laser international No. 4, 2016

Cover / Editorial / Content / Blue light laser-assisted crown lengthening in restorative dentistry / Thermal damage behaviour of human dental pulp stem cells / A variety of photocoagulation techniques / Er:YAG caries treatment according to minimally invasive therapy / An all-rounder with three wavelengths / Eleven tips for success in your dental clinic - Part VI: Video Testimonials and R.A.P.P.O.R.T. / Lasers as an asset in both daily practice and marketing / 25th International Annual DGL Congress - Laser technology continues to fascinate / Manufacturer News / News international / Deutsche Gesellschaft für Laserzahnheilkunde - Editorial / 25. INTERNATIONALE JAHRESTAGUNG DER DGL / Imprint

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Vol. 8 • Issue 4/2016

issn 2193-4665

laser
international magazine of

4

2016

research
Blue light laser-assisted
crown lengthening

research
Thermal damage behaviour
dental pulp stem cells

case report
Haemostasis in oral soft
tissue and extraction socket

laser dentistry

[2] =>

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[3] =>

editorial

Review & outlook

|

Prof. Dr Norbert Gutknecht

Dear colleagues,
Dear laser society members,
Dear friends of laser technology,
With this year’s last issue of laser international magazine of laser dentistry, I would like give a brief summary of
the most important events in 2016. Without a doubt, this year’s highlight was the WFLD World Congress
in Japan with Prof. Kenjy Yoshida as the scientific head. Both scientists from various colleagues and laser
users from the dental practice met here in order to discuss the latest research results, therapy concepts
and practical experiences.
What took the international stage in Japan was transferred to many smaller venues in various countries
around the world. All these events illustrated how new wavelengths have been introduced to dentistry and,
moreover, how the already established lasers systems can be applied in new therapeutic fields.
With respect to 2017, I am looking forward to seeing which technical innovations from the field of laser
technology will be introduced to the market at IDS (International Dental Show, Cologne, Germany).
In the meantime, the old year will come to an end and a new year is going to start, which is why I would
like to send you my best wishes for 2017.
In addition, I would like wish all readers of laser international magazine of laser dentistry celebrating
Christmas peaceful and blessed Christmas Holidays.
Yours,

Prof. Dr Norbert Gutknecht

laser
4 2016

03

[4] =>

| content

page 06

| editorial
03 Review & outlook

Prof. Dr Norbert Gutknecht

page 22

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

| research
06 Blue light laser-assisted crown lengthening in
restorative dentistry
Prof. Dr Matthias Frentzen et al.

10 Thermal damage behaviour
of human dental pulp stem cells

Prof. Dr Karsten König & Dr Anton Kasenbacher

32 Lasers as an asset in both daily practice
and marketing
Dr Imneet Madan

| events
36 25th International Annual
DGL Congress
Dr Georg Bach

| case report
16 A variety of photocoagulation techniques
Sajee Sattayut et al.

| news
40 manufacturer news
41 news international

| industry
22 Er:YAG caries treatment according to
minimally invasive therapy

Swietłana Kozaczuk & Kinga Grzech-Leśniak

26 An all-rounder with three wavelengths
Dr Talat Qadri

| DGL
43 Rückblick & Ausblick

Prof. Dr. Norbert Gutknecht

44 Abstracts zur 25. Internationalen
Jahrestagung der DGL
| about the publisher
50 Imprint

laser
issn 2193-4665

international magazine of

Vol. 8 • Issue 4/2016

laser dentistry

4

2016

research

Blue light laser-assisted
crown lengthening

research

Thermal damage behaviour
dental pulp stem cells

case report

Haemostasis in oral soft
tissue and extraction socket

04

Cover image courtesy of Henry Schein Dental
www.henryschein-dental.de
Original Background: © keren-seg/Shutterstock.com

laser

4 2016

page 36

[5] =>

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*Trade-in programme available for a limited time. Epic 10 availability will vary by country. 1 Data on file.

[6] =>

| research

Blue light laser-assisted
crown lengthening in
restorative dentistry
Authors: Dr Philipp Skora, Dr Dominik Kraus, PD Dr Jörg Meister & Prof. Dr Matthias Frentzen, Germany

Figs. 1a–e: X-rays of the
upper jaw.—Subgingival
carious lesions at 11 and 21.

Abstract

Introduction

Basic investigations of the laser-tissue interaction
of a new type of laser device with a wavelength of
445 nm—the blue light spectrum—promise considerable advantages in comparison with infrared laser
systems due to the known optical parameters of oral
soft tissue. The procedure for a comprehensive laser-based gingivectomy before restorative treatment using this new type of laser is presented in the
following case report. Due to the outstanding haemostasis with the blue light laser, both gingivectomy
and adhesive filling treatment were possible in only
one session. The follow-up examination showed the
rapid healing of the wound with no complications
and with no post-operative gingival recession. The
treatment led to a very good aesthetic result at a
moderate effort.

Blue light-emitting diode lasers present an innovative alternative to the already established diode laser
systems with wavelengths within the infrared spectrum. Due to the strong absorption of blue laser light
in oral soft tissue1, the cutting capacity is improved
when comparable laser parameters are used. Blue light
lasers have very powerful coagulation effects that enable blood-free work.2 In addition, the high antimicrobial effect of blue light has been demonstrated in many
fundamental studies.3, 4 Due to these specific characteristics, blue light lasers are extremely suitable for
corrective periodontal surgery in terms of gingivectomies. In contrast to electrosurgery, laser-assisted
plastic-aesthetic periodontal surgical procedures do
not cause problems of electro-magnetic interactions
that could in turn present a contraindication in the

Fig. 1a

Fig. 1d

Fig. 1b

Fig. 1c

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4 2016

Fig. 1e

[7] =>

research

Fig. 2: Pre-operative situs.
Fig. 3: OP-situs after laser surgery
(gingivectomy).
Fig. 4: Situation after adhesive
composite restauration following
laser surgery.
Fig. 5: Post-operative recall
after 7 days.
Fig. 2

Fig. 3

Fig. 4

Fig. 5

case of patients with symptoms of cardiac disease. In
the case of multimorbid patients who are frequently
prescribed anticoagulants, the danger of secondary
haemorrhage can be minimised. In addition, in these
cases, a bloodless surgical field can be created ad hoc,
so that moisture-sensitive restorative measures (adhesive dentistry) can be carried out.

Among other things, insufficient composite restauration in the anterior tooth regions of the upper jaw were
noticeable at the initial examination. In addition, subgingival probing showed defects in dental hard tissues
at 11 and 21. For tooth 11, a fistula and an apical radiolucency were found in the vestibular marginal area in
the X-ray image (Figs. 1a–e). Teeth 12 and 21 reacted
positively to a sensitivity test, in contrast to tooth 11.
The probing depths of the teeth 11 and 21 were 4–5 mm.

In general, for multi-morbid patients it is important
that restorative procedures can be carried out in a short
time and that the use of anaesthetics should be reduced to a minimum. Excision wounds should heal in a
short time period. A dry environment is advantageous,
in particular when a dental rubber dam cannot be used.
In case of extended subgingival loss of dental hard
tissue, e.g. as a result of carious defects, it is always
necessary to enable a visual inspection of the preparation margin before the restoration can be placed.
Furthermore, a bloodless, clean, and dry adhesive surface must be guaranteed before application of restorative material. Here, laser-assisted procedures provide a fundamental advantage in comparison to
classical surgical procedures. Adequate haemostasis
after soft tissue excision with the scalpel, scalers and
cuvettes is often not achievable by styptics.
This case study presents a treatment protocol for
restorative and endodontic treatment of patients
with extensive subgingival carious lesions in the anterior tooth area.

Case report
A 72-year-old patient visited the Dental School of
the University of Bonn to obtain a dental consultation
regarding prostodontic aspects. The medical history
was unremarkable. The patient did not suffer pain.

The treatment plan was explained thoroughly to
the patient. In the first session, tooth 11 was trepanated as part of an emergency procedure. After exposure of the root canal, it was rinsed with NaOCl and
calcium hydroxide was applied. Ahead of this emergency endodontic procedure, the carious lesions on
11 and 21 were excavated incompletely and treated
temporarily with glass ionomer cement.
The patient came for further treatment five days
later. The fistula on 11 had closed, clinical symptoms
were no longer present (Fig. 2). After an infiltration
anaesthesia (1.8 ml UDS), the subgingival carious defects in teeth 11 and 21 were visualised in a gingivectomy (Fig. 3). For both teeth, approximately 4 mm of
soft tissue had to be removed to expose the affected
area. The gingivectomy was carried out using a
445 nm diode laser (Sirona K-Laser blu, Sirona, Bens
heim, Germany) with a power output of 1.5 W in cw
mode and an application tip with a diameter of
320 μm. This device is a pre-serial model equivalent to
SIROLaser Blue (Sirona, Bensheim). The resection was
carried out in six minutes. The surgical procedure was
performed with no pain. After finishing the gingival
excision, the surgical field was bloodless and dry (Fig.
3), so that the temporary fillings at 11 and 21 could be
removed and the caries completely excavated under
visual control. The defects were treated with adhesive

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4 2016

[8] =>

| research

Fig. 6

area, the probing depth was 1.5 mm. No bleeding was
found during probing. No further recession of the gingival margin was found after the primary healing, approximately two weeks after treatment or at the follow-up inspection after three months. Gingival colour
and surface texture (gingival stippling) corresponded
to a healthy appearance (Fig. 8). To ensure long-term
good oral hygiene and to prevent approximal gingival
recession at 11/21 in a further step a frenectomy
(laser-assisted) should be performed.

Fig. 8

Discussion

Fig. 7a

Fig. 7b

Fig. 6: Follow-up inspection
after 14 days.
Figs. 7a–c: X-rays documentation of
the endodontic treatment of 11.
Fig. 8: Post-operative recall after
3 months.—Healthy gums and
aesthetic restauration of the carious
lesions at 11 and 21.

Fig. 7c

restorations with a composite material in a multilayer technique (Herculite®; A 3,5). Figure 4 shows the
situation after the restoration had been completed,
including finishing and polishing of the aesthetically
complex restauration. After laser treatment, haemostatic measures were no longer necessary for all subsequent treatment steps. In the post-operative recall
after seven days (Fig. 5), the patient reported that
there was no post-operative pain. After the procedure, the patient did not find it necessary to use the
analgetics that had been made available.
After 14 days (Fig. 6), the excision wounds had
healed to a very great extent. There was still slight redness in the marginal area. No swelling occurred in the
entire post-operative phase. At this time, endodontic
treatment was also performed for the devitalised
tooth 11. After preparation and sealing of the root canal, the trepanation cavity was closed using a composite material (Figs. 7a–c). Three months after the operative procedure, the endodontic treatment of tooth 11
resulted in no further clinical symptoms. In the treated

The presented treatment protocol for laser-assisted gingivectomy enabled the badly destroyed
teeth 11 and 21 to be restored in an aesthetically satisfactory manner. Due to the safe procedure and the
drying of the surgical field after laser-assisted excision, adhesive fillings were placed in the same session
and exhibited no discolouration in the marginal zone,
even after three months. This indicates a good bonding between the restorative material and the dentin.
There was only little discomfort for the 72-year-old
patient which derived from this complex therapy. After an emergency treatment, definitive rehabilitation,
including adhesive restorations and endodontics,
was carried out in two sessions. The patient did not
report any discomfort related to the laser treatment.
The patient's aesthetic appearance in the anterior
teeth of the upper jaw was restored with moderate
means. This treatment procedure improves the patient’s compliance, because it allows the patient to
partake in a systematic care and treatment concept,
which enables the continuation of additional necessary treatment measures._

contact
Author details

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

Kurz & bündig

Literature

laser

4 2016

Grundlegende Untersuchungen zur Lasergewebeinteraktion eines neuen Lasertherapiegerätetyps mit einer
Wellenlänge von 445 nm – blaues Farbspektrum – versprechen aufgrund der bekannten optischen Parameter orale Weichgewebe nachhaltige Vorteile gegenüber infraroten Lasersystemen. Im Rahmen eines Fallberichts wird das
Vorgehen bei umfassenden laserbasierten Gingivektomien vor restaurativer Therapie mit diesem neuem Lasertyp vorgestellt. Gingivektomie und adhäsive Füllungstherapie waren in einer Sitzung aufgrund der hervorragenden Blutstillung
mit dem Blaulichtlaser möglich. Die Nachkontrolle zeigte eine schnelle Ausheilung der Wunde ohne Komplikationen
und ohne postoperative Gingivaretraktion. Die Therapie führte bei moderatem Aufwand zu einem sehr guten ästhe
tischen Ergebnis.

[9] =>

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

laser
issn 2193-4665

international magazine of

Please contact:
Vol. 8 • Issue 4/2016

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

laser dentistry

4

2016

research

Blue light laser-assisted
crown lengthening

research

Thermal damage behaviour
dental pulp stem cells

case report

Haemostasis in oral soft
tissue and extraction socket

© Peshkova/Shutterstock.com

oemus media ag

Holbeinstraße 29 · 04229 Leipzig · Germany · Phone: +49 341 48474-308 · grasse@oemus-media.de

[10] =>

| research

Thermal damage
behaviour of human
dental pulp stem cells
Authors: Prof. Dr Karsten König & Dr Anton Kasenbacher, Germany

Table 1: Life/Dead Assay 1 hour und
24 hours after thermal treatment.
Fig. 1: Vitality test of thermally
treated DPSC.

10

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4 2016

Objective

Material and methods

This study was designed to examine the influence
of temperatures ranging from 37 to 65 °C on the cell
morphology of DPSC stem cells via light and electron
microscopy, a synthesis of Heat Shock Proteins (HSP)
with fluorescence-marked antibodies and vitality
via the Life/Dead Fluorescence Kit.

