Shannon Pace Brinker, CDA, CDD

For more than 10 years, Paul Moore, BDA; Hazel Hendy, MBA; and Steiriliu—the company they created—have focused on the little things that make dentists’ lives easier and more efficient. Their products include the BurButler for organizing and sterilizing dental burs, the LaminateButler for sterilizing and presenting restorative components chairside, the BlockButler for visual storage and stock control of chairside CAD/CAM block inventory, and 3D Deep Heat Seal Autoclave Pouches for effective, efficient sterilization pouching of taller items.

Paul and Hazel have twice won Practice of the Year at the Irish Dentistry Awards, and with 9 children and 8 grandchildren life is never dull. For them, innovation is a matter of survival.

Their motivation is to improve dental systems, protocols, and efficiencies. The focus is on creating tools for use in time-saving processes, as well as analyzing and streamlining workflows and handling, reducing waste, and improving sterilization standards.

Don't miss this video discussion about BurButler bur blocks between DPR Chief Clinical Editor John Flucke, DDS, and Steiriliu co-founder and BurButler inventor Paul Moore, DBA.

Innovation, design, production, and commercialization require a different level of commitment, courage, and tenacity. It is a long journey from concept to market, and not one for the fainthearted.

Creation of a concept starts by exploring the aims, benefits, features, and design needed to create something to solve the challenge at hand. Manufacturers are then engaged to explore material options, refine detailed drawings, and define production costs for prototypes, tooling, and units.

Detailed market assessments are essential. Discussions with patent attorneys to explore intellectual property rights will be needed to protect your investment of time, effort, and money.

Additionally, medical device registration and regulatory bodies must be involved. There are also marketing, sales, and distribution considerations. Will you sell directly online? Will you attend and support conferences to reach your market? Will you engage with distributors? There are numerous details to be sorted out when creating something new for the dental industry.

The EndoButler is designed for easier endodontics and more efficient instrument sterilization.

One of Moore’s and Hendy’s latest products, the EndoButler, is designed to simplify managing endodontic files during root canal treatments. During a root canal, the EndoButler allows the operator to focus on the tooth instead of the tools being used. Other systems in which endodontic files are stored on a ring force clinicians to shift their attention during the process. EndoButler keeps all files organized in a freestanding unit, making it easier for the dental assistant during treatment.

If the files are kept on a ring on the dentist’s finger, periodic shifting of attention is necessary. The EndoButler allows the assistant to help in this area of the process.

Assembling the instrumentation for a 21-mm, 25-mm, or 30-mm preparation on the EndoButler permits selection of access rotaries, hand files, engine files, working length ruler, recessed end-stopped measuring columns for setting the working length of the chosen files for cleaning and shaping, and a single-use open cell foam—all from one device. Even the final obturation can be determined with confidence using the “end-stopped” measuring columns.

The office can have 1 or 2 EndoButlers set up for the various lengths, with files pouched, sterilized, and ready for use.

“One of our prime ambitions was to reduce waste and carbon footprint. Any instruments used can be placed in the foam and disposed of as required after each visit. These can be replaced prior to processing, but any instruments unused can be left in situ. This way the clinician can have access to the full set of instruments they might require but only dispose of those they use,” Dr Moore says.

A full-arch, implant-supported restoration is ready for delivery with the components organized in the LaminateButler.

When asked to create an organizer for orthodontic components, Dr Moore and Hendy considered how dentists organize and present all those small “bits” for chairside delivery of orthodontic cases, crown and bridge cases, and dental implant cases. They asked themselves how to make this a more efficient, controlled process.

Typically, when a dentist has several components needed to complete a case, they are often arranged on a piece of paper on a tray. These might be crowns, veneers, inlays, implant components, or other small items needed for a restoration. This system works well until the piece of paper is jostled. Then all the restorative parts would be in disarray. When these materials are no longer organized, it can take extra time to find the right piece for the right step of the clinical workflow, decreasing efficiency. If this happens during placement, it is a challenge to overcome.

Dr Moore and Hendy determined their solution would need to offer many features to provide clinicians with the benefits they need while working with restorations, orthodontics, implants, and other complex cases.

Components for an implant case with multiple units are organized in the LaminateButler.

The solution needed to include a tray that was autoclavable, with a cover that was also autoclavable but allowing steam penetration without compromising dust and aerosol protection.

The tray needed wells to safely hold the separate components for each tooth to be restored.

The wells in the tray should be large enough to hold an abutment, a screw, and a crown so the system could be used when restoring dental implants.

Each well should be shaped to allow clinicians to easily remove the components with gloved fingers.

