Using Lasers for Everyday Dentistry P2


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If you didn’t see this wonderful article in Dental Economics recently by Rodger Levin , the march edition I would encourage you to take a  look at that and when you’re  Dental Economic issue  arrives this month be sure  to take a look at our upcoming article, The $250 000 Smoked Ham.  In the article it talks about the fact that we a general dentist refer out of our offices each ear, approximately $250 000 in production that we can do under our roof. It’s not the exotic, its everyday destroy that we are referring. In December the UPS guy comes and brings us that wonderful smoked ham and we are so excited because we have a $95 ham while we spent $250 000 of our practise.


I got this information from Charles Blair very recently. There’s 500 dental procedures that you and I do .The referral dentist does only 60 of those 500 procedures.  Joe’s average dentist does 90 of the 500 procedures. The decathlon  dentist does 120 of  those 500 procedures so  what I want  to challenge you to do tonight is  to go back and look at the number of procedures your routinely doing and if you are under that 120 mark by adding a laser into  you practise you can became a decathlon dentist. So you’re training starts today. Also in the Dental Economic the September issue please look at my article don’t be a Sheep. We talk about how to differentiate your practise, how to separate your practise form others. When we come out of dental school sometimes we tend to follow the practise that is right in front of us and we do what they do. Let’s differentiate ourselves and laser is a great way to do that.


Perhaps  in the Orthatribune you saw our  article  that talks about how lasers relate  to orthodontist cases and things that we can do and upcoming   in the fall there will  be an article and LVI Vision The impossible is nothing which will cover a lot of the information that we talk k about tight . That was co-authored by Lorne and myself.



When the lark  goes off in the morning are you really excited to get up and go   to your office air would you rather  just hit the alarm clock like you see in the picture? Do you feel you need direction for you practise? Lasers might just be the driving force that you need. I will honestly tell you that before 1998 when  we purchased out first laser  dentistry  had really become really boring and  I was experiencing   burn out from it , the same thing  all day long , every day .


In the 1998  we purchased out first laser which was Boa Lays laser and later on we purchased a Delight and a Versa wave  and then the laser that we  currently use which I think is the finest laser  on the market is the Boa Lady MD Turbo . When you look at this picture GD black just think about all the changes that has occurred in our profession since these days. These are antique pieces that are in our witting area. Things have really come a long way since the old singer sewing machine, foot pedal driven hand pieces and belt driven hand pieces and then along amen air driven high speeds and now the modern appotoires that we have today and we can now take it one step further by the addition of a laser.


As we start tonight I want you to open your minds and erase any pre conceived notions you may have about lasers and dentistry whether good or bad. Just open up your mind to the concept tonight. The things that we say here could change your practise forever in fact they can possibly change your life.


I want you to differentiate your practise by jumping out of the dental fish bowl, not like every other practise that is out there. We want you to catch the concepts that we will present here and run with them and for those of you that choose to do that the rewards for your effort will be great. During the next 45 minutes we’re going to talk about nothing but lasers and more lasers. Lasers are all about solutions for everyday problems. You knee every day when   you and I go into the office we are faced with one problems after the other, our patients bring us those problems and from those problems we have to be problem solvers, we have to have solutions. One  of the problems we battle each and every day  on almost each and every  patient is bacteria and one of the things  that  you will learn tonight is that  bacteria is every susceptible to laser energy .


You just don’t see the problem if you don’t have a solution. What if all you had in your armentary was to set up forces. What would you see on every [patient? Of course you would see extractions but what if you wades a hand piece and then maybe threw in lights and some instruments and some filling material then we can see a lot more problems because we have a lot more solutions. Then if we added an indo cabinet to our raptor now we can actually think about saving teeth by doing root canals. If we added a soft tissue laser, just think of the soft tissue procedures that we can do now. All of a sudden we more problems because we have more solution and ultimately if we added an YSGG laser, an all tissue laser now we can really see solutions to all the problems that priest present to us.


Did you know that only 5 % of general dentist routine lead to osseous and soft tissue procedures? Don’t limit your practise. Rumanian chromium YSGG laser is juts the tool kin the dental tool box but what a fantastic tool it really is and who would have thought that you just couldn’t run dental practise without a laser. There are three things that will shut my laser in my office down and one is loss of air, once is loss of vacuum and the other is loss of laser. Our patients are so oriented towards laser that they just would not want to have procedures done without one.


