laser international No. 1, 2017
Cover
/ Editorial
/ Content
/ Periodontal therapy of deep localised pockets larger than 9 mm
/ Photodamage of dental pulpa stem cells during 700 fs laser exposure
/ Histomorphological changes in human bone
/ Diode lasers and microsurgery
/ The application of erbium laser in dental surgery
/ A novel Er:YAG dental laser-in-handpiece technology
/ Successful communication in your daily practice
/ 6th Laser Dentistry Congress of WFLD-ED
/ Manufacturer News
/ Editorial
/ News Germany
/ Imprint
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[1] =>
Vol. 9 • Issue 1/2017
issn 2193-4665
laser
international magazine of
1
2017
research
Periodontal therapy of
deep localised pockets
research
Photodamage of dental
pulpa stem cells
industry
Diode lasers and microsurgery
laser dentistry
[2] =>
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[3] =>
editorial
Wavelength
variation
|
Prof. Dr Norbert Gutknecht
Dear colleagues,
Dear laser society members,
More and more companies offer laser systems with a variety of wavelengths for dental indications. This
development gives rise to the hope that the insight in absorption, transmission, reflexion and dispersion in
different tissues after irradiation with various wavelengths and the different effects on this tissues will
increase. On the other hand we must now ask ourselves when different wavelengths should be applied alternatingly or at staggered intervals.
The upcoming IDS—International Dental Show certainly will present new and interesting combinations of
laser wavelengths, hopefully featuring well-researched and differentiated evidence on their clinical applications. The larger the number of different laser wavelengths in the dental practice, the more will the probability
of applying them more specifically in terms of individual indications increase. I am glad that this issue of
laser international magazine of laser dentistry confronts its readers with an article on this topic.
I wish all of you who are going to attend IDS much fun in examining the new dental laser generation.
Yours,
Prof. Dr Norbert Gutknecht
laser
1 2017
03
[4] =>
| content
page 06
page 22
| editorial
| practice management
03 Wavelength variation
40 Successful communication in your
daily practice
Prof. Dr Norbert Gutknecht
page 32
Dr Anna Maria Yiannikos
| research
06 Periodontal therapy of deep localised
pockets larger than 9 mm
Dr Gottfried Gisler, MSc
18 Photodamage of dental pulpa stem cells
during 700 fs laser exposure
Prof. Dr Karsten König & Dr Anton Kasenbacher
| industry
22 Histomorphological changes in human bone
Bistra Y. Blagova, Elena G. Poriazova,
Petia F. Pechalova & Prof. Georgi T. Tomov
| events
42 6th Laser Dentistry Congress of WFLD-ED
Dr Dimitris Strakas
| news
44 manufacturer news
| DGL
47 Wellenlängenvariation
Prof. Dr. Norbert Gutknecht
26 Diode lasers and microsurgery
48 news germany
32 The application of erbium laser
in dental surgery
| about the publisher
Dr Isabelle Nguyen
Dr Kinga Grzech-Lesniak
50 Imprint
38 A novel Er:YAG dental
laser-in-handpiece technology
Georg Isbaner
laser
issn 2193-4665
international magazine of
Vol. 9 • Issue 1/2017
laser dentistry
1
2017
research
Periodontal therapy of
deep localised pockets
research
Photodamage of dental
pulpa stem cells
industry
Diode lasers and microsurgery
04
laser
1 2017
Cover image courtesy of LASOTRONIX
www.lasotronix.com
[5] =>
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To schedule your personal Solea hands-on session during IDS, please write us at:
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[6] =>
| research
Periodontal therapy of
deep localised pockets
larger than 9 mm
Adjunctive laser irradiation without antibiotics
or open surgery
Author: Dr Gottfried Gisler, MSc, Switzerland
1. Introduction
Fig. 1: Light absorption constants μ A
of biological materials.22
To achieve the above-mentioned effects of laser
irradiation, the laser energy must be absorbed in the
specific chromophores or absorbers of the tissues.
The graph by Meister et al.22 in Fig. 1 gives a perfect
overview about the different wavelengths and their
chromophores applied in clinical situations. It can be
seen that there is a high absorption in water for l asers
in the mid-infrared like Er:YAG or Er,Cr:YSGG. A lower
absorption was found for hydroxyapatite. The absorption constant of 102 /cm in hydroxyapatite can
lead to misunderstandings of ablation in hydroxy
apatite containing tissues like bone or dental hard
tissues. If ablation in these tissues would occur by
absorption in the secondary absorber for these
wavelengths in the mid-infrared, the hydroxyapatite
crystals would be strongly heated above the melting
point and the generated heat would be transferred
by conduction directly in the irradiated hard tissue.
Ablation of dental hard tissues and bone occurs by
absorption in water for the wavelengths in the middle infrared. As can be seen in Fig. 1, the absorption
curve shows a very high absorption in water at about
104 /cm. If water covers the irradiated surface during
ablation, dental hard tissue and bone removal is
achieved by explosive (water-mediated) ablation,
socalled thermo-mechanical ablation.23 In this process, light is absorbed by water molecules, rapidly
heating a small volume. The vaporisation of water
Fig. 1
06
The aim of this paper is to demonstrate that even
“hopeless” teeth with very deep periodontal pockets
of 10 mm and more pocket depth can be saved. L asers
as adjunctive therapy in periodontics have been
described for a long time for the following reasons:
Bactericidal effect of low-level laser application in
photodynamic therapies1–4 and decrease of immune-
inflammatory mediators5, stimulation of wound healing with application of low-level lasers6–9, bactericidal
effect10–12 or better wound healing for lasers in the
near infrared like diode lasers13 or Nd:YAG lasers14,15,
calculus removing16,17, and bactericidal effect with lasers in the middle infrared18–20 and stimulation of bone
healing with Er:YAG lasers21.
laser
1 2017
[7] =>
research
Fig. 2
creates a strong subsurface pressure and leads to an
explosive removal of the surrounding mineral.24,25
The removal of hard tissue is done by micro-explosions far below the melting point of these tissues. If
water does not cover the irradiated surface of bone
or teeth, e.g. when the dentist’s assistant sucks off
the water spray during cavity preparation, the tissue
water of the hard substances would be consumed by
absorption very fast and the absorption takes place
in the secondary absorber, the hydroxyapatite,
which leads immediately to a strong overheating.26
The clinical effect is carbonisation of the irradiated
tissue (Fig. 2).
The chromophores that an Er:YAG or Er,Cr:YSGG
laser in a periodontal pocket can identify are water
or hydroxyapatite (Fig. 1). The laser user executing a
closed curettage by such a laser has to avoid any
absorption in hydroxyapatite. Therefore, the tissue
water in the pocket must be sufficient to provide an
absorption of the energy solely in water.
Calculus removal in a closed subgingival situation
working with an Er:YAG laser must obey the same biophysical background. The water content of calculus27
is similar to fresh dentin. Therefore the ablation
threshold for both materials must be close together.
If big masses of subgingival calculus should be removed only by an Er:YAG or Er,Cr:YSGG laser, working
efficiently demands high energy densities. The risk to
remove healthy subgingival dentin by a wrong angulation of the laser tip towards dentin or a too high energy (180 mJ) then is very high.28 In safety guidelines
for laser removal of dental calculus29 the Japanese
society for laser dentistry recommends that the laser
tip should be parallel30,31 to the root surface and the
applied laser energy be about 40 mJ.
Er:YAG and Er,Cr:YSGG lasers are suitable tools for
working in the subgingival periodontal area because
of its biophysical background. Ablation of soft and
hard subgingival deposits without any pathological
thermal side effects is possible, bactericidal ef-
Fig. 3
fects18–20 with energy densities far below 10 J/cm2 are
given, bone healing is stimulated21, and no discomfort
for the patients after treatment is to be expected. The
most important thing for closed working in very deep
pockets of 10 mm and more with these wavelengths
is to avoid any absorption of the laser energy in hydroxyapatite. There are many authors32–35 working in
a closed subgingival setting with Er:YAG lasers and
power settings of 160 mJ, 10 Hz and energy densities
of 20 J/cm2 and more. But it is obvious that the higher
the applied energies and the deeper the periodontal
pockets are, the greater is the risk of causing damage
in the hydroxyapatite-containing tissues like alveolar
bone or root dentine because of absorption of the
laser energy in the secondary absorber. To minimise
this risk, we present seven cases working with the
Er:YAG laser with energy densities close above the ablation threshold of bone and dentin.36
|
Fig. 2: Irradiation effect by absorption of the Er:YAG laser energy in
hydroxyapatite in dentine. After 10 s
of irradiation with no water at 25 Hz,
dentine will be carbonised even with
an applied fluence of only 20 J/cm2.
A tooth irradiated for 10 s with a
fluence of ~ 60 J/cm2 becomes very
hot, quite warm at ~ 40 J/cm2 and
still warm at ~ 20 J/cm2. In enamel
there is less ablation but a strong
heating.
Fig. 3: A “hot spot” at the fibre end
of the diode laser is black burned
tissue. Energies emitted with such
a fibre end would bring the contrary
desired therapeutic effect.
2. Material and Methods
Seven clinical cases, four of women and three of
men aged between 48 and 74 years are presented.
Eight periodontal pockets larger than 9 mm were
treated with pocket depths between 10 and 12 mm.
The tooth mobility degree (TM) of six teeth was 4. Not
only was the horizontal mobility measured, but also
the vertical mobility. One tooth 33 in case 4 had been
already fixed by a crown to the neighbouring tooth
and tooth 16 in case 5 had enough stability despite the
11 mm deep pocket.
All patients had to pass a strict therapy protocol
including:
–– patient instruction for an adequate oral hygiene,
–– evaluation and elimination of the pockets’ cause,
–– splinting the teeth except TM < 3
–– conventional pocket therapy with scaling and root
planing (SRP)
–– laser irradiation
Laser irradiation includes three wavelengths of
= 670 nm, = 810 nm, and = 2,940 nm.
laser
1 2017
07
[8] =>
| research
Fig. 4
Fig. 4: Development of the clinical
pocket depth. From the left:
4 January 2012,
12 November 2012 and
24 April 2014.
2.1 The conventional treatment protocol
The patient had to pass an oral hygiene phase prior
to pocket treatment, followed by a first pocket treatment session, including:
–– Splinting the tooth with wire and traditional or
acrylic and glass fibre reinforced composites (everStick®).
–– Elimination of the pockets cause or causes, e.g.
·· endo/perio laesions begin endodontic treatment,
·· occlusal traumata eliminate pre-contacts or
hyperbalances etc.,
·· food impaction (FI) close the gap with reconstructive methods,
·· foreign bodies remove them,
·· no attached gingiva if periodontal treatment
is successful free gingival graft (FGG),
·· special pathogen bacteria like Aa decontamination by laser light.
–– SRP under local anaesthesia.
In up to three or four following sessions, the conventional treatment always consists of only ultrasonic cleaning of the treated pockets to remove any
plaque formation without anaesthesia and finishing
of the conservative therapies (endodontic treatment,
fillings, occlusion, FGG, etc.).
Fig. 5: Radiological situation of bone
regeneration. From the left:
4 January 2012,
12 November 2012 and
24 April 2014.
Fig. 5
08
laser
1 2017
The therapy of deep pockets greater than 9 mm demands at least three, oftentimes four laser applications in time intervals between four to ten days. During
the whole treatment period, when common prophylactic actions in the treated area are impossible or contra productive, the patients have to rinse their mouth
with 0.2 % Chlorhexidine (CHX) solution.The healing of
the periodontally treated area with correctly applied
laser therapy is almost painless for the patient, fast and
without any uncomfortable side effects.
To understand why the local application of laser
energy is able to replace antibiotics and to substitute
augmentation procedures in many cases, it is indispensable to know the biophysical background of the
therapeutic effects of the different laser wavelengths. Antibiotics must be applied only when the
general health state demands antibiosis and augmentation procedures are needed in aesthetically very
sensitive areas.
2.2 The laser treatment protocol
2.2.1 The first laser treatment session follows directly
after the conventional SRP under anaesthesia. The curettage is not done by conventional instruments, but
by laser irradiation of an Er:YAG laser for two r easons:
–– The laser in the middle infrared region stimulates
bone growth factors.21
–– The soft tissue is removed by the laser in a sterile
way because of its ablation mechanism and disinfects the remaining soft and hard tissues.18
If we do a closed curettage of a very deep pocket of
10 mm and more pocket depth with an Er:YAG laser, it is
impossible that during such irradiation the water spray
gets inside of the deep pocket. The water spray has only
a cooling effect from outside. Therefore, the tissue
water in the pocket must be sufficient to provide an absorption of the energy solely in water. This can be safely
achieved by special settings and a special technique of
application. Our setting for closed pocket curettage
with the Er:YAG Laser (LiteTouch, Syneron) are:
–– fluence < 10 J/cm2
–– energy on the device display: 50 mJ
[9] =>
AVAILABLE
NOW
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&
7KH6PDOOHVW(DVLHVWDQG0RVW&RVW(HFWLYH(UELXP/DVHU
IURP%Ζ2/$6(\HW
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FOLQLFDODQLPDWLRQVLQFOXGHGIRUHDFKSURFHGXUH
[10] =>
| research
movement and little rests of calculus can be removed. The irradiation time is only a few seconds.
2. Curettage: The inflamed soft tissue in the periodontal crater must be removed completely. The
direction of the laser beam inside of the pocket is
slightly directed towards the soft tissue and the
movement of the chisel is from the margin of the
gum to the pocket bottom. This irradiation lasts
several minutes for each deep pocket. The curettage is finished when the chisel “reads” the osseous
pocket bottom and can feel its anatomy. The pocket
crater must be free of soft tissue.
3. Irradiation and stimulation of the bony pocket crater by removing some micrometers of the superficial surface: It’s a fresh-up of the alveolar pocket
bottom. This irradiation lasts about one minute for
each deep pocket.
Fig. 6
The expected effects in a closed periodontal treatment with lasers in the middle infrared in the first
session are:
–– Removal of little rests of concrements on the subgingival root dentin.29
–– Complete de-epithelization of the inner pocket up
to the margin of the gum.
–– Removing of the inflamed pocket soft tissue.
