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2thlaserSpectatorSorry, got so caught up in explanation, I forgot to ask you guys….Do you say they shouldn’t feel anything?
I also almost am NEVER in a focussed mode. I am usually ablating at 4mm distance, and I find they just don’t feel it. When I move in, they start to feel the sensations. Hope this helps.
MarkPS….I just want so bad for everyone to have the experiences I have had. I really have had VERY little in the way of sensitivity, and I still have only had to use anesthesia in 10 cases since last Feb. I don’t know why, it just works in my hands, and I want all of you to have the same success.
Robert Gregg DDSSpectatorHi Mark,
Back from CDA Anaheim…whew!
There are three laser approaches to these lesions:
1. Surface modify or coat them by coagulating the surface proteins of the lesion with either:
a. erbium (2.8, 2.9) at a low setting (water prevents char and pain.)
b. CO2 (10.0) at a low setting say 3.0 watts cw (no water).
c. holmium (2.1) at low setting say 2.0 watts free running (no water).2. Biostim with diode or Nd:YAG
3. Combo of both may give the most relief–in which I would biostim first, then coag the surface.
These ain’t easy……
Bob
Robert Gregg DDSSpectatorHey Bruce,
Did you then try your Nd:YAG to see if it caused the same discomfort? Say at 100 usecs 2.5 W 15 Hz and the canal wet with NaOCL…
Bob
(Edited by Robert Gregg DDS at 10:15 am on April 28, 2003)
Robert Gregg DDSSpectatorHii Guys,
What us old guys have found over the years is that multiple canal teeth–but especially teeth with very thin canal spaces (i.e. 6 year molars that have pencil thin canals and not much pulp chamber), are in various states of vitality.
It is simply harder to reach all the ares of nerve tissue with laser energy that are in several locations and down below the level of the pulp chamber in older teeth that don’t have the large juicy pulps in younger folks.
We have observed that while the pulp chamber is vital, one or two of the other canals is calcified and/or there is a empty canal.
As you then get close to the tooth to cut–and your laser gets “hotter” as the water becomes less effective and the beam intensity increases–you “fire-up” that one canal space by heating and expanding the air content inside getting a pain response.
Take a look at your x-rays on the teeth next time you have trouble. I think you will find the pulp chamber and canals are near non-existant.
Next think about occlusal trauma, hyperemia, large restorations that may have caused a crack and pulpal injury and/or pulpal retreat.
Bob
(Edited by Robert Gregg DDS at 10:14 am on April 28, 2003)
Robert Gregg DDSSpectatorIs that you Alfred??? Good to see you posting here. Had a nice time in Florida meeting and hangin’ with Al. What a nice guy….
Bob
Glenn van AsSpectatorHi folks: back from my trip to Anaheim, the meeting was busy with both work for Global (new scope introduced) and Hoya Con Bio and for social (lots of entertainment including a trip to the Boston Redsox and Anaheim Angels, and getting Pedro Martinez autograph in the bar!)
Got an opportunity to meet several people from the forum at different events and on the exhibitor floor for the first time. Saw the always present Allen Williams who came all the way from Clearwater Florida and stopped by on Friday to check out the Hoya Delight laser and he told me he liked it. It was great talking to him.
I also ran into Sameer (socalsm) who is HUGE in real life and a very good guy and very knowledgeable about many things including lasers , photography, and the cerec machine. He was at the Biolase booth where I ran into a few people (Keith Bateman, Bill Brown, Alan Reich and a few others). The booth was busy and its a really nice design and fairly open.
I also ran into Andrew Shearon alias ASI who is from my hometown Vancouver and flew down to look at the various lasers including the Delight and he sure has done alot of research into the topic before buying. He sure isnt an impulse buyer!!
I had a great time with Bill Greider and the two of us had the opportunity to go to a nice evening meeting with Bob Gregg who with Del Mcarthy put on a nice show with great drinks and also lots of appetizers. It was really great to see Bob in action with his powerpoint show for the Ndyag Periolase 7 and it was informative to see how he is building material for his marketing efforts for the laser . He has positioned himself for the only FDA certified protocol on laser periodontal therapy making it perhaps the only laser capable of regenerating bone.
His wife Janna is a great lady and I want to publically thank Del and Bob for inviting me to the gathering. I had a great time. Their laser is alot smaller than it looks in the picture here and they have spent alot of time looking at specific issues like TRAINING and SUPPORT and building a unit that is very sleek looking and also dependable.
Kudos to both of you for all your hard work Del and Bob and for getting a very tough shell to withstand the daggers that many in the perio world have and are throwing.