DPCS were cultivated at 37 °C and 5 % CO2 in
sterile cell chambers (MiniCeM, JenLab GmbH, Jena,
Germany). The cells were irrigated with pre-heated
culture medium (Eagle’s MEM, Gibco BRL, Paisley,
Scotland, 37 °C) with 20 % FCS, 2 mM L-Glutamin
and 100 µM L-Ascorbate-2-Phosphate in order to remove cellular debris previously to the temperature
trials. Filling the chamber with the culture medium
followed and a preheated water bath of different
temperatures was introduced. Up to an incubation
temperature of 46 °C, the experiments were conducted with temperatures rising every 2 °C and
0.5 °C in the sensitive temperature scale of 46 °C to
58 °C. In addition, trial series were carried out at 60 °C

Temperature

Letality %

°C

1h

24 h

37

0

0

39

0

0

42

0

0

45

0

0

46

0,5

2

47

10

17

48.5

18

29

50

17

27

55

24

59

56.5

48

54

58

100

100

60

100

100

65

100

100

Table 1

Fig. 1

[11] =>

research

|

and 65 °C. After a total of 15 min of thermal treatment, the cells were cooled down in the incubator at
a temperature of 37 °C for 1 hour.
Some of the cells which had undergone thermal
treatment were examined with the Life/Dead Fluores
cenc Assay (Molecular Probes, Eugene, OR, USA) in
order to assess vitality via fluorescence microscopy
and Axiovert 200 (ZEISS, Jena) after incubation. A
mixture of 2 µM Calcein AM and 4 µM Ethidium-
homodimer-D1 was added to the cells which were
slowly cooling down at 37°C in the incubator either
1 h or 24 h after thermal treatment and incubated for
10'. Vital cells exhibited a green fluorescence caused
by calcein, while lethal cells showed a red core
fluorescence (Ethidium-homodimer-D1 and coupled
DNA). 100 cells of each type were enumerated.
In order to examine the synthesis of HSP proteins,
the cells having undergone thermal treatment were
processed as follows:
–– Opening of the chamber and removal of the coverslip containing the cells
–– Suction of the nutritive medium, two rinses with
PBS (isotonic: 67 mM phosphate buffer pH 7.2–7.4,
0.5 % NaCl)
–– 12' fixation in 2 % paraformaldehyde in 0.1 M cacodylate buffer pH 7.2; Rinse: 3 x PBS, 2 x TBS (Tris buffered saline, 50 mM Tris-HCl buffer, 1.25 % NaCl)
–– Parting of the coverslip with Pap-Pen pen (oil pen),
possibly correct with paraffin
–– Incubate one half of the coverslip overnight at 4 °C
with 1:500 diluted antibody AK HSP25, Rabbit (Biomol), diluting solution: fish gelatin 1 %, Triton x 100
1 % in TBS)
–– Cover the other half of the coverslip exclusively in
diluting solution (without AK)
–– Wash in TBS for 3 x 10'
–– Conjugate with the second antibody AK Anti-Rabbit-Alkaline Phosphatase for two hours at room
temperature (Ziege, dilution: 1:50 with fish gelatine
1 % and Triton X 100 1% in TBS)
–– Wash in TBS for 3x10'
–– 15` Alkaline-Phosphatase verification with 3 mM
Levamisol in Chedium (induces blue-brown colouring according to Seidel).
In order to perform examinations with scanning
electron microscope, the cells were processed as follows:
–– Washing of the cells in cacodylate buffer (0.1 M)
–– Fixation with 2.5 % Glutaraldehyde in cacodylate
buffer for 20'
–– Washing with cacodylate buffer for two times, followed by two washings with Aqua dest
–– Dehydration with increasing alcohol concentration: 20 %, 30 %, 50 %, 70 %, 90 %, 2x in 100 %
EtOH for 10' each

Fig. 2

–– Further processing of the samples at the Centre for
Electron Microscopy (Critical Point Drying and
sputtering with gold; SCD 005, BAL TEC AG, Liechtenstein)
–– Microscope: Zeiss EM 902 A.

Fig. 2: HSP-detection caused by an
antibody color reaction.

Examinations with the transmission electron microscope were conducted:
–– Washing of the cells with cacodylate buffer (0.1 M)
with 6.8 % Sucrose
–– Fixation of 30' with 1 % glutaraldehyde
–– Washing with cacodylate buffer
–– Contrasting with 1 % Osmiumtetroxyde and 1 %
potassium ferrocyanide for two hours
–– Rinsing with cacodylate buffer for three times as
well as with Aqua dest.
–– Dehydration with increasing alcohol concentration: 20 %, 30 %, 50 %, 70 %, 90 %, 2x in 100 %
EtOH for 10' each
–– Embedding in Epon (epoxy resin), polymerisation
for four days at 60 °C
–– Ultramicrotomy, ultra-thin sections (70 nm; Leica
Ultracut S, Leica Mikrosysteme GmbH, Bensheim,
Germany)

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4 2016

11

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| research
Fig. 3: Control cells exhibited a
normal appearance at 37 °C under
REM. Cell processes, microvilli-like
structures on the cell surface (their
numbers seems to depend
on the level of cell activity)
as well as the elongated
cell shape are clearly visible.
Fig. 4: REM: Thermally treated
DPSC showed external signs of
cellular damage at 46.5 °C: The cell
usually changes its elongated shape
and starts to round. At 50 °C, an
increased rounding can be observed.
The cell seems to contract so fast
that a part of the cytoplasm
processes tears off (arrows). The
surface structure of the cells is
effected as appearance and number
of microvilli change.

Fig. 3

Fig. 4

–– Dyeing of the sections with 1 % Uranyl acetate in
methanol and 1 drop of acetic acid for 10'
–– Microscope: Zeiss EM 906.

Results
Light microscopy and vitality test
The cells received thermal treatment at temperatures ranging from 37 °C to 60 °C and varying intermediate temperature levels. Light microscopy examinations showed significant morphological changes
at temperatures from 46.5 °C ± 0.5 °C.
Fig. 5: REM: Thermal treatment
at 60 °C. While the exterior shape
remains mostly intact,
their surface does not exhibit any
structuring anymore.

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4 2016

Fig. 5

At temperatures from 37 °C to 45 °C, all cells exhibited a green calcein fluorescence. At temperatures of
46 °C and above, lethal results were detected in some
of the cells that had undergone thermal treatment.
The number of lethal cells increased in correspondence to a rise in temperature.
At temperatures of 46 °C to 56.5 °C, the number of
lethal cells had almost doubled 24 h after thermal
treatment in comparison to the number of lethal cells
one hour after thermal treatment (Table 1, Fig. 1).
Starting at 56.5 °C, this phenomenon ceased, with

[13] =>

research

Fig. 6

about the same number of lethal cells. This temperature of 56.5 °C corresponded to the LD50 value (50 %
lethality). No cell survived thermal treatment at 58 °C.
HSP production
Examinations with regard to the production of HSP
via light microscope or transmission laser microscopy
showed a slight, unspecific colouring of the cells after
incubation of 37 °C (control, Fig. 2). An increase in HSP
production (intense colouring) was noted at a temperature of 50 °C, while thermal treatment at 60 °C again
resulted in slight, unspecific colouring of the cells.
REM
Scanning electron microscopy showed a typical
flat, long distribution of the control cells (37 °C cells,
Fig. 3). These cells exhibited many processes and microvilli-like structures. In addition, cell-to-cell connections with neighbouring cells were observed.
The successive rise in temperature resulted in the
first critical temperature level of 46.5 °C ± 0.5 °C.
From this level onwards, significant initial changes of
the cells were registered via light and electron microscope, especially an initial deformation and rounding
of the cells. The cell structure (microvilli-like structures) was reduced. However, microvilli were observed at temperatures of up to 50 °C (Fig. 4). At 50 °C
(chance of survival > 70 °C according to Life/Dead
A ssay), the cells left distinct cytoplasm protuberances on the base of the coverslip (Fig. 4, arrow), probably caused by a rapid contraction or rounding.
Incubation at a temperature of 60 °C, at which none
of the cells survived, resulted in a different outcome.
There was no apparent deformation or rounding of
the cells, with the original cell shape remaining mostly
intact and some small reductions. The cells appeared
to have been “thermally fixed” instantly. Neither microvilli nor other surface structures were visible. Cell
processes in contact with the coverslip remained intact, but exhibited denaturation and fixation caused
by rapid heating (Fig. 5).

TEM
The fibroblast-like DPSC cells (Fig. 6) exhibited long,
extended mitochondria (M) within the 3-D network
of the cell at 37 °C (control). The nucleus (K) appeared
to be undivided and to have a normal nuclear envelope (arrows). ER/RER, free ribosomes as well as the
Golgi apparatus did not show any anomalies. A significantly expressed cytoskeleton (Z) whose filaments were aligned parallely to the longitudinal axis
(probably microfilaments) was observed. The cells
featured a number of inclusions.

Fig. 6: TEM: Control cells at 37 °C.
K: Nucleus; ER: endoplasmatic
reticulum, RER: rough endoplasmatic
reticulum; M: mitochondria;
Z: cytoskeleton; arrows: markers of
the nuclear membrane.

At 50 °C, cell rounding became irreversible (Fig. 7).
Mitochondria (M) exhibited structural changes, especially an inflation which concurred with the destruction of the christae alignment, the parallelism of
which got lost. There was no longer a three-dimensional network. The Golgi apparatus was significantly
deformed and hardly any vesicles were constricted.
The cytoskeleton was partially disintegrated and
could no longer be detected. The cell membrane appeared to have increases vacuolisation. The nucleus
(K) appeared to be damaged irreversibly. The nuclear
envelope was inflated and partially disintegrated (*).
The nuclear plasma condensed at the chromatin, resulting in a reduction of the euchromatin-areas which
condensed at the heterochromatin. The nucleus exhibited segmented chambering (arrow).
Contrarily, the external shape of DPSC cells incubated at 60 °C (Fig. 8) remained mostly intact. However, cytoplasm was hardly detectable. Mitochondria
(M) were destroyed, membranes and christae were
partially wound up (arrows). Golgi apparatus and cytoskeleton were not detected. The euchromatin areas
were reduced at the nucleus (K) and condensed at the
heterochromatin (*). The nuclear membrane was
significantly vesiculated.

Discussion
The first indications to a temperature-related damage of the DPSC were seen in the Life/Dead Assay.

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4 2016

[14] =>

| research
However, the Life/Dead Assay does not allow any
conclusions on the effects of the damages on the cell
organells, compartments or physiological reactions
such as protein production. Consequently, HSP tests
and electron microscopic examinations of the ultrastructure were conducted additionally.

Fig. 7
Fig. 7: TEM: Due to thermal treatment at 50 °C, the cells are rounded
and the cell membrane forms
vesicles (left). Mitochondria exhibit
a disrupted structure of the christae,
while the nuclear plasma starts to
condense and the nucleus (K) itself
often appears to be uncharacteristically flapped (arrow). The nuclear
membrane (*) seems to be partially
inflated or dissolved.

Fig. 8: TEM: Thermal treatment
at 60 °C. Parts of the cytoplasm
are damaged or dissolved as can
be seen by the mitochondria (M)
with inflated or wound-up christae
(arrows). The nucleus (K) shows
severely condensed areas (*).

Fig. 8

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4 2016

Calcein is able to penetrate the membrane and is only
converted to a fluorescent colouring agent inside of
an intact cell. If the cell membrane becomes permeable as a result of damages, calcein will not remain inside the cell. As a consequence, Ethidium-homodimer-D1 will enter the cell in exchange. This substance
is not permeable for intact membranes and will fluoresce red when combined with DNA.
Interestingly significant thermally-induced damages were only observed at temperatures ranging
from 46.5 °C ± 0.5 °C. Starting at this temperature, cell
membranes are destroyed apparently. Temperatures
from 56.5 °C ± 0.5 °C form another threshold at which
the 50 % lethality limit was reached.
If the vitality test was conducted 24 h after thermal
treatment, almost twice as much lethal cells as observed 1 h after incubation were seen at temperatures
from 46.5 °C to 56.5 °C. It appears that repairing processes cannot eliminate the thermal damage. Contrarily, thermal treatment will result in a lethal reaction even 1 h later.
Starting at 56.5 °C, most cells died immediately,
probably due to denaturation of the proteins (coagulation). Usually, a temperature level of 62 °C is given
as the starting point for coagulation in the literature.

Heat-Shock-Proteins (HSP) were detected very well
at 50 °C by an antibody reaction. The cells were distinctly coloured, which implies a significant reaction
of the cell on the temperature-related stress. These
cells were still able to synthesise the proteins and to
survive for some time. Controls only showed only a
light colouring, which may be the result of an unspecific reaction of the antibody with different cell
proteins as well as a production of HSP which is not
related to thermal stress.
Similarly, a temperature level of 60 °C only lead to
light colouration, which can be explained by the immediate lethal effect resulting in a missing time scale for
the biosynthesis of HSP. In general, it should be noted
that the first HSP examinations did not exhibit the expected intracellular resolution due to a low specificity.
The results of REM and TEM at the different guide
values of 37 °C, 46.5 °C, 50 °C, 60 °C and 65 °C fit very
well with the results from light microscopy. The effects
of a sudden and massive heating to more than 46 °C
on the exterior cell shape (rounding and partial reduction of external structures) are distinctly visible. The
extremely fast contraction of the cells at temperatures
around 50 °C might result in the observed tearing of
cytoplasm-processes. Thermally-related membrane
openings were not detected via REM even at temperatures of 60 °C and above. These high temperatures
probably resulted in an immediate coagulation of
membrane proteins and other intracellular proteins,
which lead to a “conservation” or fixation of the cells
in their current shape. While the external cell shape
was maintained because of the lacking time window
for morphological modification, irreversible damages

[15] =>

research

to the organells, nuclear membranes, nuclei and cytoplasm were detected electron-microscopically.
Starting at a temperature of 46.5 °C, a vacuolated
cell membrane was observed via TEM in the rounded
cells. Nucleus, organells and cytoskeleton were subject to beginning morphological changes.
The cells reacted differently on heating, probably
because their differences in physiological age, activity and cycle states influenced immediately visible
effects. For example, the cells differed in the level of
microvilli reduction.
If the survival of thermally treated cells will prevail
for a time span of more than 24 h and if there are thermally-related damages of the reproductive behaviour remains to be examined by further studies.
However, it may be postulated with caution that the
presented data indicate a chance of survival of the
examined DPSC up to a temperature of 46 °C. These
results on the thermal damage behaviour of human
dental pulp stem cells are important for the development of ultrashort dental laser systems._

Acknowledgements: The authors would like to
thank Dr Walter Richter, Dr Iris Riemann and Mr
Helmut Hörig (Clinical Centre of FSU Jena, Germany)
for their support in producing electron microscopic
and light microscopic images.

contact
Prof. Dr Karsten König
Saarland University
Campus A5.1, Room 2.35
66123 Saarbrücken
Tel.: +49 681 3023451
Fax: +49 681 3023090
k.koenig@blt.uni-saarland.de
Dr Anton Kasenbacher
Obere Hammerstr. 5
83278 Traunstein
Tel.: +49 861 4692
Fax: +49 861 12853
a.k@ts-net.de

Author details

Kurz & bündig
Es soll der Einfluss von Temperaturen im Bereich von 37 °C bis 65 °C auf Änderungen der Morphologie mittels
licht- und elektronenmikroskopischer Aufnahmen, der Synthese von Heat Shock Proteinen (HSP) mittels fluoreszenzmarkierter Antikörper und der Vitalität mittels Life/Dead-Fluoreszenzkit von DPSC Stammzellen untersucht werden.
DPSC wurden bei 37 °C und 5 % CO2 in sterilen Zellkammern (MiniCeM, JenLab GmbH, Jena) kultiviert. Für die
Temperaturversuche wurden die Zellen mit vorgewärmtem Kulturmedium (Eagle’s MEM, Gibco BRL, Paisley, Scotland,
37 °C) mit 20 % FCS, 2 mM L-Glutamin und 100 µM L-Ascorbat-2-Phosphat gespült, um Zelldebris zu entfernen.
Anschließend wurde die Kammer mit Medium aufgefüllt und in ein vortemperiertes Wasserbad unterschiedlicher
Temperatur eingebracht. Bis zu einer Inkubationstemperatur von 46 °C fanden die Versuche in Temperaturschritten
von 2 °C statt, im sensiblen Bereich (46 °C – 58 °C) in Schritten von 0,5 °C. Zudem fanden Versuchsreihen bei 60 °C
und 65 °C statt. Nach insgesamt 15 min Wärmebehandlung wurden die Zellen im Brutschrank bei 37 °C langsam für
1 Stunde heruntergekühlt.
Ein Teil der wärmebehandelten Zellen wurden nach Inkubation mit einem Life/Dead-Fluoreszenzassay (Molecular
Probes, Eugene, OR, USA) zur Überprüfung der Vitalität fluoreszenzmikroskopisch mittels Axiovert 200 (ZEISS, Jena)
untersucht. Ein Gemisch aus 2 µM Calcein AM und 4 µM Ethidium-homodimer-1 (EthD-1) wurde entweder 1 Stunde
oder vergleichend 24 Stunde nach der Wärmebehandlung zu den langsam bei 37 °C im Inkubator abgekühlten Zellen in
die Zellkammern gegeben und für 10' inkubiert. Vitale Zellen zeigten durch das Calcein eine grüne Fluoreszenz, letale
Zellen eine rote Kernfluoreszenz (Ethidium-homodimer-1 an DNA gekoppelt). Es wurden jeweils 100 Zellen ausgezählt.
Die Zellen reagierten etwas unterschiedlich auf die Erwärmung, möglicherweise nahmen ein unterschiedliches
physiologisches Alter und verschiedene Aktivitäts- und Zyklusstadien einen Einfluss auf die sofort sichtbaren Effekte,
z. B. war die Reduktion der Mikrovilli nicht überall gleich stark ausgebildet.
Ob das Überleben der wärmebehandelten Zellen über einen größeren Zeitraum als 24 Stunden gegeben ist und
inwieweit thermisch bedingte Schäden des Reproduktionsverhaltens vorliegen, müssten weiterführende Studien untersuchen. Eine teilweise Überlebenschance der untersuchten DPSC bis zu einer Temperatur von 46 °C könnte aus den
vorliegenden Daten jedoch vorsichtig postuliert werden.