–– Decontamination of the whole pocket including
root surface, osseous and soft tissue parts with
energy densities far below 10 J/cm2.19, 20
–– Stimulation of the osseous pocket crater for bone
regeneration.21
Fig. 7
Fig. 8
The whole irradiation time of a deep pocket is between five to eight minutes. To avoid any carbonisation in hard tissues (Fig. 2), such closed curettage by
lasers with wavelengths in the mid-infrared need
time. It is therefore totally different from an open cur
with high laser settings, where the water spray prevents absorption of the energy in hydroxyapatite.
Fig. 9
Fig. 6: Tooth 41, initial clinical situation
(left) and radiological situation (right).
Fig. 7: Tooth 44, initial clinical situation
(left) and radiological situation (right).
Fig. 8: Tooth 41, final clinical
situation (left) and radiological
situation (right), 15 months later.
Fig. 9: Tooth 44, final clinical
situation (left) and radiological
situation (right), 15 months later.
–– frequency: 15–20 Hz
–– saphir tip: chisel (15 mm long)
–– water spray ~ 35–40 ml/min
This setting with a fluence of about 6 J/cm2 allows
the operator to work with minimal risk for the patient
to overheat the irradiated tissues or even carbonisation of dentine or bone in the subgingival area. The
only thing to be considered is safely reaching the ablation threshold of the irradiated tissues like alveolar
bone and root dentine at about a fluence of 2–4 J/cm2
respectively.36
Application technique
1. Irradiation of the subgingival root surface: The
laser beam must be parallel29,30 to the root surface
and the movement is from crown to pocket bottom.
The pocket should be slightly enlarged by this
10
laser
1 2017
There is an easy home experiment to demonstrate
the effect of laser irradiation on dental hard tissues
without water. One takes a freshly extracted wisdom
tooth between one’s fingers and irradiates dentine at
these wavelengths without water with laser settings as
illustrated in Fig. 2. If the fluence is about 60 J/cm2, then
after some pulses of irradiation the tissue water of
dentine is totally consumed and absorption in hydoxyapatite starts immediately. After some seconds one is
no more able to hold the irradiated wisdom tooth between one’s fingers. It becomes too hot! The clinical
effect is carbonisation of the dentine. In enamel there
is less ablation but high heat generation (Fig. 2).
Directly after Er:YAG irradiation of the pocket,
transmucosal photodynamic therapy (tPDT) with a
soft laser (Med-701, LASOTRONIC®) is applied. The
tPDT is done with a buffered 1 % methylene blue
[11] =>
research
Fig. 10
Fig. 11
Fig. 12
solution as a photosensitiser and a softlaser of
670 nm wavelength having a maximal output power
of 300 milliwatt (mW) in continous wave (cw) mode.
The Er:YAG-irradiated pocket needs to be completely
coloured with the methylene blue solution. After one
minute, the pocket is washed out with a 3 % H2O2 solution and then irradiated during one minute with the
softlaser at 670 nm and a maximum output power of
about 250 to 300 mW from the buccal and oral sides.
After the Er:YAG irradiation the pocket is always
bleeding because of the intervention by itself and the
very low duty cycle37 of the Er:YAG pulse. The blood
must be washed out with water or an isotonic saline
solution, otherwise the laser energy will be absorbed
in the blood and cannot enter deep enough into the
pocket tissue. Figure 1 shows that the laser has an absorption coefficient of about 101 /cm for venous
blood at 670 nm. The penetration depth of the laser
energy is per definitionem the reciprocal value of the
absorption coefficient and in our example ~ 10–1 cm
or ~ 1 mm. In this layer, about 2/3 of the emitted laser
energy is already absorbed (Beer-Lambert absorption
law). For the same reason, methylene blue colouration of the outside of the gum must be avoided. The
patient must not feel any warmth. The expected therapeutic effect is decontamination of the pocket due
to formation of oxygen radicals by absorption of the
Fig. 13
energy in the coloured cell walls of the bacteria1–4 and
stimulation of wound healing.6–9
2.2.2 The second treatment session for the patient is
normally one week after the first treatment and is
done without anaesthesia. The conventional pocket
treatment is only an ultrasonic cleaning of the pocket
followed by the second laser treatment:
First, a diode hardlaser with a wavelength of 810 nm
(White Star) is applied directly after the conventional
pocket treatment. The output power is 1 Watt in cw
mode, and the application time lasts three times
30 seconds for each pocket side. The laser fibre has a
diametre of 0.4 mm. The energy is emitted at the fibre
end with a divergence angle of about 12°. The fibre is
placed at the pocket bottom. In his other hand, the
operator holds e.g. a 5 ml syringe with physiological
NaCl solution. Before starting the laser, blood in the
pocket is washed out with the rinsing solution. To
avoid any formation of “hotspots” (Fig. 3) at the end
of the laser fibre, the pocket is rinsed simultaneously
with the isotonic saline solution during the application of the laser energy. A “hot spot” is black burned
soft tissue at the fibre end. The emitted energy will be
absorbed there with an absorption coefficient of
about 102 /cm (Fig. 1). For this reason, the fibre end
|
Fig. 14
Fig. 10: An 11-mm pocket on the
buccal side 21.
Fig. 11: X-ray shows the deep pocket
on 21 and a heavy subgingival
resorption distally from 22.
Fig. 12: Restitutio ad integrum,
clinically.
Fig. 13: Radiological health, CO2
positive.
Fig. 14: Three years later, a healthy
periodontal situation at 21.
Fig. 15: A 12-mm active pocket
mesially from tooth 33.
Fig. 16: X-ray, teeth 33, 34 and 37.
Fig. 17: Ten months later: A small
recession of the gum.
Fig. 18: Ten months later:
regeneration of the periodontal bone.
Fig. 15
Fig. 17
Fig. 16
Fig. 18
laser
1 2017
11
[12] =>
| research
Fig. 19
Fig. 20
Fig. 22a
Fig. 22b
Fig. 19: Cause of the 11 mm deep
pocket distally from 16: FI.
Fig. 20: Pocket’s cause restored.
Fig. 21: An 11 mm deep pocket, active.
Fig. 22a: Eight months later: 6 mm
inactive pocket.
Fig. 22b: The corresponding X-ray with
bone regeneration.
Fig. 23a: Two years later: healthy
clinical situation.
Fig. 23b: Corresponding bite wing.
Fig. 21
Fig. 23a
becomes very hot and damages the surrounding tissue by overheating.
The laser fibre is guided from the pocket bottom to
the papilla or the margin of the gum in uniform movements and several times during 30 s. This is repeated
three times for each pocket. The optical property of
non- or less-pigmented tissue allow a deep penetration of the laser light (Fig.1). The expected therapeutic
effects will be decontamination of pigmented bacteria10,11 and stimulation of bone regeneration and
wound healing12,13 without any generation of heat. Directly after the diode laser treatment the pocket undergoes tPDT.
2.2.3 The third treatment session for the patient is
normally one week after the second session and is
identical to the second session with:
–– ultrasonic cleaning of the pocket
–– diode laser irradiation
–– tPDT
If necessary, it can be added one week later a fourth
session identical to session two and three.
3. Case presentation
Case 1
Patient MU, a 69-year-old man complained on food
impaction at tooth 34. The clinical situation showed
an occlusal gap between 34 und 35 due to a fractured
composite filling. The X-ray showed a 10 mm deep
pocket crater distolingually from 34. The treatment of
this pocket under local anaesthesia followed the general periodontal treatment protocol described in
point 2.1 with two new composite fillings and 34 and
35 splinted together. The laser protocol was added.
This first treatment session was followed by four
12
laser
1 2017
Fig. 23b
other laser sessions, a combination of a diode laser at
810 nm and tPDT as described under section 2.2.2. In
Figures 4 and 5, the clinical and radiological development of the pocket on 34 is shown: Complete regeneration of the alveolar bone. The clinical state is stable
until today (2017).
Case 2
Patient SA, a 74-year-old woman, came to see us
because of a loose bridge in the upper jaw. Incidental
findings: 10 mm pocket distolingually from 41, TM 4
and 10 mm pocket circularly 44, TM 4. Pocket’s causes
41: calculus, food impaction, occlusal pre-contacts,
and 44: occlusal dysfunction, food impaction, calculus, no attached gingiva on the buccal side. Tooth 41
(Fig. 6) and 44 (Fig. 7) were extremely mobile and
could be easily brought into their original situation.
They were fixed with wire and composite to the other
lower incisors and to 45, respectively. In the same session, calculus removal, correction of the occlusal dysfunction and adding the laser protocol were performed. Tooth 44 got an FGG from 45 to 41 three
months later. Figures 8 & 9 show the final clinical and
radiological situation of 41 and 44 15 months after
beginning the pocket treatment.
Case 3
Patient ED, a 48-year-old woman came into our
practice due to fear of losing two upper-front teeth
because of their high mobility, teeth 21 and 22, TM4.
Tooth 21 on the buccal side featured a periodontal
pocket of 11 mm. Pockets’ cause: occlusal dysfunction. All upper front teeth were CO2 positive. Figure 10
shows the clinical periodontal situation and Figure 11
the radiological situation of 21 and 22. Tooth 21 was
splinted on the palatal side with a wire and composite
to the neighbouring teeth 11 and 22, similar to an orthodontic retainer. Under anaesthesia, SRP and laser
[13] =>
[14] =>
| research
Fig. 24a
Fig. 25a
Fig. 25b
Fig. 24b
Fig. 24a: A 12 mm deep pocket
mb to ml 32.
Fig. 24b: Initial X-ray.
Fig. 25a: Three months later:
7 mm pocket depth.
Fig. 25b: Beginning bone regeneration.
Fig. 26a: Eleven months later, 5 mm
pocket depth.
Fig. 26b: Final bone regeneration.
Fig. 27: Two years later, healthy
clinical situation.
Fig. 26a
Fig. 26b
protocol were applied. Here, it was very important to
not go deeper than about 8 mm to prevent a devitalisation of 21 by SRP or laser irradiation. Figures 12
& 13 depict the situation six months later. The periodontal situation was normal and both teeth 21 and
22 had normal CO2 vitality. Figure 14 shows a clinically
healthy periodontal situation three years later, lessened symptoms and both teeth 21/22 CO2 positive.
Case 4
Patient TA, a 70-year-old man came for a general
consultation into our practice, with no pain. Canine
33 had an active, 12 mm deep periodontal pocket,
shown in Figure 15 and the X-ray of 33 in Figure 16.
The tooth was CO2 negative, the pocket’s cause:
Endo/Perio. In the same session, we started endodontic treatment for 33, the bridge was separated
distally from 34, and we removed 37, did SRP for 33,
and applied laser treatment protocol. Ten months
later Figure 17 shows a little recession of the gum, a
healthy periodontium, and in Figure 18 a very nice
bone regeneration corresponding to the pocket’s
anatomy. Five years later, no change in the periodontal situation of 33 was seen.
Case 5
Patient BA, 71-year-old man was referred for periodontal treatment of tooth 16, with a 11 mm deep
active pocket distobuccally and distopalatally.
Pocket’s cause: food impaction as seen in Figure 19
between 16 and 17. Tooth 16 was CO2 vital and
crowned. In a first session, we restored tooth 17 with
a new composite filling to close the gap. Figures 20 & 21 show the periodontal situation. In a
second session, SRP was done and laser protocol
was followed with four sessions.
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Fig. 27
Eight months later, Figure 22a shows a healthy periodontal situation with a small recession of the gum
and in Figure 22b the corresponding X-ray and visible
regeneration of the bone can be seen. Two years later,
we found a clinical, inactive 6 mm pocket (Fig. 23a),
and in Figure 23b a radiologically acceptable situation. Because of a heavy calculus formation we recommended that the patient visit the dental hygienist
three times a year.
Case 6
Patient BL, a 69-year-old woman was referred for
laser treatment of the 12 mm deep pocket at the mesiobuccal to mesiolingual side of tooth 32, with no
pain, TM 4 and CO2 vitality. Pocket’s cause: occlusal
dysfunction. Fig. 24a shows the initial clinical periodontal situation and Fig. 24b the initial X-ray of 32.
After following the conventional treatment protocol described in section 2.1, splinting 32 to 33, 41, 31,
occlusal reseating and applying laser protocol in three
sessions. Figure 25a shows the clinical state with
7 mm pocket depth and Figure 25b the beginning
bone regeneration. After eleven months, 5 mm pocket
depth remained as depicted in Figures 26a & b (final
bone regeneration). Figure 27 shows the healthy
clinical situation two years later.
Case 7
Patient BS, a 55-year-old-woman, was referred by
her diabetologist for a general periodontal consultation. The only heavy periodontal problem was an active pocket of 12 mm mesially from tooth 24 and
11 mm distally and mesiopalatally from 23 due to
food impaction and occlusal dysfunction, with TM 4
for tooth 24 and TM 3 for tooth 23. The pathogenic
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bacteria found in the analysis were Porphyromonas
gingivalis and Tannerella forsythia. Figure 28a shows
the initial clinical and Figure 28b the initial radiological situation before laser treatment. On the X-ray, no
calculus can be seen in the interdental area 23/24 and
neither mesially from 23. The therapy of choice was
therefore to splint the teeth together, to eliminate
the occlusal dysfunction and to eliminate the pathogenic bacteria. After SRP followed laser protocol in
four sessions.
Eight years later, the whole regenerated bone mesial of 23 was stable and the bone had regenerated
interdentally at 23/24 according to the pockets’ anatomy. Clinically, both teeth in Figure 29a present normal periodontal clinical values and Figure 29b shows
osseous regeneration ad integrum mesially from 23
and the maximally possible bone regeneration interdentally at 23/24.
The reduction of the pocket depth to an inflammation-free, painless and long-term satisfactory periodontal situation has always been described as a
combination of gingival shrinking and bone regeneration. Bone regeneration was in all patients dependant of the pockets’ anatomy and is rather well predictable, whereas the predictability of the extent of
gingival recession after such a treatment is less safe.
4. Discussion
When we started with lasers in our practice nine
years ago, we had only the wavelength of 670 nm and
methylene blue at our disposal. We then treated a
young lady of 37 years with a 12 mm deep pocket dis-
|
tally at 23 (Fig. 30). We remember that we told her this
would be a very long and expensive treatment with
augmentation procedures. She was really shocked
about the future costs. Then we informed her that another therapy exists but no guarantee for success
would be given. She agreed to commence this treatment. The pocket was caused by Actinobacillus actinomycetemcomitans (Fig. 31).
