laser international No. 3, 2011
Array
(
[post_data] => WP_Post Object
(
[ID] => 56141
[post_author] => 0
[post_date] => 2011-10-19 16:34:35
[post_date_gmt] => 2011-10-19 16:34:35
[post_content] =>
[post_title] => laser international No. 3, 2011
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => laser-international-no-3-2011-0311
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 19:56:23
[post_modified_gmt] => 2024-10-21 19:56:23
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/epaper/la0311/
[menu_order] => 0
[post_type] => epaper
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56141
[id_hash] => 97ee3278e22d58d4fbc506ced93e6a2d232244f098bdfa25694b495d89ec3ae4
[post_type] => epaper
[post_date] => 2011-10-19 16:34:35
[fields] => Array
(
[pdf] => Array
(
[ID] => 56142
[id] => 56142
[title] => LA0311.pdf
[filename] => LA0311.pdf
[filesize] => 0
[url] => https://e.dental-tribune.com/wp-content/uploads/LA0311.pdf
[link] => https://e.dental-tribune.com/epaper/laser-international-no-3-2011-0311/la0311-pdf-2/
[alt] =>
[author] => 0
[description] =>
[caption] =>
[name] => la0311-pdf-2
[status] => inherit
[uploaded_to] => 56141
[date] => 2024-10-21 19:56:17
[modified] => 2024-10-21 19:56:17
[menu_order] => 0
[mime_type] => application/pdf
[type] => application
[subtype] => pdf
[icon] => https://e.dental-tribune.com/wp-includes/images/media/document.png
)
[cf_issue_name] => laser international No. 3, 2011
[contents] =>
)
[permalink] => https://e.dental-tribune.com/epaper/laser-international-no-3-2011-0311/
[post_title] => laser international No. 3, 2011
[client] =>
[client_slug] =>
[pages_generated] =>
[pages] => Array
(
[1] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-0.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-0.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-0.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-0.jpg
[1000] => 56141-85c20753/1000/page-0.jpg
[200] => 56141-85c20753/200/page-0.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[2] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-1.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-1.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-1.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-1.jpg
[1000] => 56141-85c20753/1000/page-1.jpg
[200] => 56141-85c20753/200/page-1.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 56143
[post_author] => 0
[post_date] => 2024-10-21 19:56:17
[post_date_gmt] => 2024-10-21 19:56:17
[post_content] =>
[post_title] => epaper-56141-page-2-ad-56143
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-56141-page-2-ad-56143
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 19:56:17
[post_modified_gmt] => 2024-10-21 19:56:17
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-56141-page-2-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56143
[id_hash] => 61fa9232086bd0f321c2cc48ba456d2a0d1d7eea5525ca42b2a765416722bde3
[post_type] => ad
[post_date] => 2024-10-21 19:56:17
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/content/id/47
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-56141-page-2-ad-56143/
[post_title] => epaper-56141-page-2-ad-56143
[post_status] => publish
[position] => 0.35,0.27,87.33,98.91
[belongs_to_epaper] => 56141
[page] => 2
[cached] => false
)
)
[html_content] =>
)
[3] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-2.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-2.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-2.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-2.jpg
[1000] => 56141-85c20753/1000/page-2.jpg
[200] => 56141-85c20753/200/page-2.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[4] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-3.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-3.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-3.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-3.jpg
[1000] => 56141-85c20753/1000/page-3.jpg
[200] => 56141-85c20753/200/page-3.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[5] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-4.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-4.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-4.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-4.jpg
[1000] => 56141-85c20753/1000/page-4.jpg
[200] => 56141-85c20753/200/page-4.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[6] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-5.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-5.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-5.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-5.jpg
[1000] => 56141-85c20753/1000/page-5.jpg
[200] => 56141-85c20753/200/page-5.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[7] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-6.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-6.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-6.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-6.jpg
[1000] => 56141-85c20753/1000/page-6.jpg
[200] => 56141-85c20753/200/page-6.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[8] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-7.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-7.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-7.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-7.jpg
[1000] => 56141-85c20753/1000/page-7.jpg
[200] => 56141-85c20753/200/page-7.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[9] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-8.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-8.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-8.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-8.jpg
[1000] => 56141-85c20753/1000/page-8.jpg
[200] => 56141-85c20753/200/page-8.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[10] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-9.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-9.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-9.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-9.jpg
[1000] => 56141-85c20753/1000/page-9.jpg
[200] => 56141-85c20753/200/page-9.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[11] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-10.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-10.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-10.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-10.jpg
[1000] => 56141-85c20753/1000/page-10.jpg
[200] => 56141-85c20753/200/page-10.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[12] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-11.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-11.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-11.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-11.jpg
[1000] => 56141-85c20753/1000/page-11.jpg
[200] => 56141-85c20753/200/page-11.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[13] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-12.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-12.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-12.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-12.jpg
[1000] => 56141-85c20753/1000/page-12.jpg
[200] => 56141-85c20753/200/page-12.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 56144
[post_author] => 0
[post_date] => 2024-10-21 19:56:17
[post_date_gmt] => 2024-10-21 19:56:17
[post_content] =>
[post_title] => epaper-56141-page-13-ad-56144
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-56141-page-13-ad-56144
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 19:56:17
[post_modified_gmt] => 2024-10-21 19:56:17
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-56141-page-13-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56144
[id_hash] => 393cae03c1f4dbd6a034d1bc81c2b6e5c93b2c034c36f6d183de6f4ccddace69
[post_type] => ad
[post_date] => 2024-10-21 19:56:17
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/content/id/3469
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-56141-page-13-ad-56144/
[post_title] => epaper-56141-page-13-ad-56144
[post_status] => publish
[position] => -0.81,0.27,91.58,98.64
[belongs_to_epaper] => 56141
[page] => 13
[cached] => false
)
)
[html_content] =>
)
[14] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-13.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-13.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-13.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-13.jpg
[1000] => 56141-85c20753/1000/page-13.jpg
[200] => 56141-85c20753/200/page-13.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[15] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-14.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-14.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-14.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-14.jpg
[1000] => 56141-85c20753/1000/page-14.jpg
[200] => 56141-85c20753/200/page-14.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[16] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-15.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-15.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-15.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-15.jpg
[1000] => 56141-85c20753/1000/page-15.jpg
[200] => 56141-85c20753/200/page-15.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[17] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-16.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-16.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-16.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-16.jpg
[1000] => 56141-85c20753/1000/page-16.jpg
[200] => 56141-85c20753/200/page-16.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[18] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-17.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-17.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-17.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-17.jpg
[1000] => 56141-85c20753/1000/page-17.jpg
[200] => 56141-85c20753/200/page-17.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[19] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-18.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-18.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-18.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-18.jpg
[1000] => 56141-85c20753/1000/page-18.jpg
[200] => 56141-85c20753/200/page-18.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[20] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-19.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-19.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-19.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-19.jpg
[1000] => 56141-85c20753/1000/page-19.jpg
[200] => 56141-85c20753/200/page-19.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[21] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-20.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-20.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-20.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-20.jpg
[1000] => 56141-85c20753/1000/page-20.jpg
[200] => 56141-85c20753/200/page-20.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[22] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-21.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-21.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-21.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-21.jpg
[1000] => 56141-85c20753/1000/page-21.jpg
[200] => 56141-85c20753/200/page-21.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[23] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-22.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-22.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-22.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-22.jpg
[1000] => 56141-85c20753/1000/page-22.jpg
[200] => 56141-85c20753/200/page-22.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[24] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-23.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-23.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-23.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-23.jpg
[1000] => 56141-85c20753/1000/page-23.jpg
[200] => 56141-85c20753/200/page-23.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[25] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-24.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-24.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-24.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-24.jpg
[1000] => 56141-85c20753/1000/page-24.jpg
[200] => 56141-85c20753/200/page-24.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[26] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-25.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-25.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-25.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-25.jpg
[1000] => 56141-85c20753/1000/page-25.jpg
[200] => 56141-85c20753/200/page-25.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[27] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-26.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-26.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-26.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-26.jpg
[1000] => 56141-85c20753/1000/page-26.jpg
[200] => 56141-85c20753/200/page-26.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[28] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-27.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-27.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-27.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-27.jpg
[1000] => 56141-85c20753/1000/page-27.jpg
[200] => 56141-85c20753/200/page-27.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[29] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-28.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-28.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-28.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-28.jpg
[1000] => 56141-85c20753/1000/page-28.jpg
[200] => 56141-85c20753/200/page-28.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[30] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-29.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-29.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-29.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-29.jpg
[1000] => 56141-85c20753/1000/page-29.jpg
[200] => 56141-85c20753/200/page-29.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[31] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-30.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-30.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-30.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-30.jpg
[1000] => 56141-85c20753/1000/page-30.jpg
[200] => 56141-85c20753/200/page-30.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[32] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-31.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-31.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-31.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-31.jpg
[1000] => 56141-85c20753/1000/page-31.jpg
[200] => 56141-85c20753/200/page-31.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[33] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-32.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-32.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-32.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-32.jpg
[1000] => 56141-85c20753/1000/page-32.jpg
[200] => 56141-85c20753/200/page-32.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[34] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-33.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-33.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-33.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-33.jpg
[1000] => 56141-85c20753/1000/page-33.jpg
[200] => 56141-85c20753/200/page-33.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[35] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-34.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-34.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-34.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-34.jpg
[1000] => 56141-85c20753/1000/page-34.jpg
[200] => 56141-85c20753/200/page-34.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[36] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-35.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-35.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-35.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-35.jpg
[1000] => 56141-85c20753/1000/page-35.jpg
[200] => 56141-85c20753/200/page-35.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[37] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-36.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-36.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-36.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-36.jpg
[1000] => 56141-85c20753/1000/page-36.jpg
[200] => 56141-85c20753/200/page-36.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[38] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-37.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-37.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-37.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-37.jpg
[1000] => 56141-85c20753/1000/page-37.jpg
[200] => 56141-85c20753/200/page-37.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[39] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-38.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-38.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-38.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-38.jpg
[1000] => 56141-85c20753/1000/page-38.jpg
[200] => 56141-85c20753/200/page-38.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[40] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-39.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-39.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-39.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-39.jpg
[1000] => 56141-85c20753/1000/page-39.jpg
[200] => 56141-85c20753/200/page-39.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[41] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-40.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-40.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-40.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-40.jpg
[1000] => 56141-85c20753/1000/page-40.jpg
[200] => 56141-85c20753/200/page-40.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[42] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-41.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-41.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-41.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-41.jpg
[1000] => 56141-85c20753/1000/page-41.jpg
[200] => 56141-85c20753/200/page-41.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[43] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-42.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-42.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-42.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-42.jpg
[1000] => 56141-85c20753/1000/page-42.jpg
[200] => 56141-85c20753/200/page-42.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[44] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-43.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-43.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-43.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-43.jpg
[1000] => 56141-85c20753/1000/page-43.jpg
[200] => 56141-85c20753/200/page-43.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[45] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-44.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-44.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-44.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-44.jpg
[1000] => 56141-85c20753/1000/page-44.jpg
[200] => 56141-85c20753/200/page-44.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[46] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-45.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-45.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-45.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-45.jpg
[1000] => 56141-85c20753/1000/page-45.jpg
[200] => 56141-85c20753/200/page-45.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[47] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-46.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-46.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-46.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-46.jpg
[1000] => 56141-85c20753/1000/page-46.jpg
[200] => 56141-85c20753/200/page-46.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[48] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-47.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-47.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-47.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-47.jpg
[1000] => 56141-85c20753/1000/page-47.jpg
[200] => 56141-85c20753/200/page-47.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[49] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-48.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-48.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-48.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-48.jpg
[1000] => 56141-85c20753/1000/page-48.jpg
[200] => 56141-85c20753/200/page-48.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[50] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-49.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-49.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-49.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-49.jpg
[1000] => 56141-85c20753/1000/page-49.jpg
[200] => 56141-85c20753/200/page-49.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[51] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-50.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-50.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-50.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-50.jpg
[1000] => 56141-85c20753/1000/page-50.jpg
[200] => 56141-85c20753/200/page-50.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[52] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-51.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-51.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-51.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-51.jpg
[1000] => 56141-85c20753/1000/page-51.jpg
[200] => 56141-85c20753/200/page-51.jpg
)
[ads] => Array
(
)
[html_content] =>
)
)
[pdf_filetime] => 1729540577
[s3_key] => 56141-85c20753
[pdf] => LA0311.pdf
[pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/56141/LA0311.pdf
[pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/56141/LA0311.pdf
[should_regen_pages] => 1
[pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/epaper.pdf
[pages_text] => Array
(
[1] =>
issn 1616-6345
Vol. 3 • Issue 3/2011
laser
international magazine of
laser dentistry
3
2011
| overview
LANAP—Laser-Assisted New Attachment
Procedure
| research
Swap Drills for Light Energy
| meetings
3rd European Congress of the WFLD in Rome
[2] =>
After endodontic laser
treatment there is no smear
layer around the opening
of the lateral canal.
www.fotona.com
The universe at your fingertips.
Introducing the highest technology dental laser system
Supreme clinical results in:
TM
TwinLight Perio Treatments (TPT)
TwinLightTM Endo Treatments (TET)
No-sutures soft tissue surgery
Gentle TouchWhiteTM bleaching
Patient-friendly conservative dentistry
Unmatched simplicity of use:
Pre-sets for over 40 applications
Intuitive user navigation
Balanced and weightless OPTOflex arm
Nd:YAG handpiece detection system
Er:YAG scanner ready
88897/12.0
Journey into a new dental experience with speed, precision and great results.
Visit www.lightwalkerlaser.com today!
[3] =>
editorial _ laser
Happy Birthday
DGL!
I
Prof Dr Norbert Gutknecht
WFLD President
Editor-in-Chief
_Twenty years ago, the DGL (German Society for Laser Dentistry) was founded in
Stuttgart, Germany. The DGL was the third laser society to be founded following the foundation of the ISLD (International Society for Lasers in Dentistry) in 1988 in Japan and the
ALD (Academy for Laser Dentistry) in 1990 in the US.
In addition to the formation of international and regional societies, the establishment
of national societies is one of the most important promotion activities in the field of laser
dentistry in order to explain and promote the use of lasers in the daily dental office. Furthermore, national laser societies can establish positive relationships with national dental associations in order to dispel long-existing prejudices resulting from a lack of information.
The integration of the DGL into the German Dental Association (DGZMK) might prove
to encourage all the other laser societies worldwide to continue developing a network
with the dental associations and universities in their respective regions.
Prof Norbert Gutknecht
Editor-in-Chief
laser
3
I 03
_ 2011
[4] =>
I content _ laser
page 06
36
I editorial
03
page 10
Happy Birthday DGL!
Efficient and ergonomic apical resection using the
Kaiserswerth algorithm
| Prof Marcel Wainwright
| Prof Dr Norbert Gutknecht
I overview
I feature
06
40
LANAP—Laser-Assisted New Attachment Procedure
page 24
“The Scanner mode is going to revolutionise dentistry”
| An interview with Dr Ladislav Grad & Dr Matjaz Lukac
| Dr David Kimmel
I research
I meetings
10
42
International events 2011 & 2012
44
3rd European Congress of the WFLD in Rome
Swap Drills for Light Energy
| Prof Matthias Frentzen
| Umberto Romeo
I case report
12
46
Lase to amaze
Basic Laser Certification Course in Malaysia
| Dr Kirpa Johar
16
18
Treatment of epulis using the 980 nm diode laser
I news
| Dr Merita Bardhoshi
48
Novel technique for using the diode laser
to treat refractory erosive oral lichen planus
I about the publisher
| Prof Dr Sajee Sattayut
50
Manufacturer News
| Imprint
I user report
22
Laser ridge preservation
| Dr Darius Moghtader
24
Optical imaging in the oral cavity
| Danielle Le et al.
30
Morphological changes in hard dental tissue
prepared using Er:YAG laser
Cover image courtesy of A.R.C. Laser GmbH,
www.arclaser.de
| Dr Snejana Ts. Tsanova et al.
page 36
04 I laser
3_ 2011
page 40
page 44
[5] =>
Photodynamic breakthrough
®
• Extreme effective against
Gram-positive and
Gram-negative bacteria
• The reliable PDT-therapy –
designed for the treatment
of periodontitis
t
ri
an
i-
al
100%
bacte
www.arclaser.de
[6] =>
I overview _ LANAP
LANAP—Laser-Assisted
New Attachment Procedure
Author_Dr David Kimmel, USA
Fig. 1
Fig. 2
Fig. 1_Selective thermal ablation of
epithelium.
Fig. 2_Formation of the stable fibrin
clot.
_A historical perspective of the development of
the Laser-Assisted New Attachment Procedure is
presented in this article. The simplicity of the protocol is discussed, as well as its nuances.