Well that was it off the top of my head…….OH ya one last thing. I spent some times with the DEKA lasers people. They are awaiting FDA approval for several lasers including :
810 and 980 nm Diodes (the 980 will compete with the Biolitec product)
a 532 nm ( I think its a frequency doubled Nd Yag meaning its half the 1064 nm wavelength) that is a bright green color that is designed for bleaching and for cutting soft tissue like an argon.
Two Nd Yags (one is larger and one is a table top that are 8 and 10 watt versions that are pulsed (I think there are short versions)).
Finally , there are the two articulated arm versions that are their flagships including a CO2 unit that they are really positioning for periodontal therapy, and in addition a Erbium Yag .
The lasers are sleek looking and will give people another choice in the marketplace. Thanks to Chris Justen and to Sonny for showing me the products and to Sonny for sharing a few laughs and cocktails at night.
Wow , it was a busy show and great to see people…….I hope I didnt forget anyone, and like I said it is neat to see the lasers garnering so much attention.
Take care.
Glenn
Glenn van AsSpectatorHi guys………its a problem I do hear unfortunately from Biolase users and one of the things that does concern me about the unit is the reliability.
I can honestly say that I have had my Delight for 3 + years and only replaced…..
1. A foot pedal when the connection frayed (my fault)
2. The support pole when the spring broke.
3. The filter packs every year which are 100 dollars or so Canadian.
4. Tips…….I havent replaced the fiber (2200 dolllars) so I feel fortunate. I wonder if other users of the Delight have had similar experiences.
The one thing that I hear more often than not from Waterlase users is that they must be very careful moving the unit and maintaining the unit because of the mirror design, and trunk fiber sensitivity.
That is what I have seen but from a marketing and innovation standpoint the company and the product are top notch.
Hope that helps…….its just an opinion from talking to many users.
Glenn
Robert Gregg DDSSpectatorHey Glenn,
Glad you made it back safe and sound.
It was great to finally meet and spend some time with you!
Thanks for the kind words and kudos too.
You really did a fantastic summary of the overall meeting, devices, companies, and people.
I also got to meet and talk at length with Andrew (ASI). Exactly right, Glenn about his due diligence. Andrew even wanted to know all about my personal background!! (Just checkin’ up). I guess I should post in the Member’s Forum, huh Ron?
Spoke at length with Allen Williams. Told him I really liked that picture of his “daughter” on Dental Town! :biggrin:
We also spent some time talking about the mechanism of laser anesthesia with erbium lasers and why, when they are highly absorbed into tooth structure and water, would they induce anesthesia if the beam itself (maybe) doesn’t get to the pulp……we also mused about some future erbium laser device designs, configurations, delivery systems and specifications. Nice to meet you Allen!
Andy S, a periodontist using the PerioLase came by and got to meet Leigh Colby a long time PerioLase I user. It was fun to watch them discuss results from two very different perspectives…..3 years versus 30 days (and 50 quads)
Bill Grieder also got together with Leigh Colby. Bill was busting my chops that, “the word on the street is that only Bob and Del get bone regeneration.” Leigh assured Bill it wasn’t so…..
And it really was quite an honor to have Glenn and Bill come to the MDT hospitality suite to spend the evening with us. These guys are in high demand by their various fans and benefactors, and other activities that it was great to have them stick around for more than just a cameo appearance. Thanks guys.
Met Sameer and Arun from Dental Town. Spoke at length with my old friend of many years in lasers Bill Brown now a VP with Biolase.
On a sad note, ADT was not present at the meeting. And one of their recent executives hired for their “turn-around” is now with another laser company.
And some of those dentists that started using lasers with ADL/ADT 10-14 years ago are still using their dLase 300’s and dLase 500 upgrade lasers and their clinical use has out-lived the company–just as many warned the hot sot executives when they were too cocky, too big, too successful, too highly regarded by Wall Street analysts to listen to their users. Then came the customer class-action lawsuit that was the beginning of the fall…….So sad for the dental laser industry. You’d think other companies will learn from this experience? History suggest they might not if ADT didn’t learn from Premier’s demise. Denial ain’t a river in Egypt.