There should be larger wells to hold bridges, drivers, or other instruments, materials, or components that are larger than an individual crown.

The color of the tray should allow contrast for visualization.

There should be a numerical system to identify each well to increase the level of organization and allow enhanced clinical communication.

The prototype for the LaminateButler made its debut at the International Dental Show 2019 in Cologne, Germany. Early reaction made it obvious to Dr Moore and Hendy that they had found a simple, elegant solution. They said every clinician who saw the LaminateButler instantly understood what it was, how it worked, and how it could help.

The LaminateButler is designed to provide a waterproof tray that organizes all parts, tools, and instruments, and eliminates confusion during treatment. When restoring the upper teeth, the curve of the tray is kept toward the patient and the natural teeth all correlate to the arch of the tray. For the lower teeth, the arch is away from the patient. This way the symmetry of the arch matches that of the teeth being restored.

The LaminateButler when used as a palette for stains.

Implant laboratory work can be taken off the model on return from the technician and can be kept organized by individual tooth while the components are autoclaved prior to placement.

The LaminateButler’s silicon construction offers durability, ease of cleaning, and a soft, nonsliding touch. The tray can be used as a color palette for stain and glaze systems, and the cover can help reduce dehydration of the stains.

With both solutions, as well as the company’s other products such as the BurButler silicone bur block, Steiriliu is focused on making clinicians’ jobs less complex when it comes to managing instruments in the operatory and the sterilization center.

Articles

Steiriliu is designing seemingly simple solutions that enhance organization and streamline workflows for everything including restorative cases, implant cases, and orthodontics.

Novel Organization Systems Drive Operatory Efficiency

A Safe, Fast Way to Clean Dental Appliances

Designed to clean, store, and protect all types of removable dental appliances, HyGenie was developed for 5 years by a group in Australia led by Dr Mark Wotherspoon. The group sought cleaner, faster, safer options that did not require soaking in dirty cleansing solutions. A recent evaluation conducted by Pace Brinker’s evaluations team examined the opinions of 5 clinicians from different practices around the United States after making Dr Mark’s HyGenie available to several patients. The clinicians, on average, provided HyGenie to 14 patients.

Germs thrive in moist, warm, dark environments; cleaning and safely storing removable appliances is critical for patients’ oral health. According to a study published by Academy of General Dentistry, mouthguards can breed life-threatening bacteria, yeast, and mold. When used and stored as they usually are, they transmit these disease-causing organisms.

As you hand the patient their appliance, show them how to care for it using the HyGenie system. This will help with patient adherence and may extend the life of the appliance. Include Dr Mark’s HyGenie in the price of the appliance.

Hold the bottom handle (blue) and device body (clear) in one hand. Turn the top handle (white) in either direction until it clicks into place. Take off the top.

Place the appliance into the bottom brush. Paired orthodontic aligners can be placed together, with 1 facing upward and 1 facing downward.

HyGenie ease of use

Line up the arrows found on the top handle and transparent body, as shown. Gently press down until the handle “sits” into place. Twist it in either direction, and it will “click and lock” closed.

Holding your HyGenie over a basin, squeeze 1 to 2 generous drops of Dr Mark’s DentalFresh

 into the device through the perforations and apply water.

Rotate the top and bottom handles in opposite directions. Alternate top and bottom washing by holding 1 handle in place and rotating the opposite handle. Wash for 30 to 45 seconds or until DentalFresh foam thoroughly covers your appliance.

Rinse the HyGenie under gently running water, rotating the handles in opposite directions until all DentalFresh foam is rinsed away and water runs clear through the device.

Now that your dental appliance is clean, fresh, and ready, you can wear it or store it safely in Dr Mark’s HyGenie until you need it next.

The Academy of Chairside Assisting recently reviewed 6 product evaluators in dental practice who provided HyGenie to over 20 patients, including patients who use retainers, aligners, splints, nightguards, sports mouthguards, sleep appliances, and dentures.

All the clinicians participating in the evaluation agreed that Dr Mark’s HyGenie provided their patients with a great way to clean their removable appliances. HyGenie improved oral health and the smell, look, and life span of the removable appliance. Of the evaluators, 73% utilized the HyGenie for clear aligner care, 15% for nightguard and sleep appliances, and 12% for partial and denture care. Additionally, 98% of the patients noted a significant difference between the aligner care cleaner they were using and Dr Mark’s HyGenie.

For 30 years in practice, I have seen far too many people struggle to clean and protect their removable dental appliances adequately. But did you know that wearing and unhygienic dental appliance can lead to unsightly, painful, and costly oral disease? An oral disease that can lead to even more severe heart, lung, and throat diseases? Our mission is to change all that.” 

