Glenn,
I know you will have fun!  FYI   In my own accounts I have quite a bit less (about 2/10) than last year because I felt perception was ahead of reality when prices went up uninterrupted earlier this year.  Now that the price is more reasonable, I am willing again.  

Here I am giving all the anti-HK folks a chance to destroy one of the pillars of HK.  The pulpal temperature measurements by Riziou et al.  Stick to the data and prove it wrong WITH OTHER’S DATA and you would have gone a long ways in convincing me.  Heck, spend the &#3610K at a dental school lab and destroy without any doubts your competiition technical underpinnings – do it now!!!  It’s one hell of a return.  I don’t get it though, it’s been 5 years since the publication of the Riziou et al data and nobody has done a thing about it?  I would think Biolase competitors are smarter than that.

Lets just for the sake of argument that water shocks (and I am referring to both DELight and Waterlase here Glenn) does not augment ablation.  All three Opus, ConBio and Biolase will be out of business because all three companies are using the wrong wave length.    Take that and chew on it.

(Edited by lagunabb at 8:32 pm on Sep. 21, 2003)

Ray:

You can easily look up the Watson study on line yourself.
As you will find, the heat measurements are within statistical error of the Riziou study.

HOWEVER, as the Riziou study will tell you, they only made 5mm circular patterns with the drills and laser ablation sites to test for pulpal heat.

We as dentists (not you) rarely if ever keep a preparation to a 5mm diameter, especially if there is decay or an old restoration. Hence, more area drilled or ablated, obviously means more friction or energy delivery and more heat.

That is simply a rediculous standard (5mm diameter preps) to measure pulpal heat against in the real world. Hence my characterization of Bullsh-t data, among the many other reasons that I already discussed ad nauseum.

Riziou then extrapolated this data to further levels of rediculousness by bringing in the “HK” logic, and suggesting that because the pulp temp (measured with a thermocouple) did not rise significantly, there was a “new mechanism of cutting, unlike that of other laser systems” ie. “Hydrokinetics”.

I DON’T THINK SO.

Everyone can also re-read my proofs against the “HK” theory on previous posts, and Riziou’s less than steller references to back it up.

Now that I know what and who I am dealing with (not a clinician by any means), I think that it is time for me to put my energies into other people and arguements.

I personally would rather argue and debate with a practitioner or scientist that is actually interested in patient care, and how the patient is affected with these lasers.

I have no bias against what you are doing, this is America after all. However, I will follow Bob Gregg’s lead and put my energies into being a Bullsh-t filter, to help the patients and dentists that are actually involved with the lasers.

Make no mistake, if I see you put out crap, doublespeak, or wrong information to confuse people, I will challange your assertions with with every bit of intellect, science and logic that I can muster. Our patients, and dentists that have yet to buy a laser, deserve no less.

But, I am through bantering with you about data from studies that you are not trained to understand.

As, Bob Gregg said, you have never picked up a handpiece or laser and put it in someones mouth. Hence you have no reliable perspective to interpret the data and make a clear arguement. We are not dealing with stationary oil rigs (as per your last post).

After trying to make sense of some of your questions and assertions about these dental and surgical studies, your lack of adequate perspective is painfully obvious. It would be like me debating you on the flow values of oil wells (again as per your previous post), when I have never stood on one.

Again, no animosity, just a whole hell of a lot less respect for your point of view.

I am glad that you posted your disclaimer, it will now save me a great deal of time trying to figure out why certain things that should be obvious, or important from a clinical perspective, seem to escape you entirely (re-read your comment about Eversole possibly wanting to achieve heamostasis in bone for the temp readings that he got). Now comments like that, from you, make sense to me and everyone else.

Best of luck in the future.

Eric Bornstein DMD

Ray:

Did you ever get “does not listen well to others” checked off on report card in first grade?

One more time:

After I posted “Riziou data is within statistical error of the Watson study for temp measurements”, in the next sentence I presented the flaw in “5mm preps to measure pulp temp” as not by any means “representing the real world”. I concede nothing, but disdain for the entire process and way Riziou tried to present the heat and “HK” arguement.

Please stop taking “PIECES” of my posts out of context. This is probably the fifth or sixth time you have done this to try and make a point.

Eric Hoffer once said, “You can discover what your enemy fears most by observing the means he uses to frighten you.” I am beginning to think this is true of your arguements. You seem to fear presenting my arguements in full, by posting only pieces of them.

As to the difficulty of my position???

I honestly have no idea what you are talking about. If someone else can chime in, and educate me as to what my position is, other than ultimately helping practitioners make better decisions for their patients, I am all ears.

Ray, take a close look at this other important quote.

“At that time [1909] the chief engineer was almost always the chief test pilot as well. That had the fortunate result of eliminating poor engineering early in aviation.”

