laser international No. 2, 2016

Cover / Editorial / Content / Er - Cr:YSGG treatment of gingival melanin hyperpigmentation / Recurrent aphthous stomatitis: A case presentation with 915 nm diode laser therapy / Biomodulation in dentistry: Case series on the use of a new flat-top handpiece / Laser-activated irrigation with PIPS®: The power of better irrigation / Eleven tips for success in your dental clinic Part IV: ROI and PEST / Events / Manufacturer news / News international / Industry / News Germany / Imprint / Subscription form

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Vol. 8 • Issue 2/2016

issn 2193-4665

laser
international magazine of

laser dentistry

2

2016

research
Laser treatment
of gingival melanin
hyperpigmentation

case report
Diode laser treatment
of recurrent aphthous stomatitis

industry
Laser-activated irrigation with PIPS®

[2] =>

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[3] =>

  |

editorial

And yet it moves!

Dr Georg Bach

Dear colleagues,
When I first learned about the content of this issue of laser international magazine of laser dentistry which you
are now holding in your hands, the following famous quote by Galileo Galilei came to my mind: When leaving the court of inquisition, where he was forced to renounce the Copernican world view, he notoriously
whispered, “And yet it moves”!
In this line, I would like to tell you that, after all, laser light does make a difference by setting things – and
sometimes even people—into motion. I highly recommend this issue of laser; it proves a good read and
illustrates this sentiment perfectly. The removal of melanin hyperpigmentation, the treatment of recurrent
aphthous stomatitis or tissue b iomodulation—this large of variety of laser applications leaves no doubt that
laser therapy is an enrichment to dentistry. Even if our immediate environment—which forms, by the way,
yet another interesting parallel to Galalei and his time—may not always be ready to accept these findings,
I am convinced that the application of monochromatic and coherent light has been a substantial enhancement of the scope of dental therapy in the past decades. This is, indeed, a therapeutic gift!
The current issue of laser is an eloquent testimony to this view on laser dentistry. If you wish to learn more
about the rich spectre of laser dentistry, you will be given ample opportunity in the upcoming weeks, as two
assets of modern laser dentistry have organised exciting events this year:
On the one hand, the 15th WFLD Congress will be held in Japan, and on the other hand, DGL will host its
25th anniversary congress in Munich, Germany, in autumn. Both of the two events feature high-calibre
speakers and will guarantee an excellent scientific programme within an attractive setting. Make sure to use
these opportunities!
Thus, I hope you will enjoy reading this issue of laser with a maximum gain in knowledge and that, furthermore, laser light will give many beneficial impulses to you and your day-to-day work.
Warm regards
Your colleague

Dr Georg Bach

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2 2016

03

[4] =>

| content
© Michael Thaler/Shutterstock.com

page 06

page 20

page 32

| editorial

| events

03 And yet it moves!

30 15th International WFLD Congress—Preview

| research

32 “I want to spend the rest of my life
studying light”

Dr Georg Bach

06 Er,Cr:YSGG treatment of gingival
melanin hyperpigmentation
Dr Habib Zarifeh et al.

| case report
10 Recurrent aphthous stomatitis
Dr Foteini Papanastasopoulou

| industry
14 Biomodulation in dentistry
Alberico Benedicenti et al.

20 Laser-activated irrigation with PIPS®
Dr Ralf Schlichting

40 Introducing LASOTRONIX—
lasers for generations

Claudia Jahn

Claudia Jahn

| news
34 manufacturer news international
36 news international
| DGL
43 Und es bewegt doch etwas!
Dr. Georg Bach

44 news germany
| about the publisher
50 imprint

| practice management
26 Eleven tips for success in your dental clinic
Dr Anna Maria Yiannikos

Cover image courtesy of Fotona,
www.fotona.com
Original Background: © Tumanyan/Shutterstock.com

04

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2 2016

[5] =>

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[6] =>

| research

Er,Cr:YSGG treatment
of gingival melanin
hyperpigmentation
Authors: Dr Habib Zarifeh, Dr Monique Hanna & Dr Dany Salameh, Lebanon

Introduction
In the past few decades, the improvement of intraoral soft tissue aesthetics has become a significant
element in clinical dentistry, including gingiva, which
is the most commonly affected intraoral tissue, causing an unpleasant appearance.1, 2 In fact, oral pigmentation is a discoloration of the oral mucosa or gingiva
due to several exogenous and endogenous factors,
such as drugs, heavy metals, genetics, endocrine disturbance, and inflammation.3–5
Also, melanin produced by melanocytes can cause
melanin pigmentation,3–5 varying from light to dark
brown or black, according to the quantity and distribution of active melanin in the tissue.4 Oral pigmentation occurs in people of all races.6 Indeed, oral pigmentation increases in darker-skinned individuals.
However, there is no difference in the number of melanocytes between fair-skinned and dark-skinned
people. The variation is related to differences in the
activity of melanocytes.7

laser therapy. Various lasers, such as carbon dioxide
(CO2) laser, Nd:YAG laser, semiconductor diode laser,
argon laser, Er:YAG laser and Er,Cr:YSGG laser, have
been indicated as an efficient, pleasant and reliable
method with minimal postoperative discomfort and
faster wound healing for depigmentation procedures.8
A healthy 39-year-old male with no previous surgical history and no allergies and no current medication
had a chief complaint of dark pigmented areas in the
anterior part of the upper and lower maxillary gingiva,
stating that he was an occasional smoker. During the
clinical examination, no abnormalities nor gum disease were revealed, but deep melanin pigmentation in
the upper and lower mucosa, along with the marginal
gingiva, was noticed. This lead to a dark gum colour
and by consequence a less aesthetic smile (Fig. 1).
L aser depigmentation procedure was planned. The
process was explained to the patient and his consent
obtained.

Several procedures have been suggested for gingival depigmentation, varying from bur abrasion, surgical scraping, cryotherapy, and electrosurgery to

Digital images of the pigmented gingiva were
taken preoperatively and on postoperative visits. Laser safety protocols were respected. The patient was
treated with local anaesthesia. A Er,Cr:YSGG laser of

Fig. 1

Fig. 2

Fig. 1: Melanin pigmentation
(preoperative photo).
Fig. 2: Melanin depigmentation
procedure.

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2 2016

[7] =>

research

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

2,780 nm was used with the following parameters:
gold handpiece, Z6 tip, 60 % water, 40 % air, H Mode,
3.0 W, 20 pps, direction of the tip was slightly parallel
or with 30 degree to the gum surface (Fig. 2), up to
the second premolar on both the right and left side of
the maxillary and mandibular anterior gingiva. We
worked at a distance of 2 to 3 mm in non-contact
mode with 30 degrees to the gum surface, with slow
shaving movements until the removal of the pigmented layers of the epithelial cells and the connective tissue to remove melanin pigmentation (Figs. 3
& 4).

The patient was prescribed saline mouthwash three
times daily for one week, as well as application of
vitamin E three times daily for seven days and para
cetamol 500 mg, two tablets every eight hours in case
of pain. The patient was advised to avoid hot meals
during the first couple of days after surgery.

After the total removal of the pigmented layers of
the gum (Fig. 5), an additional application of the
Er,Cr:YSGG of 2,780 nm was done using different parameters: gold handpiece, Z6 tip, 0 % water, 0 % air,
non-contact mode, S Mode, 2.0 W, 50 pps, direction
of the tip 45 degrees to the gum surface. The aim of
this procedure was to dehydrate the surface of the
connective tissue and by consequence melting the
nerve endings, which in the end leads to a reduction
or absence of postoperative pain. This method is also
referred to as “laser bandage”.

Discussion

Fig. 3: Immediate comparison after
depigmentation of half
of the upper-maxilla gingiva.
Fig. 4: Immediate comparison after
depigmentation of the upper-maxilla
gingiva.
Fig. 5: Immediate postoperative
photo of the depigmentation of the
upper and lower maxillary gingiva.
Fig. 6: Postoperative appearance
of the gingiva after two days.
Fig. 7: Postoperative appearance
of the gingiva after four days.
Fig. 8: Postoperative appearance
of the gingiva after seven days.

No infection or significant postoperative complications, such as pain or bleeding, were encountered. The
patient was reviewed two, four and seven days after the
procedure (Figs. 6–8). The fifteen-month follow-up
showed no signs of recurrence of the pigmentation.

Numerous modalities for depigmentation have
been used and described in the literature. First, removing pigmented layers can be performed by using
chemical methods9 or surgical methods such as surgical scalpel technique10, surgical abrasion9, cryosurgery11, 12, electrosurgery13 and laser14–17.
Chemical methods are not recommended because
the chemical action cannot be restricted to the oper-

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2 2016

[8] =>

| research
ative area11. The scalpel technique is the most economical procedure compared to other methods
requiring a more sophisticated armamentarium.
However, this technique causes unpleasant bleeding
during and after the operation, and it is necessary to
cover the surgical site with periodontal dressing for
seven to ten days.
Abrasion involves eliminating the epithelium of
pigmented areas using a round diamond bur in a
high-speed handpiece with copious irrigation.18 The
use of a large-size diamond bur is recommended, because small burs do not smooth surfaces easily.9
Cryosurgery is a treatment method in which the tissue is destroyed by rapid freezing as described by Tal
et al.19 It can be followed by considerable swelling, and
it is accompanied as well by increased soft tissue destruction because of its uncontrolled depth of penetration. Electrosurgery has its own limitations because of its repetitive and prolonged use, provoking
heat accumulation and undesired tissue destruction.20
The documented advantages of lasers for depigmentation consist of removing the melanin pigmentation by a less invasive procedure in order to eliminate a thin layer of epithelium21, less bleeding during
the procedure22, reduced infection, swelling and scarring22, 23, decreased postoperative pain24, a fast healing process and increased patient satisfaction regarding aesthetics.22 The Er:YAG laser used in this case
report produced the desired results efficiently. The
patient was pleased with the result, which is the
definitive objective of any treatment accomplished.

Yet, there is no scientific evidence to establish that
laser depigmentation is superior to scalpel depig
mentation. On the other hand, techniques masking
pigmented gingival from less pigmented gingival areas can be done using free gingival grafts25, 26 or acellular dermal matrix allografts27.

Conclusion
Considering the results of this case report, the
depigmentation procedure was successful and the
patient was satisfied. It may be concluded that the
application of Er,Cr:YSGG laser appears to be secure
and efficient for the treatment of gingival melanin
pigmentation._
Editorial note: A list of references is available from
the publisher.

contact
Dr Habib F. Zarifeh
DDS, MS in Oral surgery, MSc in Laser dentistry
RWTH Aachen University
Head Of Clemenceau Medical Center dental
department affiliated with Johns Hopkins International,
Head of HIMC Hospital dental department
Tel.: +96 11488842
Fax: +96 19933338
Habib Zarifeh, PO box: 90993, Jdeidet el-Metn, Lebanon
info@habibzarifeh.com
www.habibzarifeh.com

Kurz & bündig
Im vorliegenden Artikel vergleicht der Autor anhand einer Zusammenfassung der Erkenntnisse aus der Fachliteratur konservative Ansätze zur lasergestützten Behandlung einer Melaninhyperpigmentation der Gingiva. Ein Fallbericht
aus seiner eigenen Praxis beschreibt das mögliche Vorgehen bei einer Laserbehandlung dieser Pigmentationsstörung,
welche meist aufgrund einer individuellen Kombination endo- und exogener Faktoren auftritt. Im Vergleich mit der
chemischen Behandlung einer Melaninhyperpigmentation oder chirurgischen Ansätzen wie der Skalpelltechnik, der
chirurgischen Abrasion, Cryochirurgie oder Elektrochirurgie besitze die Lasertherapie laut Autor und Literatur bereits
gut dokumentierte Vorteile: Zum einen werde die Melaninpigmentation durch ein weniger invasives Vorgehen entfernt,
indem nur eine dünne Schicht des Epitheliums abgetragen werde.21 Des Weiteren gäbe es eine geringere Blutungsneigung22, weniger Infektionen, Schwellungen oder Narbenbildung22, 23, einen weniger starken postoperativen Schmerz24,
einen schnellen Heilungsverlauf und eine gesteigerte Patientenzufriedenheit hinsichtlich der Ästhetik.22 Im Folgenden
beschreibt der Autor anhand des Falles eines 39-jährigen männlichen Patienten die lasergestützte Behandlung dunkel
pigmentierter Areale im anterioren Bereich der oberen und unteren maxillaren Gingivia. Der Patient rauchte gelegentlich, wies aber darüber hinaus keine auffällige Krankengeschichte, Allergien oder Medikamentation auf. Im Anschluss
an die Behandlung kam es zu keinen signifikanten postoperativen Komplikationen und der Patient zeigte sich hoch
zufrieden mit dem ästhetischen Ergebnis. Anhand der Studienlage und des vorliegenden Fallberichts ist laut Autor der
Rückschluss zulässig, dass die Anwendung eines Er,Cr:YSGG-Lasers eine sichere und effiziente Methode der Behandlung einer gingivären Melaninpigmentation sei.

08

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2 2016

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[10] =>

| case report

Recurrent aphthous
stomatitis
A case presentation with 915 nm
diode laser therapy
Author: Dr Foteini Papanastasopoulou, Greece

Recurrent aphthous stomatitis (RAS) is one of the
most common oral diseases and it is characterised by
round ulcers surrounded by an erythematous halo.
The lesions are usually painful due to the exposed
nerve endings in the underlying lamina propria and
the pain can range from mild to severe, affecting the
patient’s everyday life. RAS has three clinical presentations: aphthous minor, aphthous major and herpetiform ulcers. The cause of RAS is unknown, although several factors are suspected. These include
stress, hormonal changes, genetics, diet, nutritional
deficiencies, immunological and systemic disorders
(such as Behçet’s syndrome, Reiter’s syndrome, and
gastrointestinal malabsorption disorders).
The treatment of recurrent aphthous stomatitis is
symptomatic. Accurate diagnosis of the cause of the
disease and a treatment plan that is tailored individ-

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2 2016

ually to each patient can lead to successful management of RAS. The treatment goals are reduction of
pain, healing time, number and size of ulcers and prevention of the recurrence of the disease. There are
several treatment options for the management of
recurrent aphthous stomatitis. Antiseptic mouthwashes containing chlorhexidine decrease the number of ulcers but do not prevent the recurrence of the
disease. In addition, chlorhexidine can stain the teeth
if it is used frequently. Topical analgesics reduce the
pain but cannot be used extensively. Topical and
systemic antibiotic treatments are empiric and are
used because of a belief that the cause of the disease
is an undiscovered infectious agent. Cauterising
drugs are used, but they prolong healing time due to
their destructive activity. Topical corticosteroids
and systemic immunomodulators are commonly
used when the immunopathogenesis is the cause of

[11] =>

case report

the u lcer. However, both of them have numerous side
effects. Dental lasers have also been used for the
treatment of RAS.
It was found that laser irradiation accelerates
wound healing, promotes pain relief and decreases
recurrence of the lesions. There are three factors that
accelerate wound healing: the increased production
of ATP which results in greater tissue regeneration in
the healing process, increased microcirculation which
facilitates the cell multiplication and the formation of
new vessels. The reason of pain reduction could be
attributed to the release of endogenous pain relievers
such as endorphins and encephalins, the increased
production of serotonin and suppression of bradykinin activity.

