I am very much impressed by the comments and desire of so many to concentrate on the positives of laser dentistry. I take the need to “move forward with the times” seriously. I shall be meeting with the conference chair ans scientific sessions chair this week-end and I shall press them on the hopes of visible improvements.
Any invitation to dinner is too good to miss – I guess I’ll have to try and earn it! Thank you all for helping me to see the situation more clearly. Kind regards, Steven

Glenn,

I am revisiting this post because I have done some (dozen or so) crown lenghtening using the open technique, and while I enjoy the results find that it is so time consuming, I am beginning to wonder if there are some shortcuts. Any tips that you have run across?

I like the “fat” tip for osseous even though it takes more water to make less charring, which if it occures relates to post op pain, but it is very slow. How high can an Erbium power density go and still be atraumatic?

Is the angle significant? I am beginning to think that it is in addition to the parallel to the root concept. Perpendicular to the boney surface seems to work well but in a tiny area. Slow slug (slimy giant snail without shell for those not bless with these garden creatures) march across the osseous area to reduce then becomes the working mode. An angular approach is necessary when feathering out the reduction further under the flap (I use a periosteal elevator wide end to protect the flap and reflect and stray beams) and it goes even slower.

My conclusion is that I need different calculations on power settings for my tips or different tips. I refuse to change machines, so do not even go there. I am using the S and C series tips for the Waterlase “Classic”.

Any thoughts on power settings in Watts? I converted your settings by watts=mjoules*Hz.

Thought you guys might find this useful-
J Oral Maxillofac Surg. 2005 Oct;63(10):1522-7. Related Articles, Links  

Surface properties of endosseous dental implants after NdYAG and CO2 laser treatment at various energies.

Park CY, Kim SG, Kim MD, Eom TG, Yoon JH, Ahn SG.

Department of Oral and Maxillofacial Surgery, Oral Biology Research Institute, College of Dentistry, Chosun University, 421 SeoSeogDong, GwangJu City 501-825, Korea.

OBJECTIVES: Dental lasers have been used for uncovering submerged implants as well as decontaminating implant surfaces when treating peri-implantitis. The objective of this study was to compare the possible alterations of the smooth surface and resorbable blast material (RBM) surface implants after using NdYAG and CO(2) lasers at various energies. MATERIALS AND METHODS: Ten smooth surface implants and 10 RBM surface implants were used. Two smooth surface implants and 2 RBM surface implants served as a control group that was not lased. The remaining implants were treated using NdYAG and CO(2) lasers. The surface of each implant was treated for 10 seconds on the second and third threads. The smooth surface implants (group 1) were treated using a pulsed contact NdYAG laser at power settings of 1, 2, 3.5, and 5 W, which are commonly used for soft tissue surgery; the corresponding energy and frequency were 50 mJ and 20 Hz, 100 mJ and 20 Hz, 350 mJ and 10 Hz, and 250 mJ and 20 Hz, respectively. The group 2 RBM implants were treated using a pulsed contact NdYAG laser. The group 3 smooth surface implants were treated using a pulsed wave non-contact CO(2) laser at 1, 2, 3.5, and 5 W, and the group 4 RBM implants were treated using a pulsed wave non-contact CO(2) laser. Data were analyzed using scanning electron microscopy. RESULTS: The control surface was very regular and smooth. After NdYAG laser treatment, the implant surface showed alterations of all the surfaces. The amount of damage was proportional to the power. A remarkable finding was the similarity of the lased areas on the smooth and RBM surfaces. CO(2) laser at power settings of 1.0 or 2.0 W did not alter the implant surface, regardless of implant type. At settings of 3.5 and 5 W, there was destruction of the micromachined groove and gas formation. CONCLUSION: This study supports that CO(2) laser treatment appears more useful than NdYAG laser treatment and CO(2) laser does not damage titanium implant surface, which should be of value when uncovering submerged implants and treating peri-implantitis.

Note “contact”. Seems to indicate that, like endo, a distance from the target(4mm?) should be respected, as well as the angle. Bob, thoughts?

Great thinking there as it will not only clot the area but sterilize it as well and prevent the bacterial infections that are so common with these oroantral communications.

