Laser dentistry!

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Ante - 25 Nov 2004 20:02 GMT

Anybody who has experience whith LASER in dentistry please tell me how it
is.
I want to hear both sides dentists and patients.
Thank you!

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Mark Thorson - 25 Nov 2004 21:38 GMT

> Anybody who has experience whith LASER in dentistry
> please tell me how it is.
> I want to hear both sides dentists and patients.
> Thank you!

Isn't the so-called "laser" actually a high-pressure
water jet?

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W_B - 25 Nov 2004 22:02 GMT

>> Anybody who has experience whith LASER in dentistry
>> please tell me how it is.
[quoted text clipped - 3 lines]
>Isn't the so-called "laser" actually a high-pressure
>water jet?

No.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE

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StovePipe - 26 Nov 2004 04:57 GMT

> >> Anybody who has experience whith LASER in dentistry
> >> please tell me how it is.
[quoted text clipped - 8 lines]
> --
> W_B

Correct. There is as yet no consensus as to what exactly the function of
the water *IS* in the process. The only thing we do know is that it does
give a clean and relatively undamaged tissue treatment that is well
tolerated, if not somewhat like being in a rain shower.

Cheers
SP

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Joel M. Eichen - 26 Nov 2004 01:02 GMT

>> Anybody who has experience whith LASER in dentistry
>> please tell me how it is.
[quoted text clipped - 3 lines]
>Isn't the so-called "laser" actually a high-pressure
>water jet?

Nope, its a laser. The tooth cutting laser does have a water spray.

Joel

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Happy Oyster - 26 Nov 2004 07:30 GMT

>> Anybody who has experience whith LASER in dentistry
>> please tell me how it is.
[quoted text clipped - 3 lines]
>Isn't the so-called "laser" actually a high-pressure
>water jet?

No, Sir. It is a laser which lets particles explode. The laser is NOT
as harmless as thought.

Regards,

Aribert Deckers

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W_B - 25 Nov 2004 22:02 GMT

>Anybody who has experience whith LASER in dentistry please tell me how it
>is.
>I want to hear both sides dentists and patients.
>Thank you!

Stove Pipe is your man.

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE

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StovePipe - 26 Nov 2004 04:57 GMT

> >Anybody who has experience whith LASER in dentistry please tell me how it
> >is.
[quoted text clipped - 5 lines]
> --
> W_B

cf: http://www.biolase.com

... Not any more.... my Laser is dead. It will be resurrected when my
penny pinching gang of patients realize that if they want me to support
them, they must support me... I cannot afford to fix it, and the Biolase
rep doesn't even want to fix it... He wants to replace it with a more
modern one. If you WANT Laser treatment, PAY for it. Then decide if it
is hype or real for yourself. That said:

The Laser is pulsed (flashes and not continuous), with water spray at
the same time, like the dental turbine that it replaces and resembles.
The beam has water sprayed in front of it and this 'exploding water' is
what does the cutting/cleaning, according to one school; the other
school believes that the water exploding as Laser energy is absorbed is
merely a characteristic if this system, and it is still the Laser beam
of coherent light that does the therapy. The WaterLase's claim to faim
is a light frequency in the infra-red that is absorbed by enamel and
dentin. Thus it cuts enamel and dentin, as well as oral tissues and
bone. The bur or drill bit is replaced by a similar sized rod of
zirconium or other synthetic crystal. Look on the BioLase site for some
pictures.

Surguries ( mucco-gingival and osseous ) are said to be very well
tolerated and healing is said to be quicker. I NEVER did any surgeries
WITHOUT local anesthetics given previously. I don't believe in forcing
patients to submit to this type of procedure. I HAVE done surgeries with
anesthetic and in some cases, I HAVE found that from the dentists' point
of view, it IS easier to do.

I have personally 'drilled' into teeth that were very deeply involved
with caries and have had quite good success in finishing them without
the need for ansethesia. As the tooth is irradiated/sprayed, it enters a
state of relative analgesia, where, even though you feel what is going
on, you don't feel pain.

One can remove older fillings after soothing the tooth with a continuous
irradiation of 2 minutes or so before attacking it with the regular
turbine. This works, but not always. However, it is never a situation
where things go well, and then, all of a sudden, BANG!!! Excrutiating
pain. It comes on gradually, and you will have time to tell the dentist
to stop.

Once or twice I have taken the Endodontic points into canals that were
symptomatic and soothed them within 10 minutes or so.

I have not had any demonstrable success using the Laser in Periodontics,
but others have said that they do.

The major problem with these types of instruments is the lack of
scientifically based studies showing superiority of the Laser versus
well-admisistered traditional treatments. Most of the published studies
or case descriptions have been in Dentistry Today and Dental Town.