Case report
A 63-year-old female patient presented with
painful lesions in her mouth. The patient was diagnosed with recurrent aphthous stomatitis. The ulcers
were extremely painful and she had difficulties in
eating, speaking and brushing her teeth. The patient
had suffered from ulcers for several weeks and was
extremely anxious and very sensitive to pain. She had
tried to relief the pain by many different topical medications, but to no avail. Also, new lesions developed
as the older lesions resolved. The patient had no systemic disorders and was a non-smoker. Eight minor
ulcers were found in her mouth (Fig. 1): One in the
upper left lip (Fig. 1: lesion a1, Fig. 2), two ulcers in
the palate (Fig. 1: lesions a4 and a5, Fig. 3: lesion a4),
two ulcers in the right buccal area (Fig. 1: lesions a2
and a3, Fig. 3: lesion a2, Fig. 4: lesion a3), two lesions

Fig. 1

in the lower lip (Fig. 1: lesions a6 and a7, Fig. 5:lesion
a6) and one minor ulcer below the tongue (Fig. 1: lesion a8, Fig. 5). Laser therapy was selected for the
treatment of recurrent aphthous stomatitis.
The patient was treated by 915 nm diode laser. A
300 μm fibre was used with power settings of 2 W,
cw and in non-contact mode. The tip was moved
with circular movements of 1 mm/s in speed from
the periphery towards the centre of the lesion. The
tip was also moved gradually closer to the lesion
from 10 mm to 1 mm distance. The irradiation time
of each lesion was 30 s/cm2. Consecutive to each irradiation, the patient was asked if she was still feeling pain. Most lesions were irradiated twice (Fig. 1:
lesions a4, a5, a6, a7, a8) and the larger and painful
lesions were irradiated thrice (Fig. 1: lesions a1, a2,
a3). At the end of the treatment, the patient reported
that five ulcers were free of pain (Fig. 1: lesions a4,
a5, a6, a7, a8) and three out of eight ulcers were
mildly sensitive to the touch (Fig. 1: lesions a1, a2,
a3). The patient was send home and instructions
were given to avoid hard, acidic and salty foods.
The patient was recalled a week later. She was
content and she reported that eating was painless.
She felt like the ulcers started healing earlier than
the previous attacks. The patient was clinically examined and it was found that five ulcers had completely healed (Fig. 6: lesions a2, a4, a6, a7, a8, Figs. 9
and 10) and three ulcers out of eight were still sensitive to the touch (Fig, 6: lesions a1, a3, a5, Figs. 7
and 8). Additionally, two new painful ulcers were
found: one below the tongue (Fig. 6: lesion b2, Fig. 9)
and the other on the palate (Fig. 6: lesion b1). The

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Initial examination
Fig. 1: Eight minor ulcers were
found (a1–a8).
Fig. 2: Ulcer in the upper left lip (a1).
Fig. 3: Ulcer in the right buccal area
(a2) and ulcer in the palate (a4).
Fig. 4: Ulcer in the right buccal
area (a3).
Fig. 5: Ulcer in the lower lip (a6) and
ulcer below the tongue (a8).

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[12] =>

| case report

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

After seven days – Fig. 6: Completely healed ulcers (a2, a4, a6, a7, and a8), still painful old lesions (a1, a3, and a5), new painful ulcers (b1, b2). – Fig. 7: Still painful old ulcer
in the upper left lip (a1). – Fig. 8: Still painful old lesion in the right buccal area (a3). – Fig. 9: Completely healed ulcer below the tongue, left side (a8) and new painful lesion below
the tongue, right side (b2). – Fig. 10: Completely healed ulcer in the lower lip (a6).

same laser treatment protocol was followed for the
three old lesions (Fig. 6: lesions a1, a3, a5) and the
two new ones (Fig. 6: lesions b1, b2). The old lesions
were irradiated two times and the new lesions three
times. Then the patient was recalled three days later.
All five lesions were without pain and had completely healed (Fig. 11: lesions a1, a3, a5, b1, b2).

Fig. 11

However, two new lesions had developed in the
lower lip (Fig. 11: c1, c2, Fig. 15). The two new lesions
were irradiated three times each with the same laser
protocol. After five days all the lesions had completely healed and no new lesions were detected
(Fig. 16: lesions a1, a3, c1, c2, Figs. 17–19). A bi-weekly
follow-up showed no recurrence of the d isease.

Fig. 12

Fig. 13

Fig. 14

Fig. 15

After three days (ten days after the first irradiation) – Fig. 11: Completely healed ulcers (a1, a3, a5, b1, b2), new painful ulcers (c1, c2). – Fig. 12: Completely healed ulcer in the upper left lip (a1). – Fig. 13: Completely healed ulcer in the right buccal area (a3). – Fig. 14: Completely healed ulcer below the tongue, right side (b2). – Fig. 15: New painful ulcers (c1, c2).

12

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[13] =>

case report

Fig. 17

Fig. 16

Fig. 18

Fig. 19

After five days (15 days after the first irradiation) – Fig. 16: Completely healed ulcers (a1, a3, c1, c2). – Fig. 17: Completely healed ulcer in the upper left lip (a1). –
Fig. 18: Completely healed ulcer in the right buccal area (a3). – Fig. 19: Completely healed ulcers in the lower lip (c1 and c2).

Conclusion
Laser treatment of recurrent aphthous stomatitis is
an easy, fast and pain-free procedure. Multiple appointments were required in order to treat the newly-developed lesions. Studies have shown that ulcers
treated by laser therapy provide immediate pain relief
and fewer recurrences in the future. The main advantage of the laser treatment compared to other treatment options is that it can be used for all the causes
of the disease both without having any side effects

and without the risk of medication overdose. In conclusion, laser treatment offers advantages for both
the clinician and the patient._

contact
Dr Foteini Papanastasopoulou, MSc
Private dental practice
L. Kalamakiou 73, Alimos,Greece
foteinel@yahoo.gr

Kurz & bündig
Die Behandlung einer rezidivierenden Stomatitis aphthosa erfolgt in der Regel symptomatisch und ist dann erfolgreich, wenn der Behandlungsplan individuell auf den Patienten zugeschnitten wird und auf eine präzise Diagnostik folgt.
Im vorliegenden Fallbericht beschreibt der Autor die lasergestützte Stomatitistherapie bei einer 63-jährigen Patientin.
Diese stellte sich mit schmerzhaften Aphthen in der Praxis des Autors vor. Die Geschwüre verursachten Probleme beim
Essen, Sprechen und bei der Zahnpflege. Da die Patientin bereits seit mehreren Wochen unter den Geschwüren litt,
war sie hochgradig ängstlich und schmerzempfindlich. Bevor sie sich beim Behandler vorstellte, hatte sie erfolglos
versucht, ihre Schmerzen durch verschiedene topische Medikamente zu lindern. Weiterhin entwickelten sich neue
Läsionen dort, wo alte Läsionen abklangen. Nach mehreren Behandlungen mithilfe des 915 nm-Diodenlasers waren
alte und neue Geschwüre der Patientin verheilt und es konnte keine Neubildung von Läsionen festgestellt werden.
Auch der Recall in zweiwöchigen Intervallen ergab kein Rezidiv.
Der Autor kommt zu dem Schluss, dass die Laserbehandlung einer rezidivierenden Stomatitis aphthosa eine einfache, schnelle und schmerfreie Therapieoption darstellt. Den Hauptvorteil der Lasertherapie im Vergleich zu anderen
Behandlungsansätzen sieht er darin, dass sie individuell, ohne Nebenwirkungen und ohne das Risiko einer Über
dosierung angewendet werden kann. Zusammenfassend vereine die lasergestützte Stomatitistherapie damit Vorteile
für Behandler und Patient.

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2 2016

[14] =>

| industry

Biomodulation
in dentistry

Case series on the use of a new
flat-top handpiece
Authors: Alberico Benedicenti, Andrea Amaroli, Wayne Selting, Nicola Deangelis & Stefano Benedicenti, Italy

Introduction
The influence of electromagnetic energy on biological tissue has been recognised since the 19th
century, with the basic concept of photochemistry
dramatically demonstrated in photosynthesis.
Photobiomodulation (PBM) is the term applied
to the manipulation of cellular behaviour using
low-intensity light sources. It works on the principle of inducing a biological response through energy transfer.1 PBM has been used in clinical practice for more than 40 years and its mechanisms of
action at cellular and molecular levels have been
studied for about 30 years.2 As photonic energy irradiates tissue, it modulates biological processes
within that tissue and, at least indirectly, within the
biological system of which that tissue is a part.3 It is
Fig. 1: Intrabony defect
of tooth #23.
Fig. 2: Pre-existent
gingival recession.
Fig. 3: Debridement of the
granulation tissue.
Fig. 4: Placement of a graft.
Fig. 5: Irradiation points
after the surgery.
Fig. 6: Genova handpiece.
Fig. 7: Situation after six months.

Fig. 1

Fig. 5

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2 2016

Fig. 2

generally accepted4, 5 that the mitochondria of
eukaryotic cells are the initial absorption sites for
laser radiation in the visible to near-infrared optical
region, and cytochrome c oxidase is the responsible
photoacceptor.
There are two primary methods of influencing tissue with laser energy — photochemical and photothermal interaction. The most frequently used
mechanism of photon energy conversion in laser
medicine is photothermal. Very significant heating
of irradiated samples occurs with all surgical methods of tissue interaction (cutting, vaporisation, coagulation, and ablation). However, at low light intensities, photochemical conversion of the energy
absorbed by a photoacceptor prevails. In order to
produce effective photobiomodulation, it is neces-

Fig. 3

Fig. 6

Fig. 4

Fig. 7

[15] =>

industry

Fig. 8: Situation before the
mucogingival surgery.
Fig. 9: Creation of the recipient bed.
Fig. 10: Irradiation points after
graft stabilisation.
Fig. 11: Situation after 14 days.
Fig. 12: Situation after 42 days.

sary to minimise the thermal increase and to avoid
a tissue temperature rise of more than 4–5 degrees
Celsius.6
In clinical applications, photobiomodulation has
been used to successfully induce wound and bone
healing7–10, for pain reduction11 and for anti-inflammatory effects12–14. Little is known about the use of
the neodymium-doped yttrium aluminium garnet
(Nd:YAG) laser in a biostimulatory mode. Most investigations have centred on the use of laser
energy in the range of 400 nm to 980 nm. In this
range of wavelengths, photons can penetrate effectively to reach deeper structures. Nd:YAG, at a
wavelength of 1,064 nm, is near this window and
exhibits some advantages. In terms of penetration
of the radiation, longer wavelengths, such as produced by the (infrared) diode laser and Nd:YAG laser, penetrate as much as 6 millimetres, whereas
laser energy with a shorter wavelength, such as red
light produced by the He-Ne laser, has significantly
less penetration.15

Fig. 8

Fig. 9

Recently, Usumez et al. demonstrated that lowlevel Nd:YAG laser therapy accelerates the wound
healing process by changing the expression of PDGF
and bFGF, genes responsible for the stimulation of cell
proliferation and fibroblast growth.16
Significant effort has been made to clarify the
parameters of deposited energy that will effectively
promote positive change in individual cells while
avoiding negative effects. Karu observed that high
fluencies cause the destruction of photoreceptors
which is accompanied by growth inhibition and cell
lethality.17 Other researchers have also demonstrated
that irradiation with fluencies higher than 10 J/cm2
damages DNA.18,19 Finally, Bensadoun suggested the
optimal dose is in the range of 2–3 J/cm2 for prophylaxis and not more than 4 J/cm2 for therapeutic effects, and recommended application over a single
spot on a lesion rather than using a scanning motion
over the entire lesion surface.20 The World Association of Laser Therapy (WALT) has stated that applying
energy in the range from 3 J/cm2 to 10 J/cm2 will promote effective biostimulation while avoiding bio
inhibitory effects.21
While this range of energy density seems well documented, achieving this goal is problematic. Radiated
energy must reach target cells at this intensity level to
be effective. Since the cells being targeted often lie
deep within the tissue, absorption and scattering in
overlying structures has a very significant effect on
photon distribution. Laser energy density and distribution at the tissue surface is a poor predictor of
deeper tissue distribution. A method of delivering
photons to a group of individual cells, often deep

Fig. 10

Fig. 11

Fig. 12

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Fig. 13: Fracture of an implant and
missing teeth from 12 to 22.
Figs. 14–17: A regenerative
procedure with bone substitute.

within a tissue mass, in a uniform and predictable
manner, has been lacking.

