Using a red laser beam as part of a feedback loop for decay or calculus presence is finicky to be sure. I use a red laser beam in a device called the DetecTar from Ultradent. It “alerts” on calculus alright–and bone and crown margins (below which calculus loves to hide), even root dentin at the right angulation.

Since there are no controlled studies showing the safety as well as efficacy of the KavoKey 3 for combined erbium/red calculus removal, I would be concerned about using it as designed.

Some of us here on the LDF spoke with a rep from Danaher–the parent company of Kavo, who was researching the dental laser market in the US. I know that I told them not to market stuff to dentists with little or no research to support the intended use. I hope they listen. It takes time to conduct proper research, and money for sure, but it is really the only responsible way to introduce new laser applications anymore.

Now I think there may be some value in using an erbium for calculus removal–but we need basic science to show what happens to the calculus and root cementum and dentin at clinically relevant light dose and other operating parameters right Glenn?!

Remember, calculus removal may not be so critical to remove ever speck. It is the plaque and bacteria layer on top of calculus that is most pathologic.

Meta analysis of the perio research (Cobb in Annuals of Perio 1996, Mechanical Instrumentation) shows that pocket resolution takes place even though 50% residual calculus is left behind after closed flap S/RP and 43% is left behind afer open flap S/RP.

So decontamination of the caclulus by S/RP and a “deep penetrating” laser like FRP Nd:YAG might push the balance of bacterial load of the bio-burden in favor of the host.

Bob

Hi David,
Do you mean Er:YAG to remove calculus?
Yes, he meant 15 min per tooth. i asked him a few times! He said the procedure is really slow! I’ll asked him again to confirm this.
Ken

I dont know Olaf……..

Schwarz et al have done several studies looking at the erbium laser for calculus removal.

I have one question…..

Is this wavelength selective for calculus removal……..

ANSWER ………NOPE

The laser will remove calculus if the beam is angled perpendicular to calculus (not easy) but will remove cementum as well.

I seem to remember reading that suggested settings were 10Hz and 160 mj.

That is one heck of alot of energy regardless of tip size. I can tell you that will easily etch enamel at a distance of 1.5-2mm. In addition you can bet that it will notch cementum.

I am not a big fan of any laser being used for subgingival calculus removal at this time regardless of feedback or not from the Detectar.

In addition, I would like to see how the laser selectively removes soft tissue and the depth of penetration (50 microns ) will not be very good for bacteria deeper in tissue like the NdYAG.

I have seen very little in the literature to support erbium lasers for pocket reduction, and remember the laser is absorbed in water not black pigmented bacteria like the NdYAG.

I hope that we can see some nice research showing

1. Full calculus removal
2. Not alot of cementum removal (unlikely)
3. Pocket reduction hopefully through no long junctional epithelium. (Not likely)

Finally, the laser is not marketed for restorative purposes as I had the original CD or DVD that was promoting it primarily for periodontal purposes.

I am not a big fan of that wavelength for that procedure.

But then again I am but a lowly laser dentist, not a researcher looking for an application for a particular wavelength to market (tongue firmly planted in cheek)

Glenn

Olaf, I do agree with you fully on the combination units. These units are quite large usually (Lares) but they do offer two wavelengths and you can look at laser absorption spectrums to easily figure out which wavelength is best suited for one application.

As I am fond of saying…….ONE LASER (ERBIUM FAMILY) CAN DO IT ALL.

Problem is that it cant do it all well!!

I think that your idea of the combination either in one unit or as separate entities will be attractive to those educated enough to realize that an erbium is a nice machine, but lets not try to make it the be all wavelength for all procedures.

Just like I told Bob Gregg many years ago, just because the NdYAG can remove pigmented enamel caries doesnt mean that it should be marketed for that procedure!

There are better wavelengths for caries removal (Er:YAG, Er, Cr,:YSGG) and there are better wavelengths for perio including NdYAG and perhaps CO2 and DIode if the studies ever come out with protocols and treatment regimens to provide true attachment instead of just improvements in gingivitis and pocket reduction through tenuous long junctional epithelial attachments. I guess its better than nothing I suppose!

Take care and isnt it interesting to read the differences in thought processes from someone who is designing the lasers to someone who is at the end of the cycle using them. The patients are the only ones not responding here but its nice to get input from those along the manufacturing pathway.

Thanks again

Glenn

I knew I should have changed that online registration to read- all input from ldf used for research purposes will be accessed @ 1% of profit. 😉

Olaf–That’s very gosh, darn nice of you to say that.  Accurate depiction of our thought processes as well.  How refreshing.  

Ron–NEVER, my friend, accept a percent of profit or net, only of the gross.  “Expenses” can be artificially created to eat up all profit, but gross is sale price from which all division of proceeds must come from.  Get yours off the top like everyone else.;)

Glenn–starting next year MDT has a new hard tissue marketing plan for the Nd:YAG…………….:biggrin:  I think we’ll announce it right before your presentation in Las Vegas!!  LOL………..

Bob