Dental Lasers

What you need to know, by Dr. David Winn (bought the first diode laser in the US)

Dental lasers are now starting to gain widespread acceptance. Many practices are starting to consider them as a standard tool. Whether you are a specialist or a GP, lasers can really benefit your practice, but as always in this area of dentistry, the buyer must enter the market armed with dispassionate information about what they want and what each laser model will provide. At least twice since 1990 the profession has been approached with products that had more hype than actual performance, and there are signs that this may be happening again, so here is a brief primer on what to look for. Here is the time tested way to make sure you get what you want and need:

Step One

Determine what you want to do with a laser. The big areas are:

1. Soft tissue
   1. Periodontal therapy, provided by either Dentist or Hygienist. The requirements are different, and this may affect what laser to buy.
   2. Cosmetic reshaping of gingival tissue in the cosmetic zone
   3. Restorative access for fillings, crown and bridge
   4. Pre-prosthetic surgery
   5. Peri-Implant treatment.
2. Hard tissue
   1. Teeth: operative, endodontics, sealants
   2. Bone
3. Diagnostics
4. Curing
5. Cavity prevention
6. Whitening
7. Biostimulation and wound healing
8. Muscle therapy
9. Headache Therapy

Step Two:

Who will use the Laser?

Dentists have much broader scope of practice than Hygienists and this will figure heavily in what equipment is right for your practice. How many users will there be is also important. Once lasers are introduced into a practice, the best economics are derived if each clinician has a laser available at all times.

Step Three:

Consult a competent advisor, preferably a practicing dentist who does not represent any single laser manufacturer about the following:

1. Will you disinfect or sterilize your fibers?
2. How many lasers will you need? What order to buy them in  to maximize profitability.
3. What procedures that you do not do now will you be likely to start doing after acquiring a laser
4. How to code for laser procedures so that you get paid for them
5. How to make your laser more than pay for it self in month one.
6. How to train your team on all aspect of lasers
   1. Marketing
   2. Set up/breakdown
   3. Sterilization/ disinfection
   4. Supplies
   5. Clinical uses and exact procedures
   6. Tissue effects
   7. How to develop or expand your Perio program
   8. How to schedule for lasers
   9. What is delegatable to whom on your team…. You will be surprised what your CDA, EFDA and non-certified chairsides can do for you… and you won't be able to figure it out quickly for your self.  If you have one or two emergency/pain patients per day, one trick alone will have your soft tissue  laser paid for in two months, with out the dentist or hygienist touching the machine!

Most laser companies do not sell a comprehensive training package with the laser, especially for lasers under $10,000, and in any case, most buyers need pre-sales assistance.These things and many more can best be learned from someone who has been doing laser procedures for a while. No doubt some of you will be thinking “I don’t need a trainer… I can figure it out for myself”, and given time and luck you will figure out a lot for yourself…. But it will cost you more to do it that way. Walter Haley of Dental Boot Camp fame once said “It is better to copy genius than to invent mediocrity” A good trainer will teach you in one day enough so that you should be able to cover the cost of the training  in one to two weeks.

Another reason to have a trainer is that old saying “a prophet is without honor in his own country”. Your team will learn more and retain more if you bring in someone else to train them because they know that you are new to lasers and are not an expert yet. If you get someone who has 10-20 years in lasers, it will show them that you respect your team enough to get the best for them, and they will reward you with enthusiasm and support in ways that you could not generate on your own. While many teams distrust practice management consultants [often with good reason!] they do not feel the same way about a specialty trainer, especially if that person is a practicing dentist who understands them and their issues.

What to Avoid

1. Don’t be fooled by hype or sales people who are interested in a sale as opposed to your needs
2. Don’t buy because the machine is pretty or has lots of  “presets”.  Many machines with presets are actually harder to learn and take longer to use that ones that are simpler. A good trainer will have you knowing in the first 10 minutes how to tell how to set a machine correctly, and wading through menus rather than directly setting the machine will be very frustrating.
3. For Diodes and Nd:YAGs don’t buy fibers and hand-pieces that are not fully sterilizable
4. Don’t fall for the pitch that there is only one laser that will regrow bone. One of the companies had spent a lot of money and produced great studies that other companies  have not duplicated, but many, many dentists have seen lasers of all types used properly result in regrowth of bone. Osteoblasts grow bone, not lasers.
5. Don’t fall for the pitch that all diodes are the same. They most certainly are not! The author had the first diode dental laser  in the United States and presented the first protocols to the Academy of Laser Dentistry in 1995… and that same laser, a Premier Aurora, is still in use today, has had one minor service call that was handled in the office, and has never gone back to the factory for repairs. Look for a focused beam module based diode not a bundled fiber diode. The best focused beam laser currently in production that we have tested was a Beamer STL which was calibrated to within 2% of factory specs, the average for a high quality laser is +/- 15%, while bundled fiber diodes have been reported to be off by as much as 50% of indicated power. Diodes come in at least three wavelengths today… 810, 940 and 980 and there are some differences, especially in how effectively they coagulate and how cleanly they cut. Black is not a healthy tissue color.

Space is too constrained to list all the lasers that are currently available, and all evaluators are biased, including the author, who owns 14 lasers purchased from six different companies starting in 1991. His favorites by category are as follows:

1. Diode: Beamer STL By King Dental Company, 866-848-5720
2. Hard Tissue: Hoya ConBio 800-562-1064
3. Curing Argon: Sventech 847-838-5273
4. CO2: Centers For Dental Medicine 866-546-5444 ext 703
5. Nd:YAG: Millennium Dental Technologies, Inc 888-495-2737
6. Diagnostic Laser: Kavo Diagnodent  888-432-6037
7. Biostimulation Lasers: Q-Laser 605-342-5669