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

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Several problems complicate the adoption of a
standardised protocol. While the biostimulatory effect of laser energy is experienced on a cellular level,
the energy is applied macroscopically to large volumes of tissue in a non-uniform manner. As energy
passes through tissue, part of it is absorbed so each
successive depth of cells is irradiated differently.
Beers law is usually used to define this relationship.
However, this is inadequate since the dominant form
of interaction at wavelengths between 600 nm and
1,400 nm is scattering.22 Thus, as energy enters tissue,
its density decreases rapidly.
The output of most clinical lasers is Gaussian in spatial profile. Therefore, cells directly in the centre of the
beam are irradiated at a very high fluence, while those
on the periphery of the incident beam receive a very
low dose. As a result, cells at the beam centre may be
overstimulated far above the scientifically recommended range of 3–10 J/cm2 and inhibited while
those on the periphery receive insufficient cellular
energy to produce any effect.
Further complicating standardisation is the issue of
beam divergence. Fibre-delivered laser energy exits
the fibre with a significant divergence, usually on the
order of 8 degrees. The applied energy is, therefore,
distributed over an increasing area as the tip-to-
tissue distance increases, dramatically affecting energy density at the cellular level. At currently reported
beam divergences, energy density can be diminished
by 90 per cent with only 3 millimetres of tip-to-tissue
distance. This makes the repeatable application of
an appropriate energy density extremely technique-
sensitive and operator-sensitive.
As a result of these problems, a handpiece was developed that provides homogeneous irradiation over
a 1 cm2 surface with a constant irradiation area (spot
size) irrespective of the tip-to-tissue distance (from
10 to 100 mm) from the target tissue. With the introduction of this new flat-top handpiece,14 it is now possible to irradiate a target surface with a homogenous
energy density, using relatively high-power densities,
in less time and without risk of significant thermal
damage. This would make the application repeatable
and not operator-sensitive,14, 23 a significant step forward in standardisation of treatment parameters.
The aim of this study is to present, through a series
of clinical cases, a preliminary report on the dental
and medical applications of a new flat-top handpiece
used in conjunction with an Nd:YAG laser according
to the therapeutic protocols described in Benedicenti’s textbook.24

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Fig. 18: Biomodulation spots
after suturing.
Figs. 19 & 20: Situation after
three months.
Fig. 21: Stable tissue after
six months.

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Materials and methods

onds per point (Fig. 6). The healing was uneventful,
with minimal pain and swelling. A control after six
months showed a good stability of both the bone
graft and the soft tissue (Fig. 7).

A standard irradiation protocol was used in each instance for the clinical series presented here. In all
cases, an Nd:YAG laser (LightWalker ATS, Fotona,
Ljubljana, Slovenia) was used in conjunction with a
flat-top handpiece (Genova handpiece, Fotona, Slovenia). The laser was used in MSP mode, which produces
individual pulses with a width of 100 microseconds.
An average power of 0.5 watts and a pulse repetition
rate of 10 pulses per second were used in each case,
and irradiance was calculated as 0.5 W/cm2. Therapy
sessions occurred every other day, with the total number of sessions varying in accordance with clinical
judgement and the characteristics of the particular
tissue target.

Case 1
A 52-year-old female presented with aggressive localised periodontitis. After stabilisation of the acute
inflammation, the patient was checked and a deep infrabony defect was evident on the distal aspect of
tooth #23 (Fig. 1). The flap design aimed also to correct the pre-existent gingival recession (Fig. 2). A
careful debridement of the granulation tissue was
done (Fig. 3) and, afterward, a graft with inorganic
bovine-derived hydroxyapatite was placed (Fig. 4).
After the surgery (Fig. 5), the area was irradiated
with Nd:YAG laser (LightWalker ATS, Fotona, Slovenia)
with the flat-top Genova handpiece every other day
for ten days (five applications) with the following parameters: 0.5 W, 10 Hz in MSP modality, and 60 sec-

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Case 2
A 41-year-old male patient presented with traumatic severe gingival recessions on the lower incisors.
After a careful consultation, the patient was scheduled for the mucogingival surgery (Fig. 8). Due to the
lack of keratinised tissue and the shallow vestibule,
the only possible treatment was to harvest a free
gingival graft for the root coverage procedure.
The recipient bed was created with a partial-thickness flap and all of the epithelial part was removed
(Fig. 9). The graft was completely stabilised on the
area with a tight suture in order to avoid the formation
of a thick layer of exudate, which could jeopardise
the final outcome of the procedure (Fig. 10).
Biomodulation was performed every other day for
14 days (seven sessions) with the flat-top handpiece
in MSP modality, 10 Hz, 0.5 W (LightWalker ATS,
Fotona, Slovenia), and 60 sec per point. After the initial phase of 14 days (Fig. 11) and for the whole maturation stage of 42 days (Fig. 12), the graft appeared
successful and the root coverage was achieved.

Case 3
A 65-year-old female patient showed a fracture of
an implant in the frontal area and missing teeth from

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12 to 22 (Fig. 13). At the time of the implant placement, the buccal bone displayed an insufficient
thickness, resulting in an improper aesthetic contour. Thus, a regenerative procedure with bone substitute (inorganic bovine derived hydroxyapatite)
and an absorbable collagen membrane was performed (Figs. 14–17).
Suture was done carefully to prevent dehiscence
and complications in the healing period. Biomodulation was performed to speed up bone healing and
graft integration. A flat-top handpiece with Nd:YAG
laser was applied every other day for ten days (five
sessions) (LightWalker ATS, Fotona, Slovenia) at 0.5 W
of power, MSP modality, 10 Hz, and 60 sec per point
(Fig. 18).
After three months, the tissues appeared healthy
and thick, and simultaneously to the second stage
surgery, temporary crowns were placed (Figs. 19 & 20).
At six months after implant placement, the tissues
could be considered stable to deliver the final prosthesis (Fig. 21).

Conclusion
Within the limitation of this study it can be concluded that:

1. Nd:YAG laser, because of its high penetration,
seems to be an appropriate wavelength for biomodulation.
2. With this flat-top Genova handpiece, irradiation is
homogenous compared to a conventional defocused handpiece with a Gaussian output profile.
Using relatively high power densities, biostimulation may be applied in less time and without risk of
thermal damage if proper parameters are used.
3. Homogeneous irradiation is developed over a
1 cm2 surface with a distance from the target tissue
of 10 to 100 mm. This would make the application
repeatable and not operator-sensitive._
Editorial note: A list of references is available from
the publisher.

contact
Stefano Benedicenti
University of Genoa, Department of Surgical Sciences
and Integrated Diagnostics
L.go Rosanna Benzi 10
16132 Genova, Italy
Tel.: +39 0103537309
benedicenti@unige.it

Kurz & bündig
Die photochemische und die photothermische Interaktion stellen die beiden vorherrschenden Methoden der Ge
webemanipulation durch Laserenergie dar. Am häufigsten wird dabei auf photothermische Mechanismen zurück
gegriffen. Um dabei möglichst effektiv vorzugehen, sei es notwendig, den resultierenden Temperaturanstieg auf
maximal 4°C bis 5°C zu beschränken. Um dies zu erreichen, wurde ein neuartiges Handstück entwickelt, welches
eine homogene Bestrahlung von Oberflächen von 1cm2 bei einem festgelegten Bestrahlungsbereich und unabhängig vom Abstand zwischen Laserfaser und Gewebe (10 bis 100 mm) ermögliche. Weiterhin entfalle das Risiko von
Hitzeschäden und die Anwendung werde nicht nur wiederholbar, sondern mache auch vorhersagbare Ergebnisse
unabhängig vom Anwender möglich. Ziel der vorliegenden Studie ist es, im Rahmen einer Fallstudie die medizinische
Anwendbarkeit dieses neuen Flat-Top-Handstücks in Verbindung mit einem Nd:YAG-Laser zu ermitteln. Dies geschah
gemäß den therapeutischen Protokollen nach Benedicentis Handbuch.24
Für alle der drei vorgestellten Fälle wurde ein Standard-Bestrahlungsprotokoll verwendet. Hierbei handelte es sich
um eine 52-jährige Patientin mit einer aggressiven lokalisierten Parodontitis, einem 41-jährigen Patienten mit traumatischem, gravierendem Zahnfleischrückgang im Bereich der unteren Schneidezähne und eine 65-jährige Patientin
mit einem frakturierten Implantat im Frontzahnbereich sowie fehlenden Zähnen in Regio 12 bis 22. Der Nd:YAGLaser wurde im MSP-Modus und individuellen Pulsen mit einer Breite von 100 ms (0,5 W, 10 pps, Strahlungsbreite
0,5 W/cm2) eingesetzt.
Die Autoren kommen aufgrund der Ergebnisse zu dem Schluss, dass der Nd:YAG-Laser aufgrund seiner hohen
Gewebedurchdringung eine geeignete Wellenlänge für die Biomodulation besitze. Weiterhin ermögliche das Flat-TopHandstück im Vergleich zu konventionellen Geräten eine homogene Behandlung mit relativ hoher Leistungsdichte,
sodass im Rahmen der korrekten Parameter die Biostimulation in kürzerer Zeit und ohne das Risiko von Hitzeschäden
erfolgen könne. Diese homogene Bestrahlung generiere zudem einen wiederholbaren und anwenderunabhängigen
Behandlungsverlauf.

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Laser-activated
®
irrigation with PIPS
The power of better irrigation
Author: Dr Ralf Schlichting, Germany

Why endodontics?
Bacterial infections of the root canal system are
one of the main causes of apical periodontitis.1 The
infection usually enters through the dentinal tubules.
Carious lesions, leaky fillings, leaky dental implants,
hairlines, traumas, or erosion may be the cause of
canal system infections.2 For the primary and for the
secondary infection as well, an intra-radicular mixed
bacterial flora was proven.3 The median bacterial
count for the primary infection was 4.6 x 107 colony
forming units (CFU) per apex.4 For persistent infections, 5.4 x 104 CFU per apex were determined.5 Bacteria may enter very deeply into the dentinal tubules
and ramifications of the root canal system.6 Colonies
of E. faecalis, for example, can be found up to 500 µm
away from the main canal (Fig. 1).7 The bacteria
within the infected canal system appear either in
plankton form, i.e. swimming in tissue fluid8, or relatively “organised” in the so-called “biofilm”. This is a
conglomerate of various bacterial species, which organise themselves in an extra-polysaccharide matrix
that adheres tightly to the canal walls and the dentinal tubules (Fig. 2).9 The almost symbiotic interrelations among the bacteria within the biofilm results in
a much higher resistance of the individual bacterial

species against antimicrobial agents.10 In advanced
stages of apical periodontitis, you can therefore
always refer to an infectious disease triggered by
biofilm.11 With regard to the preferably complete
removal of bacteria from the canal system and the
dentinal tubules, the increased resistance of the
bacteria embedded in biofilm, together with the
extremely strong adhesion due to the extra-poly
saccharide matrix, is one of the essential problems
in endodontic treatment. In summary, bacteria are
the main cause of apical periodontitis.12 The purpose
of any endodontic therapy must therefore be the
extensive eradication of microorganisms, infected
tissue residues, and infected dental hard tissue from
the canal system and dentinal tubules.13

Antimicrobial treatment concept
To meet this requirement as best as possible, it is
necessary to comply with a strict antimicrobial treatment concept. This includes the imperative application of a dental dam, the removal of potentially infected dental restorations and scrupulously exact
caries excavation as well as the preparation of a
dentin-adhesive tight pre-endodontic buildup. The
preparation of the correct access cavity facilitates all

Fig. 1: Bacterial infection of dentinal
tubules. Source: Prof. V. Kaitsas.
Fig. 2: Biofilm. Source:
Prof. V. Kaitsas.

Fig. 1

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Fig. 3

Fig. 4a

work steps following the pre-endodontic build-up.
The direct correlation between the correctly prepared
endodontic access cavity and the success of endodontic therapy has been verified (Fig. 3).14 After having applied the access cavity and prepared the coronal root canals, we measure the length of the root
canal and determine the working length. Given the
development of electrometric measurement systems
in the past years, electrometric length determination
is the measure of choice for this purpose.15

Chemomechanical preparation
As already mentioned above, bacterial infections of
the root canal system are the main cause of apical
periodontitis.16 Solely preparing the root canals mechanically does not lead to sufficient reduction of microbial contamination. It was shown that major parts
of the canal were not even attended to mechanically
by means of mechanical preparation using rotating
instruments.17 The combination of mechanical preparation, activated irrigation by means of antimicrobial
and tissue-resolving agents as well as the application
of antimicrobial medication between the treatment
sessions may reduce bacterial contamination of the
canal system considerably.18

Fig. 4b

Fig. 5

Fig. 3: Correctly prepared access
cavity of the upper molar.
Figs. 4a & b: Upper molars after
reciprocal preparation, irrigation with
5 % NaClO and 17 % EDTA, PUI and
thermoplastic obturation.
Fig. 5: Surface after laser treatment
in dry canal with end firing tip;
Er:YAG laser at 75 mJ, 15 Hz, 1.1 W,
and 300 micron.57

can be limited to a few file sizes, depending on the
available canal anatomy. This makes handling easier
for the attending doctor and his/her team.

Chemical preparation—
irrigation solutions
The irrigation solutions applied to reduce bacterial
contamination must fulfill various tasks in the root
canal system:22
1. Antibacterial effectiveness against a broad microbial spectrum
2. Destruction of biofilm
3. Dissolution of potentially infected tissue
4. Removal of the smear layer

The smear layer is debris generated by the mechanical preparation, consisting of die dentin chips, bacteria, infected tissue, organic particles etc.23 Especially with the rotating or reciprocal preparation, this
debris is positively pressed into the dentinal tubules
and compacted by the rotational movement. The
smear layer thus prevents intra-canal antimicrobial
agents and drugs from entering into the dentinal tubules and sub-canals.24 The combination of sodium
hypochlorite (NaClO) and ethylene diamine tetra-
acetate (EDTA) is the gold standard for the chemical
Mechanical preparation
reduction of intra-canal microorganisms to this day
and has been proven in many research studies. The
Mechanical root canal preparation, depending on combination of both solutions and the mechanical
the available anatomy of the canal, may be performed preparation makes it possible to reduce contaminawith either manual instruments or rotating nickel- tion of root c anals by the factor of 100 to 1,000.25
titanium instruments. Compared to manual instru- NaClO has an excellent antimicrobial effect against
ments, the use of rotating instruments leads to most of the microorganisms that are significant in
considerably improved results with regard to the endodontics.26 With regard to the tissue-resolving
preparation geometry and the preservation of the effect, NaClO is clearly superior to all other known
original topography of the canal.19 The introduction of irrigation solutions.27 This tissue-lytic, effect coma novel preparation pattern, i.e. reciprocal prepara- bined with the excellent antimicrobial effectiveness,
tion movements, facilitates an even better mechani- are key factors to accomplish comprehensive bactecal preparation. Besides the reduced risk of fracture20, rial reduction in the root canal system. Concentrabetter alignment of the files in the canal system and tions between 1 per cent and 5.25 per cent are disthe resulting predictable and repeatable preparation cussed. The higher the concentration, the quicker the
seems to be one of the main advantages of reciprocal lysis of the tissue.28 Because of the rapid inactivation
movements. Another advantage over fully rotating of NaClO when it contacts organic tissue, a large
systems is the effective and thus more rapid canal quantity of irrigation fluid of at least 10 ml per canal
preparation.21 Because of the improved mechanical is required.29 Heating the NaClO increases the effecproperties of reciprocal file systems, the preparation tiveness of the irrigation solution in the canal sys-

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Fig. 6: PIPS® tip.

