I totally agree with you Glenn and Ron. We place very few fissure “sealants” these days. The fact is conventional “sealants” were probably only good for fissure anatomy that wouldn’t get caries in the first place!!!!

Al

David:

Your experience is quite common.

Somehow we need to get the word out that dentists need to ask the laser company about service beyond the warranty period and also encourage companies to discuss this at the sale.

Look at it this way: My laser is two years old. In three years it will be obsolete. At some point I will need to purchase a new laser.

Do you see where I am going?

Al

All,  According to Joseph Neev (formerly of Beckman Laser Institute and former editor of Lasers in Surgery and Medicine) charring a is direct consequence of the ablation rate not being high enough.  When that happens, the material (tooth in this case) heats up faster than material removal and charring occurs.  Water cooling doesn’t buy you much in this case unless it speeds up the ablation rate to the point where the hot material is removed faster than it can build up.  He gives a very nice and detailed description of the mechanism in US patent 6,156,030.  See equations 38 – 45 and Figures 5a – 5d.  I will give a quiz on the paper next week and I will treat you to lunch if you get 90%+ on the quiz.  Who will take the challenge?

ps I can’t believe I am doing this on a Saturday night.

(Edited by lagunabb at 8:51 pm on Mar. 1, 2003)

Mike

I am also a newbie to the wonderful world of lasers and have realized an immediate ROI mainly because of less referrals for frenectomies, perio surgery and an enhanced awareness for the untreated perio that I have “watched” for many years. I made the choice to open an office that has excellent location but limited space- just 2 chairs. I do my own hygiene which I welcome on some days for relaxation between difficult procedures and have found that the Diagnodent and the Biolase laser combo has increased my income for the hygiene visits. The reason being that if say two small lesions are found (Diagnodent) on #s 19 and 30 the restorations are done on that visit without anesthesia which is welcomed by the patient- no numbness and no return visit. Much time is saved by not having to reschedule another appointment, because statistically some of these apps will be missed wasting more valuable time. Twenty years ago I elected to work 3 days a week and have continued this pattern. My production last year was 365K and my overhead only 45%. I pay my two office personnel top salary and use the best materials and dont like waste. I figure the laser will be paid for in about 18 months-tax advantages being considered.

Go for the gold

Best regards

Welcome Jerry, great to have you posting here and I am sure that you will find the information here to be of tremendous benefit to you.

I think that the way you have set up your practice is admirable and something many of the newer grads (I know you have been out a while) should look at for improving their gross while trying to maintain their net.

Great points JErry………….and welcome to the laser world.

Glenn

Hi Ray–

How’s Yossi doing?  I’m still waiting for my phone call for a tour of Y-Beam!  Lunch is still on me if it ever happens….;)

Del  has been playing wth erbiums since 1990, and he and I did quite a bit in 1996 as consultants to a start-up company that did not bring their laser to market.

I know you are teasing, but Del and I love lasers.  ALL laser devices, wavelengths and configurations.  That’s why he and I get peturbed when they are misrepresented in their features and functions.:(

Yossi has it partly right about the char and the cooling.  (His patent description is unbelievably detailed!!!):o

Here’s why:  Water spray (See Laser Endo Tech/Biolase patent from circa 1990) prevents charring when using the pulsed Nd:YAG on hard tissue  (i.e. Laser 35).  So is that HK or simply oxygen exclusion and debris removal?  If it’s HK, then the Fr Neodymium:YAG has an HK effect as well and Er, Cr, YSGG is nothing unusual from Erbium:YAG, let alone Nd:YAG for the “cooling” mechanism on hard tissue–contrary to the marketing claims (that they seem to be distancing themselves from lately).

When you came to visit, I didn’t demonstrate char prevention or removal with the Fr, Nd:YAG.  Happy to show you that.  I use that phenomenon of physics every time I laser etch dentin.

Take a look a this Laser Endo Technic (later renamed to Laser Medical Technologies, then Biolase) patent by Guy Levy et all from 1994 and you can see the evolution in their thinking about the function of water.

5,318,562
Levy ,   et al. June 7, 1994

Levy; Guy (Tustin, CA); Tillotson; James H. (Rancho Mirage, CA); Gollihar; William A. (Moreno Valley, CA)
Assignee: Laser Endo Technic Corporation (San Clemente, CA)
Appl. No.: 848179
Filed: March 10, 1992

“By providing a flow of cooling fluid through the handpiece, and particularly through the chamber which is adjacent the radiation delivery end of the handpiece, those surfaces or bodies which transmit, receive or reflect laser radiation can be effectively cooled, thereby allowing the handpiece to successfully conduct laser radiation having higher power levels. The cooling effect serves, in particular, to prevent damage or deterioration at surfaces from which radiation is reflected or through which radiation passes, and additionally promotes dimensional stability of optical components which act to focus the laser radiation, thereby stabilizing the optical performance of those components.”

It is up to Biolase to provide the scientific evidence to proove the new physics of HK.  But you and I know they have no plans to spend &#36&#36 do this.  New FDA claims, marketing and advertising is where they spend their money, not on hard science to proove their claims.

I know Bill Gollihar reasonably well, and I know you spent some time talking with him recently.  What did he tell you about HK??

Beautiful day outside!

Bob

(Edited by Robert Gregg DDS at 2:02 pm on Mar. 2, 2003)