Laser Assisted Dentistry In The st 21 Century

A presentation by Mark Cronshaw B.Sc,BDS LDS MFHom(Dent) Fellow World Class Laser Institute UK Dental Laser Academy Private Practice Cowes

The Magic of Lasers

Pre course Questionnaire:

Please answer the following

question: a. I am a laser owner b. I do not currently own a laser

Lasers in Dentistry:

There are many types of lasers available in dentistry today

Waterlase MD & Waterlase i-Plus

Erbium Chromium
Yttrium Scandium Gallium Garnet (ErCr:YSGG) 2780nm

Wavelength Type 1V laser

(light amplified stimulated emission of radiation)

Ez-lase and i-Lase:

Both are diodes (semiconductors) Wavelength 940nm Type IV lasers

What is the advantage of the laser over conventional methods?

Why not stick to conventional techniques?

Laser safety
Isn`t it a bit dangerous?

Is it safe?
Safety limit set at 5cm for the
Waterlase mm

Effective cutting range within 1-5 Precise and clean cuts Minimal risk of thermal trauma Superb control of all parameters

 Safety limit set at 3m for the

Ezlase/Ilase

Safety glasses for 940nm essential! Effective cutting range in contact

only

Precise and clean cuts Minimal risk of thermal trauma Superb control of all parameters

 Hard tissue: class I,II,III,IV,V,VI Caries removal Surface roughening and etching Root canal: all stages of preparation
including debridement and cleaning

Indications for the Waterlase:

Pulpotomy

Further indications for the Waterlase:

Endo surgery: flap preparation,bone

removal,apicectomy. Removal of cysts and granulation tissue

Bone: cutting,shaving,contouring

and resection. Osteoplasty,grafting and osseous crown lengthening, remove tori, prepare implant sites

...even more applications for the Waterlase!

Periodontal applications:

gingivectomy, laser curettage, decontaminate pockets frenectomy, excise polyps, remove mucocoele etc etc!

Other oral surgery applications:

The Waterlase MD & the Waterlase i-Plus add many additional procedures:

Less referrals to specialists Better clinical outcomes: less

pain/quicker healing times

Increased revenue Happy patients!

Diode applications:
Haemostasis Crown troughing Sulcular debridement Gingivectomy/gingivoplasty Frenectomy/frenotomy Implant recovery Excisional/incisional

biopsies Operculectomy Crown exposure Tooth whitening Ulcers

Diodes offer many clinical benefits at a low cost

Highly versatile Inexpensive Easy to use Hi-tec Excellent clinical outcomes

But why bother??

What can a laser do for me that offers any advantage over my current techniques?

An introduction to laser dentistry:

21st Century solutions to old problems!

Pretreatment: aesthetic recontouring

Diode gingivectomy

One week post treatment

The gingival component is often a management problem

Elevation of the incisal plane and crown lengthening surgery (closed flap)

Gummy smile reduction:

Crown lengthening surgery: before and after

Same case at two years:

 Bone may need to be removed to

prevent gingival regrowth

Crown lengthening surgery may require osseous recontouring:

Hard tissue lasers allows for

flapless minimal approach

Less pain/ faster healing Increased case acceptance due to

reduced trauma

One week later

How useful is a diode for crown lengthening?

Soft tissue reduction only Can be used together with special

bone chisels for flapless osseous remodelling

Care in case selection! Not recommended for flap incisions

Why Laser Perio?

 Limited availability Frequently inadequately diagnosed Dated management philosophies As a result: treatment frequently
fails

Periodontal care in the UK:

Regarded historically as the poor

cousin to restorative and surgical dentistry

 168% increase in risk of heart attack

(42% if gingivitis alone!)

Systemic effects & health risks:

250% increase in risk of stroke 300% increase in risk of diabetes 500% increase in respiratory disease 700% increase in chance of
premature birth risk?

Harvard study: increased cancer

The scale of the problem:

10% of the population are highly There are only 300 registered Medico-legal settlements of

susceptible to periodontal disease specialist periodontists in the UK! supervised neglect run to 5 figure sums

Site Specific Perio

Scaling and Root Planing & Local Chemotherapeutics Do not disrupt the Biofilm

The need for curettage: Which is more effective and kind?