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4 2016

[16] =>

| case report

A variety of photo
coagulation techniques
Haemostasis in oral soft tissue
and extraction socket

Authors: Chaivasan Malakam, Nuttakarn Rungrojwittaya, Nattaya Sanposh & Sajee Sattayut, Thailand

Introduction
There is a variety of surgical procedures, such as
soft tissue biopsy and surgical extraction, which usually results in difficulties for haemostasis. One of the
major concerns in oral surgery is to minimise bleeding
and postoperative complications. Currently, a number of laser wavelengths have been used in oral surgery and dentistry, including CO2 laser, Nd:YAG laser,
argon laser, diode lasers in various wavelengths,
Er:YAG laser and potassium titanyl phosphate (KTP)
laser. Their applications were soft tissue procedures,
such as gingivectomy and gingivoplasty, excision of
tumors and lesion, incisional and excisional biopsies,
frenectomy, control of bleeding in vascular lesions,
Fig. 1: Left lateral border of the
tongue with 6 mm and 2 mm in
diameter of leukoplakia in the tongue.
Fig. 2: Buccal mucosa with a 7-mm
diameter and whitish
moderate-thickening lesion.
Fig. 3: Post-CO2 excision of
the lesion was completed
with no active bleeding.
Fig. 4: Intra-operation of CO2
excisional biopsy (photoablation).

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4 2016

arthroscopic temporomandibular joint surgery, caries
diagnosis and removal.1, 2
The photothermal reaction, which depended on the
tissue absorption of the laser energy, played an important part in the laser-surgery procedure with hemostasis.3 This reaction was mainly applied in soft
tissue surgery comprising 1) photoablation, 2) photovaporisation, and 3) photocoagulation. Each reaction or a combination of reactions occurred with varied laser parameters and procedures.
Regarding the procedure with pure photocoagulation, there have been various techniques of laser application4, 5 or light-emitting diodes in dental prac-

Fig. 1

Fig. 2

Fig. 3

Fig. 4

[17] =>

case report

Fig. 5: Immediate postoperative
view; A) oozing in the surgical area
after CO2 laser photoablation;
B) coagulative surgical area after
CO2 laser vapourisation.
Fig. 6: Immediate
post-photocoagulation using
LED showed an initial blood clot
formation without oozing.
Fig. 5

Fig. 6

tice6, which were well absorbed by haemoglobin for
achieving haemostasis after oral surgery. In the following case reports, we present a variety of photocoagulation techniques in cases of soft tissue biopsy,
simple extraction socket and surgical removal of the
wisdom tooth involving hard tissue surgery. The clinical outcomes of haemostasis and patient satisfaction are also reported.

Dentistry Khon Kaen University, with a whitish lesion
at the left lateral border of the tongue. In the past
three months, the patient was treated with low intensity laser therapy and topical steroid for the chronic
ulceration at the left lateral border of the tongue. The
ulcer was healed with a coverage of the whitish
patches. There was also a whitish lesion at the buccal
mucosa of the left cheek with intermittent pain on
palpation.

Case 1: Photocoagulation for
soft tissue haemostasis in excisional
biopsy by LED light unit
A 65-year-old male patient presented at the Department of Oral and Maxillofacial surgery, Faculty of

The clinical examinations showed three nonscrapable whitish lesions as follows: 1) a moderate
thickening whitish patch at the left lateral border of
the tongue, measuring approximately 6 mm in diameter; 2) a mild thickening whitish lesion at the left venAD

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Dysphagia
Radiation dermatitis
BRONJ

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4 2016

[18] =>

| case report

Fig. 7a

Fig. 7b

Fig. 8a

Fig. 8b

Figs. 7a & b: Two-week post
photoablation biopsy and the healing
with coagulum coverage.
Figs. 8a & b: Five-week follow-up
after photoablation biopsy, complete
coverage with mild whitish mucosa.

Fig. 9: Oozing at the sockets of
bleeding after tooth extraction.
Fig. 10: Immediate post-photocoagulation using LED showed an initial
blood clot formation.

Fig. 9

tral side of the tongue, measuring approximately
2 mm in diameter (Fig. 1); and 3) a moderate thickening
whitish patch at the buccal mucosa of the left cheek,
measuring approximately 7 mm in diameter (Fig. 2).
The surgical procedure involved local anaesthesia
(2 % lidocaine with epinephrine 1:100,000) and excisional biopsy of the lesions at the buccal mucosa by
using 10,600 nm CO2 laser at 5 W and continuous
wave. Then tissue coagulation for haemostasis was
undertaken using a defocused CO2 laser at 3 W and
continuous wave. The ablation with haemostasis was
easily achieved (Fig. 3).
At the left lateral border of the tongue, the photoablation was undertaken using a 10,600 nm CO2 laser at 5 W and continuous wave (Fig. 4). After excisional biopsy, there was an active bleeding over the
lesion because of a highly vascularised tissue (Fig.
5-A). A blue light-emitting diode (LED) for dental
practice (WOODPECKERTM LED light unit; a single
blue light source non-heat producing, energy density
1,000-1,200mW/cm2) was irradiated for 5 seconds to
the oozing area. This was repeated for four episodes
to gain an initiating blood clot (Fig. 6). For the smaller
lesion at the ventral side of the tongue, the vapourisation technique was applied using 10,600 nm CO2
laser at 3 W and continuous wave. There was no active
bleeding at the surgical site (Fig. 5).

Fig. 10

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4 2016

Clinical results
The outcome after using laser for surgical removal
of the soft tissue lesion showed ablation with haemostasis except the lesion at lateral border of the
tongue, a site with high vascularity. In this case, the
irradiation of LED at the active bleeding area promoted blood clot formation without producing any
clinical soft tissue destruction. Furthermore, soft
tissue biopsy using laser had many advantages, for
example, providing a dry clean surgical field enhancing visibility for the operator and reducing operation
time. At the two-week follow-up, there was soft tissue healing with some coagulum coverage and no
clinical signs of inflammation or infection (Figs. 7a
& b). The histopathology investigation was obtainable. In this case, epithelial keratosis was diagnosed.
The five-month follow-up after excisional biopsy
showed complete healing of the mucosal coverage
with some thin whitish areas and without tethering
of the scar (Figs. 8a & b). Based on the histopathological finding, these should be in a condition for observation.
Patient satisfaction
Without any efforts to stop bleeding such as biting
on gauze pads, he felt more confident with regard to
the operation being necessary and agreed with routine follow-up. There was still no pain and bleeding
interfering routine activities after laser surgery.

Case 2: Photocoagulation for hard
tissue haemostasis after routine tooth
extraction by LED light curing unit
The second case study was a 66 year-old woman
who had a history of diabetes mellitus and hypertension. The upper left canine and second premolar were
diagnosed “chronic periodontitis”. The tooth extraction was requested as a treatment. Routine tooth
extraction was performed under local anaesthesia;
2 % mepivacaine with 1:100,000 epinephrine. The
LED at an energy density of 1,000-1,200 mW/cm2 was
irradiated at the extraction socket for 5 sec per cycle
for a total of four episodes.
Clinical results
There was an oozing of bleeding after extraction
(Fig. 9). An initial clot occurred in the bony socket immediately after LED photocoagulation procedure
(Fig. 10).
Patient satisfaction
The patient seemed to be anxious about the operation at the beginning. After using LED light photocoagulation to accelerate blood clot formation into the
sockets, she seemed more comfortable and satisfied
with the procedure with no need to be worried about
pressure compression by biting a gauze.

[19] =>

case report

Case 3: Photocoagulation for surgical
site after surgical removal of impacted
tooth by 790 diode laser
A 19 year-old woman with no systemic disease presented with a lower right third molar partial bony impaction. This needed to be removed by surgical extraction. The standard procedure including flap
operation, osteotomy and tooth section was conducted
under local anaesthesia; 2 % mepivacaine with
1:100,000 epinephrine. After the tooth was delivered,
there was bleeding in the bony socket (Fig. 11). A 790 nm
diode laser at 0.3 W was used to irradiate the socket and
wounded area for 30 sec per cycle, for a total of two episodes. An initial blood clot was found (Fig. 12).
Clinical results
There was no active bleeding, but an immediate
haemostasis in the surgical removal area, which was
different compared to our experiences of using standard technique. Also the healing in a week was favourable (Figs. 13a & b).

ment. The standard procedure including flap operation
ostectomy and tooth section was conducted under local anesthesia; 2 % mepivacaine with 1:100,000 epinephrine. After the tooth was delivered, there was
bleeding in the bony socket (Fig. 14). An 808 nm diode
laser at 0.5 W was used to irradiate the socket and
wounded area for 5 sec per cycle and a total of four episodes. The initial blood clot with some carbonisation
was found (Fig. 15).
Clinical results
There was no active bleeding and an immediate
haemostasis in the surgical removal area, which was
different from our experiences of using standard
technique.
Patient satisfaction
The patient seem to be satisfied that there was no
bleeding after the operation.

Discussion

Case 4: Photocoagulation for bony
socket and soft tissue haemostasis
after surgical removal of soft tissue
impaction by 808 nm diode laser

Although the CO2 laser was commonly used in the
surgical removal of intraoral lesions due to the limitation of lateral damage, which made specimen available for histopathological investigation together with
the ability of sealing of vessels up to 500 micron in
diameter,7-9 we experienced insufficient tissue coagulation at the lateral border of the tongue in case 1. In
this case, we used the LED photocoagulation in order
to avoid photoablation and carbonisation effect.

A 26 year-old woman with no systemic disease had
a chief compliant of a lower right third molar soft tissue
impaction. The surgical removal was required for treat-

The benefits of using lasers in oral surgical procedures were clinically significant to both the dental
surgeons and the patients. All techniques and wave-

Patient satisfaction
The patient seem to be satisfied with immediate
haemostasis after the operation.

Fig. 11

Fig. 12

Fig. 13a

Fig. 13b

Fig. 11: After surgical removal of
the lower right third molar impaction,
it was oozing via the bony socket.
Fig. 12: Initial blood clot formation
without oozing was found immediately
after post-photocoagulation using a
790 nm diode laser.
Figs. 13a & b: One week
after o peration, there was no
complication. Surgical wound
healing was observed.

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4 2016

[20] =>

| case report
Fig. 14: After surgical removal of the
lower right third molar impaction, it
was oozing via the bony socket.
Fig. 15: Initial blood clot formation
without oozing was found immediately
after post-photocoagulation using
808 nm diode laser.

Fig. 14

Fig. 15

lengths used in these case reports were able to create
immediate haemostatic effect on soft tissue and
bone socket without any complication. It was noticed
that, using 808 nm diode laser, at least the parameter
used in case 4 was able to produce some carbonisation, while LED and 790 nm did not show such an effect. Therefore, using 800 nm diode laser for photocoagulation may make reducing irradiation time or
power necessary to avoid a photovapourisation effect.

ment in terms of clinical outcome of haemostasis and
healing together with patient’s satisfaction.

With regard to wound healing, the results from soft
tissue laser biopsy were favourable. These were supported by in vivo studies showing laser wounds found
a significantly lower number of myofibroblast and inflammatory cells, resulting clinically in less wound
contracture and less post-operative complication for
inflammation.10,11 In our reports, these clinical benefits were also found in the cases limited to photocoagulation such as case 3.

Conclusion
Both LED (single blue light source, non-heat producing) and diode laser of 790 nm at 0.3 W and 808 nm at
0.5 W were able to produce localised coagulation and
enhance haemostasis in soft tissue after excisional biopsy and bone-socket due to tooth extraction and surgical removal. The results showed successful manage-

Acknowledgement
We absolutely thank Dr. Rattiya Hathaidechadusadee, postgraduate student in oral and maxillofacial
surgery, Faculty of Dentistry, Khon Kaen University,
for being an operator in the surgical removal of impaction and all members of staff in LDRG-KKU and
Faculty of Dentistry, Khon Kaen University. We are
also very thankful for every patient who trusted us
and permitted data to be reported._

contact
Assoc. Prof. Sajee Sattayut DDS, PhD
Lasers in Dentistry Research Group,
Khon Kaen University
Department of Oral and Maxillofacial Surgery,
Faculty of Dentistry, Khon Kaen University
123 Mittraphap Rd. Amphur Muang Author details
Khon Kaen, KhonKaen,
Thailand 40002
Tel.: +66 0935466178
Fax: +66 43202862
sajee@kku.ac.th

Kurz & bündig

Literature

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4 2016

Im Rahmen von Laseranwendungen mit Hämostase spielen photothermale Rekationen in Abhängigkeit vom Absorptionsvermögen des Gewebes für Laserenergie eine entscheidende Rolle. Diese Wechselwirkungen finden vor
allem in der Weichgewebschirurgie mit Photoablation, Photovaporisation und Photokoagulation Anwendung. Jede
Gewebsreaktion oder eine Kombination dieser tritt dabei bei unterschiedlichen Laserparametern und -anwendungen
auf. In den hier vorgestellten Fallberichten erläutern die Autoren eine Vielzahl von Techniken der Photokoagulation bei
Weichgewebsbiopsie, an der Extraktionsalveole oder im Rahmen der chirurgischen Entfernung eines Weisheitszahns
im Zusammenhang mit der Hartgewebschirurgie. Zusätzlich berichten die Autoren auch über Hämostase und Patientenzufriedenheit bei verschiedenen Laseranwendungen und -wellenlängen. Dabei konnten sowohl LED (einfache
blaue Lichtquelle ohne Wärmeentwicklung) als auch Diodenlaser mit 790 nm und 0,3 W sowie 808 nm und 0,5 W eine
lokalisierte Koagulation erzielen und die Hämostase verbessern. Die Ergebnisse zeigen ein erfolgreiches Management
der klinischen Ergebnisse in Bezug auf Hämostase, Heilungsverlauf und Patientenzufriedenheit.

