Forums Erbium Lasers General Erbium Discussion Kavo Key Laser 3

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  • #2855 Reply

    davidmylo
    Spectator

    First of all, I would like to express my most sincere thanks to all you guys here for the amount of precious information. I’m not using a laser yet but to me, laser definitely marks the future trend of dentistry. I’m seriously considering perchasing a laser and is in the process of gathering info and valuable opinion from laser users.

    However, it seems a lot have been discused regarding waterlase and the versa wave hoya conbio laser but little has been mentioned about the kavo key laser 3.

    It’s a ER:YAG solid-state laser with a feed back system claiming it can selectively remove calculus in perio pockets leaving sound root surface un-touched in perio treatments and later, with a touch-technique handpiece, can selectively remove carious dentine only leaving sound remineralisable dentine untouched during restorative treatment.

    Any info or opinion welcomed. Thanks again. :confused: :biggrin:

    #6586 Reply

    Kenneth Luk
    Spectator

    Hi David,
    I spoke to a user last night. He said that it would take him 15 mins to complete one suggingival scaling with laser alone. The chisel tip is place at an angle towards the calculus, the laser automatically fires away at a pretty low Hz. He would then feel the lack of resisitance and then he would move the tip further down. Asking about the parameters,he could not recall. Hopefully , he would let me know later. After this, he would turn of the water and use it for decontamination and soft tissue ablation of the pocket. He also said the bleeding would also be controlled. I’m not too sure and confused about this.
    There are three handpiece, a window, contact tips and non-contact tips.
    The selective caries remval will be in the Keylaser 4. So I was told and they basically include the Diagnodent with the laser.
    Ken

    #6589 Reply

    Robert Gregg DDS
    Spectator

    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

    #6579 Reply

    davidmylo
    Spectator

    Thanks Ken and Rob for the prompt reply.

    As far as I know, the Kavo handpiece for caries removal is utilising non-touch technique and the red beam is for aiming purpose.(Do correct me if I’m wrong).

    For accurate detection of caries/calculus, the distance of the handpiece to the object must be fixed for proper calibration and hence must incorporate the “touch technique”.  That’s probably why the next generation of the kavo laser will be utilising the touch technique for the restorative handpiece.

    I was told that the perio handpiece is utilising the touch technique to detect presence of calculus to trigger the firing of the laser. Once calculus is not detected, the laser stops until the laser tip detects (touches) calculus again.

    It’s certainly using the diagnodent technology and supposingly, once the detecting laser hits calculus (or caries), the feed back mechanism triggers the firing of the Nd:YAG laser to ‘explode’ the water molecules in the calculus/caries to remove them.

    The theory certainly sounds great but Ken, when your friend said takes 15 min to do one subgingival scaling, how many teeth is he referring to? One tooth of full mouth?

    And Rob, when you say pocket resolution takes place even eith 50% residual calculus in situ, is it just healing of the soft tissue or includes re-attachment of the periodontal fibres?

    Thanks again and have a nice day.

    #6587 Reply

    Kenneth Luk
    Spectator

    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

    #6580 Reply

    spider24
    Spectator

    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.

    Kavo is a pioneer in Er:YAG application. I think they started 16 years ago with the first Key laser. I also think they had the fist Erbium for dental application.

    On their website you find a list with 230 scientific and clinical publications. I think thats a good scientific base.

    The unit itself seems not to be one of the fastest and powerfull systems. Newer systems show more performance.

    Olaf

    #6583 Reply

    Glenn van As
    Spectator

    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

    #6581 Reply

    spider24
    Spectator

    First of all: i´m no friend of the KAVO feedback system, because i find it very risky to give a machine the control of switching the laser power on and off. I´m an engineer and i know that every software has bucks.

    QUOTE
    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.

    Absolutly agree. The question is what energy comes realy out of the tip when the diplay shows 160 mJ ? . I think 30-50 mj at the tip are enough.

    IMHO bacteria reduction in closed pockets is not effective with an Erbium – the penetration depth is too small. But removal of calculus works pretty good with the right settings.

    Thats the reason why Fotona / Lares has developed an Erbium/Nd:YAG combination and i developed an Erbium/Diode combination unit. Erbium for Removal of calculus, diode or Nd:YAG for reduction of bacteria.

    QUOTE
    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)

    I think combined units like Erbium+Nd:YAG or Erbium+diode with standarized treatment protocols have the potential to show this. But with one single wavelength it is impossible. The units i talked about are brand new (production of the elexxion delos started just 6 weeks ago) and studies takes time and money. The future will show.

    Olaf

    #6584 Reply

    Glenn van As
    Spectator

    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

    #6582 Reply

    spider24
    Spectator
    Quote:
    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.

    Quote:
    Dear Glenn,

    i think the differences between dentists on the application side and designers on the manufacturer side are not so big when both understand and respect the physical limitations of wavelengthes, energy and power.

    I´m now reading here for nearly one year and i have highest respect for guy´s like you and some others who try to look behind the marketing stategies of the manufactureres.

    There are lots of companies trying to market there systems as “universal laser”. In Euope as well as in the US.

    There are only a few, like Bob Gregg, who decided to design a laser with a specific wavelength for a specific application. And they did it right because they accepted the physical properties and limitations of their specific wavelength.

    Elexxion has a similar philosophy: Understand the problems of dentistry, respect the physics and try to develop a usefull product to give the best possible treatment for the patients.

    I hope to get some usefull input here for further developments and for a succsessfull launch of elexxion products on the US market in 1 or 2 years.

    Olaf

    #6578 Reply

    Anonymous
    Guest
    QUOTE
    I hope to get some usefull input here for further developments and for a succsessfull launch of elexxion products on the US market in 1 or 2 years.

    Olaf

    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. 😉

    #6585 Reply

    Glenn van As
    Spectator

    Remember Ron…….1% of nothing is……..

    You got it.

    glenn

    #6588 Reply

    Robert Gregg DDS
    Spectator
    QUOTE
    Quote: from spider24 on 4:52 pm on Oct. 27, 2005

    There are only a few, like Bob Gregg, who decided to design a laser with a specific wavelength for a specific application. And they did it right because they accepted the physical properties and limitations of their specific wavelength.

    Elexxion has a similar philosophy: Understand the problems of dentistry, respect the physics and try to develop a usefull product to give the best possible treatment for the patients.

    I hope to get some usefull input here for further developments and for a succsessfull launch of elexxion products on the US market in 1 or 2 years.

    Olaf

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

    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.;) cool.gif

    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

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