I’m so thankful that I have found something that works to clean my dentures. For years, I’ve been trying to find a way to remove the stains on the teeth. Using these products together works excellent, is easy to open for arthritis, and the scent is icing on the cake. I highly recommend it to all denture patients.” 

I hated having to mix crystals in water to clean my Invisalign trays. It was a pain having to open a packet, pour the crystals into a cup, and trying to fit the trays into a cup to get them clean. When my mom brought home HyGenie, I laughed at how easy it was to use and took just minutes to clean. Now I want the sports guard HyGenie. Where can I get that?” 

Dr Mark’s HyGenie system is easy to use and effective. The DentalFresh cleansing gel includes pure peppermint oil, which is a natural antibacterial agent. The gentle pH5 formula removes plaque and calculus safely. For splints and mouthguards, both the upper and lower appliances can be cleaned together. For dentures and sleep appliances, clean the pieces separately. For larger appliances, the SureGrip brush allows for an extra cleaning with DentalFresh.

The clinicians participating in the evaluation reported that Dr Mark’s HyGenie provided patients with efficient, effective cleaning and storage protocols. After using HyGenie, 97% of evaluating clinicians reported that they want to offer Dr Mark’s HyGenie to their patients along with their removable appliances. Several said they already raised the fees of their services to include Dr Mark’s HyGenie for patient appliance home care.

With an average rating of 4.9 on the diamond scale by the clinician evaluators, Dr Mark’s HyGenie provides a simple solution for overall improved dental care

Combining the expertise of the world’s leaders in their field, the evaluators for Shannon Pace Brinker, CDA, and her team at The Academy of Chairside Assisting maintain a sharp eye for emerging products in the field of general and restorative dentistry by providing a “total office” perspective of clinical information and application.

The HyGenie® will offer a new cleaning experience for dental appliance owners who want safe, quick performance. 

Created by a dental industry professional and an experienced fashion creative design expert, Helcasio high-performance, comfortable scrubs don’t sacrifice style. Every piece is made with breathable fabric that features an impenetrable layer resistant to water and stains. The Smart Textile fabric is designed with membrane technology to keep wearers dry and comfortable, and the fabric’s stretch ensures a good fit. These scrubs are wrinkle-resistant and easy to maintain.

Helcasio uniforms are available in various designs compared with others on the market. They are made for every size and shape and provide comfort, function, and protection for all dental professionals. Available sizes include extra-small, small, medium, large, extra-large, and double extra-large, and color options are black, charcoal, plum, and stellar.

The uniforms are made from a flexible, high-performance, breathable fabric engineered with unique membrane technology. With the addition of an impenetrable layer, the uniform is water-resistant and prevents stains, keeping dental professionals cool and dry. The advanced fabric technology also allows for stretch, ensuring an excellent fit, easy movement, and optimal comfort.

The wrinkle- and fade-resistant scrubs have a clean, modern look. The trendy, durable scrubs also can be personalized with embroidery on the sleeve or chest.

Teams consisted of the dentist, hygienist, dental assistants, and treatment coordinators. After evaluating Helcasio uniforms, 94% of the evaluators rated the uniform with a 4.5-diamond rating, and 98% said the uniforms were of high-quality fabric. Nearly 80% indicated the scrubs fit exceptionally well, especially for various movements performed during clinical procedures. One hundred percent said they never felt as protected as they do with Helcasio. Eighty-nine percent said the price point was right in line with previous uniform costs. Two dentists who are oral surgeons complimented the protection of the double-layer fabric. Several evaluators applauded the fact that they were water-resistant, which is a big issue in dentistry considering all the products that can stain uniforms. Eighty-seven percent of the evaluators mentioned the long-lasting color after more than 37 to 60 washes. Six percent said they wished there were more colors, with 2% commenting that they wanted the uniforms in petite.


“Your product is superior.”

“These scrubs have proven from the first washing to keep their shape and color. Most uniforms, after the second wash, start to look faded. As a dentist, I never wore uniforms until now!”

“Finally, a uniform made for a MAN!”


“With COVID-19, my main concern was my protection. When I saw the advertisement on Instagram that said they were waterproof, I ordered that day. Practices need that added layer of security and peace of mind.”

“I felt like I was wearing Spanx. I looked like I lost weight in these.”

“These scrubs have proven from the first washing to keep their shape, color, and sharpness. It still amazes me how they look brand new right out of the washer.”



“When your patients give you compliments about your uniform, you know these look good!”