After SRP and curettage under local anaesthesia
we added four sessions only with tPDT as described
under section 2.2.2. No antibiotics or augmentation
procedures were applied. Five months later, Figure 32
shows that all pathologic bacterial flora was eliminated only by the correct application of tPDT. Nine
years later, the patient is very happy and completely
satisfied with the stable result.
In September 2009, the author, 62 years old at the
time, was immatriculated at RWTH university of
Aachen for the master course of lasers in dentistry.
He finished two years later.
The literature for lasers in dentistry in periodontal
treatments is still contradictory. There are many authors that cannot find better therapeutic results
compared to conventional closed periodontal treatments alone or with adjunctive lasers. Neither a PDT
with toluidine blue and a laser wavelength of
632 nm38 could improve the clinical parameters of
bleeding and probing, probing pocket depth and clinical attachment level nor did a diode adjunctive laser39
therapy improve the above mentioned clinical parameters and the measured gingival cervicular fluid inflammatory mediator interleukin-1b (IL-1b). Even the
Fig. 28a: Clinical initial situation of
teeth 23 and 24.
Fig. 28b: Radiological initial situation
after splinting 23/24.
Fig. 29a: Clinical situation eight
years later.
Fig. 29b: Corresponding X-ray:
mesial 23 restitutio ad integrum and
interdental 23/24, the maximally
possible bone regeneration.
Fig. 28a
Fig. 28b
Fig. 29a
Fig. 29b
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Fig. 30a
Fig. 30b
Fig. 30c
Fig. 31
Fig. 32
Fig. 30a: The pocket depth
on 23 d and 26 mp.
Fig. 30b: X-ray of 23.
Fig. 30c: X-ray of 26, all images
from 18 March 2008.
Fig. 31: The bacterial situation in the
pockets, 28 April 2008.
The main responsible bacteria
for the pockets is Aa.
Fig. 32: All pathologic bacteria
eliminated by tPDT. Analysing date of
bacteria pocket probe:
8 October 2008.
16
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Er:YAG laser could not improve the conventional periodontal treatments.40
As we know that the field of laser adjunctive therapy in periodontics or other fields is very young in
dentistry and is not integrated in the general education of dentists, we must assume that many laser applications perhaps do not respect the biophysical
background of the different laser wavelengths. Too
much venous blood in the pocket absorbs the laser
energy for lasers with wavelength from excimer laser
to the diode laser of 940 nm. Hotspots at the fibre end
overheat the irradiated tissues very fast and too much
energy or energy densities with lasers in the middle
infrared can harm subgingival tooth surface or alveolar bone. And we clinicians know that for physical
reasons a parallel access to the subgingival area
during a closed periodontal treatment with our laser
handpieces is very, very difficult. For this reason the
author thinks that settings of 160 mJ, 10 Hz in subgingival, closed working can be dangerous ablating too
much health dentine too fast. However, we were able
to demonstrate with the presented cases that very
good clinical results can be reached safely with settings close above the ablation threshold of the hard
tissue. And in the author’s opinion, it is a pity that the
industry has not yet produced slightly angulated sapphires for the handpieces. This would allow easier and
safer access to the subgingival root surface. A parallel
laser beam to the root dentine of the Er:YAG or
Er,Cr:YSGG laser would minimise the risk for our patients. Whatever the sellers of laser devices do promise during a sales pitch, in this context the laser user
may always be reminded of the fundamental principle
in medical ethics “primum non nocere”.
It is absolutely necessary to sensitise laser practitioners to respect the properties of the different laser
wavelengths on the one hand and on the other hand
to correctly assess the optical properties of the irradiated tissue. In our cases, we observed no uncomfortable side effects after treatment and the wound
healing was much faster than when done only with
SRP and curettage with conventional instruments like
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Fig. 33a: Clinical situation nine years
after the beginning of the
conventional closed periodontal treatment with adjunctive laser therapy.
Fig. 33b: Radiological situation.
Fig. 33a
scalers and curettes. The regeneration of the alveolar
bone progressed according to the pockets anatomy.
5. Conclusion
The successful clinical treatment of very deep periodontal localised pockets of 10 mm and more without
antibiotics or augmentation procedures can be
achieved by consequently following the conventional
periodontal therapy principles and by performing adjunct laser irradiation.
Laser irradiation is a local decontamination of the
treated areas by formation of oxygen radicals (PDT) or
absorption of the laser energy in the chromophores of
the bacteria-like pigments (diode lasers in near infrared) and water (erbium group in mid-infrared). In addition, the three presented wavelengths have inhibitory effects of the inflammation process of the soft
tissues after treatment and stimulate wound healing
and osseous regeneration. The patients do not experience any uncomfortable side effects from the correct laser application and the wound healing is fast
Fig. 33b
and almost painless. To minimise the risk for iatrogenically generated tissue damages by laser application,
for example overheating or carbonisation of the irradiated tissues, the applied power settings are laser
much lower then generally described in the literature
for diode (810 nm) and the Er:YAG (2,940 nm). To
achieve the best clinical results, it is indispensable to
know the biophysical background of the applied laser
wavelengths and to assess correctly the optical properties of the irradiated tissues._
contact
Dr Gottfried Gisler, MSc
Praxis Dres. med. dent. Gottfried
& Vanessa Gisler
Bahnhofstr. 14
8708 Männedorf, Switzerland
Tel.: +41 44 9200453
info@zahnarzt-gisler.ch
www.zahnarzt-gisler.ch
Author details
Kurz & bündig
Die Eliminierung von pathogenen Keimen in der parodontalen tiefen Tasche ohne Antibiotika als ein wesentliches
Behandlungsziel wird mittels Lasereinsatz von verschiedenen Wellenlängen sicher und zweckmäßig erreicht, sei es durch
Bildung von Sauerstoffradikalen in photodynamischen Therapien1–4 oder durch Absorption der Laserenergie in den Pigmenten (naher Infrarotbereich)10–12 oder im Wasser (mittlerer Infrarotbereich)18–20 der Bakterien. Die zusätzliche entzündungshemmende und biostimulative Wirkung von Laserlicht5–9,13–15 verkürzt die Abheilungszeit und macht den Eingriff für
den Patienten erträglicher und schmerzärmer. Die geschlossene Parodontalbehandlung von sogenannten „hoffnungslosen“ Zähnen mit Taschentiefen von 10 mm und mehr erlebt dank adjunktiver Lasertherapie erstaunliche, ja verblüffende,
mit viel Knochenregeneration stabile Langzeitresultate, was in den beschriebenen Fällen gezeigt werden konnte. Voraussetzung für solche Resultate ist der korrekte Einsatz der Laserenergie und das Einhalten allgemeingültiger Therapie
grundsätze konventioneller Zahnmedizin und hier speziell der parodontalprophylaktischen Maßnahmen. Um iatrogenen
Gewebeschäden durch Laserbestrahlung möglichst vorzubeugen, wurden hier sowohl für den Diodenlaser wie auch für
den Er:YAG-Laser viel tiefere Laserleistungen eingesetzt als häufig in der Literatur beschrieben.32–35 Grundsätzlich gilt
es beim Einsatz von Lasern im mittleren Infrarotbereich eine Absorption der Energie im Hydroxylapatit zu vermeiden, bei
Lasern im nahen Infrarotbereich die Bildung eines „Hotspots“ am Faserende zu verhindern und bei der transmukosalen
photodynamischen Therapie mit Methylenblau im sichtbaren Rotbereich das durch die Behandlung im Operationsgebiet
ausgetretene Blut simultan während der Irradiation auszuwaschen. Wer Laserlicht als Therapie einsetzt, muss die biophysikalischen Grundlagen und Wechselwirkungen der einzelnen Wellenlängen mit dem Gewebe kennen und die optischen
Eigenschaften des bestrahlten Gewebes richtig einschätzen – man denke an Zahnstein, Dentin und Erbium-Laser!
Literature
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Photodamage of dental
pulpa stem cells during
700 fs laser exposure
Authors: Prof. Dr Karsten König & Dr Anton Kasenbacher, Germany
Material and methods
Fig. 1: Femtosecond laser system
with pulse-stretching unit.
Laser-scanning
microscope
Sensor diode
Objective
Cells
Human stem cells from the dental pulp of adults
(given by S. Gronthos, NIH, Bethesda, USA) were
cultivated in a-modified Eagle’s Medium (MEM)
by Gibco BRL Life Technologies (Paisley, Scotland)
while adding 20 % FCS, 2 mM L-glutamine, 100 µM
L-ascorbate-2-phosphate, 100 u Penicillin and
100 µg/ml Streptomycin at 5 % CO2 and 37°C in 25 ml
and 75 ml cell culture flasks (Greiner, Frickenhausen,
Germany).1 The cells were treated for experiments
and cultivation with 0.25 % trypsin, 5 mM glucose,
0.05% EDTA in PBS for 5 minutes at 37 °C. After having been thus detached from the base of the culture
flasks, the cells were incubated in cell chambers
(MiniCeM, JenLab GmbH, Jena, Germany) for laser
microscopy.
Comparative studies were conducted on Chinese
hamster ovary (CHO) cells, which are available in
many international laboratories as reference cells.
Mirrors with threepoint support
Beamer
expander
Autocorrelator
Pulse
strechter
Grating 1
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Grating 2 on
motorized
translation
stage
Mirror
The CHO cells were incubated in Dulbeccos HAM-F12
Medium (Gibco BRL) with 10 % FCS, L-glutamine and
an antibiotic mix of Penicillin, Streptomycin and Amphotericin B at 5 % CO2 and 37 °C. Trypsinisation corresponded to that of the stem cells.
Individual cells were marked by special diamond
engravings in the exterior glass window. In case of
the detection of cellular damage, these engravings
were easily located by applying the phase-contrast
technique.
Laser microscopy
An 80 MHz Ti:Sa Laser, Mai Tai (Spectra-Physics,
Mountain View, USA) was applied for femtosecond-laser microscopy in the near infrared (NIR)
spectrum. The laser power at microscope entrance
and objective plane (power at the sample) were determined by the measuring instrument Fieldmaster
(Coherent, Santa Clara, USA) and the measuring
head LM2 and varied by grey filters when necessary.
The measured values were specified as corrected in
the presented protocol. This correction results from
a limited measurement area and altered radiation
conditions in the medium when compared to air.
Laser microscopy was realised via a modified
LSM 410 (ZEISS, Jena, Germany) with a 40 x/1.3
oil immersion objective. The microscope scan
modus 512 x 512 with a laser
scan time t = 16 s was applied for cell irradiation. The
cells were scanned ten times
Attenuator
at the same focus plane.
These experiments were
Fs laser
realised at a central wavelength of 800 nm. After
irradiation, the cells were
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35
DPSC cells
CHO cells
30
Lethality / %
is transformed by an enzymatic reaction to the
strongly green fluorescent calcein which cannot
pass the intact membrane. Ethidium-homodimer-D1
is a red fluorescent so-called dead-cell staining
agent which can only permeate damaged cell membranes and is significantly intensified by binding to
DNA. The Life-/Dead-Kit was incubated 5.5 h after
irradiation. Fluorescence was achieved by two-photon excitation.
34.7
25
20
15
10
14.5
7.2
5
0
0
26
20
Laser power / mW
transferred to an incubator in order to guarantee
optimal conditions for further growth, cell division
and repairing processes.
Pulse-stretching unit, generation and measurement of 700 fs pulses
In order to increase the pulse duration at the sample to 700 fs, a pulse-streching unit was implemented in the light path in front of the microscope.
This unit consists of coated mirrors and two parallel
arranged gold-sputtered gratings with a grating
constant of 600 lines/mm. The second grating was
mounted on a motorised stage with micrometre precision. The pulse width was varied in dependence on
the grating distance. The laser beam received a spatial dispersion by the first grating, which was compensated at the second grating (Fig. 1).
The pulse duration was initially determined at the
laser exit with the autocorrelator MINI (APE, Berlin,
Germany) with 88 fs at a central emission wavelength of 750 nm, 80 fs at 800 nm and 91 fs at
850 nm, hypothesising a Gaussian function. In general, measurements at the focal plane of the objective proved difficult, as divergent beams exist. A flat,
non-linear measurement diode was employed, thus
facilitating the measurement at the focal plane of
high-aperture objectives. The autocorrelation function (ACF), which can be fitted with either Gauss-,
Lorentz or Secanthyperbolicus-based analysis programmes in order to calculate the pulse duration.
Life-/Dead-Test
In order to examine the vitality of dental pulp stem
cells (DPSC), a test by Molecular Probes (Eugene,
Oregon, USA) was applied. A mixture of 2 µM calcein AM and 4 µM ethidium-homodimer-D1 was
added to the cell chambers and incubated for
20 min at 37 °C.
Live cells were stained by calcein (emission in the
green spectrum), dead cells by ethidium-homodimer-D1 with an emission in the red spectrum (nucleus). Calcein AM is a non-fluorescent dye which
easily permeates the cell membrane of live cells and
|
Fig. 2: Laser-induced damage rate
(lethality).
Verification of laser-induced ROS-formation
The formation of ROS was verified in situ via
two-photon excitation of the membrane-permeable fluorophore dihydroflurescein (DHF) according
to the method by Hockberger et al.2 First, the cells
were incubated with the marker (10 µM, Fluka, Germany) and irradiated after 15 min incubation time.
Only one ROI (region of interest) was subjected to
irradiation. Surrounding cells were used as control.
After irradiation, a full-frame scan was realised
with the low power of 4 mW in order to visualise the
effect.
Results
The pulse-stretching unit was adjusted in a way
that allowed for each laser wavelength a pulse duration of 700 fs ± 50 fs in the focus. Single DPSC
cells were scanned 10 x and the effect compared to
the non-irradiated surrounding cells was determined. In addition, comparative experiments were
accomplished using CHO cells. Cells or cell clusters
were selected which were widely spaced in order to
inhibit any intercellular communication as far as
possible. During scanning, the transmission signal
was detected and displayed as a picture on the
monitor. A total of 325 cells was subjected to morphological examinations as well as a life-/deadtest, 50 cells underwent ROS examination. The results were compared to earlier findings with a pulse
width of 170 fs.
Morphological changes
So-called black spots resulted from specific irradiation power perameters in locations with significant granulation in the cells. The laser power was
gradually increased by 2 mW in order to measure the
threshold value for the appearance of the first laser-induced morphological changes (Tab. 1). Under
these conditions and with optimum focus, the minimal power for the appearance of black spots was
20 mW for the DPSC cells and 22 mW for the CHO
cells (Tab. 2). At a power of 26 mW, 30 % of the DPSC
cells and only 15 % of the CHO cells presented these
morphological changes. Cells with laser-induced
black spots generally revealed morphological
changes within the following five hours thus indicating a photodamage effect.