Diode periodontal treatment

Dr. Solveiga Kelbauskiene Kaunas Medical University Kaunas, Lithuania

Laser Induced Gingival Reattachment In Periodontal Disease Using The Waterlase Versus Conventional Methods

Conclusions
The average pocket reduction of those teeth All pockets treated with the laser were
treated with the laser was at least twice that of those treated conventionally. reduced to normal probing depths at 3,6,9 and 12 months post operatively. and 78% of the laser group had bleeding on probing.

Before treatment 74% of the non laser group After 12 months 29% of nonlaser group still
bled and only 8% 0f laser group had bleeding.

Non surgical treatment of an infrabony defect

Non surgical New bone

Marked

management

reduction in pockets

What else can the laser do?

Frenectomy: an easy procedure with

many clinical indications- speech difficulties, gingival recession, stabilize implant sites, orthodontics scarring/no bleeding

No sutures/ fast healing/ no

9 MOS POST OP

12 MOS POST OP

NURIN 2009

Removal of a fibroma:

One week later

Low Level Laser Therapy:

Low level laser Activates Reduces

mitochondria inflammation

energy promotes healing

Reduces post

treatment pain

Whitening

Whitening procedures

Clinical Results
Typical results range from 6 to 12 shades of improvement on the Vita Shade Guide Brightness Scale
BEFORE LASER WHITENING AFTER LASER WHITENING

Results may vary depending on type of stain, enamel thickness, tooth structure, and age

The very latest laser from Biolase:

Waterlase iplus:
An emerging new World standard in
dental laser technology

Able to do hard and soft tissue

procedures quickly and easily

Much improved user interface to More power, higher hertz

facilitate new users in applications

 All tissue surgery (diode is soft

Waterlase iplus:

tissue only): excellent for crown lengthening surgery, no flap surgical extractions as well as the optimum tool in periodontal disease management quicker cavity preparation, often without need of a local anaesthetic dilemmas

Enhanced ability to do more and

One stop solution to many clinical

These three pen lasers look very similar....

i-Lase features:
Peak power of 5w Unique Comfortpulse technology:
reduces post operative pain and discomfort all the common soft tissue procedures

Easy to use with factory settings for Excellent ergonomics

There are however many points of difference!

Max power i-Lase 5watts versus 4 Watts Quicklase
& 2 watts NV Discus

i-Lase 940nm wavelength vs 810nm for the i-Lase has an excellent range of tips: more
operator choice/easier procedures

others:940nm cuts at much lower energy in avascular tissue cf 810nm

Pulse form: i-Lase has unique comfort

pulse:reduced heat build up. i-Lase has three different pulse settings vs. one for the Quicklase and two for the NV Discus

940 nm The New Standard in Diode Lasers from the World Leader in Laser Dentistry
Optimum absorption for haemoglobin and water Less energy required to cut through avascular tissue

Unique ezlaseTM pulsed mode TM cool cutting - Comfortpulse

Laser clinical advantages:

Faster healing: excellent tissue

response

Less trauma: reduced bleeding Precise control & easy to use Highly adaptable with many clinical
applications investment

Excellent revenue return on Popular with patients!

Every dental practice in the UK deserves a laser!

Lasers are being adopted Worldwide Within a decade the majority of

as the tool of choice in clinical dentistry: in the USA 15-20% already own a laser dentists will choose to use a laser due to the excellent clinical results!

Post course questionnaire:

Please answer the following:

a. I would like to introduce laser treatments in my practice b. I am happy with my practice without introducing new technology

..thank you for your kind attention!

Thank you ! Any Questions?

Mark Cronshaw macron5@hotmail.com

Laser Education Programme

Friday 11th November 2011 London HS Education Centre 18 Stanhope Place London W2 2HH Friday 2nd December 2011 London HS Education Centre 18 Stanhope Place London W2 2HH

Friday 28th & 29th October 2011 Cardiff HS Education Centre Courtney House Pacific Business Park, Pacific Road Cardiff CF254 5HJ