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This much is clear: Laser dentistry is here to stay. And according to many observers, that’s a very good thing-lasers have enabled dentists to do new kinds of procedures and improve the healing time and efficiency of current procedures.
The Academy of Laser Dentistry (ALD) is an international professional membership association dedicated to improving the health and well-being of patients through the proper use of lasers and light technology. One of the major objectives of the ALD is the implementation of educational and clinical standards in laser dentistry in order to help promote safe and efficacious laser use on patients. Successful completion of the dental laser certification program is a way to formally demonstrate advanced knowledge and clinical proficiency in laser dentistry.
That’s why we recently asked six ALD spokespeople to share their dental laser experiences. We wanted to know: Where is laser dentistry-and where’s it going? Read on for comments from Drs. Ed Kusek, Arun Darbar, Sam Low, Charles Hoopingarner, Larry Kotlow and Grace Sun.
What has been the biggest development in laser dentistry over the last five years?
Ed Kusek, DDS, General Dentist, Sioux Falls, S.D.: That would be availability of lasers in dentistry and education. It seems as though laser dentistry has hit mainstream dentistry and is accepted in virtually every aspect of dentistry. Dentists have all kinds of different avenues to learn laser dentistry from online education to classroom setting to a number of hands-on courses. Education has gone from sales rep show-and-tell to tried-and-true techniques with scientific backing and long-term results.
Larry Kotlow, DDS, Pediatric Dentist, Albany N.Y.: I would say from my experience the development of a new wavelength for hard and soft tissue lasers. The use of the 9300 nm wavelength gives dentists the best of two worlds: the closest laser that can do almost everything in restorative and surgical care of our patients.
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Charles Hoopingarner, DDS, General Dentist, Houston, Tex.: That is a hard question because I see two things that have and will have a large and long-lasting impact on the practice of dentistry using lasers. One is the development of a system that controls and harnesses the energy of the 9300 nm CO2 laser. It gives us the ability to treat both hard and soft tissue at speeds comparable to traditional instrumentation. The other, even more industry-shifting event, has been the development of economical and versatile diode lasers that can readily be a part of every dental practice. The lower investment cost has made owning lasers within reach of nearly all dental practices. This opens the door for developing a much larger skill base and offering more services to the patients we serve. There are many soft tissue procedures that easily become valuable services to benefit the patients we treat. Some are even adaptable to Low Level Laser Therapy or photobiomodulation.
Sam Low, DDS, Periodontist, Palm Coast, Fla.: Educating dentists as to the benefit of lasers resulting in a wider range of acceptance in all phases of dentistry. The vast improvement in consistent training [has helped] to develop consistent protocols with predictable results. Companies continue to create products that are user-friendly and affordable with service after the sale.
Arun A. Darbar, BDS, General Dentist, Lighten Buzzard, U.K.: The acceptance of Low Level Laser Therapy (LLLT and now formally to be addressed as photobiomodulation PBM) by ALD as a science-based modality and its importance in laser dentistry. Several new lasers are now been designed and manufactured.
Grace Sun, DDS, General Dentist, Los Angeles, Calif.: The biggest development over the past five years in laser dentistry is rapid growth of various clinical applications for laser energy, including more wavelengths for hard tissues and healing.
What is the one procedure that you depend on your laser the most?
Dr. Kusek: I would not do a soft tissue procedure without the use of a dental laser: Frenectomies, tissue removal for biopsies, tissue troughing, pontic site development, orthodontic exposure of impacted teeth, flap reflection of tissues, gingevectomies, treatment of apthous ulcers, Laser Assisted Periodontal Therapies, pocket surgery, crown lengthening, implant uncovering, treatment of peri-implantitis, lip tuck procedures and use of photobiomodulation for wound healing. The ability to heal quickly with less bleeding than with the use of traditional methods separates the need to use a laser in the soft tissue realm.
Dr. Kotlow: I am not sure that can be answered since I use my laser for all of my patient restorative as well as surgical treatments.
Dr. Hoopingarner: I use my laser most often in the preparation of the tissues prior to taking impressions. Obtaining a dry and open area below the margin of the tooth preparation prior to the taking of an impression is imperative to successful indirect dental restorations. The use of lasers enables me to do this faster, better and with less trauma than with the use of retraction cord packed in layers deep into the gingival sulcus.
Dr. Low: Managing periodontitis with micro invasive laser techniques resulting with comparable clinical results to traditional surgery and, moreover, excellent patient acceptance.
Dr. Darbar: Use of PBM laser therapy as preconditioning and post conditioning after most hard or soft tissue laser surgery for accelerated healing, pain management and better outcomes for the patient with minimum post-operative complications.
Dr. Sun: I rely on laser energy to do my soft tissue surgery and management.
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What is the one procedure that most dentists should be using a laser but aren’t?