My own feeling: many treatments are easier with the Laser, since there
are no moving parts, you can wall off a lesion from the adjacent teeth
or gingival tissues and blast it relatively painlessly, without
disturbing the adjacent tissues. Is this worth the price of a Laser? Not
if you are trying to pay for it exclusively on the increased revenues
that this treatment is supposed to bring you. This is why I am not
getting my own Laser fixed anytime soon or even ever. The sad bottom
line is that people appreciate this type of treatment, but they are not
willing to pay for it (at least around here).

What this all means to you: Hurry up and give it a try, as your own
dentist just might wake up as I have and come to the same conclusions
and decide to turn it off one day when it breaks.

If you have any specific questions about Laser treatments, ask and I'll
get back to you with what I know. It's just that lately, all hell is
breaking loose in my little clinic, (maybe you heard the rumbling of the
tectonic plates... so, it may be awhile befor I can get back to you.

I hope SFawks chimes in with his experiences with the Laser. He has a
more modern version of the same Biolase laser.

cf: http://www.biolase.com

YMMV, JMO, not responsible for lost and stolen items, one cross to a
prisoner, etc etc etc etc......
SP

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Steven Bornfeld - 26 Nov 2004 18:42 GMT

> ... Not any more.... my Laser is dead. It will be resurrected when my
> penny pinching gang of patients realize that if they want me to support
> them, they must support me... I cannot afford to fix it, and the Biolase
> rep doesn't even want to fix it... He wants to replace it with a more
> modern one. If you WANT Laser treatment, PAY for it. Then decide if it
> is hype or real for yourself. That said:

    Well, this is the basis for my objection to the laser. It is marketed
as something that will distinguish your practice as "cutting-edge", and
that this will give you a hugh competitive advantage.
    I am old enough to remember when Oringer was touting the advantages of
electrosurgery over cold steel. I remember seeing one of my professors
heating up a Dycal placing instrument in a flame, applying it to the
gingivae, and calling it a "poor-man's electrosurgery".
    Personally, I had heard much more about soft-tissue surgery early on,
and hard-tissue cutting with laser only considerably later. I would
think perio surgery would be a pretty good indication, but then I'm not
aware of any local periodontists who use a laser.
    In any case, this is obviously a very expensive piece of hardware.
What kind of warranty are they offering you? Obviously it's not
enough--though I'd think it would be pretty trouble-free with no moving
parts.
    I always wondered how in an age of managed care a dentist with a
$30,000 laser could compete with a dentist with 7 or 8 handpieces for
$300-$500/ a piece. I'm sure the right person would be able to make it
work, but your experience was my fear.

Steve

> The Laser is pulsed (flashes and not continuous), with water spray at
> the same time, like the dental turbine that it replaces and resembles.
[quoted text clipped - 67 lines]
> prisoner, etc etc etc etc......
> SP

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StovePipe - 27 Nov 2004 02:31 GMT

> > ... Not any more.... my Laser is dead. It will be resurrected when my
> > penny pinching gang of patients realize that if they want me to support
[quoted text clipped - 6 lines]
> as something that will distinguish your practice as "cutting-edge", and
> that this will give you a hugh competitive advantage.

Firstly, you should go by the majority and not one dumb-a.s (me) who
made a dumb-a.s mistake by not taking the time to find out as to what is
happening with the Laser industry before jumping in. There is no
question in my mind that you, SB, could make the Laser pay for itself.
Hell, SFawks does, in a much lower market-savvy area than you are in (
unless I am very much mistaken ). The thing to do would be to go to more
than one of the symposia and compare the bravado of one group over the
other. Take a couple of hand-on sessions and see if it is for you.

_My_ problem was buying an older model (Millenniumm) from Ash_Temple and
not checking with Biolase to see if this model was still being supported
or not. _If_ they were honest, they would have told me at that time
(2001, summer) that the Millenniumm was being phased out. They did offer
to upgrade the old M1's to WaterLases for a flat fee of 20,000 US$,
whech I just could not afford at that time.

The moral here: If you DO buy a hard-tissue laser, get it in writing
that you must be supported for at least FIVE years by the company for
parts and labor (to insure they don't drop your model without
compensating you).

What REALLY bugs my a.s ('scuse the language) is that the High-Tech rep
for Ash-Temple did not inform me that for another 10,000$ Kannaddiaann
dollarettes, I could have had a WaterLase à la SFawks with company
support and company quarantee as well, instead of buying an old model
from them with no meaningful guarantee.