The concept of the Laser-Assisted New Attachment Procedure (LANAP) was born back in 1989 with
Drs Robert Gregg ll and Del McCarthy. As with most
general dentists battling with the day-to-day realities of periodontal disease, they were looking for an
answer on how to better care for their patients. The
reality at the time was that periodontal disease was
difficult to treat and maintain. It was primarily based
on older concepts of wound debridement and amputation. Once treated, relapse was common. We know
periodontal disease is a multifactorial disease
process and patient behavioural routines can play a
significant role. It is a wonder that the conventional
treatments worked as well as they did. Even when
they did work, there often were significant secondary repercussions clinically as well as psychologically. Clinically, many of these traditionally treated
cases were difficult to restore whenever dental prosthetic treatment was needed and patients were often
left with the compromised aesthetic result of a long
tooth appearance. Post-surgically, there was significant root surface exposure and with patients’ increased life span and the incidence of dry mouth, root
caries can become a very difficult entity to control.
More problematic, is that psychologically many of
these patients felt that the discomfort from the procedure and/or the residual tooth sensitivity after
treatment was so great that they would not complete
remaining areas that needed treatment or declined
retreatment when they relapsed. Further complicating matters, the patients would recant their experiences to friends and family, making case acceptance
for periodontal treatment often a challenge. During
this same time, Drs Gregg and McCarthy were involved in the early use of Nd:YAG lasers in dentistry.
Confronted with patients not wishing to lose teeth
and declining traditional surgery or extraction, they
developed the LANAP protocol, which eventually led
to its US FDA clearance in 2004.
In concept, the LANAP protocol is rather simplistic. The ultimate goal is to set up the periodontal environment to promote self-regeneration of the lost
attachment and osseous structure that result from
Fig. 3_Periodontal charting.
Fig. 3
06 I laser
3_ 2011
[7] =>
overview _ LANAP
Fig. 5
Fig. 4
periodontal disease. Regeneration is a rather complex event and, as seen with guided tissue regeneration or scaling and root planning alone, can be very
unpredictable. LANAP is predictable. Clinically, those
clinicians who have been using the LANAP protocol
for some time know this, and its predictability was
reinforced when new attachment was found on all
the LANAP-treated teeth in the initial histology
studies done by Dr Ray Yukna. LANAP is also a very
safe protocol. The use of the Nd:YAG laser has often
been of concern by some owing to possible damage
to root surfaces and the tissue attachment but, with
a basic understanding of laser physics, laser–tissue
interaction parameters were developed that enabled
the use of an Nd:YAG in a very safe and effective
manner. LANAP is also standardised. That is, before a
doctor can obtain his laser he goes through three
days of training: one day of laser physics and
laser–tissue interaction and then two days of handson training with patients. This is then followed up by
two more separate days of treating patients to refine
techniques and add other treatment modalities utilising the Nd:YAG. Because of the simplicity, predictability and standardisation of LANAP, it has become a very safe and effective way to treat periodontal disease.
The simplicity of the LANAP protocol can be seen
in Table I.
I
Fig. 4_ Pre-op CBT scan.
Fig. 5_Post-op periodontal probing
at 15 months.
_The LANAP protocol
Step A
Patients undergo a full dental examination and
treatment plan—as with all dentistry. If they have an
appropriate diagnosis of Type III or greater periodontal disease, all treatment options are presented to the
patient. The initial step of the LANAP protocol, after
anaesthesia has been administered, is bone sounding
around each tooth. The objective is to determine areas of osseous defects that cannot be seen radiographically.
Step B
This is the first time the laser is used. The objective
of this step is to remove only diseased epithelium, to
affect selectively bacteria associated with periodontal disease, to affect the calculus present, and to affect thermolabile toxins. The bacteria that are associated with periodontal diseases are pigmented and
are found in the sulcus, within the root surface and
within the epithelial cells. One of the reasons for the
predictability of this step is in the selection of a freerunning pulsed Nd:YAG laser with a wavelength of
1,064 nm and pulsed in a range of seven different microseconds. The shorter 1,064 nm wavelength was
selected for its affinity for melanin or dark pigmentation, unlike the longer wavelengths that are highly
absorbed in water and would have a shallow depth of
Tab. I
laser
3
I 07
_ 2011
[8] =>
I overview _ LANAP
Fig. 6
Fig. 7
Fig. 6_CBT scan 15 months post-op
LANAP.
Fig. 7_Pre-op photograph.
penetration. This ability to increase the depth of
penetration of the laser energy with minimal collateral damage is the reason that the diseased epithelium can be selectively removed without damage to
the underlying tissue, leaving intact rete pegs. The
diode lasers are also known for this selective absorption in pigmented tissues, but the free-running,
pulsed Nd:YAG lasers differ in their ability to operate at very high peak powers in very short timeframes, which allows the Nd:YAG to have the greater
depth of penetration and the lack of collateral damage (Fig. 1).
Step C
This step in the LANAP protocol is straightforward; it is just a matter of using the piezo-scalers to
remove the calculus present on the root surfaces.
The removal of calculus is believed to be easier after
the interaction of the laser energy with the calculus.
The first interaction of the laser results in the initial
formation of a mini-flap, thereby further assisting in
the removal of calculus because of increased visibility and access to the calculus.
Fig. 8_Post-op photograph.
Fig. 9_Pre-op X-ray.
Fig. 10_Post-LANAP X-ray
at 36 months.
Fig. 8
Step D
The next step again utilises the laser. This time the
parameters are varied to enhance the ability to form
a fibrin clot to close the mini-flap and to disinfect
the site again. The formation of the stable fibrin clot
is significant, as it is stable for approximately 14
days. The role of the fibrin clot is to keep the sulcus
sealed against bacterial infiltration and to prevent
the growth of epithelium down into the sulcus.
Other laser wavelengths not only lack the ability to
form this stable fibrin clot, but also require repeated
Fig. 9
08 I laser
3_ 2011
treatments to prevent epithelium growth down into
the sulcus. The ability to select the laser–tissue interaction specifically is unique to the PerioLase
MVP-7 (Millennium Dental Technologies). Through
the use of specific fibre sizes, energy, repetition
rates, pulse durations and standardisation of the energy at the fibre tip, this protocol can be followed in
a predictable and reproducible manner. The high
standard of training that each LANAP doctor receives also contributes to the predictability of this
protocol and to its safety. Patients often present
with different tissue types along with different degrees of disease. One of the purposes of the handson training is learning to recognise these differences
and how to change the laser parameters accordingly
so that the desired laser–tissue interactions are
achieved. (Fig. 2)
Step E
The fifth step in LANAP is the compression of the
fibrin clot to enhance the healing process. Because
laser wounds heal by secondary intention, closer approximation enhances the healing time.
Step F
Following the compression and stabilisation of
the clot, the last step of LANAP is refining the occlusion. Occlusion has been considered a greater cofactor in the progression of periodontal disease than
smoking. In order to minimise this role, extensive adjustments are made to the dentition.
The patients are then followed for nine to 12
months with routine supra-gingival cleanings and
occlusal refinements. No sub-gingival restorative or
periodontal probing is done during this time. Only
during the final post-operative visit is a periodontal
probing done.
The results that are seen from LANAP treatment
are very similar to the following cases, where new
bone fill can be seen in vertical osseous defects. The
bone fill ranges from simple proximal defects to the
more complex furcation defects. The hallmark of
LANAP is pocket reduction, new tissue attachment
and a lack of tissue recession.
Fig. 10
[9] =>
overview _ LANAP
_LANAP case 1
The patient in this case was a 40-year-old female
patient with a history of lupus, rheumatoid arthritis
and Sjögren’s syndrome. She was also a smoker. There
was generalised deep pocketing as seen in her periodontal charting (Fig. 3). The extent of the osseous
defect is shown on the lingual view of the right quadrant preoperative CBT scan (Fig. 4). The initial postLANAP evaluation was done at 15 months. Post-operative probing is shown in Figure 5. The CBT from the
lingual view of the right quadrant at 15 months postoperatively is shown in Figure 6. The change in the osseous defects is apparent. Minimal to no recession is
shown in the preoperative clinical photograph in Figure 7 and the post-operative in Figure 8.
the test of time. There are over 1,000 trained clinicians
applying LANAP. They have all been standardised. The
uniqueness of the protocol is that whether the doctor
is new to LANAP or a veteran “LANAP’er”, his results are
similar. During its early stages, early adopters accepted
LANAP with anecdotal evidence alone, which was reinforced by the individual successes seen clinically. It
was further validated by Dr Ray Yukna’s histological
studies in 2003. As the LANAP multicentre clinical
studies move to completion, it would be reasonable to
expect to see LANAP become the conventional manner or the standard for the treatment of periodontal
disease. It is a very simple but eloquent protocol, one
in which the patient has no to minimal discomfort
and treatment acceptance is high._
_contact
_LANAP case 2
I
laser
Dr David Kimmel
The patient in this case was a 59-year-old male
patient, with Type 1 diabetes and a smoker. His periodontal pocketing was 7 mm on the mesial second
premolar. The preoperative X-ray is shown in Figure
9 and the 36-month post-LANAP X-ray in Figure 10.
The 7 mm pocket had been stable and maintained at
3 mm for the last 36 months. The LANAP protocol will
be 21 years old this year. It is coming of age. It has stood
12124 Cobble Stone Dr
Bayonet Point, Florida 34667
USA
E-Mail: dskimmel@mac.com
Tel.: +1 727 862 8513
AD
--BTFS)'¥
BTFS)'¥
Las
Laser
ser mee
meets Radio Frequency
RF:
Coagulation
RF
F: C
oagulati
Diode Laser
LaserHF®
Worldwide first combined Laser plus HF unit
RF: Cutting
t 1SFBEKVTUFEQSPHSBNTGPSBMMEFOUBM
TPGUUJTTVFUSFBUNFOUT XJUIJOEJWJEVBM
QSPHSBNNJOH
Therapeutic
Laser
t &BTZIBOEMJOHCZEVBMPQFSBUJOHDPODFQU
UPVDITDSFFOBOEBVUPNBUJDTUBSUJOHTZTUFN
t .PEFSOSBEJPGSFRVFODZTVSHFSZ .)[
BMMPXTFBTZ GBTUBOEQSFDJTFDVUUJOH
t %JPEFMBTFS ON GPSQFSJPEPOUPMPHZ
FOEPEPOUPMPHZBOEJNQMBOUFYQPTVSF
t 5IFSBQFVUJDMBTFS ON GPS-PX-FWFM
-BTFS5IFSBQZ ---5 BOEBOUJNJDSPCJBM
1IPUPEZOBNJD5IFSBQZ B1%5
3 technologies
technologies –
1 unit
XXXIBHFSXFSLFOEF
X
X XIBHFS XFSLFOEF
55FM
FM
·'BY
·'BY
t (PPEWBMVFPGNPOFZ
[10] =>
I research _ MiLaDi
Swap Drills
for Light Energy
An interdisciplinary collaborative research project
Author_Prof Matthias Frentzen, Germany
_The overall aim of prevention-oriented dentistry
is to offer (laser) light-based diagnosis and treatment
with outstanding capabilities. An example of this is the
early detection of hidden carious lesions, which are
clinically and radiographically barely detectable, using
light-induced fluorescence. Through a combination of
photosensitisers and light, bacteria-contaminated
gingival pockets can be disinfected. Laser light is even
capable of replacing the scalpel, allowing incisions resulting in reduced blood loss and benign alterations of
the mucous membrane. These are just a few of the
many new possibilities and developments in the clinical diagnosis and treatment of oral and dental disease
through laser-based technology.
For 20 years, the Laser in Dentistry working group
at the University of Bonn’s Dental and Oral Health Centre has collaborated on research, directed by Prof M.
Frentzen, and participated in a number of national and
international development projects. This includes the
collaborative MiLaDi (Minimally Invasive Laser Ablation and Diagnosis of Oral Hard Tissue) project for researching ultra-short pulse laser technology. The Federal Ministry of Education and Research-funded project involves a research collaboration between the
Lasers in Dentistry working group and two industrial
Fig. 1_Selected, fluorescense
controlled caries removal.
10 I laser
3_ 2011
Fig. 1
companies: Sirona Dental Systems GmbH and Lumera
Laser GmbH, a medium-sized business with many
years of experience in manufacturing ultra-short
pulse lasers in science and industrial material machining. The main goal of the MiLaDi project is to develop
new laser therapy systems based on ultra-short pulse
laser technology through the dental biological and
medical research and testing of a laser diagnostic and
treatment device with a large range of applications.
The project has a total current budget of €6.8 million.
During the last few years, ultra-short pulse laser
has been introduced to fundamental research in dentistry. This technology offers the prospect of treating
oral hard and soft tissues efficiently and with minimal
damage. The highly precise removal of biological tissues is expected to be associated with reduced pain as
well.
The first experience of this technology was in the
1990’s with the nanosecond, pulsed excimer laser,
which radiated in the ultraviolet area of the spectrum.
The newly developed ultra-short pulse laser technology is based on laser devices with wavelengths of
around 1 μm (e.g. Nd:YAG lasers), and pulse durations
of picoseconds to femtoseconds. Tissue ablation with
this type of laser is not based upon the physical principle of absorption, but on non-linear optical effects
with changes to plasma generation.
In the near future, short pulse laser therapy should
enable users to:
– remove hard tooth substance (enamel, dentine, as
well as caries) and mineralised concretions (such as
tartar or concrements) in a minimally invasive manner with little or no pain, and allow an objective
analysis of the material removed (Fig. 1);
– carefully handle surrounding tissue when treating
bone (when performing orthopaedic surgery or implantology, for instance);
[11] =>
research _ MiLaDi
I
Fig. 2_Fundamental examination of
test samples on an optical bench.
Fig. 3_SEM of a laser drilled cavity.
Fig. 2
Fig. 3
– perform surgical procedures on healthy and diseased oral soft tissue, and carry out analysis of the
material removed;
– perform biofilm management of plaque-associated
diseases in the areas of cariology, endodontology
and periodontology.
The cavities do not show any histological indications of thermal damage but a smooth and extremely
sharp-edged contour. It seems as though no smear
layer forms (Fig. 3). Consequently, it is possible to prepare cavities with laser. In order to ensure a sufficient
width of the therapy spectrum with ultra-short pulse
laser technology, restorative materials were also
tested with this technology to demonstrate the extent
to which they could be handled. Clinically relevant ablation rates, by the usual tested materials, indicate the
possibility of effective laser treatment of restorative
materials (Fig. 4).
As a part of ongoing research, a fundamental examination is performed to examine the effect of ultrashort pulse radiation on biological tissue and restorative materials (Fig. 2). The detection procedure can
then be tested, based on fluorescence and plasma
spectroscopy.
To test clinical relevance in the treatment of dental
hard tissue, the processing speed of enamel and dentine must be determined. The ablation volume of dentine, without air or spray filling, is approximately
10 mm3/min. The efficiency seems to improve significantly due to optimisation and in particular due to the
scan parameter. Carious dentine can be ablated four
times faster than healthy dentine.
The basis for the surgical application of ultra-short
pulse laser is the efficient and careful ablation of oral
soft and hard tissue. As histological studies demonstrate, bone can be handled without spray and air cooling with no detectable side-effects (Fig. 5). The clinical
efficiency is, according to available results, comparable to traditional methods.
The collaborative project is currently focusing on
systematic examination relevant to laser parameters, as well as the development of a suitable radiative transfer system, including adequate detection
systems. The results achieved so far are very promising and make patient-oriented advancement a possibility._
Fig. 4
_contact
laser
AG Laser in der Zahnheilkunde
Zentrum für Zahn-, Mund- und Kieferheilkunde der
Rheinischen Friedrich-Wilhelms-Universität Bonn
Welschnonnenstr. 17, 53111 Bonn, Germany
Tel.: +49 228 287-22470
Fax: +49 228 287-22146
frentzen@uni-bonn.de
www.miladi.uni-bonn.de
Fig. 5
Fig. 4_Photomicrograph of laser
cavity in composite. The 3-D display
of the same cavity appears on the
right. The defined edges of the cavity
are particularly distinguishable here.
Fig. 5_Histological section of a laser
cavity in bone slowing no
side-effects.
laser
3
I 11
_ 2011
[12] =>
I case report _ functional and aesthetic restoration
Lase to amaze
Author_Dr Kirpa Johar, India
_Today’s patients expect restorations that are
both functional and aesthetic. Unlike yesteryear’s, today’s patients have better knowledge of the advanced
materials available and state-of-art equipment. Consequently, they have high expectations when designing their smile and other procedures to achieve optimum results. The specialist’s main aim is to achieve
complete oral rehabilitation in the most conservative
manner.
Phase 1: Preliminary phase
Impressions were taken and study models were prepared. An OPG was taken. Oral prophylaxis was done.
The patient was recalled after two days for further treatment.
When choosing a treatment option, dentists and
technicians must satisfy both the clinical criteria and
the patient’s expectations. To design the optimal outcome for a patient during aesthetic enhancement, the
dentist must seek to create a symmetrical and harmonious relationship between the lips, gingival architecture and the positions of the natural dentition.
Gingivectomy
Lasers offer increased operator control and minimal
collateral tissue damage. The fine tip of the diode laser
can be manipulated easily to create the gingival margin
contours required to perform the aesthetic crownlengthening procedure. The surgical site was anaesthetised and the biological width was determined.