Bob
lagunabbSpectatorThis seems to be an important issue (although probably second order compared to other considerations) that require more open disclosure. I tried a couple of years ago to get some data on mean-time to failure (MTTF) for comparison purposes. Understandably, both ConBio and Biolase were reluctant to disclose data like that since there are experience factors as well. Now that there are enough units out there, the statistics should be meaningul and helpful to the entire user community and would also keep the competitive juices flowing on the respective engineering departments to improve ruggedness. The physics of light transmission in solid waveguides is the same whether is brand x or brand y I don’t expect much difference for the Er based wavelenghts when it comes to waveguide durability. Nevertheless, seeing some data would be more useful than soft arguments and marketing hype. Are ConBio and Biolase willing to step forward with MTTF stats? I have my doubts.
AnonymousSpectatorI was wondering how many board members have been contacted recently regarding their investing in Biolase? This is becoming a frequent occurance for me. Today I received a letter from someone at Oppenheimer who suggested that since I was an owner of a Biolase product I should consider investing in the company.
Last week ,I know Glenn and I were both contacted by another source regarding Biolase. Below is the correspondence that went on between this research analyst and myself. He was going to post himself (joined the board) but hasn’t yet done so. He also gave me permission to post the following:
Original Message
From: “Eldar Brodski”
To:
Sent: Monday, April 21, 2003 4:12 PM
Subject: Comparison of Waterlase to all other comparable lasers: is it
markedly superior, slightly superior, basically the same, or inferior on a
price/performance basis?> Dear Dr. Schalter,
>
> I came across your name on dental town and laserdentistry forum. I am
> comparing the Biolase Waterlase with the OpusDent OpusDuo, Softlase by Zap
> Laser, the Millenium laser, and the relevant lasers offered by Continuum
> Biomedical, one of which is called DELite, as part of an investment
analysis
> of Biolase, Inc. for my firm, Abacus Capital.
>
> I do not have expertise in this area and different dentists say they
prefer
> different lasers. Is one of these, or perhaps one I have not mentioned,
> superior to the rest? If so, is it markedly superior, the same, or
inferior
> when you consider how much it costs?
>
> Many dentists have said that the Waterlase is superior because unlike the
> OpusDuo and the Continuum lasers, including DELite, it does not heat the
> tooth. The latter do and hence carry a higher risk of injury to the tooth.
> Also, and perhaps related, though I am unsure, is the higher incidence of
> pain with the non-Waterlase lasers. Dentists claim that the heat emitted
by
> these non-Waterlase lasers causes the pain and the incidence of pain is
50%
> higher than with the Waterlase. Also, because of the heat, the
non-Waterlase
> lasers are constrained in the power levels at which they can be used–too
> much power will cause too much heat; such constraint on power is much less
> or non-existent with Waterlase.
>
> One of the other reasons dentists chose the Waterlase was that it had the
> ability to work on both hard and soft tissue, with only a small % of soft
> tissue procedures being outside the ability/scope of the Waterlase. This
> argument seems wrong in that OpusDuo comes with two lasers, one for hard
and
> for soft. Am I missing something?
>
> I am curious to hear your thoughts, especially because you own the
Waterlase
> and know others, like Dr. van As (to whom I’ve also written), who own
> competing lasers. In case you are interested in learning about us, I have
> attached a profile of my firm. Thanks.
>
> Eldar Brodski
> Research Analyst
> Abacus Capital(My response in blue)
Eldar Brodski,You have already discovered one of the most important issues, regarding
dental lasers, which is trying to determine what is truth and what is hype.It would be unfair of me to claim that I could tell you one laser is better
than another when I have not personally used all the lasers you mention.
What I can tell you is that your focus first needs to be on the wavelength
of the laser, rather than the make.Otherwise you are comparing apples with
oranges.I believe that some of the information you are getting regarding lasers
heating up teeth, other than the Waterlase, is inaccurate. The Waterlase is
an er,cr:YSGG laser .Dr. vanAs’s Continum product (DELight) is also an
erbium laser. Both are absorbed by water and cause vaporization of tissue.
Any of the erbiums that use water for cooling will not heat up the tooth.
The literature actually shows a drop of a few degrees during laser use.
Erbium use w/o water would be a whole different story.As far as which laser is best for soft tissue , it again comes back to
wavelength of the laser and the target tissue. Can the Waterlase be used on
soft tissue-yes.Is it the best for soft tissue-probably not. The best soft
tissue lasers target pigment rather than water. These would be diodes or
nd:YAG’s.Probably the most useful information for you would be found in a book
,Dental Applications of Advanced Lasers ( http://www.jgma-inc.com/
) . It will help with the differences between types of lasers according to
target tissue and absorption. Once you have an understanding of that you
will be better able to compare products. Part of the problem with the info
you are getting from dentist is that ,unfortunately, there are many who have
not taken the time to investigate these things themselves and thus rely on
the companies info. For those giving you info regarding pain-ask to see any
scientific studies. They are just giving you anecdotal info or the company
line.My opinion of the Waterlase is-
1. great service from company
2. poor training
3. great promotion by company
4. more problems w/ maintenance than Continuim
5.wouldn’t want to practice w/o itWith your permission, I’d be willing to post your email and let others
respond if you’d like?
