Lares PowerLase AT

Introduction

Recently I had the opportunity to evaluate the Lares PowerLase AT(All-Tissue) Er:YAG/Nd:YAG unit. My evaluation was done in a booth at a dental convention and is not meant to be comprehensive or offer advice to prospective users. The review may contain factual and scientific errors and for the most part relates to the Er:YAG. Where I have added subjective comments, please either ignore them or take them with a grain of salt.

Base Unit

a)Unit is medium sized. Larger than HOYA or current Biolase units but much smaller than original Biolase erbium. Appears it would fit just fine in a standard sized operatory.

b)Electrical connection is 220-230V. The laser is self contained without need for air or water connections. Has an onboard air compressor. Distilled water bottle supply appeared adequate for normal use.

c)Keyboard appeared user friendly. LCD type display with easy to use selections for wavelength, energy setting, pulse duration, pulse rate and air/water.

Delivery System

a) Er:YAG
Articulated arm with several mirrors. Arm is surprisingly flexible and of adequate length. Appeared to have a bit of pull back when compared to the optical fiber delivery systems I have used. Each elbow of the arm has a removable plate on the back in case the mirror needs to be changed. Air/water lines are individual and run external to the arm.

b) Nd:YAG
Optical fiber emanating from right front of the base unit. Fiber is stored on a non rotating wheel on right side of unit similar to how one might store a garden hose.

Handpiece(Er:YAG)

a) Contact handpiece
Right angle handpiece similar to original Biolase Waterlase. Removable mirror access on top of 90 degree distal bend on handpiece. Air water appears to spray straight down tip similar to original Waterlase. Removable quartz or perhaps sapphire tips of 800-1000 micron diameter with metal proximal base. Visible red 650nm aiming beam emanates from distal end of tip. These tips are used in contact, they cost &#3680 apiece and are recommended for 40 uses.

b)Non-Contact Handpiece
A glass like window on the distal underside of the handpiece delivers the Er:YAG wavelength. Appears the air water spray and visible red aiming beam emanate just proximal to the window. The red aiming beam intersects with the air water spray at a very specific point a few millimeters from the window. This is the focal point for the Er:YAG wavelength. It is important to periodically wipe away ablation products and waterspray from the window.

Operating Parameters

a) Average Power Maximum
Erbium component has a maximum setting of 1000mJoules at 20Hz so this is how the 20Watt setting is calculated. There are energy setting limitations for the various Hz rate selections. Nd:YAG is 15W and was told this is related to 230V electrical connection. When I expressed safety concerns, was told that the user would be instructed never to use the Nd:YAG above 4.0Watts.

b) Pulse Rate
Repetition rate or pulse per second on the erbium is 2-50Hz. Appeared that the Pulse Rate is adjustable in single increments.

c) Pulse Duration
I specifically asked what is the convention for measuring Pulse Duration – Full Width Full Maximum(FWFM) or Full Width Half Maximum(FWHM). Response was Full Width Half Maximum. The pulse wave is reported to be a digital with a square waveform.
Theory behind the short 50 microsecond Er:YAG pulse duration appears to be that the ablation front stays ahead of the thermal front. In other words the laser is cutting hard tissue below the thermal relaxation constant. That combined with a report that there is less ablation product interference is supposed to make the 50usec Er:YAG cut faster with less discomfort to the patient.
When I asked what would be the clinical use of a 1000usec pulse duration with an erbium, was told would be for situations where one desired a low peak power. The company does not appear to promote soft tissue coagulation effects with a long pulse duration erbium wavelength. They were encouraging most or all soft tissue treatments to be provided with the Nd:YAG.

Subjective In Vitro Ablation Impressions

In a lab bench type situation at a dental convention booth, the Er:YAG in both contact and non-contact modes appeared to cut extracted human posterior teeth and bovine bone faster than anything I have ever utilized. The non contact window handpiece was much easier to focus than I had anticipated. Focal point of 2940nm wavelength is precisely at intersection of aiming beam with the waterspray.

Training

Lares provides Compact Disc based didactic and clinical training. Technician sets up laser and instructs doctor on physical operation. Over the shoulder clinical instruction by a Lares clinician can be provided and is recommended. The company does claim they are the only laser manufacturer recognized by the Academy of Laser Dentistry as a laser training course provider. Now I have to take down my official ALD issued Standard Proficiency diplomas: Two in Er:YAG, one in 800nm Diode and one in 10,600nm Carbon Dioxide(please ignore the immediately previous sarcastic comment).

Warranty

Unit has standard one year warranty. Asked about extended warranty or service contract. Was told no info available at this time but that info would be available prior to expiration of one year initial warranty.

Investment

Powerlase AT(All Tissue Er:YAG/Nd:YAG) &#3672,500 US.

Powerlase HT(Hard Tissue Er:YAG) &#3662,500 US.

Couldn’t say it was faster than a highspeed handpiece but it definitely approaches the ablation speed of a high speed. Again this is subjective, but playing with the two different handpieces it almost seemed like the non contact window handpiece cut faster than the contact tips.