980 nm, and erbium lasers at 2,780 nm (Er,Cr:YSGG)
and 2,940 nm (Er:YAG).
First reports on the application of Nd:YAG lasers in
the root canal were published in 1984 already.38 In
this procedure, special endodontic optical fibers were
used which could emit the laser light only linearly. For
this reason, the optical fiber had to be moved in spirals in the canal to reach as many canal sections as
possible. At 15 Hz and 100 mJ, the antibacterial effect
may then reach up to 1,000 µm39 and enter deeply
into the dentinal tubules.

Fig. 6

tem.30 Furthermore, you can improve the effectiveness by a longer reaction time.31
Ethylene diamine tetra-acetate (EDTA) serves to
remove the smear layer mentioned above. Irrigation
with approx. 5 ml of EDTA in a concentration of 17 per
cent leads to the complete removal of the smear layer
within one minute.32 The reason why this effect is so
important is that antimicrobial agents like e.g. NaClO
can react deeply in the dentinal tubules only after the
smear layer was removed. We should also mention
that the effectiveness of EDTA against fungi like e.g.
Candida albicans has been proven (Fig. 4).33 The antimicrobial effect of EDTA is of rather minor importance.34 The combination of the two described irrigation solutions is still the gold standard. Please refer to
the related technical literature for more detailed information.

Laser in endodontics
In the past decades, lasers were established in
endodontics.35 Laser is the abbreviation of light amplification by stimulated emission of radiation. They
are electromagnetic waves with a high-energy density. In endodontics, lasers of different wavelengths
are used. By photothermal and partly photomechanical effects, laser radiation can unfold its bactericidal
effect, depending on the wavelength and the associated absorption in the irradiated tissue. Mostly because of heating and the subsequent change of the
osmotic gradient within the bacterial cell wall, the
cell dies.36 Lasers used in endodontics so far differ in
their wavelengths, which again have critical influence on the interaction with the irradiated tissue.37
Nd:YAG lasers function at a wavelength of 1,064 nm,
diode lasers within a range between 810 nm and

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Compared to that, the reduction of bacteria using
NaClO was proven to a depth of only 100 µm.40 However, the linear emission and the high energy density
in connection with the work in the dry canal had detrimental effects. The antibacterial effect is lower in
curved canals because of the linear emission of laser
radiation.41 In addition, heat of up to 38°C developed
in the canal, which may cause the dental hard tissue
to burn (Fig. 5).42
Matusomo et al. explain that, due to the linear
emission of the laser beam, on the one hand consistent wall contact was impossible and on the other
hand, because of the heat formation, emission over
the apex had to be avoided, making the work in the
apical third considerably harder.43 When comparing
the disinfecting effect of Nd:YAG lasers with “traditional” disinfection using NaClO and ultrasound,
DeMoore et al. arrived at the conclusion that the
Nd:YAG laser has no advantage in this respect.44 The
effects described for the Nd:YAG laser apply to the
diode laser as well.
Two different wavelengths are differentiated
for erbium lasers: 2,780 nm for Er,Cr:YSGG and
2,940 nm for Er:YAG lasers. These wavelengths have
their maximum absorption in water and hydroxy
apatite.45 When erbium laser radiation hits the dental
hard tissue directly, the water contained in the tissue
evaporates immediately and dental hard tissue is ablated “gently” with only minimal thermal effects.46
With regard to endodontics, experimental studies
with erbium lasers proved the removal of the smear
layer to be more effective than by other types of lasers and endodontic irrigation solutions.47 Furthermore, the canal walls were free from debris and smear
layer and had mostly open dentinal tubules.48 Because of the linear emission of the laser beam by the
optical fiber and due to the cumbersome handling,
the canal walls were cleaned imperfectly.49
To resolve these limitations, special endodontic
so-called “side-firing” tips were developed, which
are intended to emit irradiation laterally and apically
sealed: 50 Unfortunately, a construction-related re-

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quirement for the application was the minimum
preparation size of ISO 60, which resulted in the unnecessary sacrifice of dental hard tissue. Because of
the apical sealing, the apical cleaning effect was
only low.

Laser Activated Irrigation (LAI)—
a revolution
How can the major advantages of erbium laser radiation be maintained without having to accept the
application-related drawbacks? In 2007, Blanken et
al. described for the first time the intra-canal application of a pulsed erbium laser in the canal lumen
filled with NaClO.51 They observed a few interesting
effects: Each laser pulse caused great acceleration of
the fluid in the root canal. At the same time, they
proved a strong cavitation effect in the root canal.52
Both effects combined resulted in vitro in a cleaning
effect, which is superior to the passive ultrasonic irrigation (PUI), the previous gold standard of cleaning.53 LAI in root canals, however, had some disadvantages too.
Irrespective of the laser tip design, sometimes a lot
of irrigation fluid was extruded through the apical
constriction. This extrusion was significantly higher
than in conventional irrigation systems.54 Additionally, the formation of gas bubbles because of the laser
pulse may cause the irrigation fluid to vanish from the
respective canal section completely, which again may
cause thermal damage of dental hard tissue.55

PIPS®—the evolution of revolution
In 2010, DeVito presented a novel tip design for the
first time, combining all advantages of erbium laser
radiation, Laser Activated Irrigation (LAI) and the mi-

Fig. 7

nimisation of the risk of irrigation fluid being extruded
(Fig. 6).56

Fig. 7: Cavitation. Luther et al. 2001.

PIPS® is the abbreviation of Photon Initiated Photoacoustic Streaming. In this procedure, the PIPS® tip
is inserted only into the pulp cavity filled with irrigation fluid. The pulsed laser beam generates shockwaves in the irrigation fluid and cavitation effects in
the whole root canal system, intended to create a
cleaning effect in the entire canal system, including
isthmuses, lateral canals and deep down into the dentinal tubules, which is superior to any of the previous
techniques. The almost complete elimination of bacteria, smear layer, and biofilm was proven in the in vitro experiment for NaClO and for EDTA.57 No indication of irrigation fluid being extruded was noticed.58
What does the mechanism leading to this superior
cleaning effect look like? When the laser pulse starts,
the rapid heating of the irrigation fluid causes an expanding vapor bubble to form. The more the vapor
bubble expands, the more it cools down, leading finally to its implosion.
This affects the root canal in the following ways:
1. The volume changes of the vapor bubble lead
to heavy movement of the fluid in the root canal.59
2. The implosion of the bubble is a high-energy
process. Shockwaves with large amplitudes and
“micro-jets” develop. Shear stress builds up near
surfaces (primary cavitation).60
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3. In addition to the primary cavitation, secondary
cavitation processes are caused by the formation
of subsequent, smaller bubbles (Fig. 7).61
These laser-induced effects depend on the absorption spectrum of the endodontic irrigation medium.
That means: The better a certain medium absorbs the
laser radiation, the better is the primary and the
secondary cavitation effect. NaClO 5.3 %,
EDTA 17 % and water have almost the
same absorption spectrum.62
Wavelengths that are badly absorbed
by the irrigation fluid may cause damage
to the root canal walls, dentinal tubules, or
even the periodontal ligament. This is one
of the key differences between the two
erbium wavelengths. The absorption coefficient of Er:YAG at 2,940 nm is almost
twice as high as that of Er,Cr:YSGG. The
PIPS® system operates exclusively at the
wavelength of Er:YAG of 2,940 nm.

Fig. 8: Fotona LightWalker ® and
PIPS® handpiece.
Fig. 9: PIPS® tip in orifice.

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The manufacturer recommends the following settings for PIPS®: 50 µS pulse
length, 10 to 20 Hz and 0.15 to 0.5 W, i.e.
peak powers of 400 W up to 1,000 W are
achieved with each pulse due to the interaction with irrigation fluid. Air/water spray
is not required. These settings triggered
the shockwaves and the strong current of
irrigation fluid as described above.63 The
temperature of the root surface increased
by only 1.5 °C with the PIPS® activated for
20 to 40 s.64 Clinical application should
follow the manufacturer’s instructions.
At the end of the preparation, irrigation
with 17 % EDTA is performed to remove
the smear layer. The pulp cavity should be
flooded with EDTA. Then the PIPS® tip is
inserted into the orifice and activated for
30 seconds (Fig. 9). After rinsing intermediately with saline solution, rinsing with
NaClO is performed. This is followed by activating the NaClO twice for 30 seconds
respectively with a break of 30 seconds
between the intervals. A sufficient quantity of fluid in the orifice is important in
this procedure. If necessary, the assistant
needs to add irrigation fluid continuously.

The PIPS® tip design is also a key influence on the effectiveness of cleaning: It is
a 9 mm long tip with a diameter of 600 µm,
the apical 3 mm of which are not sheathed
Fig. 8
with polyamide and have a tapered end
(Fig. 6). The lacking sheath of the apical
3 mm results in better lateral emission. The tip is
The research results regarding PIPS® so far have
connected to the laser source (LightWalker®, Fotona, been promising. One study compared the bacterial
Slovenia) via a special endodontic handpiece. The reduction as well as the biofilm removal between
free axial flexibility facilitates the application even in PUI and PIPS® in vitro. The application of PIPS® redifficult anatomic situations (Fig. 8).
sulted in the reduction of bacterial contamination
by 99.5 %, the significantly better reduction of biofilm, and the significantly greater number of samples that are free from bacteria.65 In another study,
Jaramillo et al. compared the removability of biofilm
applying various techniques to activate the irrigation. Besides PIPS® (LightWalker®, Fotona, Slovenia),
these were the passive ultrasonic irrigation (PUI)
and sonic activation (EndoActivator). The laser-induced irrigation with PIPS® was significantly superior to all other techniques as regards removing the
biofilm (Fig. 10).66 Another study deals with the removability of calcium hydroxide from root canals.
The authors compared as well PIPS®, PUI, and sonic
activation of irrigation fluids. After the laser-activated irrigation with PIPS®, all the samples were free
from calcium hydroxide, 24 per cent still showed
residues in case of PUI.67 The removal of E. faecalis
from artificially infected root canals using PIPS®
and the sole irrigation with saline solution without
activation was the subject matter of another study.
The remarkable result of this study was the complete
removal of E. faecalis from all canals in the PIPS®
group, in which the preparation was effected only
Fig. 9
to the Pro Taper® F1 file.68 This study may be an in-

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Fig. 10: Dentinal tubules after PIPS ®
application. Jaramillo et al. 2010.

dicator that minimally invasive canal preparation
might be possible because of the good cleaning effect of PIPS®, certainly always depending on the anatomic situation.

PIPS®—the force awakens
The eradication of microorganisms and tissue
from the root canal system must be the goal of every
endodontic therapy. Complete removal of bacterial
contamination was achieved only rarely so far due
to complex anatomic canal structures and technology-related limitations. The development of PIPS®
to reduce bacteria by laser-induced activation of irrigation fluid could have the crucial advantage over
all currently known therapeutic procedures. The research results have been promising so far, but further studies should and will be conducted, in particular in vivo studies, to consolidate the positive trend.
All endodontic treatment steps must be implemented in the therapy using PIPS®. However, the superior cleaning effect of PIPS® seems to realise two
key advantages for dentists specialising in endodontics:
1. Improved cleaning effect of the canal systems,
which will result in an improved success rate of
endodontic therapies.
2. More substance-friendly preparation because of
the better cleaning effect. This preserves the dental
material, which again influences the fracture behavior of endodontically treated teeth directly.
The integration of PIPS® into a strictly antibacterial
endodontic treatment concept might improve the
therapeutic success of endodontic therapies again

Fig. 10

considerably. PIPS® will be in any case a clear evolution in endodontic treatment. Only the future can
show whether the introduction of PIPS® will revolutionise endodontology in a similar way as the introduction of NiTi files. However, the force of laser-induced irrigation has awakened._
Editorial note: Initially published by dental journal
edition 01/2016. A list of references is available
from the publisher.

contact
Dr Ralf Schlichting
Specialist in endodontics
Dr.-Hans-Kapfinger Straße 30
94032 Passau
www.endo-dontie.de

Kurz & bündig
Bei PIPS® (Photon Induced Photoacoustic Streaming) handelt es sich um eine photoakustische Spülmethode.
Durch die Energie eines Er:YAG-Lasers werden nichtthermische photoakustische Schockwellen erzeugt, mit denen die
Reinigungs- und Säuberungslösungen in den Kanal eingeführt werden. Nach dieser Behandlung sind die Kanäle und
Seitenkanäle gereinigt und die Dentinkanälchen von der Schmierschicht befreit. Zu Beginn des Laserimpulses kommt
es durch die rapide Erhitzung der Spülflüssigkeit zur Entstehung einer sich ausdehnenden Dampfblase. Je weiter sich
diese Dampfblase ausdehnt, desto mehr kühlt sie sich ab, was letztlich zu ihrer Implosion führt. Dies führt zu folgenden
Effekten im Wurzelkanal: Die Volumenänderungen der Dampfblase führen zu einer starken Flüssigkeitsbewegung im
Wurzelkanal.60 Die Implosion der „Bubble“ ist ein sehr energiereicher Prozess. Es kommt zur Ausbildung von Schockwellen mit großer Amplitude und zur Ausbildung von „micro-jets“. Nahe von Oberflächen kommt es zum Aufbau von
Scherspannungen (primäre Kavitation).61 Neben der primären Kavitation kommt es durch Ausbildung nachfolgender,
kleinerer „Bubbles“ zu sekundären Kavitationsprozessen (Bild 7).62 Diese durch Laser induzierten Effekte sind vom
Absorptionsspektrum des endodontischen Spülmediums abhängig, das bedeutet, je besser die Absorption der Laser
strahlung durch ein bestimmtes Medium, desto höher der primäre und sekundäre Kavitationseffekt. NaClO 5,3 %,
EDTA 17 % und Wasser haben annähernd dasselbe Absorptionsspektrum.
PIPS® ist ebenso wirksam als abschließende Spülung im Vorfeld der Obturation. Zur Anwendung von PIPS® in Ihrer
Praxis benötigen Sie einen Fotona Er:YAG-Laser.

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[26] =>

| practice management

Eleven tips for success
in your dental clinic
Part IV: ROI and PEST
Author: Dr Anna Maria Yiannikos, Germany & Cyprus

Welcome to the fourth part of the series Eleven tips
for success in your dental clinic. Our new tips are about
knowing how to choose the right investment for your
clinic in order to have the greatest possible ROI!

ample by asking them questions such as: What are the
most important treatments for you? Are you getting
what you are expecting from us? What new treatments and trends are you interested in?