[21] =>

Dear authors, thank you for your contributions in 2016.
Looking forward to working with you in 2017!

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Fluorescence-guided caries
excavation of decayed teeth

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Laser treatment
of gingival melanin
hyperpigmentation

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Diode laser treatment
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Laser-activated irrigation with PIPS

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A novel blue light diode laser (445 nm)
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Er,Cr:YSGG laser and
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Pedonomics: lasers in
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Blue light laser-assisted
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Please contact:

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Thermal damage behaviour
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Haemostasis in oral soft
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[22] =>

| industry

Er:YAG caries treatment
according to minimally
invasive therapy
Authors: Kinga Grzech-Leśniak & Swietłana Kozaczuk, Poland

Main MiCD principles are based on the following
five rules:
1. “The-sooner-the-better”—Early diagnosis of illness or the cavity allows minimising the need of
invasive treatment in the future.
2. Smile Design Wheel—the procedure taking into
account the psychological, health, functional, and
aesthetic situation of the patient.
3. “Do-no-harm”—One should choose therapeutic
methods which saves healthy tissues of teeth to a
maximum extent.
4. “Evidence-based approach”—The choice of materials and instruments should be based on the results of scientific research.
5. “Keep-in-touch”—more attention should be paid
to regular check-ups and examining the patients
carefully, explaining to them why this is so important.
Tooth decay is one of the most prevalent infectious diseases, and continuous progress of knowledge, d evelopment of new techniques of treatment
in the early stages cause that physicians face new
challenges and opportunities.
Currently, the patient also expects from the clinician an interdisciplinary, innovative and minimally
invasive approach. Over the years, a significant
change of the approach of surgical treatment for socalled biological treatments has been made. Biological treatment presupposes the elimination of bacterial infection (by the use of ozone or laser, for
example) and impermeability of fillings, relying on
the adhesion properties of the restorative materials.
This concept is also based on the selective removing
of the decayed tissues without unnecessary preparation of healthy tissues surrounding the defect.

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4 2016

Thus, the concept of minimally invasive therapy and
early diagnosis correlate with the innovative idea of
treatment involving laser techniques.
In conservative dentistry, in order to prepare decayed hard dental tissue and replace dental fillings,
high-energy Er:YAG laser is used.2 Er:YAG eliminates many harmful experiences of the patient (vibration, overheating of the tissues during preparation, unpleasant sound) 3, introducing him/her to a
new d imension of treatment. No pressure occurs,
as unpleasant experiences of the patient are fully
eliminated, and thus, the patient is motivated to
further cooperation. Moreover, pain sensation is
limited. In the case of Er:YAG laser, there is very
short pulse duration and nerve endings are often
not stimulated.
In many clinical trials, limited use of anesthetics
was reported and full acceptance of this therapy
method by the patients was demonstrated. The technique of laser preparation of the cavity allows performing the procedure painlessly, or with a mild pain
sensation (NRS—Numerical Rating Scale < 3) for
profound tooth decay in 59.8 %, and medium tooth
decay—at 94.8 %.5
The use of laser technology in restorative dentistry
refers to the action scheme described below. Er:YAG
laser radiation at 2,940 nm is preferably absorbed by
water and hydroxyapatite. This process of a non-thermal nature is based on “evaporating” the tissue by
short light pulses of high energy (photoablation).
The key role is played by the water molecules incorporated in the crystalline structure of the mineralised tooth tissue. Water, activated by the supplied
energy, is converted into steam, and the pressure
within the mineral structure of teeth increases rap-

[23] =>

industry

Fig. 1: Laser screen. The parameters
of Er:YAG laser: H14/conical tip, QSP,
0,90 W/90 mJ, 4 W/4 A.

Fig. 1

idly, leading to microexplosion heard in the typical
form of a short acute sound.6 During work, a certain
amount of heat is emitted, being dispersed together
with the removed material. Only its small part is
transferred to the surrounding tissue. This process,
based on maximal reduction of the thermal effects,
has been tested for more than 30 years, and still focuses on determining the most optimum parameters
of the laser beam for minimally invasive work.7–9 The
thickness of the evaporated surface layer (the depth
of ablation) depends on the tissue parameters (the
depth of absorption of laser radiation, thermal conductivity coefficient, temperature diffusion coefficient, and heat evaporation coefficient), and the

l aser beam parameters (wavelength, energy density
and duration of the laser pulse).
At high energies and pulses of short duration the
entire laser energy is consumed in the so-called cold
ablation because ablation speed is higher than the
speed at which the heat passes into the tissue. However, using too little energy and/or too long pulse
duration leads to an increased heat transfer to the
deeper layers of the tooth.10 Thermal effects become
more pronounced and therefore we are dealing with
the so-called warm and hot ablation, bearing in
mind that this is an undesirable phenomenon. In the
precise and safe procedures of the therapeutic work
Figs. 2 & 3: Tips dedicated to
preparation of the cavity.

Fig. 2

Fig. 3

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4 2016

[24] =>

| industry

Fig. 4

Fig. 5

Figs. 4 & 5: Caries on tooth 47.

on hard tissues—both on enamel and dentin, it is
recommended to work at energies and pulse durations that are significantly above the threshold
value of ablation.11 Moreover, efficiency and the
safety level of work with the Er:YAG laser can be increased by spraying the water spray on the target
tooth surface.12 This also improves the efficiency of
the cavities preparation. The radiation penetrates
into the water molecules, causing the molecules vibrations to increase and therefore raising the pressure and temperature in the area of application, thus
initiating the ablation process. Note, however, that
a thick layer of water can cause the opposite effect—
isolation of the laser beam from the tissue.

Figs. 6–8: Cavity of 47 and 48
healed.

Preparation of tissue without water can lead to
raising their temperature, causing surface carbon-

Fig. 7

Fig. 6

Fig. 8

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ization, resulting in a color change to soft bronze.11
Properly prepared tissue has a microporous structure. A macroscopic view of cavity prepared with
the use of drill shows its smooth walls, compared to
the image of the ablation with Er:YAG laser, where
the edges and walls of the cavity are of irregular
shape.13 After laser preparation, we get the characteristic view of craters with smooth walls with no
carbonised areas, pre-melted enamel and dentin, or
the smear layer. Surface of the enamel obtains micro retention structure, enamel prisms are clearly
recognizable, dentine tubules are open and free
from the smear layer, allowing the bonding material
to penetrate deeply and enhancing the adhesion of
the composite material to the cavity walls.14–16
Er:YAG laser operating speed depends not only on
the laser beam parameters and the operator's skills,

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but also on the tissue's chemical composition. The
enamel contains 95 per cent of hydroxyapatite
(Ca10 (PO4) 6 (OH) 2), 4 per cent of water and 1 per cent
of collagen fibres. Dentine consists of 70 per cent of
hydroxyapatite, 20 per cent of collagen fibres and
10 per cent of water.17 Decayed tissue contains
more water than healthy tissue.
The above information suggest that the speed of
Er:YAG laser preparation of dentine is higher than
of enamel, and diseased tissue is more easily removed than healthy tissue. This should be kept in
mind during the cavity preparation, in order to
safely and consciously control the scope of the cavity according to the concept of minimally invasive
therapy. The light of laser shows antibacterial properties, and it acts through overheating and disruption of bacteria cell.18 Er:YAG laser is a promising
tool for the cavity preparation in primary teeth due
to the reduction of pain perception and antibacterial effect.19 The contraindications to the use of
Er:YAG laser are cutting crowns and the removal of
amalgam fillings. There are no restrictions on the
removal of cement and composite fillings; however,
in these cases, because of the modest speed, take
advantage of the combined approach and use the
turbine additionally. The big advantage of Er:YAG
laser is its low invasiveness, which allows to work
according to the concept of minimally invasive
therapy.20–21 Simultaneously, it is characterized by
the efficiency and safety at work,22 and is well perceived by patients.

preparation according to the concept of minimally
invasive therapy, various techniques of Er:YAG laser
application with the same parameters were used
(H14 conical tip, QSP, 0.90 W/90 mJ/10 Hz, 4 W/4 A).
The average caries in the buccal groove of the tooth
46 was prepared using a non-contact technique
(head H02). No pain during the preparation
(NRS = 0). Deep carries in the buccal groove of 47
was prepared using a contact technique (head H14,
cylindrical tip). Moderate sensation of pain during
the preparation (NRS = 4). Deep carries on the occlusal surface of the tooth 47 was prepared using a
combined method—a turbine (diamond drill) and
Er:YAG laser (H14 head, cylindrical tip). During the
preparation, severe pain was experienced (NRS=8),
infiltration anaesthesia was administered (Ubistesin forte 1/2 of ampoule) and the preparation was
completed. Direct reconstruction of hard tissues of
tooth was performed with the use of composite
material (Gradia A3/NT)._

Author details

Clinical case
A 23-year-old, non-smoker, generally healthy
patient visited the clinic. The following was reported in a clinical study: numerous carious focuses in the buccal grooves of 46 and 47, the primary decay on the occlusal surface of 47 and
recurrent decay on the occlusal surface of 46. The
patient reported no pain of these teeth. During the

contact
Dr n. med. Kinga Grzech-Leśniak
– specjalista periodontolog, Polskie
Towarzystwo Stomatologii Laserowej PTSL
www.periocare.pl
www.laser.org.pl

Kurz & bündig
In ihrem Artikel beschreiben die Autoren die fünf Prinzipien der Kavitätenpräparation und Kariesbehandlung: 1) So
schnell wie möglich, 2) Beachtung von physiologischen, gesundheitlichen, funktionalen und ästhetischen Faktoren,
3) Minimalinvasive Behandlung, 4) Evidenzbasierte Behandlungsansätze, 5) Regelmäßige Check-ups und Recall-
Intervalle. Im Anschluss gehen sie näher auf die Kariestherapie mithilfe des Er:YAG-Lasers ein, der zur Preparation
des betroffenen Hardgewebes für den Austausch dentaler Füllungen genutzt werden kann. Gleichzeitig zeigen sie die
Vorteile der dentalen Lasertherapie auf: Schmerzreduktion aufgrund geringer Vibrationen und Wärmeentwicklung,
kurzer Pulsdauer und der Vermeidung einer Stimulation der Nervenenden sowie eine Minimierung der für manche Pa
tienten angstauslösenden Geräusche. Dies habe zur Folge, dass die Patienten stärker für die weitere Zusammenarbeit
motiviert werden können. Neben umfassenden Erkenntnissen aus der Literatur führen die Autoren auch einen kurzen
Fallbericht an, um die Vorteile der Er:YAG-Kariestherapie zu belegen.

Literature

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4 2016

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| industry

An all-rounder with
three wavelengths

Efficient treatment with a new diode laser
Author: Dr Talat Qadri, Sweden

One dental laser, three diodes,
more than 20 indications
Diode lasers have long been established in dentistry. Thanks in part to their broad indication spectrum, they are considered dental “all-rounders.” In
the following article, Dr. Talat Qadri (Enköping,
Sweden), explains why he is convinced of the diode
laser technology. As Doctor in Odontology in Laser
and Periodontology, he holds his own clinic and is a
lecturer at the Karolinska Institute for Laser Dentistry; therefore, he is very familiar with the technology that has been in use since 1990 for treating
periodontitis and peri-implantitis, during surgery,
for germ reduction in endodontics, as soft laser
therapy and even for treating herpes simplex. Furthermore, Dr. Qadri will talk about the advantages
of using the new SIROLaser Blue for patients and
users.
Figs. 1a & b: The clinical situation
and dental X-ray show, amongst
others, the remains of the root
of tooth 12.
Fig. 2: The clinical situation following
extraction of the root remains of
tooth 12 prior to treatment with the
SIROLaser Blue.
Figs. 3 & 4: The clinical situation
after use of the SIROLaser Blue
(Fig. 5) with the red diode, wavelength: 660 nm, 8 mm probe/6 J
Lasing was conducted at 2 J buccally
and lingually in contact mode, occlusal at a distance of approx. 0.5 cm at
100 mW with an 8 mm probe for
20 seconds on each side.

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4 2016

Fig. 1a

Fig. 1b

Fig. 2

Fig. 3

In my specialisation—periodontology and peri-
implantitis—daily adjuvant use of a diode laser has
become an essential tool for treating patients in a
contemporary manner. Even though applications
could be replaced by conventional dental treatments,
the use of laser therapy ensures the following can
mostly be conducted:
–– Faster healing after surgery and extraction.
–– Less pain for patients but simultaneously less need
for anesthesia.
–– Generally no need for sutures following surgery.
–– Swelling and the post-operative intake of analgesics are rare.
Having actively followed the development of this
technology for almost 30 years, I have an abundance
of experience in the use of dental lasers. Diode lasers
have proved particularly successful in dentistry because they cover the widest treatment spectrum and

Fig. 4

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Fig. 5: The clinical situation following
LLLT around the extracted tooth 12
after one day.
Fig. 6: The clinical situation of
tooth 12 one week after surgery.
Fig. 7: The clinical situation of
tooth 12 three weeks after surgery.
Fig. 5

Fig. 6

have the aforementioned advantages. In the meantime, we now have convincing long-term studies for
diode lasers as well as numerous scientific studies that
have shown positive results. Diode lasers are suitable
for all patients, including those fitted with heart pacemakers (in contrast to electrosurgery). Additionally,
patients can avoid being unnecessarily anaesthetised. The lasers are also extremely cost-effective and
long lasting.

The advantages of the new
three-diode laser
The SIROLaser Blue (made by Dentsply Sirona) is a
third-generation laser and the world's first dental
laser equipped with a blue (445 nm), infrared (970 nm)
and red (660 nm) diode. In my view, combining three
wavelengths in a single device that now only weighs
a little more than 1 kg makes the new model user
friendly. According to the manufacturer, it is suitable
for 20 medical indications, and in terms of the treatment provided at my clinic, that includes primarily
periodontitis, peri-implantitis, dentine hypersensitivity, herpes infection, endodontics, minimal-invasive laser surgery, the treatment of abscesses, for
haemostasis and for gingivectomy. One practical feature is that the device can be programmed individually, although even the factory default settings save
time and effort.
In my clinic, we mostly use red laser light (660 nm),
as part of soft laser applications like low-level laser
therapy (LLLT) and biostimulation. I use the infrared
light (980 nm) for reducing germs in periodontology
and endodontics. The blue 445 nm diode is used for
incisions and advanced laser surgery. Every week I
treat about 30 patients for periodontitis or peri-implantitis. Therefore, we prefer using curettage and
de-epithelialisation. During surgery, I use the wavelengths 445 nm and 980 nm. To help wounds heal
more quickly, I then follow up with the red laser light
(660 nm) again.