“These scrubs are amazing! Waterproof and breathable? This assistant is impressed. Please do yourself a favor and order a pair; they speak for themselves. These are now my go-to brand!”

“When I bend over, they do not slip down. I hate most uniforms for this very reason. I am a big girl, and most uniforms do not fit my size. I was pleasantly surprised. Thank you for not assuming everyone is a size 4."

With the combination of the world’s leaders in their field, The Academy of Chairside Assisting’s knowledgeable and experienced leadership team maintains a sharp eye for emerging products in the field of general and restorative dentistry by providing a From Our Side Of The Chair® perspective on clinical information and application, incorporating photographs and videos to assist chairside procedures for better patient results. The ACA will continue to evaluate one product at a time with professionalism, integrity, and a commitment to excellence.

Dentists, hygienists, and assistants at 15 practices reported feeling more protected with Helcasio uniforms.

Helcasio Uniforms Are Designed to Impress With High-Quality Fabrics

This article is eligible for 2.0 hours of continuing education credit from the Academy for Chairside Assisting and Dental Products Report.

The airborne spread of severe acute respiratory syndrome coronavirus 2 is well reported in literature. Documentation shows many procedures in dentistry produce aerosols and droplets that are contaminated with the virus.

 Dental practices have many concerns about droplets and aerosol transmission of coronavirus disease 2019 (COVID-19), as the particles from droplets or aerosols are small enough to stay airborne for an extended period before settling on environmental surfaces or entering the respiratory tract.

Now more than ever, the use of a dental rubber dam is necessary for handpieces with rotating turbines at a high speed.

COVID-19 has the potential to spread through droplets and aerosols from infected individuals in dental clinics and hospitals.

 When dentists work with devices in the patient’s oral cavity, a large amount of aerosol and droplets mixed with the patient’s saliva—or even blood—will be generated.

A survey last year noted that less than 10% of practices were using a dental rubber dam. The No. 1 reason at the time was lack of proper training and time.

 Documentation proves the placement of a rubber dam significantly reduces airborne particles in a 3-foot diameter of the operational field by 70% during a procedure.

Before beginning the rubber dam application, dentists should tell patients what to expect and explain why they are using a rubber dam. Many patients have not been exposed to the dam and may not understand or fear its use. There is much to learn about the rubber dam and its benefits in operative dentistry. Below is a comprehensive list of dental dam materials and equipment, as well as guidance on their proper uses.

The dental dam procedure requires a variety of instruments and materials. The materials and equipment may be on a separate tray or stored at the dental unit or in a tub for easy use. Contents typically include the dental dam material, dental dam napkin, dental floss, tape, dental dam clamps, forceps, frame, punching guides, and punch (

The dental dam is a latex or latex-free material supplied in various sizes, weights, and colors selected according to the operator preference. The most common sizes of the dental dam are 5 × 5-in or 6 × 6-in precut squares. These squares usually come in a box of 50 or more and are lightly powdered on one side to prevent sticking.

A dental dam is available in different weights (thicknesses), including thin, medium, heavy, extra heavy, and specialized heavy. Various colors (shades) are also available, including dark gray or green and lighter pastels. The darker shades provide more contrast with the teeth and make it easier for the operator to see.

A rubber dam stamp or rubber dam template can help the dental clinician accurately mark tooth positions, whereas the dental dam napkin provides comfort between the rubber dam and the patient’s skin. The dental dam napkins are disposable and made of soft, precut, absorbent fabric, reducing possible allergic reactions. The dental dam napkin also absorbs saliva, water, and sweat.

The frame or holder is designed to stretch and secure the dam in place across the patient’s face. The frame stabilizes the dental dam and keeps the operating area open. Frames are made of metal or plastic and have small projections around the borders to secure the dental dam.

Similar to a paper punch, a dental dam punch has a handle and a working end. The working end of the punch has a stylus—a sharp projection to punch through the dam—and a punch table or plate. The punch has a rotating metal disk with up to six holes of various sizes and a tapered, sharp-pointed plunger.

The clinician adjusts the dental dam punch table, making sure each tooth that is isolated is centered under the stylus before the punch is applied. The clinician should punch the holes of the dental dam according to the patient’s arch. An improper cut hole will result in a nick or a tag that may cause the dam to rip at placement before the procedure. Smaller holes are better suited for incisors, canines, and premolars, whereas larger holes are better for molars, the posterior anchor tooth.

Proper rubber dam placement may require other items. These could include scissors for cutting the dental dam material and floss, which can be used through contacts and help secure anchor clamps. Other items include forceps and clamps.