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Occurance of black spots in DPSC cells
Occurance of black spots in CHO cells
mW
Total of irradiated cells
Cells with spots
mW
Total of irradiated cells
Cells with spots
16
10
0
16
10
0
18
10
0
18
10
0
20
69
1
20
69
0
26
72
21
26
72
11
Figs. 3a–f: Verification of the
laser-induced formation of ROS.
Fig. 3a
Table 1
Life-/Dead-Test
First, the DPSC cells were irradiated with different
power parameters (4 mW, 12 mW, 16 mW, 20 mW and
32 mW). The irradiated cells were marked, incubated
after 5.5 hours with the Life-/Dead-Kit and after
1 hour of incubation tested concerning their fluorescence behaviour. At an irradiation of 20 mW, 64 of 69
DPSC cells revealed a green cytoplasm fluoresence,
Fig. 3b
Table 2
while a red fluorescence was observed in 5 DPSC cells
(Tab. 3). This corresponds to a damage of 7%. When
the power was raised to 26 mW, already 35 % were
subjected to a lethal effect. However all of the CHO
cells tolerated a power of 20 mW, with 15 % of them
dying at 36 mW (Tab. 4 and Fig. 2). The comparison with
experiments of shorter pulse widths, at which already
73 % of the DPSC cells were damaged at a power of
20 mW, shows that the longer pulse width of 700 fs is
better tolerated by the cells.
Verification of the laser-induced formation of ROS
(reactive oxygen species)
The irradiation showed that no detectable DHF signals occurred at average power lower than 35 mW. As
can be seen from Figure 3 (upper part of a and b) ROS
signals were detected at a higher power of 37 mW in
both upper irradiated cells. Weak fluoresence signals
occurred in the lower non-irradiated cell too. However,
this cell was linked to the irradiated cells via membrane
contacts. If the power is only insignificantly increased,
its effects become more pronounced. In Figure 3c the
irradiated cells show a significantly higher intensity.
This effect is also confirmed by the considerable fluorescence of the irradiated cell (Fig. 3f). Thus, destructive oxygen radicals are formed during irradiation of a
pulse duration of 700 fs. In comparison to the 170 fs
experiments, a significantly higher average power is
necessary to achieve detectable ROS formation.
Conclusions
Fig. 3c
Fig. 3d
Fig. 3e
20
Fig. 3f
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DPSC are less sensitive to irradiation with femtosecond NIR laser at a pulse width of 700 fs under the described irradiation conditions than to shorter pulse
width of 170 fs. At average power parameters of
20 mW, up to 10 % of the cells were subjected to lethal
effects within six hours after irradiation. At an average
power of 26 mW, still two thirds of the cells survived.
At the shorter pulse width all cells would be subjected
to a lethal effect.
The observed lesser sensitivity at higher pulse
widths and constant pulse energy corresponds to the
results of earlier studies on Chinese hamster ovary
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Lethality of DPSC cells
|
Lethality of CHO cells
mW
Total of
irradiated cells
vital
lethal
% lethal
mW
Total of
irradiated cells
vital
lethal
% lethal
16
10
10
0
0
16
10
10
0
0
18
10
10
0
0
18
10
10
0
0
20
69
64
5
7
20
69
68
0
0
26
72
47
25
35
26
72
65
11
14,5
cells (CHO) at an irradiation wavelength of 780 nm.3 In
these earlier studies, it was concluded that the damage
is subject to a two-photon effect, for which a damage
effect E can be expected according to the formula
E ~ P² / with P: average laser power and : pulse width.
As in comparison an increase of the pulse width by
factor F = 700 fs / 170 fs = 4 exists, it follows that a
power increase by factor S = 1.7 to 2 should be necessary in order to achieve the same destructive effect.
This relation cannot be confirmed exactly basing on
the presented data, but a factor S > 1.25 can be assumed, as already 7 % of the DPSC cells died at an
average power of 16 mW and a pulse duration of
170 fs, but 20 mW at 700 fs were necessary to achieve
the same effect.
DPSC cells react slightly more sensitive at a pulse
width of 700 fs than CHO cells. At an exposure of
26 mW laser power only 15 % of the CHO cells were
Table 3
Table 4
damaged in comparison to 35 % of the DPSC cells.
The detected ROS formation indicates a photochemical damage process._
contact
Prof. Dr Karsten König
Saarland University
Campus A5.1, Room 2.35
66123 Saarbrücken
Germany
Tel.: +49 681 3023451
k.koenig@blt.uni-saarland.de
Dr Anton Kasenbacher
Obere Hammerstr. 5
83278 Traunstein
Germany
Tel.: +49 861 4692
a.k@ts-net.de
Author details
Author details
Kurz & bündig
Die humanen Stammzellen aus der Zahnpulpa Erwachsener (erhalten von S. Gronthos, NIH, Bethesda, USA) wurden
in a-modifiziertem Eagle´s Medium (MEM) bei 37 °C in 25 ml und 75 ml Zellkultur-Flaschen (Greiner, Frickenhausen,
Deutschland) kultiviert. Die Zellen wurden für Versuche und Zucht mit 0,25 % Trypsin, 5 mM Glucose, 0,05 % EDTA
in PBS für ca. 5 min bei 37 °C behandelt. Die so vom Boden des Kulturgefäßes abgelösten Zellen in Zellkammern
(MiniCeM, JenLab GmbH, Jena, Deutschland) für die Lasermikroskopie inkubiert. Vergleichend fanden Untersu
chungen an Chinesischen Hamsterovar-(CHO-)Zellen statt, die weltweit in vielen Laboren als Referenzzellen vorliegen.
Einzelne Zellen konnten markiert werden, indem ein Spezialdiamant in das äußere Glasfenster Gravierungen erzeugte.
Diese konnten bei Detektion von Zellschäden leicht mit dem Phasenkontrastverfahren lokalisiert werden.
Auf eine Bestrahlung mit einem Femtosekunden-NIR-Laser mit einer Pulsdauer von 700 fs reagieren die DPSCZellen nach vorliegenden Bestrahlungsbedingungen weniger empfindlich als bei einer kürzeren Pulsdauer im Bereich
um 200 fs. Bei mittleren Leistungen von 20 mW erleiden bis zu 10 % der Zellen letale Wirkungen innerhalb von
6 Stunden nach der Bestrahlung. Bei einer mittleren Leistung von 26 mW überleben immer noch 2/3 der Zellen. Bei
der kürzeren Pulsdauer wären bereits alle Zellen einer letalen Wirkung unterlegen. Die DPSC-Zellen zeigten sich bei
der Pulsdauer von 700 fs etwas empfindlicher als CHO-Zellen. So wurden bei Einwirkung von 26 mW Laserleistung
nur 15 % der CHO-Zellen im Vergleich zu 35 % der DPSC-Zellen geschädigt. Die detektierte ROS-Formation deutet auf
einen photochemischen Schädigungsprozess hin.
Literature
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Histomorphological
changes in human bone
After in vivo Er:YAG laser and
ultrasound osteotomy
Authors: Bistra Y. Blagova, Elena G. Poriazova, Petia F. Pechalova & Prof. Georgi T. Tomov, Bulgaria
Introduction
Tab. 1: Histopathological changes
in 60 bone specimens taken in vivo
from human mandibles by ultrasound- and Er:YAG-laser osteotomy.
Bone surgical interventions are performed using
two major techniques: an osteoplasty and osteotomy. They are carried out by a great number of tools
(osteotomes) which cause certain changes in bone
morphology, i.e. cell vitality and physiology.1-14 The
applicability of different osteotomes in bone surgery depends on the severity of tissues damage and
the healing process afterwards.1 Therefore, the features of bone repair have been object of a many
histomorphological research trials performed on
laboratory animals.1–3 The analyses of the results
published showed tissue recovery following ultrasound and laser osteotomy to be superior to the procedures performed by conventional rotary tools.1,4,5
However, the conclusions from these researches are
not automatically relevant to humans. Therefore,
the aim of this study was to evaluate the histological
changes in the border area following in vivo human
Histopathological changes in 60 bone specimens
Histomorphological
changes
Woodpecker®
LiteTouch™, Light
Instruments
border configuration/
margins
sharp,
severely fragmented and
irregular (Figs. 1 & 2)
sharp,
precise configuration
(Figs. 3 & 4)
debris fragments
a satellite zone of
numerous debris fragments
(Figs. 1 & 2)
no smear layer of
debris fragments
(Figs. 3 & 4)
thermal damage/
carbonisation
no significant signs,
preserved bone microstructure
(Figs. 1 & 2)
no significant signs,
mildly expressed darker
superficial area (Figs. 3 & 4)
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bone cutting by an ultrasonic device and an Er:YAG
laser during extractions of impacted mandible wisdom teeth.
Materials and methods
Objects in this study were outpatients aged between 18 and 35 in order to minimise age-related
bone changes. All patients were indicated for surgical extraction of their mandibular third molars. Presence of any co-morbidities or bone infection were
considered as exclusion criteria. The research objects
were sixty bone specimens divided into two groups
equal in number according to the tool used for their
collection: an ultrasonic surgical device (Woodpecker Ultrasurgery®, China) and an Er:YAG laser
(LiteTouch, Light Instruments®, Israel). All bone samples were obtained by a trained oral surgeon. No
complications occurred either intra- or postoperatively. A standard setup of both devices for bone manipulations were used as follows:
–– Ultrasonic unit—Bone function—Bone quality 1—
frequency utilised up to 29.5 kHz—water pump 5;
–– LiteTouch™ Er:YAG laser—wavelength 2.94 μm
(2,940 nm)—bone remodeling—Hard Tissue— NonContact mode—300 mJ—25 Hz—water spray 8.
Laser specimens were obtained using a cylinder
sapphire tip of 1.3 mm in diameter and 19 mm in
length (LiteTouch™, Light Instruments, Israel) in a
non-contact mode at a distance of 1–2 mm from the
target surface. Ultrasound-obtained bone chips were
taken by a tip # US 1.
All samples were fixed in 10 % buffered formalin,
decalcified and cut into slices within 3–5 μm each. The
slices were stained with haematoxilin-eosin (H&E)
[23] =>
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|
Fig. 1: Ultrasound obtained human
bone specimen (H&E x100).
Fig. 2: Ultrasound obtained human
bone specimen (H&E x400).
Fig. 1
Fig. 2
(Bio-Optica®, Italy). The microscopic observations
were performed by pathologist in a blind manner under optical microscope (Olympus®, Japan) at magnifications of x100 and x400.
formed by ultrasound- and Er:YAG-laser and to compare them to the ones reported in animals.
The histomorphological evaluation included
groups of observation:
1. border configuration/margins quality;
2. presence of debris fragments;
3. thermal damage/carbonisation.
All the sixty bone fragments were investigated according to the above-mentioned histological criteria.
Results
The histomorphological findings in both groups
(30 specimens for each) are summarised in Table 1.
Discussion
Osteotomes, technical characteristics and principles of action determine their biological effects reported in different trials on laboratory animals. Based
on extensive studies, fundamental differences between humans and animals in bone morphology and
physiology were proved.11 These publications led our
team to verify on human bone in real-time procedures, the tissue changes following osteotomy per-
Ultrasound obtained specimen from human bone
Ultrasonic devices work through mechanical waves
within frequencies of approximately 25–30 kHz
created by the piezoelectric effect.8 Bone cutting is
performed by vibrations of lineally oscillating movements within 20–80 microns. Exactly these para
meters establish the micro-precision of the ultrasound-assisted osteotomy and its effects only on
mineralised tissues as well as the depth of insertion
into them.8,12 Histologically, in vivo ultrasound obtained specimens from human lower jaw showed
sharp margins1,6,7 corresponding to these observed by
Romeo et al. in their in vitro study on fresh porcine
mandibles (Figs. 1 & 2).1 Meanwhile, the configuration
of the cutting area on the investigated bioptata was
irregular with clearly detectable layer of bone debris
attached to the main fragment (Figs. 1 & 2). No signs
of morphology alteration were detected during the
collection of human bone chips. All examined in vivo
ultrasound obtained specimens revealed a preserved
microstructure (Figs. 1 & 2). The open vascular canals
observed were likely to improve nutrition during the
early healing phase of the bone repair sequence as reported by Sohn DS et al.7 Based on the histopathological findings established in the presented study and
the non-complicated postoperative period in our patients, we confirmed that ultrasound-assisted bone
Fig. 3: Laser obtained human bone
specimen (H&E x100).
Fig. 4: Laser obtained human bone
specimen (H&E x400).
Fig. 3
Fig. 4
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surgery in humans is an atraumatic and minimally invasive procedure. Same conclusions were reported by
Berengo M. et al.13
Er:YAG laser obtained specimens from human bone
Er:YAG lasers emit infrared light with a wavelength
of 2.94 μm which is absorbed predominantly by water
and hydroxyapatite.14 The Er:YAG radiation is an efficient tool in bone surgery. In contrast with ultrasound
devices, osteotomy by laser is performed in a
non-contact mode. The laser tip is positioned 1–2 mm
away from the target surface and there is no collateral
friction damage to surrounding tissues.
Under light microscopy observation, the cutting
surfaces in laser obtained bone chips from our
patients revealed a precise border configuration
(Figs. 3 & 4) confirming previously-published statements based on animal models for clear and effective
osteotomy achieved by thermo-mechanical laser ablation.1,9,10 In all laser ablated human bone samples, a
mildly expressed darker amorphous layer within
microns was observed superficially near to the incision line (Figs. 3 & 4). Romeo and Panduric et al.
reported analogous tissue characteristics found in
laboratory research on porcine mandibles and ribs respectively.1,10 The reason for detected bone changes in
all specimens in the group could be the cumulative
heat deposition within the area surrounding the lased
tissue.1,10 Compared to the ultrasound-obtained
specimens, laser-obtained human bioptata in our
study showed no smear layer or debris bone fragments attached to the cutting surface (Figs. 3 & 4).
Those findings correlated to the results of Romeo
et al. in their in vitro trial on fresh porcine mandibles
and also could explained the benefits for bone healing
after laser bone ablation proved by Kesler et al. in rats
models.1,4 Probably the increased blood elements adhaesion potential ensured by laser irradiation due to
the absence of any smear layer enhancde the start of
the remodeling process.1,10 The non-complicated
postoperative period in our study confirmed that all
tissue changes histologically approved on the biopsied specimens were harmless with regard to the bone
healing in humans.