Let   look very briefly and I do mean briefly at physics tonight. Abler Einstein certainly understood that the impossible was nothing. He talked about laser mathematically woven before there was laser. The word laser is an acronym for light amplification by stimulated emission of radiation. In the room that you are sitting right now you probably have some lights in, some ordinary visible light that is multiple wave lengths, non-directional and non-focused. With the laser it monochromatic and its collimated and its coherent light. It’s a single wave length of light.


The light energy that travels from the laser itself travels  via fibre optic  delivery system to a hand piece and then the   energy is admitted at  the end of a tip .When the laser energy  leaves the tip it comes in contact  with the tooth and it would either  reflect , transmit , hit and scatter or be absorbed  and the thing that you and  I care about the most  is the absorption . The 2780 anatomy of wave length is the peak absorption in water and hydroxyl appetite sow when we aim the laser at the tooth it’s looking for water. In enamel there is 3%-5% water, dentin have has 10% – 12%, carouse has 16%-18%. Maybe sometimes as high as 40%.


The more water that the tooth structure has or the tissue or the bone the faster the laser cuts. The more water it has the faster the laser will cut. That’s why soft tissue cuts faster than any other tissues.  When the tip is aimed at the tooth it’s looking for the water molecules. The water molecule that highly absorb that wave length and as it absorbs it expands and eventually that water molecule will explode and when it does it blows off everything that surrounds it.


One blast from the laser will leave a crater that’s about 30 – 50 microns deep into his diameter of the tip that was used. Now let’s move unto some cases. Let’s look at operative dentistry. As we go through this bear in mind problems that you see each and every day in your office. Anybody ever see an area like this? Probably saw one today? The carious extends under the tissue, we have to move the tissue back. We can think about electro surge, we can think about retraction cord door we can think about a laser.


In this case without any anaesthesia we were able to move the tissue back, access the decay, remove the decay and place the restoration in a dry environment. All without anaesthesia, without packing cord in a comfortable four hour patient.



Class four

This patient fell on the asphalt in school. You can tell by the asphalt that is still left on the initial edge there. The mother brought this patient in unscheduled and we were able to clean the tooth up, prep it with a laser without anaesthesia and then send the child back to his mom. Unscheduled patient so we sent that  young patient out looking  just like they hid right before the accident and you don’t think we were a hero  that because of what the laser was able to  do for us and for our patient .


A class three

Take the amalgam out with a hand piece and turn to the laser for a nice prep. By the way we get a 50% stronger bond when we prep with the laser than we would if we prep with just burg


Class ones

We see class ones all day, every day in our practise and it’s so nice to be able to go in and do these without anaesthesia. Our patients really appreciate the fact from allusions such a and they can return to work or school or home without a numb lip.


I don’t know how many  of you  may use a diagnodent in your practise  but a diagnose  is also  a laser and its works  wonderfully  hand  in hand with the Boa Lays laser. We like   early detection of the decay. 80% of the decay occurs in in the inclusion surfaces and with visual and bite wing we probably diagnose about 50%.  In our practise anything that measures 20 or above on our diagnodent we fill. We like to fill it early that meets it a lot easier for us to do it without anaesthesia. By the way being even very conservative we do 80% of our restoration without anaesthesia.


Class two

When you are working on a class two you make sure you protect the adjacent tooth with the matrix band. This sis showing the Boa Lays turbo hand piece as it preps a class two. We are able to go through and do this without anaesthesia in most cases.


Now let’s talk briefly abound indo .Lets start by talking about direct pulp exposure, mixed incision and we receive a direct pull exposure in this case. As all of you know when you get a direct pupil exposure we can do a pulp cap but we usually expect in about 6 months, 12 months it will be going back and then variably do an indo on a tooth like that.  With laser we can treat a direct pulp exposure a little differently. When we get the red pinpoint we can tune it brown using the laser. What this does is to sterilise the environment.  Then we can place on top of that some MTA and then   go ahead and place our restoration. You can see in the radiograph how deep the restoration was that we placed here. This has been two to three years now, post operatively and the tooth is doing very well.


Now why if we get a  pulp exposure  and we treat it with a laser is that going to be different than what we’ve  done in the past .When we get the mechanical  exposure we have no way of getting rid of the bacteria. Remember we talked about it in the beginning that lasers are problem solvers and so with the laser we can actually sterilise that environment before we seal it up with our restoration. That h why we see almost assuredly when we do a pulp exposure we will see success.

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