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No FDA approvals yet for the applications shown by Dr. Karna.

There are many uses of lasers the limit is in the imagination of the dentist. FDA limits the laser’s company’s advertising claims, but does not tell dentists how to practice dentistry. You practice under your state’s practice act. You will, however be held to standards for misappropriate and harmful use as they affect your patients, as you would a scalpel or handpiece.
Your laser training, educational certification, experience, CE units, etc come into play.
Also what laser do you use? Type of wavelength, power setting, pulse widths, Type of tip, pulsed or continuous wave matter. One laser does not do all.
I use one of my lasers for decontamination and coagulation after every extraction. No calls at home for post-ext bleeding, No dry sockets in 3 years.
Low energy applications can be used post Endo to promote periapical healing, healing post soft tissue surgery, after tramautic accidents, etc, etc. New uses everyday.
I just got back from the Academy of Laser Dentisry Conference. Thirteen dentists recieved the Academy’s Advanced Profiency Certificaion, over 50 the Standard Certification. In workshops and presentations I learned another dozen uses and taught others some of my techniques. It’s a continuous learning cycle.

Hi Janet,

Before I answer your question, I want to say it was great to meet Ron Shalter and Todd Ryan spend some time getting to know both better at the ALD meeting.  

Ron’s too modest to tell ya’ll, but he would have stayed longer, except he went to watch his daughter win the MVP award in the State Volleyball Championships.

One more thing….Jeff Cranska’s lecture on laser perio was fantastic!  He hit the high notes and made a terrific impression on the audience.  I was sitting in the back and gauging the applause.  It was both spontaneous and simultaneous, which told me he impressed the audience at an individual level.  He showed everyone there–even the old-timers–a new perspective about periodontal regeneration.  Great job again Jeff.

OK, Janet.  See if I can make this understandable.

Jeff is right about the FDA.  So is Ray Tang.  Although a company (I forget–Missouri I think) last January 2002 received FDA clearance for LLLT for carpal tunnel pain relief and improved range of motion.  And my friend John Karna is just scratching the surface of LLLT applications.  It works extremely well.

Low level laser therapy (“LLLT”–pronounced lilt) is typically used when referencing the use of “soft” lasers (non surgical lasers–aka dedicated biostimulation lasers).  These are usually 635 (red) to 810-980nm (near IR) hand held lasers for treatment of pain, inflammation, swelling–of ANYTHING.  Output energies on these devices are in the range of 100-250millijoules on Continuous Wave (CW).

High level laser therapy (“HLLT”–pronounced hilt) is the use of a surgical “hard” laser in a defocused (non surgical) mode for biostimulation.  Defocused, the hard laser will penetrate and biomodulate, but more intensely than soft lasers.  I prefer HILT since the power densities we can use are 6000 millijoules versus 250, so it takes less time, I think, to get biostimulation effects.

Tina Karu, the Russian Biostim expert, and Dr. Paul Bradley from the UK are using all sorts of wavelengths for biostim and biomodulation (e.g. pain relief).

They are using everything from red laser pointers to CO2 for biostim.  So you can conceivably use your erbium 2.9 as well as your 810 diode.

So the answer for your patient is yes, you can help her.

Ron, the setting for extraction sites with diodes is .4 to 1.0 watt Gated pulse–non activated.  Go to the base of the socket for reference w/o emission.  Back off a few mm.  Lase against the socket walls and stir as you come up.  Do not let the socket dry out.  If no bleeding, initiate it in the bone or crestal tissue.  Repeat the sequence when socket fills with blood.  Then after the socket fills with blood, put the fiber in the middle of the socket filled now with blood.  Hold fiber steady and lase until a “tear drop” of blood forms on the fiber (by lifting and visualizing), or no more than 60 seconds.  The blood will turn to a “rust” color, or have “rust” or darker colored bandings form streaks in the surface of the clot.  Observe for cessation of blood flow, except at the soft tissue margins, which is ok.  Just dab at margins with tip of a 2×2.  Blood flow must stop before dismissing.  Clot must be present before dismissing.

We’re just makin’ gravy!

Bob
 

Hi Ron,

That’s an easy one:

3.0-3.5 watts at the fiber tip, 20 hz, 150-250 usec.  

Same technique as described above. Don’t linger or drag…..

Welcome to another Periolase user, Rick Williams from West Texas.:biggrin:

Bob

Ok, review time for me (I lent Todd my books)
Pulse Width is…
time of the pulse?
636usec vs. 250 usec
_   _    _
l  l_l  l_l  l_    length(time) peaks??

and the purpose of the increased pulse width-deeper penetration?

Thanks for yopur patience,

Hi Jeff,

“Bob, Why would’t you use a wider pulse width when coagulating an extraction site?”

That’s the neat thing about having choices in our devices, we can choose the settings that match our comfort zone.

With wider pulse widths, one has to be very careful not to over-warm the bone.  So the “shorter” at 150 usec has sufficient coag capabilities for most extraction sites.

But you are absolutely right about the the long pulse at 635 being a quick coagulator, and one I might also use in a hemophiliac or Coumadin patient.

Remember too, Jeff, you have 4 years experience under your belt, and I want Ron’s learning curve to be a gentle slope, not a “hockey stick”.

Yes, it is also known as:

1.  pulse time
2.  pulse duration
3.  pulse length
4.  pulse shape
5.  pulse profile
6.  waveform

:confused: Sometimes this stuff gets very confusing since there are so many interchangable words to say the same thing.:confused:

250 versus 650 (635) is about 3 x’s shorter in pulse time/duration.  That is the time the pulse is ON before shutting OFF and firing again.  At 20 Hz (50,000 usec in 20 pulses/sec).  Ask Del to do the math! It’s right.

250 usec ON = 49,750 usec OFF (repeats until 20 pulses have fired)

650 usec ON = 49,350 usec OFF

So the refractory tissue cooling OFF time is not changed much at all.

What has changed is EXPOSURE TIME of the tissue during the ON portion of the pulse, that can be varied by a factor of 1.5 x’s to 6.5 x’s for the Periolase MVP-7.  Or from 150 usec to 635 for the Periolase I, by a factor of 4.2 x’s.  Either way 635 or 650 will coagulate quickly without burning or charring.

and the purpose of the increased pulse width-deeper penetration?

Yeah, pretty much.  Deeper, wider, and to envelope large capillaries with the pulse shape.  But now we’re getting in too deep!  It’s a longer exposure time to the tissues like the shutter of a camera controls the “burn” of the film.  Short shutter durations are good for action shots.  Long shutter durations are good for low light conditions.  Too much light and we OVER EXPOSE the film.  We don’t want to do that with patients’ tissue, so we employ long pulse durations when they are called for.

I hope that makes sense.

Bob