Hope I helped a little,
R.W. Schalter DDSThe followup is below:
Dr. Schalter,
You helped a lot. Your response is thoughtful. I would appreciate you
posting my email. Thanks.Also, some more questions:
1. It seems that one ought to be able to come to a conclusion about which is
the best laser on a price performance basis. Am I wrong? I mean: given two
lasers, A and B, A costs X and B costs X/2 (which seems to be roughly the
case with Waterlase versus Continuum, maybe I am off), and yet B’s
functionality and quality of functionality is 90% of A’s, then B is probably
the better choice (unless the 10% is crucial). Am I thinking about it the
wrong way? Can one determine which laser is best? If yes, then how?
2. Why is the training poor?
3. Why are there more problems with maintenance than with Continuum?
4. By #5, do you mean “Wouldn’t want to practice without it”? If so, why
wouldn’t you? In other words, why wouldn’t another laser be able to
adequately substitute the Waterlase?
5. Why wouldn’t you want to practice without it given that the training is
poor and maintenance problems are greater than with Continuum? In other
words, your #5 (if I read it correctly) implies that Waterlase has strengths
that more than compensate for its weaknesses relative to the competition,
i.e. though it has weaknesses relative to the competition, it is still
better overall. Is this an unfair interpretation?Please feel free to post any of my responses.
Eldar Brodski
(My response again in blue)
My response in bold italics- Remember these are opinions and also anecdotal.Dr. Schalter,
You helped a lot. Your response is thoughtful. I would appreciate you
posting my email. Thanks.Also, some more questions:
1. It seems that one ought to be able to come to a conclusion about which is
the best laser on a price performance basis. Am I wrong? I mean: given two
lasers, A and B, A costs X and B costs X/2 (which seems to be roughly the
case with Waterlase versus Continuum, maybe I am off), and yet B’s
functionality and quality of functionality is 90% of A’s, then B is probably
the better choice (unless the 10% is crucial). Am I thinking about it the
wrong way? Can one determine which laser is best? If yes, then how?
To determine the best laser you have to determine the purpose for which you want to use the laser. Some wavelengths are better for soft tissue, some better for hard tissue.Since there are also differences in operator skill, knowledge, and experience , the only way to determine this would be to take the operator factor out of the equation and then standardize the test by procedure.
2. Why is the training poor?Training usually starts with an office visit from a tech who will teach a cookbook approach to using the laser. The purchase price does include a credit toward training in a doc’s office but it often occurs later. The emphasis should be 1st-understanding the physics behind the laser and then how to. 3. Why are there more problems with maintenance than with Continuum?Check the posts on the forum regarding trunk fibers- again anecdotal but there seems to be a difference 4. By #5, do you mean “Wouldn’t want to practice without it”? If so, why
wouldn’t you?
In other words, why wouldn’t another laser be able to
adequately substitute the Waterlase?Didn’t say it wouldn’t. My intent was that I wouldn’t want to practice w/o a laser.
5. Why wouldn’t you want to practice without it given that the training is
poor and maintenance problems are greater than with Continuum?I’ve pursued certification and extra training and knowledge on my own and am now comfortable with it.Biolase service has been outstanding in taking care of problems. In other words, your #5 (if I read it correctly) implies that Waterlase has strengths
that more than compensate for its weaknesses relative to the competition,
i.e. though it has weaknesses relative to the competition, it is still
better overall.
Is this an unfair interpretation?Yes.Again, not having used the other lasers it is hard for me to offer opinions other than on that which I have used.
I think you might find it interesting if you posted your questions to the forum as a whole. I ‘d be happy to then post my reponses to get things rolling. Good luck with your research.
What is the deal with the Biolase push? Is this common with what others are seeing?Is it that Biolase just hit a high enough stock price to get more attention? What do you think?
Glenn van AsSpectatorGreat question Ray…….I dont think the problem is only with the fiber but perhaps with the mirror design in both.
Hoya makes fiberoptics so it might be possible for them to make a good fiber , then again maybe not.
I can honestly say though that fiber breakdown is not an issue for me.
