cjrd volume 2, issue 4 (pdf)

ISSN

1916

-7520

Laser Dentistry / Dentisterie laser

Special Issue / Numéro spécial

Dental Materials / Matériaux dentaires

PEER-REVIEWED –JOURNAL - REVUE DES PAIRS

VOLUME 2-4

FALL / AUTOMNE 2009

www.cardp.ca

Canadian Journal ofRestorative Dentistry & ProsthodonticsThe official publication of the Canadian Academy of Restorative Dentistry and Prosthodontics

Publication officielle de l'Académie canadienne de dentisterie restauratrice et de prosthodontie

Journal canadien dedentisterie restauratrice et de prosthodontie

Canadian Journal ofRestorative Dentistry & ProsthodonticsThe official publication of the Canadian Academy of Restorative Dentistry and Prosthodontics

Publication officielle de l'Académie canadienne de dentisterie restauratrice et de prosthodontie

Journal canadien dedentisterie restauratrice et de prosthodontie

www.andrewjohnpublishing.com

PUBLICATIONS AGREEMENT # 40025049

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM

PDF compression, OCR, web optimization using a watermarked evaluation copy of CVISION PDFCompressor

http://www.cvisiontech.com

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



3Canadian Journal of Restorative Dentistry and Prosthondontics

VOL. 2, NO. 4 • FALL / AUTOMNE 2009

Official Publication of the CanadianAcademy of Restorative Dentistry andProsthodontics

Publication officielle de L’Académie canadienne de dentisterie restauratrice et de prosthodontie

EDITOR-I N-CH I EF/RÉDACTEU R EN CH EFHubert Gaucher

Québec City, Québec | [email protected]

ASSOCIATE EDITORS/RÉDACTEU RS ASSOCIÉSEmmanuel J. Rajczak

Hamilton, Ontario | [email protected] Andrea

Chester, Nova Scotia | [email protected] Nimchuk

Vancouver, British Columbia | [email protected]

SECTION EDITORS/RÉDACTEU RS DE SECTION

Occlusion and Temporo-Mandibular Dysfunctions/Occlusion et dysfonctions temporo-mandibulaires

Kim ParlettBracebridge, Ontario | [email protected]

Implant Dentistry/Dentister ie implantaireRon Zokol

Vancouver, British Columbia | [email protected] Fortin

Québec City, Québec | [email protected] Dentistry / Dentister ie esthétique

Paresh ShahWinnipeg, Manitoba | [email protected]

Dental Technolog y / Technologie dentairePaul Rotsaert

Hamilton, Ontario | [email protected]

MANAGI NG EDITOR /DI RECTEU R DE LA RÉDACTION

Scott [email protected]

CONTRI BUTORS/CONTRI BUTEU RSMaureen Andrea, Hubert Gaucher, Helmut Goette,

Luciana Fávaro Francisconi, Paulo Afonso SilveiraFrancisconi, Anderson Pinheiro de Freitas,

James Jesse, Ron Kaminer, David Kimmel, Ernesto A. Lee,Robert J. Miller, Gildo Coelho Santos Jr., David M. Sarver,

Christian von Rosenbach

ART DI RECTOR /DESIGN / DI RECTEU R ARTISTIQU E/DESIGN

Binda [email protected]

SALES AN D CI RCU LATION COORDI NATOR /COORDONATRICE DES VENTES ET DE LA DI FFUSION

Brenda [email protected]

TRANSLATION/ TRADUCTIONGladys St. Louis

ACCOU NTI NG / COMPTABI LITÉSusan McClung

GROU P PU BLISH ER / CH EF DE LA DI RECTIONJohn D. Birkby

[email protected]_____________________________________________

CJRDP/JCDRP is published four times annually by Andrew JohnPublishing Inc. with offices at 115 King Street West, Dundas, On, CanadaL9H 1V1. We welcome editorial submissions but cannot assume respon-sibility or commitment for unsolicited material. Any editorial material,including photographs that are accepted from an unsolicited contributor,will become the property of Andrew John Publishing Inc. FeedbackWe welcome your views and comments. Please send them to Andrew JohnPublishing Inc., 115 King Street West, Dundas, On, Canada L9H 1V1. Copyright 2009 by Andrew John Publishing Inc. All rights reserved.Reprinting in part or in whole is forbidden without express written con-sent from the publisher.Individual CopiesIndividual copies may be purchased for a price of $19.95 Canadian. Bulkorders may be purchased at a discounted price with a minimum orderof 25 copies. Please contact Ms. Brenda Robinson at (905) 628-4309 orbrobinson@ andrewjohnpublishing.com for more information and specif-ic pricing.

Publications Agreement Number 40025049

ISSN 1916-7520

Return Undeliverable Canadian Addresses to:

AJPI 115 King Street West, Suite 220 Dundas Ontario L9H 1V1

The educator, dental student, and prac-titioner all understand that in den-

tistry nothing is static. We work in anever changing environment with newmaterials, methodologies, and technolo-gies. Some just come and go while otherschange the face of dentistry forever; how-ever, we are always fighting the sameenemy – dental caries and periodontaldisease. Since the “barber-dentists” of theRenaissance there has been a forwardmotion to expand our knowledge and sci-entific curiosity. This issue of CJRDP isdedicated to dental lasers and is the firstthematic issue we have published. The arti-cles review the history, theory, and practiceof dental lasers. To imagine that we nowhave technology other than the drill andscalpel to practice the art and science ofdentistry is such advancement.We learn from Dr. James Jesse the scienceof laser technology and that the ruby laserwas used to vaporize enamel and dentin in1964. At the turn of the new millenniumbrought about the first laser designedspecifically for dentistry.Dr. Ron Kaminer discusses the businessbehind lasers. He rationalizes why this tech-nology has not been utilized fully. Withlasers being produced with reduced cost,more access to continuing education, andpatient demand, today’s dental offices canreap outstanding financial rewards incorpo-rating this technology.Dr. Robert Miller, a past scientific presenterat CARDP, comprehensively reviews thechallenges associated with hard and soft tis-sue management with respect to dentalimplants and the proper use of the appro-priate laser wavelengths to address thesechallenges. He concludes that the laser“appears to be ideal in the treatment of theinfected implant” and can result in cell pro-liferation and repair.A new periodontal protocol LAPAP (laser

assisted new attachment procedure) is casestudied by Dr. David Kimmel. This simplebut effective procedure “tips the scales infavour of the periodontal regeneration.” Dr. Kimmel reviews the methodology andbenefits of this minimally invasive treat-ment which is well received by patients. The use of the soft tissue diode laser forperio-restorative procedures in the anteriormaxilla is addressed by Dr. Ernesto Lee.Management of gingival tissue in the aes-thetic zone can make-or-break a case andDr. Lee assesses the benefits of using thislaser: hemostasis, operator control, gin-givectomies, and pre-impression gingivaltroughing.Dr. David Sarver, an orthodontist, illustratesthe versatility of the soft tissue diode laser.The ability to create a smile design by ideal-izing the position of a bracket is made pos-sible in a single visit by adjusting gingivalcontour.With the privilege of practicing the art andscience of dentistry comes responsibility tothis great profession to offer our patients anideal in tooth form, function and aesthetics.To accomplish this maintaining a harmo-nious relationship with hard and soft tissuesin an environment comfortable to ourpatients is a skill we all aspire to. The use oflasers in dentistry is applicable to the entirescope of practice and in the end, if we cantreat disease, we win!I would like to give thanks our authors whotook time out of their busy schedules tocontribute to this issue of CJRDP. It is great-ly appreciated. On behalf of your Editorial team andmyself, we wish allour readers and spon-sors a Happy HolidaySeason and New Year!