Clinicians should use dental dam forceps to place and remove the dental clamp. The forceps has two prongs that fit into the holes of the jaws of the clamp, engages the clamp, and enables activation during placement and removal of the clamp.

Dental dam clamps are supplied in a variety of designs and sizes to fit around the teeth and stabilize and secure the dental dam material (

). Clinicians should always select a rubber dam clamp that maintains a 4-point contact with the tooth’s proximal surface. If a clamp is too large, it will impinge on the soft tissues. If it’s too small, it will not grasp the tooth’s surface and will be unstable. The bow of a clamp should be positioned on the distal of the tooth (

The specific type of clamp is identified by a number. A clamp number followed by an A identifies a clamp with subgingival jaws. Clamps are separated into two categories, winged and wingless. Winged clamps have projections at the jaw, whereas wingless clamps are identified by a W proceeding its number.

At a Glance: Placing a Rubber Dam

Determine the tooth to be restored, and then determine the anchor tooth, which is usually 1 or 2 teeth distal to the tooth being restored. A good technique for learners is to punch to the canine of the opposite quadrant.

Posterior isolation: Include one tooth distal to the tooth (teeth) being treated and extend to midline

Anterior isolation: Include premolar to premolar.

Single-tooth isolation (endodontic and sealants): Include only the tooth being treated.

Examine the size and shape of the arch so they can be duplicated on the dental dam as carefully as possible to match the patient’s arch. Examine the area for missing teeth, teeth that are out of alignment, or fixed prosthetics. The dental dam is punched accordingly. Identify tight contacts and open spacing.

Be sure to examine the oral cavity to determine the anchor tooth, the shape of the arch, tooth alignment, missing teeth, and the presence of crowns and bridges (

). Also, examine the gingival tissues, and check for tight contacts. Next, prepare the dam material by dividing it into sixths, then punch the dam, aligning the stylus and the holes carefully. Center the punch in the upper or lower middle third of the dental dam.

Holes are punched according to the size of the tooth, the keypunch being the largest to accommodate the anchor tooth and the clamp, and holes should be punched following the pattern of the patient’s arch. Lubricate the dental dam on the tissue side with a water-soluble lubricant and select the clamp or several clamps to try on the tooth. Attach a safety line (floss) on all clamps to keep the end of the safety line in hand.

Secure the clamp on the clamp forceps, and spread the jaws slightly to lock the forceps. Place the clamp over the anchor tooth. To widen the jaws of the clamp, squeeze the forceps handle slightly to release the locking bar. Fit the lingual jaws of the clamp on the lingual side of the tooth first (

. Then spread the clamp and slide the buccal jaws of the clamp over the height of contour of the buccal surface of the tooth (

). Release the pressure on the clamp forceps slightly against the tooth to evaluate the clamp, but do not release the clamp from the forceps.

The jaw points of the clamp should be at the cementoenamel junction, adapting to the gingival embrasures on the buccal and lingual. The clamp should be secure on the tooth, not pinching any gingival tissue. Place the dental dam over the clamp bow by grasping the dam material and placing the index fingers on each side of the keyhole punch. Spread the hole wide enough to slip over the clamp. Stretch the hole over the anchor tooth and one side of the clamp, then expose the other clamp jaw so the entire clamp and anchor tooth are exposed. Pull the safety line through the dam and drape it to the side of the patient’s mouth. Isolate the most forward tooth, usually the opposite canine.

The dam material is secured on the distal of this tooth with a double loop of floss, a corner cut of the dental dam material, or a stabilizing cord. Place the dental napkin around the patient’s mouth. Place the frame or holder to stretch the dam, covering the oral cavity.

The frame can be placed either under or over the dental dam material, depending on the type of frame and the preference of the operator. Beginning with the most anterior contact with rubber septum not already passed, floss a minimum of twice for each contact, to pass septa of the dam through the proximal contacts.

Isolate the remaining teeth, gently working the dental dam between the contacts with dental floss. Invert the edges of each hole around the tooth by simultaneously drying and turning edges under with a sweeping motion of the cord instrument. If teeth have small or absent cingulum, wrap floss around the lingual surface, and invert the entire lingual of the tooth at once by positioning the edge of the hole below the height of contour using cord instrument and floss, then air-drying prior to removing floss. If absolutely necessary, the anterior tooth may be ligated by tying this loop of floss on the facial, but trauma to the proximal gingival attachments is likely. Using the air syringe to dry the teeth at this time facilitates the placement of the dam material.

