Fred S. Margolis, DDS, F.I.C.D., F.A.C.D., F.A.D.I., M.A.L.D.

How laser dentistry can revolutionize your practice, plus a dental laser roundup. 

A little more than 11 years ago, I read an article about lasers being used for hard-tissue dentistry. I called three dental colleagues, one of whom has conducted research on 

After speaking to these three individuals, two of whom happened to be past presidents of the Academy of Laser Dentistry, I thought it was time to take a serious look at lasers and see if the technology would fit into my practice vision. These dentists, two general dentists and a periodontist, thought that because the Erbium laser was available for cavity preparations, it was a “great time” for a pediatric dentist to incorporate laser dentistry into his/her practice.

I then called two laser companies selling the Erbium laser and met with their sales representatives. One of the companies was willing to bring a laser to my office for a demonstration and to let my associate and I practice with the laser on extracted teeth and lunch meat. I could immediately perceive the value in having an Erbium laser in our practice.

		Exposure of teeth to aid tooth eruption

		Gingival removal to expose areas for restoration

		Abnormal gingival architecture associated with orthodontic movement

		Excision of soft-tissue tumors, including fibromas, lipomas, etc.  

Our pediatric group dental practice now has seven lasers in four different wavelengths. Many of my patients requiring routine dentistry don’t need local anesthesia nor do we have to wait for them to get “numb.” Multi-quadrant dentistry can be performed because of the patient not having anesthesia. More than 90% of my cavity preparations are done without giving the dreaded shot. I know your injections are probably “painless,” but I recently had dentistry done in my own mouth and hate that “numb” feeling. How about your child or special needs patients that bite their numb lip, tongue or cheek?  
	
	My first 27 years in dentistry I never performed soft-tissue surgery except for a simple excision of  gingiva over an unerupted tooth. Now I have given presentations on hard-tissue (cavity preparations, for example) and soft-tissue surgery to many dental schools and dental societies throughout the world and have had periodontists, orthodontists, oral surgeons, pediatric dentists and general dentists attend my courses. This has been my wonderful world of laser dentistry. I have oral surgeons, orthodontists and periodontists referring patients to me-why? Because I perform laser dentistry and in most soft-tissue surgeries-no shots! (a topical anesthetic is used). An oral surgeon said to me: “I’m going to refer you all of the frenectomies.” When I asked him why he said, “Because with the laser you have less bleeding and faster healing.”  

My youngest patient that I have performed laser surgery on was 2 days old (ankyloglossia Class IV)-my oldest is 65 years old (fibroma excision and cavity preparations with no shots).


	This past year, more than 250 pediatric dentists attended my presentation to the American Academy of Pediatric Dentistry (AAPD). The interest is so great that there will be an introductory laser course with a hands-on session at the AAPD 2013 meeting. There are so many dentists now interested in pediatric and laser dentistry that the 

Academy of Laser Dentistry’s Pediatric/Orthodontic day

 the past two years have met with overwhelming success. I invite you to attend the upcoming Academy of Laser Dentistry’s 20th annual conference set for Feb. 6-9 in Palm Springs, Calif. Please see 

I now have had the Erbium:YAG laser in my practice for more than 11 years. Laser dentistry has become such an integral and important part of our pediatric practice, that we purchased a second Erbium laser less than one year after purchasing the first. I use dental lasers (Erbium and diode) every day in my practice.

The EPIC™ laser’s graphical touchscreen

 puts 20 soft-tissue procedures, plus 20-minute full-mouth whitening and FDA-cleared temporary pain relief at the clinician’s fingertips. The ComfortPulse modes are can reduce pulse length to as little as one ten-millionth of a second to avoid heat build-up at the surgical site for fast cutting with less patient discomfort.
	
	BIOLASE Inc.
	888-424-6527 • 

What is the most frequent question or concern you hear from dental professionals about this category?


	A common question we hear is whether  EPIC is as good as traditional methods, such as an electrosurge or retraction cord.

How does your company and your product specifically, seek to answer that question or meet that need?

With EPIC, we aimed to create the simplest, most complete diode laser 

on the market. A vivid, elegant touch screen eases the user into the experience, with easy pre-sets to everyday procedures, like gingival troughing for impression-taking, pocket therapy for hygiene, and many other procedures.  Plus, all procedures are backed by years of scientific research.  

What about this product category do you think helps the dentist practice better clinical dentistry?


	Lasers in general are a great alternative to traditional devices such as drills, scapels,and electrosurge devices. The literature shows that lasers cut cleaner, with less bleeding, less swelling, less pain and less post-operative discomfort than traditional modalities. For years, BIOLASE has been at the forefront of innovation in this category, finding new and better ways to deploy laser technology in the field of dentistry.