Dr. Maureen AndreaGuest Editor

MESSAGE FROM TH E GU EST EDITOR

Look How Far WeHave Come!

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



MESSAGE DE NOTR E RÉDACTRICE I NVITÉE

L’enseignant, l’étudiant et leclinicien comprennent bien

qu’en art dentaire, rien n’est sta-tique. Nous travaillons dans unmilieu en évolution avec de nou-veaux matériaux, de nouvellesméthodologies et technologies.Certains jouent un rôle plusprépondérant que d’autres. Enbout de ligne, nous luttons contrele même ennemi – la carie den-taire et la maladie parodontale.Depuis les barbiers dentistes de laRenaissance, une approche prospec-tive a été adoptée à vouloir élargirnos connaissances et à satisfairenotre curiosité scientifique. Cenuméro du JCDRP est consacréentièrement et pour la première foisaux lasers dentaires. Les articlesporteront sur l’historique, la théorieet l’utilisation des lasers dentaires.Quel progrès d’imaginer que nousprofitons maintenant d’une tech-nologie autre que la turbine et lescalpel pour pratiquer l’art dentaire!Nous apprenons du Dr James Jessela science de la technologie laser etque le laser à rubis était utilisé pourvaporiser l’émail et la dentine en1964. Le premier laser conçu spéci-fiquement pour la médecine den-taire a vu le jour avec l’arrivée dunouveau millénaire.Le Dr Ron Kaminer fait part de sesobservations sur les lasers et leurrôle dans la pratique. Il nous donneles raisons pour lesquelles cettetechnologie n’a pas été utilisée à sapleine mesure. Les cabinets den-

taires peuvent maintenant récolterd’immenses gratifications finan-cières en adoptant cette technologie,car les lasers sont produits à coûtréduit, l’éducation continue est deplus en plus accessible et les patientsen font la demande.Le Dr Robert Miller qui a déjà faitdes présentations scientifiques àl’ACDRP passe en revue les enjeuxassociés à la gestion des tissus durset des tissus mous en ce qui a traitaux implants et à l’utilisationadéquate des longueurs d’onde dulaser pour cerner ces enjeux. Enconclusion, le Dr Miller révèle quele laser semble être idéal dans letraitement d’un implant infecté etpeut entraîner la prolifération et lerenouvellement cellulaires.Le Dr David Kimmel fait l’étude decas d’un nouveau protocole paro-dontal appelé le LANAP (laser-assisted new attachment proce-dure). Ce traitement simple, maisefficace fait pencher en faveur de larégénération parodontale.Le Dr Kimmel passe en revue laméthodologie et les avantages de cetraitement légèrement invasif quiest bien reçu des patients.L’emploi du laser à diode pour lestissus mous pour les restaurationsparodontales au maxillaire est abor-dé par le Dr Ernesto Lee. La gestiondu tissu gingival dans la zone esthé-tique peut favoriser ou non un cas.Le Dr Lee évalue les avantages d’u-tiliser ce laser : hémostase, contrôlede l’opérateur, gingivectomie et cre-

vasse gingival pré-empreinte.Le Dr David Sarver, orthodontiste,illustre la versatilité du laser àdiode. La capacité de créer un motifde bande en arc en idéalisant laposition d’un boîtier est renduepossible en une seule visite en ajus-tant le contour gingival.Le privilège de pratiquer l’art et lascience de la dentisterie va de pairavec la responsabilité de cette belleprofession à offrir aux patientsl’idéal quant à la forme, la fonctionet l’esthétique des dents. Pour arriv-er à cet art que nous aspirons tous àposséder, il faut créer une harmonieentre les tissus durs et les tissusmous dans un milieu confortablepour les patients. L’utilisation deslasers en médecine dentaire est per-tinente à toute la pratique. Noussommes gagnants si, à la fin, nouspouvons traiter la maladie.J’aimerais remercier nos auteurs quiont consacré leur temps précieux àrédiger des articles pour ce numérodu JCDRP. Nous vous en sommestrès reconnaissants.Au nom de votre Comité de rédac-tion et moi-même, nous souhaitonsà tous nos lecteurs et commandi-taires des Heureuses Fêtes et uneBonneAnnée!

Dr MaureenAndrea

Rédactriceinvitée

Voyons un peu où nous en sommes?

Journal canadien de dentisterie restauratrice et de prosthodontie Automne 20094

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



5Canadian Journal of Restorative Dentistry and ProsthondonticsFall 2009

WINTER ISSUE: Esthetic Dentistry / PARUTION HIVER: Dentisterie esthétiqueContacts: Dr. Paresh Shah [email protected]; Dr. HubertGaucher [email protected] Due date for Submissions: February 3rd, 2010 / Soumissions 3 février 2010

SPRING ISSUE: Implant Dentistry / PARUTION PRINTEMPS: Dentisterie implantaireContacts : Dr. Ron Zokol: [email protected]; Dr. Yvan Fortin: [email protected]; Dr. HubertGaucher:[email protected] Due Date for Submissions: May 3rd, 2010 / Soumissions 3 mai 2010

SUMMER ISSUE: Dental Research / PARUTION ÉTÉ: Recherche dentaireContact : Dr. Hubert Gaucher: [email protected] Due Date for Submissions: August 3rd, 2010 / Soumissions 3 août 2010

FALL ISSUE: Occlusion / PARUTION AUTOMNE: OcclusionContacts : Dr. Kim Parlett: [email protected]; Dr Hubert Gaucher: [email protected] Due Date for Submissions: November 1st, 2010 / Soumissions 1 novembre2010

2010 Journal IssueAnnouncementAnnonces des parutions du Journal 2010

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



CJRDP Editorial Board/Le comité de rédaction JCDRP

Editor-in-Chief/Rédacteur en chefHUBERT GAUCHER Québec City, Québec

Associate Editors/Rédacteurs associés

Section Editors/Section éditeurs

Occlusion and Temporo-MandibularDysfunctions/Occlusion et Dysfonctions temporo-mandibulaireKIM PARLETTBracebridge, Ontario

Implant Dentistry/Dentisterie implantaireRON ZOKOLVancouver, British Columbia

Implant Dentistry/Dentisterie implantaireYVAN FORTINQuébec City, Québec

Esthetic Dentistry /Dentisterie esthétiquePARESH SHAHWinnipeg, Manitoba

Dental Technology / Technologie dentairePAUL ROTSAERT Hamilton, Ontario

V O L U M E 2 • I S S U E 4

Content/Sommaire

FEATU RES/ARTICLES

3 Message from the Guest Editor4 Message de notre rédactrice invitée16 AMD Lasers: Interview with Allan Miller, President and CEO19 Share Your Knowledge / Partagez votre Savoir

ACADEMY NEWS / NOUVELLES DE L’ACADÉMIE8 CARDP Introduces Dr. Vernon Shaffner as New President9 Journal News10 Synergy Between the Journal and the Scientific Program

FALL / AUTOMN E 2009

INDICATES PEER REVIEWED/INDIQUE REVUE DES PAIRS

Laser Dentistry / Dentisterie laser20 Laser Dentistry from A to Z

By James Jesse, DDS

22 Lasers: Financial Freedom or Financial Disaster?By Ron Kaminer, DDS

24 The Use of Lasers in OralImplantologyBy Robert J. Miller, MA, DDS, FACD, DABOI

28 Laser Assisted New Attachement ProceedureBy David Kimmel, DMD

31 Use of the 810 nm Diode Laser:Soft Tissue Management andOrthodontic Applications ofInnovative TechnologyBy David M. Sarver, DMD, MS

41 Laser-Assisted Gingival TissueProcedures in Esthetic DentistryBy Ernesto A. Lee, DMD, DCD

36 Product Profile / Profil de produitSIROLaser Advace DeliversExcellent Results in Connection withCeramic RestorationsBy Helmut Goette