Now what is ROI? ROI stands for the acronym
Return on Investment. Let’s explain the term a little bit
further. It shows our clinic’s ability to use its assets to
generate profits. How many of you have bought a new
equipment bursting with excitement and, six months
later, had completely forgotten about it and never
used it? How many of you bought an intra-oral camera and are still using it?

Never ever buy a new piece of technology because
your friend/competitor/colleague has done it! Why?
Because he does not have your patients. Please always remember this, it is very important!

I will present to you now a very unique protocol that
I use every time I purchase or I am thinking of purchasing new equipment or making an investment at my
clinic. This protocol includes four components:
1. Patients
2. Your clinic
3. The environment
4. The actual investment.
Now, for example, you are thinking of buying a new
piece of laser equipment:

Observe your patients’ needs
Which patient needs are we going to cover with laser treatments? Let’s brainstorm a little bit more on
this! By choosing a laser treatment instead of a conventional treatment, we can cover their needs for:
minimal pain, minimal or no anaesthesia, no drill
sound, less fear, anxiety or stress, minimal or no
bleeding, faster healing, reduced postoperative
complications, reduced chair time.
We are responsible to choose the investment with
the highest ROI and we can do it by asking our patients
for their needs based on an efficient protocol, for ex-

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2 2016

Furthermore, you can assess your patients by
yourself: What is your main target group? To which
society groups do they belong? Are they afraid of
the dental procedures or are they comfortable with
them? Do you have a lot of patients and need to make
more fillings in less time?

Know thyself and thy clinic
You can achieve this by learning in which areas we
should improve ourselves (clinic) and in which areas
we are in advantage. We can do that by using a very
essential tool every six or twelve months, the socalled SWOT analysis. This is composed of four elements: our strengths, weaknesses, opportunities and
threats as dentists. And we have already talked about
it in the first part of this series (please see laser
3/2015).

Analyse your environment
The third component of the protocol that I would
love to share with you is PEST analysis. PEST stands for
political, economic, social and technological environment. By knowing potential problems in advance, you
will be more prepared and capable of finding the correct solutions. By making effective use of PEST analysis, you ensure that what you are doing is positively
aligned with the forces of change that are affecting
our world. By taking advantage of change, you are

[27] =>

practice management

much more likely to be successful than if your activities oppose it. Good use of PEST analysis helps you to
avoid taking action which is condemned to failure for
reasons beyond your control.
PEST is useful when you start operating in a new
country or region. Applying PEST analysis helps you
to break free of unconscious assumptions, and helps
you to quickly adapt to the realities of the new environment. Its four components include:
– Political aspects: government type and stability,
regulation and de-regulation trends, social and
employment legislation, tax policy and trade/tariff
controls, environmental and consumer-protection
legislation, likely changes in the political environment
– Economic aspects: stage of business cycle, current
and projected economic growth, inﬂation and interest rates, unemployment and labor supply, labor
costs, tax system (corporate tax: 10% in Cyprus),
likely changes in the economic environment
– Socio-cultural aspects: population growth rate
and age profile, population health, education and
social mobility, and attitudes to these, population
employment patterns, job market freedom and
attitudes to work, press attitudes, public opinion,
social attitudes and social taboos, socio-cultural
changes

– Technological environment: impact of emerging
technologies, impact of Internet, reduction in communications costs and increased remote working.
Some years ago, Cyprus held the monopoly in communication services, but now the prices have dropped
dramatically since there are a lot of players in the market. For example changes, in the government policy
may affect the nature of treatments that may be
available, for example under the NHS. Changes in the
economic climate can have a direct impact on the
spending power of patients. The so-called ‘feel good
factor’ amongst home owners when interest rates are
low and house price inﬂation is high is one example of
how the state of the economics affects the mood of
consumers.
Social changes can also affect our practice. People
are tending to work longer hours. This could have an
effect on your practice opening hours. Or maybe
there are many people in your area who are older than
60 years old and, as a consequence, there is an increased need to treat this group of people. Or there
are less births and thus there is no need of orthodontists.
Technology has made a huge impact on our lives
and the internet in our workplace. We need to raise

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| practice management
vestment like an expert by applying the ELIT (Invest
Like an Expert Table) table excel formula.
The above protocol is one of the tools that you can
be taught by the DBA educational programme full
courses and seminars, including how to design your
own ELIT. In the next issue, we will reveal two brand
new tips and practical solutions that will help you
access new opportunities and potentials of your
dental clinics and change the way you see and make
business in dentistry. Until then, please remember
that not only are you the dentist in your clinic, but you
are also its manager and leader.

You can always send me your questions and
request for more information and guidance at
dba@yiannikosdental.com or via our Facebook account. Looking forward to our next trip of business
growth and educational development!_

the expectations of our patients, using for example
Google advertisements, Facebook pages etc.

Make an investment
The last element of this unique protocol is the investment itself. We should see to regaining our money
for this investment, as well as when and how we can
do that! I have designed a model that could assess
whether a dental investment is both viable and profitable according to the data of each clinic. For this,
I choose ROI and payback as parameters of assessment. You are going to learn how to choose your in-

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

Kurz & bündig
Im ersten Teil der Serie „11 Tipps zum wünschenswerten Erfolg in Zahnkliniken“ ging es darum, sich als Praxisinhaber intensiv mit den eigenen Fähigkeiten, Stärken und Schwächen auseinanderzusetzen. Der zweite Teil befasste
sich im Anschluss mit der Suche nach dem idealen Praxismitarbeiter. Im dritten Teil ging es dann ganz um den
Umgang mit den Patienten. Die Autorin zeigt den Lesern in fünf einfachen Schritten, wie sie ihr Terminmanagement
optimieren können und auf unvermeidbare Verzögerungen und Wartezeiten reagieren.
Im nun vorliegenden vierten Teil befasst sich die Autorin damit, wie Zahnärzte ermitteln können, welche Investition
in ihre Praxis sinnvoll ist. Das Akronym ROI umschreibt dabei den sogenannten Return on Investment, die Investitionsrentabilität. Anhand von vier Schritten lässt sich diese strategisch ermitteln, sodass eine gute Entscheidungsgrundlage
für mögliche Investitionen gegeben ist. Diese vier Aspekte umfassen die Erwartungen und Bedürfnisse der Patienten,
eine Stärken-Schwächen-Analyse der eigenen Person und Praxis, alle Faktoren im direkten und weiteren Praxisumfeld
sowie die finanziellen Aspekte der Investition.
Bei Analyse des Praxisumfelds stehen vier Faktoren im Fokus: politische Aspekte, insbesondere der Gesetzgebung,
wirtschaftliche Gesichtspunkte, soziokulturelle Einflüsse sowie der technologische Entwicklungsstand. Die Autorin erläutert alle Punkte ausführlich und gibt so einen Leitfaden zur Entscheidungsfindung. Seien Sie gespannt auf die
nächste Ausgabe der laser international magazine of laser dentistry, in der Ihnen die Autorin zwei weitere Tipps für Ihren
Praxiserfolg an die Hand gibt.

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2 2016

[29] =>

E

KT

16

T

LDU GSPU
N

N

FOR

BI

Fascination of Laser in Munich




25th INTERNATIONAL CONGRESS OF THE DGL
LASER START UP 2016
30 September — 1 October 2016
Munich | The Westin Grand hotel Munich

ORGANIZER/SCIENTIFIC CHAIR
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
Klinik für Zahnerhaltung, Parodontologie und
Präventive Zahnheilkunde
Universitätsklinikum der RWTH Aachen
Pauwelsstraße 30 | 52074 Aachen | Germany
Tel.: +49 241 8088-164 | Fax: +49 241 803388-164
sekreteriat@dgl-online.de | www.dgl-online.de
ORGANIZATION
OEMUS MEDIA AG
Holbeinstraße 29 | 04229 Leipzig | Germany
Tel.: +49 341 48474-308 | Fax: +49 341 48474-290
www.oemus.com | event@oemus-media.de
REGISTRATION
www.dgl-jahrestagung.de | www.startup-laser.de

Fax Reply +49 341 48474-290
I would like to receive further information on the:


25th International Congress of the DGL		
 LASER START UP 2016

Stamp

Title, Name, Prename

E-mail adress (for digital programme)

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[30] =>

| events

Fig. 1

© vichie81/Shutterstock.com

15 International WFLD
Congress—Preview
th

International laser summit in Nagoya, Japan
Author: Claudia Jahn, Germany

From 17 to 19 July 2016, Nagoya is going to host
the 15th International WFLD Congress with Hajime
Yamamoto and Isao Ishikawa as honorary presidents
and Kenji Yoshida as the Chair of the Organising
Committee. This year’s theme is going to be “Light to
brighten the future”—illustrating the society’s endeavour to move away from traditional laser dentistry
and dental care, towards new developments by incorporating light into both diagnosis and treatment.

Research and dental practice

Fig. 1: Nagoya, famous for its
light illuminations, welcomes
WFLD2016 with its theme
„Light to brighten the future“.

30

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2 2016

As the submission period has already ended in May
2016, the congress organisers are now finalising the
congress programme which is composed of invited
lectures, symposiums, workshops, oral and poster
sessions as well as exhibitions and seminars. International laser specialists from both engineering and
medical fields, including dentistry, will assemble to
deliver lectures and presentations on the latest scientific findings in their fields: Thus, the preliminary keynote lectures include topics such as “Er:YAG Laser
Supported Endodontic Retreatment” by Adam Stabholz (Israel), Aldo Brugnera Junior (Brazil) and Am-

brose Chan (Australia), “Low Level Laser Therapy in
Esthetic Dentistry” by Carlos de Paula Eduardo
(Brazil), Kenji Yoshida (Japan), Norbert Gutknecht
(Germany) and Samir Nammour (Belgium), and “Current Surgical and Therapeutic Uses with Future Prospects for CO2 Lasers in Oral and Maxillofacial” by Toni
Zeinoun (Lebanon) and Umberto Romeo (Italy). The
WFLD2016 organisers hope that the diverse programme will promote further advancement of academic research and clinical applications, heralding
“the beginning of a new development of medical devices and a new expansion of the industry in Japan”.

High scientific standards
Strict criteria and high standards were applied to
reviewing the scientific abstracts. For example, all
submissions with regard to research and studies on
human or animal subjects must abide by the Declaration of Helsinki of the World Medical Association,
which provides guiding principles for experimental
procedures. Furthermore, they must be approved by
an IRB (institutional review board). In addition, the
WFLD2016 Programme Committee has established

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events

its own set of submission guidelines (please see congress homepage for further information).

WFLD Basic Laser Certification
In order to give official accreditation for passing a
test on the basic knowledge of laser dentistry, WFLD
has developed a special Laser Certification course.
Lecturers will be high-calibre international professionals who are well-experienced in dental laser applications.

15th anniversary in Japan
WFLD’s history started in 1988 with the foundation
of ISLD (International Society for Laser in Dentistry). In
the same year, the first International Congress of Laser
Dentistry was held in Tokyo, Japan. Ever since then, the
society has been active as an international organisation for laser dentistry, holding its international congresses every two years in different locations. After
14 years, WFLD2016 is going to be the third congress
taking place in Japan. Since 2002, the JSLD (Japanese
Society for Laser Dentistry) has served as a full WFLD
member. History is coming full circle as Hajime Yamamoto, professor emeritus at Tokyo Medical and Dental
University and ISLD’s first president, is this year’s
WFLD Congress president. Isao Ishikawa, professor
emeritus at Tokyo Medical and Dental University and
this year’s second congress president, already was appointed congress president in 2002.

Industry meets history

modern-design shopping complex illuminated by
large-scale LEDs and fed on well water, has become its
flagship. Its axis pointing towards Nagoya Castle, this
piece of modern architecture builds a bridge to Nagoya’s ancient history._

contact
WFLD2016 Secretariat:
c/o Convention Linkage, Inc.
Asahiseimei Bldg., 3–32–20, Sakae, Naka-ku,
Nagoya, 460–0008, Japan
Tel.: +81 52 2625070
wfld2016@c-linkage.co.jp
Online registration closes 8 July, 2016.

Fig. 2

Fig. 2: Fountain and cherry-blossom
trees in Nagoya.
Fig. 3: Nagoya Castle.
Fig. 4: Spaceship-Aqua in Oasis 21,
one of Nagoya’s design flagships.

Nagoya is rich in both history and industry. Located
at the centre of Honshu, Japan’s main island, it is home
to traditional industries such as ceramics and textiles
as well as modern industrial branches like automobiles, aviation and machine tools. Not only does Nagoya thus play an important role in Japan’s industry,
but it also has become an international city of a population of 2.24 million people.
Nagoya’s main sites mirror this dichotomy of history and modernism: On the one hand, Nagoya is famous for its castle. Crafted in 1612, its magnificent
gold-plated kinshachi (tiger-headed dolphins) on the
topmost castle roof are notoriously the most wonderful of all kinshachi in Japan. On the other hand, Nagoya hosted the World Design Expo in 1989, leading
to aesthetic developments and modernisations in its
infrastructure. A major aspect of these changes,
which is still predominant today, is Nagoya’s famous
light illumination, creating a comfortable and safe atmosphere for citizens and visitors alike. This modern
influence is also palpable in Nagoya’s famous environment-friendly Oasis 21 area, combining parks,
public and commercial facilities. Spaceship-Aqua, a

Fig. 3
Fig. 4

[32] =>

| events

Fig. 1

“I want to spend the rest
of my life studying light”
Munich—Venue of the 25th DGL Congress
Author: Claudia Jahn, Germany

Born in Munich, legendary scientist Albert Einstein,
made this quote in 1905, at a time when the nature of
light was a highly discussed and controversial topic in
modern physics and especially quantum physics. One
hundred years later, the mechanisms of light have become an integral part in all aspects of society, science
and especially medicine. This year’s International Annual DGL Congress returns to Einstein’s birthplace:
From 30 September to 1 October 2016, Munich will
be hosting the 25th anniversary of the event which will
illuminate laser-light applications in dentistry.

Fig. 1: The 25 International Annual
Laser Congress of the DGL is held
in Munich during the this year’s last
Oktoberfest weekend.

