Incorporating into Everyday Practice Incorporating Lasers into Everyday Practice

Ron Kaminer D.D.S. [email protected]

Ron Kaminer DDS [email protected] Disclosure

• I consult, lecture and teach for a variety of Dental companies. Some are represented here today. Everything I talk about I use day to day in my two offices. While I do receive an honorarium for today’s program, I have no financial interest in sales of any product or technique that I discuss. I want to thank the following sponsors for graciously sponsoring my four programs here at Star of the South. • Bisco • Acteon • Doxa • Voco • Ultradent Catapult Education is the only dental CE provider that integrates clinical expertise, management effectiveness, and growth strategies to support thriving practices.

• Many of ’s Most Trusted Educators • Practical, Actionable CE That Helps Practices Grow • Reviews & Leading Edge Topics • Simple Online Education Format & Live Events To: 33444 Text The Word: Kaminer Catapult Speaker Group  AG Nuevo  Milestone Scientific  Air Techniques  Microcopy  Anutra-Medical  Perio-Protect  Bisco  Premier   Denmat Proctor and Gamble  Pulp Dent  Dentsply  SDI  Dentist Select  Shofu  DMG  Southern Dental Industries  Doxa  Solution Reach  GC Amercia  Springstone Financial  Financially Fit  SS White  Heraus Kulzer  Sybron  Triodent  KavoKerrGroup  VOCO  Kettenbach  Weave DRKAMINER

Learn about the latest in Dentistry, Food and Travel Goals of this program

• Understand basic science and how it can impact clinical Dentistry. • Be familiar with the various lasers on the market today. • Realize what type of laser may be right for your practice. My History With Dental lasers

• 1986- Sophomore at UB Dental School • 1987- Began working with Co2 lasers during my junior year in Dental school. • 1988- Published my first abstract and my first article on Lasers. • 1989- UB student dto the ADA meeting. • 1990- Spoke at the Academy of and Medcine meeting. • 1993- Purchased a CO2 laser for my practice. • 1994- Purchased a hard tissue laser for my practice( Biolase) • 1997- Started training for Biolase. • 2006- Purchased a Powerlase, Started training for Lares. • 2010- Started training for AMD Lasers 2015- Became medical director of AMD lasers. What Do Dental Lasers Mean To You?

• Fun toy vs. practice need? • Ability to provide a higher level of Dentistry? • Ability to solve many clinical problems in day to day practice? • Desire to be high tech? • Marketing tool? IS IT OK TO BE LIKE EVERYONE ELSE?

•

IF NOTHING CHANGES , • NOTHING CHANGES! J ROBINSON

•WRESTLING COACH MINNESOTA GOLDEN GOPHERS Change! Advantages of Using Lasers in Dentistry • Minimally Invasive. • Less discomfort post operatively. • Reduction of anesthesia. • Less bleeding (laser dependent). • Patient feels you are high tech! • Marketing! So If Lasers Are the Cat’s Meow, Why The Slow Adoption? • Cost Section 179 Deduction Chronology

1913 - Neils Bohr Postulated the quantum theory of light 1916 - Laser light was postulated by Einstein 1960 - First ruby laser built in Southern California 1991 - First soft tissue Nd:YAG dental laser was introduced by American Dental Laser 1997 - Lares Research entered the dental laser business 1997 - First hard tissue laser Er:YAG was introduced by Premier Laser Systems

Explanation of Laser science Wavelength?

• Wavelength is the measurement of distance from crest to crest of a wave of light. • Laser light is monochromatic (of one wavelength) • Measured in nanometers (nm).

Wavelength Er:YAG ( 2.94µ) Electromagnetic Wave Scale Diode 980nm 2 Excimer KTP (532nm) CO (10,600 nm) XeF(351 nm) Diode 812nm KrF (248nm) HeNe (632nm) ErCr:YSGG 2.78 µ

Ultraviolet Visible Infrared 100 400 nm 750 nm 10,000 nm nm

Argon (488nm) ArF (193nm) Argon (514 nm) Nd: YAG Excimer XeCl (308 nm) (1064 nm) Diode Lasers

• 800-1064 nm • Soft tissue only. • Energy absorbed by pigment and hemoglobin. • Versatile, everyday use. • Small. • Inexpensive. • AMD, Ultradent, Biolase, Fotona. Sirona, CAO and others…. ND YAG

• 1064 nm • Soft tissue with very limited hard tissue capabilities. • Energy absorbed by pigment and hemoglobin. • Ideal for Perio. • Large( on wheels) • Expensive • Millenium, Fotona CO2 Soft Tissue

• 10,600nm • Soft tissue. • Energy absorbed by water. • Ideal for soft tissue surgery where bleeding may be an issue. • Large ( on wheels) • Expensive • Light Scalpel CO2 Hard Tissue

• 9600nm • Cuts hard tissue fairly rapidly • Very Expensive(over $100,000) • Solea Er Cr: YSGG

• 2780 nm • Hard and Soft tissue. • Energy absorbed by water and hydroxyapatite. • Ideal for hard tissue cutting , and cuts soft tissue well ( despite some bleeding). • Large( on wheels). • Expensive • BIOLASE Er Yag

• 2940 nm • Hard and soft tissue. • Energy absorbed by water and hydroxyapatite. • Good hard tissue cutter and cuts soft tissue well. ( despite the bleeding). • Expensive • Fotona, AMD Science

Laser Physics and Science

• L ight • A mplification by • S timulated • E mission of • R adiation Laser history and physics

1916- Einstein took Bohrs theory of Spontaneous emission and came up with the stimulated emission theory that would be the basis of laser technology.

Slide courtesy of Don Coluzzi Lasers in Dentistry

• Charles Townes developed the MASER- Microwave Amplification by Stimulated Emission of Radiation, early 1950. • In 1960, Theodore H. Maiman inserts a ruby rod into a photographic flashlamp and the LASER is born. • In 1964, Ralph Stern and Reidar Sognnaes used the ruby laser to vaporize enamel and dentin. • In 1966 Leon Goldman used the laser clinically on enamel and dentin. What Makes Laser Energy Unique?

