NEWS & ARTICLES
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ARTICLES
Latest News
Notes and Articles
Erbium lasers in dentistry
News

Lumenis / OpusDent gets FDA clearance for laser bone removal
BIOLASE gets continuation patent
OmniGuide reports clinical results with hollow photonic-crystal fiber for CO2 laser delivery
Millennium Dental gets FDA clearance for Laser ANAP
BIOLASE launches new Waterlase MD product at ADA Annual Meeting

Notes and Articles

Millennium Dental Technologies breaks new ground in the dental laser world
Diode laser prices continue to drop
Ivoclar Vivadent enters the dental laser market
Erbium lasers in dentistry



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News

Lumenis / OpusDent gets FDA clearance for laser bone removal

3 January 2005; Yokneam, Israel – Lumenis Ltd. and its dental laser division, OpusDent Ltd., announced FDA clearance of the OpusDuotm Er:YAG laser for contact bone removal during oral surgery and periodontal procedures, using the company’s proprietary contact sapphire tip.

BIOLASE gets continuation patent

13 December 2004; San Clemente, CA – BIOLASE Technology Inc. announced it had been granted U.S. patent No. 6,821,272, which includes 111 claims covering its Waterlase® YSGG and Waterlase® MD erbium laser products. It is a continuation of U.S. Patent No. 6,288,499. The patents pertain to the specific laser pulse technology used in the Waterlase products which is claimed to allow the lasers to effectively interact with water spray to produce a fast, clean, and precise cutting action on dental hard and soft tissues.

OmniGuide reports clinical results with hollow photonic crystal fiber for CO2 laser delivery

30 November 2004; Cambridge, MA – OmniGuide Communications Inc. announced the first clinical results achieved with its hollow-core, photonic crystal fiber for delivering CO2 laser energy. A prototype OmniGuide Fiber was used by Dr. Jamie Koufman at the Center for Voice and Swallowing Disorders of Wake Forest University to treat recurrent respiratory papillomas (RRP) in patients who suffered from near-total obstruction of the larynx and trachea.

The OmniGuide Fiber was used to deliver CO2 laser energy through a flexible Pentax endoscope and treat patients on an outpatient basis. Patients were awake during the procedure and received no anesthesia other than spraying a numbing spray in the throat and trachea. Patients went home immediately after the surgery. When it can be used, this procedure is expected to reduce RRP treatment costs by several tens of thousands of dollars per surgery.

Hollow-core photonic crystal waveguides offer important advantages compared to conventional hollow waveguides for CO2 laser delivery, including longer lengths, reduced bending losses, and improved beam quality. Photonic crystal waveguides are not yet offered for use with CO2 lasers in soft-tissue dental applications, but such products are probably not far off in the future. A more in-depth discussion of photonic crystal fibers and waveguides will appear in an up-coming issue of DAAL™ Update On-line Newsletter.

Millennium Dental gets FDA clearance for Laser ANAP

8 October 2004; Cerritos, CA – Millennium Dental Technologies announced it had received the first FDA clearance ever for MDT’s Laser ANAP® procedure. The specific claim or labeling cleared by FDA is “cementum-mediated new periodontal ligament attachment to the root surface in the absence of long junctional epithelium.” MDT’s Laser ANAP and patented Laser Periodontal Therapy (LPT) procedures are performed with MDT’s PerioLase® MVP-7 pulsed Nd:YAG laser, and are used to treat chronic periodontal gum disease in a minimally-invasive fashion. See Section 11 of DAAL-2004 for more information on the PerioLase MVP-7, Laser ANAP, and LPT.

BIOLASE launches new Waterlase MD product at ADA Annual Meeting

7 October 2004; San Clemente, CA – BIOLASE Technology, Inc. announced successful launch of its new flagship dental erbium laser product for hard and soft tissue dental applications, Waterlase® MD, at the ADA conference held in Orlando, FL from October 1 to 3, 2004. BIOLASE reports it received more than $2.6 million in orders during the three-day conference.

The Waterlase MD provides many new ergonomic features and performance improvements, including a maximum pulse rate of 50 Hz for smoother cutting of soft tissue, and a long-pulse mode for improved hemostasis when cutting soft tissue. The new HydroBeam™ Illuminated Laser Handpiece facilitates hard-tissue applications on teeth and bone. See Section 9 of DAAL-2004 for more information on the Waterlase MD and a color photo.