How is your company or product leading the way for innovation in this category?


	With 25 years of dedicated dental laser experience under our belt, BIOLASE has pioneered some of the most important laser innovations in this industry, such as laser cavity preparations, no-shot, no-pain dentistry, laser whitening, radial firing tips, and much more. All of us at BIOLASE look forward to continuing to lead in this category for years to come by offering innovation and solutions for dental professionals and their patients.

Now Playing: John Bernhard, Director of Marketing for Biolase Inc., discusses the new EPIC diode laser at the ADA Annual Session.


	The Odyssey Navigator is a soft-tissue diode laser from Ivoclar Vivadent that is battery operated for ultimate portability. The touch screen monitor simplifies program selection, and the screen can be inverted for readability in any orientation. The ergonomic handpiece has a detachable sleeve for easy sterilization and the wireless foot pedal allows for cordless operation. Pre-cleaved, procedure specific disposable tips make preparation fast and easy.
	
	

Danny forcucci, Marketing Manager-Clinical for
	Ivoclar Vivadent


	Most dental professionals did not learn how to use a dental laser in dental school. Therefore, most customers ask about clinical training. Most dental professionals want hands-on clinical training that gives them confidence to start using a laser in their practice the next day. Training is also critical because some state dental boards require new users to be adequately trained.

How does your company, and your product specifically, seek to answer that question or meet that need?


	This is one area that sets Ivoclar Vivadent apart from other dental laser manufacturers. Ivoclar Vivadent gives every new customer the opportunity to attend a live full-day hands-on training course at an Ivoclar Vivadent training center for free. The courses are taught by world-leading laser trainers. At the end of the day the participants are typically highly confident in their ability to start using the laser in their practice.

Another area that sets Ivoclar Vivadent apart is local support. All Odyssey lasers come with in-office support, provided by highly-trained Ivoclar Vivadent professionals. This gives the dental professional an additional level of comfort.

How do lasers help the dentist practice better clinical dentistry?


	Ivoclar Vivadent offers two different training programs; one for dentists and one for dental hygienists. Both programs teach dental professionals how the Odyssey® diode laser can help them practice better dentistry. For example, the doctors are taught how the laser is used to help them take better impressions, reduce the need for sutures after surgery, cut tissue with little to no bleeding, etc. Among many other things, the dental hygienists are taught how the Odyssey® diode laser kills bacteria in periodontal pockets.


	In addition to providing free hands-on clinical training and local in-office support, Ivoclar Vivadent has designed features into the laser to make them very easy to learn how to use. The Odyssey® Navigator™ comes standard with more than 30 pre-set clinical procedures installed.  It has an intuitive touch-screen for easy activation. 


	The Odyssey 2.4G combines 810 nm laser wavelength with user-friendly features and design. An elective 630 nm laser pointer assists with location and placement of the laser. They Odyssey 2.4G also features 3 user-defined programs, 2 modes of operation (continuous wave and pulsed mode), and a wireless pedal for exceptional flexibility.
	
	Ivoclar Vivadent
	800-533-6825 • 

I purchased the Navigator Diode Laser in 2007 to adjunct treatments with my CEREC technology. I had planned to use it for troughing the tissue around margins for better visualization, but it does so much more! I don’t know how I practiced for so long without it.

My Navigator has become an integral tool in my practice. Of course it is always by my side for crown and bridge, but I have found it great to remove excess tissue during other restorative procedures, and wonderful for exposing margins for cervical lesions. If I need to recontour the tissue collar above an implant fixture, or change the tissue profile for a more natural crown emergence, I don’t need to worry about contact with the metal as is the case with electrosurgery. 

We treat cold sores and apthous ulcers to the great delight of our patients. I can debride periodontal pockets, easily perform frenectomies, and expose unerupted teeth quickly and easily. It is a joy to be able to recontour facial gingiva in the esthetic zone for high cosmetic procedures right here in my office.

My patients have had no post-operative sensitivities with the Navigator. Healing is predictable. It is easy to select the power that I desire with the preprogrammed settings, or change to what I need for differing types of tissues.

My laser easily goes where I go. It is portable and easy to use. I recommend it for all dentists!


	The LightWalker is a dual wavelength, hard and soft all-tissue laser  featuring the Erbium & Nd:YAG all in one advanced system.  The laser encompasses the two preferred, proven dental laser wavelengths in one cost effective package. The versatile Lightwalker performs the exclusive Photo Active Systems Technology (PHAST) laser endodontic and periodontal  treatments and expanded soft and hard tissue applications.
	
