The benefits of a better laser
Two laser-dentistry experts share their insight as to how diode lasers can be used for more and with better results.
Dr. Kenneth Magid, DDS, FICD helped develop the Epic Pro and was involved in lasers since they first came to dentistry in the 1980s. Dr. Magid has not only lectured extensively on lasers around the world, but he’s also written articles and textbooks on them. He’s director of laser dentistry at NYU College of Dentistry.
Dr. Sam Low, DDS, MS, MEd, is the chief dental officer and vice president of clinical and dental affairs for BIOLASE. He has 30 years of private practice experience as a periodontist and 20 years’ experience as an associate faculty member of the L.D. Pankey Institute. He’s also professor emeritus at University of Florida, College of Dentistry. He lectures and teaches dental professionals nationwide.
DPR spoke to them about the BIOLASE Epic Pro Diode Laser and what makes it different than the other diode lasers available.
How is the Epic Pro different or unique from the other diode lasers available today?
Dr. Low: The Epic X is an excellent laser, but with most everything in life, there’s always something called the starter and then there’s the next level. The Epic X is an excellent all-around laser for hygienists and for dentists who want to do a frenectomy biopsy and things of this nature. That’s not just about the Epic X, but diodes in general.
Dr. Magid: The most common soft-tissue laser in dentistry is the diode laser. It is the most commonly used and least understood laser that exists today.
Dr. Low: Some clinicians use diodes as electro surgery devices. In other words, they’re primarily using them as a heat stick. Most diodes work off thermal reaction. For the most part, diodes are slow. They tend to drag through tissue. Debris builds up on the tips as a coagulum and must be wiped off, and that somewhat undermines the continuous nature of a procedure. So, diodes are effective; they’re more effective than electro surge, but they still have limitations to them.
Dr. Magid: Unlike an Erbium laser and a CO2 laser, which cut with laser energy, the diode laser cuts with a hot tip. The first question then becomes, if it cuts with a hot tip, how hot? With other diode lasers, the dentist has no idea and no way of controlling how hot the tip is. Second, the question is how consistent is that heat? In other words, if I could set it at a certain temperature, does it stay at that temperature? The answer with any other laser is no. It varies all over the place, creating some unique, untoward problems.
Dr. Low: The Epic Pro performs all procedures that a diode does, but quicker with no buildup of tissue debris on the tip.
Dr. Magid: With the Epic Pro laser, you not only can control the heat and control the heat consistently but you can add to that what’s called Super Pulse where you have tremendous energy, tremendous heat in a cutting mode for 100 microseconds and then it’s off, very much like the Nd:YAG laser.
Dr. Low: Power is measured in watts, and the peak power on a high-level diode can elevate up to 10 watts. The Epic Pro goes up to 150 watts. And then you might ask, well, my goodness, that would be so much, wouldn’t that be dangerous? Well, the fact is that even though it may go up there, it only lasts for a very short time, much shorter than any other diode out there.
How does this help with clinical practice?
Dr. Low: Since one does not get overheating of the tissue, the wound healing is quicker and renders a more positive patient response, which is what you want any time you do any procedure in dentistry. By having such great energy for a short period, the Epic Pro almost acts like a blade. In other words, it’s fast, it’s clean and tissue doesn’t collect around it.
Dr. Magid: With other diode lasers, the dentist spends an enormous amount of time and effort compensating for the deficiencies in the device.
For example, if you are doing a gingivoplasty with a standard diode laser, you get lots of charring and tissue tags. If you’re troughing the tooth and you use a standard diode laser, what you’ll get again is charring and tissue tagging, which makes it difficult if you’re going to use a standard impression material. If you’re using CAD/CAM scans, you can’t have tissue tags or charring because the scan won’t allow you then to do a restoration.
Dr. Low: Restorative dentistry is rapidly moving toward digital impression. But the unfortunate aspect is that when you do digital, your impression must be so much more accurate than when you use impression material. When you use impression material, the tray assists in moving the tissue away from your restorative margin. When you use digital, there’s no physical moving the tissue away from the margin, so one must use significant retraction cord.
When you use an Epic Pro for retraction, the margin is exposed via troughing and you don’t see those tissue tags and this coagulum sticking to the area that you’ve been working on. Not only just the tip, but also in the physical area that you’re working on. It’s much cleaner. It’s just such an improvement over current diodes.
Up next: What makes the Epic Pro different ...