jetsfan,
I considered using the Waterlase for currettage, as the people from Biolase were suggesting, but decided not to for the following reasons;
1. the tips only have end action- how do you do  treat the inside lining of a pocket with something that is only has its effect at the tip with no side action?
2. the perio tips I saw were very inflexable-hard to get 360′ access to teeth
3.since the Waterlase seeks H20 molecules rather than pigment, how do you keep from affecting the hard tissue
cementum/bone?

I think there are better choices – nd:YAD or Diode.

If you look up some of the stuff Bob Gregg has done with the nd:YAG or what Bob Barr has done with the Diode you’ll see some amazing results.I don’t think the same can be said for the Waterlase and perio tx. JMO

Hi Ron and Pat,

I LIKE Ron’s reasoning!!!

Good News

The forward firing aspect of the FR pulsed Er, CR:YSGG means that unless you are pointing the fiber directly at the root (or greater than 30 degrees), it’s unlikely there will be much absorbtion on the root surface.  That seems to be born out by hisology I saw a few months ago (I can’t remember the reference).  So keep your fiber oriented to the long axis of the root surface.

Bad News

But the histology showed that the forward penetration into the bone and PDL transceptal and crestal fibers couldn’t be determined/controlled, and the laser pulse cut a nice chunk of healthy attachment and underlying bone–oops.

Thirdly, since the 2.8 wavelength “sees” water, collagen, and hydroxapatite equally, there is no differentiation between the epithelial lining and the connective tissue Rete pegs.  That means there is no selective removal of the ulcerated lining from the connective tissue that ideally we want to leave behind and intact in laser curettage.  That is better accomplished with near infrared lasers (810-980 nm diodes; 1,064nm pulsed Nd:YAGs)

There are also access problems, fiber stiffness and LENGTH issues, hemostasis challenges– all limitations that reduce the expectations and predictability of results.

This is not to say it is dangerous or “bad” to use Er. Cr,:YSGG in the perio pocket.  It’s just that there are better devices and configurations to perform “laser curettage” that are safer, more predictable, more reproducible.

It can be used at lower powers and settings as a “decontamination” device.  Sweep back and forth until you get “fresh bleeding” as you visual end-point, I would say.  

Great News

There is another larger unappreciated distinction between near-infrared lasers (810-980nm and 1,064nm) and mid-infrared lasers (2,800-2,900nm).

Mid-infrared laser beams are stopped or absorbed by all tissues of the body that contain water, collagen, and hydroxapatite.  That means the killings of pathogens is a surface phenomenon–no tissues can be between the laser beam and the bacteria.

Near-infrared lasers, on the other hand, transmitt through water in tissues (you too Biolitec) with NO attenuation of the beam intensity until the beam hits a pigment the wavelength is highly absorbed into–like black pigmented anaerobes embedded out into the tissues (i.e. a papillary cellulitis, or bony invasion).

These near-infrared beams of light will transmitt through tissues without biologic effect (to varying degrees and %) until the beam comes in contact with a black bug, and…..Instant Death!  Pretty cool huh?

Even Better News

FR pulsed Nd:YAGs (1,064nm) because they have high peak powers in each pulse, keep the beams intensity deeper, longer, and SAFER than a continuous wave or “gated pulsed” 810-980nm diode.  More Bad Bugs DIE at greater distances from the pocket wall, therefore, than with any other laser wavelength or configuration.

The Er, CR: YSGG is best employed as a scalpel replacement, that is, a reverse gingivectomy.  But that is getting closer to the incident angle of 30 degrees that needs paying close attention to.

Hope that helps a little.

Bob

Glenn,

Thanks for the compliment…I think…..:confused:

You don’t need to worry about the &#36&#36 for our Fr Nd:YAG.  The patented LPT procedure pays for the laser in 12 patients (24 Canadian);)

Bob