough implant
surfaces, for example after treatment with plastic
curettes. In this diluted, reduced biofilm, photodynamic/photothermal therapy can reach its full potential
more easily, killing the remaining pathogenic germs.
_Which amount of time does therapy with perio
green® take and how often does it have to be repeated
I
during recall? And another question: Is it mandatory
that perio green® is applied by a dentist or can it also be
applied by a trained assistant?
A full-mouth application should take about one
hour. If there are a high number of implants to be decontaminated, you should consider more time due to
the rising difficulties in probing when compared to
periodontal pockets. There are no general rules that
can be applied to the repetition of the therapy. Patients should be recalled about two to three weeks after therapy for another clinical examination. Based on
the results, any further steps should be decided upon
individually. Highly putrid or refractory periimplantitides among our patients were treated with perio
green®. After two or three applications, they entered
a stable, stagnating situation. With regard to treatment delegation, there is still a grey area which has yet
to be defined. That means: a non-invasive application
can be transferred to dental assistants. However, the
dentist is responsible for his personnel to be adequately educated and trained in the correct use of the
equipment. The dentist must state the treatment indication and give instructions to start the therapy. The
patient has to be informed about the delegation, and
the dentist must supervise the procedure. Furthermore, the dentist is liable for any treatment consequences.
_New elexxion laser systems come with the software necessary for the application of perio green®.
Can older devices also be modified?
Older elexxion laser systems can be modified without any problems. All it takes is the new software to be
loaded on the devices. This can be done during the
standard safety check-up. In addition, elexxion offers
another interesting service: if perio green® is ordered
on a regular basis, we provide you with our laser system pico lite for free.
_What are your experiences with perio green® and
can you recommend this treatment without any
reservations?
The application of perio green® is fairly easy, secure and effective. Of course you have to be aware of
its restrictions. For example, you cannot expect a regenerative effect from the therapy. However, especially an effective decontamination of tooth or implant surfaces before surgical-regenerative therapies
can help to prepare the defect situation. Furthermore,
the application of perio green® can result in even difficult situations becoming static, thus prolonging implant preservation, for example if the patient does not
approve of any surgical procedure. Photothermal
therapy with perio green® can reduce the widespread application of antibiotics in dentistry, along
with its side-effects, significantly.
Thank you for this interesting conversation.
laser
2
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[44] =>
I interview
“We still have a long
way to go”
Author_Daniel Zimmermann, Germany
[PICTURE: ©OLLYY]
First introduced in the early 1990s, dental lasers are
now used in almost every area of dentistry. DT Asia
Pacific had the opportunity to speak with Dr Kirpa
Johar, a dentist from Bangalore in India who received his dental laser education from the University of Vienna, about new trends in the field and the
difficulties in Asia of it becoming a mainstream
product despite its clinical benefits.
_Last year, the first carbon dioxide (CO2) laser,
which is also suitable for hard-tissue indications, received approval by the Food and Drug Administration
in the US. Could this be the next big thing in laser dentistry, in your opinion?
A CO2 laser receiving FDA approval for hard-tissue
indications looks promising and could definitely be a
game changer, as it could alter the way we understand
laser dentistry right now. We will have to wait and see
how things develop in this regard.
_The laser community is split about whether CO2 or
erbium-based lasers are the superior technology.
Which type do you think is better suited to dental applications?
CO2 lasers are usually considered to cut faster and
with more precision. They also offer several advantages, such as galvanometer manipulation of the
beam, a foot pedal to control speed and the ability to
change the spot size with a tap on the touch screen.
However, in Asia, being a price-sensitive market, the
cost of dental equipment is always a decisive factor. I
think a performance evaluation comparing erbium
44 I laser
2_ 2014
and CO2 lasers supported by more clinical studies
would provide us with a better understanding of
which technology is more suited to which application.
