Lasers in dentistry have been available in one form or another for a good few years and the current renewed interest in UK dental circles in laser applications is a relatively recent phenomenon. The clinical benefits of applying lasers in treatment are many, as along with reduced patient discomfort and more rapid post operative healing, they are easy to use. Laser clinicians appreciate the laser as a primary tool of choice due to the excellent precise and predictable tissue control that makes so many procedures relatively easy, quicker and cleaner. Subject to adequate training and providing they have bought the right one, current laser users are happy with the technology. So what historically has been the bar to the uptake of lasers within the profession?
I think the answer to this is due to a number of reasons of which the issues of cost and the hassle of registration with the Care Quality Commission have been significant factors. More manufacturers are now building and selling lasers to dentists, the cost is coming down and a top quality diode laser can now be purchased at a cost affordable by any dentist. As a result lasers are slowly beginning to appear in NHS/mixed economy surgeries as well as the exclusively private practices. As for the CQC, all dental practices fall under the impending new registration requirement regardless of whether or not they use a laser so this is no longer an issue.
The range of applications available to the laser user does depend on what laser they own as a diode laser cannot cut through hard tissues. The biggest single advantage of the laser is the ability to manipulate soft tissues. Any kind of soft tissue surgery becomes a joy as there is little if any bleeding which makes the operator’s life a good deal easier and the patients appreciate the first class clinical outcomes. The soft tissue applications of lasers are many including laser assisted bacterial reduction in periodontal pockets, along with gingivectomy, frenectomy, troughing, pulpotomy, exposure of implant heads, excisional biopsy, low level laser therapy and bleaching. All of these very valuable treatment modalities can be achieved with a relatively cheap diode laser. Also, in combination with a few simple hand instruments, it is possible to do flapless osseous crown lengthening. Any dentist worth his salt will want a laser when he sees what it can do for him as clinical dentistry becomes a deal easier when you have the right tool for the job. For soft tissue applications the diode is a wonderful piece of kit.
When choosing a diode there are certain features definitely worth having. The best wavelength to go for is in the 940-980nm range as this wavelength permits cutting in relatively avascular tissues and requires much less power to do the job. Less power equals less energy being dumped into the tissues which in turn means less trauma and quicker healing. I work with the top of the range diode from Biolase, the Ez-lase and I rarely if ever use more than 1.5watts, as opposed to some cheaper diodes which need 3-4watts to achieve the same cutting ability. The Ez-lase has a whole host of advantages for the clinician, including the easy to bend, quick to fit fibre tips. Most diodes need the fibre to be stripped and cleaved prior to use which takes valuable surgery time. The bendable tips for the Ez-lase make it easier to gain access to surgical sites. The handpiece is slim and the touch panel controls are easy to use so the initial learning curve is very short, and it is fast and simple to apply in a busy surgery setting. This unit also has a special healing attachment that can be used for low level laser therapy (LLLT) and promoting healing. The benefits of LLLT have to be seen to be believed: the near immediate relief of myogenic pain associated with TMD is like a miracle to the patient. I have seen swelling associated with trauma markedly reduce in under a minute. Surgical wounds exposed to LLLT heal three to four times faster than normal with much reduced pain and swelling.
Biolase have recently launched a new 940nm diode called i-Lase. This is in the form of a highly portable pen laser which takes the same ready prepared tips as the Ez-lase. It is highly portable and the ergonomics are great as it is a hand operated unit with no cables or foot switches. It is being marketed at roughly half the price of its big brother the Ez-lase and I expect it will prove a very popular buy at the forthcoming BDTA meeting at Excel.
Dental lasers are now mature technologies which are being adopted worldwide as the new gold standard in clinical care. At present, lasers have not been widely adopted within the UK which is surprising considering the benefits to be had at a very modest cost. I expect over the course of the coming decade most UK clinicians will have adopted a laser of one form or another.
Mark Cronshaw regularly lectures for Henry Schein Minerva, covering a wide range of topics on laser dentistry. Courses will be taking place across the UK on the following dates:
A practical introduction to lasers in dentistry: Two day intensive course
November 19–20 London
Diode in dentistry foundation course
December 10 London
For more information visit www.henryschein.co.uk and click on education or www.biolase.com