When the operator is ready to remove the dental dam, the area is rinsed and dried using the evacuator and the 3-way syringe. Explain to patients the procedure to remove the dental dam and caution them not to bite down when the dam is removed.

The correct placement of a dental dam can be quick if clinicians follow and understand these steps. Practicing ensures familiarity with the materials, making for easy rubber dam placement.

For CEU course information, download this 

To obtain your 2.0 CEUs for this article 

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2020;395(10224):e39. doi:10.1016/s0140-6736(20)30313-5

To KK, Tsang OT, Chik-Yan Yip C, et al. Consistent detection of 2019 novel coronavirus in saliva. 

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Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. 

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Samaranayake LP, J Reid, D Evans. The efficacy of rubber dam isolation in reducing atmospheric bacterial contamination. 

Samaranayake LP, Peiris M. Severe acute respiratory syndrome and dentistry: A a retrospective view. 

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When dental devices work in the patient’s oral cavity, a large amount of aerosol and droplets will be generated. The use of a rubber dam can help stop the spread of these particles.

How to significantly reduce airborne particles with a rubber dam

Since their introduction nearly 60 years ago, light amplification by stimulated emission of radiation (i.e., laser) devices have been widely used in the manufacturing, electronics, consumer, and medical industries.

	The first laser for dentistry-called the ruby laser-became available in 1964 and was used primarily for hard-tissue ablation, but it was eventually abandoned for dental hard-tissue preparation due to the thermal side effects of the laser light wavelengths, which increased temperatures in dental pulp, caused microcracks, and carbonization.

	In the 1980s, ultraviolet excimer lasers and infrared erbium lasers were developed to provide better-quality temperature control and shallower penetration depths. Smaller dental laser devices were introduced in the 1990s, enabling new ablation techniques that limited damage to surrounding tissues.

	Over the years, a variety of dental lasers have been introduced and are now used increasingly for a wide range of applications.

 In fact, applications for today’s dental lasers range from soft-tissue procedures, hard-tissue (i.e., tooth) 

procedures, diagnostics, intraoral scanning for digital impressions, low-level laser therapy to relieve pain, provide wound healing, and tooth whitening, among others.

 In particular, specific dental laser devices are cleared by the FDA for certain applications. Broad clearance for soft-tissue surgery includes incision, excision, and coagulation of intraoral soft tissues. Other procedures range from treating herpetic lesions/aphthous ulcers to sulcular debridement, cementum-mediated new attachment, reducing bacterial level and inflammation, and pulpotomy. Cleared hard-tissue applications include composite curing, tooth whitening, carious lesion removal and tooth preparation, osseous surgery (e.g., osteotomy, bone shaping, osseous crown lengthening), and endodontic procedures (e.g., canal debridement, preparation, cleaning, apicoectomy).

	Additionally, dental lasers have been instrumental in diagnostic applications for detecting carious lesions and calculus, as well as providing pain relief. For example, dental laser photobiomodulation (PBM) procedures are useful for temporarily increasing local blood circulation, and also temporarily relieving minor muscle and joint aches, pains, and stiffness.

	However, each dental laser is cleared for use for only certain indications and according to specific techniques. These are determined by the dental laser technology’s specific wavelengths of laser light, which dictate the types of tissues (e.g., hard or soft) on which a particular device can be used.

 As a result, nearly every dental specialty-such as periodontics, endodontics, orthodontics, and oral and maxillofacial surgery-have dental lasers of different wavelengths available for use to facilitate appropriate procedures.

 A laser very good for use with one procedure may not be appropriate for another, since no single wavelength will treat all dental tissues.

	Therefore, it behooves dentists and their team members to understand their treatment objectives, what they want to accomplish, and different dental laser mechanisms of action before purchasing and subsequently using a dental laser in practice. This requires knowledge of a laser’s effects on tissue and how those affects are achieved.

	Dental lasers are typically distinguished by their active medium and can contain gas, a crystal, or a solid-state semiconductor.

 The center of a laser device contains a cavity core, which comprises an active medium consisting of chemical elements, molecules, or compounds. When stimulated, it is the materials in the optical cavity core that produce specific laser light wavelengths.

 Different than ordinary light, lasers produce monochromatic light, with each wave identical in physical size and shape. The coherent, collimated, and monochromatic wave of light creates a uniquely efficient energy source.

	The wavelength of a laser’s light dictates its interactions, indications, and specificity for use in treatment procedures and for which types of tissues. Soft-tissue lasers’ wavelengths range within the visible light spectrum from argon at 488 nm, argon at 515 nm, to potassium titanyl phosphate at 535 nm.