A 980 nm diode laser with a 400 µ cable was used for the
surgical procedure. The amount of gingival tissue to be
incised was outlined. Initial incision for the laser-assisted gingivectomy was similar to that of using a blade
with an external bevel approach. The distance of the incision from the coronal marginal gingiva is based on the
pocket depth and the amount of attached gingiva. The
gingival chamfer is achieved and the initial cut is made
slightly apical to the pocket depth measurement. A slow,
unidirectional hand motion is used, moving the tip at an
external bevel towards the tooth structure. Caution is
necessary, especially near the root structure, because of
a possible laser—hard tissue interaction, which could
harm the tissue. During the course of surgery, care was
taken to maintain the biological width and to preserve
the attached gingiva (Figs. 3, 4, 5). The access cavity was
prepared according to the traditional method. The rotary instruments were used along with the ProTaper files
for cleaning and shaping the root canals.
_Case report
A 27-year-old patient visited our practice with the
chief complaint of attrition in the lower front teeth and
generalised discoloration of all the teeth. He also complained of reduced visibility of the lower anterior teeth
along with blackish discoloration of the gingiva.
Fig. 1 & 2_Initial clinical examination showing attrition and
depigmentation of the
mandibular anteriors.
Fig. 3_Immediately post operative.
Fig. 1
Examination and treatment plan
Clinical examination revealed attrition of the lower
anteriors up to the level of the middle third of the coronal tooth structure in relation to teeth #31, 32, 41 and
42. All the teeth were discoloured and extrinsic stains
due to the patient’s seven-year history of tobacco
chewing (as reported by the patient) were present.
Overall gingival asymmetry was observed. Generalised
pigmentation of the gingiva was also observed (Figs. 1,
2). It was decided to treat the patient in four phases.
Fig. 2
12 I laser
3_ 2011
Phase 2: Surgical phase
The second phase entailed a laser-assisted gingivectomy and laser-assisted endodontic sterilisation.
Fig. 3
[13] =>
[14] =>
I case report _ functional and aesthetic restoration
Fig. 5
Fig. 4
Fig. 6
and 22. Each tooth was then irradiated for 30 seconds
in the same sequence, constantly moving the tip of the
laser, so that the laser energy was not directed at one
place (at 1 W). Fluoride gel was applied to each tooth and
irradiated with the laser for 15 seconds to provide resistance to acid attacks on enamel and dentine. The patient was recalled after two weeks.
Fig. 7
Fig. 8
Fig. 4_One week post operative.
Fig. 5_Laser assisted sterilization
of the root canals in relation
to 31, 32, 41 & 42.
Fig. 6 & 7_Laser assisted bleaching.
Fig. 8_Post operative intraoral
view.
Sterilisation
A 980 nm diode laser with a 200 µcable was used for
sterilisation of the canals along with regular chemical
disinfectants. The advantage of laser sterilisation to a
conventional irrigant regime to provide sterilisation is
that while irrigating solutions have a limited depth of
penetration, the laser beam transmitted through the tip
of a fibre is emitted in a lateral direction and has an effective penetration depth of more than 1,000 µm. This
was followed by obturation and coronal access restoration with composites. The patient was recalled after one
week for further treatment.
Phase 3: Aesthetic phase
The third phase entailed laser-assisted depigmentation and laser-assisted bleaching.
Phase 4: Prosthetic phase
Crown preparation of teeth #42, 41, 32 and 31 was
done. Elastomeric impressions were taken. Bite registration records were taken and the appropriate shade
was sent to the laboratory for the fabrication of the
crowns. Temporary restorations were fabricated using
temporisation material. The patient was recalled after
six days for the cementation of the crowns. Excess cement was removed, the occlusion was adjusted and
contours were checked.
Inference
The final result showed that the definitive restorations and the soft-tissue procedures had restored the
normal form, function and harmony of the oral cavity,
while keeping the patient’s functional and aesthetic
concerns in mind.
_Conclusion
Depigmentation
The diode laser was used at 2 W, continuous wave in
a defocused mode. This causes a reduced depth of penetration, ablating only the superficial epithelium, which
primarily contains the melanin pigments, leaving behind a carbonised layer. Only a surface anaesthetic spray
was used for this procedure.
Bleaching
Laser light has the unique property of being absorbed by the chromospheres. These emulsions can be
added to the bleaching gel, which are capable of absorbing laser energy and thus inducing and promoting
a fast, safe and effective reaction. Cheek and tongue retractors were positioned and a dry operatory was maintained. The gingival protection material was applied
along the margin of the gingival covering approximately 1 mm from the tooth surface in the cervical region. The bleaching gel was applied to teeth #11, 21, 12
14 I laser
3_ 2011
Dental lasers promote patient compliance through
the non-invasive nature of treatment, faster recovery
time and reduced post-operative discomfort. The use of
laser reduces chairside time and improves operator efficiency and thereby reduces fatigue._
_contact
Dr Kirpa Johar
FF-3, Business Point,
137, Brigade Road,
Bangalore 560004, India
drkirpajohar@ldrr.org
www.ldrr.org/home.html
www.joharslaserdental.com/
laser
[15] =>
Lay the Foundations to your
successful Future now!
Next master course starts: Aachen 26.09.11, Dubai 17.10.11
Master of Science (M.Sc.) in Lasers in Dentistry
Would you also like to be part of the International Dentists‘ Elite?
• The first accredited M.Sc. programme in dentistry in Germany
• Career-accompanying postgraduate programme of two years at the University of Excellence RWTH Aachen
• Internationally accepted and accredited by the German Government, the European Union,
the Washington Accord and the Bologna Process
• Science-based and practice-orientated on highest national and international level
• Bronze Award of the European Union for „Life-Long Learning programmes“
More information:
AALZ GmbH · Pauwelsstrasse 19 · 52074 Aachen · Germany
Tel. +49 - 2 41 - 9 63 26 70 · Fax +49 - 2 41 - 9 63 26 71
www.aalz.de · info@aalz.de
In cooperation with the University
of Excellence RWTH Aachen
[16] =>
I case report _ Treatment of epulis
Treatment of epulis using
the 980 nm diode laser
Author_Dr Merita Bardhoshi, Albania
_Abstract
Fibromatous epulis is treated through surgical removal and a good treatment modality is the 980 nm
diode laser. This article reports on the treatment of
eleven patients with fibromatous epulis at the University of Tirana’s Dental School. Diagnosis was confirmed
by biopsy. The laser was used with a power setting of
4 to 6 W, 300 µm optical fibre, set at continuous wave
and in focused mode. The patients were examined at
one week, four weeks and six months to one year after
surgery. Post-operatively, no bleeding, swelling or
oedema was observed. The laser surgery was well accepted by all patients. Use of the 980 nm diode laser in
the treatment of fibromatous epulis offers advantages
for both the patient and surgeon.
Figs. 1–3_Initial situation showing
fibromatous epulis.
Fig. 4_During treatment: the lased
area appears bloodless.
Figs. 5–7_Laser treatment of the
lesions.
envelop one or more teeth. The cause is unknown. An
epulis is treated by surgical removal. A good treatment
modality is laser surgery. Many different laser wavelengths have been used in the field of oral surgery and
offer many advantages especially because of laser’s
high coagulation property and bactericidal effect.
The 980 nm diode laser is portable, compact, efficient and of benefit in the treatment of epulis. It can be
used with infiltration anaesthesia, set at continuous
wave (cw) and in focused mode. The short duration of
surgery is an advantage of this method because it reduces the fear and anxiety that patients have during
dental procedures. The aim of this report is to present
the clinical effects of the 980 nm diode laser in the
management of epulis and to demonstrate woundhealing characteristics after laser surgery.
_Introduction
_Material and methods
Fibromatous epulis refers to any benign lesion situated on the gingiva. Firm, pink tumours develop along
the gums and while they are benign, non-invasive
growths, they may become quite large and completely
Eleven patients aged between 14 and 50 with epulis
participated in this study. Diagnosis was confirmed by
biopsy. All clinical cases were treated as outpatients at
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
16 I laser
3_ 2011
[17] =>
case report _ Treatment of epulis
I
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
the Department of Oral Surgery at the University of
Tirana’s Dental School using the 980 nm diode laser. The
laser parameters were as follows: 4 to 6 W power setting, 300 µm optical fibre, cw, focused mode. The specimens were histologically examined. All patients were
examined at one week, four weeks and six months to
one year after surgery for evaluation of early and longterm results. Written informed consent was obtained
from all patients before treatment commenced.
(school, job) immediately after surgery. No analgesics
or antibiotics were prescribed. At four weeks, the
wound-healing characteristics were evaluated. All patients reported good, comfortable healing without
complications or functional disturbance (Figs. 11 & 12).
At six months to one year, there was no recurrence (Fig.
13). In general, patient acceptance of laser treatment
was high.
Figs. 8 & 9_Immediately after
treatment.
Fig. 10_The specimen excised.
Fig. 11_Wound-healing after four
weeks.
Fig. 12_Four weeks after surgery,
the wound has healed completely.
_Conclusion
_Diode laser treatment
Before treatment, all precautions were taken for the
safety of the patients, operator and assistant. Preoperative photographs were taken to document progress
(Figs. 1, 2 & 3). Infiltration anaesthesia (lidocaine 2 %,
1 cc) was used before each treatment. The diode laser
was calibrated. The surgical technique was excision.
Traction was applied to the lesion using forceps and it
was excised along its base (Figs. 4, 5, 6 & 7). No sutures
were placed (Fig. 8) and all specimens were histologically examined (Fig. 10). The histopathological examinations confirmed fibromatous epulis. No bone problems were revealed by X-rays and neither the teeth adjacent to the epulis nor any part of the jawbone had to
be removed. The surgery took four to six minutes. The
patients were advised to put ice on the lesion to prevent
oedema and given instructions regarding follow-up.
Laser surgery is a treatment modality for epulis that
offers beneficial effects and advantages. An intra-operative advantage is the high coagulation property of
the 980 nm diode laser, owing to its good absorption by
haemoglobin, which allows the surgeon a good view of
the operating field. As post-operative advantages,
wound-healing was without complication and there
was no pain, bleeding or swelling one week after surgery. The short duration of surgery minimises patients’
fear and anxiety during the procedure. Laser surgery
was well accepted by all the patients. In conclusion, the
treatment of epulis with laser offers advantages for
both the patient and surgeon._
_contact
laser
Dr Merita Bardhoshi
_Results
The patients were followed up at one week, four
weeks and six months to one year after surgery. At one
week, the patients were examined for pain, bleeding
and swelling. In post-operative clinical observations
(eleven clinical cases), no pain, swelling or bleeding was
reported. All patients resumed their normal activities
Department of Oral Surgery
Dental School
University of Tirana
Tirana, Albania
meritabardhoshi@yahoo.com
laser
3
I 17
_ 2011
[18] =>
I case report _ oral lichen planus
Novel technique for using the
diode laser to treat refractory
erosive oral lichen planus
Author_Prof Dr Sajee Sattayut, Thailand
_Refractory erosive oral lichen planus (OLP) is a
common oral disease and treatment thereof poses a
considerable problem in oral medicine. Conventional
surgery, cryosurgery and CO2 evaporation can offer
temporary pain relief without promising healing of the
ulcer. This article presents a case report of erosive OLP
that did not respond to a topical steroid and only partial
symptomatic pain relief by low intensity laser and CO2
laser irradiation was obtained. Complete healing of the
ulcer was achieved two weeks after treatment according to the laser welding technique using an 830 nm
diode laser (continuous wave) for two treatment
episodes. The three-month follow-up showed no ulceration or symptoms.
_Introduction
Fig. 1_The erosive OLP lesion before
laser welding.
Fig. 2_The laser welding procedure
for treating OLP using an 830 nm
diode laser.
Fig. 3_Immediate post-laser welding
of the OLP lesion.
Fig. 1
Oral lichen planus (OLP) is a common autoimmune
disease resulting from auto-cytotoxic T lymphocytes
triggering apoptosis of epithelial cells, leading to
chronic inflammation of oral mucosa. Regarding the
symptoms, atrophic and erosive OLP are generally
painful for sufferers.1 The management of OLP is still
symptomatic relief by reduction of inflammation, aiming for pain control. There is a range of treatment options, such as avoiding initiating factors, applying a topical steroid, or taking an immune-suppressive drug or
systemic steroid.1 Low intensity laser therapy is an additional therapy for conservative treatment of OLP.2 For
refractory OLP, particularly erosive OLP, treatment
Fig. 2
18 I laser
3_ 2011
choices are surgical methods such as surgical removal
with a free soft tissue graft, cryosurgery and CO2 laser
evaporation.1, 3 The results of these surgical methods appear to be satisfactory in terms of pain relief, but not
promising in terms of healing of the lesion, particularly
in the case of erosive OLP and recurrence overall. Concerning the risk of malignant transformation of longterm OLP, especially the erosive type,1, 4 an innovative
therapy for recovery from OLP ulceration is still under
consideration. Regarding the laser technique for treating OLP, the welding technique with the benefit of promoting closure of the surgical wound margins in large
vessels and skin5 has not been applied to treatment of
this oral lesion. This report introduces the novel technique of using the diode laser to treat an erosive OLP
case with no response to a topical steroid and only partial pain relief from refractory to low intensity laser therapy and CO2 laser irradiation.
_Case report
A 55-year-old male patient was referred by his
general dentist for treatment of refractory erosive
OLP with spontaneous moderate pain and severe pain
when drinking and eating.
_Past history of treatment
The diagnosis was confirmed by histopathological
investigation. The patient had no response to treatment
Fig. 3
[19] =>
20th ANNUAL CONGRESS OF THE DGL e. V.
LASER START UP 2011
Please fax this form
+49 341 48474-390
More information:
p 20th ANNUAL CONGRESS OF THE DGL e. V.
p LASER START UP 2011
October 28–29, 2011, Düsseldorf, Germany
October 28–29, 2011
Düsseldorf, Hotel Hilton Düsseldorf, Germany
OFFICE STAMP
NAME
E-MAIL
laser 3/11
[20] =>
I case report _ oral lichen planus
Fig. 4_Recovery of the buccal
mucosa from OLP one week after the
first laser welding.
Fig. 5_Recovery of the buccal
mucosa from OLP one week after the
second laser welding.
Fig. 4
Fig. 5
with a topical steroid for three months and could not
tolerate the side-effects of severely oily skin and generalised acne from the systemic steroid. He had no known
allergies or systemic disease.
hot and spicy foods. At the three-month follow-up after the second laser welding treatment, there was no evidence of ulceration or the previously inflamed buccal
mucosa.
The patient had then been treated with low intensity
laser therapy (830 nm, continuous wave, 100 mW, 4 J)
once a week for four treatment episodes and defocused
CO2 laser (continuous wave, 1 W) irradiation with a high
water content absorbing gel once a week for two treatment episodes. These laser treatments partially relieved
pain and offered some temporary reduction in the size
of the ulcer but did not bring complete recovery. The patient continued to complain of pain in the region of the
ulcer, stimulated by drinking and consuming spicy
foods.
_Discussion
_Oral examination
The extra-oral examination showed no palpable superficial cervical lymph nodes or other significant abnormality. From the intra-oral examination, there was a
2 x 4 mm ulcer covered with a yellowish slough and surrounded by a 1 to 2 mm band of erythematous mucosa
(Fig. 1).
_Laser welding technique and result
A novel laser technique, laser welding, was undertaken using an 830 mm diode laser (continuous wave,
2 W) under topical anaesthesia. The laser was applied
with light touch contact at the ulcerated area and with
near contact at the peripheral reddened area (Fig. 2).
Post-operatively, the surface of the area treated appeared dry and brownish without any carbonisation
and with a reduction in the reddened mucosa of the
peripheral area (Fig. 3).
The results at the one-week follow-up showed remarkable pain relief and a decrease in the size of the ulcer to 1 x 4 mm (Fig. 4). Laser welding was then repeated
using the same technique mentioned above. One week
after the second treatment, there was no ulceration only
a few white striae on the buccal mucosa (Fig. 5). The patient occasionally felt a mild burning sensation in this
area when eating spicy food. He was advised to avoid
20 I laser
3_ 2011
The results of this novel technique suggest that it has
the ability to achieve complete recovery of erosive OLP,
in terms of both symptoms and mucosal healing, while
the low intensity laser and CO2 laser irradiation, at least
the methods used in this case, were able to relieve the
spontaneous pain only partially. The reason for this is
that this technique has a bio-modulation effect as always observed when using 830 nm low intensity therapy,2 together with minor changes in tissue structure in
the welding mode, 70 to 80 °C, producing helical unfolding collagen in a favour of healing6 and wound closure.5
_Conclusion
The novel technique used here (we have called it the
“laser welding technique for oral mucosa”), using an
830 nm diode laser (continuous wave, 2 W), was able to
gain complete recovery from ulceration clinically in a
case of refractory erosive OLP. Therefore, the laser welding technique is worth further study with regard to exploring basic tissue reaction and clinical efficacy._
Editorial note: A list of references is available from the
publisher.
_contact
laser
Assoc Prof Dr Sajee Sattayut
(Chairman of Lasers in Dentistry Research Group)
Khon Kaen University
Khon Kaen City, 40002
Thailand
sajee@kku.ac.th
Tel.: +66 8 1544 2460
Fax: +66 4334 8153
[21] =>
[22] =>
I user report _ elap-rp
Laser ridge
preservation
Author_Dr Darius Moghtader, Germany
Fig. 1
Fig. 2
Fig. 1_Condition after extraction.