Notes and Articles

Millennium Dental Technologies breaks new ground in the dental laser world

Millennium Dental Technologies continues to break new ground in the world of laser dentistry. Dr. Robert Gregg II, DDS, and Dr. Delwin McCarthy, DDS, have been performing laser dentistry since the mid-1980’s. In 1994, they founded MDT with the goal of providing dentists with a laser product that could cost-justify itself on the basis of one or two soft-tissue procedures performed with the laser. This was a very ambitious goal at the time. MDT was also the first company to offer a pulsed Nd:YAG laser that allows the practitioner to select among several different pulse durations, which MDT claims is critical to the success of the clinical procedures developed by the company. Other companies who offer pulsed Nd:YAG dental lasers have since followed MDT’s lead and now offer variable-pulse-duration products.

MDT has also proven to be a leader in the training of laser dentists. MDT will not ship a purchased laser until the dentist has completed MDT’s Laser BootCamp™ training program. This was also a rather bold concept in the world of laser dentistry back in the mid-1990’s.

Today, MDT’s PerioLase® MVP-7 pulsed Nd:YAG laser product is used to perform the company’s patented Laser Periodontal Therapy (LPT) procedure and its recently FDA-cleared Laser-Assisted New Attachment Procedure (Laser-ANAP®). These procedures allow a general dentist to perform soft-tissue management of chronic periodontal disease and treat many patients who would otherwise have to be referred out to a periodontist. The Laser-ANAP procedure is innovative in that it appears to involve a biostimulation-type laser-tissue interaction that, MDT thinks, stimulates the activity of stem cells present in the environment of the periodontal ligament.

Testimony to MDT’s market approach and success is provided by the fact that MDT has been able to significantly increase the number of lasers it sells annually even though it has raised the price of its pulsed Nd:YAG product from about $45K to $55K. (The laser price includes licenses to practice MDT’s LPT and Laser-ANAP procedures). This success appears to continue even though much lower-priced dental diode laser products, also intended for soft-tissue management applications in the oral cavity, are being introduced by more and more competitors.

Diode laser prices continue to drop

Semiconductor diode lasers intended for soft-tissue dental applications provide power levels of 2 to 5 watts (some as high as 10 watts) for general purpose cutting of gum tissue with hemostasis. Diode lasers compete with pulsed Nd:YAG, CO2, and argon lasers for use in soft tissue applications.

Many new diode laser products have appeared commercially in recent years that are extremely compact, reliable, and portable. These features are a direct result of the very high electrical-to-optical power efficiency enabled by semiconductor laser-based designs. Their main drawback is that diode lasers do not provide the high peak power levels provided by lasers such as pulsed Nd:YAG and Er:YAG lasers. High peak power capability enables pulsed Nd:YAG lasers to be used for some hard-tissue applications (removal of first-degree caries), and Er:YAG lasers to be used for all hard-tissue and soft-tissue applications. Diode lasers can be used only for soft-tissue procedures, and as a heat source during laser tooth whitening procedures.

The technology of semiconductor diode lasers continues to evolve rapidly. Higher power levels are being provided through smaller-core fibers. New wavelengths are being provided by diode laser-based sources. But, most importantly for the world of laser dentistry, prices of high-power diode laser components are coming down. We at JGM Associates expect that, within the next several years, dentists will be able to purchase a 5-watt dental diode laser for substantially less than $10,000. Nobody really knows where the “trigger level” will be, but we surmise that an eventual sell price in the $5,000 range would dramatically increase the penetration of laser-based soft-tissue management (and tooth whitening) procedures in the dental marketplace by a factor of ten or more.

Ivoclar Vivadent enters the dental laser market

Ivoclar Vivadent, a world renown supplier of dental supplies and equipment, gave a shot in the arm to the credibility soft-tissue laser dentistry when it entered the marketplace in 2004 with its Odyssey® diode laser and bluephase® blue-LED-curing products. With a list price of $11,750, the Odyssey became the most affordable 5-watt diode laser on the market (priced slightly below that of ZAP Lasers’ SoftLase Dental product) when it was introduced in the United States earlier this year. It should be interesting to see if Ivoclar Vivadent can drive down the prices of dental diode lasers just on their basis of their marketing clout.