38 Dental Materials / Matériaux dentaires

Influence of Light Cure andStorage Time on theDiametral Tensile Strength of aResin-based Luting CementBy Anderson Pinheiro de Freitas, DDS, MSc, Phd,Luciana Fávaro Francisconi DDS, Paulo AfonsoSilveira Francisconi, DDS, MSc, PhD, and GildoCoelho Santos Jr., DDS, MSc, PhD

3429 37

7Canadian Journal of Restorative Dentistry and Prosthondontics

EMMANUEL J. RAJCZAKHamilton,Ontario

MAUREENANDREAChester,

Nova Scotia

DENNISNIMCHUKVancouver,

BritishColumbia

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



ACADEMY N EWS / NOUVELLES DE L’ACADÉMI E

The CanadianAssociation of Restorative

Dentistry and Prosthodontics isproud to introduce its new

president, Dr. Vernon Shaffner ofHalifax, Nova Scotia

L’Académie canadienne de dentisterie restauratrice et de

prosthodontie est fière de vousprésenter son nouveau Président :

Dr. Vernon Shaffner, Nouvelle Écosse

Education: Dalhousie University School ofDentistry, 1969, DDS; Indiana University School ofDentistry, 1972, MsD Prosthodontics.Teaching Career: Full-time teaching at Dalhousie1972–1975, Half time 1975–1977, Part time 1977 topresent. Associate Professor At Dental Faculty atDalhousiePrivate Practice: part time 1972-1977, full time1977-2005 and part time2005 to presentAffiliations: Membership; Member, Royal Collage ofDentists Canada; Member, American Collage ofProsthodontics; Nova Scotia Dental Association;New Brunswick Dental Society; Canadian Academyof Restorative Dentistry and Prosthodontics;Canadian Academy of restorative Dentistry (Past

President); Association of Prosthodontists of Canada; Canadian Dental Association; PierreFauchard Academy.Family: Wife Dianne, son Jonathan and his wife Kelly and their children Tara, Matthew andLogan; and son Matthew and his wife Melanie and their children Maggie and Hallie.Hobbies: Skiing, Kayaking, Building cedar strip kayaks, walking the beaches of Nova Scotia.

8 Journal canadien de dentisterie restauratrice et de prosthodontie Automne 2009

Dr. Vernon Shaffner

It is with great sadness we announcethe passing of Dr. Nasser Dubai andDr. Walter Kowal. Dr. Dubai passedaway this past March 2009. While hewas not a current member he was thechair for CARDP the year of the amal-gamation and many will rememberhim.

Dr. Walter Kowal, from Toronto, was aCARDP Life/Honorary Member. Hisdaughter Joyce advised of his passing inAugust of 2007.Our sincere condolences go out to thefamily and friends of Dr. Dubai and Dr. Kowal.

In Memoriam

Dr. Walter Kowal

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



ACADEMY NEWS / NOUVELLES DE L’ACADÉMIE


JOURNAL NEWS / NOUVELLES DU JOURNALFrom the Editor-in-Chief/ / du Rédacteur en Chef

CONSENSUS at the Montréal Annual Meeting: The CJRDP/JCDRP is going Digital!Consensus au congrès annuel à Montréal: le CJRDP/JCDRP devient aussi numérique!

Dr. Ian Tester, CommunicationCommittee Chair, called to order the

Communication/ Journal Meeting withthe following CARDP members attend-ing: Executive Committee, Communi-cation Committee, PublicationCommittee, CJRDP/JCDRP EditorialBoard, and Andrew John Publishing Inc.Andrew John Publishing Inc. (AJPI): Mr. John D. Birkby, President, presented arecent industry survey conducted by AJPIindicating that your Journal has been wellreceived and is considered above averagecompared to other dental publications. Allrespondents liked the idea of a themed issuealong with other topics to be included.Furthermore, a Combined ConferenceProgram and Product Directory was sug-gested by industry respondents. Discussionsat this meeting resulted in a consensusfavouring a fifth issue dedicated to suchinformation for our members and allAnnual Meeting participants. The industryalso favours an electronic version of theJournal (e-Journal) that would be a com-panion to the printed version. All respon-dents support both the Journal and theAnnual Meeting. All respondents approveof having other “like-minded” organizationsrecognize our Journal as “SupportingAffiliates” thereby benefiting cohesion inthe dental community. Dr. Hubert Gaucher, Editor, expanded onexisting dental e-Journals now available onthe Internet and how they function forreaders wishing either a full e-version jour-nal subscription or individual articles.Dr. Gaucher presented a motion to haveAJPI launch an e-CJRDP/JCDRP version atthe start of 2010. This motion was passedunanimously by all meeting attendees. In addition, AJPI received support from allmembers present to launch an e-CJRDP/JCDRP NEWS feature that would be e-mailed to all readers of the Journal. Each e-Journal News capsule would highlightforthcoming topics and authors in theprinted version, announce new initiatives/events from CARDP and from the Journal’s

affiliate supporters, present related dentalnews and information that would not benormally be published in the Journal, andoffer new products and services availablefrom the industry. AJPI is aiming to start e-News in the first quarter of 2010 andreceived the full support from all memberspresent. CJRDP/JCDRP Editorial Board Meeting: Dr. Hubert Gaucher, Editor-in-Chief,called the meeting to order and thanked Dr.Ian Tester for his initiatives and activeworking relationships with all members ofthe academy and AJPI over these manyyears. Some results of an electronic journalmembership survey undertaken recently atthe request of its editor were highlightedincluding the following:• 87% of the respondents considered the

overall design and look of the Journalto be Good to Excellent

• 79% of the respondents rated the over-all content of the Journal to be Goodto Excellent

• 87.5% of the respondents find theinformation contained in the Journal

useful in their daily practice• 92% of respondents considered the

Journal Same as Most or Better ThanMost other Canadian dental journals(i.e., appearance, content quality, valueto the reader)

The integral Membership Journal Surveyresults are accessible on CARDP’sMembership Section for all to peruse and toalso complete the joined MembershipJournal Contribution Form. This formallows all members to involve themselves inthe Journal’s affairs at either the manage-ment level, the editorial board level, or ascontributing authors. There is somethingfor everyone and all able bodies are calledon deck to enjoy the breeze as your Journalsails into the world of the Internet.In closing, Dr. Gaucher thanked all the edi-torial board members present, as well asAJPI for their support in publishing theJournal, their team work and dedication tothe academy’s objectives. He also under-lined the important commitment and wellappreciated contributions of guest co-edi-tors in the coming issues of the Journal.

