Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Laser perio treatment Question
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mickey franklSpectatorI understand there are now new Diode lasers with variable pulses.
I understand that the Periolase is still the ultimate laser for perio treament,just woundered
how do these diodes compare to the Periolase ?
kellyjblodgettdmdSpectatorHey, Mickey! Good question. I think that the main factors to consider are these: (1) Absorption and (2) Mode of energy transmission (i.e. Free-running pulsed vs. gated pulse).
The diode I have in my office allows me to change both the length of the pulse and the length of time between pulses. The way that this differs from the free-running pulsed Nd:YAG with variable pulse widths (the Periolase) is that the shortest pulse I can get with the diode is 20 milliseconds. So let’s say I’m running at 10Hz and the pulse width is 20 msec – this means that in any given second there is 200msec of exposure to the light energy (10Hz x 20msec/pulse). Or put another way, the light is on 20% of the time and off 80% of the time.
Let’s compare this to the free-running pulsed comparison. The shortest pulse width being 100microseconds (usec) and the longest being 650usec. If we use the same 20Hz and the LONGEST pulse width (650usec) the laser is only on 13000usec, or 13msec during any given second of time. This means that 1.3% of the time the light is on, and 98.7% of the time it’s off. This obviously gives you a much greater amount of thermal relaxation time.
If you’re acheiving the desired hemostasis result needed at this “low” setting, why would we want any more light exposure? We don’t. It like taking 2000mg of ibuprofen q6h. Only 800mg can be used to give the best effect, everything else just adds to the negative side effects.My experiences using both wavelengths (diodes and FRP Nd:YAGs) has shown me that the Nd:YAG is much kinder to tissue.
For a better discussion on absorption I’ll try to link to a past discussion: <a href="http://www.rwebstudio.com/cgi-bin/ikonboard//topic.cgi?forum=38&topic=23
I” target=”_blank”>http://www.rwebstudio.com/cgi-bin….=23
I hope this helps.
Kelly
emc85Spectatorkelly
i have the biolitec 980 diode. it gives us the same ability to adjust on/off times and pulse durations.
i know you have several lasers so what are your thoughts of treating perio with the diode laser vs nd:yag? advantages or disadvantages?
Robert Gregg DDSSpectatorHi Mickey,
Kelly gave a great answer. Let me just add a little more perspective.
One of the most dangerous near IR lasers ever introduced into the market was the Nylad Laser 35. It’s duty cycle was only 8%. 800 usec and 50 Hz was the only user option.
Most folks who use diodes can get some nice perio resolution, but then say later the pocket breaks down due to long junctional epithelium.
Remember, it isn’t the laser alone that gets the results. The protocol of Laser ANAP gets the results and the Periolase supports the necessities in the Laser ANAP procedure steps.
Bob
kellyjblodgettdmdSpectatorHaving just completed my “Day 4” Training at Bob’s laser institute, I would like to echo his comments. So often, the reason a person is dealing with periodontal issues lies as much, if not more, in the occlusal issues rather than a bacterial overload. Of course, bacteria play a large role in the etiology of periodontal disease, and selecting the most effective means of erradicating them is very important, but the occlusion (I am finding) is such a huge factor.
Norman: to answer your question, you have to do the same math I did previously. Also, you have to consider how the bacteria selectively absorb each wavelength. In the link I previosly posted, Dr. Gregg provided some research which concluded that the bacteria P. Gingivalis selectively absorbed the 1064nm wavelength 15X more than the 810nm. I don’t know where the 980nm wavelength lies relative to this study, but I can comment on the effectiveness of the emission mode. The gated-pulsed mode of emission of diodes provides less thermal relaxation time than a FRP Nd:YAG. If any thermal relaxation time less than 98.5% yields negative sequelae, meaning cautery rather than hemostasis, then why would we want to do this. I suppose if all you had is a diode, it would still be helpful for removing diseased sulcular epithelium. But achieving predictable, repeatable hemostasis is pretty hard unless your laser can produce pulse widths in the 550-650usec range.
Not only does the science show that this is true, but in my own personal experience using the Pulsemaster 600 (fixed pulse width of 150usec) and a 810nm diode, I was never able to attain great, repeatable hemostasis. The variable pulse width of the Periolase allows me to do this. Hope this helps, Norm.
Kelly
spider24SpectatorHi Mickey,
with the 810 nm diode all perio treatments are done with protocols from 1994/1995. This means 1 W CW with an exposure time of 20 s each pocket. Until now this protocol is programed even in the elexxion claros.
With the possibility of ultra short pulses in the elexxion claros we saw very much better results regarding thermal relaxation in nearly every application. So we decided some weeks ago to start a clinical study with pulses between 6 µsec and 150 µsec in perio treatment compared to classical CW Mode.
If there are good results, it can be integrated into the claros very easy.
Olaf
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