Fig. 2_Launch of glass rod from
laser.
Fig. 3_Membranisation.
Fig. 4_Elap-rp membrane.
Fig. 5_Situation after three days.
Fig. 6_Recall after four weeks.
Fig. 4
_Abstract
The following article describes an alternative treatment option to reduce bone resorption post-tooth extraction with the help of laser technology and autologous materials, thereby creating the optimal conditions
for implantation.
Many prosthodontic dentists are familiar with the
problem of the crucial buccal lamella being partially or
completely resorbed within six weeks post-tooth extraction. This resorption then leads to subsequent implantation problems. Treatment of insufficient bone is
attempted via expensive and cumbersome bone augmentation procedures either during or before implantation. Numerous procedures have already been introduced to prevent this bone resorption: from direct implantation to filling the alveole with materials of different origins and frequently additional membranes to
cover the introduced material.
Fig. 5
22 I laser
3_ 2011
Fig. 3
This costly bone graft procedure, usually using foreign materials, can unfortunately lead to unforeseeable
results, ranging from very good to very poor. Aside from
the often-mentioned risks related to bone substitutes of
human or animal origin, it is very disagreeable to find
non-osseointegrated bone replacement material instead of the desired newly formed bone during implantation and being worse off than without the procedure.
Amongst some surgical colleagues, the phrase “party
crasher”1 is used, i.e. the bone formation party fails to
happen. Unfortunately, even immediate implantation,
which would help in most cases, is often no solution, because infection, insufficient treatment time, unsuited
implant systems, and especially the legally uninformed
patient are obstacles to an immediate implantation.
Even if immediate implantation is a success, the results
are not reliably predictable, especially with regard to
aesthetics. For these reasons, I searched for an alternative, affordable, fast and non-cumbersome procedure
using autologous materials to reduce bone resorption
Fig. 6
[23] =>
user report _ elap-rp
Fig. 7
and create optimal conditions for subsequent implantation. This procedure, elap-rp (elexxion laser-assisted
protocol-ridge preservation), will be presented in this
article.
_Theoretical reflections
Romanos2 demonstrated in his study with a highperformance Nd:YAG laser that a laser cut heals distinctly slower than a scalpel cut, but therefore scar free.
After three weeks, at the earliest, the laser cut is completely healed. It is assumed that thermal damage to the
external epithelial layer slows the healing process. This
undesired result occurs with every thermal laser and
therefore with an undesired, related tissue carbonation.
_Effectively slowing healing
The effect described is of use to the experienced laser
operator during de-epithelialisation of movable mucomembranes for controlled reproduction of attached
gingiva. The de-epithelialisation area acts as the barrier
that slows the healing process. In brief, the area treated
with the high-performance laser acts as a natural, resorbable, highly effective membrane with all known and
desired effects. The way in which the laser-created autologous membrane can be optimally used for ridge
preservation will be illustrated later. The second important factor for optimal bone regeneration is blood, as already conclusively presented and practised by Schulte3
with autologous blood coagulum of cysts. If the
vestibular lamella can be retained during tooth removal,
when compared to a hexagonal cube, it is about a defect
in five of the sides and a missing “lid”. This can be compared to a cyst defect; the sole difference being that no
primary wound closure can be achieved without otherwise unnecessary additional surgical intervention.
_Retaining vestibular lamella
Accompanying the elap-rp procedure, a whole
bleeding of the alveole is absolutely necessary postextraction (Fig. 1). The bleeding can be achieved conventionally via alveole planing or preferably via laser
application. Generally, a claros soft laser (elexxion) in
the healing programme with a pulse of 75 mW with
I
Fig. 9
Fig. 8
8,000Hz for 120 seconds or with 100 mW for 60 seconds, i.e. approx. 6 J per alveole, is sufficient in such
cases. The T4 soft laser glass rod should be inserted to
the base of the alveole and all exposed bone surfaces
should be collected on a grid without contact (Fig. 2).
Sometimes, a second or third procedure is necessary,
and of course possible, to achieve sufficient bleeding.
The alveole filled with blood is then membranised
(Fig. 3) grid-wise with the claros in the haemostasis programme with 30 W with 20,000 Hz and a pulse duration
of 10 seconds with the non-initialised 600 fibre, beginning distally at an unfocused distance of 1 to 2 mm
(Fig. 3). This procedure initially requires some practice,
but is then simple, fast and reproducibly successful. Afterwards, the patient leaves the clinic with instructions
not to brush or rinse too thoroughly (Fig. 4). The threeday (Fig. 5) and four-week (Fig. 6) follow-ups of a different case showed a successful, almost complete retention of the vestibular lamella. In the following illustrative examples (Figs. 7–10), further results are shown that
were also achieved with this new, systematic elap-rp
procedure. Please note the almost completely retained
vestibular lamella that invites each implant surgeon to
a simple and safe implantation at a prosthetically sensible location. With the elap-rp procedure, ideal conditions for implantation or an ovate pontic can be created
quickly and affordably without additional material
costs. Use it to offer you patients an optimal and affordable laser treatment._
Fig. 10
Fig. 7_Four weeks after elap-rp.
Fig. 8_Six weeks after elap-rp.
Fig. 9_Directly after x and elap-rp.
Fig. 10_Situation after twelve weeks.
Editorial note: A list of references is available from the publisher.
_contact
laser
Dr Darius Moghtader
In den Weingärten 47
55276 Oppenheim
Germany
dr-moghtader@hotmail.de
www.oppenheim-zahnarzt.de
www.laser-zahn-arzt.de
laser
3
I 23
_ 2011
[24] =>
I user report _ optical diagnostic
Optical imaging
in the oral cavity
Innovative and emergent imaging techniques
Author_Danielle Le, Anh Le, Jennifer Holtzman, Joel Epstein & Petra Wilder-Smith, USA
_As the emphasis shifts from damage mitigation to disease prevention or reversal of early disease
in the oral cavity, the need for sensitive and accurate
detection and diagnostic tools becomes more important. Many novel and emergent optical diagnostic
modalities for the oral cavity are becoming available
to clinicians with a variety of desirable attributes, including: (a) non-invasiveness; (b) absence of ionising
radiation; (c) patient friendly; (d) real-time information; (e) repeatability; and (f) high-resolution surface
and subsurface images. In this article, the principles
behind optical diagnostic approaches, their feasibility and applicability to imaging soft and hard tissue,
and their potential usefulness as a tool in the diagnosis of oral mucosal lesions, dental pathologies, and for
other dental applications will be reviewed.
_Introduction
Light-based imaging of tissue detects minimal
changes, such as: (a) cell microanatomy (e.g. nuclear/cytoplasmic ratio); (b) redox status; (c) expression of specific biomarkers; (d) tissue architecture
and composition; (e) chemical changes (e.g. mineralisation); and (f) vascularity/angiogenesis and perfusion. These properties are ideal for the detection of
minimal (early) changes, for assessing the margins of
lesions and potentially the presence of subclinical
abnormalities beyond the clinical margins, for re-
24 I laser
3_ 2011
peated non-invasive monitoring of existing lesions,
and for rapidly examining at-risk populations.
_Oral cancer
A. Chemiluminescence: ViziLite
This imaging device has been used in the oral cavity since 2001. After rinsing with an acetic acid mixed
solution, the oral cavity is examined under chemiluminescent illumination at 430, 540 and 580 nm
wavelengths. This method allows increased visual
distinctions between normal mucosa and oral white
lesions (Huber et al. 2004; Kerr et al. 2006; Epstein et
al. 2006; Epstein et al. 2008). The detected signals
may be related to the altered thickness of the epithelium, or to the presence of a higher density of nuclear
content and mitochondrial matrix that preferentially reflect light. Hyper-keratinised or dysplastic lesions appear distinctly white when viewed under a
diffuse low-energy wavelength light. In contrast,
normal epithelium will absorb light and appear dark
(Lingen et al. 2008). Since the majority of studies investigating chemiluminescence reported subjective
perceptions of intra-oral lesions in terms of brightness, sharpness and texture versus routine clinical
examination, data interpretation may vary significantly between examiners (Huber et al. 2004; Kerr et
al. 2006). In January 2005, a combination of both
toluidine blue and ViziLite systems (ViziLite Plus with
[25] =>
user report _ optical diagnostic
TBlue system) received FDA clearance as an adjunct
to visual examination of the oral cavity in populations at increased risk for oral cancer. In a multicenter study of high-risk patients, it was reported that
the majority of lesions with a histological diagnosis
of dysplasia or carcinoma in situ were detected and
mapped using ViziLite and toluidine blue (Epstein et
al. 2008). Recently, a new chemiluminescence device
(Microlux/DL, AdDent) has been introduced as an adjunct tool for oral lesion identification (McIntosh &
Farah 2009).
B. Spectroscopy and autofluorescence
Tissue autofluorescence has been applied in the
screening and diagnosis of pre-cancer and early cancer of the lung, uterine cervix, skin and, more recently,
of the oral cavity. During the disease process, the altered cellular structure (e.g. hyperkeratosis, hyperchromatin and increased cellular/nuclear pleomorphism) and/or metabolism (e.g. concentration of
flavin adenine dinucleotide and nicotinamide adenine dinucleotide) affect tissue interaction with
light. Spectroscopy or autofluorescence imaging can
provide information about these altered light interaction properties.
In the last decade, several forms of autofluorescence technology have been developed for inspection of the oral mucosa. LED Medical Diagnostics Inc
I
in partnership with the British Columbia Cancer
Agency has marketed the VELscope system (Lingen
et al. 2008; Patton et al. 2008; De Veld et al. 2005).
When viewed through the instrument eyepiece, normal oral mucosa emits a pale green autofluorescence upon stimulation with intense blue excitation
at 400 to 460 nm wavelength, whilst dysplastic lesions exhibit decreased autofluorescence and appear darker with respect to the surrounding healthy
tissue. Several studies have investigated the effectiveness of the VELscope system as an adjunct to visual examination, and determined an improvement
in the ability to distinguish between oral lesions and
healthy mucosa, and between different lesion types
(De Veld et al. 2005). Overall, the technique appears
to show high sensitivity, but low specificity (De Veld
et al. 2005). Using histology as the comparative gold
standard, VELscope demonstrated high sensitivity
and specificity in identifying areas of dysplasia and
malignancy that extended beyond the clinically evident tumours (Lingen et al. 2008; Patton et al. 2008;
De Veld et al. 2005; Onizawa et al. 1996; Schantz et
al. 1998). A direct clinical application entails assessing pathology margins in patients with potentially
malignant oral lesions, thereby assisting in guiding
surgical management (Poh et al. 2007; Rosin et al.
2007). However, reported evaluations of the
VELscope system are from case series and case reports rather than clinical trials, and no published
studies have assessed the VELscope system as a diagnostic adjunct in screening patient populations
(including patients with or without a history of dysplasia/oral squamous cell carcinoma).
In another study using quantitative fluorescence
imaging in 56 patients with oral lesions and 11 normal volunteers, healthy tissue could be discriminated from dysplasia and invasive cancer with a sensitivity of 95.9 % and specificity of 96.2 % in the
training set, and with a sensitivity of 100 % and
specificity of 91.4 % in the validation set. Lesion
probability maps qualitatively agreed with both clinical assessment and histology (Roblyer et al. 2009).
Further clinical studies are needed in diverse populations to evaluate fully the clinical usefulness of this
promising technology. Other devices using a range of
spectroscopic techniques are under development, often combined with other technologies. These include
the FastEEM4 System, the Identafi (Remicalm) and
the PS2-oral (Schwarz et al. 2009; McGee et al. 2008;
Lane et al. 2006; De Veld et al. 2005; Wagnieres et al.
1998; Ramanujam et al. 2000; Culha et al. 2003;
Choo-Smith et al. 2002; Bigio et al. 1997; Farrell et al.
1992). Clinical studies are still at a relatively early
stage, but preliminary results are encouraging. The
Identafi technology combines anatomical imaging
with fluorescence, fibre optics and confocal microscopy to map and delineate precisely the lesion in
laser
3
I 25
_ 2011
[26] =>
I user report _ optical diagnostic
the area being screened. In a screening of 124 subjects, a sensitivity of 82 % and specificity of 87 % were
determined for differentiating between neoplastic
and non-neoplastic sites in the oral cavity. Results appeared to vary between sampling depths, and keratinised versus non-keratinised tissue (Schwarz et al.
2009). Major challenges to diagnostic spectroscopy
include the often low signal-to-noise ratio, difficulty
in identifying the precise source of signals, data
quantification, and difficulty in establishing definitive diagnostic milestones and endpoints, especially
given the wide range of tissue types within the oral
cavity. The depth of tissue penetration is an inherent
limitation of the technology. Additional concerns relate to the potential mutagenicity induced by UV light
in the clinical setting.
C. Photosensitisers
When topical or systemic photosensitisers are administered, their ability to accumulate in cancer cells
and to fluoresce under specific wavelengths can be
used to identify and delineate areas of microscopic
changes (Kennedy et al. 1992; Cassas et al. 2002). This
approach permits 3-D mapping of the epithelial surface and subepithelial boundary, screening of large
surface areas and offers the option of subsequent
photodestruction of the photosensitised lesion.
Some promising agents for photodetection include
aminolevulinic acid (Levulan), hexyl aminolevulinate
(Hexvix), methyl aminolevulinate (Metvix),
tetra(meta-hydroxyphenyl)chlorin, as well as porfimer sodium (Photofrin; Ebihara et al. 2003; Leunig
et al.1996, 2000, 2001; Chang & Wilder-Smith, 2005).
In a blinded clinical study of 20 patients with oral neoplasms, diagnostic sensitivity using unaided visual
fluorescence diagnosis or fluorescence microscopy
approximated 93 %. Diagnostic specificity was 95 %
for visual diagnosis, improving to 97 % using fluorescence microscopy (Chang & Wilder-Smith, 2005). A
recent study using epidermal growth factor-targeted
fluorescent agents by topical application to oral mucosal lesions, combined with in vivo imaging, demonstrated encouraging results with regard to lesion detection, margin delineation and as an adjunct guiding tool for biopsy (Nitin et al. 2009). Depending on
the photosensitiser and its mode of application (systemic versus topical), limitations include systemic
photosensitisation over prolonged periods, penetration-related issues, the need for specialised fluorescence detection and mapping equipment, and lack of
specificity when inflammation or scar tissue is present.
D. Optical coherence tomography
Optical coherence tomography (OCT) was first introduced as an imaging technique in biological systems in 1991 (Huang et al. 1991). The non-invasive
nature of this imaging modality, coupled with a pen-
26 I laser
3_ 2011
etration depth of 2 to 3 mm, high resolution (5–15
µm), real-time image viewing and capability for
cross-sectional, as well as 3-D tomographic images,
provides excellent prerequisites for in vivo oral
screening and diagnosis. OCT has frequently been
compared to ultrasound imaging. Both technologies
employ back-scattered signals reflected from different layers within the tissue to reconstruct structural
images, with the latter measuring sound rather than
light. The resulting OCT image is a 2-D representation
of the optical reflection within a tissue sample. Crosssectional images of tissue are constructed in real
time, at near histological resolution (approximately
5–15 µm with current technology). These images can
be stacked to generate a 3-D reconstruction of the
target tissue. This permits in vivo non-invasive imaging of epithelial and subepithelial structures, including depth and thickness, histopathological appearance and peripheral margins of the lesions.
Several OCT systems have received US FDA approval for clinical use, and OCT is deemed by many as
an essential imaging modality in ophthalmology. In
vivo image acquisition is facilitated through the use
of a flexible fibre-optic OCT probe. The probe is simply
placed on the surface of the tissue to generate realtime, immediate surface and subsurface images of
tissue microanatomy and cellular structure, whilst
avoiding the discomfort, delay and expense of biopsies. Several studies have sought to investigate the diagnostic utility of in vivo OCT to detect and diagnose
oral pre-malignancy and malignancy (Tsai et al.2008;
Wilder-Smith et al. 2009). In a blinded study involving 50 patients with suspicious lesions, including oral
leukoplakia and erythroplakia, the effectiveness of
OCT for detecting oral dysplasia and malignancy was
evaluated (Wilder-Smith et al. 2009). OCT images of
dysplastic lesions revealed visible epithelial thickening, loss of epithelial stratification, and epithelial
downgrowth. Areas of oral squamous cell carcinoma
of the buccal mucosa were identified in the OCT images by the absence or disruption of the basement
membrane, an epithelial layer that was highly variable in thickness, with areas of erosion and extensive
epithelial downgrowth and invasion into the subepithelial layers. Statistical analysis of the data gathered
in this study substantiated the ability of in vivo OCT to
detect and diagnose pre-malignancy and malignancy in the oral cavity with excellent diagnostic accuracy. For detecting carcinoma in situ or squamous
cell carcinoma (SCC) versus non-cancer, sensitivity
was 0.931 and specificity was 0.931; for detecting
SCC versus all other pathologies, sensitivity was 0.931
and specificity was 0.973.