_Since dental lasers were introduced in the early
1990s, the range of treatments has expanded from
soft-tissue treatment to cosmetic dentistry and endodontics, for example. In which areas of dentistry is
this technology most commonly used at the moment?
In this part of the world, dental lasers are commonly used for soft-tissue applications, including surgical, cosmetic and endodontic sterilisation. A contributing factor to this trend is that diode lasers have
become more affordable and are available on the market in much larger variety. As lasers allow surgical procedures on soft tissue to be performed with no sutures
and less anaesthesia, they are increasingly used in surgical and mucogingival procedures.
_Is this one of the fields in dentistry to have benefited most from dental lasers?
Besides mucogingival procedures, I personally
think that periodontal treatment has gained most
from the use of laser technology. More patients are
definitely motivated to undergo various periodontal
procedures done with lasers compared with conventional surgery. Flap surgeries where bone loss is not
very advanced, release of tongue-tie in infants, gingivectomies and operculectomies are some of the procedures that are simplified with laser.
_Wound healing appears to benefit particularly
from laser therapy. Could you explain why?
In my practice, I have seen good results in wound
healing in cases in which I have used laser therapy for
[45] =>
interview
I
soft-tissue injuries and lacerations in the orofacial region after trauma, as well as in post-extraction cases.
Post-operative discomfort was reduced too.
The biostimulatory effects of laser have been thoroughly investigated. In vitro experimental evidence has
demonstrated the acceleration of collagen synthesis in
fibroblast cultures. Increased formation of granulation
tissue and increased rates of epithelialisation in laserirradiated wounds were some of the effects found in in
vivo tests on animals. Low-level laser therapy has
proven to be a great boon in wound healing.
_With a penetration into dental practices of 20 to
50 per cent, dental lasers cannot exactly be called a
mainstream product. Would you agree with that statement?
It is true that dental lasers are not very common,
even in technologically advanced countries. In Asia,
the use of laser dentistry is still marginal. I remember
when I started working with dental lasers in my practice eight years ago, this field of treatment was completely unknown and the benefits of lasers were not
yet fully understood then. Awareness among the dental community however has improved and the market
is growing, but we still have a long way to go in lasers
being recognised as a mainstream product.
_You offer international laser dentistry courses in
India. What is the most common misconception concerning laser technology that you have encountered
there?
I think the most common misconception still is that
laser dentistry is for the elite and that that it will not
work in the practice owing to the cost–benefit ratio.
However, more dentists have recently begun to realise
that lasers can improve their patient experience and
help them add more procedures to the practice, which
in turn makes it more profitable and rewarding.
What is clearly lacking in this field is unbiased quality education. Dentists need to understand that with
the use of dental lasers they would be providing better
dentistry to their patients and would make their own
work more comfortable, which would in turn lead to
happier patients, more referrals, and the subsequent
overall growth of their practice. My academy, Laser
Dentistry Research and Review, is working in this direction and we hope to become a centre in Asia known
for helping dentists receive the best in laser dental education and add value to their practice.
Once the use of dental lasers increases, more competitors will come into the market, which would help
to keep prices competitive—which is good as long as
the competition stays healthy. However, cost still plays
an important role in the acquisition of the technology,
particularly when it comes to hard-tissue lasers.
_Can dental lasers be economically viable?
They definitely are. The simplification of many procedures with laser dentistry makes it possible to perform them in-house without having to refer the patient to a specialist. As the dentist would be considered someone providing the best in his or her field, referrals and income would most likely increase. I
foresee that within the next decade every dental clinic
will possess at least a soft-tissue laser. It is just a matter of time.
Dr Johar Kippar.
_What would manufacturers have to do to make
this technology more attractive to the masses?
Hard-tissue lasers need to evolve to a stage where
they can be expanded to crown preparation and implant dentistry. If erbium lasers were capable of providing a wider range of applications along with routine
soft-tissue procedures, this would make them more
attractive. Dental Er:YAG lasers are now being developed for non-surgical facial aesthetic treatment and
non-surgical treatment of sleep apnoea. Adding these
procedures to the practice by incorporating laser technology will also help dentists make the investment in
lasers a more viable option.