Monochromatic - Very precise color/wavelength

Collimated - Very directional, stays narrow over long distances

Coherent - Synchronized in phase, can be focused Laser Properties

• All Dental Lasers have delivery systems that are END CUTTING. • Can’t cut sideways like a bur or scalpel. • Depending on the laser and the desired outcome, lasers can be used in contact or out of contact. Photo-Thermal Reaction

• All dental lasers are PHOTO THERMAL. • Laser Light is absorbed by TARGET TISSUE (Chromophore) and turned into heat that cuts tissue. Laser Tissue Interaction

 Reflection  Absorption

Erbium Nd:YAG Erbium Nd:YAG CO2 CO2 DIODE DIODE Metal, Glass Melanin Water Titanium Hemoglobin Hydroxyapatite  Transmission  Scatter

Nd:YAG Erbium CO2 DIODE

Enamel Not in Oral Dentin Tissues Bone Soft Tissue Model Laser energy

cut

Superficial coagulation

Heat dissipation with little/no edema Operation

• Lasers can operate in a continuous or pulsed mode. • Depending on the laser wavelength, the procedure being done and how quickly we want to perform that procedure, we can decide which way we want to use that laser. Varying The Pulse Duration

• The pulse duration or the length of time that the laser pulse lasts and is one of the parameters that can be varied in a pulsed free running laser device. • The longer the pulse the better the coagulation. • The shorter the pulse the better the laser will cut. Power density

Amount of energy delivered by the laser to the area of the tissue being lased.

Measured in watts/cm2 Power density is affected by

• Amount of power delivered (watts) • Distance of the tip ( HP) from the tissue • Diameter of the tip (spot size) Laser Safety

• While the unit is very safe there are certain protocol that you must understand and follow. • For safety there is no compromise! Safety Glasses

• Technically safety glasses are to be worn, by patient, doctor and staff. • Remember that every wavelength has specific safety glasses. • When finished, patient’s glasses are the last to come off! Nominal Hazard Zone • Nominal Hazard Zone (NHZ) is the controlled area where the laser is being fired. • The NHZ is different for every laser being used and is determined by that laser’s Nominal Ocular Hazard Distance (NOHD). • NHZ is essentially the entire operatory. Documentation and signs

• Laser warning signs and “Authorized Personnel Only” signs need to be out and in clear view for all to see. • Chart documentation need to be clear and concise and must include laser type, number, procedure, Watts used, Air,water settings, tip size and HZ and mode if applicable.

Respiratory Hazards

• Laser plume is a biological hazard of gas fumes created when tissue is ablated (vaporized), also referred to as Laser Generated Airborne Contaminants (LGAC). • Laser plume can contain vital strains of the Human Papilloma Virus (HPV) and other organisms. • High Volume Evacuation (HVE) should be used when a laser is in use to remove the laser plume. • Surgical masks must be worn. Diode Lasers

• Energy absorbed by pigment and hemoglobin. • In my opinion should be a staple in EVERY Dental office. • Laser functions as a result of energy absorbed by target tissue and heat does the rest. • Inexpensive. • Ultra Portable • Versatile. Wavelength

• Diodes can range in wavelength from 810- 1064. • 810 and 980 are the two most common wavelengths.

Imagine A World Without Soft Tissue Lasers

• Packing cord • Uncovering teeth/implants • Creating gingival symmetry and proper zeniths for aesthetics • Releasing tongues • Treating disease • The list goes on Some of The Diode Lasers on the Market Diodes

• Great for soft tissue. • No ability to cut hard tissue. • Applications in Restorative, Endo, Perio, Oral surgery. AMD Lasers

• Picasso + and Picasso Lite+ • 7 watt and 3 watts lasers • Perfect for any soft tissue applications. New Features

• 3 watts • Full Touchscreen Interface with preset modes (Continuous, Pulsed, Perio, Aphthous Ulcer, Custom) • 5 second and 30 second timers for Perio and Aphthous Ulcer modes • Pulsed Mode “Interval” & “Duration” adjustable • NO Remote Interlock Key • Fiber delivery system located on the front of the unit with NEW electronic connection detection • NEW Internal Features for Improved Quality New Features

• Full Touchscreen Interface with preset modes (Continuous, Pulsed, Perio, Aphthous Ulcer, Whitening, Custom) • 5 second and 30 second timers for Perio, Whitening, and Aphthous Ulcer modes • Pulsed Mode “Interval” & “Duration” adjustable • NO Remote Interlock Key • Fiber delivery system located on the front of the unit with NEW electronic connection detection • NEW Internal Features for Improved Quality Scalpel Button A Closer Look aka Continuous Mode

• Preset to 1.8 W continuous, adjustable from 0.5–7.0 W

Smiley Face Button aka “Comfort” or Pulsed Mode

• Preset to 1.5W 30ms interval and duration • Adjustable 0.5– 7.0W, 20 ms – 9.9 sec interval and duration A Closer Look Perio Preset 1

• 0.5 W 30ms interval and duration with a 5 second timer • Adjustable Settings

Perio Preset 2

• 0.5W continuous with a 30 second timer • Adjustable Settings October 27-30, 2016 Dual Wavelength Super-pulsed with 20 W Peak Power Autoclavable Hand Piece for Faster Cutting Single-Use Pre-Initiated Tips Three Wavelength Modes: 810nm/980nm/Dual Stunning Design Featuring a Fully Transparent Electroluminescent Display Variable Intensity Tip Illumination Designed and Assembled in the USA 19 Pre-set Procedures Standard Laser Procedures

• Gingival Troughing for • Operculectomy Impressions • Papillectomies (oral) • • Reduction of Gingival • Incision and Excision Hypertrophy • Hemostasis and Coagulation • Treatment of Oral Lesions • Biopsies • Vestibuloplasty • Exposure of Unerupted Teeth • Incision and Drainage • Fibroma Removal • Treatment of Leukoplakia • Frenectomy • Pulpotomy with Root Canal • Implant Recovery Therapy • Sulcular Debridement • Treatment of Canker Sores, • Laser Soft-Tissue Curettage Herpetic and Aphthous Ulcers Diode vs Electrosurgery

• Diodes- precise, • Electrosurgery= • May be able to be used Somewhat precise. without anesthetic. • Always need anesthetic. • Minimal thermal • Considerable amount damage. off thermal damage. • Little to no recession. • Recession • Safe around metal. • Not to be used around • Can be used for treating metal. minor Perio and Endo. • Cannot be used for treating Perio and Endo Cell Removal/Zone of Necrosis =Predictability

3-5 times Cell layers more Cell layers

Zones of thermal damage 3-5 times wider after electrocautery use than after laser use.1 1 Source : Wilder-Smith P, Arrastia AM, Liaw LH, Berns M. Incision properties and thermal effects of three CO2 lasers in soft tissue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:685–691. Laser Dentistry and Magnification. • Most visually demanding discipline outside of endodontics therefore magnification to view the laser tissue interaction is critical to the success of the integration of the laser. • Laser tips and fibers diameter can be 200 microns = resolution of the human eye. • Diode laser tips require a deft, soft brush like stroke to be effective so high mag viewing is important to success. • Hard tissue lasers operate in non contact ablation and must be held at prescribed distances to effectively ablate enamel.