Dr. Gaucher and Mr. Birkby

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM




The CARDP/APC Joint ScientificMeeting – Montreal, Quebec

September 24 to 26, 2009: A GRAND SUCCESS

Le Congrès scientifique conjointde l’ACDRP et de l’APC

24 au 26 septembre, 2009UN FRANC SUCCÈS

By/Par Dr. Chris von Rosenbach

The annual CARDP Scientific meeting is always anevent to look forward to. This year was no excep-

tion. Under the joint sponsor ship of the CanadianAcademy of Restorative Dentistry and Prosthodonticsand the Association of Prosthodontists of Canada, themeeting’s theme was “Tomorrow’s Dentistry Today.”The setting couldn’t have been more perfect. Thesparkling, new Westin Hotel, in downtown Montreal, isjust a five minute walk from the beautiful Notre DameCathedral, and all the sights and sounds of the old city.The walking tour is definitely to be recommended as awonderful introduction to historic Old Montreal.As usual, the pre-meeting activities offered fellowship andfun in a more informal setting. For those who wentkayaking on the Lachine Canal, the fun was to be had inan aquatic format. The golfers who didn’t manage toavoid the water hazards, had some of the same. For thosewho couldn’t wait for the dental sessions to begin, Dr.Claude Martel presented an informative Hands-On Clinicthat addressed the current and future capabilities of theCEREC CAD-CAM technology system. This was certain-ly a thought-provoking presentation.The traditional opening reception on Thursday nightprovided the first opportunity for registrants to cometogether as a group. With a buffet featuring Montrealsmoked meat (served by none other than a carver directfrom Schwartz’s) set up in the exhibitor’s area and a barconveniently located nearby, conversation started to flow(perhaps not with same majesty as the near-by St.Lawrence River but certainly with the same volume!).Under the capable guidance of Dr. Robert David, the sci-entific program got underway on Friday. First up were theteam of Dr. Lesley David (who thanked her dad for her fabuloushead of hair!) and Dr. John Zarb speaking on CurrentConcepts in Computer-Guided Implant Solutions. Thisvery high-quality presentation from two rising stars wasfollowed by one from an established and well-knownname, Dr. Pierre Boudrias. Speaking on the topic of zirco-nia and its application in conventional and implant den-tistry, Dr. Boudrias displayed his in-depth understandingof this topic in an excellent session. Then, we were luckyenough to entice Dr. Paulino Castellon north from the

Journal canadien de dentisterie restauratrice et de prosthodontie10 Automne 2009

Synergy Between the Journal and the Scientific Program at the

Montréal Joint MeetingSynergie entre le Journal et le Programme

scientifique au Congrès conjoint à Montréal

Clinical Trials and Clinical ChoicesEssais cliniques et Choix cliniques

The topic of Clinical Trials and Clinical Choices (CJRDP/JCDRP, Editorial,Vol. 2-1, March 2009) was expanded upon by Dr. Hubert Gaucher, Editor,while presenting at the Scientific Program addressing the theme of“Tomorrow’s Dentistry Today.”

The Editor of CJRDP/JCDRP has formulated the following objectives in sup-port of Evidence Based Dentistry:

This integral PowerPoint presentation can be reviewed on the JournalSection of CARDP’S Website www.cardp.ca

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



11


Cajun sunshine of Louisiana. He continuedthe theme of Tomorrow’s Treatment Todaywith a very informative talk on how newtechnologies, such as CT guidance, havepositively impacted our ability to deliverpredictable implant-supported treatmentsto our patients. Our next speaker was based in Montrealand came to us from the field of medicine.Dr. Ashook Oommen had his audiencespellbound with his very entertaining pres-entation on living a longer, healthier life.Among his recommendations: eating fivecarrots per week can reduce stroke risk by68%; walking daily reduces all cancer riskby 40%; upper body strength training threetimes per week is crucial for maintainingphysical health; and his most popular rec-ommendation (which received an enthusi-astic round of applause): regular sex and 1to 3 glasses of wine (a daily prescription!).Dr. Stefan Holst, who holds an assistantprofessorship at the University of Erlangen-Nurenburg, in Germany was up next. Asdifficult as it was to follow Dr. Oomen, Dr. Holst gave a superb presentation on theimpact that new technologies, includingconoscopic holographic-based techniques,are having on digital impression taking. Heemphasized the team approach between thedentist and dental technician to optimizetreatment outcomes with these new tech-nologies. Finishing off the day was our ownDr. Izchak Barzilay, speaking on the mainte-nance of implants in the face of the manycomplications that can arise, once theimplant supported restoration becomes sub-ject to the rigors of daily use. Many usefultips, based on long years of clinical experi-ence, were shared by this very experiencedclinician.After an evening of enjoying fine meals inthe old Montreal restaurant district, the 7am breakfast meeting for CARDP memberswas a challenge, but we managed!Afterwards, everyone returned for the nextday’s presentations, under the chairmanshipof Dr. Barzilay. Evidence-based Dentistrywas the theme of presentations from ourown journal’s editor-in chief, Dr. HubertGaucher, and from Dr. Chris and Anne vonRosenbach; both of these presentationsdemonstrated how and why the ability toaccess and assess underlying evidence is akey skill in providing Tommorow’sDentistry Today. Dr. Francince Albert (alsothe current president of APC) gave a mostenlightening lecture on Anterior BondedPorcelain Veneers. Her talk emphasizedassessing the current literature to supporttreatment decisions. Dr. Jean-FrancoisBrochu continued the research-focused

theme, as his presentation flowed fromcomputed tomograpy image, to computer-based planning, to the surgery itself. Thekey concept that emerged from these ses-sions was how important proper planningand communication are to the ultimate suc-cess of every procedure.Mr. Peter Barry, who has had articles pub-lished in our CJRDP, gave an informedpresentation that focused on the impor-tance of active listening to our communica-tion process. Effective communicationallows us to successfully manage our prac-tices and, perhaps most importantly, to suc-cessfully present our clinical treatment pro-posals to our patients. One subject thatengages us all is determining when a toothshould be extracted in favour of an implant.The decision-making process was assessedfrom an endodontic perspective by Dr. Michael Auerbach, and from a peri-odontal perspective by Dr. Mark Spatzner. The next speaker was Dr. Fred Muroff,whose presentation focused on the peri-odontal effects of orthodontic treatment. Asmany treatment plans involve pre-prostheticorthodontics, this topic was timely and use-ful. Dr.’s Bobby Baig and Mario Rotellarounded out a fine morning with a sessiondiscussing research on some specific topics:burr-cutting efficacy – use them once; com-paring PVS versus polyether implantimpression techniques – PVS wins!; the useand misuse of verification jigs; and openversus closed-tray accuracy – use closedtrays!After another excellent lunch, meetingattendees moved to the table clinic area,where 17 excellent small group presenta-tions awaited. Dr. Patrick Arcache assem-bled a diverse group of presenters, whodemonstrated why the table clinic portionremains a perennial favourite at the CARDPmeeting.The sponsors for the meeting were especial-ly supportive this year and special thanks goto Dr. Dennis Nimchuk for the excellent jobhe and his committee did in arranging verysolid sponsorship support for this wonder-ful annual meeting.Our learning completed, the only thing thatremained was to enjoy the President’sChampagne Reception and the Gala Dinnerand Dance. Outgoing President StanleyBlum gave a heart-warming and emotionalfarewell address and introduced our incom-ing President, Dr. Vernon Shaffner. Theband was first rate and, judging from thetwirling and whirling happening on thedance floor, a good time was had by all.The 2009 CARDP Annual Meeting in

Fall 2009 Canadian Journal of Restorative Dentistry and Prosthondontics

Montreal was a great success and testamentto the hard work of the members of theMontreal organizing committee, under thecapable chairmanship of Dr. Jay McMullen,as well as to the diligence and creativity ofour CARDP administrative professionals,David Alexander and Glen Richardson.

Practice Management: “TheAmazing Power of Listening”

Mr. Peter Barry,founder of

Successful PracticeArchitects, and pastcontributor of aseries of practicemanagement articlesin the initial issuesof the CJRDP/JCDRPexpanded on thetheme of “TheAmazing Power of

Listening (The 21st Century Formula ofSuccess). The resounding success of Mr.Barry’s presentation with participants isan indication that we can all benefit fromreceiving coaching in the area of interper-sonal skills in our daily lives as well as forour professional services.For more information please contact Mr. Barry at [email protected].

Evidence Based Dentistry in aDo-It-Yourself World

Dr. Christian vonRosenbach and

Anne von Rosenbachpresented the topic of“Evidence BasedDentistry in a Do-It-Yourself World.” Theirdetailed presentationpertaining to successful-ly conducting a literaturesearch in PubMed wasvery well received by theparticipants and offeredthe working tools neces-sary for all to supportthe CJRDP/JCDRP

endeavours to publish our readers’ EBDquestions. These presenters have beeninvited to contribute a series of articles onthis topic in order to further acquaint ourreaders with this most essential and con-temporary practice management tool.