_Laser experts and companies claim that laser
technology is the future of dentistry. In your opinion,
what role will the technology really play in clinical
practice?
Laser dentistry definitely changes the way we practise dentistry. It is minimally invasive, simplifies things
and reduces patient discomfort, as well as post-operative complications. It gives the dentist scope to expand his or her services to other fields, such as facial
aesthetics or sleep apnoea treatment. These are some
of the factors that make me believe that laser dentistry
is the future of dentistry.
Thank you very much for the interview.
laser
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_ 2014
[46] =>
I meetings
Laser Dentistry
in the City of Light
Welcome to Paris
Author_Katrin Maiterth
_For the 14th World Congress for Laser Dentistry, the WFLD chose—in the words of Prof. Josep
Arnabat, chairman of the European Division of
WFLD—“one of the most beautiful and breathtaking
cities in the whole world“ as their location. „Paris is
a city of culture, artists, designers and researcher“,
Arnabat states. In fact, this statement describes the
emotional perspective most people might associate
with Paris as well as the main themes of this place.
Starting its life as the Celto-Roman settlement
Lutetia on the island in the Seine, the city got its
present name from the then dominant tribe Parisii.
In medieval times, the small settlement expanded
onto the right bank into the so-called le Marais.
Nowadays, this area is one of the most stunning and
oldest quarters in Paris, where still a number of historical buildings can be seen. At first populated by
the working-class and immigrants, le Marais
evolved to a wealthy and prestigious quarter. Surely,
this is not the liking of all. But without a doubt, it has
made this area a well worth seeing place to eat,
drink, lounge and walk around.
In the middle ages, also one of the most important centres for learning in old Europe was founded:
the Parisian University Sorbonne. Divided into the
faculties Arts, Medicine, Theology and Law, the university brought forth lots of famous clever and creative heads. For several hundred years, students
from all over Europe, if not the whole world, came
here to expand their knowledge and still do.
[BACKGROUND: ©PHOELIX]
Thanks to the aims of governing elites to set
themselves a monument, numerous impressing
buildings such as Notre Dame, Arc de Triomphe,
Louvre, Palais Royal or Eiffel Tower were built up in
the course of time. More and more, the city became
the cultural and intellectual hub of the Western
world with its philosophers, scientists, artists and
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literati. They got together in scientific houses, parks or in one of the
hundreds of Parisian cafés—places for bruits publics and rumour. The
first café was established by François Procope in 1686 and became
the midpoint of Enlightenment with famous people like Rousseau,
Voltaire and Diderot stopping by.
Nowadays, with about 23 per cent of the total population born
outside of France, Paris is one of Europe’s biggest melting pots of nations. Germans, Italians, Russians, Armenians, Poles, Spaniards, Portuguese, African and Asians—since the beginning of the 19th century,
people from many different countries immigrated to Paris and made
the city’s culture even richer and colourful in the course of time. Besides a visit of the classic Paris, it is always a good idea to just stroll
through small alleys and hang out in cosy cafés, eating pastry and
drinking café au lait. Around Place de la Bastille one can check out
young fashion designers and newest street wear, find romantic
places as well as neo-punk lolitas, tattooing and mangas. The
bustling Parisian street markets invite their visitors to buy food and
wine, maybe for a romantic picnic in a park or along the Seine.
When the evening comes, haute cuisine restaurants are waiting
for their guests to serve fine and delicious food— don’t forget to start
the evening in the civilised French way with an aperitif hour. Finally
one maybe ends up in Paris nightlife in trendy bars or clubs for dancing. In the summer, there are several outdoor music events, bringing
people onto the street or Paris Plages.