64 Laser Dentistry and Magnification.

• The better you see the laser tissue interaction the easier it is to complete the task at hand. • Clinically the more you rely on magnification the lower the settings you will need to accomplish the task at hand. • The less power and time- the lower the postoperative sequelae and less charring occurs.

65 PRESENTING ClearView Laser Telescopes Tested and Certified to the highest international standards

• Dual Multiwave clear glass lenses in the Telescopes

• Filters laser wavelengths before being amplified/magnified • Filters the wavelengths a second time after being amplified • Vision through the Telescopes is Clear! Two different carrier lens configurations: Each covers more than one laser system Q Optics

• Laser Loupe • Based here in Texas • Very light loupe . Innovative Optics

• Inserts to fit inside loupes

• www.innovativeoptics.com

• 1-800-990-1455 Fiber vs Tips

• Some diodes use fibers that need to be cleaved. • Some have pre-cleaved tips. Tips Initiating vs Non Initiating the Tip

• Initiate any time you want to use the tip to cut. • Do not initiate anytime you want to use the energy without cutting. “Non-Initiated” or “Initiated”

.

Non-Initiated Initiated with pigmentation 50-60C 100-800C Disinfects Photothermal energy-vaporize Temperature Management

•37-50C - Hyperthermia; bacterial inactivation Non-initiated •>60C - Coagulation; protein denaturation

•100-150C - Vaporization of water = ablation Initiated

•>200C - Carbonization; tissue charring

Laser-Tissue Interaction

What is the Hot Tip effect?

a heated “Black Body” of charred protein on the fiber tip. • Fibers can be initiated with either cork or articulating paper. • I prefer articulating paper. Procedures : BEFORE & AFTER Papilla Reshaping: BEFORE & AFTER Gingivectomy Smile Enhancement Stent

`

Exposure: BEFORE & AFTER Tissue Retraction

• Traxodent • Cord • Lasers • SOMETHING PLEASE!!! 50% of all dental impressions do not show the entire margins needed for fabrication of the restoration. 70% of impressions have incomplete finish lines. 36% of dentists retake impressions 3 or more times per month. It costs a dentist between 35 and 75 dollars to retake an impression. OH Where Oh Where Have My Margins Gone? WTF? Are You Kidding Me? Don’t Matter How Pretty The Color Is!

Our #1 Nemesis #2 Nemesis Retraction

• Diodes will do a great job as they will allow you to retract tissue and have a clean bloodless field. • Adding retraction paste will help in absorbing crevicular fluid that can creep upwards from within the sulcus and contaminate an impression. Retraction Pastes and Clays

• Traxodent- Premier • Expasyl- Acteon

Traxodent for Hemostasis and Retraction

1. Traxodent only

100 Traxodent for Hemostasis and Retraction

1. Traxodent only

After 2 minutes, rinse Traxodent away

101 Images courtesy of Shalom Mehler DMD, Teaneck, NJ

Expasyl

Diode Laser Tissue Managment

1 1 6 Diode Laser Tissue Managment

1 1 7 Post Operative Photos

1 1 8

Frenectomies

• Common to do with a diode. • Predictable. • Usually no sutures needed.

Implant Uncovery

• Safe around metal • Conservative • No sutures necessary Implant Uncovery

Our Options With Peri Implantitis

• Flap, debride, graft- conventional methods. • Flap, laser debride, graft. • Laser decontaminate. • Remove implant.

• Always take a CBCT prior to treating a failing implant! • Lasers Med Sci. 2015 Jul 19. [Epub ahead of print] • Non-surgical periodontal treatment of peri-implant diseases with the adjunctive use of diode laser: preliminary clinical study. • Lerario F1, Roncati M, Gariffo A, Attorresi E, Lucchese A, Galanakis A, Palaia G, Romeo U. • Peri-implant diseases present in two forms: peri-implant mucositis and peri-implantitis. The prevalence of peri-implant complications is significantly rising. The aim of this study was to compare conventional treatment of inflamed peri-implant tissues with conventional treatment together with diode laser application. ms, energy density = 24.87 J/cm2). Paired t test was used to evaluate the difference in repeated measurements of considered indexes at T 0 and T 1 (1 year) in both groups. A total of 606 sites were taken into account in the test group (TG) and 144 in the CG. PD mean variation in the TG was 2.66 mm ± 1.07, while mean PD variation in the CG was 0.94 ± 1.13 mm. Paired t testing of the variation in PD in CG and TG revealed a statistically significant difference between the two groups (p < 0.0001). A reduction of pathological sites from 89 % (T 0) to 14.35 % (T 1) was achieved in the TG, while reduction obtained in the CG was from 75.69 % (T 0) to 50 % (T 1); BoP scores at time T 1 had fallen below 5 % in the TG and decreased to 59.7 %, in the CG. Within the limitations of this study, diode laser seems to be an additional valuable tool for peri-implant disease treatment • Clin Oral Implants Res. 2015 Sep 16. doi: 10.1111/clr.12689. [Epub ahead of print] • Two-year clinical outcomes following non-surgical mechanical therapy of peri- implantitis with adjunctive diode laser application. • Mettraux GR1, Sculean A2, Bürgin WB3, Salvi GE2. • Author information • Abstract • BACKGROUND: • Non-surgical mechanical therapy of peri-implantitis (PI) with/without adjunctive measures yields limited clinical improvements. • AIM: • To evaluate the clinical outcomes following non-surgical mechanical therapy of PI with adjunctive application of a diode laser after an observation period ≥2 years. • MATERIAL AND METHODS: • At baseline (BL), 15 patients with 23 implants with a sandblasted and acid-etched (SLA) surface diagnosed with PI were enrolled and treated. PI was defined as presence of probing pocket depths (PPD) ≥5 mm with bleeding on probing (BoP) and/or suppuration and ≥2 threads with bone loss after delivery of the restoration. Implant sites were treated with carbon fiber and metal curettes followed by repeated application of a diode laser 3x for 30 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms). This procedure was performed at Day 0 (i.e., baseline), 7 and 14. Adjunctive antiseptics or adjunctive systemic antibiotics were not prescribed. • RESULTS: • All implants were in function after 2 years. The deepest PPD decreased from 7.5 ± 2.6 mm to 3.6 ± 0.7 mm at buccal (P < 0.0001) and from 7.7 ± 2.1 mm to 3.8 ± 0.9 mm at oral sites (P < 0.0001), respectively. The % of implants with ≥1 site with BoP decreased from 100% at BL to 43% after 2 years (P = 0.0002). The % of implants with suppuration decreased from 87% at BL to 0% after 2 years (P < 0.0001). • CONCLUSION: • Non-surgical mechanical therapy of PI with adjunctive repeated application of a diode laser yielded significant clinical improvements after an observation period of at least 2 years • Non-surgical treatment of peri-implantitis with the adjunctive use of an 810-nm diode laser • Marisa Roncati, Alessandra Lucchese,1 and Francesco Carinci1 J Indian Soc Periodontol. 2013 Nov-Dec; 17(6): 812–815