CJRDP 2-4 2009:Layout 1 11/12/09 8:24 AM



CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM




Companions on a Tour of Historic Montreal

Dr. Jonathan Adams, Dr. Vernon Shaffner, Dr. Rick Beauchamp, Dr. Karyn Ibister, Dr. Stanley Blum& Dr. Mary Currie

Dr. Baxter Rhodes

Dr. Lesley David & Dr. John Zarb

Dr. Vernon Shaffner, Dr. Stanley Blum,Unknown, Dr. Rick Beauchamp, Dr. KarynIbister, Dr. Jonathan Adams & Dr. Mary Currie

Dr. & Mrs Parlett & Dr. & Mrs Tester

Dr. Blum, Dr. David & Dr. Barzilay presenting a cheque to the Dr. George Zarb Fund

Dr. Robert David Thanking Dr. Ashok Oomen Dr. Racich & Dr. Tester

Montreal 2009 Joint Scientific MeetingCongrès scientifique conjoint, Montréal 2009

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM




PRODUCT PROFILE / PROFIL DE PRODUIT

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM




CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



Automne 2009Journal canadien de dentisterie restauratrice et de prosthodontie18

President: Dr. Vernon Shaffner,

Halifax, NS

Executive Council Councillors (years left in term)

Canadian Association of Restorative Dentistry andProsthodontics 2009-2010 Executive Council and Councillors

Académie canadienne de dentisterie restauratrice et deprosthodontie 2009 – 2010 Conseil exécutif et Conseillers

President Elect: Dr. Kim Parlett, Bracebridge, On

Atlantic Provinces: Dr. Maureen Andrea (1),

Chester, NS

Quebec/Nunavut: Dr. David Blair (2),

St. Lambert, QC

Vice President: Dr. Maureen Andrea,

Chester, NS

Past President: Dr. Stanley Blum,

Montreal QC

Ontario: Dr. Kim Parlett (1),

Bracebridge, ON

Manitoba/Saskatchewan: Dr. Terry Kolteck (3),

Winnipeg, MB

Secretary Treasurer:Dr. Les Kallos, Burnaby, BC

Alberta/NWT: Dr. Doug Lobb (1),

Edmonton, AB

BC/Yukon: Dr. Myrna Pearce (2),

Vancouver, BC

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM




SHARE YOU R KNOWLEDGE / PARTAGEZ VOTR E SAVOI R

of its application throughout theseries of wavelengths in the visibleand infrared spectrum. The authoruses numerous colour images toillustrate its use in a variety of clini-cal applications including generaldentistry, periodontics, endodonticsand implantology.The simplicity and organization ofthis textbook makes it a quick andeasy read. As such, it does not pro-vide for any comprehensive under-standing of the use and applicationof any specific laser product. The

The author is an acknowledgedexpert in his field having

achieved mastership status withthe Academy of Laser Dentistry,and having served as its presidentas well as editor for its Journal.This material in this textbook isgeneric, giving no special attentionto specific products. It provides asuccinct history in the evolution oflaser technology and its progresswithin the field of dentistry. Theauthor explains the science of lasertechnology and the broad spectrum

field of laser technology is continu-ally advancing, and there are cur-rently clinical applications activelybeing used today and speculationsin this text. However, this shouldnot deter anyone from reading thistextbook if their purpose was tounderstand laser technology and itspotential applications in dentistry.

The book can be ordered fromthe British Dental Associationwebsite at:www.bda.org/shop/bdj-books/.

Textbook Review:

Lasers in Dentistry by Dr. Stephen Parker

Reviewed by Dr. Ron Zokol, Director,Pacific Implant Institute, Vancouver, BC,Canada.

The author designed this publication to be an authorative reference for students and dental practi-

tioners in their early learning curve of laser technology. As such, it is a generic and scientifically

founded text that covers the history, safety factors, and clinical applications for the use of lasers in

dentistry over the full wavelength spectrum of dental laser technology.

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



LASER DENTISTRY / DENTISTER I E LASER

As dentists we are driven tochange for two reasons:

1. For our patients, we want toprovide better service.

2. For ourselves, we want den-tistry to be “easier,” “faster,”and “better.”

Unfortunately, there is often moreemphasis on faster rather than bet-ter; however, twenty-first centurydentistry can provide both. Laserdentistry has made it possible toimprove the patient experience andhas improved the dentistry we pro-vide. As lasers continue to evolve,we are able to provide a higherstandard of care than ever before.Laser is an acronym forL = lightA = amplification byS = stimulatedE = emissions ofR = radiation

The theory of light amplification bythe stimulated emission of radiationwas first postulated by AlbertEinstein. In 1916, in his treatise,“Zur Quantum’s theoric derStrahlung,” he developed the theoryof spontaneous and stimulatedemission of radiation. What isimportant from his treatise is that,as an atom absorbs a quantum ofenergy it is pumped to an excitedstate or higher energy level, Einsteinfound that electrons have separateenergy levels. An electron excitedby energy moves to the outer orbitof the atom. When it returns to itsnatural state a photon of energy orlight is emitted. Lasers are deviceswhich gather and harness the light.During stimulated emission an out-side source is used to excite thealready excited atoms to releasestored energy. Here, the excitedphoton and the released photon

stimulate two more excited atomsproducing a chain reaction. Theend results are photons of identicalwavelength travelling in the samedirection as well as oscillatingtogether in phase.

Characteristics of LaserLightSpatial and temporal beamcoherency – laser light is in phase(same time and space).Monochromaticity – laser light isall one wavelength (the same color).Collimation – laser light travels ina straight line.

Active Medium of LasersSolid State Laser: Active medium issuspended in a transparent crystal.The host material is grown in or“doped” with atoms that will createthe desired wavelength – erbium,neodymium, holmium, etc. Gas Lasers have a hollow tube filled

Laser Dentistry from A to ZBy Dr. James Jesse, DDS

Technology and dentistry have been progressing together with the “idea” of making the dental experience “more pleasant” for the patient and less stressful for the dentist. Anybody who has experiences belt drive

to electric high speed will concur.


About the AuthorJames Jesse, DDS, graduated from Loma Linda University’s acclaimed School ofDentistry in 1973. He has been running a private practice in Colton, California for thepast 34 years. In addition to his busy practice, Dr. Jesse has returned to his alma materas an assistant professor teaching applications of the YSGG laser to hundreds of dentalstudents. He is also part time faculty at the Columbia University’s School of Dentistry inNew York. Dr. Jesse is an active member of the American Dental Association, the California DentalAssociation, and the Academy of Operative Dentistry. Dr. Jesse also lectures nationally

and internationally, with the Masters of Laser Dentistry group, on various topics including laser applicationin dentistry and endontics. Dr. Jesse continues to explore and advance new techniques in laser treatments. He can be reached at [email protected].

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



Important Dates in the History ofDental LasersEarly 1900sEinstein theory and Bohr’s theory are thefirst major developments in lasers.MASER in 1950sMicrowave Amplification by StimulatedEmission of Radiation (MASER). This wasthe first device to put Einstein and Bohr’stheories to the test.1960Theodore H. Maiman produced the firstruby laser by inserting a ruby rod into aphotographic flashlamp.1964Townes, Basov, and Prokhorov receive theNobel Prize for the development of thelaser. Stern and Sognnaes used the rubylaser to vaporize enamel and dentin.1966Leon Goldman used the laser clinically onenamel and dentin. Goldman, Stern, andSognnaes are recognized as the first to uselasers on tooth structures. One of their find-ings was that the heat build-up in teeth gen-erated by early continuous wave laserscaused damage to the pulp.1989Introduction of the first true dental laser,the erbium:YAG laser, which was importedto dentistry from plastic surgery.Formation of first laser company for den-tistry (American Dental Laser)2000Introduction of the Er,Cr:YSGG laser, onlywavelength designed exclusively for dentistry.

