WaterlaseMD 700usec Pulse Duration - Laser Dentistry Forum

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June 28, 2005 at 3:09 am #2886 Reply

Swpmn
Spectator

The WaterlaseMD has now been available for nine months. Must be quite a few clinicians using the MD. From an engineering and clinical standpoint, the unit appears to be a vast improvement over the Waterlase I leased in April 2001.

WaterlaseMD has a user selectable pulse duration – 140microsec for hard tissue and 700microsec for soft tissue. I believe the theory behind the 700microsec soft tissue setting is that a longer on time of the pulse will result in absorption of the wavelength over a larger, deeper area and thus improve hemostasis.

Since I’ve only used erbium lasers with relatively short pulse durations of 140-300usec, would like to ask Waterlase MD users:

1) Does the 700 microsecond pulse duration setting effectively control bleeding?

2) If you have used electrosurge or a diode or Nd:YAG laser, how does it compare?

3) Do you find that the MD tips become contaminated and difficult to cleanse once used on soft tissue? Particularly if used without water spray? With cleavable fibers on diode and Nd:YAG you just extend and cut so tip contamination not much of a problem.

June 28, 2005 at 12:49 pm #6823 Reply

whitertth
Spectator

Al,
Let me try and answer some of your questions….having used the MD for a while now, I can comment a little bit. As far as cutting soft tissue effectively….My best description is the feel of the cut is smooth kinda like a scalpel….Very different from the Waterlase or other erbiums…
Hemostasis is very good and and much better than the other erbiums as well and as long as you dont get a real “bleeder” you can do alot with little to no heme…..I dont think anyone will say that it is a good hemoststically as a diode, CO2 or electrosurge…Just much better than the other erbiums because still in the presence of a real bleeded you will get some bleeding but still much better than the other erbiums.
The tips clean easilly as with the other erbium tips…I rarely cut even soft tissue without water as there really is no need to……Hope that help..

June 28, 2005 at 4:23 pm #6833 Reply

Swpmn
Spectator

Thank you Ron.

June 29, 2005 at 1:42 pm #6824 Reply

2thlaser
Spectator

Ron, Al,
Actually, I have used the MD a ton, as has Jim Jesse. When you cut with the water off in the 700ms mode, it performs very much like a diode. In fact Ron, I disagree with you about a bleeder. When I get one, I use the MD without water, very low settings with higher hz rates and can control it very very well. I don’t even get the diode out anymore. Cleaning the tips are easy, and yes, tissue clings to the tip in a dryer cut, but can be cleaned easily with a wet guaze. I only have this problem with the zirconium tips.

Ron S…any way we can start to show some video clips on the site, maybe in the pushing the envelope section? so as to keep it easy? Just a thought.

Mark

June 29, 2005 at 5:49 pm #6819 Reply

Anonymous
Guest

QUOTE

Quote: from 2thlaser on 9:42 am on June 29, 2005

Ron S…any way we can start to show some video clips on the site, maybe in the pushing the envelope section? so as to keep it easy? Just a thought.

Mark

Sorry, no video, just can’t fund the server space. Now if some company wanted to purchase LDf, in exchange for a MD or Versawave, I’m sure they could afford unlimited server space…. :biggrin: 😉

Actually, anyone can put video on any server they choose and then just place the link on ldf.

June 30, 2005 at 2:33 pm #6831 Reply

Robert Gregg DDS
Spectator

What?!

Varying the pulse duration actually, really, honestly makes biologic difference in tissue?!

Get OUT of here. Or as Ron K might say, “Fu get about it.”

Some professor-type academicians in the ALD have been telling the members and saying for years that pulse duration doesn’t matter and it’s just a marketing gimick!

You mean I didn’t learn it all correctly from ALD?? And here I am an ALD Certified Educator and all……….:confused: Time to git myself retrained and educated again.:angry:

Sorry, I couldn’t help myself……..

Now if some company wanted to purchase LDf……..

Hummmmm………

June 30, 2005 at 4:09 pm #6825 Reply

2thlaser
Spectator

LOL, Bob, I FEEL, I mean I FEEL your pain with ALD…..oh man!

Mark

June 30, 2005 at 10:09 pm #6832 Reply

Swpmn
Spectator

QUOTE

Actually, I have used the MD a ton, as has Jim Jesse. When you cut with the water off in the 700ms mode, it performs very much like a diode. In fact Ron, I disagree with you about a bleeder. When I get one, I use the MD without water, very low settings with higher hz rates and can control it very very well. I don’t even get the diode out anymore. Cleaning the tips are easy, and yes, tissue clings to the tip in a dryer cut, but can be cleaned easily with a wet guaze. I only have this problem with the zirconium tips.