In another study of 97 patients using OCT imaging
to detect neoplasia in the oral cavity (Tsai et al. 2009),
the results revealed that the main diagnostic criterion
[27] =>
user report _ optical diagnostic
for high-grade dysplasia/carcinoma in situ was the
lack of a layered structural pattern. Diagnosis based
on this criterion for dysplastic/malignant versus benign/reactive conditions achieved a sensitivity of 83
% and specificity of 98 % with an inter-observer
agreement value of 0.76. This study concluded that
OCT, with high sensitivity and specificity combined
with good inter-observer agreement, is a promising
imaging modality for non-invasive evaluation of tissue sites suspicious for high-grade dysplasia or cancer. Other studies have utilised direct analysis of OCT
scan profiles, rather than image-based criteria, as a
means of delineating the site and margins of oral cancer lesions (Tsai et al. 2008). Using numerical parameters from A-scan profiles as diagnostic criteria, the
decay constant in the exponential fitting of the OCT
signal intensity along the tissue depth decreased as
the A-scan point moved laterally across the margin of
a lesion. Additionally, the standard deviation of the
OCT signal intensity fluctuation increased significantly across the transition region between the normal and abnormal portions. The authors concluded
that such parameters may well be useful for establishing an algorithm for detecting and mapping the
margins of oral cancer lesions. Such a capability has
huge clinical significance because of the need to better define excisional margins during surgical removal
of oral pre-malignant and malignant lesions.
_Dental pathologies and other
applications
Light scattering, reflection, absorption and laserinduced fluorescence can provide much information
regarding hard-tissue structure and pathology. The
techniques described below—OCT, polarisation-sensitive OCT (PS-OCT), laser fluorescence (DIAGNOdent,
KaVo), quantitative laser fluorescence (QLF), fibre-optic transillumination—exploit this concept, achieving
varying degrees of specificity and sensitivity for detecting demineralisation and decay of the dental matrices, the anatomical structure of the tooth organ, as
well as the attached microbial biofilms and calculus.
I
dia is gradual, the reflection will be minimal (Brenzinski et al. 2006; Colston et al. 1998; Feldchtein et al.
1998; Otis et al. 2000). The changes between the hard
tissues such as enamel and dentine and between
healthy and demineralised or carious states can then
be interpreted to create 2-D and 3-D images of the
hard tissues. As such, various optical properties are
under investigation as potential quantifiers of the
mineralisation changes to detect dental caries (Li et
al. 2009). In the relatively early days of OCT, two
groups of researchers investigated the feasibility of
using OCT in vivo to image sound and demineralised
tissue, and even monitored restorative procedures
(Colston et al. 1998). A recent publication described
the use of in vivo OCT to determine the effectiveness
of a proton pump inhibitor in treating gastro-oesophageal reflux by monitoring dental erosion with
OCT (Wilder-Smith et al. 2009). The study was significant in that the researchers were able to identify an
association between the medication and a reduction
in enamel erosion.
B. Polarisation-sensitive OCT
Since both enamel and dentine have strong polarising effects, changes in polarisation provide more
structural information than conventional OCT
(Brezinski, 2006). Light is delivered in one polarisation, and the reflection is read in both polarisations.
Although we were unable to find clinical studies that
used PS-OCT, extensive research has been conducted
by Fried and others that demonstrates that this technology has the potential to monitor demineralisation/remineralisation and quantify demineralised
tooth structure, even below dental sealant (Manesh
et al. 2009; Chen et al. 2005; Jones et al. 2006; Jones
& Fried 2006; Ngaotheppitak et al. 2005; Chong et al.
2007; Jones et al. 2004). Unfortunately, PS-OCT technology has not been as effective in identifying root
caries (Lee et al. 2009).
C. Laser fluorescence
Back-scattered light from laser-induced fluores-
Fig. 1_Indispensable part of a
successful therapy:
optical diagnostic.
_Dental caries
A. Optical coherence tomography
As described above, OCT measures the intensity of
back-scattered light to create images. Light does not
travel at a constant velocity when it passes through
different structures, travelling faster in material with
a low refractive index and slower in media with a high
refractive index. Additionally, when the light hits a
sharp change in refraction, the wave is reflected either externally or internally. The amount of reflection
depends on the amount of change in refraction, the
angle the light is travelling at and the polarisation of
the light. If the change of refraction between the me-
Fig. 1
laser
3
I 27
_ 2011
[28] =>
I user report _ optical diagnostic
and fluorosis can affect QLF accuracy (Zandona &
Zero 2006). High-intensity UV light can generate free
radicals, potentially resulting in toxicity to live tissue.
Fig. 2
Fig. 2_Severe dysplasia under
white light. (With kind permission of
14th Floor Solutions; VELscope®)
cence has been reported as a tool to detect and quantify caries activity (Zandona & Zero 2006). A red laser
light (655 nm wavelength) is absorbed by organic and
inorganic matter in the tooth and then re-emitted
from the organic material as near-infrared fluorescent light. The device provides a numerical printout
and an audible signal when decay is detected. The results of studies investigating diagnostic usefulness of
DIAGNOdent vary considerably (Chong et al. 2003;
Kuhnisch et al. 2008). The lack of diagnostic consistency may reflect: (a) the need for clinicians to learn
how to use the correct position for the unit; (b) staining and/or calculus affecting the readings; and (c) difficulty in determining the numerical value at which
surgical intervention is indicated (Shi et al. 2000).
However, the literature appears to be consistent in
describing DIAGNOdent as a better tool for detecting
dentinal caries than enamel caries. Additional benefits of the DIAGNOdent may be its ability to identify
completed removal of infected tooth structure during excavation (Lussi et al. 2004). While DIAGNOdent’s high rate of false-positive results may be a
limitation in some clinical practices, in a high-risk
population with limited access to dental care, this tool
may be quite predictive in caries screening.
D. Quantitative light fluorescence
QLF uses fluorescence induced by multi-wavelength excitation at 290 to 450 nm to measure mineral loss in enamel and dentine (Hall & Girkin 2004).
Unlike the DIAGNOdent system, this device provides
colour-coded images of the target tissue. Sound
tooth structure fluoresces and carious tooth structure appears dark. As the caries scatters the light,
mapping the carious lesion can be difficult. Interestingly, the predictive nature of this technology depends on the population (Hall et al. 2004). In a highrisk population, QLF is highly predictive (.90–.98) of
future caries (Zandon & Zero 2006). In a low-risk population, it is much less predictive, and stains, plaque,
28 I laser
3_ 2011
E. Fibre-optic transillumination
This approach uses changes in the scattering and
absorption of photons by structural characteristics
to detect caries in real time. Advantages of this technology include safety, as UV light is not used. In digital-imaging fibre-optic transillumination (DIFOTI),
the light that passes through the tooth is interpreted
by a digital device on the other side of the tooth. DIFOTI seems to perform well for early surface lesions;
however, it seems to have low specificity, which can
result in overtreatment and is also unable to determine lesion depth, which limits potential sites of use
(Young et al. 2005; Bin-Shuwaish et al. 2008; Schneiderman et al. 1997). Recently, Wu and Fried used near
infra-red (NIR) transillumination to image dental
caries (Wu & Fried 2009). This technology takes advantage of the transparency of sound enamel at 1310
nm, which decreases considerably in unhealthy tooth
structure. Demineralised areas on the enamel surface
appear lighter, while deeper lesions appear darker.
However, low contrast as compared to the high reflectance signal and decreasing effectiveness with
increasing tooth thickness are important clinical
challenges. Although we were unable to identify clinical studies using NIR transillumination, the concept
holds great promise, for example, allowing clinicians
to monitor remineralisation of enamel.
_Other dental applications
Periodontics
A. Fluorescence using the periodontal probe for
DIAGNOdent
Because calculus fluoresces differently than
healthy tissue, the use of laser fluorescence has been
proposed as an aid to detect residual calculus following root planing and scaling. The DIAGNOdent perio
probe may aid in clinical detection of sub-gingival
calculus deposits far better than conventional methods (Kasaj et al. 2008; Krause et al. 2003; Krause et al.
2005). Audible sounds and measurable values as signals for presence of calculus during screening may increase patients’ awareness of their calculus levels,
leading to increased patient compliance with the recommended treatment.
B. Optical coherence tomography
Several in vitrostudies have demonstrated the potential use of OCT as an adjunct tool for diagnosis of
periodontal disease. Studies in a porcine model
showed high-resolution images of periodontal tissue, the enamel–cementum and the gingiva–tooth
interfaces (Colston et al. 1998). While results of early
in vivo studies were promising, consistent imaging of
[29] =>
user report _ optical diagnostic
I
the periodontal tissue remains challenging owing to
the limited penetration depth and scan sizes of OCT
(Colston et al. 1998). In another study by Baek et al.
the successful use of OCT for monitoring periodontal
ligament changes during orthodontic tooth movements in rats was reported (Baek et al. 2009).
Endodontics
A. Fluorescence using the DIAGNOdent perio probe
Real-time assessment of the microbial status of
the root canal system would be useful in clinical endodontic practice for determining endpoints of biomechanical treatment. In an ex vivo study using extracted teeth, the DIAGNOdent, in combination with
a prototype sapphire tip designed for periodontal assessment, was used to evaluate the pulp chamber and
coronal third of the root canal system. The fluorescence properties of bacterial colonies, biofilms in root
canals, pulpal soft tissue and sound dentine were
evaluated in 50 extracted teeth with known endodontic pathology. Sound dentine and healthy pulpal soft tissue gave an average fluorescence reading
of 5 (on a scale of 100), whereas biofilms of Enterococcus faecalis and Streptococcus mutans colonising the root canals showed a progressive increase in
fluorescence signals over time. Fluorescence readings reduced to the “healthy” threshold range when
root canals were endodontically treated, and the experimentally created bacterial biofilms were removed
completely. High fluorescence readings were
recorded in the root canals and pulp chambers of extracted teeth with radiographic evidence of peri-apical pathology and scanning electron microscopy evidence of bacterial infection (Sainsbury et al. 2009).
B. Optical coherence tomography
In a study on extracted teeth, the diagnostic accuracy of high-resolution OCT using a 0.5 mm diameter
intra-canal probe for mapping oval canals, uncleaned
fins, risk zones and root perforations approached that
provided by histology (Shemesh et al. 2007). The
probe easily fitted into a prepared root canal and its
flexibility allowed penetration and advancement
through curvatures. The optical probe rotated within
a probe sheath so that adjacent lines in each rotation
could be stacked to generate a frame showing a crosssection of the tissue architecture in the wall. The scan
was quick, about 15 seconds for a 15 mm-long root.
The authors concluded that fibre-optic OCT probing
holds promise for full in vivo endodontic imaging.
Another ex vivo study assessed apical micro-leakage following endodontic treatment using OCT
(Todea et al. 2009). OCT imaging was found to be effective in identifying the apical seal. However, in the
real clinical situation, OCT use for peri-apical diagnostics is limited by its short penetration depth into
the bone in which the tooth is embedded.
Fig. 3
_Conclusion
Emergent optical technologies show promise for
a wide range of oral diagnostic applications with capabilities for high-resolution, cross-sectional tomographic imaging of microstructure in several biological systems. OCT can achieve image resolution
one to two orders of magnitude finer than standard
ultrasound. As such, OCT functions more effectively
as a unique “optical biopsy” to delineate the crosssectional images of tissue structure at the microscale. This promising biomedical optical imaging
technology provides images of tissue in situ and in
real time, without the need for surgical biopsy and
multiple-specimen processing. OCT imaging allows
detection and diagnosis of early stages of disease in
teeth, periodontal tissue and mucosa, and facilitates large-scale screening for high-risk populations. Because of the rapid pace of innovation in this
field, the cost and ease of use of such modalities are
improving rapidly, such that many such devices are
becoming available to dental clinicians. We envisage
many benefits to patients and clinicians from the
use of these devices._
_contact
Fig. 3_The lesion viewed using
VELscope’s fluorescence visualization. (With kind permission of
14th Floor Solutions; VELscope®)
laser
Dr Petra Wilder-Smith
Beckman Laser Institute
University of California, Irvine
1002 Health Sciences Rd.
Irvine, CA 92612, USA
Tel.: +1 949 824 7632
Fax: +1 949 824 8413
pwsmith@uci.edu
laser
3
I 29
_ 2011
[30] =>
I user report _ morphological changes
Morphological changes in
hard dental tissue prepared
using the Er:YAG laser
Author_Drs Snejana Ts. Tsanova & Georgi T. Tomov, Bulgaria
Fig. 1a
Fig. 1b
Figs. 1a–c_Extracted teeth with
carious lesions.
30 I laser
3_ 2011
Fig. 1c
_In recent years, prevention and early caries
detection, as well as shifts in the understanding of
the chemical and biological basis of the demineralisation process in hard dental tissue and the possibility of carious lesions undergoing remineralisation, have superseded the classical operative approach to caries treatment postulated by Black and
promoted minimally invasive preparation (MIP).
The main categories of MIP techniques include
rotary handpieces and burs, chemomechanical
cleaning with Carisolv gel, air abrasion and dental
lasers.1, 2 The trend for alternatives to the conventional method of preparation led to a focus on the
impact of alternative techniques on hard dental
tissue and underlying dental pulp. MIP techniques
claim to be able to achieve controlled removal of
infected and softened dentine while preserving the
healthy, hard dental tissue and do so with minimal
discomfort to the patient. However, current data
provides contradictory evidence of the impact of
MIP techniques on hard dental tissue compared
with conventional preparation. Possible reasons
for this are the variety of experimental studies and
difficulties in standardising the results of clinical
research. It is worth noting that the studies that
have given the most positive evaluation of the alternative methods of preparation (Carisolv, laser)
use mainly clinical criteria for evaluation (patient’s
perception and tolerance, noise, atraumatic work,
colour and texture of the dentine when probing,
etc.), which are all rather subjective. While new, improved versions of alternative systems for preparation on the market claim to be highly clinically efficient, there is still little information about them
(the modified Carisolv colourless gel, multi-frequency, high-energy lasers, air-abrasion). This
makes it necessary for research in this rapidly developing, promising field of dentistry to be updated periodically. The objective of the present in
vitro study was to evaluate by SEM the ultrastructural changes in hard dental tissue treated with
several alternative systems for caries removal and
preparation.
_Materials and methods
The study used 20 human teeth, freshly extracted because of advanced periodontal disease.
The preparations involved natural carious lesions
on tooth surface (Figs. 1a–c). The teeth were divided into four groups of five teeth (n = 5) according to the preparation technique:
Group 1: Mechanical rotary preparation with steel
burs/micromotor;
Group 2: Mechanical rotary preparation with diamond burs/air turbine;
Group 3: Chemomechanical preparation with
Carisolv colourless gel (MediTeam AB; Figs. 2a–c);
Group 4: Laser preparation by Er:YAG laser (Lite-
[31] =>
user report _ morphological changes
Touch, Syneron; Figs. 3a–c). Preparation was done
strictly according to the manufacturers’ instructions. The removal of caries was confirmed clinically through observation and probing. After
preparation, the teeth were immersed in a 4 %
buffered glutaraldehyde fixative solution (0.075 M,
pH 7.3) for one hour. They were then rinsed in distilled water and placed in a cold sodium cacodylate
buffer (0.02 M, pH 7.2, 660 mosm) for 90 minutes
for fixation of the organic matter. Subsequent dehydration was carried out through an ascending
series of ethanol concentrations (30, 50, 70, 80, 95
and 100 %) for one hour per series. The teeth were
critical point dried in a desiccator. The dried specimens were then mounted on a metal stand and
gold-coated (200–250 nm) by cathode atomisation under vacuum.
Scanning microscopy was performed using an
electron microscope (515 SEM model, Philips), with
accelerating voltage of 25 kV in secondary emission mode. For each specimen, we took five photographs of randomly chosen areas with the same
magnification (x 2,000) and various photographs
at a different magnification. Using the SEM photomicrographs, we evaluated, described and compared the morphological findings and differences
in the enamel and dentine tissues after treating the
teeth using alternative methods for caries removal
and cavity preparation.
_Results
When analysing the SEM photomicrographs of
the specimens examined, we found that the conventional method of cavity preparation with steel
burs and micromotors at low speed without watercooling (group 1) resulted in a contaminated surface with a thick smear layer of dentine debris
without visible dentinal tubule orifices on all
treated surfaces (Figs. 4a & b). The walls of the cavities were smooth and rounded and the border between enamel and dentine hardly noticeable.
Preparation with diamond burs, an air turbine
and water-cooling (group 2) yielded a thin,
Fig. 3a
Fig. 2a
Fig. 2b
smooth, and in some places absent, smear layer
(Fig. 5a). In the area of water turbulence, there were
patent dentinal tubule orifices, but without a clear
outline of tubule lumens or peri- and intertubular
dentine (Fig. 5b). The boundary between enamel
and dentine was unclear, and the cavity had
smooth contours.
I
Fig. 2c
Figs. 2a–c_Laser preparation with
the LiteTouch Er:YAG laser in hard
tissue mode (400 mJ/20 Hz, 8 W).
The dental surface topography after chemomechanical preparation with Carisolv gel (group 3)
was clearly rougher compared with that of groups
1 and 2. The dentinal tubule orifices were visible
and there was almost no smear layer (Fig. 6a).
