Forums › Other Topics › Continuing Education › Waterlase All Tissue seminar
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BenchwmerSpectatorI am attending a seminar tomorrow night being held by a local Periodontist.
Anyone have any questions or need any information?
I’ll be glad to ask.
I have to see what I’m missing.
Jeff
AnonymousGuestAsk him/her to show you some science. The last periodontist I saw present Waterlase soft tissue procedures quoted nd:YAG studies.
Have fun 😉
Glenn van AsSpectatorI would love to see the science behind Er,Cr:YSGG and perio…….
I am not aware of the research being out there with the laser and perio. I really cant think of anything positive for using the erbium for perio treatment.
If it is one wavelength for all then I guess you gotta use it.
For my money the NdYag is the one for perio ……..
Ah and one more thing……ask him how it works!
Just kidding just kidding.!!!!
Glenn
BenchwmerSpectatorAttended a nice presentation. About 8 dentists. Periodontist did live procedures on 2 patients (Cl I preps, anesthesia, frenectomy, perio flaps, GVs). Everything worked well, nice results.
The salesman told me that I don’t need my PerioLase, the Waterlase has studies showing new attachment in PerioPockets. Average 1mm of new attachment for each laser treatment. Told me studies are on the Website, BioLase.com. Can anyone help me locate these studies?
Jeff
2thlaserSpectatorJeff,
I have to agree with you, there are NO scientific controlled studies for the Waterlase use in Perio. Just articles like you will find on the Biolase website. Clinically, I have seen many practitioners, have excellent success with it in perio tx, however, I am a bit nervous to use it in a pocket myself, as one can see under high power magnification, that even at .5W, this thing can cut tooth structure and bone, if aimed at it, very easily.
Here is the site for that “article”: <a href="http://www.biolase.com/clinicalarticles/Trovato_Perio_Oct2002.pdfLet” target=”_blank”>http://www.biolase.com/clinica….f
Let us know what you think.
Mark
BenchwmerSpectatorMark,
Another thing that bothered me in watching the demonstration, was that no laser safety glasses were being used. When I mentioned that broach of laser safety, they quickly placed a clear pair of glasses on the patient. The salesman stated there is no concern eye damage from the laser because of the limited 1/3 mm zone of penetration, but there is concern for laser energized water that could cause eye damage. Never heard of that one before.
Is this BioLase policy?
When asked how many handpieces and cost came w/ the laser, He stated that the laser handpieces don’t need to be autoclaved between patients (that only 30% of Waterlase dentists follow that sterilization regime).
There were many other statements made, that made me bite my lip and stay quiet as not to disrupt the program.
I didn’t ask the dentist giving the demonstration about his sterilization criteria.
Demonstated was an anesthesia technique of firing the tip into the sulcus at all four line angles of the tooth for thirty seconds each, prior to tooth preparation in addition to defocused painting of the tooth for LA. I believe the power was set at the lowest setting .25W, however no power meter was used to confirm tip output. I was told there was no need after calibration at set-up. Looked scarey to me.
Laser safety and sterilization protocal is important for all of us as laser users. Bad incidents will condem us all in the public eye. As the market leader, I would hope Biolase would promote laser safety to their users.
This is the third different salesman representing Biolase that I have had serious problems with his knowledge of lasers, false claims, complete disregard of laser physics and a complete my laser is better than yours in every category attitude. It pushed me to purchase a different product 2 years ago.
The performance of the laser and operator was wonderful, but I left the demonstation with a bad feeling.
Jeff
Glenn van AsSpectatorThats too bad Jeff………I think it is in everyones interest to promote laser safety and to practice with the highest degree of sterilization possible.
I want to confirm Marks finding that even at .5w the laser can cut cementum, bone and dentin. It wont do that much on enamel but lightly etch it.
I have seen now 2X at least , ulcerations that occur at the base of the pocket from the turtle technique. I would caution people using this technique.
The periolase I think is a much more applicable laser than any erbium laser (regardless of brand) in the pocket.
I think that we must remember that one laser regardless of brand , wont do it all.
Just like the periolase has limited caries removal and bone ablation , the waterlase has limited coagulation and value in the pocket.
Laser gurus like Mark , Ron Kaminer, Ron Schalter, Allen Williams, and David Kimmel all have the Waterlase but all are practitioners who have attempted to learn as much about the alternatives out there beyond their wavelengths in their office.
This one laser can do it all well mentality has got to go regardless of which rep tells you that……….its falsifying what is a tremendous technology and really makes people who are in the know shake their heads.
I give big kudos to Mark for coming on here and saying it like it is. I hope that I would do the same to disagree with statements that company reps or lecturers from brands I am affiliated with would mention.
Ah thats enough of a rant.
Gotta sleep.
Glenn
SwpmnSpectatorFrom Biolase website:
Additionally, the Waterlase ™ is the first hard tissue laser (YSGG or Er:YAG) to receive clearance for laser soft tissue curettage. BIOLASE’s LaserSmile diode laser was previously cleared for laser soft tissue curettage in October 2003.
In my opinion, erbium lasers in the 2780-2940 nm range should be considered as dental surgical cutting instruments. Due to the wavelengths high affinity for water and hydroxyl groups these lasers work very well for cutting soft tissues, enamel, dentin, bone and composite – this is what we have found in our three year clinical studies.