There has been said a lot about Paris and it has been given many
names over time: “International capital of style”, “City of culinary finesse”, “Best place to pick ideas”, “City of love”, “Heaven for all
women’s obsessions” and the “City of light”—just to mention a few.
But of course, it’s always better to get ones own expression._
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[48] =>
I meetings
Rimini show confirms
that the future of
dentistry is digital
Google Glass is currently only available in the US.
When the device will be released to European markets is
still unclear owing to some technical limitations and the
lack of distributors, according to reports. The technology, however, is currently being experimented on for its
future use in general and dental medicine. Last year, for
example, Dental Tribunereported on the first maxillofacial surgery broadcast with the device, which took place
at Hospital de Molina in Murcia in Spain.
Fig. 1_GALAXY BioMill System,
which allows digital fabrication of
restorations chairside.
_The use of digital technology seems to be
changing dentistry forever and nowhere has this been
more obvious than in Italy last week, where numerous
manufacturers from Italy and abroad showcased their
latest devices and materials to thousands of dental professionals at this year’s Amici di Brugg dental show.
Besides Henry Schein’s ConnectDental pavilion, a
booth dedicated entirely to the company’s combined
portfolio for an all-out digital workflow and other services such as Sirona's Digital Dental Academy, a new application designed for Google Glass drew special attention from visitors. Specifically designed to work on the
head-mounted device, Dental Glass is intended to improve workflow in dental practices by projecting information directly in the clinician’s field of view, similar to
a pilot’s head-up display. This way, clinicians can remotely access patient records, among other data, display radiographic images, or manage appointments
through voice recognition software or a touchpad located at the earpiece, according to the Italian developer
Gerhò, a subsidiary of the Breitschmid group. The manufacturer said that the app will also allow the capture of
photos and video in high-definition format through its
built-in camera.
48 I laser
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Completely digital solutions however are already
available in dental offices. Biolase, for example, offers
such solutions and has expended great effort on its Total Technology Solution in recent years. In addition to its
complete range of dental lasers, the US dental technology company now offers sophisticated imaging equipment and CAD/CAM solutions, such as the GALAXY BioMill System, which allows digital fabrication of restorations chairside.
“The adoption cycle of new technologies is growing
increasingly shorter and more advanced technologies
like the Waterlase will rapidly find their way into dental
practices. Dentists that do not upgrade their equipment
will likely begin to lose patients, become uncompetitive
and lag behind,” CEO Federico Pignatelli explained to
Dental Tribune International (DTI) at the show.
DTI CEO and publisher Torsten R. Oemus invited dentists who are unsure about how digital technologies
could benefit their practice to attend the Digital Dentistry Show, the first edition of which will be held in autumn 2014 at the International Expodental show in Milan in Italy. Focusing entirely on digital products and applications for dentistry, the unique expo format will not
only showcase the latest products and solutions by
leading providers in the field, but also offer education in
the form of lectures and webinars from 16 to 18 October. Information about what to expect from the event
and how to register is available on the events website
www.digitaldentistryshow.com/Milan._
[49] =>
NEWS
IDEM Singapore 2014 was
Periodontal therapy may reduce
A record-breaking success
Medical expenses
and hospitalisations
both floors of exhibition space covering
16,000 sqm. The trade fair and conference
welcomed 7,842 participants from 61 countries over three and a half days. IDEM Singapore is increasingly seen as the gateway to
Asia for dental manufacturers and distributors wishing to break into Asian markets and
this was reflected in the high number of first
time exhibitors; 170 or 30 per cent were new
to IDEM Singapore this year.
This year’s IDEM Singapore demonstrated why it is
Asia’s leading dental trade fair and scientific conference with record breaking numbers of exhibitors, conference tracks and attendees. The event saw more
than 500 exhibitors from 38 countries showcasing the
latest innovations in clinical dentistry, dental technology and patient care across every segment of the dental market, covering restorative and preventive treatments, surgical procedures and equipment, orthodontics, endodontics, periodontics and laboratory tools.