Dr. Kusek: The ability to use for a number of soft tissue procedures that they refer out to specialist that end up treating the patient in traditional methods as I discussed previously. The use of photobiomodulation to aid in healing and repair. To use simple light energy to treat erosive lichen planus. I have had several patients come to my office with a burning sensation in their mouth. The use of laser energy to make the areas heal in a short period of time when no other medical remedies were given to these patients. Untreatable neuroapathies. Two cases come to mind: The first patient came to our office because he heard we used light therapy to aid in nerve damage relief. On the left side, the patient’s ear had a ringing sensation, and he felt like his ear needed to pop after in-air flight. Use of CBCT showed no abnormal pathologies, thus use of light energy has alleviated the symptoms in a few visits. The second patient came to our office with numbness in her tongue-she could not speak correctly and felt as though the tongue had overgrown in her mouth (which it had not). A physician told this patient to always be within five minutes of a emergency room so if her tongue got too swollen she could have someone inject epinephrine to prevent a severe allergic reaction. All medical tests on this patient were negative; thus, the use of light energy got rid of all her symptoms and she now lives a normal life.
Dr. Kotlow: The CO2 laser at 9300 nm can do all soft and hard tissue treatment and therefore all dental procedures can be completed using a laser.
Dr. Hoopingarner: Any procedure that they would do with a laser that they are not comfortable doing with conventional techniques. The ease and patient comfort levels that come with frenectomies, fibroma removal or crown lengthening procedures come to mind, but I think the procedure that would benefit patients the most that is most often overlooked is preprosthetic surgery before the fabrication of removable restorations. It is so helpful to be able to easily remove the closely attached frenum or remove loose redundant tissue or even to do vestibuloplasty procedures that will make the utilization of removal appliances much more comfortable and efficient for the patient. There a very few prosthetic patients that will not significantly benefit from these procedures.
Dr. Low: Manipulating soft tissue as crown length to achieve an excellent environment and complement a restorative procedure.
Dr. Darbar: PBM laser therapy for pain management and enhanced healing after any surgical conventional treatment.
Dr. Sun: Healing or biostimulation, biomodulationor or low level laser therapy should be used more often.
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Looking into your crystal ball, where do you see laser dentistry heading over the next five years?
Dr. Kusek: The use of photomodulation therapy and the amount of research being done is phenomenal. They are working on the amount of energy needed for certain procedures to get the desired healing results after tissue damage. There [is also] research on the use of placing agents into the sulcus and then applying laser energy to a periodontally involved mouth and diminishing the amount of bacterial and thus decreasing inflammation in the patient mouth, by doing a simple non-invasive treatment. [There will also be] an increase in understanding on the use of hard tissue laser to remove decay without the use of local anesthetic agents. Or the same laser to fuse enamel surface to prevent decay from forming.
Dr. Kotlow: Consumer demand will drive more dentists to invest in laser technology since the vast majority of operative dentistry can now be completed without the need for local anesthetics and numbing.
Dr. Hoopingarner: The next major accomplishment is the inclusion of the use of lasers in dentistry into the undergraduate curriculum in our dental schools. There is currently a special interest group active in the American Dental Education Association and laser education is already included in curriculum of several dental schools across the country. I see it becoming commonplace in the dental practice shortly thereafter.
Dr. Low: Acceptance as an everyday practical adjunct to the practice of dentistry for periodontal and restorative patient management. As a component of dental education curriculums, laser dentistry will be a staple for providing quality patient care. Laser characteristics of biostimulation will continue to foster especially in the area of intraoral wound healing.
Dr. Darbar: Becoming more mainstream and patients will be seeking practitioners that provide laser dentistry and walking away if the practice does not. It’s already started-patients are looking for it.
Dr. Sun: Lower price and smaller laser units allow more users and more applications.
What is the one thing you would tell your colleagues about why they should have a laser in their practice?
Dr. Kusek: The use of laser dentistry will change the way they practice dentistry. It makes procedures faster and very predictable for both the dentist and patient. It helps dentists increase the number of procedures that can be done in the office, when before they needed to be referred out. It makes procedures a win-win for both the patient (faster healing, less pain, less post-op treatment and complication) and for the doctor (less chair time for the doctor, fewer post-op visits and complications and higher profit margins by decreasing chair time).
Dr. Kotlow: It makes common sense to invest in your patients by using lasers since it will reduce patient anxiety and stress at going to the dentist, reduce the number of appointments to complete some dental care, reduce time lost from school for children and reduce time lost from work for parents and adults. In addition, dentists who learn how to safely and correctly use their lasers will see an increase in income and productivity.
Dr. Hoopingarner: They will be able to recognize and treat conditions they do not treat now in a manner that is more comfortable and desirable for their patients.
Dr. Low: All healthcare is moving towards micro invasive procedures and patients will expect [it]. This is a primary characteristic of dental lasers. Moreover, patients will expect not only clinical results but convenience as relates to time and minimal discomfort with speedy recovery. To be competitive and attract a quality patient base, dentists must consider the addition of a laser as a technological advancement to their practice.
Dr. Darbar: If 10 potential new patients approach your practice seeking laser dentistry and if three or five walk away because you do not, what would you do? It’s not a question of whether lasers work or do not or you can afford it or not, but: Can you afford to lose these patients on a regular basis? Its like implants when they came out the first time around and went and now came back; if you do not offer them to your patients, you are doing them a disservice and [it’s] ethically wrong. That’s the way lasers are going; like it or not, they are here to stay, and the laser learning curve and proper education is the key to implementing its use on daily basis.
Dr. Sun: Patient benefits and clinician self-satisfaction.