Igor Sikorsky, reported in ‘AOPA Pilot’ magazine February 2003

Ray, you may be some type of an engineer, but you do not have the DDS or DMD so you are not a test pilot in this case.

Please stop giving the currently poorly trained or uninformed test piolets (laser dentists) confusing information.

Last point:

In all of our discussions, I have yet to once see how your interpretation of the data in these studies is superior to mine. Different yes. Superior no.

I think that there are more than a few folks on the two boards that can choose which data points, and from which individual they will take information to better treat thier patients.

My single point of view is equivalent to this.

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.
–Voltaire [Francois-Marie Arouet]

You and Biolase at times are contributing to Voltaire’s arguement, I (and others) are trying to change it.

Eric Bornstein DMD

Ray:

You are getting tiresome and boring.

Here are the specs of a TEA CO2 laser currently on the market.

Specifications*
Model 10.6 µm 9.6 µm
Wavelength10.6 µm9.6 µm
Repetition Rate <1 to 10 Hz same
Pulse Width125 nsec FWHM in the gain switch spike same
Pulse Energy15 mJ, multimodesame
Pulse to Pulse Energy Stability5% std. dev.same
Peak Power75 kWsame
Average Power 150 mW at 10 Hz same
Beam Diameter 2.5 mm same
Beam Divergence,
Full Angle6 mradsame
External Trigger Input TTL, rising edgesame
Burst InputTTL, HIGH=disable same
Sync Output TTL, rising edge triggersame
Input Voltage110 v 50 Hz;
210 v 60 Hzsame
Power Consumption1.5 A 110 VAC;
1 A 220 VACsame
Dimensions, l x w x h 18.2 x 7.6 x 4.6 in;
46.3 x 19.3 x 11.7 cmsame
Weight 20.5 lbs; 9.3 kg same

THE PULSE WIDTH OF THESE LASERS IS IN THE NANOSECONDS. WITH ALL DENTAL ERBIUMS, WE ARE IN THERMAL INTERACTIONS IN TH HUNDREDS OF MICROSECONDS! GET WITH THE PROGRAM OR PLEASE GO AWAY.

YOU ARE TALKING APPLES VS GOLF SHOES. THAT IS HOW DIFFERENT THE INTERACTIONS ARE BASED ON THE PULSE-WIDTHS OF YOUR ARGUEMENT!

If anyone comes out with a TEA CO2 dental laser, terrific, I am on board. Until then, please do not confuse the current discussion.

Also (deep breath), I just received in the US mail the second Riziou HK reference article from the CDA that I did not have last week.

I now quote you from their December 1995 article in the Er:YSGG hydrokinetic laser discussion section.

“The photon energy (2.78um) for this system activates hydroxyl groups in the water spray and in the tissues, with maximal energy delivered from 1 to 2mm from the sapphire tip.”

So as to your assertion that I am “hiding behind my blizzard of Quantum Mechanics”, I say this:

Orriginal Quantum Arguement:
Einstein’s Relativity

The second postulate of special relativity states that the speed of light in free space has the same measured value for all observers, regardless of the motion of the source or the motion of the observer: that is, the speed of light is a constant at 300,000 kilometers/sec.

If incident erbium energy (infrared light) strikes a water droplet in front of the beam, and the reaction (vaporization, hydokinetics, whatever) begins; long before even 1% of the reaction causing the hydrokinetics takes place, the rest of the erbium photons that did not interact with the water must have already hit the tooth and begun the thermal-mechanical ablative reaction that we all know. To state any different logic than this (because remember light travels at 300,000 kilometers/sec) is to say that the hydrokinetics is faster than the speed of light. Einstein says that is impossible. This is my problem with HK from Einstein’s perspective.

Again from Riziou 1995:

“The photon energy (2.78um) for this system activates hydroxyl groups in the water spray and in the tissues, with maximal energy delivered from 1 to 2mm from the sapphire tip.”

It appears that even SHE AGREES WITH my arguement from a quantum mechanics perspective RAY. She just stated that the 140um to 200um pulse widths of Erbium photons DO INTERACT WITH THE TISSUE. Hence, PROVING my Einstein arguement.

And we all know what happens when 140um to 200um Erbium photons hit tissue by this time, do we not?

Can you dig your hole any deeper?

Eric Bornstein DMD

First, my apologies to the board for this continuing diatribe. This is the last one of these “shock wave assumptions” that I am going to demistify.

Here is the paper ray is referring to:

Application of laser-induced liquid jet and shock waves to medicine

Makoto Komatsu

Water vapor bubble is produced by energy absorption of water. And large energy supply for a extraordinary short time brings about formation of underwater shock waves. Energy source for these phenomena is laser emission, electric discharge, explosive and so on.