The Benefits of LasersAlmost all dental specialties can benefitfrom the use of lasers on a daily basis.In restorative dentistry I use the laser forCL-I – CL-VI cavity preps mostly withoutanesthesia. I use a laser instead of packingcord to trough before every crown impres-sion. It is faster and less traumatic for thepatient. In surgery, I use a laser for all inci-sions. The patients have less bleeding,which allows me a much clearer view of thesurgery site, and less post-op discomfort.Tissue contouring is also easier and morepredictable with a laser than a blade. Aswell, periodontal treatments are now lessinvasive and the outcomes clinically areimproved.There are special “tips” for endo that havethe potential to dramatically change the way

with the appropriate gas or mixture ofgasses – carbon dioxide, argon.Liquid Dye Lasers have the dye dissolvedin methanol or water solvent.Diode Laser: Semiconductor crystals,pumped electronically.Lasers have the following advantages: • The have the ability to seal blood

vessels• They can seal lymphatic vessels• They can seal nerve fibres• They can reduce mechanical trauma• They cause minimal scarring• They are very precise• They reduce the need for sutures• They promote a dry operating field

with increased visibility because of littleor no hemorrhaging

• They cause minimal post-op swelling• Clinically, we see a 90% reduction in

post-op pain due to decrease in con-duction

• There is less damage to non-target tis-sue

• There is a reduced bacterial count, soyou can treat patients at risk with bac-teremias safely after lasing bacteria onthe surface

Laser Effects on TissueReflection – Laser light is bounced off thesurface of the target tissue without penetra-tion or interaction.Scattering – Individual molecules andatoms take the laser beam and deflect thebeam power into directions other than theintended direction.Transmission – Laser light travels throughthe tissue unchanged.Absorption – Atoms and molecules thatmake up the tissue, convert the laser lightenergy into heat, chemical, acoustic, ornon-laser light energy.

Common Dental LaserWavelengthsFirst generation: • CO2• Nd:YAG• Argon• ExcimerSecond generation:• DiodeThird generation:• Erbium:YAG

Fourth generation:• Er,Cr:YSGGCO2 (carbon dioxide) (first genera-tion)• 10,600 nm wavelength• Gas laser• Continuous, gated• Non-contact• Used only for soft tissue procedures• Still used in medical applications• A few models still available in den-

tistryNd:YAG (neodymium:YAG) (firstgeneration)• 1,064 nm wavelength• Solid state laser• Free running pulsed• Contact/non-contact• Used only for soft tissue proceduresArgon (first generation)• 488,514.5 nm wavelengths• Gas laser• Continuous, gated• Contact/non-contact• Soft tissue, photopolymerization, cur-

ing of composite fillingsExcimer (first generation)• Nm wavelength• Gas laser• Continuous, gated• Non-contact• Hard tissue proceduresDiode (second generation)• 800–900 nm wavelengths (830)• Solid state semiconductor chip laser• Continuous/gated• Contact/non-contact• Soft tissue/LLLTER:YAG (third generation)• 2,090 nm; 2,900 nm wavelengths• Solid state lasers• Pulsed• Contact/non-contact• Soft tissue, hard tissue

Er,Cr:YSGG (fourth generation)• 2,780 nm wavelength• Solid state laser• Pulsed• Contact/ non-contact• Soft tissue/ hard tissue

J ESSE


CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



LASER DENTISTRY FROM A TO Z


traditional endodontics are performed. Wesee better debridement and sterilizationwith a laser. All patients love the idea of no injection ifthere is no pain. Most patients accept localanesthetic because the alternative is usuallyhorrific. With lasers I am able to performbetter dentistry faster, a win for the patientand a win for me. As dentists, we should be guided by thecompass not the clock. All too often, wedon’t change because our main concern istime and not quality. With the goal of beingminimally invasive, a laser in the dentaloperatory is one of my “no brainers.”

BibliographyDederich D. Laser in dentistry. JADA

2004;135:204–12.Eversol LR. Pulpal response to cavity prepara-

tion. JADA 128;1099–1106.Folwacryny M. Removal of bacterial endotox-

ins from root surface with Er:Yag laser.Am J Dent 2003;16:3–5.

Goldman L. Impact of the laser on dentalcaries. Nature (London) 1964;203:417.

Lee C. Procurement of autogenous bone. JOI;2005:XXXI:1.

Levy M. Light, lasers, and beam delivery sys-tems. Clin Podiatr Med Surg1992;9(3):521–30.

Marquez F. Physical – mechanical Effects ofNY: Yag. Biomaterials 1993;14:1313–6.

Powell GL. Laser in the limelight. J Am DentAssoc 1992;123:71–74.

Rossman JA. Laser in periodontology. JPeriodontal 2002;73:1231–9.

Scott A. Use of Er laser in lieu of retractioncord. Gen Dent 2005;116–19.

Stern RH. Laser beams effects on dental hardtissues, J Dent Res 1964;43:873.

Wigder HA. Lasers in dentistry. Laser SurgMed 1995;16:103–33.


Dental lasers, like all forms oftechnology, go through a

cycle of events before gainingacceptance for everyday use indaily practice. The early adopters,like me, represent a core of practi-tioners that want to be the first,the leaders, in incorporating newtechnology into their practices.They are willing to go through thebumps and bruises as long as they

are the first ones on the block topractice with this device. Once theearly adopters have bought up thetechnology, sales for companiesbecome quite slow and sales tac-tics often become somewhatshady. The next groups of dentistsneed to carefully evaluate thetechnology to rationalize its pur-chase. In this brief review, we willtry to decipher the dental laser

mystery, and hopefully clarify howthis piece of technology is a musthave, which will change the wayyou practice. Lasers can assist the practitioner inperforming a wide variety of proce-dures. The laser’s properties arewavelength dependent and no onelaser can do everything very well.Hence, it is not surprising thatmany “Laser” dentists have multiple

Lasers: Financial Freedom or Financial Disaster?

Ron Kaminer, DDS

About the AuthorRon Kaminer maintains two practices in Hewlett and Oceanside New York. He hasbeen using lasers for over 20 years and currently has diodes, ErCrYSGG, and Er/NDYAGlasers in his practices He has lectured internationally and nationally on various topicsincluding laser dentistry and minimally invasive dentistry. He is a clinical consultantfor numerous Dental companies, including, Ultradent, GC America, Lares USA, andFotona. He can be reached at [email protected].