• Abstract • An 810-nm diode laser was used to non-surgically treat a 7-mm pocket around an implant that had five threads of bone loss, BoP+, and exudate, and the patient was followed up for 5 years. Non-surgical treatment, home care reinforcement, clinical indices records, and radiographic examination were completed in two consecutive 1-h appointments within 24 h. The patient was monitored frequently for the first 3 months. Subsequently, maintenance debridement visits were scheduled at 3-month intervals. The patient had a decreased probing pocket depth and a negative BoP index compared to initial clinical data, and the results were stable after 1 year. After 5 years of follow-up visits, there appeared to be rebound of the bone level radiographically. Within the limits of this case report, conventional non-surgical periodontal therapy with the adjunctive use of an 810-nm diode laser may be a feasible alternative approach for the management of peri-implantitis. The 5-year clinical and radiographic outcomes indicated maintenance of the clinical improvement Implant Rescue Diode Lasers and Perio

• Diodes work well as an adjunct to . • Not indicated for pockets 7mm and greater. • Laser use will reduce bacterial presence and eliminate biofilm. Thus decreasing or eliminating inflammation, if you get rid of inflammation the body will heal. • During laser treatments, biostimulation occurs helping the tissues to heal at the cellular level. • We have an increase in blood supply, and osteoclastic and osteoblastic activity. • Lasers Surg Med. 1998;22(5):302-11. • Treatment of periodontal pockets with a diode laser. • Moritz A1, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W. • Author information • The aim of this study is to examine the long-term effect of diode laser therapy on periodontal pockets with regard to its bactericidal abilities and the improvement of periodontal condition. • STUDY DESIGN/MATERIALS AND METHODS: • Fifty patients were randomly subdivided into two groups (laser-group and control-group) and microbiologic samples were collected. There have been six appointments for 6 months following an exact treatment scheme. After evaluating periodontal indices (bleeding on probing, Quigley-Hein) including pocket depths and instruction of patients in oral hygiene and scaling therapy of all patients, the deepest pockets of each quadrant of the laser-group's patients were microbiologically examined. Afterwards, all teeth were treated with the diode laser. The control-group received the same treatment but instead of laser therapy were rinsed with H2O2. Each appointment also included a hygienic check-up. After 6 months the final values of the periodontal indices and further microbiologic samples were measured. The total bacterial count as well as specific bacteria, such as Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis, were assessed semiquantitatively. • RESULTS: • The bacterial reduction with diode laser therapy was significantly better than in the control group. The index of bleeding on probing improved in 96.9% in the laser-group, whereas only 66.7% in the control group. Pocket depths could be more reduced in the laser group than in the control group. • CONCLUSION: • The diode laser reveals a bactericidal effect and helps to reduce inflammation in the periodontal pockets in addition to scaling. The diode laser therapy, in combination with scaling, supports healing of the periodontal pockets through eliminating bacteria • Photomed Laser Surg. 2015 Oct 5. [Epub ahead of print] • Role of Diode Lasers (800-980 Nm) as Adjuncts to Scaling and Root Planing in the Treatment of Chronic Periodontitis: A Systematic Review. • Qadri T1, Javed F2, Johannsen G1, Gustafsson A1. • Author information • Abstract • OBJECTIVE: • The purpose of this study was to systematically review currently available evidence regarding the role of diode lasers (810-980 nm) as adjuncts to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). • BACKGROUND DATA: • Mechanical instrumentation of periodontal tissues followed by diode laser application leads to complete removal of pocket epithelium compared with conventional SRP. • MATERIALS AND METHODS: • To address the focused question "Is SRP with adjunct diode lasers (810-980 nm) therapy more effective in the treatment of CP than when CP is treated by SRP alone?" databases were searched using the following key words: chronic periodontitis, diode laser, surgical, AND scaling and root planing, periodontal diseases, periodontal therapy, AND periodontal treatment. Original studies were included. Letters to the editor, case reports, commentaries, and reviews were excluded. • RESULTS: • Ten clinical studies were included. In all studies, patients were systemically healthy, and cigarette smokers were included in two studies. In five studies, SRP plus diode laser application was more effective in the treatment of CP than SRP, and three studies showed no difference. In two studies, there was a moderate reduction in periodontal inflammation using SRP plus diode laser. The diameter of optic fiber, laser wavelengths, power, pulse repetition rate, and duration of laser exposure ranged between 300 μm and 2 mm, 810-980 nm, 0.8-2.5 W, 10-60 Hz, and 10-100 ms, respectively. • CONCLUSIONS: • In CP patients with probing depths ≤5 mm, diode lasers, SRP plus diode laser (800-980 nm) is more effective in the treatment of CP than when SRP is used alone LASER BACTERIAL REDUCTION

• Use an un-initiated tip at 0.5 watts continuous.

• Laser application of 20-30 seconds per affected tooth.

• Because the tip will self-initiate in a pocket, be sure to check the tip frequently and clear accumulated coagulum.