 On the electromagnetic spectrum, near-infrared soft-tissue lasers’ wavelengths consist of 810 nm, 940 nm, 980 nm, and 1064 nm.

 Mid-infrared region lasers-such as those used for hard-tissue procedures-include wavelengths of 2,780 nm and 2,940 nm, and far–infrared region at 10,600 nm.

Four types of interactions (reflected, scattered, transmitted, and absorbed) and non-interactions occur between a laser and soft tissue. Lack of interaction occurs when the laser light beam reflects off of the surface, or when the light beam passes directly through the tissue, reflection and transmission occur, respectively.

 The most common laser interactions within soft tissue are absorption and scattering.

 Scattering occurs when the laser light disperses in a non-uniform way throughout the tissue.

 Absorption occurs when light radiation is absorbed by specific soft tissue elements, such as hemoglobin, melanin, water, and hydroxyapatite.

	Once absorbed by the tissue, laser light energy produces a thermal reaction in that tissue. For example, ablation of soft tissue-which is composed of a high percentage of water-occurs at approximately 100ËC, the point of water vaporization.

 This is also the setting that hygienists use to reduce bacteria. In other words, as light energy enters into tissue, if it’s absorbed very readily on the surface, it will vaporize the tissue by raising the temperature until the water in the cells turns to steam, explode, and the tissue is removed. 

	Other thermal points can treat the tissue, such as at 50ËC and above, which inactivates non-sporulating bacteria,

 or at 60ËC, the point at which proteins begin to denature and coagulation occurs.

 To induce healing, the laser wavelength should not be readily absorbed, but rather penetrate deeper into the tissue to stimulate a biological response for healing.

(Fig. 1) A dental hygienist utilizing Dentsply Sirona's SiroLaser Blue Diode for Laser Bacterial Reduction, or LBR.

In addition to wavelength, other attributes of dental lasers affect the applications for which they are indicated. These include whether or not a laser operates in continuous wave mode (i.e., the laser is on the entire time that the unit is powered on) or pulsed mode (i.e., the energy is released in bursts, sometimes known as gated or chopped mode); peak power; and ability to control the laser settings-both power and pulse. The average power in a continuous-wave laser ranges from 0.5 to 14 Watts.

 Free-running pulsed mode lasers produce a true pulse every few ten-thousandths of a second.

 These lasers exhibit high peak power, up to 1,000 Watts range, but deliver low average power through extremely short pulse durations every few hundred microseconds.

A dental laser can deliver its laser energy to tissue through one of several systems. Optic fibers, which are the most common delivery system, use small flexible glass fibers directly in contact with the tissue to deliver the energy.

 Semi-flexible, hollow waveguides and rigid sectional articulated arms are other delivery systems available.

 Some delivery systems also incorporate additional small quartz or sapphire tips that attach to the handpiece and contact the tissue.

	Used in dentistry for more than 25 years, carbon dioxide (CO

) lasers produce wavelengths of 10,600 nm and are ideal for incising and excising biopsies, frenectomies, and gingivectomies because their laser light readily interacts with free water molecules in the soft tissue and vaporizes the intercellular wall of pathogens.

 lasers incorporate continuous-wave emission mode, many also include gated-pulse interruption in either super-pulsed and micro-pulsed modes.

 lasers use waveguide and articulated arm delivery systems.

	The continuous-wave mode with gated pulse reduces the potential of thermal damage to the root surfaces, enabling CO

The very short duration gated pulsing also provides precise control of the laser thermal action.

 laser produces a positive effect on osteoblast proliferation and differentiation,

 laser in combination with augmentative techniques to treat peri-implant infrabony defects by decontaminating implant surfaces can be an effective way to address peri-implantitis.

 The Solea laser from Convergent Dental was the first CO

 dental laser to be cleared by the FDA for treatment on hard and soft tissue and operates at 9,300 nm. 

	Diode lasers produce invisible near-infrared light at wavelengths of 810 nm, 940 nm, 980 nm, and 1,064 nm,

 lasers, diode lasers are continuous-wave emission mode that can also be manipulated into a gated pulse. Diode wavelengths specifically target the pigments in soft tissue, pathogens, and inflammatory and vascularized tissue.

	Effective for performing gingivectomies, biopsies, impression troughing, and frenectomies, diode lasers also produce bactericidal effects.

 lasers, diode lasers avoid creating surface defects on zirconia implants because they do not penetrate zirconia material.

 With a single application, diode lasers are also efficient in controlling inflammation around treated implants.