The city of dreams

nichen—Latin for “Home of the Monks”—near a Benedictine monastery, Munich today is Germany’s
third-largest German community. With more than
1.4 million inhabitants, the Bavarian capital is home
to 2 million people in its metropolitan area alone,
among them more than 50,000 students at 13 different universities and enjoys a first-rate reputation as a
competence centre for science and medicine. More
than 90 museums, a rich theatre landscape and, of
course, the typically Bavarian beer gardens will make
sure that any visitor will find a place to pass the time.
Contrarily to its monastic originals, this mixture
makes for anything but a tranquil lifestyle.

The city of Munich is renowned for its relaxed and
joyful way of life, its big heart, its green parks and its
vast cultural landscape. Founded in 1158 as Apud Mu-

However, Munich is also called the German city of
dreams because of its romantic landscape and architecture. This includes the many buildings designed by

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2 2016

[33] =>

events

Fig. 2

Fig. 3
© demarcomedia/Shutterstock.com

Fig. 4

King Ludwig I, among them the Siegestor, the Königsplatz, and the Ruhmeshalle. Other famous Munich
sites are the Old and New Town Halls, the Frauenkirche
and Maximilianstraße, one of Munichs integral boulevards. Munich’s modern architecture is exemplified
by the Allianz Arena, the internationally renowned
football stadium. In addition, Munich features an
abundance of parks, among them the famous English
Garden, which is bigger than New York’s Central Park.

More than beer: diverse industry
Munich’s vast cultural landscape is balanced by its
diverse industry. The city has become a centre of
banking and finances as well as print, publishing and
television. Furthermore, it features manufacturers of
precision instruments, optical and electrical as well as
high technology appliances, among them important
branches of aerospace industry. In addition, you can
find one of Europe’s largest wholesale markets for
vegetables, fruits and animal produce in Munich. And
of course, finally, the Bavarian capital is home to several of Germany’s largest breweries. Industry and Munich’s general joy de vivre come together in celebrating the brewery sector every year with the famous
Oktoberfest.

Oktoberfest
Munich’s Oktoberfest originally started as a celebration of the marriage between Crown Prince Ludwig and Princess Therese in 1810. The name Oktoberfest presumably was coined when these celebrations
culminated in a grand horse race on 17 October in this
year. More than 200 years later, Oktoberfest is still

Fig. 5

held at the original venue Theresienwiese, located in
Munich’s borough Ludwigsvorstadt-Isarvorstadt
south-west of the city centre. In 2015, the site was
visited by more than 6 million people from around the
world. This year, even more visitors are expected.

25th International Annual DGL Congress

Fig. 2: Siegestor.
Fig. 3: View on the Marienplatz
with Munich’s Frauenkirche and
the new town hall.
Fig. 4 & 5: Beer-garden in the English
Garden and traditional bavarian beer
and brezel.

On this year’s last Oktoberfest weekend, DGL will
hold its 25th International Annual Congress in Munich.
Parallely to LASER START UP, the 46th DGZI Congress,
the 7th Munich Forum and the 5th Oral Hygiene Day,
the two-day event will feature top-level speeches
and workshops to enlighten its visitors on all aspects of modern laser dentistry. In addition, participants are invited to a culinary trip through
Munich, combining sightseeing via the Munich
tram, a diversity of culinary specialities and exclusive musical entertainment by a local DJ.
For more information on the 25th International Annual DGL Congress, please visit
www.dgl-jahrestagung.de._

contact
DGL – Deutsche Gesellschaft
für Laserzahnheilkunde e.V.
Pauwelsstraße 30
52074 Aachen, Germany
Tel.: +49 2418088164
Fax: +49 241803388164
www.dgl-online.de

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[34] =>

manufacturer news
Fotona

LA&HA Symposium review

The 6th Annual Laser & Health Academy Sym
posium took place in May at the Slovenian Alpine
resort of Lake Bled. During the symposium more
than 40 clinical experts from around the world
presented the latest innovations and applications
in the field of medical laser technology. The field
of laser dentistry was well represented this year,
with more than a dozen presentations on leading-edge topics such as TwinLight® treatments
in periimplantitis, periodontitis and endodontics,

as well facial aesthetics and sleep-disordered
breathing treatment with NightLase®. And of
course there were numerous opportunities for
networking and socialising with lecturers and fellow participants.
The annual LA&HA Symposium is held to exchange research and education among medical professionals in the field of laser medicine,
with a focus on practical instruction and presentations of the latest laser procedures and

LASOTRONIX

SMARTM dental diode laser –
versatile and functional
LASOTRONIX is launching its new diode-based
laser platform for dentistry, the SMARTM series.
SMARTM is offered as a combination of two lasers in one package, providing a wide range of
applications including microsurgery, dermatosurgery, endodontics, periodontology, whitening,
pain therapy, biostimulation and PAD (photoactivated disinfection).
Thanks to its thoughtful design that allows integration with the dedicated workstation or a dental unit, the SMARTM
laser meets the needs of every dental office
and assures perfect operation comfort. At the
same time, the small size of this versatile device
makes it very easy to carry around, enhancing
portability. The laser unit also features a very ad-

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2 2016

vanced user interface, including an expandable
database covering a set of predefined therapy
protocols, which can be modified and assigned
to a patient.
Combining two wavelengths (980 nm/10 W
and 635 nm/400 mW) in one functional device,
LASOTRONIX offers advanced dental laser services for all soft tissue
procedures. If you want
to join us and promote our innovative products,
please kindly contact us.
LASOTRONIX
ul. ˚ytnia 1
05-500 Piaseczno, Poland
www.lasotronix.pl

research. Over 400 participants attended at
this year’s meeting, which enjoyed an exceptionally high level of visitor engagement and
positive feedback. For further information, visit
www.laserandhealthacademy.com.
Fotona
Stegne 7
1000 Ljubljana, Slovenia
www.fotona.com

[35] =>

PROTECT-Laserschutz

New spectacles for diode laser in dentistry
The new laser safety spectacles
ONTOR and WINDOR XL offer optimum protection during treatments
with diode lasers (800–820 nm
wavelength) in dentistry (also usable for Excimer- and UV-laser). The
laser safety filter is characterised by
an excellent colour view and certification according to DIN EN 207.
The model ONTOR can be used as
spectacles for wearers of prescription
glasses and offers additional wearing
comfort due to a soft rubber cushion
in the forehead area. The temples can
be adjusted in temple length and angle. The eyewear is also available as
model WINDOR XL. The aerodynamic
spectacles convince with a wide field

of vision due to the wraparound lens
and a perfect fit due to ﬂexible sport
temples and soft nose pads.
PROTECT-Laserschutz GmbH is a
manufacturer of laser safety products, e.g. eyewear, curtains and barriers, as well as work safety products
from Nuremberg.
PROTECT-Laserschutz GmbH
Mühlhofer Hauptstraße 7
90453 Nuremberg, Germany
www.protect-laserschutz.de
AD

Publish your expertise!
Become an author for laser — international magazine of laser dentistry

laser
issn 2193-4665

international magazine of

Vol. 8 • Issue 2/2016

laser dentistry

2016

Laser treatment
of gingival melanin
hyperpigmentation

case report

Diode laser treatment
of recurrent aphthous stomatitis

industry

Laser-activated irrigation with PIPS®

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

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2 2016

[36] =>

international

Increasing number of pregnant

Brånemark performs first

Women seek
dental care

Osseointegration Surgery on amputee in US

A survey conducted by non-profit organisation Delta Dental Plans Association among over
1,300 parents of children aged 6–12 has shown
that more expectant women in the US are paying attention to oral health, an important area
of health that is frequently overlooked during
pregnancy. According to the survey, the number
of pregnant women going to the dentist has increased by nearly 7 per cent over the last year.

Discovered by Prof. Per-Ingvar Brånemark,
the concept of osseointegration has become
the basis for implant dentistry and revolutionised the treatment of edentulous patients worldwide. Continuing the work of
his late father, Dr Rickard Brånemark has
adapted the concept to orthopaedic surgery in order to improve the treatment of
amputees. His approach has been developed and applied for over 20 years, mainly
outside the US, however. Together with
his colleagues at the University of California, San Francisco (UCSF), Brånemark has
now performed the first osseointegration
surgery in the country.
Similar to dental implants, Osseointegrated Prostheses for the
Rehabilitation of Amputees

(OPRA) consist of an external
prosthesis anchored directly to
the patient’s remaining bone
through a permanently implanted titanium screw. Therefore, the
prosthesis always attaches correctly
and remains firmly in place, preventing
patients from suffering pressure sores,
pain, heat, chafing and general discomfort
often found with traditional solutions using a
socket.
The patient, George Kocelj, lost most of his
right leg owing to a rare nerve tumor caused
by neurofibromatosis. The 54-year-old had tried
several external prostheses before, but without
success. As the sockets of these prostheses
were unworkable for him, he largely had to rely
on a wheelchair.

Dental tourism and lasers to fuel

Growth of dental equipment market

In 2015, 57.5 per cent of mothers in the US reported that they had visited the dentist during their
pregnancy. The 2016 survey results show that the
number has now increased to 63 per cent. Owing
to hormonal changes, pregnant women are at an
increased risk of developing dental conditions,
including gingivitis and periodontitis. In order to
avoid these diseases, expectant women should
consult with a dentist on a regular basis.
Delta Dental Plans Association conducted the
Children’s Oral Health Survey between Dec. 16,
2015, and Jan. 14, 2016, among a nationally
representative sample. The data was released
to coincide with Pregnancy Awareness Month,
which was established in 2008 to provide support for expectant women and their families and
is celebrated annually during May. The campaign
focusses on four key initiatives: education, exercise, nutrition and wellness, as well as nurture.

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2 2016

Market research company Transparency Market Research has reported that the global
dental equipment market is expected to reach
US$ 7.6 billion by 2018, from US$ 5.5 billion in
2011, growing at a compound annual rate of
4.7 per cent from 2012 to 2018. Technological
innovations and increasing awareness of dental hygiene are contributors to the segment’s
growth, but high initial costs for dental equipment remain. The report analyses different types
of dental equipment, including dental radiology
equipment, systems and parts, laboratory machines and hygiene maintenance devices.
Dental lasers are predicted to grow at an accelerated pace owing to the increasing adoption of
minimally invasive surgical procedures that remove dental decay without harming the soft and
hard tissue. The growing ageing population

eFlow /
© Imag k.com
c
to
rs
Shutte

and the baby boomers are additional factors
for the rising demand for dental procedures.
The full report is available for purchase at
www.transparencymarketresearch.com/dentaldevices-market.html. The Grand
View Research report can be
bought at www.grandviewresearch.com/industry-analysis/
dental-equipment-market.

news

[37] =>

EU dentists concerned about

Increased pancreatic cancer risk

Future of dentistry

Certain oral bacteria may indicate

Researchers have found that the risk of developing pancreatic cancer is associated with specific bacteria in the mouth. They hope that the
findings could enable earlier and more precise
treatment of the disease. Other studies have
shown that pancreatic cancer patients are susceptible to periodontal disease, cavities and poor
oral health in general. Therefore, the research
team at the NYU Langone Medical Center set out
to search for direct links between the makeup
of bacteria driving oral disease and subsequent

development of pancreatic cancer. The researchers compared
bacterial contents in mouthwash samples from 361 American men and women who had
developed pancreatic cancer
with samples from 371 people
of matched age, sex and ethnic
origin who did not. They found
that men and women whose
oral microbiome included Porphyromonas gingivalis, a major
contributor to periodontal disease, had an overall 59 per cent greater risk of
developing pancreatic cancer than those whose
microbiome did not contain the bacterium. Similarly, people with oral microbiomes containing
Aggregatibacter actinomycetemcomitans, which
has been associated with severe periodontitis,
were at least 50 per cent more likely overall
to develop the disease. The findings were first
presented on April 19 at the annual meeting of
the American Association for Cancer Research
in New Orleans.

On 20 and 21 May, representatives of member
and observer organisations of the Council of
European Dentists (CED) gathered for the first
general meeting under the chairmanship of its
new president, Dr Marco Landi, in The Hague/
Netherlands. In addition to adopting policy statements on sugar, specialist dentists and dental
amalgam, delegates expressed concerns about
economic pressures affecting the profession.

©i

How electronic cigarettes affect

t/
ep

ut t

oc
r st

k .c

Oral health
New York researchers have received a grant
to determine the adverse health effects of
e-cigarette use on oral health for the first time.
“Based on compelling data from our preliminary
research, we hypothesise that e-cig aerosol
mixtures disrupt the oral cavity’s microenvironment, increasing vulnerability to periodontal disease,” said Dr. Deepak Saxena from the
New York University College of Dentistry, which
was awarded a four-year $ 1.6 million grant by
the National Institute of Dental and Craniofacial
Research (NIDCR).
“Smoking is a major risk factor for periodontal
diseases, immuno-suppression, and impairment

of soft tissue and bone cell function,” added
co-researcher Dr. Xin Li. “The prospective study
we proposed to the NIDCR entails the enrollment of 120 individuals.”
The researchers will recruit and
stratify members of the e-cigarette group by the type of disposable e-cigarette and number
of cartridges they consume per
week. “To determine the mechanism by which e-cig aerosol affects
oral health we will design a novel 3-D
epigingival tissue model to mimic the
oral microenvironment,” Li explained.

According to Landi, the meeting elucidated the
increase of commercial chains that in many
European countries are changing dentistry in a
direction that is motivated by short-term profits
rather than quality. “I am concerned with the
commercial drivers affecting patients’ rights to
receive dental health care in their best interests,” he said. “The CED will be dedicating more
resources to look into this issue.”
Moreover, the association advocated new regulations for dental amalgam that restrict the use
of the material to an encapsulated form and suggest the mandatory use of amalgam separators
from 1 January 2019. The CED is a non-profit
association that represents over 340,000 practising dentists from 30 European countries.

laser
2 2016

[38] =>

Tooth analysis finds advantages of

Will India be the next

Modern humans
vs. Neanderthals

Big dental market?

news

The Indian dental care services market is estimated to experience a double-digit growth rate,
reaching up to US$2.2 billion (147 bn. Indian
rupees) by 2020. According to Ken Research,
India has already witnessed a compound annual
growth rate of 12 per cent for the period of 2010
to 2015 as dental awareness and disposable income have increased. Taking into account factors
such as continued economic growth and reforms,
India might have the potential to become the
largest market for dental products and materials
worldwide.
According to the Indian Dental Association, India’s population of 1.2 billion had access to
180,000 dentists, including 35,000 specialists,
in 2014. This number is projected to grow to
300,000 by 2018. Around 5,000 dental laboratories and 300 dental institutes currently provide
basic and advanced oral health care. Expected
growth in the number of dental chains will increase the share of organised dental clinics
across the country. Although the vast majority of

dental products are imported from Germany, the
US, Italy and Japan, foreign companies continue
to invest in India and establish production units.
Most importantly, patient demand for better
health care facilities has increased.
The publication, India dental care service market outlook to 2020—Increasing awareness on
oral care and rising number of organised players
to foster future growth, is available online at
www.kenresearch.com. The report covers various aspects, such as market size, structure and
segmentation, as well as the demographics of
domestic and foreign customers.

international

Dental microwear texture analysis involves the
examination and analysis of wear features on
tooth surfaces at a sub-micrometre scale. By assessing the type and degree of wear on 52 molars
that were taken from the remains of European
and Levantine individuals from 37 sites dating
back to between 500,000 and 12,000 BP, the
study examined the possible influence of dietary
strategies on human development.