22

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



lasers in their practices. To clarify the dentallaser mystery, we can divide lasers into twocategories: soft tissue lasers and hard tissuelasers. Soft tissue lasers can be the least expensiveway that dentists can get involved with lasertechnology. The most common soft tissuelaser is the diode laser. Its wavelength fallsin between 810 and 1064 nm, and its energyis absorbed by pigment and hemoglobin.These lasers cut soft tissue very well, aregood coagulators, and are easy to learn howto use. These lasers cost between $3,500 and$15,000 with little variation between theleast and most expensive models. Becauseof their relative low cost, diodes are themost common form of lasers seen in dailypractice today. NDYag lasers are lasers thatcut soft tissue very well, and have beenextensively studied for the treatment ofperiodontal disease. They cost approxi-mately $60,000, but can do many things adiode cannot do. Hard tissue lasers can be divided into twowavelengths, ErYag, and ErCrYSGG. Bothwork in similar fashion and their energiesare absorbed by water and hydroxyapatite,with wavelengths falling in the 2760–2940nm range. These lasers can cut hard andsoft tissue very well, making them very ver-satile tools for the general practitioner. Theyrepresent the most expensive class of dentallasers, with prices approximately $80,000.One company has actually bundled anNDYag and an ErYag into one unit, makingit the most complete all around laser indentistry today. As previously mentioned, lasers are not aninexpensive piece of technology. In ordernot to have buyer’s remorse, one must care-fully evaluate if the laser will add some-thing, some way into the practitioner’s dailyroutine. With the recent addition of aninexpensive diode laser into the market(under $5, 000), the dentist can add anincredible tool into their daily routine withlittle financial risk. Even so, lasers must ful-fill one of two criteria to justify theirexpense. They either must make your lifeeasier in your daily routine or allow you toprovide care to your patients above andbeyond what could be achieved by tradi-tional means. Diodes allow you to abandonthe packing of cord for impressions, allowyou to treat and contain minor periodontalconditions, and allow you to excise soft tis-sue with minimal anesthesia and post-oppain. Diodes actually fill both criteria, mak-ing them a must have in today’s practice.Their inexpensive cost breaks down the

usual financial barrier involved in the deci-sion-making process. I predict that over thenext five years, diodes will become a staplein every dental office.NDYag lasers are a far more expensiveoption with one major advantage overdiodes; NDYag lasers can effectively treatperiodontal disease with results rivallingtraditional means. The major difference isNDYag periodontal surgery removes thediseased tissue and allows the body to healnaturally from the inside out. Scientificstudies confirm its effectiveness. As the pro-cedure requires no sutures, it is far less inva-sive than conventional surgery, with mini-mal bleeding and post-operative pain.Patients when given an option, almostalways choose laser surgery over traditionalmeans. With price tags over $60,000, thepractitioner must evaluate if he/she does orwill treat periodontal disease in their prac-tice. Laser-assisted periodontal surgery, canadd a tremendous amount of money to thebottom line of a practice. Fees for these pro-cedures are typically 2/3 to 3/4 of the fees ofwhat the specialist would charge and sincethese patients are placed on three or fourmonth recall, the hygiene department gets aboost as well. These lasers also fulfill bothpreviously mentioned criteria and in theright practice make a tremendous invest-ment that will lead to financial success. Hard tissue lasers are the most expensiveoption of the one’s being discussed. Theyallow the practitioner to perform a widevariety of procedures. Routine restorativecan usually be done without anesthetic, andminor soft tissue procedures can be donewith only topical anesthetic. Periodontal,endodontic, and oral surgical applicationsmake this laser very versatile with everydayuse. Patients love this high-tech option ofhaving their teeth fixed. The newest hardtissue lasers have drilling speeds that rivaltraditional high-speed hand pieces. Onecompany has created a laser that has anNDYag and an ErYag in one unit. With justthe touch of a button, the dentist can switchbetween wavelengths, maximizing the bene-fits of each. The ErCrYSGG or the comboErYag/ NDYag laser costs in the vicinity of$80,000; however, this price point tends toscare off some dentists, regardless of thelaser’s benefits. Lasers in general represent outstandinginvestments in our practices. One must lookpast cost and focus on return of investment,to really appreciate this technology. Returnof investment can be broken down to finan-cial and emotional. Will the laser make me

more money? Or, Will it make my day gobetter? are both valid reasons to own a laser. By using diode lasers to treat minor peri-odontal conditions, we can add a bottomline profit to our practices. By using diodesto trough around tissue, we eliminate theaggravation of packing cord and even theoccasional bleeder when we pull the cord.Diodes are an essential option in everypractice and with the addition of a low costdiode, the financial barrier to purchase isessentially removed.NDYag lasers can add a tremendousamount of money to the annual gross of apractice. With the typical cost of laser-assisted periodontal surgery being approxi-mately $4,000 for a full mouth of treatment,just doing one case per month will addalmost $50,000 to the bottom line and payfor the laser in just 18 months. Add to thatan additional 24 re-care appointments peryear (assuming the patient was alreadygoing twice per year), with an average fee of$100, the potential return of investment ofowning an NDYag laser is $52,400 for thefirst year.ErYag and ErCrYSGG lasers, when utilizedappropriately can also add a tremendousamount of revenue to the bottom line of anypractice. The hard tissue laser allows den-tists to be more productive per visit due tothe need for little to no local anesthetic.Adding procedures such as closed crownlengthening, gingivoplasty, and other minorsoft tissue procedures all add tremendousamounts of money to annual gross. Thecombo ErYag and NDYag laser allows thedentist all of the benefits mentioned above,plus adding laser assisted periodontal treat-ment for additional financial benefits. Mostdentists report a six figure increase in theirincome once this laser is incorporated intotheir daily routine. The integration of lasers in today’s dentalpractices has been slow. High costs, lack ofinformation for the dentist, and pure fear ofthe technology has kept many dentists awayfrom lasers. Slower sales, causing companysales person turnover, further contribute tothe dentist’s apprehension of adding thistechnology into their practice. Passionateearly adopters have begun to teach laser“newbies” on the benefits of dental lasers.There is more continuing education avail-able on lasers than ever before. New ownersneed to get proper training to fully utilizetheir lasers. Once trained, the dentist willuse the laser multiple times every day andwith everyday use, buyer’s remorse will

KAMI N ER


CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



LASERS: F I NANCIAL FREEDOM OR FI NANCIAL DISASTER?

never exist and financial rewards will alwaysbe achieved.

BibliographyKara C, Demir T, Orbak R, Tezel A. Effect of Nd:

YAG Laser Irradiation on the Treatment ofOral Malodour Associated with ChronicPeriodontitis. Int Dent J. 2008;58(3):151–8.

Kilinc E, Roshkind DM, Antonson SA, et al.Thermal Safety of Er:YAG and Er,Cr:YSGG

Lasers in Hard Tissue Removal. PhotomedLaser Surg 2009;27(4):565–70.

Lomke MA. Clinical Applications of DentalLasers. Gen Dent 2009;57(1):47–59.

Roshkind DM. The Practical Use of Lasers inGeneral Practice. Alpha Omegan 2008Sep;101(3):152–61.

Schwarz F, Aoki A, Becker J, Sculean A. LaserApplication in Non-Surgical PeriodontalTherapy: A Systematic Review. J Clin

Periodontol 2008 Sep;35(8 Suppl):29–44.Tracey R. Soft-tissue Surgery: Use of the

Er,Cr:YSGG Laser. Dent Today2008;27(2):156–9.

Yukna RA, Carr RL, Evans GH. HistologicEvaluation of an Nd:YAG laser-AssistedNew Attachment Procedure in Humans.Int J Periodontics Restorative Dent2007;27(6):577–87.



The desire to find a laser appli-cable for dental procedures

began shortly after the first opera-tional ruby laser was demonstrat-ed in 1960.1 The challenge forlaser engineers has been to bal-ance the effects of directed lightenergy on both hard and soft tis-sue. Laser interactions with bothtypes of tissue tends to be wave-length specific. Each wavelengthmay target specific tissue compo-nents such as melanin, hemoglo-bin, hydroxyapatite, or water con-taining tissue.2 Parameters such aspulse duration, repetition rate,and fluence become variables in

how a wavelength reacts with itsspecific target tissue.3 Laser inter-actions with gingival and biocalci-fied tissues have been studiedusing a variety of different wave-lengths and altering laser parame-ters. Most soft tissue lasers, whosetarget tissues may be melanin,hemoglobin, or water, have limit-ed usage in cutting biocalcifiedtissues.4

The affinity, or lack of affinity, of alaser for water becomes an issue interms of a lasers ability to effectivelycut, ablate, or coagulate tissue, andis a factor in the laser’s depth of

penetration into soft tissue. Toomuch affinity for water is not desir-able because the laser will not pene-trate tissue deep enough to seal offcapillary beds and the lymphaticsystem. Too little affinity for watercan result in deep tissue penetrationleading to tissue necrosis and, in thecase of implant dentistry, unpre-dictable tissue response and heal-ing.5

Oral implantology is a multi-modaldiscipline and represents the con-fluence of all of the specialties ofdentistry. The complexities in treat-ment planning cases involving den-

The Use of Lasers in Oral Implantology

By Robert J. Miller, MA, DDS, FACD, DABOI

About the AuthorRobert Miller is chairman, Department of Oral Implantology, Atlantic Coast DentalResearch Clinic, Palm Beach, Florida; diplomate American Board of Oral Implantology,and director of The Center for Advanced Aesthetic and Implant Dentistry, Delray Beach,Florida. He can be contacted at: [email protected].