Conclusion
The microscopic observations in the presented
study showed that both the type and quality of bone
transformations is attributed to the cutting mechanism per se. Tissue changes in human bone following
in vivo laser- and ultrasound-assisted osteotomy established on the evaluated samples proved the tolerable effects of the two studied tools toward the vital
human bone. The choice of adequate osteotome
should be always influenced by evidence-based results. The Er:YAG laser offers advantages over ultrasound osteotomy techniques because of the noncontact intervention, with no mechanical vibration,
free-of-debris cutting lines and aseptic effects. Nevertheless, with adequate training and experience, the
surgeon is able to use this device for certain and selective procedures in bone surgery._
Acknowledgement: This research was funded by
Medical University of Plovdiv (Grant SDP-06/2015).
contact
Prof. Georgi Tomov
DDS, MS, PhD
Associate Professor and Chair of
the Department of Oral Pathology,
Faculty of Dental Medicine
dr.g.tomov@gmail.com
Author details
Kurz & bündig
Im Vorfeld zum Verfassen des Artikels recherchierten die Autoren ihre Analyseergebnisse zur Zellregeneration nach
Ultraschall sowie Laserosteotomie im Vergleich zu rotierenden Instrumenten. Da die bisher vorliegenden Studien zu
diesen Themen nicht zwingend auf menschliche Zellen anwendbar waren, zielt der hier präsentierte Bericht auf einen
histologischen Vergleich der Zellveränderungen nach In-vivo-Einschnitten in menschlichen Knochen durch Ultraschall
sowie Er:YAG-Laser während der Extraktion geschädigter mandibulärer Weisheitszähne.
Literature
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Die mikroskopischen Untersuchungen zeigten, dass sowohl Art als auch Qualität der Knochenveränderungen
in starker Abhängigkeit zu den angewendeten Schneidmechanismen standen. Zellveränderungen im menschlichen
Knochen in In-vivo-Laser- sowie Ultraschallosteotomie resultierten in den untersuchten Proben tolerierbare Effektive
der zwei Instrumente auf das vitale humane Knochengewebe. Die Auswahl des passenden Osteotoms sollte immer auf evidenzbasierten Ergebnissen beruhen. Aufgrund der kontaktfreien Intervation ohne mechanische Vibration,
ablagerungsfreien Schnittkanten sowie seiner aseptischen Effekte besitze der Er:YAG-Laser deutliche Vorteile im
Vergleich zur Ultraschalltechnologie.
[25] =>
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| industry
Diode lasers
and microsurgery
Author: Dr Isabelle Nguyen, France
Many families of dental lasers have become avail
able in recent years. Throughout this article we will
review a diode laser, which is unusual in that it
supports three different wavelengths in the same
device. A large number of studies have awakened
interest in near infrared wavelengths, 970 nm for
example, which enable the use of high penetration
lasers for disinfecting endodontic canals and perio
dontic pockets. The 660 nm wavelength promotes
biostimulation.
Diode lasers can be used for surgical applications in
mucous tissue, though it should be noted that bleed
ing from the tissue has always occurred because the
rays penetrate the tissue below, thus requiring cau
tion when heating the tissue underlying the target
tissue. The factors above resulted in a new wave
length of 445 nm—in the blue range—as a potential
solution for dealing with mucous tissue as it is more
readily absorbed by haemoglobin (Fig. 1). As it is not
possible to cover the wide range of potential uses of
diode lasers in a single article, we will focus here on
their microsurgical applications.
In the presented case, there was an old bridge with
three incisors and reduced intercanine space, but the
patient refused orthodontic treatment. Figure 2a
shows the initial state in which two pontics were im
plemented with a 970 nm 3 W CW diode laser to rec
reate the emplacement for two central posts under
local anaesthesia with air/water irrigation (Fig. 2b).
There was no bleeding, which simplified the work of
preparing and installing the temporary resin bridge
(Fig. 2c). An examination of scar healing was per
formed seven days later (Fig. 2d). An impression was
then made for the permanent bridge (Fig. 2e). Figure
2f shows the permanent bridge when installed.
Widening the sulcus
The diode laser is an excellent alternative to the
conventional technique for widening the sulcus be
fore creating an impression. It makes avoiding unde
sired secondary gingival retractions possible as its
use in these cases requires less force, and since the
MELANIN
HEMOGLOBIN
Fig. 1: Influence of different laser
wavelengths on haemoglobin,
melanin and water.
Creating pontics
WATER
10,000
100
Copyright Prof. Dr. Andreas Braun, Philipps Unviversity Marburg
ABSORPTION COEFFICIENT (CM-1)
1,000
10
1
0.1
0.01
0.001
0.0001
445
26
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1 2017
660
810
940 970
WAVELENGTH (NM)
[27] =>
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Fig. 2a
Fig. 2b
Fig. 2c
Fig. 2d
Fig. 2e
Fig. 2f
temperature remains under 60 °C, the treatment is al
ways in the reversible range and the tissue that is re
moved will be restored (Table 1). With its biostimula
tory action, the diode laser promotes high-quality
healing of wounds in the target tissue.
pragingival conditions (Fig. 3c). A follow-up exam
ination on D+7 shows that the gingiva had returned
to its original position (Fig. 3d).
Figure 3a shows the peripheral subgingival prepa
ration of tooth 16. Figure 3b shows the opening of the
sulcus with a 970 nm, 1.2 W diode laser with air/water
irrigation and without anaesthesia. The CEREC®
crown can then be bonded within one hour under su
Temperature °C
Fig. 2a: Initial state: two pontics
were implemented with a 970 nm
3 W CW diode laser.
Fig. 2b: Recreation of the
emplacement for two central
posts under local anaesthesia with
air/water irrigation.
Fig. 2c: Preparation and installation
of the temporary resin bridge.
Fig. 2d: Examination of scar healing
after seven days.
Fig. 2e: Impression-taking for the
permanent bridge.
Fig. 2f: Installation of the permanent
bridge.
Detaching the implant
and implant abutment
In implant applications, it is important to note the
axis of the laser fibre to avoid aiming it directly at the
implant or touching it. Working with an air/water irri
gation circuit prevents the implant system from be
Thermal effect of laser energy on soft tissue
45
Vasodilation
50
Disruption of cellular activity
60
Denaturation of proteins
70
Denaturation of collagen
80
Carbonization and cellular necrosis
100
Dehydration by vaporization of water
> 100
|
Tab. 1: Overview on thermal effects
of laser on soft tissue.
Evaporation of tissues
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Fig. 3a: Peripheral subgingival
preparation of tooth 16.
Fig. 3b: Opening of the sulcus at
970 nm, 1.2 W (diode laser) with
air/water irrigation and without
anaesthesia.
Fig. 3c: Bonding of the CEREC ®
crown after one hour.
Fig. 3d: Follow-up examination after
seven days.
Fig. 4a: Covering of implant head 14.
Fig. 4b: Introduction of a wider,
higher gingiva former.
Fig. 4c: Wound healing after two
days, impression-taking.
Fig. 4d: Bridge on implants 14/16
in location.
Fig. 5a: Biostimulation at 660 nm to
induce bleeding.
Fig. 5b: Haemostasis.
Fig. 6a: Surgical exposure with a
970 nm 3 W laser and bonding of the
bracket at 23.
Fig. 6b: Follow-up after one day.
Fig. 6c: Follow-up after five months.
Fig. 3a
Fig. 3b
Fig. 3c
Fig. 3d
Fig. 4a
Fig. 4d
Fig. 4b
Fig. 4c
Fig. 5a
Fig. 5b
Fig. 6b
Fig. 6a
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Fig. 6c
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Fig. 6e
Fig. 6d
Fig. 6h
coming heated. Now we turn to irreversible gingivec
tomies (Table 1).
gaining traction on impacted teeth (Figs. 6a to 6c) and
for frenectomies (Figs. 6d to 6h).
Of course in this clinical context, as the gingival
thickness conditions are favourable, there was no
need to thicken the gingiva by creating a tissue flap.
The implant head 14 was covered (Fig. 4a), and it was
exposed with the 970 nm 3 W CW laser before the in
troduction of a wider, higher gingiva former (Fig. 4b).
Figure 4c shows wound healing on D+2; the impres
sion was then made. Finally, the bridge on implants
14/16 were in location (Fig. 4d).
Surgical exposure with a 970 nm 3 W laser and
bonding of the bracket at 23 is shown in Figure 6a. Fol
low-up at D+1 month is seen in Figure 6b. Follow-up
at D+5 months in Figure 6c and the initial frenulum is
shown in Figure 6d. Rapid frenectomy with 445 nm
2 W laser under local anaesthesia is shown in Figure
6e, along with the follow-up at D+5 in Figure 6f. The
lateral view of the tongue before is displayed in Fig
ure 6g and after in Figure 6h.
Haemostasis
Realignment of crowns
Clinical case: extraction from alveolus 38. The in
terradicular alveolar wall is still visible just after the
extraction, and it was decided to biostimulate at
660 nm to induce bleeding (Fig. 5a). Haemostasis
with the 445 nm 2 W diode laser at a distance of 2 mm
is shown in Figure 5b.
Preprosthetic treatment of mucous tissue with di
ode laser promotes rapid, painless wound healing;
healing times are faster and fewer dental appoint
ments are required. The initial state is depicted in Fig
ure 7a. The crowns at 21, 22 and 23 must be realigned
after determination of the depth of the biological
space and of the gingival heights.
The general dental practitioner can also use a laser
as an aid in certain orthodontic treatments, such as
gingivectomies in cases of hypertrophy, thus improv
ing the dental hygiene of young patients, and also for
Fig. 6d: Initial frenulum.
Fig. 6e: Rapid frenectomy with
445 nm 2 W laser under local
anaesthesia.
Fig. 6f: Follow-up after five days.
Fig. 6g: Lateral view of the tongue
before frenectomy.
Fig. 6h: Lateral view of the tongue
after frenectomy.
Fig. 6f
Fig. 6g
Laser and orthodontics
|
The mock-up serves as a guide for marking out the
new crowns with the 445 nm 2 W diode laser
(Figs. 7b and 7c). Preparation and digital impression
are completed on the same day under periapical an
aesthesia. Examination of the surgery and CEREC
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Fig. 7a: Initial state.
Figs. 7b & c: The mock-up serves
as a guide for marking out the new
crowns with the 445 nm 2 W diode
laser.
Fig. 7d: Examination of the surgery
and CEREC walls at 13 to 23.
Fig. 7e: Follow-up examination of the
gingiva after one month.
Fig. 7f: Patient’s smile before
surgery.
Fig. 7g: Patient’s smile after surgery.
Fig. 7a
Fig. 7f
Fig. 7b
Fig. 7c
Fig. 7g
Fig. 7d
Fig. 7e
walls at 13 to 23 shows that the fibrin is already vis
ible (Fig. 7d). Follow-up examination of gingiva D+1
month is shown in Figure 7e. The patient's smile be
fore the surgery is shown in Figure 7f and after the
surgery in Figure 7g.
of 970 nm. Use of the laser in general dental practices
increases the level of operating comfort for the dental
team and considerably increases patient satisfaction
as well._
Conclusion
Patients treated with diode lasers unanimously
agree that the surgery causes them no discomfort.
Clinically, we observe rapid wound healing and
high-quality results from diode lasers. Surgeries per
formed with a wavelength of 445 nm are effective
because they are completed faster and cause less
contact bleeding than surgeries using a wavelength
contact
Dr Isabelle Nguyen
is a dental surgeon practicing in
Marcheprime en Gironde.
She is also a consulting specialist
for Sirolaser and a CAD/CAM
ambassador.
Author details
Kurz & bündig
Die Autorin stellt im Artikel das breit gefächerte mikrochirurgische Anwendungsspektrum des Diodenlasers vor.
Dabei werden unterschiedliche Laserwellenlängen zwischen 445 nm und 970 nm evaluiert. Anwendungsfelder wie
das Erstellen von Pontics, Sulkuserweiterungen, das Herausnehmen von Implantaten oder Implant-Abutments, die
Hämostase, die Neusausrichtung von Kronen und der Lasereinsatz in der Kieferorthopädie werden anhand von Beispielfällen umrissen. Abschließend fasst die Autorin zusammen, dass Patienten durch den Einsatz des Diodenlasers
weniger Unannehmlichkeiten nach einer chirurgischen Behandlung verspüren. Klinisch wurden nach Anwendung des
Diodenlasers eine schnellere Wundheilung und hochqualitative Behandlungsergebnisse beobachtet. Außerdem werden laut Artikel operative Eingriffe, die mithilfe eines 445 nm-Diodenlasers durchgeführt wurden, effektiver umgesetzt,
da sie in kürzerer Zeit beendet werden können und dabei weniger Kontaktblutungen auftreten als bei einer Wellenlänge von 970 nm. Die Anwendung von Lasern in allgemeinzahnmedizinischen Praxen habe den Anwenderkomfort auch
für das Praxisteam erhöht und die Patientenzufriedenheit deutlich verstärkt.
30
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[31] =>
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[32] =>
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The application
of erbium laser in
dental surgery
Author: Dr Kinga Grzech-Lesniak, Poland
Laser therapy has become a real and extremely
promising alternative to classical surgical approaches in dental surgery. Beside their cutting and
tissue ablating power, the lasers have a number of
effects on tissues which can be used in healing enhancement. The application of high-power lasers in
dental surgery has been known for many years. The
literature gives the examples of laser usage in procedures such as frenectomy, operculectomy, preparation of the prosthetic field, removal of the lesions of
the oral mucosa. Lasers are described as particularly
useful tools because of their coagulation properties,
especially in hard-to-reach areas, where suturing or
hemostasis is difficult.
The use of Er:YAG laser with a wavelength of
2,940 nm to perform almost end-to-end flap pro
cedures is no more a novelty described in the literature and neither is it controversial. On the contrary, it
has been observed that the time needed for the procedure and wound healing is shorter and generates
lower cost.
Figs. 1–3: Pre-op situation.
Figs. 4–6: Incision along the bursa
gingivalis from the vestibular side
with the use of Varian/H14 fiber
(Fotona).
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
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Fig. 6
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|
Figs. 7–9: Incision from the
palatal side.
