Hi Bob
We have a very limited number of lasers available in South Africa. I bought the Deka Smartfile. My friend was advised that “there was nothing that the Nd:Yag can do that the CO2 can not do” and that he would be better served by buying he CO2.

One of the problems with lasers in dentistry in y opinion is the lack of general knowledge. I know when I wanted a laser I was caught in the typical catch 22 of not knowing what I didn’t know. All the coversations went round in circles the whole time. I would ask which laser to get, the experts would ask what I wanted to do with it, I would ask what I could do with it and they would ask which one do I have…

I quite understand that every wavelength has a certain application which it excels in, the problem seems to be the overlapping grey areas..

Any advice?
Take care
Etienne

Advice?

Sure.

If you want to remove large volumes of tissues like dylantin or cyclosporin overgrowth–a CO2 comes in very handy. It has other applications like the other laser devices like frenectomies, fibroma removal, vestibuloplasties, but no hard tissue capabilties like the erbium family of lasers.

Diode are dedicated soft tissue lasers.

Pulsed Nd:YAG of today’s reincarnation have both hard and soft tissue applications (no enamel removal though like erbium), but with variable pulse durations (a feature the early Nd:YAGs did not have) there is much better hemostatic control. These are ideal for periodontal disease treatment.

So what is your clinical challenge? Lots of Pedo? Try an erbium/diode combo.

Lots of perio? Try a FRP Nd:YAG with variable pulse durations.

Any better help?

Bob

Hi Bob
Thanks for your reply! I was actually talking about the statement that the CO2 can do anything that the Nd:Yag can do. I have always thought that as far as perio, endo and bleaching are concerned there is no comparison between the two. Surgery is another matter of course, CO2 wins handsdown. I guess what I am trying to say is, which is the most versatile softtissue wavelength…1064nm or 10600nm?
Thanks very much
Etienne

Dear E,

I agree with your overall assessment.

Here’s my Cliff Notes on the question:

CO2:

1.  Is highly absorbed in water and hydroxapatite
2.  All tissues with water and HA will absorb CO2
3.  No tissue selectivity
4.  Is not fiberoptically delivered–access is a big problem in the posterior of the mouth.

FRP Nd:YAG

1.  Is transparent through water (no absorption)
2.  Absorbed in pigments in tissue to varying degree based on absorption profiles.
3.  Is delivered through quartz glass fiber optics–therefore the cannot “clog” like the small nozzles on CO2.
4.  Has tissue selectivity–that is the wavelenth will transmitt through tissue w/o effect until the beam encounters a pigmented protein or something else.

CO2 cannot do what Nd:YAG can do.  Nd:YAG cannot do what CO2 can do.

Why do engineers, PhD salesmen continue to insist, “our laser can do it all?”  Cuz they designed and built their “box” before doing the clinical applications studies first.  Most of the failed laser companies have built a laser then gone out to make claims their laser can do it all.  We are seeing a resurgence of that none sense with CO2 recently.

There is no one single laser that can all things equally well.

There is no color that goes with everything–except black, which is comprised of all colors of the rainbow.

So we wouldn’t want to use a blue laser to selectively remove port wine stain or hemangiomas.  We would want the complimentary wavelength of red which is green to remove ONLY the red capillary tissues and leave the surrounding tisues unharmed (unless over heated by conduction)

If you used a CO2, you would non-selectively vaporize the red capillaries and a whole lot of surrounding tissue since the red capillary and the surrounding tissue all look “black” to the CO2 wavelength and would destroy them equally.

I know no one who advocates the CO2 as the most versitile have actually used the newest generation of variable pulsed Nd:YAG lasers in a clinical setting.

Most advocates have used one or the other exclusively to arrive at their preferences.  I have used most if not all laser devices that have been promoted as being the “one and only”.

I think the most versitile is FRP Nd:YAG and I have used CO2 and all the rest…….

Hope that helps!

Bob

Hi all,
This is a very good thread to see everyone’s view!
Thanks for sharing!
Ken

Dont be working without protection with a diode. If they are a problem looki up

Innovative Optics – Talk to Tom Barrows

Trinity Technologies

Both are on the web and you can find clearer glasses than the rose colored ones from Hoya. You only need one pair for yourself. I have alot of clear ones in the office.

Working without safety glasses with a diode at distances inside 8 feet can be hazardous to your retina (thats what absorbs the diode).

Glenn