Preparation of the organic matrix using chemomechanical preparation with Carisolv while preserving mineralised dental tissue resulted in a rough
appearance of the treated surfaces and considerable micro-retention (Figs. 6b & c). Denatured collagen fibres and surface contamination occurred
in some places, blocking the dentinal tubule orifices (Fig. 6d). The cavity form in group 3 followed
the initial carious lesions’ forms without going beyond their boundaries.
Cavity forms prepared with the Er:YAG laser
(group 4) were characterised by a lack of definite
geometric configuration and outlined cavity elements (Fig. 7a). There was a rough and irregular
surface with no smear layer (Fig. 7b). Dentinal
tubules were clearly exposed. Intertubular dentine
was more ablated than peri-tubular dentine and
this made the appearance of dentinal tubules more
prominent (Fig. 7c). In the enamel, the typical architectonics of enamel prisms grouped in bundles
Figs. 3a–c_Chemomechanical
preparation with Carisolv colourless
gel and hand excavators.
Fig. 3b
Fig. 3c
laser
3
I 31
_ 2011
[32] =>
I user report _ morphological changes
Fig. 4a
Fig. 4b
Figs. 4a & b_SEM photomicrographs
of tooth surfaces prepared with steel
burs (x 500; 2,000 magnification).
The surface is covered with a layer of
debris and dentinal tubule orifices
are not visible.
Figs. 5a & b_A smooth, thin smear
layer covers tooth surfaces prepared
with diamond burs and an air turbine.
In the area of water turbulence,
partially removed contaminants and
single dentinal tubule lumens
were observed (x 500; 2,000
magnification).
Fig. 5a
was observed. Laser ablation of part of the enamel
rendered the surfaces highly retentive (Figs. 7d & e).
_Discussion
The MIP approach is based on several principles:
remove only irreversibly damaged dental tissue and
avoid macro-retention preparation in healthy tissue.1 Additionally, MIP techniques should protect
the underlying pulp and leave the treated surface
suitable for adhesive bonding.1 The antibacterial effects of the alternative preparation techniques must
not be lower than those of standard necrotomy with
rotary instruments and should excel them rather.1
Nowadays the laser devices available for clinical use are capable of effective, controlled ablation
of hard dental tissue.2 Some clinical trials have
suggested that Carisolv gel is highly efficient in
caries removal, leaving clean and retentive dentinal surfaces.2 However, not all researchers agree
with these conclusions. Therefore, such studies
should be periodically updated owing to the constant introduction of new technologies.
The experimental results of the present study
revealed significant differences in the surface
morphology of the samples studied, which would
affect the ability to perform effective adhesive
bonding. These morphological differences are
highly dependent on the mechanism of action of
the specific preparation systems.
Laser devices use a variety of physical media as
sources for generating different wavelengths that
are absorbed and interact with specific molecules
in human tissues. The explanation for the hard tissue ablation is that the water content evaporates
when exposed to laser irradiation, creating high in-
32 I laser
3_ 2011
Fig. 5b
ternal pressure and subsequent micro-explosions.
Inadequate water-cooling in this interaction of
laser irradiation with tissue will lead to undesirable
thermal effects.3 Depending on parameters such as
pulse energy and frequency, CO2 lasers, Nd:YAG
and Er:YAG lasers cause changes in enamel and
dentine in the form of roughing, craters, cracking,
slicing, carbonification, melting and recrystallisation as described in many previous studies.4–6 These
changes depend on the laser type, mode of operation, system for water-cooling and proper operation.3 Additionally, the ability to ablate carious
dentine and enamel varies greatly according to different experimental studies.4–6 There is insufficient
data that demonstrates the ability of the argonfluoride and excimer lasers to remove dental
caries.5 The krypton fluoride excimer laser, which
emits in the ultraviolet range, has been shown to
remove dentine, but enamel resists ablation.5
The high-power and high-frequency Er:YAG
laser (LiteTouch) used in the present study has an
advanced hydrokinetic system that is claimed to be
capable of effective and safe ablation of hard dental tissue. The LiteTouch laser uses unique software
that allows for the broadest range of energy and
frequency settings. Its unique handpiece prevents
loss of energy and, along with precision control
over pulse duration, pulse energy and the optimal
repetition rate, allows for a wide range of hard tissue procedures. LiteTouch is the first laser in to undesirable thermal effects.3 LiteTouch is the first
laser in yet fully explored as a possible opportunity
to eliminate acid etching of hard dental tissue and
its related adverse effects on the underlying dentine and pulp.
Carisolv is a chemomechanical, minimally invasive method for selective softening of caries in
[33] =>
www.idem-singapore.com
THE BUSINESS OF DENTISTRY
INTERNATIONAL DENTAL
EXHIBITION AND MEETING
APRIL 20 - 22, 2012
Limited space available. Secure your booth now!
We Bring the Asia Pacific Markets to You. IDEM Singapore connects you with
over 6,000 dental traders, distributers and practitioners from the Asia Pacific region.
Enriched with opportunities from the trading and showcasing of high-quality
dental equipment to learning and development in the field of dental practice,
this event is a “must-attend” for every dental and associated professional.
Endorsed By
Supported By
Held In
In Co-operation With
Co-organiser
Singapore Dental Association
North America
Franz Balve
Koelnmesse Inc
Tel: +1 732 933 1117
Fax: +1 732 741 6437
f.balve@koelnmessenafta.com
International
Stephanie Sim
Koelnmesse Pte Ltd
Tel: +65 6500 6723
Fax: +65 6296 2771
s.sim@koelnmesse.com.sg
[34] =>
I user report _ morphological changes
Fig. 6a
Fig. 6b
Figs. 6a & b_Dentine surfaces
treated with Carisolv gel are clean
and highly retentive, with many
exposed, open dentinal tubules
(x 500; 2,000 magnification).
Figs. 6c & d_Dentine surfaces
treated with Carisolv gel are rough,
granular and highly retentive. In
some areas, single collagen fibrils
are evident (x 3,000 magnification).
34 I laser
3_ 2011
Fig. 6c
dentine and its subsequent removal with hand excavators.16 The system consists of gel containing
three amino acids (glutamine, lysine and leucine)
and a transparent liquid (0.5 % NaOCl), which are
mixed immediately before application. The chlorinated amino acids obtained selectively tear the
damaged collagen fibres in carious dentine without damaging the underlying demineralised but
not denaturated collagen. The macerated, infected
dentine is removed manually using excavators.
Carisolv gel is colourless and its amino acid concentration is twice as small, while the sodium
hypochlorite concentration is increased twofold.
The mechanism of action of Carisolv gel is based
primarily on the proteolytic effect of NaOCl, which
dissolves the denaturated collagen in the carious
lesion.16 It is thought that the three amino acids enhance the effect of NaOCl on the collagen and reduce the involvement of healthy dental tissue.
Carisolv chemical effects on the underlying pulp
have been assessed as safe, and the alkaline pH
(~11) of the gel neutralises acids and has a bactericidal effect on cariogenic flora.1, 16 The presence
of NaOCl in Carisolv is problematic, however, because of the danger of NaOCl inhibiting the bonding agent’s polymerisation. Another clinical problem is the inability of Carisolv to affect the enamel
and that requires combination with rotary instruments to excavate caries.16 Additionally, the results
reported by studies on Carisolv’s capacity to remove the smear layer are conflicting. According to
some studies, Carisolv almost completely removes
the smear layer, leaving visible and patent dentinal
tubules.15, 17 According to another study, however,
Carisolv is unable to eliminate the smear layer and
no patent dentinal tubules result.18 The latter study
was conducted on a non-carious dentine surface
and the researchers observed an irregular smear
layer over enamel and dentine, and all dentinal
Fig. 6d
tubule orifices filled with debris. A third group of
researchers found results that lay in between the
findings of the other two: Carisolv does not eliminate the smear layer entirely. They observed partially patent dentinal tubules and residue of a contaminant smear layer covering the dentinal surface.2
The dentine surfaces treated with Carisolv and
observed by SEM in the present study were clean,
free of a smear layer, with some remnants of denatured collagen fibres. Conventional rotating
burs formed a smear layer on the dental surface,
while Carisolv increased the surface roughness,
leaving a relatively clean area. The dentine topography following Carisolv application was granular
and rough compared with preparation with rotating instruments and exhibited roughness similar
to that observed after laser preparation. The
marked structural changes in the dental tissue and
the surface roughness observed in our study may
play a crucial role in composite material adhesion,
possibly without requiring the use of etching
agents. However, data in the literature on structural changes following Carisolv preparation
varies considerably and we can conclude that this
system for the chemomechanical removal of dental caries is likely sensitive to the application technique, mineralisation and other dentine characteristics.2, 19
The results of some contemporary studies have
demonstrated that despite the differences between individual studies, in general the amount of
smear layer after treatment with the Er:YAG laser
and Carisolv in all cases is less than that after
preparation with conventional rotating instruments, and surface changes are characterised by
markedly rugged topography.2, 3, 12, 15
[35] =>
user report _ morphological changes
Fig. 7a
Fig. 7b
The morphological features of hard dental tissue observed in our study led us to the general conclusion that cavity preparation with the Er:YAG
laser and Carisolv is consistent with the principles
of MIP, leaving clean surfaces and strong micro-retention, suitable for adhesive restoration. The assumptions about the benefits of alternative techniques for MIP of dental tissue for adhesive
restoration need to be confirmed by other clinical
studies.
_Conclusion
SEM analysis of hard dental tissue treated with
steel and diamond burs showed surfaces covered
with a thick layer of debris, which could compromise adhesion of filling materials. Dental tubule
orifices were obturated with debris, with the exception of the areas under water turbulence, where
the debris was partially removed.
Carisolv gel does not affect the enamel or
healthy dentine. The surface topography of the
dentine remaining after complete caries removal
with Carisolv was rougher than that after conventional preparation with rotating burs. No typical
smear layer was observed, but thin patches of contaminants, much less prominent than after drilling,
were visible.
All laser-treated samples showed no evidence
of thermal damage or signs of carbonification or
melting. The SEM examination revealed characteristic micro-irregularities of the laser-prepared
dentine surface without any smear layer and with
Fig. 7c
Fig. 7d
Fig. 7e
open dentinal tubules. Intertubular dentine was
ablated more than peri-tubular dentine and that
made the dentinal tubules appear to be better exposed. The Er:YAG laser ablated enamel effectively,
leaving well-exposed enamel prisms without debris. The surfaces were very retentive._
This article was first published in Folia Medica 52/3
(2010): 46–55 (doi: 10.2478/v10153-010-0006-1; Copyright © 2010 Medical University Plovdiv).
Editorial note: A list of references is available from the
publisher.
_contact
I
laser
Dr Georgi Tomov
Department of Operative Dentistry and Endodontics
Faculty of Dental Medicine
Medical University of Plovdiv
Bulgaria
Fig. 7a_A cavity prepared with the
Er:YAG laser shows unclear cavity
outlines and craters shading into one
another (x 20 magnification). There
are no precise outlined cavity
elements.
Figs. 7b & c_Laser-treated dentine
surfaces are clean and free from
debris, and all dentinal tubules are
open. The surfaces are also irregular
and rough, and therefore highly
retentive. At greater magnification, the
more effective removal of intertubular
dentine is seen and this makes dentinal tubule orifices appear convex
(x 500; 2000 magnification).
Figs. 7d & e_Enamel surfaces
treated with the Er:YAG laser
revealed characteristic architectonics of bundles of enamel prisms with
different orientation. The surface is
highly retentive and free from
contaminants and a smear layer
(x 2,000; 500 magnification).
AD
Action is the foundational key
to all success.
Pablo Picasso
Contact Dajana Mischke.
d.mischke@oemus-media.de
[36] =>
I user report _ apical resection
Efficient and ergonomic
apical resection using the
Kaiserswerth algorithm
Author_Prof Marcel Wainwright, Germany
ago. Apical resection is a challenging surgical procedure—not least because of the limited accessibility of the surgical field. Instrumentation of an
apical resection case therefore requires a surgical
technique that is as simple as it is safe and ergonomic.
Fig. 1_The MAP system.
This report presents two clinical cases that illustrate a system for applying retrograde endodontic filling materials that has proven a consistently viable option in our clinical practice.
Fig. 1
_Introduction
_Case I
Fig. 2_Autoclavable box with syringe, mixing cup and tips.
Fig. 3_Tips with different
angulations.
Fig. 4_OPG showing active infection
at sites 16, 36, and 46
Fig. 5_Surgical site after removing a
bone block and performing apical
resections on
tooth #36.
Fig. 6_Bone block, stored in Ringer’s
solution.
Fig. 4
Thanks to minimally invasive techniques, such
as ultrasonic surgery and the availability of reliable
restorative materials, the surgical revision and rehabilitation of endodontically treated teeth have a
significantly better prognosis than only ten years
The first case is that of a 34-year-old male patient who presented at our clinic for the first time.
The orthopantomogram (OPG) yielded an accidental finding of apical translucencies at teeth #14, 36
Fig. 2
Fig. 3
Fig. 5
36 I laser
3_ 2011
Fig. 6
[37] =>
AD
and 46, which had been insufficiently treated endodontically. Clinically, these
translucencies were asymptomatic and diagnosed as instances of chronic apical
periodontitis or apical osteitis (Fig. 1).
Together with the patient, we planned for an apical resection of tooth #36 in
conjunction with a retrograde root-canal filling with subsequent removal of the
non-salvageable teeth #16 and 46.
Following extensive consultation and patient education, surgery was performed under local infiltration anaesthesia. With our protocol, block anaesthesia
is unnecessary in 98% of all surgical interventions in the mandible, and dispensing with it minimises the risk of iatrogenic nerve damage.
An incision was performed in the marginal gingiva, with a mesiodistal relief incision, followed by preparation of a full flap for adequate access to the surgical site.
Using the Piezotome II (Acteon), a buccal bone window of adequate depth was prepared to gain access to the apical region at tooth #36 in order to perform the apical resection. It is helpful for the preparation to provide for undercuts in order to
facilitate subsequent removal of the bone block. As no rotary instruments were
used and because ultrasonic surgical instruments have a vaso-constrictor effect,
the surgical field remained impressively free of bleeding and afforded a clear view
of the site. The bone block was stored in Ringer’s solution to facilitate subsequent
repositioning (Fig. 2). The root apices were then exposed and ultrasonically removed (Fig. 4).
You can also subscribe via
www.oemus.com/abo
After apical resection, our protocol called for thorough removal of all soft tissue using instruments, followed by complete decontamination of the cyst lumen
using a diode laser. Care had to be taken to ensure that the laser tip did not make
direct contact with the bone.
Retrograde preparation of the root canals was also performed ultrasonically,
which only takes a few seconds when using the Piezotome II.
I hereby agree to receive a free trial subscription of
(4 issues per year). I would like to subscribe to
for € 44 including shipping and VAT for German customers,
€ 46 including shipping and VAT for customers outside of
Germany, unless a written cancellation is sent within 14 days
of the receipt of the trial subscription. The subscription will
be renewed automatically every year until a written cancellation is sent to OEMUS MEDIA AG, Holbeinstr. 29,
04229 Leipzig, Germany, six weeks prior to the renewal date.
Following chlorhexidine digluconate and sodium-hypochlorite rinses, the
retro-prepared root canals were dried with paper points. In our clinic, we have had
excellent success with the MAP (Micro-Apical Placement) retro system (PDSA),
which has been on the market for many years (Fig. 5). The system comes in a sterilisable metal container. The triple-angled endo tips greatly simplify the uptake and
application of the material, with the syringe facilitating “injection” (retrograde obturation) of the root canal to a depth of several millimetres (Fig. 6). This well-targeted application of the restorative material keeps the surgical field clear (Fig. 7).
Reply via Fax +49 341 48474-290 to OEMUS MEDIA AG
or per E-mail to grasse@oemus-media.de
On application of ProRoot MTA (DENTSPLY Maillefer), the material was allowed
to set, the cross-section surface of the resected area was smoothed and polished,
the resection lumen was filled with a quick-hardening bone cement (VitalOs,
PDSA), and the bone block was returned to its place (Fig. 8). The post-operative
radiograph shows the site following apical resection and retrograde root filling
(Fig. 9).
Last Name
First Name
Company
Street
ZIP/City/County
The patient was prescribed Amoxicillin 750 mg and Ibuprofen 600 mg post-operatively, as well as Arnica C30 to prevent swelling. Post-operative healing was uncomplicated, and the sutures were removed after eight days. Swelling was minimal, and the patient reported virtually no post-operative pain.
E-Mail
Signature
Notice of revocation: I am able to revoke the subscription within
14 days after my order by sending a written cancellation to
OEMUS MEDIA AG, Holbeinstr. 29, 04229 Leipzig, Germany.
_Case II
The second case is that of a 65-year-old female patient who presented with an
apical resection on tooth #14 that had been performed in alio loco five years before. The patient presented at our clinic because the site had become reinfected.
Unterschrift
OEMUS MEDIA AG
Holbeinstraße 29, 04229 Leipzig
Tel.: +49 341 48474-0
Fax: +49 341 48474-290
E-Mail: grasse@oemus-media.de
[38] =>
I user report _ apical resection
Fig. 7
Fig. 8
Fig. 7_Applying MTA using the
MAP system.