The IDEM Singapore trade fair was the first ever to fill
The conference theme this year was “Dentistry—The Future Is Now” with the programme focusing on the future of dentistry, addressing the challenges and the procedural and technical
advances in the various fields of dentistry. The increased representation from countries in the Asia-Pacific region such as Australia, Cambodia, Taiwan, Hong
Kong, Korea, Japan, New Zealand, Myanmar and Sri
Lanka, highlighted another trend: IDEM Singapore,
long considered the event where East meets West, is
now also increasingly seen as the gathering point for
different parts of the East to meet each other. The next
edition will be staged from April 8 – 10, 2016.
The latest news about
IDS 2015 at a glance
[PICTURE: ©KOELNMESSE GMBH]
From 10 to 14 March 2015, Cologne will once again
become the capital of the dental world when the International Dental Show (IDS) opens its doors to visitors from around the globe for the 36th time. Dental
Tribune will be keeping its readers up to date with a
topic page solely dedicated to the latest information
about the most important dental industry show.
Alongside its official today trade
show newspaper and regular enewsletters, Dental Tribune will
be providing comprehensive
coverage of major events of the
five-day show on a daily basis
through the IDS 2015 topic
page.
An on-site editorial team will
be conducting exclusive interviews and reporting on product
launches and new technologies
to keep dental professionals
worldwide well informed about the latest innovations in dentistry.
In anticipation of the event, the topic page will offer
an overview of the developments prior to the show,
as well as a number of review stories on past IDS editions.
A study has provided new evidence for the importance of treating periodontal disease in patients with
chronic systemic diseases. From 2005 to 2009,
338,891 individuals were recruited for the study. All
participants had periodontal disease and one or
more of the following conditions: Type 2 diabetes,
coronary artery disease, cerebrovascular disease,
rheumatoid arthritis, and pregnancy.
SONG]
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Comparing the insurance data of patients who had
received periodontal treatment and those who had
not been treated, the researchers found that medical
costs and hospitalizations were significantly reduced in the first group. With regard to hospitalizations, the researchers found that admissions decreased by 39.4 per cent, 21.2 per cent, and 28.6 per
cent in patients with Type 2 diabetes, cerebrovascular disease, and coronary heart disease, respectively.
According to the latest figures provided by the Centers for Disease Control and Prevention, over 47 per
cent of US adults aged 30 and older have some form
of periodontal disease. The condition is more common in men (56.4 per cent) than in women (38.4 per
cent). It is also more common in people living below
the federal poverty level (65.4 per cent), those with
less than a high school education (66.9 per cent), and
current smokers (64.2 per cent).
The study, titled “Periodontal Therapy Improves Outcomes in Systemic Conditions: Insurance Claims Evidence,” was presented at the Annual Meeting and
Exhibition of the American Association for Dental Research on March 21. It was conducted by researchers at the University of Pennsylvania in collaboration with dental insurance provider United
Concordia.
