Lares PowerLase AT

Introduction

Recently I had the opportunity to evaluate the Lares PowerLase AT(All-Tissue) Er:YAG/Nd:YAG unit. My evaluation was done in a booth at a dental convention and is not meant to be comprehensive or offer advice to prospective users. The review may contain factual and scientific errors and for the most part relates to the Er:YAG. Where I have added subjective comments, please either ignore them or take them with a grain of salt.

Base Unit

a)Unit is medium sized. Larger than HOYA or current Biolase units but much smaller than original Biolase erbium. Appears it would fit just fine in a standard sized operatory.

b)Electrical connection is 220-230V. The laser is self contained without need for air or water connections. Has an onboard air compressor. Distilled water bottle supply appeared adequate for normal use.

c)Keyboard appeared user friendly. LCD type display with easy to use selections for wavelength, energy setting, pulse duration, pulse rate and air/water.

Delivery System

a) Er:YAG
Articulated arm with several mirrors. Arm is surprisingly flexible and of adequate length. Appeared to have a bit of pull back when compared to the optical fiber delivery systems I have used. Each elbow of the arm has a removable plate on the back in case the mirror needs to be changed. Air/water lines are individual and run external to the arm.

b) Nd:YAG
Optical fiber emanating from right front of the base unit. Fiber is stored on a non rotating wheel on right side of unit similar to how one might store a garden hose.

Handpiece(Er:YAG)

a) Contact handpiece
Right angle handpiece similar to original Biolase Waterlase. Removable mirror access on top of 90 degree distal bend on handpiece. Air water appears to spray straight down tip similar to original Waterlase. Removable quartz or perhaps sapphire tips of 800-1000 micron diameter with metal proximal base. Visible red 650nm aiming beam emanates from distal end of tip. These tips are used in contact, they cost &#3680 apiece and are recommended for 40 uses.

b)Non-Contact Handpiece
A glass like window on the distal underside of the handpiece delivers the Er:YAG wavelength. Appears the air water spray and visible red aiming beam emanate just proximal to the window. The red aiming beam intersects with the air water spray at a very specific point a few millimeters from the window. This is the focal point for the Er:YAG wavelength. It is important to periodically wipe away ablation products and waterspray from the window.

Operating Parameters

a) Average Power Maximum
Erbium component has a maximum setting of 1000mJoules at 20Hz so this is how the 20Watt setting is calculated. There are energy setting limitations for the various Hz rate selections. Nd:YAG is 15W and was told this is related to 230V electrical connection. When I expressed safety concerns, was told that the user would be instructed never to use the Nd:YAG above 4.0Watts.

b) Pulse Rate
Repetition rate or pulse per second on the erbium is 2-50Hz. Appeared that the Pulse Rate is adjustable in single increments.

c) Pulse Duration
I specifically asked what is the convention for measuring Pulse Duration – Full Width Full Maximum(FWFM) or Full Width Half Maximum(FWHM). Response was Full Width Half Maximum. The pulse wave is reported to be a digital with a square waveform.
Theory behind the short 50 microsecond Er:YAG pulse duration appears to be that the ablation front stays ahead of the thermal front. In other words the laser is cutting hard tissue below the thermal relaxation constant. That combined with a report that there is less ablation product interference is supposed to make the 50usec Er:YAG cut faster with less discomfort to the patient.
When I asked what would be the clinical use of a 1000usec pulse duration with an erbium, was told would be for situations where one desired a low peak power. The company does not appear to promote soft tissue coagulation effects with a long pulse duration erbium wavelength. They were encouraging most or all soft tissue treatments to be provided with the Nd:YAG.

Subjective In Vitro Ablation Impressions

In a lab bench type situation at a dental convention booth, the Er:YAG in both contact and non-contact modes appeared to cut extracted human posterior teeth and bovine bone faster than anything I have ever utilized. The non contact window handpiece was much easier to focus than I had anticipated. Focal point of 2940nm wavelength is precisely at intersection of aiming beam with the waterspray.

Training

Lares provides Compact Disc based didactic and clinical training. Technician sets up laser and instructs doctor on physical operation. Over the shoulder clinical instruction by a Lares clinician can be provided and is recommended. The company does claim they are the only laser manufacturer recognized by the Academy of Laser Dentistry as a laser training course provider. Now I have to take down my official ALD issued Standard Proficiency diplomas: Two in Er:YAG, one in 800nm Diode and one in 10,600nm Carbon Dioxide(please ignore the immediately previous sarcastic comment).

Warranty

Unit has standard one year warranty. Asked about extended warranty or service contract. Was told no info available at this time but that info would be available prior to expiration of one year initial warranty.

Investment

Powerlase AT(All Tissue Er:YAG/Nd:YAG) &#3672,500 US.

Powerlase HT(Hard Tissue Er:YAG) &#3662,500 US.

Couldn’t say it was faster than a highspeed handpiece but it definitely approaches the ablation speed of a high speed. Again this is subjective, but playing with the two different handpieces it almost seemed like the non contact window handpiece cut faster than the contact tips.

I just entered this forum and find the information on the Lares Powerlase AT interesting but very dated.  Does anyone have new comments to update this info?  I am looking seriously at this laser but I want to hear more from those who have experienced it.

Thanks

Jeff: I have noticed a lack of replies on the Powerlase AT in posts here and at Dentaltown.

Is that a sign?

I would definitely ask for references and a full list of them.

I myself would look at other lasers and compare including biolase and Hoyas Versawave which I own.

You decide then which brand has the most appeal for your practice.

Make sure you consider number of existing users, warrantee after the initial year, reliability, training etc.

Good luck in your search.

Glenn

I just wanted to introduce myself and my company as the Fotona dental laser dealer for the U.K. market, and would be happy to answer any questions you may have on the Powerlase unit. The unit is called the Fidelis Plus in Europe, and is one of the largest selling laser in the European market.

I have contacted Fotona direct with regards to entering this forum to answer your questions direct so as to get a manufacturers perspective on your questions.

Hope we can be of help