Erbium lasers in dentistry

Why erbium lasers ?

Due to strong absorption by the collagen, mineral (hydroxyapatite), and water components of calcified tissue, pulsed erbium:YAG lasers (Er:YAG, 2.94 µm) can precisely ablate all hard dental substances, at usefully fast rates, and with relatively low pulse energy and average power. Even healthy tooth enamel, which is highly resistant to visible and other infrared laser wavelengths, can be ablated precisely and easily with erbium laser pulse energies of only 100 millijoules. Higher pulse energies remove increasing amounts of material per pulse.

Surgical precision and control can be excellent when using erbium lasers on teeth, but laser dosimetry must be carefully controlled to avoid photoacoustic damage (tooth cracking) beyond the intended treatment area. The tooth must also be cooled with a water spray, as when using a drill, to prevent overheating of the tooth at the pulse rates typically employed (10 to 50 Hz). No topical-absorber pigment of any sort is required to ablate enamel, dentin, or cementum when using erbium laser wavelengths.

Erbium YSGG lasers (Er,Cr:YSGG) lasers operate at a wavelength of 2.78 µm and have dental capabilities similar to Er:YAG lasers.

Erbium lasers can also be used to precisely cut and ablate soft tissue. However, when using fiber delivery accessories in a non-contact mode, the amount of laser-induced thermal injury is typically so low that relatively little hemostasis (bleeding control) is provided in most situations. Cuts are scalpel-like in that there is almost no healing delay, unlike most other lasers. Erbium lasers are sometimes used with contact-mode, “hot-tip” fiber accessories to improve their utility for soft-tissue cutting with hemostasis. Some erbium laser products (BIOLASE’s Waterlase® MD) provide a long-pulse emission mode to improve hemostasis when cutting soft tissue, and pulse rates as high as 50 Hz to improve the smoothness of cut tissue edges when cutting soft tissue.

Fiber accessories for dental erbium lasers

Delivery of laser energy through an optical fiber delivery accessory greatly facilitates laser treatments in the oral cavity. However, Er:YAG and Er:YSGG laser wavelengths cannot be delivered through standard (quartz) fiberoptic delivery accessories, as are used with dental Nd:YAG and argon lasers. Quartz fibers absorb erbium laser energy strongly and long fiber lengths attenuate the beam severely.

Fortunately, “infrared fiber” accessories have emerged for use with erbium lasers. Infrared fibers include sapphire fibers, zirconium aluminum fluoride, and germanium oxide fibers. These fibers appear to be adequately reliable, cost-effective, and otherwise appropriate for delivering erbium laser energy for dental applications. Erbium laser fiber accessories are new enough, however, that some manufacturers’ fibers may be more reliable than others’. Manufacturers continue to seek new ways to reduce cost and improve the reliability of their erbium laser fiber accessories.

Some dental erbium lasers employ articulated-arm (mirror-based) delivery systems instead of optical fibers. Some laser users find articulated arms much more awkward to use in the oral cavity than fiberoptic delivery accessories, but this can vary according to individual preferences. Certain prospective periodontic and endodontic (root canal surgery) applications of erbium lasers probably require fiberoptic delivery.

Commercially available products

Several erbium laser products now have FDA clearances for hard-tissue applications on teeth. FDA clearances typically include indications such as caries removal, cavity preparation, and enamel etching for treatments in adults and children. One erbium laser product (BIOLASE) also has FDA clearances for bone cutting and apicoectomy indications. Most erbium laser products have FDA clearances for soft-tissue indications. Note that not all products have the same FDA clearances; contact manufacturers for product-specific lists of FDA-cleared indications.

Some products combine an Er:YAG laser with a CO2 laser, or an Nd:YAG laser, in the same enclosure. These so-called “combination laser” systems reduce purchase cost compared to buying two lasers. The present list of commercially available dental erbium laser products (not all of which are available in the USA) includes:

Waterlase YSGG, Waterlase MD (BIOLASE Technology)
DELight (HOYA ConBio)
Fidelis Er, Fidelis Er II, Fidelis Plus II (Fotona)
OpusDuo (OpusDent)
KEY Laser 3 (KaVo)
Smart 2940d (Deka Lasers)

See Dental Applications of Advanced Lasers-2004 for detailed descriptions of most of these products.

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