Fig. 8_The bone block is repositioned
and secured with bone cement
(VitalOs).
Fig. 9_Postoperative OPG detail following apical resection of tooth #36.
Fig. 10_Surgical site 14 following the
semilunar incision.
Fig. 11_Retrograde ultrasonic preparation (Piezotome II, Acteon)
Fig. 12_Mixed Pro-Root MTA prior to
application.
Fig. 13_Applying the MTA using the
MAP system.
Fig. 14_Resected and retro-filled
tooth #14.
Fig. 15_Baseline status of tooth #14
following apical resection alio loco
and reinfection.
Fig. 16_Revision treatment outcome
for tooth #14.
Fig. 11
Fig. 9
She reported pain at tooth #14 on occlusal contact
and percussion. A local digital radiograph clearly
showed the area of apical resection, the two rootcanal fillings and a cystic peri-apical radiolucency
(Fig. 10). Since this was a surgical re-entry case, the
same incision technique was used as chosen by the
primary treatment provider, i.e. a crescent-shaped
incision as described by Pichler (Fig. 11). The procedure was otherwise the same as in case I. Following retrograde ultrasonic preparation (Fig. 12),
ProRoot MTA was mixed to a working consistency
and applied using the MAP system (Figs. 13 & 14).
This clean and efficient application mode and controlled handling shortened the surgical procedure
and reduced post-operative complaints (Fig. 15).
The post-operative radiograph shows an efficient
retrograde filling of both root canals following revision of tooth #14. Owing to a projection artefact,
the restorative appears beside the canals, when it
is in fact located clinically exactly within.
_Conclusion
Apical resection is a routine procedure in our
clinic. Thanks to the use of ultrasonic surgery, the
Fig. 15
38 I laser
3_ 2011
surgical laser, and the MAP system, this procedure
is reliable, predictable and simple, and we have
preserved the natural teeth of many patients. Being an oral implantologist myself, I do not perceive
anything contradictory in looking at these treatment methods; rather, apical resection is a complementary treatment mode and an attempt to
preserve teeth over the longer term that would
otherwise be considered lost._
The list of references is available from the author on request.
_contact
laser
Prof Marcel Wainwright
Dental Specialists and White Lounge Kaiserswerth
Kaiserswerther Markt 25–27
40489 Düsseldorf, Germany
www.dentalspecialists.de
Fig. 13
Fig. 12
Fig. 14
Fig. 10
Fig. 16
[39] =>
[40] =>
I feature _ interview
“The Scanner mode is going
to revolutionise dentistry”
An interview with Dr Ladislav Grad & Dr Matjaz Lukac, Fotona d.d.
Our system is also perfect for surgical procedures.
For example, treating leukoplakia was a very invasive
procedure traditionally. With our laser, the lesions can
be vaporised with almost no bleeding or trauma,
which is a big advantage for patients and doctors. We
know of some clinics, where one laser is shared by different departments: three days a week, it is used in the
dental department; two days a week, the aesthetic
doctors and dermatologists use it for their patients.
Dr Ladislav Grad & Dr Matjaz Lukac
_The new LightWalker hard- and soft-tissue
dental laser system from Fotona was introduced at
IDS 2011. The system offers a wide range of dental applications and, according to the manufacturer, will
revolutionise dentistry in the coming years. laser
had the opportunity to speak to Drs Ladislav Grad and
Matjaz Lukac about the benefits of the system for
general dentists, as well as specialists.
_laser: Dr Grad, Dr Lukac, congratulations on the
launch of LightWalker! Would you please tell us about
its applications and how dentists can benefit from
using it?
Dr Grad: LightWalker has two laser sources,
offering a wide range of dental applications. The
laser can be used in all different dental specialties―
endodontics, periodontics, conservative dentistry,
tooth whitening, etc.―but there is more. Fotona is
a manufacturer of medical lasers and well known in
the field of surgical and dermatological lasers. Owing
to our background, we were able to include additional
indications. You see, in some countries, dentists can
perform aesthetic treatments, such as facial hair
removal or removal of vascular lesions.
40 I laser
3_ 2011
_What was the impetus for developing the new
laser?
Dr Lukac: We have been in dental lasers since the
early ’90s, and wanted to pool all of our experience—
in terms of use and technology—into a new system
without having to make any compromises. Amongst
the most exciting applications of LightWalker is the
photon-induced root-canal therapy that makes
treating even posterior teeth a simple procedure for
every general dentist. There is also a combined laser
wavelength procedure, the TwinLight, for periodontal
disease treatment. With TwinLight, hard-tissue calculus and soft-tissue epithelial lining can be removed.
General dentists can now treat perio patients’ disease
comprehensively, without scalpels or sutures, right in
their own practice. Amongst the aesthetic treatments, our patented TouchWhite tooth-whitening
method should be mentioned. It is extremely gentle,
yet shortens the whitening time by a factor of five.
Our patented quantum square pulse (QSP) technology allows the laser to ablate more efficiently and
with greater precision because the laser beam is not
affected by hard-tissue debris. We created this technology especially for this laser. By being able to ablate
more efficiently, the edges of individual craters are
virtually straight, creating a perfect cut and resulting
in higher levels of precision and maximum tooth
preservation in hard-tissue treatments.
_Where are your biggest markets at the moment
and which markets are you approaching?
Dr Grad: Currently, the biggest market for our
lasers is Europe. However, with LightWalker we plan
on becoming a global market leader.
[41] =>
feature _ interview
_What additional features are you offering with
the laser?
Dr Lukac: There is one feature, the scanner mode,
which we think is going to revolutionise dentistry.
LightWalker is the first dental laser system in the
world that can accommodate laser scanning technology. The scanner-ready Er:YAG laser will be able
to provide consistent and even ablation in hard and
soft tissue. The speed and consistency of ablation
performed with a scanner is virtually impossible to
achieve with any other tool. It is the “weightlessness”
of the laser light that makes this possible. Our goal
now is to guide dentists in using the scanning ability
of the laser.
We also believe that one of the first fields that is
going to be revolutionised will be implantology. Now,
it is finally possible to drill larger diameter holes with
laser. Currently, mechanical drills are used, which
cause thermal damage and a smear layer, which can
lead to problems later on, such as infections. We are
currently conducting clinical research on this and we
don’t have FDA clearance yet, but that’s where we are
going.
_What effect do you foresee lasers are going to
have on dentistry?
Dr Lukac: The big selling point for this unit is its
wide range of applications. This is what is drawing
customers. As I said, this technology evolves so that it
is easy to use. It is a tool that can be used for a variety
of indications. I am predicting that soon there will be
no more laser-specific dental meetings because the
laser is becoming part of the regular dental practice,
thus laser will become part of general meetings.
Soon, lasers will be just another dependable tool that
dentists use without hesitation.
I
_How can dentists learn
about how to use this laser
effectively? Are you offering courses?
Dr Grad: Yes. Laser dentistry is currently not part
of the dental curriculum
taught at most universities.
There are, however, many possibilities for postgraduate dental education. We have reference doctors
in different states who offer local training courses.
We collaborate a great deal with Aachen University
in Germany, which is the leading educational and
research institution for lasers in dentistry. There are
specific dates reserved on which practitioners can
attend a training seminar at the university. It is very
important for users to establish a safe and confident
handling of this technology and education is the
way to go about establishing that. There is no turning
back. Without laser technology, there is no modern
dentistry._
For information on Fotona laser workshops please
go to www.fotona.com/en/dentistry/workshops/.
_contact
laser
Fotona d.d.
Stegne 7
1210 Ljubljana
Slovenia
info@fotona.com
www.fotona.com
laser
3
I 41
_ 2011
[42] =>
I meetings _ events
International events
2011
20th Annual Scientific
Congress of the EAO
Athens, Greece
12–15 October 2011
www.eao-congress.com
Annual Congress of DGL
Düsseldorf, Germany
28–29 October 2011
www.startup-laser.de
Dentistry 2011
Abu Dhabi, United Arab Emirates
1–3 November 2011
www.dentistryme.com
Greater New York Dental Meeting
New York, NY, USA
25–30 November 2011
www.gnydm.org
2012
LaserOptics Berlin
Berlin, Germany
19–21 March 2012
www.laser-optics-berlin.de
IDEX Istanbul
Istanbul, Turkey
5–8 April 2012
www.cnridex.com
IDEM International Dental Exhibition
Singapore
20–22 April 2012
www.idem-singapore.com
13th WFLD World Congress
Barcelona, Spain
26–28 April 2012
www.wfld-barcelona2012.com
90th General Session & Exhibition
of the IADR
Rio de Janeiro, Brazil
20–23 June 2012
www.iadr.org
42 I laser
3_ 2011
[43] =>
Bella Center
Copenhagen
+
Welcome to the 45th Scandinavian Dental Fair
The leading annual dental fair in Scandinavia
The 45th SCANDEFA invites you to exquisitely meet the Scandinavian dental market and
sales partners from all over the world in springtime in wonderful Copenhagen
SCANDEFA 2012
Exhibit at Scandefa
Is organized by Bella Center
and is being held in conjunction
with the Annual Scientific
Meeting, organized by the
Danish Dental Association
(www.tandlaegeforeningen.dk).
Book online at www.scandefa.dk
Sales and Project Manager, Christian Olrik
col@bellacenter.dk, T +45 32 47 21 25
175 exhibitors and 11.422
visitors participated at
SCANDEFA 2011 on 14,220 m2
of exhibition space.
Travel information
Bella Center is located just a 10 minute taxi drive from Copenhagen
Airport. A regional train runs from the airport to Orestad Station,
only 15 minutes drive.
Check in at Bella Center’s newly built hotel
Bella Sky Comwell is Scandinavia’s largest design hotel.
The hotel is an integral part of Bella Center and has direct
access to Scandefa. Book your stay on www.bellasky.dk
Fotos from Bella Center, Wonderful Copenhagen
2012
[44] =>
I meetings _ WFLD
rd
3 European Congress
of the WFLD in Rome
Author_Umberto Romeo, Italy
_The Third European Congress of World Federation of Laser Dentistry (WFLD-ED) was held
from 9–11 June 2011, in the Department of Stomatology and Maxillo-Facial Surgery of Sapienza
University of Rome. The choiche to organize the
Congress in a university is a testimony of ever
closer bond between the realities of professional
and academic world.
The greatest scientific event at the continental
level Laser Dentistry has been chaired by the Director of the Department, Antonella Polimeni who
welcomed with warmth and affection the many
colleagues, both Italian and foreign (represented
more than 21 countries around the world), that
44 I laser
3_ 2011
have made with their presence and their scientific
contributions, the success of the Roman event.
Among the speakers at the event, were numbered
of Dentistry International big names such as: Nammour, Cantatore, Rocca, Stabholz, Parma Benfenati,
Baraldini, Gutknecht, Esapana, Sculean, Sibbet,
Wilder Smith, etc. which have enriched the conference program with their much followed reports.
That the union between University and WFLD
has been a happy intuition, have confirmed the
numbers, absolutely amazing, that characterized
Rome 2011: 450 participants, 70 posters and 63
oral comunication. The data are, really flattering,
[45] =>
meetings _ WFLD
which have rewarded the efforts and the work of
the Scientific and the Organizing Committee
chaired respectively by Umberto Romeo and Roly
Kornblit.
Considerable interest has also received scientific events on the sidelines of the main program,
starting from the Certification Course, the basic
course of a day that can be certified by the WFLD,
which had as speakers: Rocca, Nammour, Vescovi,
Romeo, Kornblit, Fornaini and Del Vecchio gave the
participants an introduction to laser dentistry at
the highest level. Similar courses have attracted
acclaim single issue of Dermatology and Aesthetic
Surgery. The Congress was also framed by mo-
I
ments of great cultural and social, from the inauguration took place in the prestigious Great Hall of
the Rectorate in the presence of the Rector, Luigi
Frati, and concludes with the popular Gala Dinner
which took place elegant Caffarelli Terrace in the
heart of the eternal city where foreign guests were
able to admire a truly unique and exclusive view.
The Congress was closed by a closing address by
Professor Polimeni, who emphasized the important work done by all the Department with a special plaudits to Professor Romeo and Dr Kornblit,
and the taking over of the banner of WFLD from the
colleagues of Barcelona for the next edition of
WFLD Congress 2012._
laser
3
I 45
_ 2011
[46] =>
I education _ Malaysia
Basic Laser Certification
Course in Malaysia
Fig. 1
Fig. 2
Fig. 1_Group photo after certificate
presentation
Fig. 2_Hands-on practical session
(Dr K. Luk surrounded by his
participants)
_Basic Laser Certification Course (BLCC) was
organized in conjunction with the 68th Malaysian
Dental Association (MDA)-AGM/Federation Dental
International (FDI) scientific convention and trade
exhibition and supported by the Malaysian Dental
Association. This year the theme for this FDI world
Dental Federation Congress is “Current Perspectives in Dentistry”. It was most
appropriate for us to begin this
Congress by presenting the
“Current perspectives in Laser
Dentistry” in this pre-congress
workshop, on the 8–9 June
2011. The workshop venue
was the Faculty of Dentistry,
at The National University of
Malaysia.
The maximum number
of participants was kept to
thirty who came locally as
well as internationally and
ranged from PhD students to dental specialist.
All who took part in this
46 I laser
3_ 2011
one and a half day lecture, including a hands-on
and examination laser course, passed with an examination mark of above 75 %.
In deed, the participant who scored the highest
was from Malaysia. The learning atmosphere and
the eagerness of learning from the audients were so
vibrant. Furthermore, the quality of question was of
a high standard and evidently everybody had a
good time. We all agree that we had run another
successful laser course.
Thanked for the tremendous supported from
Dr Muzafar Bin Hamirudin (Chair, LOC ), Dr Roberto
Vianna (Chair, FDI ExCo) and Dr How Kim Chuan
(Past President, MDA) with their team (Dr S. Kanagasingam, Dr K. Penriasamy, Dr T. Palany and others) and the Speakers from our Asian Pacific Division, included Prof Steven Loh (Chair, WFLD- APD),
Prof Kenji Yosida (General Secretary, WFLD), A/Prof
Sajee Sattayut, Dr Kenneth Luk, Dr Shigeyuki Nagai
and Dr Ambrose Chan who made this laser course
so educational as well as so enjoyable that it left
everyone with an wonderful experience that will be
remembered for a long, long time._
[47] =>
about the publisher _ submission guidelines
submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
_all the image (tables, charts, photographs, etc.) captions;
_the complete list of sources consulted; and
_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).
I
Image requirements
Please number images consecutively throughout the article
by using a new number for each image. If it is imperative that
certain images are grouped together, then use lowercase letters
to designate these in a group (for example, 2a, 2b, 2c).
Please place image references in your article wherever they
are appropriate, whether in the middle or at the end of a sentence.
If you do not directly refer to the image, place the reference
at the end of the sentence to which it relates enclosed within
brackets and before the period.
In addition, please note:
In addition, images must not be embedded into the MS Word
document. All images must be submitted separately, and details
about such submission follow below under image requirements.
Text length
Article lengths can vary greatly—from 1,500 to 5,500 words—
depending on the subject matter. Our approach is that if you
need more or less words to do the topic justice, then please make
the article as long or as short as necessary.
We can run an unusually long article in multiple parts, but this
usually entails a topic for which each part can stand alone because it contains so much information.
In short, we do not want to limit you in terms of article length,
so please use the word count above as a general guideline and if
you have specific questions, please do not hesitate to contact us.
Text formatting
We also ask that you forego any special formatting beyond the
use of italics and boldface. If you would like to emphasise certain
words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers.
Please do not use underlining.
Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line between paragraphs. Please do
not add tab stops.
_We require images in TIF or JPEG format.
_These images must be no smaller than 6 x 6 cm in size at 300 DPI.
_These image files must be no smaller than 80 KB in size (or they
will print the size of a postage stamp!).
Larger image files are always better, and those approximately
the size of 1 MB are best. Thus, do not size large image files down
to meet our requirements but send us the largest files available.
(The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more
space should there be room available).
Also, please remember that images must not be embedded into
the body of the article submitted. Images must be submitted
separately to the textual submission.
You may submit images via e-mail, via our FTP server or post
a CD containing your images directly to us (please contact us
for the mailing address, as this will depend upon the country from
which you will be mailing).
Please also send us a head shot of yourself that is in accordance
with the requirements stated above so that it can be printed with
your article.
Abstracts
An abstract of your article is not required.
Should you require a special layout, please let the word processing
programme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes
or endnotes, please let the word processing programme do it for
you automatically. There are menus in every programme that will
enable you to do so. The fact is that no matter how carefully done,
errors can creep in when you try to number footnotes yourself.
Author or contact information
The author’s contact information and a head shot of the author
are included at the end of every article. Please note the exact
information you would like to appear in this section and format it according to the requirements stated above. A short
biographical sketch may precede the contact information
if you provide us with the necessary information (60 words
or less).
Any formatting contrary to stated above will require us to remove
such formatting before layout, which is very time-consuming.
Please consider this when formatting your document.