	Technology4Medicine
	949-276-6650 • 

The most frequent questions we hear are “What is the return-on-investment for dental lasers and how will they benefit my patients and my practice?


	T4Med offers high quality, industry leading dental lasers and all of the support necessary for success. The LightWalker is a great investment because it is extremely versatile with both of the preferred, proven laser wavelengths in dentistry, Er:YAG and Nd:YAG, integrated into one system. 

The LightWalker provides dentists with the tools to perform a wide range of procedures from highly effective Photo Active Systems Technology (PHAST) laser endo and laser perio, hard-tissue procedures including fast no-shot cavity preps, bone procedures and a wide range of soft-tissue applications. Over the past decade we have witnessed thousands of laser general dentists significantly expand the quantity and quality of procedures they offer their patients because they implemented dental lasers into their practices.

The XLASE1064 is a very cost effective, compact, battery operated perio and soft-tissue laser and it is the only solid-state laser that is the exact same wavelength as an Nd:YAG laser, at a fraction of the cost. The XLASE is renowned for being a very fast cutting soft-tissue laser giving the clinician the feel of using a scalpel, but without bleeding and charring. The XLASE only weighs three pounds, so it can be easily transported from operatory to operatory, and the battery will last for 2-3 weeks with heavy use.


	Dental lasers allow dentists to expand both the quality and the types of procedures they offer in their practices. Many LightWalker dentists are now doing fast, effective endo for the first time since dental school, providing their patients with periodontal treatments that were typically just “monitored” until they needed to be referred out, performing cavity preps and also a wide range of soft-tissue surgical treatments without having to give injections and with little to no bleeding. Lasers are better for both patients and the dentists.


	T4Med is focused on and dedicated to improving and elevating patient care while providing dentists with cost effective tools to do so. The management of T4Med have all been leaders and innovators in both medical and dental lasers for more than two decades. Our R&D is always improving both the clinical and technical aspects of lasers so they are more effective clinically and also provide a better return-on-investment. T4Med is also a leader in providing world-class training, education and customer support. Patients and customers are No. 1.

I have been practicing laser dentistry for nearly a decade. A few years ago I upgraded to a dual wavelength Er:YAG/Nd:YAG all tissue laser (LightWalker, Technology4Medicine) and have been extremely pleased with this laser. My patients have been happy as well.

The Er:YAG wavelength is excellent for both hard- and soft-tissue procedures. It has replaced my highspeed handpiece for most operative dentistry and nearly 90 percent of these procedures are achieved with no local anesthesia. It allows for precise soft-tissue procedures such as gingivectomy, frenectomy, and biopsy with remarkably comfortable and rapid post-operative healing. The combined tissue abilities of the Er:YAG laser let it perform osseous crown lengthening without scalpels or burs and with minimal discomfort. I now perform many procedures I used to refer out with the added benefit that I know my patients will have a more comfortable and less anxiety producing experience than traditional methods.

Laser assisted endodontics is another area where the Er:YAG laser helps significantly. Laser activated irrigation allows for more thorough three dimensional cleansing of the root canal system through a patented process know as Photon Induced Photoacoustic Streaming (PIPS). I have been amazed by the results I am getting with PIPS and am now referring fewer root canals for specialist treatment.

The Nd:YAG wavelength allows for adding laser assisted periodontal therapy for my patients. This wavelength’s ability to selectively debride diseased tissue and decontaminate pockets has given my practice an excellent tool for fighting periodontitis.

I cannot imagine ever going back to practicing “non-laser” dentistry and neither can my patients.

See more industry leading dental lasers on the next page... 


	Designed for the first-time laser dentist and hygienist, the 

Picasso Lite features an affordable price point, ease-of-use, and a sleek design.

 It’s said to be an optimal replacement for a scalpel and electro-surge for the use of treating soft tissue. 

The laser cuts and coagulates tissue with reduced trauma, bleeding, and necrosis of tissue and is used for soft-tissue surgical procedures. It offers 2.5 watts of power and 3 customizable presets. The laser comes complete with laser certification options, multiple accessories, world power adapter, wireless foot control, option of disposable tip system or strippable fiber, and a 2-year warranty.

AMD LASERS, a DENTSPLY International Company
	866-999-2635 • 

You could pay more, but you won’t get more. This should be your laser. 

Articles

How laser dentistry can revolutionize your practice, plus a dental laser roundup.  

A Complete Guide to Laser Dentistry

	Fig. 1:  T-bands with wooden wedge (Note: Isolite mouthprop is used.)