Very neat idea………will keep that one in mind.

Cya

Glenn

I have the Claros diode by elexxion(http://www.elexxion.com) and find this laser to be far more advanced than the others.It has a variable pulse hence can be used more safely in perio pochets than the continous pulse versions.
It looks the business, and has great support in Germany.It has a digital control and cuts like a hot knife through butter.
I am no laser physics expert but found this laser to superior.

OK Steven,

Sorry for not posting back sooner.  Very busy week with patient care.  I hope you can read and review sometime during this weekend for your board meeting considerations.

I appreciate you being open to the comments from everyone here on the LDF.

Some thoughts about ALD.

First–Del and 11 other dentists formed the first laser dental Study Club on November 9, 1988 in Detroit with Terry Myers.

The Laser Study Club was a clinical meeting with academicians playing a contributing role.  

For the first several years at quarterly Study Club meetings, the meetings were clinically oriented, 1 hour presentations, with some research and scientific overview by an academician.

Now, it’s not even the other way around as clinical presentations of the sort dentists LEARN from have all but disappeared.

That needs to change drastically for the membership to be retained and ALD to grow.

There are enough scientific and research oriented laser organizations.  There is:

1.  The International Society for Laser Dentistry (ISLD) headed by Prof Lynn Powell.  
2.  The International Society for Optical Engineering (SPIE) headed up by Prof John Featherstone
3.  The European Society for Laser Applications (ESOLA)

What is missing is a clinical academy run by clinicians, giving the clincial members what they want and need to perform in their clinical dentistry using various lasers and techniques–not 15 minute abstracts of the esoteric and scientific research.

That’s where ALD has lost its direction and way regarding the original founding purpose of the founders.  ALD should be about the clinicains NOT the academicians!

That’s why the WCLI and MDT Annual Clinician’s meeting are growing in popularity and attendance–just like the good ‘ol days of the Laser Study Club.

Second–When the Institute for Advanced LAser Dentistry (ILAD) wants to attain the prestigious recognition of ADA-CERP and AGD-PACE, there are fair and unbiased requirements and criteria that are in place that IALD must meet.  But the IALD is not required to be “members” of either ADA or AGD.  There is no corporate membership required to participate, nor is there individual membership to be considered.

ALD should be no different in its standards and applications.  Clear and unambiguous standards that apply equally to all organizations and individuals seeking recognition for their courses.

When Del and I received our Category E certification, I made the comment that the certification should be required to be renewed every 2 years.   Not implemented if even considered.

Yet, even though Del and I have our “E” status–and paid quite a bit of money for the priviledge to learn how to teach, not know laser content–we were denied ALD SP recognition for 2 consecutive years while the SP Course Provider requirements from ALD were being changed.  And I would argue that our combined knowledge and understanding that we review and refine regularly together and update constantly is at least as good as the present recognized ALD SP providers.

ALD must be fair and impartial if is to be respected as an independent autonomous certifying body.

Third–Hygiene is not perio surgery.  Laser curettage is not equivalent to a surgical laser assisted new attachment procedure such as Laser ANAP.  To compare the two is not appropriate.  Putting periodontal surgery & regeneration in a “Hygiene/Perio Track” at any ALD annual meeting is inappropriate.

A world renowned periodontal reasearcher (the kind we would have been thrilled for 15 years ago–and should be today) was placed on the 4th floor balcony at the ALD’s second day of their annual meeting, in a small room with 25 seats and no AV equipment.  Ultimately the room was at maximum capacity, standing room only to hear Prof Ray Yukna.  That’s how the ALD treats a prestigious guest and academician who is a luminary in the periodontal community?

Fourth–That laser use by hygienists is illegal in 18 States in the US, yet, the dominate thinking in ALD is that the best application for dental lasers in the treatment of periodontal disease is laser sulcular debridement/laser curettage/Laser Soft Tissue Managment by hygienists is a mystery??

Nothing against hygienists.  But the realities of the State regulatory and political environments in the AAP are being ignored with such an approach.

Thanks for listening and your consideration!

Best regards,

Bob