Ron S…any way we can start to show some video clips on the site, maybe in the pushing the envelope section? so as to keep it easy? Just a thought.

Mark

Mark:

From what you are saying, control of hemorrhage is greater using the soft tissue 700 usec pulse without water? Seems to agree with the work I did using Waterlase and DELight for crown/bridge retraction. Problem was the “cotton candy” soft tissue ablation products tended to mess up my tips when I didn’t use water.

When you say “very low settings with higher hz rates” is that like 0.1-0.5W and 50Hz? Is the tip used out of contact for retraction around prosthetic preparations?

Video probably isn’t necessary but could you post some pics of crown/bridge retraction or retraction for Class V restorations using the MD with the long pulse duration?

To me this is an important topic and I haven’t seen a whole lot of discussion on whether a long pulse duration erbium can reduce the need for diode/Nd:YAG with regard to soft tissue surgery and hemostasis. Lares is currently promoting a multiple pulse duration erbium(unit looks familiar and I have a bunch of questions). Will take a look at the machine next week at our annual Florida meeting.

July 1, 2005 at 2:42 am #6821 Reply

dkimmel
Spectator

Allen we all know varable pulse duration is a marketing ploy!!!! MAn , I am sure to catch heck next weekend.

I also have had pretty good luck with the MD at 700us at higher HZ and dry. As good as the diode. Then again I think the diode is limited in that respect as well.
Then again Eric’s article with ME blue has me interested again in my diode. I ordered some made up with TAC to try out.
Back to the MD. I wonder why 700us? Seems to close toe thermal relaxation time of skin.

Allen you can come up and play again if you want. MAybe we can get someone to try out the diode, MD at 700us and the periolase on. I’ll see if I can get my mother inlaw back to the office.

DAvid

July 1, 2005 at 3:39 am #6827 Reply

Glenn van As
Spectator

David, have you got the upgrade on the DeLight.

Have you tried 50Hz and the short pulse duration to see whether the lack of water and the high pulse rate is what prevents bleeding

Non contact,
High Pulse rate (40-50 Hz)
Chisel tip
No water

All are secrets to no bleeding.

Now is this the difference or is the pulse duration of 700 microseconds more important that the tissue absorption curves I learned and loved.

Hmmmmm…..inquiring minds want to know.

All I know is my frenectomy today bled in contact.

My frenctomy posted from the other day didnt bleed (everybody ignores it) and guess what it had a pulse duration of 300 microseconds or close to it.

GRIN

Glenn

July 1, 2005 at 4:19 am #6822 Reply

dkimmel
Spectator

Glenn.
I think Wildman has forgotten about me.

July 1, 2005 at 1:22 pm #6829 Reply

Robert Gregg DDS
Spectator

Thanks Mark! LDF is my sactuary from the inane and “superior” minds that know it all……..

Allen, sounds lke soon enough you will have a wet lab in David’s office. David might even be able to help once his welts have gone down……

Powerlase Nd:YAG– 150, 300, 1000 usec. 150–good overall ablation PD, minimal hemo; 300–why bother?; 1000–malpractice coverage paid up?

Glenn here’s a thought: Defocusing away from the tissue increases the diameter of the spot size, thereby reducing the intensity (Inverse square law). It is akin to increasing the pulse duration (gimick thing) since the tissue is warmed and low settings (tissue not ablated) help the warming effect.

Did I say that David is !@#&#36%^&* TOAST?? You’re in the FRONT row!

Bob

(Edited by Robert Gregg DDS at 9:26 am on July 1, 2005)

July 1, 2005 at 1:24 pm #6820 Reply

dkimmel
Spectator

Bob beware I am bringing my WICKED LASER!!!!

I can tell we are going to have a great time next weekend. Looking forward to some fun and laser CE.

David

July 1, 2005 at 2:31 pm #6830 Reply

Robert Gregg DDS
Spectator

Oooooooh Noooooo!

Not the WICKED GREEN LASER

Okay, you can sit in the back row……..

I wonder if we can light up Catalina 26 miles offshore?

July 1, 2005 at 3:17 pm #6826 Reply

2thlaser
Spectator

With my 85mw one we could

Glenn, headed out of town, and will try to freeze some video frames I have with the MD like you ask, then post the stills. I am still learning how to take good photos with my scope, and videos as well. You didn’t TELL me about THAT learning curve!!!

It’s been real fun though. I hope everyone has a great July 4th (USA) weekend, and in Canada, uh, I mean eh? hee hee, have a great weekend too!

Mark
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