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N8RVSpectatorSadly, Nick’s right. To one degree or another, they’re all good — depending on how well you get to know your own abilities and those of the particular laser brand.
The sad part is that, for most docs, there’s no way to know which will work best for you until you’ve used it for a while — something you can’t do in an exhibition hall sales booth or even a demo in your own office.
I’ve been using my Hoya for a few years now, and am only now beginning to feel like I have a clue. Done lots and lots of restorations with it and have changed my technique and working parameters many times, with the guidance of others’ advice.
Good luck with your quest. There is no right answer.
2thlaserSpectatorHey guys,
I am shooting in HiDef, with the Sony HC3 1080i camera…how do you say unbelievable? Glenn, in presentations, its incredible detail. Even with the lower resolutions of the projectors, it still is unbeatable…Best move, next to buying the scope, and laser I have made. Wish I could show some footage here…oh the constraints of the internet!Mark
Glenn van AsSpectatorHi Hubert: thanks man for the nice comments, it really is appreciated. I have been lax on posting cases and my goal in the next couple of months is to start posting more again.
I have used both an 810 and a 980 clinically although at present I just use an 810 (Odyssey and Hoya Con Bio Diodent 1) in my practice. I wasnt sold that the water absorption and streaming water with high energy settings (ala Mike Swick) was quicker, less painful post op and the water hindered by ability to see the tissue laser interaction. Sure I got less charring when I used the water flow on the laser but I didnt see the benefit other than that AND I did seem to get more post op discomfort from the 980 group.
I post for you below something that was posted on DT about the difference between the 810 and 980 written from the 810 bias. Its kinda how I feel about the whole situation.
NOw having said that I think that the nice size of the Sirolaser is great but the glasses from all reports on not great (too dark and big). Size and weight wise the Sirolaser is great but keep an eye out for some of the other companies as there are things in the works with at least two companies that I know for producing some novel concepts. Cant say more but I know that there is stuff on the horizon.
Cya
Glenn
Here is someone from Zap lasers Alex DiSessa
DIODE LASERS – Clearing the air on the [not so new] wavelength confusion
Over the last several months, there has been significant publicity and controversy surrounding the effectiveness of various wavelengths used for dental diode lasers. Although the wavelength concept has been made to sound [overly] complex, there are some simple principles contained herein that should clarify some of the common misconceptions.
Background: Most diode lasers on the market today operate somewhere in the range between 800 and 980 nanometers (nm). There is really no mystique of using a soft tissue laser to remove or cut gum tissue, whether it be a diode from 800-980nm, or even an Nd:YAG which operates at 1064nm. The ultimate clinical objective of each of these devices is to boil the water content within the inter- and intracellular matrix of oral tissues. Once the intra- and intercellular temperature has been raised to 100-150° C, it is simply a matter of boiling or vaporizing the water within these tissues.
800 – 810 nm: Many of today’s popular diode lasers today are set to operate in the wavelength range of 800 – 810nm. This wavelength range was selected because it has extremely favorable absorption of both hemoglobin and melanin (dark pigment), and diseased tissues have more hemoglobin and also pathogenic, pigmented bacteria which live within in the gingival tissues. By initiating the tip, which focuses the photons of light at the tip, thus creating both an end cutting as well as a side-cutting instrument, the 800 – 810nm diode laser raises temperature to boil the water. This has been described as a hot tip effect. However, by initiating the tip, less power output is required, and one can safely and effectively raise the intra- and intercellular water to 100-150° C without any charring. It should be noted that some of the perceived “charring” of the 800 – 810nm diodes is not charring at all, but rather it is the absorption by hemoglobin which upon contact, causes a dark brown/black appearance.
980 nm: The 980nm wavelength is not new to the diode laser scene. In fact, models offering this wavelength have been readily available for many years. This wavelength range was selected because it has extremely favorable absorption of water. When originally introduced, tests were performed using a 980nm diode laser in order to differentiate the attributes of this wavelength from all other diode wavelengths. Such tests included cutting of gingival tissue under an external water stream with very high power output (10-15 Watts). The test results demonstrated that “radiant” energy (i.e., non-initiated tip) could effectively avoid charring given the distinctive attributes of water absorption with the 980nm wavelength. However, “non-charring” radiant energy results were conditional upon the use of high power output (i.e., at least 7 – 10 Watts) and external water irrigation.
Comparisons: Although controversy still exists about “radiant energy” versus using an initiated tip, the maximum power output level for most 800 – 980 nm diode lasers on the market today is far below those used/required in those earlier tests. Additionally, hemoglobin absorption, and consequently, coagulation, is not as effective at the 980nm wavelength as compared to the 800 – 810nm wavelengths, even when cutting in a radiant fashion. Therefore, any perceived advantage of using radiant energy with a 980nm wavelength laser is negated by a lesser control of hemostasis.
One additional factor recently adding to the wavelength controversy has been that of fiber size. It is correct that as the fiber size (diameter) decreases, the energy level emitted from the fiber is effectively increased. Unfortunately, it is also correct that as the fiber size decreases (i.e., below the 300µ range), it becomes more fragile, and thus more impractical and difficult to use for most soft tissue procedures.