I started with the laser calibrating at 82% and now it is at 75%
It has to be replaced at 65% or so……..
Glenn
Glenn van AsSpectatorHi Ron…….here is my take from talking to people in several companies.
It is not uncommon for companies to push hard to drive the stock up and then the principals (CEO, VP and many in the marketing area) bail out and a company buys them.
Several ways to drive the stock up and that is sales and marketing and getting users to buy the stock to create excitement.
I think that Biolase stock has risen in recent times to 11 dollars or so from 6-8 dollars at around Xmas.
Keith told me the stock was really doing well……….is the push on now…….
Who knows but I wont post my reply back to Eldar because some things were honest and heartfelt.
I was concerned regarding what some university dentist had told him was that the Waterlase was the only laser not to cook the pulp. The competitors apparently cooked the pulp……..god was I mad.
Opusdent doesnt do that, Hoya doesnt do that.
Where is the evidence based dentistry on this.
He didnt tell me who the person was but that they were affiliated with a university and owned a Biolase.
I do hope that the financial guys get the real goods and not some feel good story………
Thanks for posting Ron……..interesting thread.
Oh RAY…….OH BOB , where are you??
Glenn
Robert GreggParticipantOh Man!
What a topic!
It’s 1991 all over again (remember I’ve been saying it’s 1990 all over again). We’re moving closer to the next Armagedon of laser dentistry.
In 1991, when ADL went public with an IPO and for the next couple of years, Tom Chess, Kim Kutsch, Del, I and others received regular calls from analysts like this.
They started paying attention because of the IPO “road show” and PR and trade advertising that ADL was putting on that was just enormous. When ADL went public, the underwriter hype went along with it, driving the share price up. We got more calls. We invested. Tom and Kim bought low and sold high–made good money. I broke even!
We gave our best and honest answers–like Ron has done. Thoughtful, fair and measured. The responses were always appreciated. But we all missed the point.
1. Impulse buying of ADL dLase 300 in 1990 and 1991 led to some dissatisfied customers with buyer’s remorse.
2. Claims were made that couldn’t be replicated by anyone but the Guru’s.
3. Company provided training was non-existant. It was left to dentist trainers to train in their offices, similar to today (so the ALD was formalized)
4. Standardization of claims and procedures was lacking–even FDA clearance in many cases (so the curiculum Guidelines were established)
5. None of this assuaged the disgruntled, untrained laser dentists with โ,000 laser that they didn’t know how to use–or couldn’t use or integrate into the practice effectively.:angry:
6. Most lasers became plant stands.
7. Some dentists were a little bit more angry.:angry:
They filed a class action lawsuit alleging over-stated claims by the salespeople and paid “Clinical Instructors” (sales seminar dentists), fraud and a few other things.The stock of the high rising ADL plumeted. Went from ฝ to ū in just a few months–never recovered.
Today ADL/ADT (ADLI) trades at 28 cents a share– a far cry from their IPO of ฝ.00.
Hype without substance. Claims without science. Procedures without protocols. That’s the unfortunate legacy of ADL/ADT. (And ADL had a reliable, durable, stable laser device and deliver system still in use by many of us today.)
And we stopped getting calls from analysts…..
………and now they’re baaaaaack!
Hold on to your check books ladies and gentlemen. Beware: stock prices rise before they fall.:o
Bob
SwpmnSpectatorI concur, ’twas an outstanding gathering.
Finally met the colorful Glenn van As(who talks faster than I can think) and got to check out his Global scope. Using an Erbium laser at 10X was truly amazing and now I see what he means. Well, maybe next year(I did order some 4.5X loupes, Glenn, ha ha!!).
Dr. Robert Gregg was kind enough to show me his scar!!! Had a great time visiting with him and discussing ideas. Finally got to see his Free Running Pulsed Nd: YAG – one of which now officially has a pre-programmed “Allen” setting! Can we change the Pulse Duration on that one, Bob?
Met Andrew, aka “ASI” from the forum, Tom Haney from Hoya ConBio, Tom Herndon and John Rice from Opus and saw a couple of old friends Jack Miller and Bill Grieder.
Great meeting just too damn cold in Southern California this time of the year!!!!!!!
Al
Glenn van AsSpectatorAllen ……..I will know now to slooooooooowwwwwwwww down for you next time!!
Its my mind……racing as fast as my fingers type……..
Great seeing you and congrats on the loupes. You can see how the magnification helps to view what it is I am seeing with the scope.
Gonna post a case in a flash on the soft tissue forum.
See you and thanks for dropping by….great seeing you.
Glenn
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