Safe and precise contact-free incisions
Because blue light is absorbed much better by perfused soft tissue, the new 445 nm blue laser can also
make better incisions at lower power than the infrared

Fig. 7

laser light. Non-contact incision is particularly practical because it means no coagulation at the instrument tip, more precise incisions and less bleeding.
That makes it ideal for frenulum operations, for example. I also use the blue laser light for faster reliable
light-curing of composites. In my opinion, the diode
laser provides everything you need for the treatment
of soft tissues and much more. A good example is the
effective germ reduction in root canals. The diode
laser provides more limited treatment opportunities
when working with hard tissues such as bones and
teeth. However, other types of lasers are available for
this purpose.

Remarkable results:
red light with low power
The red 660 nm diode is used for what are known
as soft-laser applications (LLLT and biostimulation).
When the wavelength is absorbed in the mitochondria and cytoplasm, a chemical reaction occurs.
Therefore, the biological effect of low-level visible
light therapy happens through photochemistry
(probably by the photo activation of enzymes). This
chemical reaction leads to biostimulation. Abergel
et al. (1984) found that the irradiation of fibroblasts
in culture at 633 nm stimulated the synthesis of collagen, which helps close the wound and prevent
post-operative complications.1 Furthermore, it was
shown that the diode was beneficial in reducing the
pain (Walker et al.1987).2 All in all, the positive effects
of the red diode have been scientifically proven for
30 years, as recent reviews have shown.2,3
Some studies by Tina Karu, an internationally recognised leader in the science of laser phototherapy,
even showed that LLLT improves ATP production as
well as DNA + RNA synthesis in the mitochondria.4 A
study from Franca CM (2009) demonstrated a positive effect of low intensity red laser (660 nm) by preventing an oral mucositis.5 Tacon K C (2011) observed
a faster wound healing after using the 660 nm diode6.
I absolutely agree with that. In my opinion, wounds
heal much faster and with fewer complications after
using red laser light, and the wound area is cleaner
with less scaring. The risk of intimal hyperplasia is reduced and my patients generally no longer require

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Fig. 8a

Fig. 8b

Fig. 10

Fig. 11

Figs. 8a & b: The same patient,
remains of root of tooth 23 in situ,
X-ray of the remains of root
of tooth 23.
Fig. 9: Extraction of the remains of
the root of tooth 23. Pre-treatment:
before removing the remains of
the root of tooth 23, the patient
was lased with 445 nm laser light
(800 mW, 25 Hz, 50 % duty cycle circular) to remove the remaining tissue
around the root and prevent greater
damage to the surrounding tissue.
Fig. 10: This was followed by lasing
using red laser light (LLLT) for
biostimulation (Fig. 10).
Fig. 11: The clinical situation
one day after surgery.
Fig. 12: The clinical situation two
weeks after surgery Figs. 11 and 12
highlight the speed of healing.

Fig. 9

Fig. 12

painkillers after surgery/extraction. Accustomed oral
hygiene practices can be restarted again sooner. The
swelling that often follows tooth extraction has also
become rare at my clinic.
Red laser light can generally be used in many ways.
As early as the 1990s, scientific studies showed it produced good results with dentine hypersensitivity (for
current data: Gärtner 2013).7 LLLT is also successful
for use in conjunction with xerostomia because it
stimulates the salivary glands while at the same time
promoting their regeneration.
In implantology, using LLLT after surgery causes less
swelling, infection and pain and can stimulate wound
healing (Heinemann & Braun 2013).8 The only side effect that I have observed so far is a possible reddening
of the treated area due to the stimulation of blood flow.

Practical case study
For a patient of mine, an elderly man aged 82 (high
blood pressure, medication with anticoagulants, diabetes), I conducted LLLT for biostimulation and thus
better wound healing following the extraction of
teeth 12 and 23. I also used it to avoid possible complications that would constitute even greater stress
for his body. The individual steps are as follows:
–– Following the extraction of tooth 12, the wound was
lased within the framework of LLLT for 60 seconds
using the red diode (660 nm) at 100 mW dose 6 J with
an 8 mm probe at a distance of approximately 2 mm.
Specifically, this meant lasing at 2 J buccal and lingual in contact mode, occlusal at a distance of approx. 0.5 cm for 20 seconds on each side (Figs. 1-4).
–– Figures 5, 6 and 7 show the rapid healing of the
wound one day, one week and three weeks after
surgery.

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4 2016

–– Figure 8 shows the initial situation for the same
patient with the remains of the root of tooth 23.
–– Here, I conducted the following pre-treatment: Before removing the remains of the root of tooth 23,
the patient was lased with 445 nm laser light
(800 mW, 25 Hz, 50 % duty cycle circular) to remove
the remaining tissue around the root and prevent
greater damage to the surrounding tissue (Fig. 9).
–– This was followed by lasing using red laser light
(LLLT) for biostimulation (Fig. 10).
–– Figures 11 (the following day) and 12 (two weeks
after surgery) highlight how quickly the wound
healed.
The wounds did not need to be sutured. The patient
subsequently did not experience any swelling and
painkillers did not need to be administered. The older
patient reacted positively and was pleased with both
the procedure and the outcome of the extractions. He
was happy to have been pain-free.

Conclusions for practice
Diode lasers (e.g. SIROLaser Blue, made by Dentsply
Sirona) are suitable not only for treating inflammatory periodontal diseases, of which about one-third
of today's adults suffer, but laser therapy is also valued by patients and users alike in surgery and restorative dentistry (e.g. endodontics, dentine hypersensitivity or fissure sealing). The new SIROLaser Blue
model combines three diodes (blue, red and infrared)
for different applications, for instance for precise cutting in non-contact mode during surgical procedures
(blue diode at 445 nm). I regularly use the red diode
(660 nm) for its biostimulatory effect. It speeds the
healing of wounds, reduces postoperative complications such as pain and swelling and can even remove
the need to suture wounds in some situations. User-
friendly default settings and a compact design
facilitate efficient use in dental practice for the patient’s benefit._

contact
Dr Talat Qadri
Fjärdhundragatan 41 B
74530 Enköping, Sweden
Tel.: +46 17131261
info@Kamidental.se
Author details

Literature

[29] =>

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| practice management

Eleven tips for success
in your dental clinic

Part VI: Video Testimonials and R.A.P.P.O.R.T.
Author: Dr Anna Maria Yiannikos, Germany & Cyprus

Welcome to the sixth part of the series ‘Eleven tips
for success in your dental clinic’. Today I will teach you
the last tip of this amazing series that I encourage you
to use at your clinics in order to gain the power and
control that you deserve.

Introduction

Video Testimonials
Let me start with the concept of Video Testimonials. Why is this an essential promotion tool for us?

© Rawpixel.com/Shutterstock.com

Due to the experience that I have gained from
practicing dentistry over the last 25 years and drawn
from my studies and research in medical business,
today, I will present you an amazing new age tool:
How to receive video testimonials from your patients—a tool with zero costs but a huge impact to

the patients’ preference. Remember always to use
your own patients and clinic for promotion. It has
zero expenses and the best outcomes. By the end of
this article, I will have given you all the answers concerning why are video testimonials important for us,
how can we ask a patient to give us a video testimonial, what should the content be, when should we
ask for it and finally and most critical the R.A.P.P.O.R.T.
protocol.

30

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Research has proven that over 70 per cent of customers/patients look at a product/service review
before accepting the service. A survey sponsored
by Zendesk found that 90 per cent of participants
were influenced in their buying decisions by positive
reviews, which is an enormous amount of people.
But how do you ask your patient for a video testimonial? Start with an email. This gives you the opportunity to make your request without any interruptions, without forgetting any details and most
importantly: without putting your beloved patient
on the spot.
I will provide you now with a significant sample of
creative questions that you can use for your video
testimonial in order to ensure its success:
1. For which reason did you choose us?
2. How have you experienced our services?
3. Can you think of a word or phrase that best describes your relationship to us? Why did you choose
that particular word or phrase?
4. Why would you recommend us to someone else?
Now, you will ask me: When is the best time to
ask a patient for a video testimonial? Right after a
successful treatment, of course—when everyone is
still on an emotional high level.

The above tool is a very small part of the tools,
ideas and protocols of the presentation skills module
which is one of the ten modules that I teach during
the DBA—Dental Business Administration Mastership course. DBA is a mini MBA that will not only
teach you ten different modules in only ten days but
will also give you examples and exercises based on
our routine dental life. It is the only educational programme that can show you how to gain the business
success that you deserve. If you want to take your
dental clinic to the next successful level, you have a
choice—register now! I am looking forward to seeing you all.
During the next issue of laser magazine we will
introduce a new series of business concepts that
as always will assist you in revealing the opportunities and real potential of your dental clinic and
staff. 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 requests 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!_

R.A.P.P.O.R.T protocol
Last but not least, I will introduce to you the
R.A.P.P.O.R.T protocol which is the acronym of
the words:
R for Reward them
A for Ask creatively (run a contest)
P for never be Pushy
P for ask for a written Permission
O for give them the script of the testimonial One day
before
R for Run (post/share) it
T for videoTape it

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 sechsten und letzten Teil der Serie „11 Tipps zum wünschenswerten Erfolg in Zahnkliniken“ geht die Autorin
auf die Vorteile einer Patientenempfehlung via Videoaufnahme sowie das R.A.P.P.O.R.T PROTOCOL ein. Denn, wie
zahlreiche Studien belegen, entscheiden sich die meisten Menschen auf Basis von Empfehlungen für einen Service
bzw. ein Produkt. Um den Patienten nach einer erfolgreichen Behandlung nicht zu überrumpeln, empfiehlt die Autorin,
eine Anfrage für die Aufnahme einer Videoempfehlung per E-Mail zu verschicken. Darüber hinaus formuliert sie vier
kreative Fragen, die den Erfolg der Videoaufnahme garantieren sollen. Das R.A.P.P.O.R.T PROTOCOL bietet dabei eine
effektive Anleitung zur erfolgbringenden Umsetzung von Patientenempfehlungen.
In der nächsten Ausgabe der laser international magazine of laser dentistry beginnt eine neue Serie der Autorin. Hier
wird sie in gewohnter Weise Tipps und Konzepte präsentieren, die Praxisinhaber dazu verhelfen sollen, die Möglichkeiten und das Potenzial ihrer Zahnarztpraxis voll auszuschöpfen.

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Lasers as an asset
in both daily practice
and marketing
Author: Dr Imneet Madan, UAE

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com

Amongst the issues mentioned here, marketing
is one that is very pivotal but in most cases not yet
well prioritised. Although, current trends in practice
do focus a lot on marketing. The winning edge of today’s practice lies in a formula saying: “I project who
I am.” This philosophy brings forth the transparency
of laser-based practice. Since the costs incurred to
the patients are higher with laser treatments, the
imperative as well as the benefits coming with lasers
needed to be well known by the patients.

The Blue Ocean Strategy

In the era of advanced techno
logies, patients’ expectations are
multiply increasing: They want to
have the least invasive treatment
procedure with only minimal bleeding,
more effective healing, greater precision
and the least number of appointments.
For many years now, lasers have been proven to
be an effective device for a minimally invasive treatment. Nevertheless, any dental office that wants to
implement lasers in its daily practice has to keep in
mind several issues. These issues are:
– Safety
– Employee education
– Marketing
– Revenue channels
– Advantages.

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Most corporations do smart things and also less
smart things from time to time. In order to improve
the quality of success, it is important to evaluate what
has made the positive difference and understand how to replicate this in a systematic manner. It is also understood that the strategic
move that matters centrally
is to create blue
oceans. The Blue
Ocean Strategy challenges companies to
break out of red oceans of
conventional approaches and competition by creating uncontested market space that finally leaves
any competition irrelevant.1
The Blue Ocean Strategy in Dentistry
As stated by Masahiro Fujita, President of Sony’s
System Technological Laboratories: “The risk of not
innovating is greater than the risk of innovating.”
The success of brands relies on cutting an edge in
the existing market. The introduction of dental lasers

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is the most practical application of the principles of
Blue Ocean strategy in the dental business. Marketing and treatment protocols can be well shaped in
lines of this principle. Even though laser can prove to
be a high end investment, the success and uniqueness that follows has been well researched and documented by several practitioners around the globe.
Investment above investment
The investment in laser devices for a company is an
extra mile. Combining both hard and soft tissue lasers could add up to about 100,000 US$ to the total
cost of investment. Even though this amount sounds
substantial in the initial stage, the return on investment with lasers can range between 280 to 600 per
cent.2 These kind of returns are possible when we
successfully combine technological benefits with
appropriate marketing strategies.
Changing patients’ trends
The patients walking into the practice these days
are “Drone Patients”. Prior to their consultation,
they like to read about possible procedures, optional
treatments and latest advances. Since patients are
partly aware of the technology, stating further benefits enhances their knowledge. Hence, decisions are
made more easily and naturally in favour of lasers.

ences, a shared experience from someone close or
just the anticipation of needles and drills. With lasers, the approach to dentistry becomes different.
The need for anaesthesia is either completely ruled
out or substituted by only a few drops of intergingival infiltration.
More certain prognosis
When it comes to the treatment of endodontically compromised teeth, lasers work quite accurate
in combination with conventional treatment approaches. A recent approach of combining Diode and
Erbium lasers has given vast success rates in grossly
decayed teeth with peri-apical infections.
No drill dentistry
Since laser is a non-contact procedure, there is no
pressure or touch sensation involved; this increases
the patients’ acceptance of the treatment.
No antibiotics after minor procedures
It has been a common trend to prescribe antibiotics after any kind of surgical intervention or in endodontically compromised teeth. With laser there is
no scar formation, tissue healing is faster, site of interventions is more sterile; hence the need of antibiotics has decreased.

Benefits of lasers

Marketing Fundamentals

The usage of laser in the daily dental practice is undoubted. From a practitioners point of view there are
several benefits which basically can be divided into
intangible and tangible benefits. Intangible benefits
refer to the high technological status of lasers and
the subsequent referrals that its reputation generates. Lasers do make the procedure easier and more
comfortable for the patient. Almost all hard tissue
procedures can be done without using anaesthesia. This certainly reduces the stress for the patient
who normally relates dentistry with needles and
drills. The most important factor in private practice
is “Time Management”, which ranks amongst tangible benefits. With lasers, multiple restorations can
be performed in the same appointment as there is
no numbness involved. Additional procedures like
hygienist appointment and exam schedule with specialists can be also accommodated at the same time.
This directly adds on to saving time and increasing
profitability.3

Dr Philip Kotler defines marketing as “the science
and art of exploring, creating, and delivering value
to satisfy the needs of a target market at a profit.
Marketing identifies unfulfilled needs and desires.”4

More benefits of laser usage in the dental practice are:

Marketing 1.0 was selling the factory’s output of
products to all who wanted to buy them. The products were quite basic and designed to serve a mass
market. The goal was to standardise productions’
costs so that goods could be priced lower and made
be more affordable to buyers. This marketing strategy was part of the product-centric era.