Conclusion: The soft tissue diode laser continues to increase in its use as an effective instrument for today’s dentist. Originally starting out as converted overpowered medical lasers with extremely high wattage, today’s soft tissue lasers are specifically designed for dentistry, operating at much lower and efficient power levels. The issue of diode laser wavelength has been a continuing debate, and models in the 980nm range have been available for many years, as have models in the 800 – 810nm range. As stated, the wavelengths have slightly different attributes, but generally all diode lasers in the 800 – 980nm range are designed to function with similar results. In recent years much of the emphasis has been to operate the laser unit at the lowest level of output possible that can effectively perform the function. Such lower output levels provide a safety range for both patient and clinicians, and extend the life of the diode array component.
Alex Di Sessa
Zap Lasers, LLC
http://www.zaplasers.com
888 876 4546
Alex Di Sessa
Zap Lasers, LLC
888 876 4546
http://www.zaplasers.com
Innovations in Laser Science™
Kenneth LukSpectatorHi Hubert and Glenn,
I started with 980nm, now 810nm.
I don’t find any difference between the two wavelengths when I use the same parameters with the 810. I still use Mick technique as I use a very high power.
As I’m using a pretty high power diode with very short pulse, I’m achieving coagulation and haemostasis pretty quickly. Sometimes a bit too quick. If I observe surface dehydration/blackening(charring), I place a piece of wet gauze wiht finger pressure on the socket. This quickly cools down the area in case too much energy was delivered. .
Ken
cadavisSpectator8 Watts, WOW! Mine doesn’t even go to 8W. Sounds interesting though. I completed my case yesterday and it seemed to turn out about like what was described in the article Dr Hatcher-Rice preseted in the Wavelength Journal. I’ll be following up on it in a week and a half.
Chris Davis
(Edited by cadavis at 5:58 pm on Sep. 6, 2006)
AnonymousSpectatorQUOTEQuote: from 2thlaser on 11:20 am on Sep. 6, 2006
Hey guys,
Wish I could show some footage here…oh the constraints of the internet!Mark
Mark, email me a minute or two of the video. I think I can encode it and stream it off the server.
2thlaserSpectatorOk Ron, I have to travel tomorrow and back Saturday, so I will try asap. The files are large, but we will see what happens. I will try to find something cool, and edit down to the time frame. Thanks!!!!!
Mark
HubertSpectatorGlenn, Ken,
this is a very informative text you sent- it sheds some more light on the issue. I own both 980 (Sirolaser) plus 810 (opus 5) and am not sure about the clinically relevant differences-yet. The 980 people stress that they always use uninitiated tips which they think gives them an edge over the competition because of the higher absorption in water-a statement that I do not consider completely accurate (words chosen carefully) because all diode users know when and how to use the “hot tip” to the pts advantage. Glenn and Ken, could you send me your private e-mail adress again.
Thanks for sharing- and we thought diodes discussion had been beaten to death…
Kenneth LukSpectatorHubert,
If you want to see an un-initiated fiber in ablating soft tissue instantly with almost no contact , try the elexxion.
You can get subsurface coagulation even with a 600um fiber at 2mm distance.
you forgot my e-mail? pdent…….
Ken
HubertSpectatorKen,
thanks. Can you tell me (us) what are the typical settings and procedures with your Elexxion and what the difference is to our lower power, CW diodes. Since I have the luxury of choice between Er, CO² and the diodes I may not have employed the diodes to their full scope. In case of soft tissue surgery I traditionally turn to CO² but I like the “laser curettage” with the diode and the initiated “side-firing” tip very much and the diode is very good at it.
H.
Glenn van AsSpectator
dmd92eastSpectatorI’ve already asked the stupid question now I would like a poll on whether you would buy your erbium all over again or not? Plus I’m closing in on one particular “brand” that offers a choice of a diode and training or a trip to Cancun. So would you or Wouldn’t you and which deal is better? The extra laser or Mexico? Keep in mind I have a Periolase. Thanks
Nick LuizziSpectatorDavid:
I would buy my erbium over again. It’s the Hoya Delight. It has the reputation of being a ‘workhorse’, it’s not fussy, few problems. The company has been around along time, they value their customers as demonstrated by their upgraded versawave which can be retrofitted to the Delight for a nominal cost. They designed their upgrade with the loyal customer in mind. They honor their warrranty to the letter and offer several different warranty levels and fees for such. And their tips are polishable which gives them lots of like-new use. You can get miles and miles out of them.
I have learned the hard way that there is ‘no such thing as a free lunch’. You certainly don’t need the diode laser if you own the periolase. A free trip to Cancun? I don’t know about that, I would stick to laser purchaseing.
I have no affiliation to make these statements, it’s just from my persective and with the benefit of the due diligence that I did 3 years ago. You do yours and I’m sure you’ll be happy with your choice. Good Luck with it. Nick
HubertSpectatorGlad to hear it worked. I would probably be too concerned about hemorhage when incising and “draining” as venous pools could drain for an awful long time.
Thanks for sharing!
Hubert
Glenn van AsSpectatorDavid: I have both the DeLight and the Versawave and if I h ad to buy one all over again, I would buy the same laser because
1. The laser is reliable and rarely is down.
2. The fiber is flexible and reliable, and I can polish the tips.
3. I love the ability with the scope to see around the handpiece and I can get the laser into areas where I cant get the drill.
4. The company has been great to me, they are honest and support me in the lecturing and travelling to different places.
5. The laser works great for many things that I didnt do before including osseous and soft tissue procedures.Hope that helps…..
PS I wont be able to attend Cancun next year as I was going to try and lecture there but I have a prior engagement for lecturing here in Vancouver on the same dates. It will be a great meeting. I also like the diode laser so either way will be great.
Cya
Glenn
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