Figs. 10–13: After separating
the full-thickness flap, the flap and
the bone cavity is cleaned from
the granulation tissue.
Fig. 7
Fig. 8
Fig. 9
Fig. 11
Fig. 10
Fig. 12
Fig. 13
This laser is used in surgery, because, besides of the
cutting process, there are effects of photocoagulation and ablation obtained by evaporation of the tissues. Absorption and penetration of laser light depends on its physical parameters, such as wavelength,
power, dose of energy, water, haemoglobin and melanin content in the tissue, extent and type of lesion.1
Advantages of this tool are high precision of cutting
due to the possibility of strong focusing of the laser
beam and high selectivity, that is, affecting only the
tissues absorbing a specific wavelength. Another ad-
vantage is the possibility of non-contact treatment of
tissues (with non-contact laser tips).
Due to the use of laser therapy the procedures until
now performed with classical surgery, which had previously been very onerous for the patient, now are safer,
less invasive and often more successful than classic
ways of treatment.2 High-power laser is also effective
in removing laesions such as epulis, fibroma, papilloma,
and precise treatment of the periodontium, such as
gingivectomy and the removal of vascular lesions.3,4
Figs. 14–16: Periodontal
debridement, removal of subgingival
calculus and from the root surface.
Fig. 14
Fig. 15
Fig. 16
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Figs. 17–19: View of the cavity
cleaned by Er:YAG laser just before
the closing of the flap.
Figs. 20–21: Stitching up the
surgical area.
Figs. 22–23: Check-up two weeks
post-op.
Fig. 24–27: Pre-op situation.
Figs. 28 & 29: Patient after
hygienic procedures, prepared for
the surgical procedure.
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 24
Fig. 23
Fig. 25
Fig. 27
Fig. 28
Fig. 26
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Fig. 29
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|
Figs. 30–32: Laser incision of the
soft tissue.
Figs. 33–38: Osteoplasty, laser
crown lengthening.
Fig. 39: Stitching up the surgical area.
Fig. 31
Fig. 30
Fig. 33
Fig. 32
Fig. 34
Fig. 35
Fig. 36
Fig. 37
Fig. 38
Fig. 39
Vescovi et al. described the surgical treatment
of osteonecrosis of the jaws (ONJ) by means of
Er:YAG laser in patients during bisphosphonates
therapy (BPT). They documented that early surgical
treatment with the use of Er:YAG laser associated
with LLLT laser therapy, bisphosphonates therapy in
patients with osteonecrosis of the jaws (ONJ) is
more successful, compared to the conventional
therapy.5
Lasers are also sucessfully used in surgical crown
lenghening. Stages of these procedure include:
–– Performing an incision in order to create a flap. In
these cases Er:YAG LightWalker (Fotona) laser
was used, with the handle H14 with Varian tip (in
Case 1) and sapphire tip (in Case 2). The energy of
55 mJ, 20 Hz, power of 1.10 W with Varian tip, and
40 mJ, 10 Hz, 0.4 W using the tip intended for
cutting soft tissues (contact mode).
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Fig. 40: Situation two days post-op.
and osteoplasty were performed. In this case a conventional laser tip was used (chisel sapphire tip 1.5 x
0.5 mm).
Summary
Fig. 40
–– Removal of granulation tissue with the chisel type
tip (1.5 x 0.5 mm) with 180 mJ, 20 Hz, 3.6 W.
–– Laser periodontal debridement—40 mJ, 40 Hz,
1.6 W (Varian tip).
–– Deepithelialisation of the flap, suturing with microsurgical sutures and post-op patient instruction.
Case 1
A 43-year-old female patient has been referred by
her dentist in order to perform surgical crown lengthening because of tooth 14 distal part of the root caries. Due to the fact that the patient is a diabetic, the
procedure was performed with a Er:YAG laser with a
wavelength of 2,940 nm (LightWalker, Fotona). Each
surgical procedure in patients with diabetes involves
high risk of complications, thus reduction of bacteremia, increased sterility and immediate disinfection of
soft- and hard-tissues are advisable.
Case 2
A 52-year-old male patient was referred by his dentist for surgical crown lengthening flap procedure due
to teeth 34 and 35 root caries. Laser incision, cleaning
of granulation tissue from the flap and the bone defect with the use of laser (periodontal debridement)
In the presented cases, flap procedures performed
with the use of Er:YAG LightWalker improved the healing-tissue parameters significantly, shortened the
healing time, and reduced the costs of the surgery.
From the patient's point of view, there was a significant improvement in the treatment comfort and effectiveness through the anti inflammatory and sanitising effect of the laser.
Nowadays the usefulness of erbium lasers both in
surgical procedures in daily work of the dentist is
highly estimated and will grow significantly in future
years. The enhanced effects of the procedure and
better healing of soft- and hard-tissues afterwards
undoubtedly affects comfort, mental well-being, and
the quality of life of the patient._
contact
Dr n med. Kinga Grzech-Lesniak
Periodontoligst
Specialist Periodontist and Assistant Professor
at the Wrocław Medical University,
Department of Oral Surgery
President of the Polish Society of
Author details
Laser Dentistry, PTSL
ul. Poznanska 8
30-012 Kraków, Poland
ptsl@laser.org.pl
kgl@periocare.pl
Kurz & bündig
Literature
36
laser
1 2017
Nachdem die Autorin die Vorteile von Laseranwendungen im Dentalbereich beschreibt, geht sie auf die einzelnen
Behandlungsschritte der laserbasierten chirurgischen Kronenverlängerung ein. Dabei wird in einem ersten Schritt ein
Einschnitt für die Lappenbildung gemacht. In den später vorgestellten Patientenfällen wurde dazu ein Er:YAG-Laser der
Firma Fotona (LightWalker) mit einem H14-Handstück sowie der Varian-Spitze (Fall 1) und Saphirspitze (Fall 2) verwendet.
In Fall 1 wurden eine Energiestärke von 55 mJ, 20 Hz und eine Leistung 1,10 W, in Fall 2 40 mJ, 10 Hz, 0,4 W verwendet.
Dabei wurde die Spitze für einen sanften Gewebeschnitt (Kontaktmodus) genutzt. Es folgte die Entfernung von Granula
tionsgewebe mit der Saphiermeißel-Arbeitsspitze (1,5 x 0,5 mm) mit 180 mJ, 20 Hz und 3,6 W. Nach dem Laserscaling der
Wurzeloberfläche (Varian-Spitze, 40 mJ, 40 Hz, 1,6 W) wurde abschließend eine Deepitheliasierung des Lappens durchgeführt. Vernäht wurde mit mikrochirurgischem Nahtmaterial 6/0. Abschließend erhielt der Patient Empfehlungen für die
Nachsorge. Nachdem die Autorin kurz zwei Fallbeispiele erläutert, fasst sie abschließend die Vorteile der Laseranwendung
zusammen: Durch die Laseranwendung habe sich in den vorgestellten Fällen die Gewebeheilung erheblich verbessert, die
Heilungsdauer und die Behandlungskosten reduziert. Weiterhin führe der Laser zusätzlich zu entzündungshemmenden und
desinfizierenden Effekten, sodass sich insgesamt der Behandlungskomfort für den Patienten deutlich verbessere.
[37] =>
Return address:
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
c/o Universitätsklinikum Aachen
Klinik für Zahnerhaltung
Pauwelsstraße 30
52074 Aachen, Germany
Tel.: +49 241 8088164
Fax: +49 241 803388164
Credit institute: Sparkasse Aachen
IBAN: DE56 3905 0000 0042 0339 44
BIC.: AACSDE 33
Membership application form
Name/title:
Surname:
Date of birth:
Approbation:
Status:
self-employed
employed
civil servant
student
dental assistant
Address:
Street:
Phone:
ZIP/city:
Fax:
Country:
E-Mail:
With the application for membership I ensure that
I am owing an own practice since _______________________ and are working with the laser type
________________________________________________________________ (exact name).
I am employed at the practice ___________________________________________________________________
I am employed at the University __________________________________________________________________
I apply for membership in the German Association of Laser Dentistry (Deutsche Gesellschaft für Laserzahnheilkunde e.V.)
Place, date
Signature
Annual fee: for voting members with direct debit € 150
In case of no direct debit authorisation, an administration charge of € 31 p.a. becomes due.
DIRECT DEBIT AUTHORISATION
I agree that the members fee is debited from my bank account
Name:
IBAN:
BIC:
Credit institute:
Signature of account holder
This declaration is valid until written notice of its revocation
[38] =>
A novel Er:YAG dental
laser-in-handpiece
technology
Author: Georg Isbaner, Editorial Manager
Fig. 1: Eric Ben Mayor,
CEO of Light Instruments Ltd.
Ben Mayor, an Advocate with two and
a half decades of experience at senior executive management and international
business, provides ongoing consultancy
and legal services to multinational
companies, mainly in the field of acquisitions, mergers and international business development in the medical and
dental field. He also advises large corpo-
Fig. 1
38
During the upcoming IDS show taking place on
21–25 March in Cologne, Germany, Light Instruments
Ltd., the inventor of the revolutionary Laser-inHandpiece™ technology, will unveil a new LiteTouch™
model. In a recent interview with the CEO of Light
Instruments Ltd., Eric Ben Mayor, Georg
Isbaner, Editorial Manager of laser
international magazine of laser dentistry,
talked about the company, the new
management, vision of the company and
the new LiteTouch model.
laser
1 2017
rations on building strategic corporate visions and
creating shareholder value for multinational com
panies. We asked Ben Mayor to tell us about Light
Instruments Ltd.
Ben Mayor: Light Instruments Ltd. is the world's
leading provider of next-generation dental laser
technology for soft- and hard-tissue treatments. In
2007, Light Instruments introduced its revolutionary
and innovative Laser-in-Handpiece™ technology as
part of its flagship LiteTouch™ product, the world’s
versatile non-fiber Er:YAG dental laser device for softand hard-tissue dental treatments. The company was
recently acquired by Sino-Lite Ltd., an Israeli corpo
ration specialising in acquisitions, development and
management of medical and dental companies. Since
the acquisition, the company's business model has
been evolving and the new model reflects and supports our customers’ needs. We have made a significant investment to upgrade interactions with our
clients and to give them what they need. This is part
[39] =>
industry
|
in the USA. AMD Lasers, our distributor in
the US, is the most experienced player in the
US dental laser market and is already gaining
a huge market share with strong penetration
percentages.
of our commitment to provide industry-leading customer service.
Light Instruments is famed for its
flagship product—LiteTouch™. What
makes it valuable to the dental laser
market?
LiteTouch™ is the world's smallest
Erbium YAG dental laser for both soft- and
hard-tissue dental treatments. The unique
“Laser-in-Handpiece™” technology houses
the entire laser mechanism within a small
sized chamber (12 cm long and 2.5 cm in
diameter). This innovative solution mimics the
feel of the turbine drill, yet incorporates the
laser's unique benefits: micro surgery, faster
healing, minimal invasive treatments and higher
acceptance of patients to dental treatments.
Please share with us the highlights of the new
LiteTouch™ model.
Among the new model's features is an intuitive
touchscreen for complete control with various
adjustable pre-set options and comprehensive
status updates. This powerful function in an
addition to our LiteTouch™ applicator's manœuvrability, allowing dental practitioners easy and
rapid operations. Thanks to this unique utility
LiteTouch™ new users will definitely enjoy a very
short learning curve. The new development
includes improved and robust hardware architecture, composed of sub-assemblies for easier
service, as well as an integrated built-in power meter (energy tester). The company has also optimised
the LiteTouch™ software and included lower energy
options as well as different language possibilities.
Has the new LiteTouch™ model gained any industry award?
Yes, the new LiTeTouch™ model was given the
important Red Dot Award for product design. This
new model is significantly smaller, compact in size,
lightweight and with small footprint. Thanks to its
design, it is easily portable and has a streamlined look.
It is sold in a variety of different colours and modern
lasing illumination and contributes to the welcoming
atmosphere in the clinic.
How has the new LiteTouch™ model introduction
to the market been so far?
Our new LiteTouch™ was first launched at the
Greater New York Dental Meeting in November 2015
We asked Prof. Roly Kornblit—DMD DDS Ms.—
Light Instruments' Scientific Advisor: Based on
your experience, what in your opinion is LiteTouch™
future contribution to the dental laser market?
With LiteTouch™, dentists can improve treatment
results and increase patients' satisfaction in restorative dentistry, periodontics, endodontics, pedodontics, aesthetic dentistry and implantology. LiteTouch™
abilities for ablative and sub ablative procedures, with
different treatment modes, Hard/Soft/Gentle, provide a wide range of applications. Thanks to the new
generation of Er:YAG laser, every dentist can enjoy
laser benefits and truly perform soft- and hard-tissue
procedures, with full and free expression of their
dental mastery and experience. The growing number
of users and key-opinion leaders worldwide, adopting
this technology is vital proof of it.
What can customers expect from your IDS presentation in March?
We are pleased to launch the new LiteTouch™
model at the IDS, continuing to execute our vision
of developing the latest cutting edge technologies
and products. We believe that the new LiteTouch™
model is a breakthrough product. We will continue
to provide superior products with the highest technology in the near future. I would like to use this
opportunity to invite all dentists to participate in
Light Instruments` Scientific Conference in August
2017, on board the luxurious Celebrity Infinity
cruise to Alaska, an exclusive opportunity to learn
more about Laser Dentistry with world renowned
experts, while enjoying the spectacular scenery of
Alaska. The new LiteTouch™ model will definitely be
there rising above technology!
The new LiteTouch™ model will be unveiled at the
IDS in Cologne, Germany, during 21–25 March 2017.
R.S.V.P at Office@light-inst.com. For more information, please visit: http://light-inst.com._
contact
Light Instruments
P.O. Box 223
Yokneam
20692 Israel
Tel.: +972 738 563203
office@light-inst.com
light-inst.com
laser
1 2017
39
[40] =>
| practice management
Successful
communication
in your daily practice
Part I: Grumbling patients
Author: Dr Anna Maria Yiannikos, Germany & Cyprus
Imagine getting to your clinic every day and feeling
confident that whatever happens to you, you will be
able to resolve it. Resolve a problem easily—in a way
that not only you will feel happy with yourself but also
your patients and staff will stay loyal to you, because
they will also be happy with the service and solutions
you provide them!
This is my gift for you today: A whole new series of
the most popular and challenging scenarios that
might happen at your dental practice and how you will
deal with them so that your patients will leave your
practice with the feeling: “My dentist is THE BEST!”