Diodes in Endodontics

• Insert fiber with 2 mm of apex. • Set laser to 1 watt and fire laser and withdraw at 2 mm per second. • Complete 3 passes. • Keep canal moist with water. • J Lasers Med Sci. 2016 Spring;7(2):99-104. doi: 10.15171/jlms.2016.17. Epub 2016 Mar 27. • Comparison of the Antibacterial Effect of 810 nm Diode Laser and Photodynamic Therapy in Reducing the Microbial Flora of Root Canal in Endodontic Retreatment in Patients With Periradicular Lesions. • Asnaashari M1, Godiny M2, Azari-Marhabi S3, Tabatabaei FS4, Barati M5. • Author information • Abstract • INTRODUCTION: • The aim of this study was to compare the antibacterial efficacy of diode laser 810nm and photodynamic therapy (PDT) in reducing bacterial microflora in endodontic retreatment of teeth with periradicular lesion. • METHODS: • In this in vivo clinical trial, 20 patients who needed endodontic retreatment were selected. After conventional chemo mechanical preparation of root canals, microbiological samples were taken with sterile paper point (PP), held in thioglycollate broth, and then were transferred to the microbiological lab. In the first group, PDT with methylene blue (MB) and diode laser (810 nm, 0.2 W, 40 seconds) was performed and in the second group diode laser (810 nm, 1.2 W, 30 seconds) was irradiated. Then second samples were taken from all canals. • RESULTS: • CFU/ml amounts showed statistically significant reduction in both groups (P < 0.001). CFU/ml amounts were compared between the two groups and there was no statistical difference. • CONCLUSION: • PDT and diode laser 810 nm irradiation are effective methods for root canal disinfection. PDT is a suitable alternative for diode laser 810 nm irradiation, because of lower thermal risk on root denti • J Lasers Med Sci. 2013 Winter;4(1):8-16. • Disinfection of Contaminated Canals by Different Laser Wavelengths, while Performing Root Canal Therapy. • Asnaashari M1, Safavi N2. • Author information • a better effect for sodium hypochlorite. Studies performed in relation with anti-microbial effects of Diode laser with various parameters show that this laser can be effective in reducing intra canal bacterial count and penetration in the depth of 500 microns in dentin. In studies performed on Diode laser in combination with canal irrigating solutions such as sodium hypochlorite and oxygenated water better results were obtained. Although studies on disinfection by the Erbium laser family show that use of this laser alone can be effective in disinfecting canals, studies evaluating the disinfecting effects of this laser and different concentrations of sodium hypochlorite show that the latter alone is more effective in disinfecting canals. And better results were obtained when Erbium laser was used in combination with sodium hypochlorite irrigating solution in canals. Results of the aforementioned articles indicate that this laser is effective in combination with a rinsing solution such as sodium hypochlorite. Results from studies including several types of the different Er:YAG, Ho:YAG, Nd:YAG, Er,Cr:YSGG lasers in disinfecting canals showed that all wavelengths used in disinfection for different thicknesses of dentin were efficacious without damaging thermal effect. Considering that use of different lasers in canals can be accompanied with temperature increase which can sometimes lead to damages to teeth and surrounding tissues, thus the use of photochemical phenomenon for elimination of microorganisms have attracted attention of many researchers. Studies in this field imply the efficacy of this method in reducing canal bacterial count and recommend its use as an adjunctive after biomechanical preparation of canals. Results from performed studies show removal of intra canal debris and smear layer by different lasers and particularly the Erbium laser family. Furthermore various laser wavelengths, particularly of Diode and Nd:YAG lasers can be effective in reducing intra canal microbial count. Maximum effect is obtained when laser light is used in canals in combination with sodium hypochlorite irrigating substance in appropriate concentration. Therefore use of laser energy can improve success rate of root canal treatments Tooth Whitening Laser Bleaching with a Diode Laser

Picasso 7 w laser with Bleaching JW – Power Bleaching Gel Set for Handpiece for power bleaching. Diode and Nd:YAG lasers 1 7 4 Laser Bleaching with a Diode Laser

• Place Optragate - cheek retraction.

• Place Light Cure Resin barrier - on dry tissue.

• Apply Laser Gel - Heydent Power Bleaching Gel 1.5-2 mm thick.

• Attach Bleaching Handpiece to Picasso Laser - ( NOT Picasso Lite Laser which doesnt have enough power to bleach)

1 7 5 Laser Bleaching with a Diode Laser

•30 secs diode laser 7w ( 2.5- 2.8w output) - each area and 4 mins without light. (heat activated). •Repeat 4 more times - 1 hour total chair time. •Use Vitamin E - dab on sore spots of tissue.

1 7 6 Laser Bleaching with a Diode Laser

•Suction of Excess Laser Bleach- Must be careful to avoid contact with lips, skin, eyes as will cause sensitivity. •Apply desensitizer - liberally to teeth. •Provide take home trays- for patient to improve treatment over next 2 weeks.

1 7 7 Laser Bleaching with a Diode Laser

1 7 8 Before After Treating Apthous Ulcers

• Palliative • Patients feel better immediately. • Diode speeds up recovery and healing process.

Biostimulation

• LLLT • Cold Laser • Jan Turner and Lars Hode- Textbook • When- TMJ Pain, post extraction and implant surgery, Post Perio Surgery, Post Endo procedure Low Level Laser Therapy

• Also referred to as “Bio-Stimulation”, it is when light from a laser is directed onto tissue or cultured cells with the purpose of using extremely low-intensity lighting (rendering the heat level a non-issue) to influence tissue and cell functions. Resultant effects are due to photochemical and photobiologic reactions (i.e. photosynthesis in plants) rather than heating. • Lasers are typically referred to as “therapeutic” or “medical” lasers. • Low-level lasers differ from lasers used for surgery and esthetic purposes, which necessitate the use of strong lasers, and effects are due to the heat stemming from the absorption of strong light. • The Diode laser in particular is used extensively in dentistry. • They are very useful for wound healing. • It has a well-documented beneficial effect on mucous membrane and skin. • The most common wave lengths being 810, 940, 980,1064 nm. WHY LASERS?

