understanding your diode laser - ald · understanding your diode laser 1. diode vaporize so! tissue...

Soft Tissue Surgery using the Er:YAG laser @2940nm(PowerLase/ LightWalker) and the

1064 nm semiconductor laser ( Xlase)

Lawrence Kotlow DDS 1/1/2013

Some practitioners fail to recognize and treat

abnormal oral conditions.

Some practitioners choose to ignore abnormal

oral soft & hard tissue problems.

Some practitionersrefer all soft tissue abnormalities and

pathology out.

Missed opportunities & lost income

Lawrence Kotlow DDS 2012 2

Understanding your diode laser1. Diode vaporize so! tissue by a photothermal effect 2. Tissue is heated and vaporized,excised or incised by direct contact of the laser tip to the tissue.3. The two desired tissue interaction of laser energy are absorption and scattering which increases absorption by increasing the number of target chromophores potentials. 4.Primary targeted tissue is pigmented tissue ( tissues that contain hemoglobin and/or melanin).5.The 1064 and 980 wavelengths are more highly absorbed in water than lower wave lengths such as the 810 nm6.Delivery is by fiber or replaceable fiber tips7.Lower cost and easier portability8.Continuous wave and gated or pulsed wave


There are a variety of dedicated soft tissue lasers available in the wavelength range of 810 nm though

1064 nm which can be classified as a semiconductor or diode laser.

1064

xlasetechnology4medicine


Understanding your Erbium lasers 1.The Erbium family consists of two very close wavelengths

a.Erbium : YAG @ 2940 nm b. Erbium,Chromium:YSGG @2780 nm2.Delivery is either by Fiber or an Articulated arm3.So! tissue surgery is completed without the need for water due to the high water content of the so! tissue.4.Tissue ablation,excision or incision is by photo-acoustic activity rather than photothermal, which causes the primary chromophore - OH (water) within the tissue to explode.5.Free running pulsed6.Non-contact


The effect of pulse duration on tissue ablation and control of bleeding

1. Pulse durations longer than 700 usec provide residual thermal energy for for coagulation.2. Pulse durations in the range of 50-100 usec are precise and appear to accelerate hard issue ablation and reduce patient discomfort

****Principles and practice of Laser Dentistry 2010 CONVISSARRef 73: Nishimoto Y et al :Effect of the pulse duration of the Er:YAG Laser on dentin ablation Dent

Mater J 27::433-439 2008

Lawrence Kotlow DDS 2012

Hemostasis can be attained by using Erbium lasers having long pulse durations which a+ow for good

control of bleeding.

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The Erbium Family2780 nm & 2940nm

Biolase

ConBio

Lares(Fotona)


Erbium : YAG @ 2940 nm

Er, Chromium:YSGG @2780 nm

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WUcIWYG WUDcSIWYG

Extremely important concept


Erbium lasers Diode lasers

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Soft tissue procedures in pediatric and orthodontic practices

Procedure Diodes/Nd:YAG Erbium 1. Maxi+ary lip-tie yes yes 2. Lingual tongue-tie yes yes3. Biopsies yes yes4. Herpes labialis most effective yes5. Aphthous ulcers yes yes6. Lip-split tissue welding ? yes7. Venous lake lesion removal yes n/a8. Mandibular ,enum revision yes yes9. Caries exposure yes yes


Soft tissue procedures in pediatric and orthodontic practices

Procedures Diodes/Nd:YAG Erbium

10. Phase three orthodontics yes yes a. Gingival recontouring yes yes

b. Gingivectomy yes yes11. Alternative to mandibular yes yes cle! gra!ing/ ,enectomy12. Periodontal therapy yes yes 13. Pulp therapy ? yes14. Exposure of unerupted teeth yes yes15. Crown lengthening yes yes16. Pericornal flap problems yes yes


Su-ested Settings for so! tissue surgery

Erbium:YAG 2940 nm LightWalker/Powerlase AT Spa1. Surgical settings for excision of so! tissue 20-30 Hz and 55-100 mj using longer pulse durations (LP 600 msec )

1064 nm xlase laser1. Surgical settings for excisions f so! tissue pulsed or gated at 24 msec on 18 msec off 200u fiber 1.5-3.0 w (in most cases actual power wi+ remain below 1.5 w)


*Be careful of preset factory settings

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Preparing your laser tips & fibers for surgery

Erbium1. Quartz tips can be reshaped and polished2. Sapphire tips are hotter than quarts at same settings and may not be polishable

1064 fiber1. Fibers must be cleaved prior to eachprocedure and may need additional cleaving if the procedures are long or difficult.

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Maxi+ary lip-tie (also know as maxi+ary ,enectomy !Older children and teen-aged patients

The maxillary frenum should be redefined and identified as a vertical band of lip tissue extending from the inside portion of the upper lip attaching to the alveolar mucosa of maxillary arch. In certain instances this attachment may become a factor in limiting the mobility and function of the upper lip, other times this tissue attachment may not appear to create any significant problems.


