Ray:

Schalter’s thoughts on delivery of topical anesthetic are good.

I do want to make some comments regarding the use of erbium lasers for treatment of periodontitis. Since the wavelength is highly absorbed by water and hard dental structures, I just don’t think erbium is the proper laser for conservative periodontal treatment. To me, erbium lasers are surgical cutting instruments best suited for procedures like composite resin preparations, frenectomies and in certain cases reduction of bone.

Do want to state that I don’t provide any type of laser periodontal therapy in my practice and others here can share a vast amount of information on the subject. But, the pilot studies I did with my erbium laser showed no improvement in periodontal health. Furthermore, I weekly use the erbium laser to separate periodontium from teeth to be extracted and find that even when carefully aimed, the erbium causes significant damage to cementum/root structures.

Another concern is that some research has shown many periodontal pathogens contain pigmentation. Although all bacteria contain water, there is some indication that laser wavelengths about one-third that of erbium might specifically target pigmented bacteria. So maybe if these wavelengths reduce the pathogenic population without disturbing root structure, the sulcus can recolonize with healthy flora and in some cases regeneration of attachment occur.

Bottom line to my ramble is that if I were to get involved with some sort of laser treatment of periodontitis would either use:

1) Nd:YAG and specifically the unit and technique promoted by McCarthy and Gregg of MDT. I think these guys are on to something which in selected cases may eventually be shown to be a legitimate alternative to conventional periodontal surgery.

2) Diode lasers in the 800-980nm range.

Best wishes and welcome to LDF!!!!

Al

P.S. Product Recommendation Disclaimer
I don’t own a Periolase MVP-7 from MDT and have no plans to purchase one in the foreseeable future. On the other hand, Robert Gregg and I have been known to get together for drinks;)

I’ve got a Periolase II and we’ve been getting phenomenal results with it for laser perio surgery. Bob and Del at Millennium really do have a much better alternative than traditional scalpel perio surgery. Patients really love it, especially if they’ve had traditional perio surgery in the past because the postop course is almost uneventful. Very little soreness or root sensitivity to cold like you’d have with traditional perio surgery. I’m trying to justify in my mind getting an erbium. Has anyone actually used both the Waterlase MD and the Hoya con Bio Versawave, if so what would be your choice and why?

Loyd, more than one active member here on LDF has both in their office (namely Drs Kimmel and Williams) and I am sure they would be DeLighted to give you there opinions on the strengths and weaknesses of both machines (and both do have plusses and minuses)

Cya

Glenn

Ditto to what Bruce said. I’ve used both Nd:YAG and Er,Cr:YSGG for about 3 years and have found that you simply need more than one “tool” to fix issues in the oral cavity. Er lasers and Nd:YAG lasers are absorbed into oral tissues so differently, it’s like comparing apples and oranges.

I will say that the only time I’ve had successful perio therapy with the YSGG was when I did a FT flap, exposed roots, ablated all calculus with the laser under 8.0X magnification with the scope and sutured back together. The healing was great, but the invasiveness was significant. After 1 year of LANAP in our office, we’re seeing better, more predictable results with a significantly less invasive protocol.

Kelly