Better treatment of

Dry mouth disorders

The results show that the lineage was capable of
adapting to severe fluctuations between climatic
cycles of the Ice Age. However, while Neanderthals adapted their diet to the resources that were
most readily available and easily accessible, modern humans seemed to have invested more effort
in obtaining food resources with the help of tools,
for example, for getting at roots in the soil. It is
this use of new technology that may have given
modern humans a crucial benefit over the Neanderthals, the researchers concluded.
The study, titled “Neanderthal versus modern human dietary responses to climatic fluctuations”,
was conducted by researchers from the University of Tübingen in cooperation with colleagues
from the Max Planck Institute for Evolutionary
Anthropology in Leipzig in Germany and Stony
Brook University and the University of Arkansas in
Fayetteville in the US. The results were published
online on 27 April in the PLOS ONE journal.

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2 2016

A new study has now determined the previously
largely unknown mechanism that triggers salivary
secretion. The researchers from the University of
Rochester Medical Center hope that the findings
will help advance treatment for many diseases.
In the study, the researchers focused on intracellular calcium, which is involved in the production
and secretion of bodily fluids and regulates such
processes as muscle contraction, neurotransmitter release, insulin
secretion, and general such as gene
expression, proliferation
and cell death.
It is known that the presence
of the inositol 1,4,5-trisphosphate (IP3) receptor

is necessary to increase intracellular calcium.
The researchers discovered that all four IP3
molecules are required to activate the channel
for calcium to increase in a cell and initiate processes like fluid secretion. This ensures that the
calcium channel only opens under strict conditions, avoiding harmful discharge that could kill
cells, the researchers explained. The study, titled
“Defining the stoichiometry of inositol
1,4,5-trisphosphate binding required to
initiate Ca2+ release,” was published in the April issue of the
Science Signaling journal. It
was conducted in
collaboration with
the University of
British Columbia in
Canada.

Kyrillos /Shu

tter stock.c

[39] =>

[40] =>

| industry

Introducing
LASOTRONIX—
lasers for generations

om
]

With more than twenty years of experience in laser
technology, LASOTRONIX covers a wide range of dental applications thanks to a variety of diode sources
and therapy accessories. Cutting-edge technology is
the trademark they all have in common: one unit is set
to equal five different devices, making the use of CO2,
Nd:YAG, low-power diode lasers, PAD lamp or an
ozone equipment as well as teeth whitening lamps.
Applying the most powerful laser results in the shortest possible treatment time and low operating costs.

plex. In addition, accessories such as wide range of
fibre delivery systems, application end tips and a
variety of surgical handpieces provide maximum

v ersatility. As a result, SMARTM is suitable for a vast
number of t herapies, including microsurgery, endo
dontics, periodontology, whitening, biostimulation
and photoactived disinfection.
The laser unit also features very advanced user interface including an expandable database covering a
set of predefined therapy protocols, which can be
modified and assigned to a patient. Its unique versatility makes SMARTM an essential asset to any modern
dental office._

Only recently, LASOTRONIX has launched its new
diode laser SMARTM, especially designed for dentistry.
Combining two laser wavelengths (635 nm/400 mW
and 980 nm/10 W) enable achieving both photo
thermal and photobiochemical effects and cover all
soft tissue procedures by one device.
Fast cutting and coagulation as well as “cold” stimulation and disinfection never was so easy and com-

laser

2 2016

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

[41] =>

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

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

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

self-employed

employed

civil servant

student

dental assistant

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

Street:

Phone/fax:

Email:

Private/place:

Street:

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

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

and are working with the laser type
(exact name)

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

Signature

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

IBAN:

BIC:

Credit institute:

Signature of account holder

This declaration is valid until written notice of its revocation

[42] =>

E

KT

16

T

LDU GSPU
N

N

FOR

BI

Faszination Laser in München




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

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

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

25. Internationale Jahrestagung der DGL		
 LASER START UP 2016

Praxisstempel

Titel, Name, Vorname

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

laser 2/16

[43] =>

  |

editorial

Und es bewegt
doch etwas!

Dr. Georg Bach

Liebe Kolleginnen und Kollegen!
Als ich den Inhalt dieser Ausgabe, welche Sie nun in Händen halten, erstmals zu Gesicht bekam, fiel mir
spontan der Satz des berühmten Galileo Galilei ein, das er beim Verlassen des Inquisitionsgerichtes gemur
melt haben soll, wo man ihn gezwungen hatte, dem kopernikanischen Weltbild abzuschwören: „Und sie
bewegt sich doch!“
In Anlehnung an dieses weltberühmte Zitat würde ich Ihnen gerne zurufen: „Und es bewegt doch etwas –
das Laserlicht!“ und Ihnen dabei wärmstens die Lektüre dieser Ausgabe ans Herz legen. Ob Entfernung
von Melaninhyperpigmentierungen, ob Behandlung rezidivierender Aphthen, oder Biomodulation von Ge
weben – wer will da noch ernsthaft die Sinnhaftigkeit und vor allem die Nachhaltigkeit laserunterstützter
Anwendungen in der Zahnheilkunde infrage stellen? Auch wenn das direkte Umfeld – auch hier übrigens
eine interessante Parallele zu Galilei und seiner Zeit – dieser Erkenntnis nicht immer wohlgesonnen gegen
übersteht, steht für mich außer Frage, dass der Einsatz des monochromatischen und kohärenten Lichtes
eine der ganz wesentlichen Erweiterungen des Therapiespektrums unserer Zahnheilkunde in den vergan
genen Jahrzehnten darstellt, in der Tat ein therapeutisches Geschenk!
Als beredter Beweis hierfür möge Ihnen einerseits die vorliegende Ausgabe der laser international magazine
of laser dentistry dienen. Wer jedoch mehr wissen und erfahren möchte, hat indes in den nächsten Wochen
zwei ganz hervorragende Möglichkeiten dafür:
Gleich zwei Aktivposten der modernen Laserzahnheilkunde richten in den kommenden Wochen sehr
schöne Veranstaltungen zur Laserzahnheilkunde aus. Da ist zum einen der 15. WFLD Congress in Japan zu
nennen, und dann im Herbst der bereits 25. (Jubiläums-)Kongress der DGL. Beide mit bedeutenden Referen
ten bestückte Veranstaltungen bieten Gewähr für ein hervorragendes wissenschaftliches Programm in ei
nem jeweils hochattraktiven Umfeld. Nutzen Sie diese Gelegenheiten!
Und so wünsche ich Ihnen zunächst viel Spaß und Erkenntnisgewinn beim Lesen der aktuellen Ausgabe
der laser und ferner auch, dass Laserlicht auch bei Ihnen und in Ihrer täglichen Arbeit etwas „bewegen“ möge!
In diesem Sinne grüße ich Sie herzlich und kollegial!
Ihr

Dr. Georg Bach

laser
2 2016

43

[44] =>

news

germany

20. Jubiläum:

LASER START UP 2016 in München

Save the
Date
30. Sept
ember/
1. Oktob
er

Programm

Abb. 1

Abb. 2

Abb. 3

Abb. 1: Tagungsleiter Dr. Georg Bach. – Abb. 2 und 3: Expertenworkshops vermitteln relevante praktische Aspekte der Laserzahnmedizin.

Am 30. September und 1. Oktober 2016 findet im Münchner Hotel The Westin
Grand zum 20. Mal der LASER START UP statt. Die Einsteigerveranstaltung
für künftige Laser-Anwender kehrt damit auch räumlich in gewisser Weise
an ihren Ursprung zurück, denn genau vor zwanzig Jahren war in München
der Auftakt für diese erfolgreiche Kongressreihe, die heute in Kooperation
und unter wissenschaftlicher Leitung der Deutschen Gesellschaft für Laserzahnheilkunde (DGL) e.V veranstaltet wird. Die Tagungsleitung liegt auch in
diesem Jahr in den Händen von Dr. Georg Bach/Freiburg im Breisgau.
Der Einsatz von Laserlicht besitzt in der Humanmedizin einen sehr hohen
Stellenwert. Wenn sich angesichts dieses schier unbegrenzten Indikationsspektrums der Laser hingegen in unseren Zahnarztpraxen noch nicht komplett und flächendeckend etabliert hat, so gab es dafür in der Vergangenheit
im Wesentlichen zwei Gründe: Zum einen gab es keine universell einsetzbare
Lasergerätschaft für alle Anwendungen in der Zahnheilkunde und zweitens

waren Laser im Vergleich zu herkömmlichen Instrumenten relativ teuer. Die aktuellen Dentallaser jedoch
sind flexibel, leistungsfähig und letztlich wirtschaftlich. Weiterhin gilt: Der Laser kann in der Zahnmedizin in der Regel nichts,
was nicht auch mit konventioneller Therapie erreichbar wäre. Aber, und das
ist entscheidend, der Laser kann vieles einfacher, schneller und im Verhältnis von Aufwand und Ergebnis deutlich wirtschaftlicher. Genau hier liegt eine
ganz wesentliche Chance für einen Lasereinsatz, und was das technische
Niveau und die Vielfalt der Einsatzmöglichkeiten anbelangt, waren Dental
laser noch nie so perfekt und ausgereift wie heutige Gerätschaften.
Der LASER START UP 2016 wird in diesem Zusammenhang fachliche Grundlagen in Form von wissenschaftlichen Vorträgen und Hands-on-Kursen vermitteln sowie einen Überblick über die für dieses spezielle Therapiegebiet
relevanten Produkte und Anbieter geben.

Neuer Höchststand bei

Ärztemangel in Deutschland
Im Vergleich zum Vorjahreszeitraum stieg die Nachfrage nach Ärzten um mehr als 14 Prozent, die Anzahl
der Stellenausschreibungen für Pflegepersonal sogar
um rund 35 Prozent. Damit erreichen beide Berufsgruppen dem StepStone Fachkräfteatlas
zufolge neue Höchststände seit Beginn der
Messung im Jahr 2012.
„Diese Entwicklung wird sich zukünftig
noch verschärfen. Der demografische
Wandel sorgt für ein weiter steigendes Patientenaufkommen. Doch schon
heute können längst nicht alle offenen
Stellen mit qualifiziertem Personal be© Andrey_Popov/Shutterstock.com
setzt werden. Arbeitgeber im Gesundheits-

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2 2016

bereich befinden sich mittendrin im ‚War for Talents‘“,
erklärt StepStone Arbeitsmarkt-Expertin Dr. Anastasia
Hermann. Jeder zweite Arzt und jede zweite Pflegefachkraft nimmt an, bei Bedarf innerhalb von nur drei Monaten
eine passende neue Stelle zu finden.
Bei einem Jobwechsel erwarten sieben von zehn Ärzten
und Pflegefachkräften ein höheres Gehalt. Mehr als jeder Zweite wünscht sich mehr inhaltliche und organisatorische Freiheiten. Gerade bei Positionen, die aufgrund
von tariflichen Bestimmungen wenig Handlungsspielraum bei Gehaltsfragen lassen, kann Gestaltungsfreiheit
im Job daher ein entscheidendes Argument sein.
Quelle: ZWP online

[45] =>

Mehr Aufmerksamkeit für

Plaque enthält

Parodontale Gesundheit

Mehr DNA als Zähne
oder Knochen

Nachdem die Briten aufgrund ihrer desaströsen Zähne immer wieder in den Fokus lokaler Medien rückten, startete nun die BSP, die
British Society of Periodontology, unter dem
Claim #howsyoursmile eine landesweite Kampagne, um Menschen verstärkt für das Thema

Zahnfleischerkrankungen und die in diesem Zusammenhang stehenden Auswirkungen auf die
Gesundheit zu sensibilisieren.
Die Initiatoren der innovativen Medienkampagne griffen dabei auch auf die Macht der
sozialen Netzwerke zurück und machten sich
diese geschickt zunutze. In Pubs, Praxen und
an Universitäten wurden sogenannte Face
Cards verteilt, die ausgeschnitten werden und
zeigen sollen, wie Menschen mit Parodontose
aussehen können. Neben der Face Cards Kampagne, die sich vorrangig auf Facebook großen
Interesses erfreut, läuft auch eine landesweite
Videokampagne in Einkaufszentren und an
Haltestellen.
Parodontitis ist nicht zu unterschätzen – 45 Prozent der Briten leiden an dieser Erkrankung.
Daher erhofft man sich von der Kampagne, dass
diese das Bewusstsein für regelmäßige Mundhygiene und den Zahnarztbesuch schärft.

Wissenschaftlern des American Journal of
Physical Anthropology ist es gelungen, aus
700 Jahre alten Plaque DNA zu sequenzieren.
Damit haben sie nicht nur eine neue Möglichkeit gefunden, Rückschlüsse auf das Leben im
Mittelalter zu finden, sondern auch eine zuverlässige Quelle, die mehr DNA enthält als Zähne
oder Knochen.