• Some might argue for the use of monochromatic non- coherent light over the use of lasers. • Monochromatic non-coherent light – such as LEDs, for example – can have beneficial effect on superficial tissues, such as wounds. • However, lasers have consistently demonstrated efficacy in clinical studies, especially in deep tissues. HOW DEEP WILL IT GO? • Penetration depth is contingent upon wavelength, power output, and whether the laser is super-pulsed, as well as on the technical design of the device. • An important consideration is the compressive removal of blood in the target tissue. When the laser probe is pressed lightly against skin, blood flows to the sides, and the area surrounding the probe is mostly desanguinated. Hemoglobin is responsible for most absorption, so this removal of blood vastly increases penetration depth. • It doesn’t matter if the laser probe’s light, in contact with skin, is a parallel beam or not. • The further the light penetrates, the weaker it becomes and, at a certain point, becomes so low that no biological effect can be registered. The limit where the effect is cut off is the “greatest active depth”. It is dependent on pigmentation, type of tissue, or even dirt on the skin being treated. • Laser light can also penetrate muscle and fat tissue (the latter being more transparent than the former), as well as bone. • A systematic review with meta-analysis of the effect of low-level • laser therapy (LLLT) in cancer therapy-induced oral mucositis. • Bjordal JM, Bensadoun RJ, Tuner J, Frigo L, Gjerde K, Lopes-Martins RA • Centre for Evidence-Based Practice, Bergen University College-HiB, Moellendalsvn. 6, 5009,

• There is consistent evidence from small high-quality studies that red and infrared LLLT can • partly prevent development of cancer therapy- induced OM. LLLT also significantly reduced • pain, severity and duration of symptoms in patients with cancer therapy-induced OM. • Laser in medicine, vol I, issue 1, October 2012 • HERPES VIRUS INFECTION LOW LEVEL LASER THERAPY (LLLT) • -PHOTOBIOSTIMULATION APPLIED AS MONO THERAPY IN • TREATMENT OF HUMAN PATHOGEN HERPES VIRUS • Zlatko Simunovic M.D., F,M.H

• Low level laser therapy (HeNe, IR) application proves with all virus diseases less relapse and very good and with 100% curable healing results as monotherapy (virocide effect .Pharmacological products (acyclovir,zovirax,virulex,ehinacin etc.)available for treatment of herpes simplex type HSV 1 , HSV 2 and herpes zoster have only virostatic effect • THE EFFECT OF LOW-LEVEL LASER THERAPY IN PATIENTS WITH NERVE IMPAIRMENT FOLLOWING THE TREATMENT OF BISPHOSPHONATE - A CASE REPORT. • Acta Physiologica 2011; Volume 203, Supplement 686 Joint Congress of FEPS and Turkish Society of Physiological Sciences 03/09/2011-07/09/2011 Istanbul, Turkey

• LLLT seemed to be effective in reducing nerve impairment following the treatment of bisphosphonates. Biostimulation For You

• AMD Laser website , special code CEKAMINER17 Or call AMD Lasers www.amdlasers.com Erbium Family of Lasers

• ErCrYSGG • ERYAG

• Both preferentially absorbed by water and hydroxyapatite • Can cut ,tooth structure, composite, bone, soft tissue. • Cannot Cut Metal ER YAG And ER YAG And ND YAG Combination Units • Lightwalker- Fotona- Combo ND YAG and ERYAG • ND YAG Laser energy absorbed by pigment and Hemoglobin. • Is ND Yag the same as Diode? Restorative Dentistry

• These lasers work in a non contact mode to cut hard tissue. The laser emits, air water and hydroxyapatite to cut the target tissue. In soft tissue laser can be in contact or not. • Very often procedures can be completed with anesthesia. • Big advantage over high speeds- less heat, no vibration, no micro-cracks. Why Laser Dentistry?

LiteTouch Turbine Drill Almost no anesthesia Anesthesia is required No post-operative numbness & sensitivity Post-operative numbness & sensitivity Multiple quadrant treatment Single quadrant treatment No drilling noise & vibrations Drilling noise & vibrations Bactericidal effect Threat of bacterial contamination Coagulation: fast healing, not bloody Scalpel: slow healing, scars, bloody No micro-fracturing / no smear layer Micro-fracturing and smear layer Lightwalker

• Fotona • Has a number of handpieces for contact and non contact use. • Restorative, Endodontic, Periodontic, Aesthetic and Sleep applications • Tips- • $75,000 Powerlase/Lightwalker Ablation with an Er:YAG laser?

http://www.yo utube.com/wat ch?v=- g81KfaEIUw

Link to the fast camera movie Class I Class II Class V Class V with gingivectomy Fibroma removal Frenectomy Frenectomy ND Yag Maxillary Frenectomy Implant Uncovery (tipless) Gingivectomy Hemangioma Endodontics

• Both the ND Yag and Er Yag can be used in Endo. • ND Yag- sterilizes the root canal system • Er Yag- PIPS

• Peters O, Bardsley S, Fong J, Pandher G, DiVito E. Disinfection of Root Canals with Photon- initiated Photoacoustic Streaming, JOE — Volume 37, Number 7, July 2011 • “This SEM study demonstrated the effective ability of an Er:YAG laser…. to clean and debride the root canal system. This laser system and the technique used appeared to have no thermal effects on the dentinal walls….. The dentin surface and its collagen and hydroxyapatite matrices were essentially undisturbed and clean. The use of the laser utilized in this study appeared to enhance the removal of the smear layer from dentin tubules when used with EDTA for both 20 and 40 seconds.” • DiVito E, Colonna M, G. Olivi, The Photoacoustic Efficacy of an Er:YAG Laser with Radial and Stripped Tips on Root Canal Dentin Walls: An SEM Evaluation, J Laser Dent 2011;19(1):156- 161; • Laser technology used in endodontics in the last 20 years has undergone important developments…. Research in recent years has been directed towards producing technologies (impulses of reduced length, “radial firing and stripped” tips) and techniques (LAI and PIPS) that are able to simplify the use of laser in endodontics and minimize the undesirable thermal effects on the dentinal walls, using lower power in the presence of chemical irrigants. EDTA has proved to be the best solution for the LAI technique that activates the liquid and increments its chelating capacity and cleaning of the smear layer. The use of NaClO increases its decontamination activity. Finally, the PIPS technique reduces the thermal effects and exerts a potent cleaning and bactericidal action thanks to its streaming of fluids initiated by the photonic energy of the laser.” • G. Olivi, Crippa R, Iaria G, Kaitsas V, DiVito E, Benedicenti S. Laser in endodontics (Part II), roots, 2_2011 • G. Olivi, R. Crippa, G. Iaria, V. Kaitsas, S. Benedicenti, E. DiVito, Laser in endodontics (Part I), roots, Jan 2011 • G. Olivi, R. Crippa, E. DiVito, G. Iaria, V. Kaitsas, Laser in Endodontics: a review and outlook,

Maximizing Minimally Invasive Dentistry and equally…Time management LiteTouch™ by AMD

• Hard/Soft Tissue Dental Lasers • Fast cutting, high-energy non-fiber Er:YAG dental laser for treating both hard and soft oral and maxillofacial tissues.