You might be one of the best dentists in your area
that has all the knowledge, the experience and the
latest technology. But your clients do not see that,
they might not understand it. Maybe they cannot see
your expertise because of the way you are dealing and
communicating with them; maybe your way of communication is not clear enough or not at the level
that some of your clients desire!
Let’s start with the first script: How to deal with a
patient that complains just for the sake of complaining? In the following, I will introduce to you 5 steps of
how to deal with this problem successfully and
peacefully.
How to deal with…grumbling patients?
How many times have we completed an excellent
work or have we followed every step of the treatment
protocol (for example whitening)? How many times
have we informed our patient in detail regarding any
discomfort that he or she might feel during a treatment? But the patient still loves to grumble: “Doc, I
feel…, the bleeding is excessive…, I have such
sensitivity after the whitening…” and so on.
5 steps for a successful communication
© TheGigerRange/Shutterstock.com
Of course, in view of such a patient you might get
upset, angry or frustrated; this is absolutely normal
and an expected reaction. The important thing is to
deal with your patients, to keep them and nothing
else. Let’s investigate now the steps that we can apply
to get a successful result.
40
Step 1: Breath
I know it’s hard to not get angry with grumbling
patients, but let’s vision ourselves as the conductor
laser
1 2017
[41] =>
practice management
|
© Lightspring/Shutterstock.com
Step 5: Ask the right question!
Do never ask her: “Is everything all right?” Why not?
Just because of the fact that she will then start
complaining again. Ask instead: “I just call to check
that everything is ok!” By using this phrase you will
not allow space or thought for more complains.
It is so simple!
Start using the described 5 steps each time that you
have this ‘invisible problem’. At least, try it as an
experiment and see if it works for you as well! Write
me your comments or even add-ins. I will love to hear
them!
of an orchestra: We are responsible to guide them all
in the path that we desire.
Step 2: Listen
What is the real problem? Maybe the patient just
wants to be listened at and pampered a little bit? Or
she wants her ‘problem’ to be resolved by giving her
something back (see Step 3). Of course, she has
nothing to complain about, everything is normal and
expected, but you will never say that to her!
Step 3: Act accordingly
Give your patient something so that she will feel
that her problem is acknowledged and that it will be
resolved immediately by you—her trusted doctor!
This could be an advice like “Do not rinse for 6 hours”,
or a prescription as “Use this cream, it will reduce the
sensitivity”.
Step 4: Follow-up
Of course, it is a must to call her and check that
she is all right some hours before she calls you
(which might the same or the next day, it depends
on the case).
In the next issue of laser magazine, I will present
you the second part of this new series of communication concepts that will teach you with 5 simple steps
how to shush the patients that have too many questions with courtesy and caring. Until then, remember
that you are not only the dentist of your clinic, but also
the manager and the leader. You can always send me
your questions and request for more information and
guidance at dba@yiannikosdental.com or via our
website www.dbamastership.com. Looking forward
to our next trip of business growth and educational
development!_
contact
Dr Anna Maria Yiannikos
Adjunct Faculty Member of AALZ
at RWTH Aachen University
Campus, Germany
DDS, LSO, MSc, MBA
dba@yiannikosdental.com
www.dbamastership.com
Author details
Kurz & bündig
Im ersten Teil ihrer neuen Serie zum Thema erfolgreiche Kommunikation im Praxisalltag gibt unsere Autorin
fünf Tipps, wie Zahnärzte erfolgreich mit notorisch unzufriedenen Patienten umgehen können. Denn ein grundlos
meckernder Patient kann aufseiten des Behandlers schon mal schlechte Laune hervorrufen. Der erste Schritt für
eine harmonische Kommunikation ist daher: Durchatmen! Im zweiten Schritt rät die Autorin, genau darauf zu hören,
was der Patient eigentlich will. Oftmals möchte er oder sie einfach ein bisschen mehr Aufmerksamkeit. Diesem lässt
sich wie in Schritt drei beschrieben, mit einigen zusätzlichen Empfehlungen oder Handlungsvorschlägen begegnen.
Im vierten Schritt geht es dann darum, den Patienten nach seinem Befinden zu fragen, noch eher dieser es geäußert
hat. Ganz wichtig dabei: Keine Frage stellen – wie in Schritt 5 beschrieben –, sondern eine Aussage im Sinne von „Ich
wollte nur mal hören, ob alles ok ist“ formulieren. Auf diese Weise nehmen Sie Ihrem Patienten den Wind aus den
Segeln und geben ihm, was er braucht. In der nächste Ausgabe gibt die Autorin Tipps, wie Sie Patienten mit vielen
Fragen elegant begegnen können.
laser
1 2017
41
[42] =>
| events
©E
mil
ia D
obr
ean
/ Sh
u t te
r s to
ck.
com
Fig. 1
6 Laser Dentistry
Congress of WFLD-ED
th
Author: Dr Dimitris Strakas, Greece
The World Federation for Laser Dentistry (ISLD before 2006) has been founded in 2008 and its aim is
to serve as a non-profit medium for the exchange,
advancement and dissemination of scientific knowledge, elated to the use of lasers for application and
research in the oral and dental environment.
Fig. 1: The 6th Laser Dentistry
Congress of WFLD-ED will be
held in Thessaloniki, Greece. For
this reason, the congress logo is
designed after the Thessaloniki
“Umbrellas”, a famous artwork by
sculptor Giorgios Zoggolopoulos.
42
laser
1 2017
After almost 30 years, it is the foremost known
organisation for laser dentistry. The European Division of WFLD is one of the most active divisions and
had its first congress in Nice already in 2007. The
successful event was continued every two years and
the cities that hosted it were Istanbul in 2009, Rome
in 2011, Brussels in 2013 and Bucharest in 2015.
With the moto “Bringing Laser to Sunlight”, the
second largest city of Greece, Thessaloniki, is hosting the upcoming 6th Laser Dentistry Congress of
WFLD-ED, on 22 and 23 September 2017.
The Congress Logo is a mix of the well-known
landmark of “The Umbrellas” in Thessaloniki and the
wavelength analysis of the visible spectrum. Thessaloniki has been selected not only for the stunning
views, the fabulous promenade by the port, the
easy access via the Makedonia Airport (SKG), the
wonderful culinary experiences and the numerous
modern bars and cafes, but, more importantly, for
the Dental School of the Aristotle University of
[43] =>
|
events
Thessaloniki which has had its own Dental Laser
Clinic since 2012.
With this big step towards laser dentistry, Thessaloniki is pioneering as the only dental school in
Greece offering under-graduate and post-graduate
education on lasers for future dentists. Thessaloniki’s
Aristotle University and its Dental School give us their
full support for our upcoming congress.
Taking a look back on the past congresses and fully
understanding the current financial problems in Europe, we decided to lower the registration fees and
sponsor fees without lowering the quality of the congress. The aim is to attract many dentists to make
Thessaloniki Congress a milestone for our federation.
Our official website (wfld-thessaloniki2017.com)
is fully functional and has all the information that a
participant needs, including call for abstracts, reg
istration form and a direct link to the hotel reservation page, where a discounted room price for congress participants can be found. Of course you can
find us on Facebook where we update frequently
news on our upcoming event.
We are very happy to already have many sponsors
that will also be present with their booths in our congress exhibition area and we are confident that all
laser companies will be present with their current
and new devices being introduced to the dentists
and which are involved in one of the most advanced
technological fields in our profession, dental lasers.
Call for papers is already open and we invite all laser clinicians to show and share their knowledge,
techniques and experimental findings in the fields of
laser dentistry. We are expecting all of you for a
magnificent event, not only scientifically due to our
prestigious invited speakers, but also in form of social events.
So let us bring laser light to sun light! You are all
cordially invited._
contact
Dimitris Strakas
Chairman of WFLD-ED
DDS, MSc. in Lasers in Dentistry,
RWTH Aachen University
PhD cand. Department of Operative Dentistry
Aristotle University of Thessaloniki
Spiridi 28
38221 Volos, Greece
Tel./Fax: +30 24210 32525
www.wfld-thessaloniki2017.com
Author details
AD
30
Laser Safety Eyewear
Lasersafe Binocular Loupes
Patients Eyewear
MADE IN
GERMANY
uvex-laservision.de
[44] =>
manufacturer news
BIOLASE
Worldwide launch of new
all-tissue laser system
BIOLASE, the global leader in dental lasers, announced today
that its new, fifth-generation Waterlase Express™ all-tissue
laser system, having received 510(k) clearance for commercial
distribution from the US Food and Drug Administration (FDA),
is available for immediate sale to dentists in the US as well as
select international markets in Europe, the Middle East and Asia.
Waterlase Express will first be unveiled internationally in Cologne,
Germany, at the International Dental Show (IDS), which is the world's
leading trade show for the dental industry.
With extensive qualitative and quantitative research from a team of dentists around the world guiding the design of the system, Waterlase Express
represents the new foundation of the Company’s strategy to greatly expand
all-tissue laser use in dentistry.
Biolase
4 Cromwell
Irvine, CA 92618, USA
www.biolase.com
LASOTRONIX
SMARTM laser—Versatile and functional
LASOTRONIX is proud to present the diode-based
laser platform especially designed for dentistry.
SMARTM laser is offered as a combination of two
lasers in one package: 10 W at 980 nm wavelength for a wide range of applications in microsurgery, endodontics, periodontology, pain therapy and whitening as well as 400 mW at 635 nm
wavelength for cold therapies like biostimulation
44
laser
1 2017
and PAD (Photoactivated Disinfection). Combining two wavelengths in one device made SMARTM
laser a unique and advanced application for all
soft tissue procedures in dentistry.
Thanks to thoughtful design that allows integration with the dedicated workstation or a
dental unit, SMARTM laser meets the needs of
every dental office. In addition, accessories such
as a wide range of fiber delivery systems, application end tips and a variety of surgical handpieces provide maximum versatility.
LASOTRONIX
˚ytnia 1 str.
05-500 Piaseczno, Poland
www.lasotronix.com
[45] =>
Convergent Dental
Revolutionary laser
technology
Convergent Dental, Inc., is the developer of the
revolutionary Solea, the world’s first CO2 9.3 µm,
computer-aided dental laser with CE clearance to cut hard-, soft- and osseous-tissue.
A two-time winner of the Gold Edison Award
for innovation and development, Solea is a
unique type of carbon dioxide laser.
Its unique wavelength and computer
controls enable any dentist to work
without anaesthesia for nearly
any cavity preparation and without bleeding or sutures for most
soft tissue surgeries, thus
performing several more
procedures per day. Providing a unique patient experience enables substantial practice growth for
the hundreds of dentists who use Solea
every day.
See Solea for the very first time at IDS hall 2.2,
booth F050. To schedule your personal Solea
hands-on session during IDS, please write us at:
soleaidesoe@convergentdental.com.
CONVERGENT DENTAL
140 Kendrick Street, Bldg C3
Needham, MA 02494, USA
www.convergentdental.com
LASERVISION
The light laser safety goggle with magnifier
Especially in dentistry and its modern dental
therapies, laser safety magnifiers are necessary
for precise laser treatments. With the newlydeveloped adapter, LASERVISION has succeeded to combine the well-known LASERVISION
goggle F18/F22 with a magnifier by a popular
German manufacturer.
The lenses can be individually adjusted and
matched to the pupil distance. Due to the large
number of available laser safety filters for this
eyewear, it is possible to support almost every
laser safety treatment with a suitable magni-
fier. In particular, the combination with the
HR2.5x/380 binocular magnifier covers nearly
all micro-laser treatments within the dental or
dermatological range. More information regarding this innovation can be found on the web site:
uvex-laservision.com, at your local LASERVISION
distributor or LASERVISION directly.
LASERVISION GmbH & Co. KG
Siemensstr. 6
90766 Fürth, Germany
www.uvex-laservision.de
Light Instruments
New laser-in-handpiece model announced
Light Instruments launched a new LiteTouch™
laser-in-handpiece model, a significantly smaller
size version of Er:YAG dental lasers for hard- and
soft-tissue dental treatments. This LiteTouch™
Laser-in-Handpiece™ technology houses the
entire laser mechanism within a small-sized
chamber, avoiding energy lose and allowing freehand movement. The LiteTouch™ new model
software provides three treatment modes: “Hard
Tissue”, “Soft Tissue” & “Gentle Treatment”.
The purpose of the “Gentle
Treatment” mode is to give the
users the opportunity to use
low laser energies between
20–40 mJ with frequencies of
10–50 Hz for sub-ablative treatments. To mention a few: caries
prevention, sulcus preparation
for impression, biofilm removal,
enamel conditioning, pulp capping, laser-activated endodontic
irrigation, pocket debridement
and decontamination, implants
decontamination.
The new LiteTouch™ is a
breakthrough product, as noted by Mr. Eric Ben Mayor, Light
Instruments’ CEO: “It provides the company with
the opportunity to continue and strengthen our
tradition of developing the latest advanced technologies and products.”
Light Instruments Ltd.
Industrial Zone, Tavor Building,
P.O.B. 223
20692 Yokneam, Israel
www.light-inst.com
[46] =>
FÜR JEDE KLINISCHE INDIKATION
DAS OPTIMALE SYSTEM
LASER EINFACH, SICHER & SANFT
www.henryschein-dental.de
HENRY SCHEIN DENTAL – IHR PARTNER IN DER LASERZAHNHEILKUNDE
Wir bieten Ihnen ein breites und exklusives Sortiment marktführender
Lasermodelle verschiedener Hersteller an.
Unsere Laserspezialisten beraten Sie gern über die vielfältigen Möglichkeiten
und das für Sie individuell am besten geeignete System.
Laser ist nicht gleich Laser und genau hier liegt bei uns der Unterschied:
Sie, Ihre Patienten und Ihre gemeinsamen Bedürfnisse stehen bei uns
an erster Stelle.
Bei Henry Schein profitieren Sie vom Laserausbildungskonzept!
Von der Grundlagenvermittlung über hochqualifizierte Praxistrainings
und Workshops zu allen Wellenlängen bis hin zu Laseranwendertreffen.
Unsere Laser-Spezialisten in Ihrer Nähe beraten Sie gerne.
