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dkimmelSpectatorNice to see Dentistry Today with some good Laser articles. Nice job Eric!
David
Glenn van AsSpectatorEric , it was a very interesting read, it jogged alot of thoughts on my part and I will have to read it agian
The literature that is mainstream needs articles like yours to make dentists aware of the necessity to get adequate training before or shortly after they purchase their product to use it to its maximum efficiency safely.
thanks for sharing it and wonderful stuff
Glenn
SwpmnSpectatorI’m not sure what the heck I just read, reminds me of the Spanish classses they forced me to take and barely passed to get in grad school.
From a clinical perspective:
1) Why would the operator want to contact hard, mineralized dental structures with an erbium laser tip? What are the advantages? The erbium lasers I use ablate hard tissues effectively out of contact at approximately 1mm. Is the proposal that the ablation is more efficient when used in contact? I did not find that at all in my extracted tooth experiences with the Opus Er:YAG system. Is the “Contact Concept” geared toward non-laser users which are accustomed to tactile feedback from a carbide/diamond bur in a high-speed handpiece?
2) Wouldn’t keeping an erbium laser tip out of contact with the substrate avoid all of the proposed negative sequelae? Heat buildup in the target site is avoided, the absorption spectrum shift of water molecules should be reduced and also the “ejecta” or products of ablation are efficiently washed away to facilitate the next ablation pulse of the erbium laser.
No disrespect is intended toward Dr. Bornstein but just seems to me that recommendations of “up and down” and “back off” indicate that ablation efficiency with an optical surgical instrument is best when used defocused or out of contact.
Al
michael simSpectatorThe shift of the absorption effectiveness shifting to a LOWER wavelength at HIGHER temperature may be the reason why the Biolase laser operates at a lower wavelength instead of the 2940nm we use. Does this also mean that the Er.YSGG laser MUST OPERATE AT A HIGHER TEMPERATURE? Will this therefore create potential thermal damage to the dental structures deeper beneath what we are cutting/ ablating ?
dkimmelSpectatorAllen, There is help! Lets get Al to present the paper this month at our meeting.
David
SwpmnSpectatorQUOTEThe shift of the absorption effectiveness shifting to a LOWER wavelength at HIGHER temperature may be the reason why the Biolase laser operates at a lower wavelength instead of the 2940nm we use. Does this also mean that the Er.YSGG laser MUST OPERATE AT A HIGHER TEMPERATURE? Will this therefore create potential thermal damage to the dental structures deeper beneath what we are cutting/ ablating ?I believe a study done by Daniel Fried indicated that a 2790nm erbium initiated enamel ablation at about 800 degrees Celsius while enamel ablation with a 2940nm erbium started at around 400 C.
Does this really translate into anything clinically as long as the treatment site is properly irrigated and cooled with water? In my opinion the answer is no. I use both wavelengths clinically and see no trend of the Er,Cr:YSGG erbium causing pulpitis/necrosis.
Al
Glenn van AsSpectatorBut it can cause the operators hair to fall out!!
Just kidding.
Glenn
SwpmnSpectatorQuote:But it can cause the operators hair to fall out!!/quote]Arf, arf, very funny.
At least my BMI(Body Mass Index) is below 27. It’s an obvious fact that use of the 2940nm erbium above the 49th parallel results in the operator developing a “spare tire”.
Al:wink:
SwpmnSpectatorFor some clinical feedback regarding the use of contact tips with erbium lasers:
This evening I had dinner with a local colleague who utilizes the Opus Duo(specific reference to the 2940nm Er:YAG). He relayed to me that he likes the contact tips because they give him the tactile sensation that we are so familiar with when using burs in a high speed handpiece. I’m still quite interested in any physical or tissue interaction advantages when erbium laser tips are used in contact. Can anyone help with their knowledge or perhaps propose a theory?
Al
SwpmnSpectatorFrom correspondence with the author of the paper, Eric Bornstein DMD:
1) Contact tips with erbium lasers afford the operator the advantage of the tactile sensation dentists are accustomed to while utilizing burs in dental handpieces. These contact tips have a narrower margin of error(heat buildup) when compared to erbium tips used in a defocused or out of contact mode. In order to avoid the negative sequelae of heat buildup at the ablation site, it is most important to only keep the tip in contact for one to two seconds and then back off from the treatment area. This was the purpose of the paper, to educate doctors using contact tips on proper technique and warn them not to keep pushing with an erbium tip like we do with a bur.
2) There are no physical or tissue interaction advantages with erbium laser contact tips. The purpose of the contact tip concept is simply to provide the clinician with tactile feedback. Dr. Bornstein added that he finds this particularly useful when performing apicoectomies and alveoplasty.
Al
AnonymousGuestHeads -up!
Coming in April (Dentistry Today)- CW near infrared Diode, and its use in Closed Periodontal Pocket procedures.This paper has more than 25 references from across the dental/medical spectrum, to help illustrate the points about “hot tips” in the closed environment of the periodontal pocket.
Soon as its in print it will be here also!
Thanks E.B.
Dentist2013SpectatorLasers are revolutionizing the dental and medical world as i think. Laser dentistry is fascinating, but for many of us it is confusing — access to information is limited because the cutting-edge technology is so new. Lasers may just revolutionize the way we practice dentistry and change the way we approach periodontal disease as a whole.
dentaltourismguideSpectatorThis is really great information article …
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