	Today’s parents are concerned about esthetics for their children. Esthetic dentistry can provide the beautiful smile that parents and their children desire. It is important for our young patients to look and feel good.
	We have all experienced the wonderful smile of a patient when we have turned the “ugly duckling into a beautiful swan”.

	We are fortunate to have the dental materials and devices that allow us the opportunity to provide esthetic dentistry. Some of the techniques and materials we have available for our teenage patients’ smile creations include: porcelain veneers, direct composite veneers, microabrasion, bleaching, orthodontics (including clear braces and aligners), direct and indirect composite restorations, implants, and porcelain crowns.


	Many dentists feel that it is preferable to place an amalgam restoration due to speed and longevity.

	Yet plenty of pediatric and general dentists, including myself, have been using composite materials for Class II restorations for decades and I am very pleased to be able to offer a “tooth-colored” vs. a “silver” restoration.  With the modern adhesive materials we have available today, one can place a Class II composite, glass ionomer, or resin modified glass ionomer restoration that will provide years of service and are very easy to use.  The resulting restorations will have excellent function and form and, of course, improved esthetics.

	When restoring Class II adhesive restorations in children, teenagers, and adults, the goal is to provide: 1. tight contacts;  2. good contours; and 3. proper anatomy. Additionally, you want to provide comfort for the patient during the procedure and you want the matrices to be easy to place and remove.

	Fig. 3: Slick Bands (Garrison Dental Solutions)

	There are many types of matrices on the market. The purpose of this article is to discuss the advantages and disadvantages of the various types of matrices available.


	The T-bands come in a variety of materials and thicknesses, and widths. The 0.001” brass matrix is available in narrow, wide, curved and straight forms. I suggest the 0.001” straight narrow brass matrix for cuspids (Class III restorations), primary molars, and bicuspids; the wide matrix for permanent molars (Fig. 1).

	The advantages of T-bands is the cost of the disposable band and the ease of use. The disadvantage of T-bands is the difficulty in getting excellent contours and contacts.


	The Tofflemeir matrix has been manufactured as a disposable system (Ultradent’s Omni™), and Ultradent has provided us with a good selection of both pediatric and adult size Omni™ matrices in both metal and celluloid material (Fig. 2). Several manufacturers are making the matrix bands for Tofflemeir retainers in non-stick and color-coded matrices, including Garrison Dental Solutions (Fig. 3).

	The sequence of placing the segmental matrix is as follows:  place the individual matrix one at a time; placement of the wedge, placement of the matrix ring.  Fig. 4A illustrates the use of a matrix forceps (Composi-tight Matrix Forceps™, Garrison Dental Solutions) which allows for easy handling by the dental assistant and operator.  Figs. 4B and 4C show multiple segmental matrices in both primary and permanent Class II restorations. 
	There are several styles available from various manufacturers. One company now offers a non-stick segmental matrix (Fig. 4) and color-coded matrices corresponding to the various shapes available (Fig. 5).  Fig. 6 shows the Ultradent™ matrix system.

	The segmental matrix, when used with a wedge and separation rings, gives tighter proximal contacts in permanent Class II restorations than any other matrix system I have used.Also, I recently discovered another advantage. Many of our teenage and adult patients are undergoing orthodontic treatment and therefore may have bands, brackets, and archwires in place when a Class II restoration may be needed. With a segmental matrix, the operator does not have to remove the wires and or bands and brackets, but can utilize the segmental matrix to provide the required contour and proximal contacts (Fig. 7). 

	Garrison Dental Solutions has newer 3D-Rings that can be used for permanent teeth, however due to their shape the author prefers the Gold or Grey rings for primary molars.   The Soft Face 3-D ring (orange) is more difficult for primary molars and around orthodontic appliances.

	In these cases, the Composi-Tight Gold or Grey thin tine G-Rings are indicated. These matrices are ultra-thin and dead soft which allows for easy contouring after the matrix is placed.

	According to Loomans, B.A., et al; “The use of sectional matrices combined with separation rings resulted in tighter proximal contacts compared to when circumferential systems were used.” I have found this to be true in both primary and permanent teeth when restoring Class II resin composite, compomer, resin modified glass ionomers, and glass ionomer materials. 

	Fig. 7: Composi-tight matrix on orthodontic patient

	There are a variety of types of matrix bands for use in restoring Class II restorations in both the primary and permanent dentition, and some include advantages and disadvantages when compared to one another for use in different situations. Dentists must decide which system will provide well-contoured restorations with excellent interproximal contacts. Based on the current research available I have concluded that a segmental matrix provides tighter proximal contacts compared to circumferential matrix band systems.
	 

   Fig. 1:  T-bands with wooden wedge (Note: Isolite mouthprop is used.)