Ray:

Schalter’s thoughts on delivery of topical anesthetic are good.

I do want to make some comments regarding the use of erbium lasers for treatment of periodontitis. Since the wavelength is highly absorbed by water and hard dental structures, I just don’t think erbium is the proper laser for conservative periodontal treatment. To me, erbium lasers are surgical cutting instruments best suited for procedures like composite resin preparations, frenectomies and in certain cases reduction of bone.

Do want to state that I don’t provide any type of laser periodontal therapy in my practice and others here can share a vast amount of information on the subject. But, the pilot studies I did with my erbium laser showed no improvement in periodontal health. Furthermore, I weekly use the erbium laser to separate periodontium from teeth to be extracted and find that even when carefully aimed, the erbium causes significant damage to cementum/root structures.

Another concern is that some research has shown many periodontal pathogens contain pigmentation. Although all bacteria contain water, there is some indication that laser wavelengths about one-third that of erbium might specifically target pigmented bacteria. So maybe if these wavelengths reduce the pathogenic population without disturbing root structure, the sulcus can recolonize with healthy flora and in some cases regeneration of attachment occur.

Bottom line to my ramble is that if I were to get involved with some sort of laser treatment of periodontitis would either use:

1) Nd:YAG and specifically the unit and technique promoted by McCarthy and Gregg of MDT. I think these guys are on to something which in selected cases may eventually be shown to be a legitimate alternative to conventional periodontal surgery.

2) Diode lasers in the 800-980nm range.

Best wishes and welcome to LDF!!!!

Al

P.S. Product Recommendation Disclaimer
I don’t own a Periolase MVP-7 from MDT and have no plans to purchase one in the foreseeable future. On the other hand, Robert Gregg and I have been known to get together for drinks;)

I’ve got a Periolase II and we’ve been getting phenomenal results with it for laser perio surgery. Bob and Del at Millennium really do have a much better alternative than traditional scalpel perio surgery. Patients really love it, especially if they’ve had traditional perio surgery in the past because the postop course is almost uneventful. Very little soreness or root sensitivity to cold like you’d have with traditional perio surgery. I’m trying to justify in my mind getting an erbium. Has anyone actually used both the Waterlase MD and the Hoya con Bio Versawave, if so what would be your choice and why?

Burp……burp…….its the tequila that I had with Bob.

I also dont own a Periolase, but commend Bob and Del for seeing a niche for lasers, for perfecting not only a machine, a wavelength for perio but in my opinion for working through a specific technique to address periodontal disease.

I have seen great cases from Bob, Dawn Moore and many others at the Millenium meetings and it was quite eye opening.

Erbiums are as Allen so eloquently put it not intended in my opinion for periodontal pockets as they arent selective down there, they cut cementum, bone, soft tissue and calculus, just not any one more than the other.

Great thread.

Glenn

Now that’s the proof, Jeff. Love seeing some good post-op pics. Thanks!

Kelly

I’d like to echo the efficacy of the DRK Liquid. Ron gave me a sample in January and we haven’t stopped using it since. Phenomenal stuff. Patients really appreciate it.

In response to Nick’s question about applying to apical tissue and using an Erbuim laser @ 20Hz: I don’t know what benefit the Erbium would have by using it on soft tissue in conjunction with the topical? The topical is certainly effective enough by itself for soft tissue anesthesia. If you are asking if you could anesthetize the tooth pulp this way, I think it is a potentially dangerous proposal. You’d have far better results just sticking in the needle and administering a local, but without the risk of ablated soft tissue.

I have found that if true, predictable pulpal anesthesia is desired with a laser, then use a Nd:YAG w/ a 100-150usec pulse-width @ 20Hz defocused for 30-60 seconds, depending on the tooth. I’ve been able to do this successfully even with root canals. It’s truly unbelievable to watch.

(P.S. Thanks, Ron, for the great topical!)

Kelly

Kelly:

This certainly piqued my interest.

Are you saying that you are routinely anesthetizing teeth with your Nd:YAG? To me the concept makes a lot more sense than using an erbium.

Why is the Nd:YAG fiber used in a defocused manner and what is the distance? If you place the fiber in contact with or 1-2mm from enamel do you see ablation? I see enamel ablation with erbium lasers even when highly defocused.

What would you estimate to be your overall success rate where you do not have to resort to chemical anesthesia? With erbium lasers, I estimate mine to be about 67% for composite placement.

I see you are using the technique for root canal therapy. Have you used Nd:YAG anesthesia for routine composite placement or crown preparation? What is the typical duration of the anesthesia? If the patient experiences discomfort, have you been able to “reanesthetize” using the Nd:YAG?

If the patient presents with a sensitive tooth(reversible pulpitis), how does the Nd:YAG anesthesia technique go? Does the patient experience pain while the laser is applied for anesthesia?

Lots of questions but thanks for you help when you have the time,

Al

Kelly, Thanks for the input. I am very interested in your confidence that predictable anastesia is attainable with the Nd:yag. So have you tossed your needles and syringes out? Would you be alittle more specific on duration? Best regards, Nick