Fear factor control
Most patients walking into the practice have dental fears or phobias for various underlying reasons.
Their fears could be caused by negative past experi-

Marketing, in simple terms, is a management process through which goods and services move from
concept to customer. It includes the coordination of
four elements called the four P's of marketing:
1. Identification, selection and development of a
product,
2. Determination of its price,
3. Selection of a distribution channel to reach the
customer's place, and
4. Development and implementation of a promotional strategy.
Changing trends
Over the years, marketing has evolved through
three stages: Marketing 1.0, 2.0 and 3.0.

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Marketing 2.0 is the principle attached to marketing in current times which is information age
where the core is information technology. Thereby,
the job of marketing no longer stays simple. The
golden rule of marketing 2.0 is: “Customer is King.”
Customers are better off as their needs and desires
are prioritised.
Marketing 3.0 denotes a “Value Driven” era. This
concept of marketing uplifts into the arena of human aspirations, values and spirits. It believes that
consumers are complete human beings whose complete needs and hopes should never be neglected.
Therefore, this principle complements emotional
and human spirit marketing.

Lasers as a tool for Marketing 3.0
Marketing 3.0 incorporates lasers pretty well as it
keeps in consideration the benefits to the patients,
the producers credentials, and the high end technological status. The current age also follows the new
Wave technology which enables connectivity and
interactivity of individuals and groups. This enables
the customers and the dentists to be well aware of the
advances in lasers availability.
FDA approval for dental laser marketing
Applications for and research on lasers in dentistry continues to expand since their introduction
to the dental profession. Dental laser systems are
cleared for marketing in the United States via the
Food and Drug Administration (FDA) Premarket
Notification [510(k)] process. The review team de-

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termines whether the product under review meets
relevant criteria for “substantial equivalence” to a
predicate device (the term “predicate” is used to describe any device that is marketed for the same use
as the new device, even if the actual technologies are
not the same).5
There are three key points in the marketing of
dental lasers:
1. Efficiency: In a dental practice, efficiency is one
of the key factors that draw the thin line between
growth and failure. Efficiency is based on the application of technology. The more we succeed in
incorporating the latest advances, the more we
ensure that our practice is increasing revenues,
enhancing patient experiences and expanding

referrals. Efficiency in a practice accounts to increase the happiness quotient of both patient and
dentist.
2. Reduced chair time: Speed is another major variable to consider when choosing the dental laser.
Lasers are certainly a bit slower than the conventional drill, but this lapse of time does get well compensated with the fact that there is no waiting period of numbing involved.
3. Improved patient experience: Drill-free and no anaesthetic procedures are always more welcoming to the patients. Dental lasers create a virtually
pain-free experience, which is a definite gamechanger for the vast majority of patients.
The above mentioned points can be easily used as
key markers in promoting dental lasers. Since there
are umpteen amounts of data supporting these facts,
patients can also be encouraged to search around
online before booking in their appointments. Relevant information can be communicated by different
forms of media:
– Social Media such as Facebook, Twitter, Snapchat,
Instagram
– Advertisements through Radio or TV Channels
– School Screenings: information leaflets on lasers
can be included along with the school dental reports. This makes information reach home and
triggers the first step of curiosity to get to know
more and use the service if or when required.

Laser marketing and practice
Dental lasers add a lot on the functioning of dental
practices. They not only boost up the revenues, primarily due to the cost differences between laser and
conventional treatments, but also improve the actual
functioning of the practice in several manners.
Significant decrease in missed appointments
Pain is certainly an abstract phenomenon and its
perception changes from one patient to another.

[35] =>

practice management

Having lasers in the dental practice with their added
advantages certainly decreases the perception of
pain to a large extent. Patients are no longer afraid
to sit in the chair and receive the care they need. This
helps decreasing the number of missed appointments.
Increased new patient volume
Satisfied patients add a lot to any practice. Dental lasers give dentists the opportunity to increase
new patient referrals because of the unique experience lasers enable for existing patients. Patients
feel so positively motivated that they talk about their
experience to family and friends, thereby spreading
the name of practice by word of mouth.
More referrals
Being unique projects the practice as a cut above
the rest. This helps increasing the referrals from other
practices and also from colleagues in the same practice. When the practice comes to be known as laser
specialty practice, it becomes a known referral base
for specific procedures and also for those who are
technology-friendly.6
New procedures
Laser equips the dentist to perform a wide variety
of procedures that could not be handled otherwise.
The lack of anaesthesia, blood, sutures and minimal
post-operative discomfort enables dentists to perform procedures such as labial and lingual frenectomies, fibroma removals to exposures, crown lengthening and much more. New procedures get added
to a dentist’s repertoire that would previously have
been referred out or untreated. Many of these procedures can be performed during the same visit;
thereby, increasing revenue growth without having
to add a s econd appointment.

Conclusion
There has been a long road between the times
when lasers were taken as the adjunct only for high
end practices and procedures, to the current times,
where laser is used as a regular armamentarium. In
the world of marketing, lasers have brought dentistry
to Blue Ocean. The frequent use of a laser by offices
has resulted in a higher level of patient comfort, increased case acceptance for routine care, larger
cases, and improved doctor productivity.7
Following the principles of the Blue Ocean Strategy, practices that offer compassionate care using
advanced technologies such as lasers will be the offices that experience the largest influx of new patients in the future._

contact
Author details

Dr Imneet Madan
Specialist Pediatric Dentist
MSc Lasers Dentistry (Germany)
MDS Pediatric Dentistry
MBA (Hospital Management)
Children’s Dental Center, Dubai
Villa 1020 Al Wasl Road, Umm Suqeim 1, Dubai,
United Arab Emirates
Tel.: +971 506823462
imneet.madan@yahoo.com
www.drmichaels.com

Kurz & bündig
Patient und Behandler profitieren gleichermaßen von den positiven Eigenschaften einer Lasertherapie, auch wenn
der Laser in der Anschaffung teuer und die Behandlung für den Patienten mit höheren Kosten verbunden ist. Umso
wichtiger ist es daher, den Patienten umfassend über die Notwendigkeit und die Vorteile einer Laserbehandlung zu
informieren. Hier hilft ein gut durchdachtes Marketing-Konzept.
Im Artikel stellt die Autorin die Blue-Ocean-Strategie vor. Diese soll Unternehmen dazu anregen, gewohntes Terrain
zu verlassen und neue, innovative Wege in der Vermarktung ihrer Leistungen zu gehen. Der Dentallaser lässt sich dabei gut mit den Prinzipien der Blue-Ocean-Strategie verbinden. Für ein gewinnbringendes Laser-Marketing sind dabei
vor allem drei Aspekte wichtig: die Herausstellung der Effizienz einer Lasertherapie, die verkürzte Behandlungszeit
sowie das verbesserte Patientenerlebnis. Diese drei Aspekte lassen sich weiter ausbauen und anhand von Fakten
belegen. Über verschiedenste Kanäle wie soziale Medien und Werbung in Radio oder TV werden die Informationen an
den Patienten herangetragen. Unter Verwendung der Blue-Ocean-Strategie werden Zahnarztpraxen, die fortschrittliche Technologien wie den Laser in ihrem Praxisalltag selbstverständlich einsetzen, in Zukunft den größten Zulauf an
Patienten haben.

Literature

laser
4 2016

[36] =>

| events

Fig. 1

25 International
Annual DGL Congress
th

Laser technology continues to fascinate
Author: Dr Georg Bach, Germany

When a dental society celebrates its 25th annual congress, this constitutes a significant events, as only a
few societies are granted to prevail for a quarter of a
century. If, moreover, a dental laser society celebrates
its 25th annual congress, it is a remarkable event: compared to other European dental laser societies, the
DGL assumes a unique position, both by being active

for 25 years and by being soundly established as a
member of the DGZMK (German Society for Dental
and Oral Medicine).
Therefore, DGL President and co-founder Prof. Dr
Norbert Gutknecht insisted on organising this special
anniversary congress. And it was not long until the
well-earned success became visible: The lecture hall
was brimming with more than 250 participants and
many DGL associates and renowned speakers from
Germany and abroad followed Prof. Dr Gutknecht’s
call to the Bavarian metropolis Munich.

The path towards laser dentistry
“Rocky and with small detours now and then”—the
path towards laser dentistry (in Germany) can be
described in those terms. Much like in implantology,
the first impulses for this discipline derived from the
daily practice and, another parallel to implantology,
they were regarded with a sceptical eye and sometimes even criticised by universities. In spite of that,
laser dentistry prevailed, mostly in the form of a
renunciation of the “all-round laser”, which can be
applied universally in all fields of dentistry, and after
defining lasers as an adjuvant, highly effective tool for

Fig. 2

laser

4 2016

[37] =>

events

Fig. 3

Fig. 4

special applications. The activities of RWTH Aachen Basic research
University proved a special case of luck for the German
laser users in dentistry, as Prof. Dr Gutknecht and Prof.
The influence of laser wavelengths which are able
Dr Angelika Lampert promoted scientific, evidence- to remove dental hard tissue and bone tissue on
based standards early on, thus providing credibility to implant surfaces was discussed controversially. A
the then-young discipline of laser dentistry.
working group from Aachen, Germany, led by Prof. Dr
Gutknecht and Dr Fahlstedt succeeded in arguing that
These efforts were awarded with acceptance of the Er;CR:YSGG laser light will not cause root surface
DGL by the DGZMK (German Society for Dental and changes even at an irradiation of 0.75 and 1 Watt. The
Oral Medicine), which must be seen as one of the second “hard tissue wavelength”, the Er:YAG laser,
highlights of DGL’s 25-year-old history.
was investigated by another working group led by
Dr Luk, with an energy density of 10.6 J/cm2 leading
The congress makers payed special tribute to this to irreparable damages of the implant surface.
unique success story on the first congress day
themed “From the origins of the DGL to new horizons”.
A very active working group formed by DGL veteran Dr Michael Hopp (Berlin, Germany) attested
DGL international
that 445 nm diode lasers, Er:YAG lasers and CO2 lasers played only a minor role in tissue damages folAlmost 50 per cent of the speakers on this first lowing laser cutting, whereas Nd:YAG lasers and dicongress day had travelled to Munich from abroad, ode lasers of a wavelength of 810 and 980 nm caused
which speaks for DGL’s international attractiveness. pronounced damage zones with continued bleeding
As the DGL is among the world’s oldest dental soci- at the incision margins. Conclusion: healing included
eties such as those in Japan and Brazil, the congress’ an (desirable) primary healing prompted by Er:YAG
list of speakers read like the Who is Who of interna- laser application as well as a defect healing caused
tional laser dentistry.
by other laser types (which should be avoided).
Dr Kenneth Luk from Hong Kong started the international contributions with his speech on the influence of different pulse durations on the microstructure of titanium implants. As is shown by the latest
S3-Guideline “Periimplantitis” of the DGZMK and a
number of implantological dental societies, the
Er:YAG laser more and more forms the central part of
laser applications in implantology.
The predominance of hard-tissue lasers (Er:YAG
and Er,Cr:YSGG) in the scientific programme of the
first congress day was noteworthy, with conservation
forming the focal point of the contributions (Dr
Riman Nasher, Sannaa, „Entfernung des Smearlayers
mit dem Er,Cr:YSGG“, Dr Ana Nogueira da Silva, Lissabon, „Composite auf laservorbereitete Zahnoberflächen“ , Dr Berchem Kalender, „Präparation im
Hartgewebe“ and Dr Tamara Al. Karadaghi, Bagdad,
„Dentinpermeabilität nach Laserbestrahlung“).

Fig. 1: A large audience presented at
the two-day event on Munich’s last
Oktoberfest weekend.
Fig. 2: On Friday, 30 September,
long-standing DGL members were
awarded a certificate for their
dedication, among them also
Prof. Dr Norbert Gutknecht and
Prof. Dr Mathias Frentzen.
Fig. 3: Parallel to the 25th anniversary congress, LASER START UP
2016 was held. Its scientific leader
Dr Georg Bach opened the traditional
education event on Friday.
Fig. 4: Dr Detlef Lutz and
Dr Angela Wilke-Lutz were also
among the awardees for long-
standing membership.

News from the realm of wavelengths
Prof. Dr Matthias Frentzen (Bonn, Germany), who
has been among Germany’s most important members of the DGL, has been the society’s general secretary for many years. He also has been doing research
on the development short-pulse laser applications in
dentistry, which is why he decided to contribute a
concise overview to the congress speeches.
The audience proved receptive for Prof. Frentzen’s
main message: research and development of new ultrashort-pulsed lasers, which will replace the more
complicated and less efficient excimer-lasers in the removal of dental hard and bone tissues, has been accelerated in such a way that soon high-performance and
compact short-pulse laser sources will be available. The
associated findings will have a positive influence on the
further development of Er:YAG and CO2 lasers.

laser
4 2016

[38] =>

| events
Parts of the first congress day as well as the complete second day were dedicated to indications of current laser dentistry. Let me say that much: it is simply
incredible what has happened in this field during the
last quarter of a century. The variety of laser-aided
therapies is remarkable. In particular since those new
forms of therapy are not just laser-aided applications
in hard-tissue (tooth and bone) such as laser-aided
endodontics and implantology ( periimplantitis treatment).

Fig. 5

The assiduous Aachen working group uses
Er,Cr:YSGG laser to remove implants that cannot be
saved. This approach is, according to the group,
superior to conventional methods (Trepan) and

guarantees best possible tissue protection. Although
most of the scientific contributions at the 25th annual
congress of the DGL concerned conventional approaches, there was a clear orientation towards new
horizons: laser systems are being growingly employed in areas such as orthodontics (Dr Peter Kleemann, Luxembourg), oral and maxillo-facial surgery
(Prof. Siegfried Jänicke, Osnabrück) and diagnostics
(Dr Thorsten Kleinert, Berlin).

Fig. 6
Fig. 5: And the winner is …
Eva Speck (DGL) and Sebastian
Kiehne, Sales Manager Instruments
at congress sponsor Dentsply Sirona,
were happy to announce the winner
of the SIROLaser Blue prize draw.
Fig. 6: The scientific congress
was completed by an extensive
industry exhibition.