	Erbium lasers (i.e., Er,Cr:YSGG and Er:YAG) produce wavelengths of 2,780 nm and 2,940 nm, respectively,

 and can effectively treat both hard and soft tissues;

 they are often referred to as all-tissue devices due to their short temporal emission and laser light absorption by hard and soft tissue. Used for periodontal procedures, gingival contouring, biopsies, frenectomies, and pre-prosthetic procedures,

 these lasers provide higher powers and more efficient delivery systems for faster cutting speeds and improved hemostasis.

 With free-running pulsed emission mode, erbium lasers deliver square pulses rather than bell-curved analog pulses, resulting in quick ablation and reduced pain.

 Erbium lasers also create photo acoustic shockwaves to increase efficient debridement of endodontic canals.

	Used as a single treatment, or for complementing surgical procedures,

erbium lasers ablate soft tissue, hard tissue, and biofilms while avoiding thermal damage to the adjacent tissue.

 Use of Er:YAG lasers can eliminate the need for local anesthesia, minimize post-operative pain, and decrease recovery time.

  Additionally, erbium laser irradiation may increase osteoblast proliferation and differentiation.

	Further, Er:YAG lasers can be used to successfully debride/decontaminate implant surfaces,

 regenerate osseous tissues without complications but with high patient and clinician satisfaction,

 and treat peri-implantitis, resulting in improvements in plaque index, bleeding on probing, probing depth, gingival recession, inflammation, and clinical attachment level.

	Developed for use in periodontal treatments, Nd:YAG lasers produce wavelengths in the near-infrared range of 1,064 nm and target the pigments in the soft tissue, primarily hemoglobin and melanin.

 With free-running pulsed emission mode, Nd:YAG lasers have various pulse increments for transitioning from cutting to hemostasis.

 Ideal for gingivectomy, frenectomy, impression troughing, biopsy, debridement, and disinfection, Nd:YAG lasers may also be used for bacterial ablation and reducing implant contamination, without damaging the surface properties.

	Additionally, surgical and non-surgical Nd:YAG laser treatments may even be performed without local anesthesia, enabling full-mouth treatment in one appointment and with minimal bleeding, reduced post-operative pain, no swelling, and no sutures.

 Due to these benefits, patient acceptance of laser therapy is greater than for conventional treatments because Nd:YAG laser approaches require about 50 percent less time.

	Within surgical procedures, good hemostasis and reduced need for sutures is achieved when soft-tissue lasers are used. Other benefits include selective and exact interaction with tissues-which results in less trauma, ability to lower the bacterial load in the surgical field, reduced inflammation, and stimulation of new fibroblasts and osteoblasts for improved healing.

	Soft-tissue lasers have also been instrumental for managing gingival tissues for esthetic treatment, non-surgical and surgical periodontal pocket therapy, osseous surgery, and implant therapy.

 What’s more, compared to a scalpel, lasers produce excellent coagulation, reduce pathogens, temporarily seal nerve endings and lymphatic vessels, and potentially eliminate the need for sutures, all with less scar formation.

	Additionally, soft-tissue dental lasers are beneficial in helping to manage periodontal disease.

 Various soft-tissue laser wavelengths for treating chronic periodontitis-in addition to conventional scaling and root planning-have been shown to effectively reduce probing depth and subgingival bacterial populations.

	Erbium lasers can prepare enamel, dentin, caries, cementum, and bone. In addition, erbium and other hard-tissue lasers can be used for removing bone in crown-lengthening procedures for esthetic enhancements.

 When used for hard-tissue applications, erbium lasers diminish or eradicate vibrations, the sound of dental drills, microfractures, and alleviate a great deal of stress that patients associate with high-speed handpieces.

 Restoratively speaking, and compared to a drill, hard-tissue lasers produce no smear layer on dentin or bone, no microfracturing of enamel rods, and simultaneously disinfect hard-tissue surfaces.

In fact, hard-tissue lasers have been used in conjunction with endodontics since the early 1970s. Laser applications within endodontics include pulp diagnosis, treating dental hypersensitivity, pulp capping and pulpotomy, root canal sterilization, root canal shaping, and obturation and apicectomy.

	Low-level laser therapy (LLLT) or PBM, has been a treatment modality for the past 30 years. Low-level laser therapy or cold laser therapy is used for wound healing and muscle repair. LLLT also has FDA clearance for treating and managing oral mucositis.

	LLLT uses light energy from adenosine triphosphate (ATP) to stimulate the body’s biological responses. This increases cellular energy and alterations in the cell membrane, resulting in pain relief, wound healing, muscle relaxation, immune system modulation, and nerve regeneration.

Dental lasers provide an alternative to traditional treatments, are less invasive, and limit complications. 