Questions?
Dajana Mischke
d.mischke@oemus-media.de
laser
3
I 47
_ 2011
[48] =>
I manufacturer _ news
Manufacturer News
A.R.C. Laser
edged therapy concept based on wide-range studies and the direct cooperation with AALZ Aachen,
Germany.
A.R.C. Laser convinces with EmunDo®
An increasing number of users speak on their enthusiasm concerning the positive impact of the entirely new Photodynamic Therapy. They are reporting of the simple and gentle laser-method to treat
periodontitis.
For the first time in dental history, PDT is considered
to achieve consistently effective and predictable
outcomes in combination with a normal FOX diode
laser.
The colorant EmunDo®—stimulated through the
laser—generates aggressive singulett oxygen. As
a consequence EmunDo® kills effectively all grampositive and all gram-negative bacteria particularly in the periodontal therapy. Patients which
have had problems with antibiotics and its side effects in the past, can be relieved now. EmunDo® is
not only any kind of PDT agent—it is a acknowl-
Fotona
LightWalker AT—
Award-winning Dental
Laser
Fotona’s new laser system, LightWalker AT, has
been recognized in the dental community by key
opinion leaders. It has recently received the Pride Institute’s Best of Class Technology Award for 2011
and was selected as one of Dentistry Today’s TOP
100 Products of 2011.
A panel of dental technology experts, organized by
the Pride Institute, a dental practice management
consulting firm based in Novato, California, selected
this year's winning products through a rigorous assessment selection process. The aim of the award is
Hager & Werken
LaserHF—Radio
frequency and laser
combined for the first
time
LaserHF® from Hager & Werken is a combined unit
which for the first time offers two technologies in
one device: laser and radio frequency. While tissue
can be perfectly cut, resected and coagulated with
radio frequency, the laser offers additional, fascinating applications in endodontics, periodontics as well as in implant surgery. On top of
that, new approaches, such as the tissue treatment
48 I laser
3_ 2011
to provide an unbiased, non-profit assessment of
available technologies in the dental space. LightWalker AT was an honoree in the Therapeutic category.
What is more, Dentistry Today, America’s leading
clinical news magazine for dentists, featured the
LightWalker as one of the TOP 100 dental products
in therapeutic terms (Low Level Laser Therapy) and
antimicrobial photodynamic therapy (aPDT) can be
carried out. LaserHF includes two types of laser: A
Unique selling point for your office:
– 100 % anti-bacterial impact
– even germs in tissue are accessible
– Reliable therapy concept
A.R.C. Laser
Bessemerstraße 14
90411 Nürnberg, Germany
info@arclaser.de
www.arclaser.de
of the year. According to the magazine, LightWalker
was selected on the basis of reader response and
represents what is new and innovative in the profession today. LightWalker is the latest dental laser
to be introduced by Fotona. The system is designed
for high-speed cavity preparations, virtually all softtissue surgical procedures, as well as minimally invasive TwinLight (Er:YAG and Nd:YAG) endodontic
and periodontal treatments. It is the only dental laser
system on the market that includes built-in scannerready technology.
Fotona d.d.
Stegne 7
1210 Ljubljana, Slovenia
info@lightwalkerlaser.com
www.lightwalkerlaser.com
diode laser with 975nm/6W and a diode soft laser
with 650nm/100mW for LLLT and aPDT.
An easy to use touch-screen offers 15 pre-set programs in the laser unit (10x diode laser, 5x diode
soft laser). The radio frequency-unit offers various
pre-set programs. Additionally the user can save
individual programs. Further information is available at:
Hager & Werken GmbH & Co.KG
PF 10 06 54
47006 Duisburg, Germany
info@hagerwerken.de
www.hagerwerken.de.
[49] =>
manufacturer _ news
KaVo Dental
5-star light for your
dental practice
Ideal working conditions in the dental practice, begin with the best possible view
of the treatment site. The KaVoLUX 540 LED light, with its unique optical system
and four different coloured LEDs, supplies natural white light of the highest quality, at up to 40,000 LUX at every point in the illuminated field. Thus the user always has the best view, ensuring optimum treatment results. With outstanding
color rendering index values and the natural daylight-like, full spectrum of light,
it is possible to accurately compare tooth and composite colors, directly at the
dental chair.
The innovative COMPOsave mode, filters out all blue components of the light and
thus slows down undesirable polymerization of composites. It is thus possible
to adapt light-cured materials at a relaxed pace, without having to dim the light.
Even, illuminated field
The KaVoLUX 540 LED light delivers the ideal light-field, for a perfectly illuminated treatment area: homogenous, precisely delineated and with reduced
shadow formation. The colour-temperature can be individually adjusted in five
steps, e.g. for higher contrast on soft tissue. Even the most inaccessible parts
of the mouth are clearly illuminated, thanks to the impressive, light penetration properties. The detailed structures thus can be seen in sharper focus and
can be optimally identified, without eye-strain.
I
Ergonomic, practical, flexible and hygienic
With its unique, lockable 3D-joint, the KaVoLUX 540 LED can
be variably positioned: if required, it is possible to switch from
the fixed 2-D mode, to a flexible 3-D movement. Regardless
of the position of the dentist and the patient, outstanding illumination of the treatment site, is thus always achieved.
The light can be switched on and off without direct
contact, or be intuitively operated via
the treatment centre’s dentist element controls. Removable
handles and smooth surfaces,
enable rapid and thorough disinfection, thus supporting simple
and fast hygiene regimes.Optimally
coordinated in combination with a KaVo dental chair, the KavoLUX 540 LED offers perfect hygiene,
high illumination quality, long service-life and maximum operating comfort.
KaVo Dental GmbH
Bismarckring 39, 88400 Biberach/Riß, Germany
Tel.: +49 7351 56-0
Fax: +49 7351 56-71104
Syneron Dental Lasers
info@kavo.com
www.kavo.com
“Our business operations are rapidly expanding
while our close-knit synergy with the existing dis-
Syneron Dental
Lasers
Partnerships will bring the LiteTouch™ and
Laser-in-Handpiece™ technologies to Poland,
the Netherlands, the Czech Republic and Serbia
Dental Markets.
tributors is further empowering the Syneron Dental family worldwide, thus contributing to the
company’s ongoing success. As an emerging,
fast-growing market leader, Syneron Dental
Lasers is strategically aspired to continue establishing its global footprint and alongside with its
steadily increasing market share, is already
changing the shape of the laser dentistry market.
Syneron Dental Lasers, the inventor of the LiteTouch™ and Laser-in-Handpiece™ technology
announced the signing of four distribution agreements in Europe.
The company has solidified partnerships with
Shar-Pol in Poland, International Equipment Center (IEC) in the Netherlands, and B.P.C. Ltd. in the
Czech Republic and Serbia. The new distributor
agreements follow Syneron Dental’s existing
strong partnerships with other European distributors such as Dentacon, its Balkan region distributor, and Swiss distributor Orcos Medical,
among other international distributors.
into additional countries within Europe and Asia
during the second half of 2011.
Under these agreements, the distributors will sell
Syneron Dental’s LiteTouch™ and D-Touch™ as
well as promote, educate and train the customers. Syneron Dental Lasers plans to expand
“We are very excited about the opportunities
these partnerships present to Syneron Dental
Lasers,” said Ira Prigat, Syneron Dental’s President.
Syneron Dental Lasers is committed to promoting
technology innovations, cross-continent clinical
research collaborations, laser dentistry education and long-term support and services to LiteTouch™ customers worldwide.”
Syneron Dental Lasers
POB 223
Yokneam 20692, Israel
dental@syneron.com
www.synerondental.com.
laser
3
I 49
_ 2011
[50] =>
I about the publisher _ imprint
laser
international magazine of
laser dentistry
Publisher
Torsten R. Oemus
oemus@oemus-media.de
CEO
Ingolf Döbbecke
doebbecke@oemus-media.de
Members of the Board
Jürgen Isbaner
isbaner@oemus-media.de
Lutz V. Hiller
hiller@oemus-media.de
Chief Editorial Manager
Norbert Gutknecht
ngutknecht@ukaachen.de
Co-Editors-in-Chief
Samir Nammour
Jean Paul Rocca
Managing Editors
Georg Bach
Leon Vanweersch
Division Editors
Matthias Frenzen
European Division
George Romanos
North America Division
Carlos de Paula Eduardo
South America Division
Senior Editors
Aldo Brugneira Junior
Yoshimitsu Abiko
Lynn Powell
John Featherstone
Adam Stabholz
Jan Tuner
Anton Sculean
Editorial Board
Marcia Martins Marques, Leonardo Silberman,
Emina Ibrahimi, Igor Cernavin, Daniel Heysselaer,
Roeland de Moor, Julia Kamenova, T. Dostalova,
Christliebe Pasini, Peter Steen Hansen, Aisha Sultan, Ahmed A Hassan, Marita Luomanen, Patrick
Maher, Marie France Bertrand, Frederic Gaultier,
Antonis Kallis, Dimitris Strakas, Kenneth Luk, Mukul Jain, Reza Fekrazad, Sharonit Sahar-Helft, Lajos Gaspar, Paolo Vescovi, Marina Vitale, Carlo
Fornaini, Kenji Yoshida, Hideaki Suda, Ki-Suk Kim,
Liang Ling Seow, Shaymant Singh Makhan, Enrique Trevino, Ahmed Kabir, Blanca de Grande, José
Correia de Campos, Carmen Todea, Saleh Ghabban
Stephen Hsu, Antoni Espana Tost, Josep Arnabat,
Ahmed Abdullah, Boris Gaspirc, Peter Fahlstedt,
Claes Larsson, Michel Vock, Hsin-Cheng Liu, Sajee
Sattayut, Ferda Tasar, Sevil Gurgan, Cem Sener,
Christopher Mercer, Valentin Preve, Ali Obeidi,
Anna-Maria Yannikou, Suchetan Pradhan, Ryan
Seto, Joyce Fong, Ingmar Ingenegeren, Peter Kleemann, Iris Brader, Masoud Mojahedi, Gerd Volland, Gabriele Schindler, Ralf Borchers, Stefan
Grümer, Joachim Schiffer, Detlef Klotz, Herbert
Deppe, Friedrich Lampert, Jörg Meister, Rene
Franzen, Andreas Braun, Sabine Sennhenn-Kirchner, Siegfried Jänicke, Olaf Oberhofer, Thorsten
Kleinert
Toni Zeinoun
Middle East & Africa Division
Loh Hong Sai
Asia & Pacific Division
Executive Producer
Gernot Meyer
meyer@oemus-media.de
Designer
Sarah Fuhrmann
s.fuhrmann@oemus-media.de
Customer Service
Marius Mezger
m.mezger@oemus-media.de
Editorial Office
Dajana Mischke
d.mischke@oemus-media.de
Published by
OEMUS MEDIA AG
Holbeinstraße 29
04229 Leipzig, Germany
Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de
www.oemus.com
Printed by
Messedruck Leipzig GmbH
An der Hebemärchte 6
04316 Leipzig, Germany
laser
international magazine of laser dentistry
is published in cooperation with the World Federation for Laser Dentistry (WFLD).
WFLD President
University of Aachen Medical Faculty
Clinic of Conservative Dentistry
Pauwelsstr. 30
52074 Aachen, Germany
Tel.: +49 241 808964
Fax: +49 241 803389644
ngutknecht@ukaachen.de
www.wfld-org.info
Copyright Regulations
_laser international magazine of laser dentistry is published by Oemus Media AG and will appear in 2010 with one issue every quarter. The
magazine and all articles and illustrations therein are protected by copyright. Any utilization without the prior consent of editor and publisher is inadmissible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Oemus Media AG. Responsibility for such articles shall be borne by the author.
Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed
for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty
representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.
50 I laser
3_ 2011
[51] =>
laser
international magazine of
laser dentistry
You can also subscribe via
www.oemus.com/abo
Subscribe now!
I would like to subscribe to laser international magazine of
laser dentistry (4 issues per year) for € 44 including
shipping and VAT for German customers; € 46 including shipping and VAT for customers outside of
Germany unless a written cancellation is sent within 14
days of the receipt of the trial subscription. The subscription will be renewed automatically every year
until a written cancellation is sent to OEMUS MEDIA AG,
Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior
to the renewal date.
Reply via Fax to +49 341 48474-290 to
laser 3/11
OEMUS MEDIA AG or via E-mail to
grasse@oemus-media.de
Last Name, First Name
Company
Street
ZIP/City/County
E-mail
Signature
Notice of revocation: I am able to revoke the subscription within 14 days after my order by sending a written
cancellation to OEMUS MEDIA AG, Holbeinstr. 29, 04229 Leipzig, Germany.
Signature
OEMUS MEDIA AG
Holbeinstraße 29, 04229 Leipzig, Germany, Tel.: +49 341 48474-0, Fax: +49 341 48474-290, E-Mail: grasse@oemus-media.de
[52] =>
The Dual Wavelength Waterlase iPlus
Advancing Laser Technology to Its Ultimate
NCOMPARABLe
ACCess & FieLd OF VisiON
• No Pain, Therefore No Shot Necessary
• No Micro-fractures or Thermal Damage
• No Cross Contamination as with Burr
• Best Ergonomic & Smallest Design
NTUiTiVe
GRAPhiCAL UseR iNTeRFACe
NCRediBLe
POweR
• Cutting Speed that Surpasses the High
Speed Handpiece and Any Other Dental
Laser on the Market
• Cuts Faster and More Efficiently than
Lasers with More Power Watts
• Combines 0.5-10 Watts Power with 100 Hz
& Short Pulse for 600 mJ of Laser Energy
• Patented Laser Technology
LAse 940nm
diOde LAseR
• Step 1: Application
• Step 2: Procedure
• Step 3: No Shot/No Drill
©2011
Intuitive Power™
• 5 Watts of Power with ComfortPulse
• Handheld & Ergonomic
• Battery Operated with Finger Switch Activation
• Proprietary Multi-diameter/Length Bendable Tips
• Single Use for NO Cross Contamination
)
[page_count] => 52
[pdf_ping_data] => Array
(
[page_count] => 52
[format] => PDF
[width] => 595
[height] => 842
[colorspace] => COLORSPACE_UNDEFINED
)
[linked_companies] => Array
(
[ids] => Array
(
)
)
[cover_url] =>
[cover_three] =>
[cover] => ![laser international No. 3, 2011]()
[cached] => true
)
)
[3] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-2.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-2.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-2.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-2.jpg
[1000] => 56141-85c20753/1000/page-2.jpg
[200] => 56141-85c20753/200/page-2.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[4] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-3.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-3.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-3.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-3.jpg
[1000] => 56141-85c20753/1000/page-3.jpg
[200] => 56141-85c20753/200/page-3.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[5] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-4.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-4.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-4.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-4.jpg
[1000] => 56141-85c20753/1000/page-4.jpg
[200] => 56141-85c20753/200/page-4.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[6] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-5.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-5.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-5.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-5.jpg
[1000] => 56141-85c20753/1000/page-5.jpg
[200] => 56141-85c20753/200/page-5.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[7] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-6.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-6.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-6.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-6.jpg
[1000] => 56141-85c20753/1000/page-6.jpg
[200] => 56141-85c20753/200/page-6.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[8] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-7.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-7.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-7.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-7.jpg
[1000] => 56141-85c20753/1000/page-7.jpg
[200] => 56141-85c20753/200/page-7.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[9] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-8.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-8.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-8.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-8.jpg
[1000] => 56141-85c20753/1000/page-8.jpg
[200] => 56141-85c20753/200/page-8.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[10] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-9.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-9.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-9.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-9.jpg
[1000] => 56141-85c20753/1000/page-9.jpg
[200] => 56141-85c20753/200/page-9.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[11] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-10.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-10.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-10.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-10.jpg
[1000] => 56141-85c20753/1000/page-10.jpg
[200] => 56141-85c20753/200/page-10.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[12] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-11.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-11.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-11.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-11.jpg
[1000] => 56141-85c20753/1000/page-11.jpg
[200] => 56141-85c20753/200/page-11.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[13] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/2000/page-12.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/1000/page-12.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56141-85c20753/200/page-12.jpg
)
[key] => Array
(
[2000] => 56141-85c20753/2000/page-12.jpg
[1000] => 56141-85c20753/1000/page-12.jpg
[200] => 56141-85c20753/200/page-12.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 56144
[post_author] => 0
[post_date] => 2024-10-21 19:56:17
[post_date_gmt] => 2024-10-21 19:56:17
[post_content] =>
[post_title] => epaper-56141-page-13-ad-56144
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-56141-page-13-ad-56144
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 19:56:17
[post_modified_gmt] => 2024-10-21 19:56:17
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-56141-page-13-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56144
[id_hash] => 393cae03c1f4dbd6a034d1bc81c2b6e5c93b2c034c36f6d183de6f4ccddace69
[post_type] => ad
[post_date] => 2024-10-21 19:56:17
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/content/id/3469
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-56141-page-13-ad-56144/
[post_title] => epaper-56141-page-13-ad-56144
[post_status] => publish
[position] => -0.81,0.27,91.58,98.64
[belongs_to_epaper] => 56141
[page] => 13
[cached] => false
)
)
[html_content] =>