Maxi+ary lip-tie (also know as maxi+ary ,enectomy !Older children and teen-aged patients


1064 laser

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Er:YAG laser

Preoperative One year later

No scaring, no orthodontics and not waiting until age 9-12

two years later

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Maxillary Lip-Tie revision, emla

Preoperative post-op

No scaring, no orthodontics and not waiting until age 9-12

2006 2007 2010

1710/6/107/3/08

28 year old female

5 days post surgery

Ankyloglossia

1 week post surgeryLawrence Kotlow DDS 2012 1064 laser 19

erbium

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ErbiumSix days post-op

Thick tissue required local anesthetic

Suture placed toprevent reattachment

Lingual ,enum revision with local and suturing

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Biopsies

6 days post


1064 laser22

Biopsies


BiopsiesBiopsy of mucocele


Biopsy

Biopsy of mucocelelocal anesthetic

suturesPowerLase AT

Six days post-op

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Biopsy

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Mucocele & Maxillary lip-tie surgery :Female BD 2/6/06Lip-Tie Revision-2/3/11 Mucocele 1/27/11

1064 Diode 24/18 2.5w 200u Combined Er:YAG/106420/75 LP 24/18 2.3w

Six days post

Six days post surgery

14 days post

Herpes labialis


1064 laser

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Herpes Labialis200u .5-.7w cw 2 minutes


24 hrs 4 days

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Aphthous Ulcers


Er:YAG

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Aphthous Ulcer Treatment

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Aphthous Ulcer 1064 laser

1064 nm CW .5w32

The photothermal effects of laser energy

37- 50 C Tissue warming

60- 70 C Coagulation & protein denaturing

Tissue welding

VaporizationCarbonization

70- 80 C

100- 150 C > 200 C

> 50 C Bacteria deactivation

Photothermal heating effects in soft tissue

Tissue welding using Erbium lasers


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Tissue weldingTissue welding of split lip

Immediately after Laser treatment

Approximately 48 hours

post treatment

19 days post treatment


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Removal of venous lake lesionsDiode : Removal of *venous pool 8yr old female

980 nm or 1064 .6w 300u/200u fiber cw

14 days post 3 months postLawrence Kotlow DDS 2012

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Removal of venous lake lesionsDiode : Removal of *venous pool 8yr old female

980 nm or 1064 nm @ .6 w 300u/200u fiber cw


Removal of impacted teeth Mandibular frenum revisions ( alternative to gingival grafting)

Periodontal problems: mandibular frenum release

Pre-surgery Post-surgery


Mandibular frenum revisions


1064 laser with using topical only 39

Mandibular frenum revisions

1064 laser with using topical only 40

Mandibular frenectomy (OFD)

6 days post op

9/25/2012

7/30 /2010

1064 gingivectomy

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8 days post surgery

Crown lengthening to expose cariesPericoronal flap problems


!Erbium:YAG!Lasers• Lasers&are&an&effective&alternative&for&

treating&pulps&with&the&additional&the&benefits&of&providing&pulp&therapy&

without&the&need&to&introduce&chemicals&into&children’s&systems.&

45

Pulp therapy in primary teeth


Pulp therapy in primary teeth


10/30/2007

10/30/20078/30/2002

8/30/2002

5&years&&2&months

5&years&&2&months

47

Phase III orthodontics


Orthodontists using lasers may need to consider the effect of doing their own so! tissue surgical

procedures and how it could effect referral sources.

48

Exposure of crown or crown lengthening for orthodontic bracket placement




one week post-op

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1/5/11



Lawrence Kotlow DDSPractice limited to pediatric Dentistry

WWW.KIDDSTEETH.COM

Topical only 15 Hz /100 mj

51

Exposing teeth for Orthodontic Bracket placement

52Lawrence Kotlow DDS

Topical anesthetic only :Emla1064nm laser 24/18 300u 1.2w

Gingivectomy during or immediately after orthodontic treatment


Intercepting the decalcification process

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Lip-tie release and gingivectomy

8 days post-

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Gingivectomy during or immediately after orthodontic treatment


5 days post surgery

Combined mandibular ,enum revisions and gingivectomy

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Due to all lasers creating a photobiostimulating effect once the laser is used you can use your conventional instruments and then finish the

procedure using you laser

Lawrence Kotlow DDSPractice limited to pediatric Dentistry

WWW.KIDDSTEETH.COM

Cut first and finish using your laser

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Removing hyperemic tissue

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Six days post treatment

Erbium Laser with local “Cut” and laser

Removing hyperemic tissue

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Gingival reshaping after orthodontic removal of brackets

Lawrence Kotlow DDS 2012Erbium

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Torus removal :Er:YAG

Removal of boney lesions and recontour soft tissue post op

Photos courtesy of Dr. Don Coluzzi61

Gingival reshaping after orthodontic removal of brackets


Additional non-traditional pedo-ortho procedures


Periodontal disease treatmentsFiberotomyImplant recoveryEndodontics: PIPS(lares)ApicoectomiesClosed flap crown lengtheningTorus removal

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Apicoectomy :Erbium 2970nm

Don Coluzzi 64

Surgery: adult tooth removalDifficult extraction using Erbium:YAG


1 month post-op

Open flap bone reduction


1 month post-op

Closed bone reduction

Don Coluzzi

Soft tissue removed first

Closed flap osseous removal

67

1 month post-op

Closed bone reduction

Don Coluzzi

Soft tissue removed first

Closed flap osseous removal

68

“If we don’t change, we don’t grow

If we don’t grow, we aren’t

really living !”Gail Sheehy


THANK YOU

Thank you for you interest and time today


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understanding your diode laser - ald · understanding your diode laser 1. diode vaporize so! tissue...

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