Quelle: ZWP online

Zahnﬂeischentzündung hemmt

Positive Effekte von Sport
Schlechte Mundhygiene wirkt sich in vielen
Fällen negativ auf die Gesundheit des gesamten Körpers aus. Eine neue Studie hat jetzt herausgefunden, dass Zahnfleischentzündungen
sogar die positiven Effekte von Sport ganz und
gar zunichtemachen können.
Je älter wir werden, desto mehr verkürzt sich
die DNA, die für die Erneuerung unserer Zellen
zuständig ist. Ausreichend
Sport kann diesen Prozess jedoch deutlich
verlangsamen oder
sogar ganz stoppen
und sich positiv auf

unser biologisches Alter auswirken. Dadurch
bleiben wir länger jung und fit. Bei Untersuchungen konnte Prof. Jörg Eberhard allerdings
feststellen, dass sich die DNA bei Personen,
die zwar Sport treiben, gleichzeitig aber auch
Parodontitis aufweisen, genauso schnell verkürzt wie bei den sogenannten Couch-Potatos.
Im Gegensatz zur Kontrollgruppe, ebenfalls
sportlich, aber mit einer tadellosen
Mundgesundheit. Effektive Zahnpflege hält also nicht nur gesund,
sondern auch jung.
Quelle: ZWP online

Was für den Zahnarzt ein Albtraum ist, entpuppt sich einer neuen Studie zufolge als
wahrer Schatz für Anthropologen: Plaque.
Die unliebsame Ablagerung an den Zähnen
besteht nicht nur aus Speiseresten und Bakterien, sondern konserviert in Kombination mit
Speichel auch die menschliche DNA. Die Versteinerung beginnt schon zu Lebzeiten, wenn
sie nicht regelmäßig entfernt wird.
Zum Glück, für die Forscher, war die Zahnpflege vor 700 Jahren noch nicht weit fortgeschritten, sodass Plaque mit ausreichend
menschlicher DNA noch heute vorhanden ist.
Die Wissenschaftler können aus den gewonnenen Erkenntnissen Rückschlüsse auf Populationen und Migrationen ziehen, die bis dato
unbekannt waren.
Quelle: ZWP online

laser
2 2016

[46] =>

news

germany

Lasergestützter Ansatz zur

Schmerzfreien Antischnarchtherapie
Studien schätzen, dass ca. 45 Prozent aller
Männer und 30 Prozent aller Frauen regelmäßig schnarchen. Was viele Patienten nicht wissen: Mit der laserbasierten und schonenden
Antischnarchtherapie kann Abhilfe geschaffen
werden. Die Anti
schnarchtherapie ist
eine patentgeschützte, schnelle,
noninvasive und schonende
Methode, um die Schlafqualität von Patienten zu
verbessern. Sie mindert
die Gefahr eines Atemstillstands im Schlaf
und reduziert Schnarchen durch die Nutzung
von sanftem, oberflächlichem Er:YAG-Laserlicht. Die
Therapie erfordert keine Hilfs-

mittel oder Geräte, die vom Patienten nachts
getragen werden müssen, keine Behandlung
mit Medikamenten und keine Anästhetika. Um
ihre Indikationen um die Antischnarchtherapie
erweitern zu können, benötigen Zahnärzte einen Fotona Er:YAG-Laser. Henry Schein
bietet Hands-on-Trainings zur Anti
schnarchtherapie, um sich mit
dem Therapieablauf vertraut
zu machen. Hier werden
die richtige Anwendung
der neuen Therapieform
sowie überzeugende Patientenkommunikation vermittelt. Nähere Infos unter:
www.henryschein-dental.de
Quelle: ZWP online

Analyse des Fraunhofer Insituts lässt

Duromere durch Laser sprengen
Duromere konnten sich in den vergangenen
Jahrzehnten zu Hochleistungswerkstoffen entwickeln. Zu verdanken haben sie dies hauptsächlich den eingesetzten Harzen und Härtern.
Wissenschaftler des Fraunhofer-Instituts für Betriebsfestigkeit und Systemzuverlässigkeit LBF
haben nun, basierend auf der Expertise in der Polymertechnik, eine Analytik erarbeitet, mit der sie
die verwendeten Harze und Härter in Duromeren
erstmalig chemisch charakterisieren können.
Zur Identifizierung der verwendeten Harze und
Härter haben die Wissenschaftler des Fraunhofer
LBF die „Matrix-freie Laser Desorption/Ionization
Time-of-Flight Mass Spectrometry“, kurz LDI-

ToF-MS evaluiert. Bei diesem Ansatz „sprengen“
die Wissenschaftler mit einem intensiven Laser
impuls Fragmente aus dem Netzwerk des Duromers heraus. Mit der LDI-ToF-MS steht nun eine
Analytik zur Verfügung, die es kunststoffverarbeitenden Unternehmen und Anwendern ermöglicht,
ihre Duromere am Fraunhofer LBF charakterisieren zu lassen. Auf diese Weise ergeben sich im
Schadensfall neue Wege bei der Ursachenfeststellung, beispielsweise ob die eingesetzten Harze oder Härter bei einem Materialversagen mit der
Ausgangscharge chemisch identisch sind. Darüber hinaus können Unternehmen ihre Produkte
verbessern oder neuartige Duromere entwickeln.
© Fraunhofer LBF

laser

2 2016

Leseprobe

Gebündeltes Expertenwissen:

Jahrbuch
Laserzahnmedizin 2016
Mit der umfassend überarbeiteten und erweiterten 17. Auflage des Jahrbuchs Laserzahnmedizin
legt die OEMUS MEDIA AG das aktuelle Kompendium zum Thema Laser in der Zahnarztpraxis
vor. Renommierte Autoren aus Wissenschaft,
Praxis und Industrie informieren im Jahrbuch
Laserzahnmedizin 2016 über die Grundlagen
der Lasertechnologie und geben Tipps für den
Einstieg in diesen Fachbereich der Zahnmedizin
sowie dessen wirtschaftlich sinnvolle Integration
in die tägliche Praxis. Darüber hinaus sind die im
Jahrbuch enthaltenen aktuellen wissenschaftlichen Beiträge auch für jeden Laseranwender von
Interesse. Etliche Fallbeispiele und zahlreiche Abbildungen dokumentieren die breite Einsatzmöglichkeit der Lasertechnologie. Relevante Anbieter stellen ihr Produkt- und Servicekonzept vor.
Thematische Marktübersichten ermöglichen die
schnelle Information über CO2-, Er:YAG-, Nd:YAGund Diodenlaser. Präsentiert werden bereits eingeführte Produkte sowie Innovationen, die helfen
können, neue Potenziale zu erschließen.
Bei allen von der OEMUS MEDIA AG organisierten Veranstaltungen zum Thema Laserzahnmedizin erhalten die Teilnehmer das Jahrbuch
Laserzahnmedizin kostenfrei.
Das Jahrbuch Laserzahnmedizin 2016 ist derzeit
zum Preis von 49 Euro (zzgl. MwSt. + Versand)
im Onlineshop erhältlich: www.oemus-shop.de/
jahrbücher. Die Neuauflage, das Jahrbuch Laserzahnmedizin 2017, wird anlässlich des dies
jährigen DGL-Kongresses am 30. September und
1. Oktober in München erscheinen.

[47] =>

Antwort:
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
c/o Universitätsklinikum Aachen
Klinik für Zahnerhaltung
Pauwelsstraße 30
52074 Aachen

Tel.: 0241 8088164
Fax: 0241 803388164
E-Mail: sekretariat@dgl-online.de
Bank: Sparkasse Aachen
IBAN: DE56 3905 0000 0042 0339 44
BIC: AACSDE33

Aufnahmeantrag (Deutsch)
Name/Titel:
Vorname:
Geb.-Datum:
Approbation:
Status:

selbstständig

angestellt

Beamter

Student

ZMF/ZAH

Adresse: Praxis/Dienststelle/Institut (Unzutreffendes bitte streichen)
PLZ/Ort:

Straße:

Telefon/Fax:

E-Mail:

Privat/Ort:

Straße:

Aufgrund des bestehenden Assoziationsvertrages zwischen der DGL und der DGZMK fällt zusätzlich ein reduzierter Jahresbeitrag für
die DGZMK an (85,00 € p.a., falls Sie noch nicht Mitglied der DGZMK sind). Der Beitragseinzug erfolgt durch die DGZMK-Geschäftsstelle,
Liesegangstr. 17a, 40211 Düsseldorf. Sie werden hierfür angeschrieben.

Mit der Stellung dieses Aufnahmeantrages versichere ich, dass ich
seit dem
mit einem Laser des Typs

in der eigenen Praxis
arbeite. (genaue Bezeichnung)

in der Praxis

beschäftigt bin.

in der Abt. der Universität

beschäftigt bin.

Ich beantrage die Aufnahme in die Deutsche Gesellschaft für Laserzahnheilkunde e.V.
Ort, Datum

vollständige Unterschrift

Jahresbeitrag: Für stimmberechtigte Mitglieder bei Bankeinzug 150,00 €.
Sofern keine Einzugsermächtigung gewünscht wird, wird ein Verwaltungsbeitrag von 31,00 € p.a. fällig.
EINZUGSERMÄCHTIGUNG
Ich bin einverstanden, dass der DGL-Mitgliedsbeitrag von meinem Konto abgebucht wird.
Name:

IBAN:

BIC:

Geldinstitut:

Unterschrift des Kto.-Inhabers

Diese Erklärung gilt bis auf schriftlichen Widerruf

[48] =>

news

germany

BI-TRE-Projekt für lasergestützten

Neue Lasertherapie zur

Wundverschluss in
der Oralchirurgie

Verhinderung von Zahnausfall
knapp 9.000 Euro soll die Behandlung kosten.
Und auch danach gibt es keine Garantie für eine
langfristige Besserung. Ob eine solche Lasertherapie also besser ist als eine regelmäßige professionelle Zahnreinigung, muss nach Angaben der
Experten erst noch weiter getestet werden.
Quelle: ZWP online

Mit Partnern aus Deutschland, Israel, Lettland und
der Toscana wird im Projekt „Biophotonic Technologies for Tissue Repair BI-TRE“ der Einsatz
biophotonischer Technologien im industriellen,
klinischen und medizinischen Bereich konsequent
vorangetrieben. Eine dichte Wundabdeckung, ein
zuverlässiger Schutz vor eindringenden Keimen
als auch ein haftender Verband ist im MundRachen-Raum auch heutzutage immer noch ein
ungelöstes Problem der Oralchirurgie. Durch den
im BI-TRE-Projekt erforschten Ansatz zur Wundabdeckung mit Kollagenmembranen, welche lasergestützt an der Schleimhaut befestigt werden,
wird eine neue Lösung erarbeitet. Behandlungskosten und Behandlungszeit lassen sich erheblich
reduzieren, dem Patienten kann eine Transplantation auf diese Weise erspart werden.

Eine neue Lasertherapie könnte jetzt dabei helfen,
bereits lockere Zähne wieder fest zu verankern.
Die Behandlung soll schlechte Bakterien abtöten
und gleichzeitig die Knochenbildung anregen.
Perioblast (Periodontal Biological Laser-Assisted
Therapy) wurde von Dr. Francesco Martelli, einem
Kieferchirurgen aus Florenz, entwickelt und bereits erfolgreich angewendet. Mithilfe des Lasers
werden die Bakterien abgetötet, die für Zahnfleischblutungen verantwortlich sind. Gleichzeitig werden Zellen angeregt, die Knochenbildung
voranzutreiben, um den betroffenen Zahn wieder
stabiler im Kiefer zu fixieren. Eine Studie mit
2.683 Patienten, die Anfang des Jahres im
European Journal of Clinical Microbiology
& Infectious Diseases veröffentlicht wurde, konnte bereits erste vielversprechende Ergebnisse liefern. Demzufolge wurde schon nach drei Sitzungen
eine Reduzierung der Bakterien
festgestellt. Umgerechnet 6.000 bis

Spezialisten-Newsletter zum

Themenschwerpunkt Laserzahnmedizin

Die Anpassung der Laserstrahlquelle, die Konstruktion eines speziellen Handstücks, die
Entwicklung geeigneter Wundauflagen und die
Integration einer Temperatursensorik sind notwendige Voraussetzungen zur erfolgreichen Realisierung des Ansatzes. Innerhalb des Projekts
übernimmt das Fraunhofer-Institut für Laser
technik ILT die Projektkoordination sowie die
Prozessentwicklung für die erfolgreiche Laserfixierung einer Kollagenmembran. BI-TRE wird
durch das Bundesministerium für Bildung und
Forschung BMBF gefördert, Projektträger ist das
VDI Technologiezentrum.
Quelle: ZWP online

laser

2 2016

Neben den bereits bestehenden Newslettern hat
ZWP online das Angebot an monatlichen Updates
zu Spezialthemen der Zahnmedizin erweitert.
Gerade für Spezialisten ist es unausweichlich, im
eigenen Tätigkeitsschwerpunkt immer auf dem
aktuellsten Stand zu sein. Die Informationsbeschaffung und -selektion ist im normalen Praxisalltag angesichts der allgemeinen Informationsflut nicht immer ganz so einfach. Hier setzen
die Spezialisten-Newsletter von ZWP online
an, die zusätzlich zu dem bereits bestehenden
Newsletter-Portfolio erscheinen. Die Spezialisten-

Newsletter unterscheiden sich in Layout und
Struktur, aber vor allem durch ihre thematische
Fokussierung, vom sonstigen Angebot. Darüber hinaus enthalten sie neben Nachrichten ein
thematisches Video sowie die E-Paper-Verlinkung zur aktuellen Ausgabe der entsprechenden
Fachpublikation der OEMUS MEDIA AG. Diese
Newsletter bieten in einem spezialisierten redaktionellen Umfeld interessierten Unternehmen eine ideale Plattform zur Präsentation von
Produkten und Veranstaltungen sowie sonstigen
marktrelevanten Informationen.

[49] =>

49 € *

49 € *
49 € *

69 € *

49 € *

OEMUS MEDIA AG
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Tel.: 0341 48474-0
Fax: 0341 48474-290
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* Preise verstehen sich zzgl. MwSt. und Versandkosten (Kein Rückgaberecht).

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Jahrbuch Digitale Dentale Technologien 2016
Exemplar(e)
Praxisstempel

laser 2/16

Datum/Unterschrift

[50] =>

| imprint

laser
international magazine of

laser dentistry

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

Senior Editors
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Dimitris Strakas, Kenneth Luk, Mukul Jain,
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Anna-Maria Yannikou, Ryan Seto, Joyce Fong,
Iris Brader, Masoud Mojahedi, Gerd Volland,
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Executive Producer
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meyer@oemus-media.de
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Sandra Ehnert
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Published by
Oemus Media AG
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Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de
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Printed by
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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
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Copyright Regulations

laser international magazine of laser dentistry is published by OEMUS MEDIA AG and will appear in 2016 with one issue every quarter. The
magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inad
missible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
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assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or
faulty r epresentation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.

50

laser

2 2016

[51] =>

laser
international magazine of

"

laser dentistry

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[52] =>

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[cover] => laser international No. 2, 2016

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