In SWRC, production of bubble and shock waves in water with laser irradiation has been studied. Laser which has wavelength close to light absorption spectrum of water have to be employed as effective energy source. Holmium YAG (Ho:YAG) laser beam has 2.1 um wavelength, which is close to 1.9 um of a light absorption spectrum of water. Therefore, Ho:YAG laser is suitable to generate bubbles and shock waves in materials including a large amount of water.

HERE IS THE MOST IMPORTANT PART:

Laser-induced jet is produced by laser emission in narrow capillary tube. Fig. 1 explains the process of laser-induced liquid jet production. Optical fiber is inserted into a capillary tube filled with water. Laser beam transmitted via the fiber produces water vapor bubble growing toward the capillary exit, and then water is expelled from the exit by expanding bubble. Water flow generated by the emanation of water produces liquid jet finally.

This is a very nice and profound concept. But it is not remotely related to what we are doing. Please read on.

Now, if Ray did not like my Quantum Mechanics, he is going to like my Newtonian Mechanics even less.

Class, let us review:

Newton’s third law of Motion:

Newton states that whenever one object exerts a force on a second object, the second object exerts an equal and opposite force on the first. In other words, to every action there is always opposed an equal reaction. Neither force exists without the other, and forces come in pairs. The action and reaction pair of forces makes up one interaction between two things.

Now, lets extend the ideas in Newton’s third law to propulsion. Because in effect, hydrokinetics theorizes that water particles are propelled toward the tooth with enough force to exert ablation. For a rocket to be propelled into the sky, it has nothing to do with the impact of the exhaust against the atmosphere. That is a very common misconception. What propels a rocket, is the recoil force of the exhaust molecules (system #1) pushing against the rocket itself (system #2). A pair of forces, opposing each other, with system #1 overcoming system #2 and the rocket moving up through the atmosphere.

You always need two systems. Here is another maybe easier example.

If your car runs out of gas, and you get out of the car and behind the bumper and push, as long as your force overcomes the force of the car and the friction of the pavement and surrounding air, the car will move forward. However, if it is raining outside, and you say “Hey , I do not want to get wet”, and push the car with the same force on the dashboard in the front seat (as you previously did out of the car and on the bumper), the car will not move at all.

Why?

Because you and the car (with you still in the front seat) are now the same system. For Newton’s third law to apply, there must be two separate systems (ie. You pushing behind the bumper or the exhaust molecules pushing against the rocket).

With the hydrokinetic theory as presented (in my understanding) we are only dealing with one system. There is nothing to push against. The theory as presented, has erbium incident energy vaporizing part of a water molecule and propelling the rest of the water molecule towards the tooth, with enough direct vector momentum to cause ablation of enamel. My main problem with this is Newton’s third law. Where is the equal and opposite force, to such an extent, to cause up to 16,000+ psi of pressure on the remaining water “particles” to propel them forward.

To me it is all the same system, (one original water droplet) just like sitting in the front seat of your car, trying to move the car by pushing on the dashboard. This is my problem with it from Newton’s perspective.

In the above paper, THEY ARE GENERATING Laser-Induced Liquid Jet and Shock Waves IN A CAPILLARY TUBE. RAY, THE CAPILLARY TUBE IS THE SECOND NEWTONIAN SYSTEM PROVIDING THE FORCE TO PROPEL THE WATER FORWARD! In the Biolase “HK” system, THERE IS NO SUCH SECOND SYSTEM.

The above paper continues:

Besides, this system is superior to tissue damage, because there is no high temperature origin and construction is simple.

Contribution of shock wave to cut tissues and effect of shock wave on surrounding normal tissues are not revealed clearly. After this, Evaluation of them and optimization of abovementioned system are important subjects for clinical application.

I agree with everyting the paper is saying, IT AGREES WITH NEWTON AND EINSTEIN.

I will argue with you on this point no more.

Let the ladies and gentlemen of the Jury decide.

On to more important topics (like watching paint dry, at least that can be explained)

Eric Bornstein DMD

RAY:

READ THE PAPER. IT TELLS YOU EXACTLY WHAT IS HAPPENING.

“Laser-induced jet is produced by laser emission in narrow capillary tube. Fig. 1 explains the process of laser-induced liquid jet production. Optical fiber is inserted into a capillary tube filled with water. Laser beam transmitted via the fiber produces water vapor bubble growing toward the capillary exit, and then water is expelled from the exit by expanding bubble. Water flow generated by the emanation of water produces liquid jet finally.”

For all who believe that I am suggesting the direction of the shock is important within a confined capillary, with one exit, raise your hands. OOPS. No hands raised.

Here is a statistical calculation for you.

Ray, what is the answer to this problem.

(Double-speak) + (Triple-speak) + (intentional confusion) = ?

I think the rest of us know the answer.

Eric Bornstein DMD