Prof. Dr Andreas Braun (Marburg, Germany) has
also been exploring new territory. He reported on the
clinical application of the latest diode-laser wavelength. While until recently only diode lasers of a
wavelength of 810–980 nm were available, a semiconductor laser of 445 nm has now been introduced
to the market. This new diode laser wavelength from
the blue spectre can promote the coupling of energy
to pigmented tissue cells, thus ensuring a good surgical cutting at lower penetration depths and a reduced
risk of damage to underlying tissues.
Dr René Franzen (Aachen, Germany) and colleagues introduced their research results on the
445 nm diode laser when applied endodontologically, attesting strong bactericidal properties to the
blue wavelength in their in-vitro study.
Dr Ralf Borchers and Prof. Marcia Marques also
dedicated their speeches to diode lasers, if under
different circumstances. While Dr Borchers compared the effect of diode laser light when applied in
cw and superpulse mode on soft tissues and noted
significant advantages in the superpulsed diode lasers, Prof. Marques illustrated a special diode laser
treatment: low-level laser therapy (low energy),
which is mainly used to treat wound-healing dis
orders and pain.
The working group led by Prof. Dr Heinrich Wehrbein (Mainz, Germany) took up the cudgels for LLLT
applications by noting a significantly reduced retention time and relapse rate after palatal expansion and
LLLT application.

laser

4 2016

Dr Kleemann, a colleague from Luxembourg, presented laser-aided procedures in orthodontics with
various wavelengths, thus showing a real cornucopia
of laser applications with the suitable laser equipment.

Laser procedures in various
specialized areas
If a certain procedure or technique, for example the
dental laser, becomes an accepted dental discipline, it
is inevitable that combination therapies are formed
which will spread to other specialized areas. This phenomenon can be observed with laser dentistry. Hence,
Prof. Frank Liebaug talked about the combination of
laser and hyaluronic acid (he sees in this promising
duet the chance to revolutionize periodontitis therapy). In addition, Dr. D. Moghtader presented his findings on laser-aided snoring therapy and went into
questions of its legal legitimacy.
Looking back on the days spent in Berlin, one thing
is certain: 25 years of DGL and a stimulating and
multi-layered congress made travelling to the capital
utterly worth it!_

contact
Dr. Georg Bach
Fachzahnarzt für Oralchirurgie
Rathausgasse36
79098 Freiburg im Breisgau

Author details

[39] =>

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

[40] =>

manufacturer news
BIOLASE

New diode laser introduced at GNYDM
BIOLASE has introduced Epic Pro, an all-new inno
vative dental diode laser system, at the upcoming
Greater New York Dental Meeting (GNYDM on
Nov. 25–30 in New York. According to the company, the Epic Pro offers the most laser power
of any diode laser in dentistry and is the first
product resulting from BIOLASE’s strategic
development agreement with laser technology
specialist IPG Photonics.
The newest addition to the EPIC series of dental
soft-tissue lasers features new superpulse technology for more precise, enhanced laser tissue
cutting; real-time automatic power control to enhance speed and consistency when performing
surgery; and pre-initiated, bendable, disposable
tips with new smart tip technology to ensure tip
performance and quality.
Compared with other products currently available on the market, the new system will provide
a more predictable, minimally invasive solution

for soft-tissue management, BIOLASE
stated. It represents the first premium
grade diode laser from BIOLASE and an
important example of the kind of innovation BIOLASE is working on, both with
IPG and through its internal product development efforts, noted BIOLASE President and CEO Harold C. Flynn Jr.
“The introduction of Epic Pro is an important milestone for our company. We
are proud to be expanding our diode laser
range to incorporate new innovations that will
allow dental professionals to manage soft tissue
with lasers in a way that no other diode laser
has achieved,” Flynn said. “Epic Pro represents
our ongoing commitment to elevating the standard of care in dentistry, and achieving better
patient reported outcomes while enabling clinicians to realize better business returns. We are
very excited about the possibilities offered to

our customers by this new technology addition
to our portfolio.”
BIOLASE, Inc.
4 Cromwell
Irvine, CA 92618, USA
www.biolase.com

LASOTRONIX

SMARTM dental diode laser—Versatile and functional
LASOTRONIX is proud to present the diode-based
laser platform especially designed for dentistry,
the SMARTM series. 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, perio

dontology, pain therapy and whitening as well as
400 mW at 635 nm wavelength for cold therapies
like biostimulation 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 and assures perfect operation comfort. In
addition, accessories such as a wide range of fiber delivery systems, application end tips and a
variety of surgical handpieces provide maximum
versatility. As a result, the SMARTM laser is suitable for a vast number of therapies. If you want to
join us and promote our innovative products please
kindly contact us via E-Mail: mp@lasotronix.pl.
LASOTRONIX
˚ytnia 1 str.
05-500 Piaseczno, Poland
www.lasotronix.com

laser

4 2016

[41] =>

international

news

Computer simulations show

Lasers effective in killing oral bacteria

New organic toothpaste may

Inhibit harmful bacteria
A Seoul dentist has developed an all-natural
toothpaste that aims to reduce the health risks
posed by Streptococcus gordonii, an oral bac
terium that initiates dental plaque formation.
Once in the bloodstream, which it may enter
though bleeding gingivae, for example, the bac
terium also causes blood clots, which can lead
to life-threatening conditions such as infective
endocarditis, heart attack or stroke.
South Korean dentist Dr Hyung-Joo Moon, head
of the Moon Dental Hospital in Seoul, recently
obtained the patent for his bacteria-inhibiting or
ganic formula from the Korean Intellectual Prop
erty Office. Inspired by a joint study by the Royal
College of Surgeons in Ireland and the University
of Bristol, which found that S. gordonii can trig
ger an infection of the inner lining of the heart
when entering the bloodstream, Moon started
developing a toothpaste that especially inhibits
the growth of these bacteria.
The toothpaste’s anti-inflammatory ingredients
include neem and castor oil, herbal extracts
made from psyllium seed, Japanese star anise,
and Japanese cornelian cherry. As the oral mu
cosa is very susceptible to absorbing harmful
substances into the body, it is especially import
ant to use natural ingredients for oral care prod
ucts, he emphasised. Tested among his patients,
the toothpaste’s formula proved to help relieve
inflammation, as well as sore gingivae and
toothache. The toothpaste is not available for
purchase yet, but Moon is working on releasing
it to market soon.

minimal thermal damage, which leads to faster
healing, Reinisch explained. According to him,
the simulations validate the effectiveness of
dental lasers in removing oral bacteria and con
tributing to better oral health after periodontal
treatment. The study, titled “Selective photoan
tisepsis,” was published in the October issue of
Lasers in Surgery and Medicine, including video
depictions of the computer simulations.

© Mjak/Shutterstock.com

Japanese company introduces

Five-minute dental screening
New saliva test from Japan analyses various
oral parameters in a matter of minutes. Accord
ing to Lion Corporation, which developed the
Salivary Multi Test together with Aichi Gakuin
University’s School of Dentistry, the device can
identify markers associated with oral health,
such as the quantity of cavity-causing bacteria
and number of white blood cells, using just a
small sample of saliva. In addition to the Sali

© PeJo/Shutterstock.com

© Lightspring/Shutterstock.com

A team of researchers at the New York Institute
of Technology in the US has developed a com
puter model that demonstrates how dental lasers
attack oral bacterial colonies in gingival tissue.
Based on the optical characteristics of gingival
tissue and pathogenic microorganisms, the re
searchers developed a mathematical model that
simulates the periodontal procedure of laser sul
cular debridement. The virtual colonies, consist
ing of Porphyromonas gingivalis and Prevotella
intermedia, were of various sizes and placed at
different depths in the gingival model. The simu
lations indicated that 810 nm diode lasers, when
set to short pulses and moderate energy levels,
are able to destroy bacteria buried 3 mm deep in
the gingival tissue. Nd:YAG
lasers with a wavelength of
1,064 nm also proved to be
effective with similar penetra
tion depth. Moreover, both lasers
spare the healthy tissue,
the researchers found.
Their simulations showed
minimal heating of the sur
rounding tissue and therefore

vary Multi Test Meter—the actual measuring in
strument—a computer, a printer, test paper and
software (available for Windows and macOS) are
needed for analysing the saliva samples. After
applying the saliva to the test paper, the patient’s
individual results are visualised in a radar chart
on the computer monitor.
Items tested include salivary acidity, leukocyte
count, ammonia values and the presence of
fungi. According to Lion, six items
can be measured simultaneously
in one analysis and test results can
be obtained within 5 minutes. More
information about the system is
available on the company’s website,
lionpro.lionshop.jp (in Japanese
only), through which the system is
exclusively sold.

laser
4 2016

41

[42] =>

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Vorstellung Dentallaser/
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[43] =>

editorial

Rückblick &
Ausblick

Prof. Dr. Norbert Gutknecht

Sehr geehrte Frau Kollegin, sehr geehrter Herr Kollege,
liebe Mitglieder der verschiedenen Gesellschaften,
liebe Freunde der Lasertechnologie,
in dieser letzten Ausgabe des laser international magazine of laser dentistry möchte ich einen kurzen Rückblick
über das vergangene Jahr 2016 halten. Den Höhepunkt bildete der Weltkongress der WFLD in Japan unter
der Leitung von Prof. Kenji Yoshida. Hier trafen sich sowohl wissenschaftlich tätige Kollegen aus den ver
schiedensten Universitäten als auch praktisch tätige Kollegen, um neuste Forschungsergebnisse, Therapie
konzepte und praktische Erfahrungen auszutauschen und zu diskutieren.
Was auf großer Bühne in Japan international stattfand, wurde auch in vielen Ländern auf nationaler Ebene
durchgeführt. Dabei konnte man sehr gut feststellen, dass nicht nur neue Laserwellenlängen in die Zahn
heilkunde eingeführt wurden, sondern dass auch mit den bereits etablierten Lasersystemen neue thera
peutische Felder belegt werden können.
Im Ausblick auf das neue Jahr 2017 bin ich gespannt, inwieweit wir auf der IDS (Internationale DentalSchau, Köln) weitere technische Neuheiten im Lasersegment bewundern werden können.
In der Zwischenzeit wird das alte Jahr zu Ende gehen und ein neues beginnen, weshalb ich ihnen an dieser
Stelle alles erdenklich Gute für das Jahr 2017 wünschen möchte.
Allen Leserinnen und Lesern, die das Jahr mit dem Weihnachtsfest ausklingen lassen, wünsche ich auch
eine harmonische und gesegnete Weihnachtszeit.
Ihr

Prof. Dr Norbert Gutknecht

laser
4 2016

[44] =>

25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


Wundheilung nach Inzision oraler Schleimhaut mit einem 445 nm Diodenlaser
Dr. Dr. Paul Günther Baptist Heymann, Dr. Dr. Thomas Ziebart, Dr. Anne Attrodt, Dr. Dr. Christine Moll,
Dr. Dr. Frank-Hendric Kretschmer, Dr. Johannes-Simon Wenzler, Prof. Dr. Dr. Andreas Neff,
Prof. Dr. Andreas Braun, Marburg, Germany
Im Rahmen der Studie sollte die Schneideffizienz und die Wundheilung nach Inzision mit einem neuartigen dentalen Halbleiterlaser
(Wellenlänge 445 nm) untersucht werden. Im Fokus stand die Beurteilung von Behandlungszeit als auch das Heilungsverhalten nach
Laserinzision im Vergleich mit dem Skalpell.
Im Rahmen der Studie wurden zwei vergleichbare operative Eingriffe bei 15 Patienten im Mundraum durchgeführt. Studienarm I
beschreibt die Inzision der Mundschleimhaut mit einem Skalpell versus Studienarm II: Inzision der Mundschleimhaut mit einem 445 nm
Halbleiterlaser (445 nm, cw, 2 W). Im Rahmen der Nachuntersuchung
wurden die Parameter „verbliebene Wundfläche“ (VWF), GewebeKolorimetrie (GK), Behandlungsdauer und Patientenempfindung
erfasst. Die Wundfläche wurde anhand standardisierter Fotografien (Helligkeit, Abstand und Winkel) zu den Zeitpunkten direkt nach

dem Eingriff sowie eine Woche, zwei Wochen, einen Monat und zwei
Monate nach dem Eingriff festgehalten.
Es zeigte sich eine signifikant erhöhte Behandlungsdauer bei Laserinzision im Vergleich zur Inzision mit dem Skalpell. Postoperativ
wurde eine Reduktion des Schmerzempfindens bei Laserinzision
im Vergleich zur Skalpellinzision beobachtet. Bei Begutachtung der
klinischen Situation nach Laserinzision wurde eine Verminderung
von postoperativen Komplikationen wie Infekten und Dehiszenzen
beobachtet.
Die im Rahmen der Studie gewonnenen Ergebnisse zeigen, dass
eine Inzision oraler Schleimhaut mit einem dentalen Halbleiterlaser
der Wellenlänge 445 nm im Vergleich zu einer Skalpellinzision länger
dauert, allerdings postoperativ zu geringeren Schmerzen und weniger Infekten sowie Dehiszenzen führt.

Welchen zusätzlichen Wert hat das neue Scanhandstück des Fotona LightWalker
Er:YAG Lasers in der Implantatchirurgie?
Dr. Ingmar Ingenegeren, M.Sc. M.Sc., Bottrop, Germany
Ziel der Arbeit: Die Evaluation der Anwendungsmöglichkeit des
Er:YAG-Scanhandstücks zur Erlangung einer präziseren Knochenkavität zur Implantatinsertion.
Material und Methode: Der Fotona LightWalker AT mit Er:YAG und
Nd:YAG (2.940 nm und 1.064 nm) mit dem neuen Scanhandstück
(nach der Universität Aachen erste Installation in einer Praxis in
Deutschland) wurde erprobt an Eiern, Knochen, Fleisch und in vivo
bei der Implantatbettpräparation bei mehreren Patienten, um den
erhofften Vorteil des Scanners zu testen. Es wurde in allen Bereichen mit unterschiedlichen Parametern gearbeitet, um eine optimale
Einstellung herauszufinden. Pulslänge von MM (max mode) zu SSP
(super short pulse) und Leistung von 0 bis 1.500 mJ. Des Weiteren
wurde zur Implantatbettpräparation das tiplose Er:YAG-Handstück
und das Er:YAG-Handstück mit Tips angewandt, um einen Modus
zur Verbesserung der Präzision der Knochenkavität zu finden.
Ergebnisse: Auf der Eierschale produzierte der Scanner korrekte
quadratische oder runde Stellen, wie im Prospekt gezeigt. Auf kompaktem kortikalem Knochen (D1, D2) wurden runde Krater erzielt,
mit voreingestellter Tiefe von 1–2 mm und im spongiösen Knochen
(D3, D4) waren de Kavitäten weniger definiert, verursacht durch die
offene trabekuläre Struktur. Nur mit dem MM konnten tiefere Krater

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4 2016

erreicht werden. Sie waren konisch und bis 10 mm tief und somit
geeignet für Kompressionsimplantate. Auf Fleisch fand lediglich eine
oberflächliche Karbonisation statt.
Diskussion: Für eine transgingivale Knochenpräparation ist der
Scanner nicht geeignet: Es wird lediglich eine oberflächliche Weichgewebeschicht abladiert, was aber geeignet ist für eine Deepithelisation oder Karbonisation. In eine aufgeklappte Wundsituation ist
Geschicklichkeit vonnöten, um das relativ große Scanhandstück zu
manipulieren, sodass jeder Scanzyklus den vorherigen exakt überlappt, um eben die gewünschte Kavitätsform zu erreichen. Die erreichte Tiefe ist begrenzt und das Vorgehen wird eindeutig durch Blut
und Patientenbewegungen beeinträchtigt. Durch das umständliche
Hantieren in vivo ist es nicht möglich, gleiche, oder annährend ähnliche Resultate wie bei einer Labortestaufstellung zu erhalten. Der
konische Krater, geeignet für ein Kompressionsimplantat, hat keine
exakten vorhersagbaren Abmessungen. Durch die unsichere Richtungsbestimmung und die erschwerte präzise Aufsetzung ist der MM
in vivo (noch) nicht anwendbar. Obwohl für Schmelz- und Dentinpräparation, KFO und Schnarchtherapie das Scanhandstück seine
Berechtigung hat, lässt sich kein zusätzlicher Wert für die Implantatbettchirurgie erkennen.

