Except for the thermal aspect of course. Much like other metal restorative materials.

Andrew

Ga Day Vince,

Aaaaah…..another biologic width (“BW”)question!!:cheesy:

I think the DioDent (from Hoya ConBio?) is 810nm, with the only 980 being the Ceralase from Biolitec. It does make a difference in the power settings you would be using.

I’m a little confused. You said, “It is the low crest (>3mm sounding to bone from FGM) patients that i am concerned about from an aesthetic standpoint.”

Did you mean working with greater or less BW when you said “low crest”?

In general, though, if you are NOT reducing the tissue back towards the crestal bone (i.e. removing connective tissue “CT” or attached gingiva), and your BW is adequate, then you don’t need to worry about using the laser for tissue troughing or “retraction”.

Once you remove CT, then you may need to evaluate before taking an impression–like you would with a blade. Then when you get comfortable with your results, you will know when you can take an impression, and when you can know the margin will stay where you left it.

You do need to know your laser parameters and be quick and sure so as to not overheat the thin tissues on the facial.

Al will tell you 1.0 watt, CW, activated tip….Al?

Bob

Hi Andrew,

Near-infra-red wavelength laser are transparent through water, and has no absorbption (or extremely weak–say 40+mm) in the water in the tissue.  That includes 810-980-1064-1500nm.  I know some folks say 980 is highly absorbed in water, but I strongly disagree in spite of the charts that have been used to support the proponents arguements.  

We have held 980 up to a zip-lock bag of water, and fired the beam into an infra-red camera–NO attenuation was detected by the camera.  If 980 was highly absorbed, the camera could not have detected ANY light.  Imagine shining a 1064 to a black piece of paper or baggie of black ink with a near infra-red camera–nothing would get through to the camera.

Biologic interactions with live human tissues are VERY complex.  In fact, once the tissue is “hit” with a laser (or electrosurgery) it is NO LONGER the same viable tissue constituents that you started with. So what is being interacted with at that point?  Heat altered proteins.

The measurements and data collected by some investigators are looking at DEAD tissue and lab experiments that do not necessarily translate to live human tissues.

When we get water to BOIL in our patient’s tissues using near infra-red lasers (not erbiums), it is secondary to absorbption in another substance (the hot glass of the “activated” fiber) or tissue components (blood pigments or other tissues, or proteins).

Human tissues are VERY tolerant of the abuses we impose on them.  The “heat sink” (the ability to dissipate heat quickly to body temperature) is great in the area around the implant due to the thickness of bone.  There is a limit to that heat sink, but one would have to deliberately hold the fiber in one place for too long with these lasers.

Bob

(Edited by Robert Gregg DDS at 10:49 am on June 19, 2003)

Yes, the DioDent is a 810 diode from HOYA ConBio used with an activated fiber for contact ablation and hemostasis. The SmilePro 980 nm diode(formerly Ceralas) from Biolitec is supposedly used in a non-contact mode for “optical hemostasis” and ablation of soft tissues. From Biolitec:

The 980 nm Wavelength

A major benefit of the 980 nm lasers’ wavelength is the ability to cut and coagulate optically – not via a ‘hot tip.’ Because absorption in hemoglobin and water is optimal at the 980 nm wavelength – as identified by physics and photobiology – these lasers’ fiber tips do not require conditioning. As a result, laser light cuts and coagulates with these lasers – not a “hot tip.”

Therefore, many lasers use conductive heat via a ‘hot tip’ to prevent bleeding while the 980 nm lasers coagulate optically, providing hemostasis that is much more durable, solid, and beneficial for patients. Also, because laser light cuts the tissue, when ablating tissue, the 980 nm lasers maintain a controlled depth of penetration and essentially eliminate collateral tissue damage. Without charring tissue, biolitec’s 980 nm lasers minimizes post-operative swelling and discomfort.

Unlike other wavelengths, the 980 nm wavelength is neither absorbed too much nor too little in water and hemoglobin – enabling precise, char-free soft tissue ablation and hemostasis.

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So Vince, I’m not exactly sure what laser you are using?? Even if I did, wouldn’t be much help as I just got my 810 diode but I’ll keep your question in mind as I learn with you. “Low crest” means greater “biologic width”, right? With my radiosurge unit, recession always seemed to depend on whether the facial attached gingiva was thick and fibrous vs. thin and friable.

Al

Right you are, Allen.

Thin biotype has a greater tendency for recession due to delicate and friable soft tissue and the underlying thin buccal plate. Whereas, thick biotype is bulkier and more fibrous in nature hence less likely to recede after laser or nonlaser troughing.

Any input from Andy, please?

Andrew