> I am old enough to remember when Oringer was touting the advantages of
> electrosurgery over cold steel. I remember seeing one of my professors
> heating up a Dycal placing instrument in a flame, applying it to the
> gingivae, and calling it a "poor-man's electrosurgery".

You might want to look at the new bipolar radiosurgery unit. I think
Parkell carries it. There is no tissue current, so no pacemaker
problems, and it is really good for surgery, from what I saw in Ian
Shuman's lecture at the ODQ convention in May 2004.

> Personally, I had heard much more about soft-tissue surgery early on,
> and hard-tissue cutting with laser only considerably later. I would
> think perio surgery would be a pretty good indication, but then I'm not
> aware of any local periodontists who use a laser.

But then, the specialists are often the most conservative wrt new
technologies, especially if they cannot keep it to themselves.

> In any case, this is obviously a very expensive piece of hardware.
> What kind of warranty are they offering you?

Again, read the above; I didn't buy it from the company, that is the
second mistake. The first was not shopping around for which Laser would
be the best for me. If you buy it from the distributor, get a double
guarantee; one from the manufacturer, and one from the distributor.

>Obviously it's not
> enough--though I'd think it would be pretty trouble-free with no moving
> parts.

Well.... I _Did_ sterilize my handpiece in the Stat-IM, and it couldn't
take that... a fog built up gradually on the mirror and that is what
killed it, I think. You should have an alcohol based sterilization
method or other. HELL, WHY DOESN'T THE GODDAMN MANUFACTURER SUPPLY US
WITH A STERILIZER FOR THEIR DAMN EQUIPMENT????

<whew... 'scuse me...>

That is one thing you MUST demand: that the handpiece be sterilizable by
normal methods, or the company must supply you with what you need. (Dr.S
has some ideas about sterilization, but I think this is reasonable).

> I always wondered how in an age of managed care a dentist with a
> $30,000 laser could compete with a dentist with 7 or 8 handpieces for
> $300-$500/ a piece. I'm sure the right person would be able to make it
> work, but your experience was my fear.

Your guarantee must have some teeth in it. There must be TWO: one from
the manufacturer and one from the local distributor.

Why not RENT one for 6 months with a contract to buy it if things go OK?
If you go out and get a CEREC, you would have to become a zealot about
it if you want to make it pay. If ALL you're going to do is 3/4 crowns
and crowns, it won't pay for itself. If you use it for large DO and MO
and DOB restorations as well, it WILL pay for itself. It's the same with
a Laser. It really is a pity y'all didn't come up here for a short
holiday and see what the Laser can do in the mouth. Myself, I really did
apperciate putting an AutoMatrix on an large deep MO carious tooth, and
zapping the caries down to far below the gumline, and restoring it with
no bleeding (because there is no moving parts, and no scraping on
subgingival dentin, and risking scraping the gum tissue and the
resulting bleed). Also, I could put in a small piece of Tofflemeyer
matrix and wedge between the two premolars and attack a proximal carious
lesion from the buccal surface, leaving the marginal ridges intact.
Again, no moving parts means that the matrix shields the gum tissue from
injury. Sure, you can do the same thing with a turbine if you're lucky;
or air <cough, cough> abrasion, but the WaterLase does it cleanly.

That said, there are a few of my older restorations that must now be
redone, as the white stuff is turning brown, and that means that I
wasn't getting all the caries out. This is why I thought Carisolv would
be the solution. This is part of learning to use them, but that could
have been done more intelligently.

So, GO SEE THEM.... or go see some of your colleagues that are using
them and see what they do with them.

And..... just in case you didn't catch the bottom line message:

DO NOT BUY A USED LASER, UNLESS FROM THE MANUFACTURER, AND SAID
MANUFACTURER WILL GUARANTEE YOU IN WRITING THAT YOU WILL BE SERVICED FOR
AT LEAST FIVE YEARS.

If I was ever courageous enough to buy a second hand CEREC, I'd do the
same thing, unless the maching cost next to nothing.

> Steve

Cheers SP

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Steven Bornfeld - 27 Nov 2004 04:50 GMT

>>>... Not any more.... my Laser is dead. It will be resurrected when my
>>>penny pinching gang of patients realize that if they want me to support
[quoted text clipped - 124 lines]
>
> Cheers SP

Thanks for the critique, SP. I'm going to the dental meeting on
Sunday, but I think I'll stick with my handpieces for now!

Steve

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Steven Fawks - 26 Nov 2004 14:53 GMT

I've been using one for about six months. E-mail me if you would like
me to tell you what I think so far.

Fawks

> Anybody who has experience whith LASER in dentistry please tell me how it
> is.
> I want to hear both sides dentists and patients.
> Thank you!

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