• Innovative Laser-in-Handpiece technology offers all the benefits of laser dentistry with the familiar feel of a turbine drill. • The unique design makes it easy to achieve cleaner, gentler treatments with less anesthesia and minimal recovery time. • LiteTouch™ allows clinics to offer unparalleled levels of technological sophistication for the best possible patient and practitioner experience.

Restorative Dentistry

• Minimally invasive procedures: Precise & selective ablation of carious lesion, avoids unnecessary ablation of healthy tissues, class 2, 3 and 4 restorations.

Pictures courtesy of Prof. Georgi Tomov, Plovdiv University- Bulgaria Restorative Dentistry

• No vibration: No micro cracks, smooth surface, better composite adhesion.

Pictures courtesy of Prof. Georgi Tomov, Plovdiv University- Bulgaria Periodontics

Microbiological findings after periodontal therapy using A COMPARATIVE CLINICAL STUDY OF A FIBERLESS ER:YAG Er:YAG laser and currets (preliminary results) LASER AND HAND INSTRUMENTS IN THE TREATMENT OF B. Yaneva, E. Firkova MODERATE CHRONIC PERIODONTITIS Scaling and root planning study comparing a fiber-less Er:YAG laser treatment to hand instruments(preliminary results) Yaneva Bl.*, Firkova E.*, Karaslavova E.** *Department of and oral diseases, Faculty of Dental Medicine, Medical University-Plovdiv, Bulgaria **Faculty of biology, Plovdiv University “Paisii Hilendarski”

In conclusion, the results of the present study indicate that the Research Conclusions: Er:YAG laser posses better clinical effectiveness in contrast to The LiteTouch ™ Er:YAG laser has shown to have better conventional treatment of moderate chronic periodontitis with antibacterial effect, compared to hand currets, as well as hand instruments. This allows the use of fiber-less Er:YAG laser significant clinical improvement in the basic clinical treatment as effective alternative nonsurgical periodontal parameters. Thus LiteTouch™ Er:YAG laser may serve as an treatment of the most distributed periodontal disease- the effective alternative treatment modality to conventional moderate chronic periodontitis. periodontal therapy. Endodontics

In vitro evaluation of the effectiveness of LiteTouch A clinical evaluation of an Erbium:YAG laser LiteTouch for Er:YAG laser versus conventional techniques used endodontic procedures during endodontic irrigation procedures G. Tomov1, N. Bibova2 G. Tomov1, N. Bibova2, P. Zagorchev3

Summary A preliminary clinical study has been undertaken in an attempt to perform laser – assisted irrigation and disinfection of root canals by means of an Er:YAG laser at sub-ablative energy levels. Forty- six teeth in 40 patients, diagnosed with chronic apical periodontitis, were endodontically treated. Root canals were shaped using a crown- Er:YAG laser energy has the highest absorption rate down technique with 2.5% NaOCl and 15% EDTA as irrigants. The teeth in water and used at sub-ablative power levels were irradiated with pulsed Er:YAG laser (15mJ at 20Hz with an potentiates the irrigant’s action into the root canal. average power of 0.3W for 60 sec.) The canals were then obturated The low energy utilized during LT-IPI eliminates the with gutta-percha points and bio-ceramic sealer, and final radiographs were obtained. Occurrence of spontaneous pain was recorded 1 day risks of preheating, ablation and irrigant extrusion. The complex root canal system is more effectively after treatment. Percussion pain was recorded after 1 week after cleaned and disinfected than with traditional treatment. Radiographic follow-up was performed at 6 months. The endodontic techniques, improving the treatment final clinical and radiographic results suggested that the clinical prognosis. application of pulsed LiteTouch Er:YAG laser at sub-ablative energy is safe and might be advantageous for the treatment of infected root canals. Surgery & Implants

• The most effective treatment modality for periimplantitis & implants decontamination

Pictures courtesy of Prof. Georgi Tomov, Plovdiv University- Bulgaria Surgery & Implants

Platelet Derived Growth Factor Secretion and Bone The use of the LiteTouch Er:YAG laser in peri-implantitis Healing After Er:YAG Laser Bone Irradiation treatment Gavriel Kesler, DMD, Dana Kesler Shvero, DMD, Yariv Prof Tzi Kang Peng, Taiwan & Prof Georgi Tomov, Bulgaria Siman Tov, DVM, George Romanos, DDS, DMD, PhD

Research Conclusions: Research Conclusions: Among lasers used in the field of dentistry, the Er:YAG laser seems to possess the characteristics most suitable for peri-implantitis treatment Based on the present results, Er:YAG laser bone surgery because of its ability to ablate both soft and hard tissue, as well as may initiate several mechanisms that may explain these bacterial biofilm and calculus, without causing thermal damage results: bone regeneration to the adjacent tissues and implant surfaces. The decontamination due to low level laser therapy–like effects and bone effects of Er:YAG laser are also beneficial regarding peri-implantitis formation. Bone surgery with Er:YAG laser, when compared pathogenesis. In the present study, the use of the LiteTouch Er:YAG with the mechanical drill, may enhance the bone laser has been proposed for the treatment of peri-implantitis and the regeneration by increasing the amount of results indicate that the laser-assisted surgical therapy may lead to growth factors present in the rabbit stemcells. significant clinical improvements such as BoP and PPD reduction as The LiteTouch Er:YAG laser may magnify the natural bone well as a gain in clinical attachment. From a clinical point of view, these regeneration pathway that is known to continue to a results advocate the Er:YAG laser as an alternative treatment modality mature graft. to conventional mechanical therapy. The Point is…

• The LiteTouch is a very versatile tool in Dentistry and should be considered in every practice.

• AMD LASERS

LiteTouch and AF

• Let’s Look at some clinical restorative cases . Restorative Dentistry Imagine no numb lip and going to work immediately! Pearls for Caries Removal 2 Watts/1 mm. wide tip Preparation with NO anesthesia Restoring this Cavity! Calcimol

• Calcimol LC

- Light-cured, resin modified calcium ion releasing base liner and pulp capping material

• Indications • High pH level 10–12) supports healing and has an antimicrobial effect - Indirect capping of the pulp • - Lining of all restorative materials • - Acid protection at application of etch technique Fusion Wedge Features & Benefits

Features & Benefits

A real softie. 3D Fusion’s Soft-Face over-mold allows it to do what no other wedge can truly do – actually adapt to interproximal irregularities.