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[50] =>
I about the publisher
laser
international magazine of
laser dentistry
Publisher
Torsten R. Oemus
oemus@oemus-media.de
CEO
Ingolf Döbbecke
doebbecke@oemus-media.de
Members of the Board
Jürgen Isbaner
isbaner@oemus-media.de
Lutz V. Hiller
hiller@oemus-media.de
Editor in Chief
Norbert Gutknecht
ngutknecht@ukaachen.de
Coeditors in Chief
Samir Nammour
Jean Paul Rocca
Managing Editors
Georg Bach
Leon Vanweersch
Division Editors
Matthias Frentzen
European Division
George Romanos
North America Division
Carlos de Paula Eduardo
South America Division
Senior Editors
Aldo Brugneira Junior
Yoshimitsu Abiko
Lynn Powell
John Featherstone
Adam Stabholz
Jan Tuner
Anton Sculean
Editorial Board
Marcia Martins Marques, Leonardo Silberman,
Emina Ibrahimi, Igor Cernavin, Daniel Heysselaer,
Roeland de Moor, Julia Kamenova, T. Dostalova,
Christliebe Pasini, Peter Steen Hansen, Aisha Sultan, Ahmed A Hassan, Marita Luomanen, Patrick
Maher, Marie France Bertrand, Frederic Gaultier,
Antonis Kallis, Dimitris Strakas, Kenneth Luk,
Mukul Jain, Reza Fekrazad, Sharonit Sahar-Helft,
Lajos Gaspar, Paolo Vescovi, Marina Vitale, Carlo
Fornaini, Kenji Yoshida, Hideaki Suda, Ki-Suk Kim,
Liang Ling Seow, Shaymant Singh Makhan, Enrique Trevino, Ahmed Kabir, Blanca de Grande, José
Correia de Campos, Carmen Todea, Saleh Ghabban
Stephen Hsu, Antoni Espana Tost, Josep Arnabat,
Ahmed Abdullah, Boris Gaspirc, Peter Fahlstedt,
Claes Larsson, Michel Vock, Hsin-Cheng Liu, Sajee
Sattayut, Ferda Tasar, Sevil Gurgan, Cem Sener,
Christopher Mercer, Valentin Preve, Ali Obeidi,
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Seto, Joyce Fong, Ingmar Ingenegeren, Peter
Kleemann, Iris Brader, Masoud Mojahedi, Gerd
Volland, Gabriele Schindler, Ralf Borchers, Stefan
Grümer, Joachim Schiffer, Detlef Klotz, Herbert
Deppe, Friedrich Lampert, Jörg Meister, Rene
Franzen, Andreas Braun, Sabine SennhennKirchner, Siegfried Jänicke, Olaf Oberhofer,
Thorsten Kleinert
Toni Zeinoun
Middle East & Africa Division
Loh Hong Sai
Asia & Pacific Division
Editorial Office
Georg Isbaner
g.isbaner@oemus-media.de
Claudia Jahn
c.jahn@oemus-media.de
Executive Producer
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meyer@oemus-media.de
Designer
Sarah Fuhrmann
s.fuhrmann@oemus-media.de
Customer Service
Marius Mezger
m.mezger@oemus-media.de
Published by
OEMUS MEDIA AG
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04229 Leipzig, Germany
Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de
www.oemus.com
Printed by
Silber Druck oHG
Am Waldstrauch 1
34266 Niestetal, Germany
laser international magazine of laser dentistry
is published in cooperation with the World
Federation for Laser Dentistry (WFLD).
WFLD Headquarters
University of Aachen Medical Faculty
Clinic of Conservative Dentistry
Pauwelsstr. 30, 52074 Aachen, Germany
Tel.: +49 241 808964
Fax: +49 241 803389644
ngutknecht@ukaachen.de
www.wfld-org.info
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Copyright Regulations
_laser international magazine of laser dentistry is published by OEMUS MEDIA AG and will appear in 2014 with one issue every quarter. The
magazine and all articles and illustrations therein are protected by copyright. Any utilization without the prior consent of editor and publisher is inadmissible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
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assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or
faulty representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.
50 I laser
2_ 2014
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/ Diclofenac - dexamethasone or laser phototherapy? Part I
/ Laser activated irrigation Part I: The power of the bubble
/ Er - Cr:YSGG in laser-assisted aesthetic rehabilitation: A case report.
/ Periodontal decontamination in microsurgery
/ Innovative pathways for extensive and efficient tissue removal with Er:YAG laser
/ Laser dentistry course for dental students in Thailand
/ Gain power at your laser clinics!
/ Strong against bacteria – gentle to teeth and gingiva
/ Interview: “We still have a long way to go”
/ Laser Dentistry in the City of Light - Welcome to Paris
/ Rimini show confirms that the future of dentistry is digital
/ News
/ About the publisher
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