[45] =>

Einfluss eines 445 nm Diodenlasers auf das Debondingverhalten
von Keramikbrackets
Dr. Steffen Stein, Prof. Dr. Heike Korbmacher-Steiner, Prof. Dr. Andreas Braun, Marburg, Germany
Ziel: Untersuchung zum Einfluss eines 445 nm Diodenlasers auf das
Debondingverhalten von Keramikbrackets.
Material und Methode: 30 Keramikbrackets wurden auf planen,
standardisierten Schmelzoberflächen von 15 extrahierten und
kariesfreien Weisheitszähnen standardisiert geklebt. Jeweils ein
Bracket einer Probe wurde vor der Entfernung mit einem 445 nm
Diodenlaser standardisiert und verblindet bestrahlt (Lasergruppe;
n = 15), das andere Bracket wurde ohne Laserapplikation entfernt
(Kontrollgruppe; n = 15). Vor der Bracketklebung (T0), nach der
Bracketentfernung (T1) und nach der Entfernung der Kunststoffreste (T2) mittels rotierender Instrumente auf der Zahnoberfläche
wurden mikroskopische Aufnahmen der Schmelzoberfläche in 10 x
und 20 x Vergrößerung zur Bestimmung von Schmelzausrissen und
des Adhesive Remnant Index (ARI) angefertigt. Sieben Proben jeder
Gruppe wurden zu den genannten Zeitpunkten abgeformt, um die

Schmelzoberfläche auf Schmelzausrisse im Rasterelektronenmikroskop unter 200 x und 500 x Vergrößerung zu begutachten.
Ergebnisse: Der ARI-Score wurde bei 10 x und 20 x Vergrößerung
in der Lasergruppe im Vergleich zur Kontrollgruppe statistisch signifikant (p < 0,05) reduziert. Schmelzausrisse wurden unter 10 x und
20 x Vergrößerung in beiden Gruppen nicht gefunden. Unter 200 x
und 500 x Vergrößerung im Rasterelektronenmikroskop wurden vermehrt Schmelzausrisse und Schleifspuren in der Kontrollgruppe zum
Zeitpunkt T2 gefunden.
Schlussfolgerungen: Durch die Anwendung des 445 nm Diodenlasers vor der Brackentfernung wird das Debondingverhalten signifikant beeinflusst und es kommt zu weniger Restadhäsiv auf der
Schmelzoberfläche. Dieses Ergebnis ist von klinischer Relevanz, da
das Risiko von Schmelzschäden und die Behandlungszeit während
der Bracketentfernung reduziert werden können.

Können Hayluronsäure und Laser die regenerative Parodontitistherapie
revolutionieren? – Klinische Beobachtungsstudie über zwei Jahre
Prof. (Jiaoshou, Shandong University, China) Dr. med. Frank Liebaug, Ellen Institut, Steinbach-Hallenberg, Germany
Hyaluronsäure ist aufgrund ihrer Eigenschaften in vielfältiger
Weise auch für die Zahnheilkunde sehr interessant. In den letzten
Jahren hat es im Bereich der allgemeinen zahnärztlichen, aber
auch insbesondere der parodontologisch und oralchirurgisch
orientierten Praxis dank Lasereinsatz bemerkenswerte Therapie-

strategien und positive Ergebnisse gegeben. Wie die additive Applikation von Hyaluronsäure die klinischen Ergebnisse im Rahmen
der Parodontitistherapie beeinflusst, soll eine klinische Beobachtungsstudie über zwei Jahre und der Einbeziehung von mehr als
1.500 Zahnfleischtaschen näher beleuchten.

Antibakterielle laserinduzierte Photodynamische Therapie –
Geschichte, Grundlagen, Anwendung
Dr. Hubert Stieve, Rendsburg, Germany
Inhalt:
– Geschichte der PDT, Tappeiner, München
– PDT ist in etlichen medizinischen Fachbereichen eine etablierte
Standartbehandlung
– Antibiose-Problematik generell und spezifisch bei dentaler Plaque
– Keimresistenzen Laser-Basics
– Interaktion Wellenlänge-Zielgewebe/Zielorganismus

– Vorbedingungen und Schritte der Anwendung bei Gingivitis/
marginaler Parodontitis/Periimplantitis 810 nm Diodenlaser/
Smart Laser
– Bedingungen für Delegierbarkeit der PDT
– weitere kleinere Indikationen für den Einsatz von 810 nm Lasern
– Benefit für Praxis und Patienten

laser
4 2016

[46] =>

25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


Implantologie – von der Freilegung zum fertigen Zahn in einer Sitzung
Dr. Thorsten Kuypers, M.Sc., Köln, Germany
Durch das Zusammenspiel des Lasers und der CEREC Omnicam sind
Freilegung und Versorgung eines eingeheilten Implantates nun in einer Sitzung möglich. Bei ausreichendem Angebot an Weichgewebe
ist die Freilegung mittels Erbiumlaser bei uns Mittel der Wahl. Durch
die aktuelle Soft- und Hardware des CEREC-Systems kann dann di-

rekt im Anschluss die fertige Restauration hergestellt und definitiv
eingesetzt werden. Die Vorgehensweise dieses Verfahrens soll anhand eines üblichen Falls dargestellt werden. Eine perfekte Passung,
begeisterte Patienten, eine enorme Zeitersparnis und Wirtschaftlichkeit machen diese Behandlung zu einer kleinen Revolution.

Kontamination von optischen Fasern im Rahmen endodontischer Laserapplikation
Dr. Marcus Krema, Hachenburg, Germany
Based on the results available, the infection of root canals from
teeth with pulpa necrosis with or without periapical lesions are
evidence-based. Therefore, the risk of a cross-contamination
during an endodontic treatment between different root-canals of the
same tooth is given. The aim of the study was to examine if there
is a contamination of the surface of a laser-fibre after conventional
chemo-mechanical endodontic treatment and as a consequence a
risk of cross-contamination by these optical fibres.
Materials and methods: 45 parts of an optical fibre were contaminated with E. faecalis in an in-vitro study to evaluate effective
methods of disinfection. Five groups were built. A control-group
without any disinfections arrangements, wiping disinfection, the
insertion in alcohol 70 % for 15 min, the combination of these
two methods and the sterilisation process by an autoclave. In the
in-vitro study, ten teeth by nine patients with suspicion of pulpa
necrosis with or without periapical lesions were examined. Five
groups were established. Before the root-canal treatment (rct) a
sterile paper point was put into the root canal and than placed on
an Agar-Plate. After the chemo-mechanical rct with a modificated

technique of the ProTaperNext™ system, a further sterile paperpoint was examined. Than the optical fibre was disinfected, used
in the root-canal for disinfection of the wall and the underlying
dentin. After three treatments each, the fibre was scratched out
on the Agar-Plate.
Results: The in-vitro study showed a heavy infection on all fibre
parts in the control-group. All other disinfection-methods were effective for a bacterial issue (one failure in the combination group).
The in-vitro study showed that a heavy infection of each root-canal
was present before the endodontic treatment. There is no additional growth of bacteria neither on the paper point after conventional
root-canal treatment nor on the optical fibre scratches.
Conclusion: There is no contamination on the surface of the fibre
after using it for the decontamination of the root-canal and the
underlying dentin following the described chemo-mechanical
root-canal treatment and disinfections methods. Therefore, by
using the described methods, a cross-contamination by an optical
fibre between two root-canals of the same teeth of one patient is
probably not given.

Ist eine Laserschnarchtherapie für Zahnärzte rechtlich zulässig?
Dr. Darius Moghtader, Oppenheim, Germany
Immer mehr Zahnärzte beschäftigen sich mit der Schlafmedizin und damit auch mit der Therapie des Schnarchens. Eine anerkannte Methode
ist die Vorverlagerung des Unterkiefers mit einer Protrusionsschiene.
Dabei ist es unstrittig, dass die Schnarchtherapie mit Schienen von
Zahnärzten durchgeführt werden darf. Neben dieser symptomatischen
Therapie werden neuerdings auch kausale Therapieformen mit Laser

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4 2016

entwickelt. Diese Lasertherapien zielen darauf ab, erschlafftes Gewebe zu straffen und damit das Schnarchen zu reduzieren oder zu verhindern. Nun stellt sich die Frage, ob diese neuen Therapieformen im
Rahmen des Zahnheilkundegesetztes ausgeübt werden dürfen. Dieser
Vortrag analysiert am Beispiel des SNORE3-Verfahrens der elexxion
AG den Status quo und gibt erste Antworten auf rechtliche Fragen.

[47] =>

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

[48] =>

25. INTERNATIONALE
JAHRESTAGUNG DER DGL
 LASER START UP 2016


Laserunterstützte Kariesdiagnostik – Evidenz und klinische Relevanz
Olaf Oberhofer M.Sc., Erwitte, Germany
In den letzten zwei Jahrzehnten hat sich die Prävalenz von Karies
als Resultat erfolgreicher Präventionsprogramme verändert. Das Erscheinungsbild von Karies hat sich ebenfalls verändert. Die meisten
beginnenden kariösen Läsionen entstehen unterhalb des intakten
Schmelzes oder in den Approximalkontaktstellen, welche im frühen Stadium mit den klassischen Diagnostikhilfsmitteln wie Spiegel, Sonde oder Bissflügelaufnahmen objektiv und quantitativ nur
schwer diagnostizierbar sind. Mit dem Paradigmenwechsel in der
Kariestherapie ändern sich zudem die Anforderungen an Kariesdiagnostikmethoden. Sie müssen schnell, sicher, mit geringen Kosten
und geringen Belastungen für Patienten sein. In der Praxis ist eine
hohe Sensitivität und Spezifizität an den Messmethoden zu fordern.

Karies soll sicher und reproduzierbar auch im Anfangsstadium erkennbar sein. Ein sicheres Kariesmonitoring, eine Unterscheidung
von passiver und aktiver Karies muss möglich sein.
Frühzeitige Erkennung von Karies war und ist das Ziel laserbasierter
Kariesdiagnostik. Seit nahezu zwanzig Jahren werden dafür geeignete Lasersysteme für die Praxis entwickelt. Welche Relevanz haben
die laserbasierten Kariesdiagnostikmethoden für die Praxis? Sind sie
einfach in der Praxis integrierbar? Welchen wissenschaftlichen Hintergrund für diese Methoden gibt es? Ist die Anwendung dieser Methoden
rechtlich abgesichert? Diese Fragen werden im Vortrag beantwortet.
Es werden klinische Beispiele verschiedener Laserdiagnostikgeräte gezeigt und dazu die wissenschaftlichen Hintergründe aktuell dargestellt.

Innovative Wege in der Zahnmedizin: Er:YAG- und Diodenlaser im Einsatz –
Anwendungsbeispiele
Dr. Dr. (UMF Bukarest) Simona Baur, Zirndorf, Germany
Der Laser hat in der Zahnheilkunde inzwischen einen hohen Stellenwert erreicht. Die Bedeutung des Dentallasers als sinnvoll genutzte
Behandlungsalternative in der minimalinvasiven Zahnheilkunde wird
in diesem Beitrag herausgearbeitet. In ausgewählten Falldokumentationen wird zum einen gezeigt, wie der Er:YAG-Laser (2.940 nm) in
der Kavitätenpräparation (Kariesentfernung im Schmelz und Dentin)
und chirurgischen Behandlungen effektiv genutzt werden kann. Zum
anderen kommt der Diodenlaser (810 nm) in Beispielen der chirurgische Behandlung, Parodontalbehandlung und Bleaching zum Einsatz.
Die Fallberichte umfassen verschiedene Therapiemöglichkeiten bei
Patienten mit diversen Erkrankungen von Hart-und Weichgewebe im
Mundbereich. Pre- und postoperative klinische Symptome, postoperative Entwicklung und das Wohlbefinden der Patienten im Zusammenhang

mit den angewandten Arbeitsmethoden werden im Detail herausgearbeitet. Besonders in der Kinderzahnheilkunde hat die lasergestützte
Therapie (Kariesentfernung, Frenektomie, Freilegung etc.) signifikante
Vorteile gegenüber den konventionellen Therapiemethoden.
Die klinischen Ergebnisse zeigen bei der Verwendung von Er:YAGund Diodenlaser eine optimale Effizienz der Behandlung sowohl im
Hart- als auch im Weichgewebe. Gerade in Kombination mit dem
richtigen klinischen Prozedere ist die Akzeptanz bei Kindern und
Er wachsenen sehr hoch. Laserunterstütze Chirurgie, Parodontalbehandlung, Kariesentfernung und das Bleaching ermöglichen vor
allem einen erhöhten Patientenkomfort und Reduzierung der Dauer
der Operation mit verkürzter Abheilungszeit. Dadurch kann der Einsatz des Lasers klinische und wirtschaftliche Vorteile bieten

Die DIAGOcam im Praxiseinsatz
Dr. Thorsten Kleinert, Berlin, Germany
Mit dem Einsatz der DIAGNOcam erhöht der Zahnarzt die Diagnosesicherheit bei der Erfassung kariöser Läsionen. Somit ist ein Kariesmonitoring ohne zusätzliche Strahlenexposition für den Patienten möglich. Die anschließende Versorgung der Zahnläsionen wird präventiv

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4 2016

oder kurativ minimalinvasiv erfolgen. Im Vergleich zum DIAGNOpen
und DIAGNOdent existiert ein bildgebendes Verfahren, das mit einer
Röntgenaufnahme vergleichbar ist. Eine quantitative Aussage wird
jedoch nur in Kombination beider Verfahren möglich sein.

[49] =>

Antwort:
Deutsche Gesellschaft für Laserzahnheilkunde e.V.
c/o Universitätsklinikum Aachen
Klinik für Zahnerhaltung
Pauwelsstraße 30
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BIC: AACSDE33

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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.

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[50] =>

| imprint

laser
international magazine of

laser dentistry

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4 2016

[51] =>

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Vol. 8 • Issue 4/2016

research
Blue light laser-assisted
crown lengthening
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Thermal damage behaviour
dental pulp stem cells

laser dentistry

2016

case report
Haemostasis in oral soft
tissue and extraction socket

research

Blue light laser-assisted
crown lengthening

research

Thermal damage behaviour
dental pulp stem cells

case report

laser 4/16

Haemostasis in oral soft
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• Fast regeneration/healing
• Reduced inflammatory response
• Highly effective treatment
• No antibiotics needed

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[cover] => laser international No. 4, 2016

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Table of contents

[toc_titles] =>

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