When we speak of periodontal treatment, there is a host of possibilities including frenectomies, flap reflection and osseous subtractive surgery such as treatment for periodontitis and restorative crown lengthening. Erbium lasers work quite well for these procedures.
Regarding non-surgical peridontitis treatment, we found in 2001 that the Er,Cr:YSGG either provided no benefit over conventional metal scaling or in some cases appeared to worsen the patients periodontal condition.
whitertthSpectatorI think salesman will be saleman and there is no excuse for what hype or lack of safety..
Let me comment on a few things..
Laser safety is imperative….The experienced practitioners, ,yself included very often take it for granted….But…Safety glasses for the pateint is important…Mind you I think it is virtually impossible for an occurence to happen because of the proximity of the laser to any tissue to achieve an effect, but medico-legally it is absolutely necessary….
I love my Waterlase…Heck I teach others how to use it and I am passionate about the technology….
That being said….I agree here with Mark, I’m not a lover of using the waterlase for Perio…Firstly , I havent been able to achieve anywhere near the results that some others have….Just dosent work great for me when I have tried so I shy away from it….Secondly, I agree with Glen and Marc about etching cementum….
That all being said…I think the technology is still tops and anyone using an erbium today still should be proud of being tops in his field.
BNelsonSpectatorSounds like a common thread with Biolase salesmen. I get along great with mine and help him with previews, but he doesn’t like coming to my office for them since there’s a Periolase sitting near it for the perio uses. He still makes claims that the Waterlase does everything, but I tried it a few times for pocket elimination and it did only a moderately decent job and I stopped as I was concerned about the effects on the root. Now that I am comparing the one year results with the Periolase, the evidence confirms that the Nd:yag does a fantastic job on perio. Each case shows consistant improvement ( 8-9 mm now 2-3mm). I can’t think of anything I do that has this dependable results. Just like Bob told me when I bought it! Don’t get me wrong, I love the Er and use it constantly for the things it’s good for- restorative, some tissue recontouring, portions of endo, etc. Nervous kids and adults love it for fillings.
Smiles!
Glenn van AsSpectatorBruce …….what a great reply………honest and from someone who understands the value of each wavelength for a purpose it was intended for…………
I want to mention that this is the type of practitioner we all should aspire to, someone who recognizes what value the wavenlength has for a particular procedure, and bases his/her decision on science, and literature, not hype.
Kudos to you Bruce.
Glenn
kellyjblodgettdmdSpectatorThis is a great thread. I don’t know if I can offer any additional new information, but to concur with the statements already made. Bruce – I like your comment regarding having the Periolase. I have experienced the same thing when talking to potential laser-buyers. The ask me why I’m buying a Periolase if I already have a diode. So I explain to them “You need to review basic laser physics and you’ll understand why.”
Obviously, those of us that dialogue on this site all have a thorough understanding of basic laser differences (i.e. pulsed vs. continuous wave, differences in wavelength absorption, etc.) However, shrewd sales people understand that the average dentist coming to one of these at-your-office laser demos doesn’t have the foggiest idea of how a laser works. They just see tissue being ablated and a comfortable patient. It isn’t until they buy one, start using it and then realize the drawbacks (Oh, the buyers remorse!)
As I have stated numorous times, I believe that to maximize laser utilization in your practice requires numorous lasers. What I really don’t get is why the sales folks push the Erbiums so hard, when the also have other lasers to sell (diodes, Nd:YAGs). Heck, if a dentist is willing to spend ็K, why not do ๠K? It’s a great time for write-offs! (Except for you Canucks)
my two cents
kellyjblodgettdmdSpectatorP.S. I’m glad I’m not the only one who stays up beyond all reasonable hours reading posts on this site. I see Glenn likes burning the midnight oil, too. Good night!
Kelly
dkimmelSpectator“Laser gurus like Mark , Ron Kaminer, Ron Schalter, Allen Williams, and David Kimmel “
Me a guru?? ROLFMAO!! Thanks but I am still a Grasshopper!
As most of you know I have the perioscope. I have used it several times with the Waterlase in periodontally involved pockets. I have also used the waterlase on open flap perio sx and extractions. Each time I try to remove granulation tissue , I find it time consuming and fustrating. I also keep thinking to myself, How could you even do this without seeing it. You can not just go in a pocket and fire away and blow the granulation tissue out. At least with the diode the granulation tissue coagulates and is wiped out or easly peels out with a currette. Removal of the epi lining is a big part of treating perio with lasers. I cannot see this being done with an Er laser. Forget about the wavelength. It is end cutting. No side activation as in the diode. It is also one very small end cutting tip. The wipe, wipe of the sulcus several times just is not going to do it. You have to angle the tip to the lining and get very bit of it. How are you going to get the interproximal?? It is just not going to happen. Now if you made a thin slice from the top of the sulcus to the bottom, I could see it. At least on the buccal and lingual. The interproxmal area is still a problem and the epi tissue will migrate. As far as killing bugs, I think it will work and I could even buy into some biostimulation. Give me my diode for perio at least until I can get ………
David
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