FreeTel: 0800–1400044 oder FreeFax: 08000–404444
[47] =>
editorial
Wellenlängen
variation
|
Prof. Dr. Norbert Gutknecht
Sehr geehrte Frau Kollegin,
sehr geehrter Herr Kollege,
liebe DGL-Mitglieder,
Immer mehr Laserhersteller bieten Lasersysteme mit mehreren Wellenlängen für Indikationen in der
Zahnheilkunde an. Diese Entwicklung lässt uns hoffen, dass das Verständnis von Absorption, Transmission,
Reflexion und Streuung in den unterschiedlichsten Geweben nach Bestrahlung mit unterschiedlichen
Wellenlängen unterschiedliche Auswirkungen auf das jeweilige Gewebe zunimmt. Andererseits stellt sich
jetzt die Frage, inwieweit unterschiedliche Wellenlängen alternierend oder zeitlich versetzt eingesetzt
werden sollen oder können.
Die vor uns liegende IDS wird mit Sicherheit neue und interessante Laserwellenlängenkombinationen
vorstellen, mit hoffentlich gut untersuchten und differenzierten Aussagen zu deren klinischen Anwendungen. Je größer die Anzahl unterschiedlicher Laserwellenlängen für den Einsatz in der Zahnheilkunde wird,
desto größer wird die Wahrscheinlichkeit, diese Wellenlängen viel spezifischer hinsichtlich der gestellten
Indikation einsetzten zu können. Es freut mich, dass wir sie in der vorliegenden Ausgabe mit einem Beitrag
zu dieser Thematik konfrontieren dürfen.
Denjenigen unter unseren Lesern, welche die IDS besuchen, wünsche ich viel Freude bei der Inspektion
dieser neuen Dentallaser-Generation.
Ihr
Prof. Dr. Norbert Gutknecht
laser
1 2017
47
[48] =>
news
germany
Laserzahnmedizin kompakt
Das Jahrbuch Laserzahnmedizin 2017
Das kürzlich umfassend überarbeitete und aktualisierte Jahrbuch Laserzahnmedizin in seiner
18. Auflage ist die einzige rein deutschsprachige
Laserzahnmedizin-Publikation am Markt. Hinzu
kommt, dass es in der Fülle an Fachartikeln,
Grundlagenbeiträgen sowie den aktuellsten
Lasermarktübersichten einen fundierten Einblick
sowohl für Einsteiger als auch erfahrene Anwender der Laserzahnmedizin ermöglicht. Neben
bewährten Verfahren greift das neue Jahrbuch
Laserzahnmedizin 2017 in mehreren Artikeln
auch die Ultrakurzpulslasertechnologie auf,
welche entscheidende Verbesserungen auf dem
Gebiet der Laserzahnheilkunde ermöglichen
Zum OEMUS Onlineshop
könnte. Zusätzlich stellen sich erfahrene Industriepartner der Laserzahnmedizin vor und führen in ihre Produkte und Services auf diesem Gebiet
ein. Einen besseren und aktuelleren
Überblick, als es das Jahrbuch Laserzahnmedizin 2017 bietet, gibt es nicht.
Das Jahrbuch Laserzahnmedizin 2017 ist zum
Preis von 49 Euro (zzgl. MwSt + Versand) im
Onlineshop der OEMUS MEDIA AG erhältlich
oder kann über grasse@oemus-media.de angefordert werden.
Quelle: OEMUS MEDIA AG
Photodynamische Therapie
Henry Schein präsentiert
Gericht bestätigt Analogberechnung Mobiles Digitalformat
Eine private Krankenversicherung verweigerte einem Versicherungsnehmer die vollständige Erstattung der Kosten für eine durchgeführte
Parodontaltherapie durch die antimikrobielle Photodynamische Therapie
(aPDT) mithilfe des PACT®-Systems. Der Versicherungsnehmer wünschte eine gerichtliche Klärung. Ein gerichtlich
bestellter Gutachter stellte fest,
© DR- PSD /Shutterstock.com
dass in dem vorliegenden Behandlungsfall die medizinische Notwendigkeit der
aPDT bestanden habe, da
sich aus den Behandlungsunterlagen zweifelsfrei ein
Bedarf an Keimzahlreduzierung ergeben habe (Bakterienanalyse – ParoCheck®
– Diagnostik) und genau dafür
die aPDT als schulmedizinisch
anerkannte Behandlung zur Verfügung stehe. Weiterhin führte er aus,
dass hierbei „Farbstoff und Laserlicht“ im
Unterschied zu den in der GOZ beschriebenen Behandlungsverfahren in
Zahnfleischtaschen eine Keimzahlverringerung bewirke. Das Gericht stellte fest (AG Düsseldorf, Az: 22 C 11392/12 vom 16. Feb. 2015), dass der
Gutachter in seinem Gutachten und der folgenden Ergänzung überzeugend
eine analoge Abrechnung dieser Behandlung als die alleinige Möglichkeit
der Gebührenberechnung bestätige.
Quelle: ludwig-ra.de
48
laser
1 2017
Henry Schein MAG heißt das neue, mobile Digitalformat, mit dem Henry
Schein seit dem 1. März rund um die IDS und die wichtigsten dentalen
Trends und Neuheiten informiert. Das Online-Magazin richtet sich an
Messebesucher oder Praxis- und Laborinhaber, die sich von zu Hause über
die Produktneuheiten und Trends der Messe informieren möchten. Guides
zu verschiedenen Themen zeigen den Besuchern, welche Messeneuheiten sie nicht verpassen sollten. Neu ist bei Henry Schein in diesem Jahr
auch das Live-Format „Meet the Experts“. In kompakten Vorträgen geben
Spezialisten am Messestand täglich wertvolle Tipps zu Themen wie „Einstieg in CEREC – Warum und wie?“, „Vielfältigkeit des Lasersystems“ oder
„Wasser an der Einheit: So wird’s sauber und sicher ohne Chemie“. Die
Anmeldung erfolgt seit dem 1. März 2017 über das Online-Magazin unter
www.henryschein-mag.de.
Quelle: Henry Schein
[49] =>
Einladung zum DGL Workshop-Kongress 2017
Freitag, 23.06.2017, 08.00 – 18.00 Uhr
Aachen – Universitätsklinikum
Sehr geehrte Frau Kollegin, sehr geehrter Herr Kollege,
liebe DGL-Mitglieder,
der Vorstand und Sie, als Mitglieder der Deutsche Gesellschaft für Laserzahnheilkunde, haben anlässlich der
letzten Mitgliederversammlung im September 2016 in
München beschlossen, im Jahre 2017 einen Work
shop-Kongress ganz anderer Art zu organisieren. Dies
entsprach dem Wunsch nach mehr praxisrelevanter Information. Unser Workshop-Kongress wird am 23. Juni
2017 in den Räumlichkeiten des Universitätsklinikums
Aachen stattfinden.
Die ausstellenden Firmen werden nicht nur ihre Laser
systeme demonstrieren, sondern auch mit qualifizierten
Kollegen Workshops zu unterschiedlichen Indikations
bereichen anbieten.
Damit möglichst viele Kongressteilnehmer die jeweiligen
Workshops besuchen können, haben wir die Zeit eines
einzelnen Workshops auf 1,5 Stunden begrenzt. Somit
können einzelne Workshopthemen mehrfach angeboten werden, wodurch Sie in der Lage sind, unterschiedliche Workshops zu belegen.
Neben den klinisch relevanten Workshops werden wir
auch einen Abrechnungsworkshop und ein Auffrischungsseminar über die neuen Bestimmungen des
Laser
schutzbeauftragten in unseren Kongress inte
grieren. Alle Kongressteilnehmer erhalten neben ihrer
Teilnahme
bescheinigung auch Zertifikate zu den jeweils absolvierten Workshops.
Es wird uns freuen, wenn Sie dieses Vorhaben durch
Ihre Teilnahme bereichern.
Ich grüße Sie alle recht herzlich, auch im Namen des
DGL-Vorstandes.
Ihr
Prof. Dr. Norbert Gutknecht
Präsident der DGL
Einladung zur DGL-Mitgliederversammlung
Freitag, 23.06.2017, 14.00 – 15.00 Uhr
Aachen – Universitätsklinikum
Tagesordnung:
TOP 1
TOP 2
TOP 3
TOP 4
TOP 5
TOP 6
Genehmigung der Tagesordnung
Bericht des DGL-Vorstandes
Vorstandswahlen
WFLD/DGL-Weltkongress 2018 in Berlin
Anträge zur Mitgliederversammlung
Verschiedenes
DGL c/o Universitätsklinikum Aachen, Klinik für ZPP, Pauwelsstraße 30, 52074 Aachen
Assoziierte Gesellschaft
der DGZMK
[50] =>
| imprint
laser
international magazine of
laser dentistry
Publisher
Torsten R. Oemus
oemus@oemus-media.de
CEO
Ingolf Döbbecke
doebbecke@oemus-media.de
Members of the Board
Jürgen Isbaner
isbaner@oemus-media.de
Lutz V. Hiller
hiller@oemus-media.de
Editor in Chief
Norbert Gutknecht
ngutknecht@ukaachen.de
Coeditors in Chief
Samir Nammour
Matthias Frentzen
Managing Editors
Georg Bach
Leon Vanweersch
Division Editors
Umberto Romeo
European Division
Melissa Marchesan
North American Division
Carlos de Paula Eduardo
South American Division
Toni Zeinoun
Middle East & Africa Division
Ambrose Chan
Asia & Pacific Division
Senior Editors
Aldo Brugneira Junior
Kenji Yoshida
Lynn Powell
Dimitris Strakas
Adam Stabholz
Marcia Martins Marques
Editorial Board
Peter Steen Hansen, Aisha Sultan,
Ahmed A Hassan, Antonis Kallis,
Dimitris Strakas, Kenneth Luk, Mukul Jain,
Reza Fekrazad, Sharonit Sahar-Helft,
Lajos Gaspar, Paolo Vescovi, Ilay Maden,
Jaana Sippus, Hideaki Suda, Ki-Suk Kim,
Miguel Martins, Aslihan Üsümez,
Liang Ling Seow, Shaymant Singh Makhan,
Enrique Trevino, Blanca de Grande,
José Correia de Campos, Carmen Todea,
Saleh Ghabban Stephen Hsu, Antoni Espana Tost,
Josep Arnabat, Alaa Sultan, Leif Berven,
Evgeniy Mironov Ahmed Abdullah, Boris Gaspirc,
Peter Fahlstedt, Ali Saad Alghamdi, Alireza Fallah,
Michel Vock, Hsin-Cheng Liu, Sajee Sattayut,
Anna-Maria Yannikou, Ryan Seto, Joyce Fong,
Iris Brader, Masoud Mojahedi, Gerd Volland,
Gabriele Schindler, Ralf Borchers, Stefan Grümer,
Joachim Schiffer, Detlef Klotz, Jörg Meister,
Rene Franzen, Andreas Braun,
Sabine Sennhenn-Kirchner, Siegfried Jänicke,
Olaf Oberhofer, Thorsten Kleinert
Editorial Office
Georg Isbaner
g.isbaner@oemus-media.de
Claudia Jahn
c.jahn@oemus-media.de
Product Manager
Timo Krause
t.krause@oemus-media.de
Executive Producer
Gernot Meyer
meyer@oemus-media.de
Designer
Sandra Ehnert
s.ehnert@oemus-media.de
Stephan Krause
s.krause@oemus-media.de
Customer Service
Marius Mezger
m.mezger@oemus-media.de
Published by
Oemus Media AG
Holbeinstraße 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-0
Fax: +49 341 48474-290
kontakt@oemus-media.de
www.oemus.com
Printed by
Silber Druck oHG
Am Waldstrauch 1, 34266 Niestetal, Germany
laser international magazine of laser dentistry
is published in cooperation with the World
Federation for Laser Dentistry (WFLD).
WFLD Headquarters
University of Aachen Medical Faculty
Clinic of Conservative Dentistry
Pauwelsstr. 30, 52074 Aachen, Germany
Tel.: +49 241 808964
Fax: +49 241 803389644
ngutknecht@ukaachen.de
www.wfld-org.info
www.laser-magazine.com
Copyright Regulations
laser international magazine of laser dentistry is published by OEMUS MEDIA AG and will appear in 2017 with one issue every quarter. The
magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inad
missible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
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 r epresentation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.
50
laser
1 2017
[51] =>
Antwort:
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
c/o Universitätsklinikum Aachen
Klinik für Zahnerhaltung
Pauwelsstraße 30
52074 Aachen
Tel.: 0241 8088164
Fax: 0241 803388164
E-Mail: sekretariat@dgl-online.de
Bank: Sparkasse Aachen
IBAN: DE56 3905 0000 0042 0339 44
BIC: AACSDE33
Aufnahmeantrag
Name/Titel:
Vorname:
Geb.-Datum:
Approbation:
Status:
selbstständig
angestellt
Beamter
Student
ZMF/ZAH
Adresse:
Straße:
Telefon:
PLZ/Ort:
Fax:
Land:
E-Mail:
Aufgrund des bestehenden Assoziationsvertrages zwischen der DGL und der DGZMK fällt zusätzlich ein reduzierter Jahresbeitrag für die DGZMK
an (85,00 € p.a., falls Sie noch nicht Mitglied der DGZMK sind). Der Beitragseinzug erfolgt durch die DGZMK-Geschäftsstelle, Liesegangstr. 17a,
40211 Düsseldorf. Sie werden hierfür angeschrieben.
Mit der Stellung dieses Aufnahmeantrages versichere ich, dass ich
seit dem _______________________ in der eigenen Praxis
mit einem Laser des Typs ________________________________________ arbeite (genaue Bezeichnung).
in der Praxis ____________________________________________________________ beschäftigt bin.
in der Abt. der Universität _________________________________________________ beschäftigt bin.
Ich beantrage die Aufnahme in die Deutsche Gesellschaft für Laserzahnheilkunde e.V.
Ort, Datum
vollständige Unterschrift
Jahresbeitrag: Für stimmberechtigte Mitglieder bei Bankeinzug 150,00 €.
Sofern keine Einzugsermächtigung gewünscht wird, wird ein Verwaltungsbeitrag von 31,00 € p.a. fällig.
EINZUGSERMÄCHTIGUNG
Ich bin einverstanden, dass der DGL-Mitgliedsbeitrag von meinem Konto abgebucht wird.
Name:
IBAN:
BIC:
Geldinstitut:
Unterschrift des Kto.-Inhabers
Diese Erklärung gilt bis auf schriftlichen Widerruf
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/ Diode lasers and microsurgery
/ The application of erbium laser in dental surgery
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