Hey all,
Just back from two weeks in BC. Couldn’t find van As’s phone number in the book. Guess the guy is so famous he isn’t listed! Had a brief chat with Andrew. My daughters wanted to see so much of the beautiful scenery I didn’t have time to talk dentistry!
The lady I’ve been treating has decided she is finished. Last appt 2wks ago, she has a 3-4 mm diameter area at the midline of her chin that still feels numb. All other feeling has returned. Needless to say, she is very happy! The appts were 1wk appart, 7000-8500j each (approx 20-30 minutes) I explained the experimental nature and she paid &#36150US per appt. I treated the length of the IAN from just distal to the injury area to the midline. It really does seem amazing that the results were obtained that easily, just as Del had said it probably would.
Better living through science!

Hey Al,

All it takes to get an ALD accepted course provider status is MONEY! For ALD it’s all about the money and the politics of it.

Del and I are Master/Educators certified by ALD. We’re not recognized because we don’t pay to be so acknowledged–assuming they would accept our course curriculum anyway.

It would makes sense not to be so closely affliated with one company. That’s what got ALD into CREDIBILITY trouble with so many manufacturers other than American Dental Laser (ADL) in 1990 that led the others to conclude ALD was biased against all lasers except FRP Nd:YAG and specifically ADL’s Nd:YAG.

Now ALD is doing it again? What a surprise! Are some of the same people involved? Yep.

For Lares Research that has no clinicians qualified in ALD Educator status it’s kind of amazing they qualify for anything clinical/educational/instructional. Heck, they don’t even understand FWFM.

But they get away with it by having Prof Joel White on their payroll who is the keeper of the Category II Standard Proficienct CD-ROMs. He crafted a custom CD-ROM modified from those that the 1st Educators Course paid for and gave to Lares for a piece of the action in 1999 and (imagine this!) it was approved by the scientific and certification committee that White oversees at ALD!!

ALD has very arbitrary standards for “accepted” course providers and recognized instructors. They give ALD SP to those who watch an inadequate CD-ROM with a self-test, yet refused (for 2 years) to ackowledge/recognize MDT’s 3 Day Bootcamp with clinical hands-on and tests above and beyond the requirements spelled-out in the the Curiculum Guidelines for Dental Laser Education.

When I was on the Board of ALD, I tried to warn the good folks on the board at the time like Emile Martin, Dennis Petrinni, Steve Parker that ALD was risking irrelevance if they don’t apply their standards fairly and even-handedly. (They felt they did since they accepted cash, checks, credit cards, money orders, Western Union)

When two or three people have undue influence in an organization, other people’s opinions don’t matter if they conflict with the agendas and parochialism of the Powers that be–such an organization can get in trouble.

When WCLI came on the scene the statement was made by Biolase that they considered ALD irrelevant.

When ALD kept changing the requirements for MDT to obtain course recognition from year to year, failed MDT customers during Advanced Proficiency saying hygienists can regenerate bone (so LANAP is not that advanced of a laser procedure), and Joel White’s SP taught that long pulse duration was a marketing gimmick, Del and felt the ALD’s biases had gone too far.

I resigned from the ALD board, Del and I quite ALD as both corporatre and individual members.

It’s been 5 years.

We used to buy an ALD membership for each customer of MDT–the first company to ever do that. Other companies followed, for a while, until we resigned. No longer. I actually think the ALD Crew got scared of the increasing members from MDT thinking they might loose their power base. Never even ocurred to us. But that’s how important complete control over the agenda is to them.

So take heart Al. Your certificates are as good as they ever were–they just were not all that necessary and important in the first place. 12 to 15 years ago, AP and AP WERE important since most of what we did as early adopters clinically was all FDA “off-label” uses.

Nearly everything we do now with our lasers is FDA cleared, hence the need for separate qualifications establishing that we are education based in our clinical applications and not wild Cowboys are just not as necessary.

Standard proficiency will evolve away from ALD as lasers become accepted and taught in dental schools and CE courses. I’ve done CE courses at UCLA and I’m talking with other schools to develop a CE curriculum for laser standard proficiency that will follow accepted guidelines for education psychometrics and recognition by State Boards, not the narrow politics of a few in an organization that has strayed from the intention of the Founding organizers

So, Allen, I think you should be upset as a lot of others have been over the lack of a cogent, fair, evenly applied, clearly stated policy from ALD. And it should invlove more than “they paid their corporate dues”……

Bob

Glenn, I think you are right about doing these in the early mixed dentition stage. It seems to make more sense.

As far as the technique with 40/100 chissel; I noticed that when in non-contact mode it is hard to get that last layer to peel back just before bone. I have also noticed that some of my patients have reported more post-op pain the next day than when I used the soft tissue tip at 30/70. I would say that there is probably less bleeding with the “chissel technique” but slightly more pain. Am I possibly scorching the bone at the higher energy level? Have you had any of the same results?
Thanks,
Marc

Wow I am in the phone book……..too bad Bruce because I was in town.

In addition I have a patient with a lingual tongue parasthesia from a month ago. No NdYAG available here.

ANy ideas on what I might do for him with a diode or other wavelengths.

Glenn