237 Ideal Restoration(Admira Fusion) When is a Composite not a Composite? • When it is Admira Fusion! • New class of restorative material called an ORMOCER ( Organically Modified Ceramic). • Places like a composite, bonds the same way but it is different in so many manners. ORMOCER®‘s are used in different kind of industrial sectors  medical technology  optics  electronics  surface refinement  sensor Year’s of Intensive Research ORMOCER® - research:

BMBF project since July 1996 : “New biocompatible dental material” VOCO GmbH, FHG-ISC, Med. Hochschule Hanover, Biopharm GmbH

Field of Use: Composite- and glass ionomer based

filling materials, adhesives Nano Hybrid Technology

• Use of nano-particulate (small round balls of glass the size of atom (20-60 nanometers) – so small that it seems to flow like a liquid even though it is a solid.

• In composites or restorative materials nano- particulate allows for a significant reduction of composite resin – and thus a reduction of the monomers contained within it.

• The reduction of resin and increase of glass filler allows for enhanced physical properties that offer improved performance and longevity, better esthetics, easier handling and other benefits ★ Take the biocompatibility of the original Admira material…

★ Take the best properties of Nano- Hybrid materials… ® ★ Create a nano-ORMOCER direct restorative material completely free of classic monomers… The Chemistry!

★ Silicon Oxide (SiO2) is the Chemical base… ★ SiO2 - Nano Fillers ★ SiO2 - Hybrid Fillers ★ SiO2 - Silicate based “resin”…

★ The Worlds First PURE Silicate Admira Fusion

• Admira Fusion is a light-curing, radiopaque nanohybrid ORMOCER® restorative material. • Can be bonded with any adhesive(FBU). • The world’s first purely ceramic based direct universal restorative material o Pure Silicate Technology: Fillers and matrix are based purely on silicate oxide o No classic monomers for higher biocompatibility (no BisGMA, BPA, UDMA, TEDGMA, etc.) o Nano-ORMOCER technology reduces shrinkage and shrinkage stress by up to 50% compared to composites and leads to outstanding shade stability. • Non-sticky consistency for easy handling • Admira® Fusion is:

• • a light-cure material • • a radiopaque material • • a nano-ORMOCER® direct restorative • • 84% w/w filled with inorganic fillers • • compatible with all TE/SE/U Bonding Systems • • available in capsules and syringes • • available in 18 different shades that includes 3 different opacities Shrinkage [% v/v]

2.5

2

1.5

1

0.5

0 Admira Fusion Ceram X Mono Estelite Σ Quick Filtek Supreme XTE Kalore Spectrum TPH³ Series1 Synergy D6 Tetric EvoCeram Venus Diamond

VOCO internal measurement, 2014 !!!WOW!!!

• Up to 50% less shrinkage and shrinkage stress than composites • Comes in many shades and opaque shades and a bulk fill options, so you can layer, or bulk fill depending on your technique. Color Stability

Shade A3

After 2 weeks of Each A3, initial storage in red wine, 37°C 2 weeks in red wine What Else?

IT LOOKS AWESOME Really Awesome!

Comes in many shades for the “artiste” as well as a bulk fill! NO Anesthesia Polishingwith Shofu Discs Decayed Inlay

Gingivectomy and Class II

The Polish! Admira Fusion

• As Admira Fusion is really a composite type material disguised as a ceramic, or vice versa, the polish and lustre is beautiful and unique. It really looks more like a ceramic when it is polished. “Universal” Adhesive Definition

• Usable for Direct & Indirect (Film Thickness <10 um)

• No additional resin layer required (1-Layer Adhesive)

• Compatible with LC, SC & DC resin cement/composite without additional component/step (DC Activator)

• Usable with TE, SE & Select-Etch Some of the Players

269 • All have ingredients placed into one bottle, (except FBU) and some need a dual cure activator when used in dual cure technique. • Make sure cap is not left off the bottle for any period of time. Ideally

• We would like a separate bottle for primer and another for adhesive. • Why? Which One Works Better? Advantage of a Universal Adhesive

self-etch

selective-etch total-etch • Futurabnd U – Voco- Universal adhesive with out standing properties. • Unique packaging insures a fresh instant mx of material every time. • Dentist proof!! • High Bond strengths to Enamel • And Dentin in all modes . Thinking Outside the Box

• You can use the Litetouch for a variety of procedures as long as you think out side the box a bit.

How Does This Phenomena Work? Peri-Implantitis Surgery With Implant Uncovery Endodontics

Millenium

• ND Yag- Has created their education and company around their ND Yag laser and their patented procedure called LANAP. LANAP

Laser Assisted New Attachment Procedure Nd:YAG Periolase Good laser for many soft tissues procedures and Periodontal Disease Anesthesia Probe •Probe: Probe the pocket and then sound the defect to bone •Anesthesia. No papillary infiltration. •Chart any recession from CEJ to gingiva margin. •Chart Mobility First Pass •Ablation •Selectively removes epithelium while leaving connective tissue rete ridges intact Scale and Root Planning •Hand Scaling and root planning •Blunt dissection •Piezo wilth P,PS, and ball tips Second Pass Compression 1. Closes the pocket to minimize & stabilize the fibrin clot. 2. Should be less than 1.5mm wide 3. Three minutes duration Occlusion Adjustment 1. Cuspid Protection 2. No contacts on incline planes 3. No Fremus 4. No Functional Mobility 5. Reasons for Occlusal Adjustment if: a. teeth move upon function and b. mobility upon evaluation. Healing Capillary Engorgement, Epithelium Partially removed

6 Weeks Post-Op 7 Month Post-Op

LANAP Comparision

Pre-Operative 9 years Post Op Solea

• Co2 laser- 9,600 nm • Hard tissue Co2 • Solea- >$100,000 • Inefficient and cuts slower compared to an Erbium.

ROI

• Can a laser make you more money in the practice? • Can you define yourself as a laser dentist and separate you from others?

• Full mouth anesthesia free Dentistry. • Wow factor • Doing procedures that you wouldn’t have done with out a laser. Lasers

• Can be an incredible adjunct to any practice. • Will allow you to do procedures easier and maybe some you have never attempted before. • Are a great practice builder. ( patients love them) • Provide a higher level of care to your patients. Remember