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



tal implants and the manipulation of softand biocalcified tissues represent the great-est challenge in dentistry. When we add tothat the use of biocompatible implanteddevices, the challenge of finding appropriatelaser wavelengths becomes that much morecritical. Lasers may be used to supplementor entirely replace the use of traditional cut-ting instruments for implant placement,compress the wound response, enhanceimplant esthetics and sculpt emergence pro-file, implant maintenance, and repair of theailing implant.6

Laser TypesSeveral types of lasers have been testedregarding their applicability to oral implan-tology procedures. The laser types evaluatedinclude Nd:YAG, Ho:YAG, GaAlAs, CO2,Er:Yag, and Er,Cr:YSGG.7 The proceduresmay be broken down into three major areas;osseous, soft tissue and treatment of theimplant surface. Laser effects may be fur-ther broken down to those in vaporizationversus ablation modes. In vaporizationmode, the primary effect is thermal interac-tion with tissue. If the temperature rise issignificant, permanent alteration of theimplant surface may occur. If the laser inused in ablation mode with a water coolant,a hydrokinetic effect may be observed withrelatively insignificant temperature rise.8With the exception of treatment of theimplant surface, laser interactions with softand hard tissue are more widely reportedand extensively used.

Implant-Related Laser ProceduresThe earliest use of lasers in oral implantol-ogy involved soft tissue manipulation.9 In atypical two-stage implant placement, theimplant is placed at the osseous crest andthen covered by soft tissue during its inte-gration phase (Figure 1). At the secondarysurgery to expose the implant, the tissueimmediately covering the implant coverscrew is removed to allow placement of ahealing abutment, impression post, or finalabutment for temporization. Typically, thissurgery is accomplished using a scalpel ortissue punch that approximates the outerdiameter of the implant. This necessitatesthe use of a local anesthetic for patient com-fort and hemostasis. The use of a laser toperform the second stage obviates the needfor an anesthetic and creates hemostasis atthe implant site. This procedure is carriedout by first locating the center of theimplant cover screw with a periodontalprobe or explorer. A topical anesthetic maybe used if the exact position of the implant

is not readily apparent. The laser is thenused to expose the center of the cover screwand then, in a widening circular motion, thefull diameter of the implant is exposed.10

This procedure may only be carried out ifthere is adequate attached gingival (Figure2). If the implant exposure will be outside ofthe zone of attached gingiva, a standard sur-gical approach is suggested to apically repo-sition tissue to ensure that the implant willhave adequate tissue coverage. If this is notdone, a secondary soft tissue graft proce-dure may be necessary with less predictableresults. It is critical not to use a laser systemthat has a high thermal effect. If the lasercuts in vaporization mode, the cover screwmay fuse with the implant body making itunusable. It may also alter the polished col-lar or neck region, resulting in gap forma-tion at the implant/abutment interface, withresultant bacterial percolation, or soft tissueproblems as a result of pitting and increasedbacterial colonization.11

Figure 1. Two-stage implant healing withcomplete soft tissue coverage.

Figure 2. Second phase uncovering of inte-grated implant using the Er,Cr:YSGG laser.

Laser procedures may also be employedafter exposure of the implant. These proce-dures include gingival recontouring to cre-ate harmonious gingival architecture foremergence profile of the implant crown andparabolic sculpting for ovate pontic areas ofthe implant restoration.12 These soft tissuemodifications may also be carried out with

no anesthetic and immediate hemostasis.The degree of tissue ablation and depth ofcutting can be altered by changing thepower setting on the laser unit, defocusingthe laser beam, or a combination of both.Again, it is critical not to use a laser thatmay cause thermal changes to the implantsurface or necrosis of soft tissue.Soft tissue esthetics and stability is depend-ent on a number of variables and can beresearched in great depth from the peri-odontal literature. The most importantparameter in predictable soft tissue profileis the creation of parabolic osseous con-tours. In the edentulous ridge, or followingimplant placement, parabolic architecture isoften lost. We know that regrowth of thedental papilla is dependent on correspon-ding interproximal osseous support thatmimics the soft tissue profile.13

Traditionally, rotary cutting instruments orhand chisels are used to create this parabol-ic architecture. Lasers, cutting in ablationmode, can accomplish this task. Lasers thatcut in vaporization mode may cause coagu-lation, charring, or burning of bone.14 Thiseffect may destroy osteocytes and denaturegrowth factors which are responsible forbone growth and maturation, thus delayinghealing and causing unpredictable tissuecontours. Studies have shown that osseousprocedures that can be carried out usinglasers include ridge recontouring, creationof parabolic architecture, decortication ofbone during graft procedures, bone harvest-ing, removal of pathology, and lateral win-dow creation for maxillary sinus grafting(Figure 3).15 As with soft tissue surgery, thedepth of cut may be controlled by alteringthe power setting or distance of the laser tipfrom the surface of the bone.

Figure 3. Preparation of lateral wall windowfor sinus grafting comparing rotary instru-mentation (superior, right) and laser ablation(inferior, left).

(Reprinted by permission - Dr Hans-JoachimRoos; Memmingen, Germany.)

MI LLER

Canadian Journal of Restorative Dentistry and ProsthondonticsFall 200925

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



TH E USE OF LASERS I N ORAL IMPLANTOLOGY

With regard to decortication of bone andharvesting of cortico-cancellous blockgrafts, the laser is used in a manner that isconsistent with rotary cutting instrumenta-tion. By using the laser in ablation mode,and thereby minimizing thermal effects,healing is faster and there may be less post-operative discomfort following surgery.Removal of pathology, which may includeapical granulomas, cysts, retained roots, orforeign bodies, may be accomplished withfar less bone removal than with traditionalinstrumentation. In addition, certain lasersmay have a bacteriocidal effect at the surgi-cal site.16

Care of the implant patient does not endfollowing implant placement and recon-struction. Maintenance of the implantpatient and treatment of soft tissue orosseous lesions around implants are criticalfor implant success. With respect to mainte-nance of the implant site, we know thatimplants may suffer from the same diseaseprocess as natural teeth.17 This peri-implan-titis may be only a soft tissue problem, or itmay be a combination of soft and hard tis-sue problems. A concern during the main-tenance procedure is the potential for scor-ing the implant abutment or prosthesis.Traditional hand or ultrasonic instrumenta-tion cannot be used on metal because of therisk of roughening the surface. This maylead to increased plaque and bacterialbuild-up and make it more difficult forpatient home care. The peri-implant attach-ment is, at best, a weak hemi-desmosomalattachment and is easily violated.18 Thismakes traditional maintenance proceduresless than ideal for implant sites than for nat-ural teeth. The erbium-based laser systemsseem to be ideally suited for debridement ofthe implant surface. Plaque and calculus areeasily and definitively removed from metalsurfaces without any thermal effects. Laserssettings are generally kept on soft tissueparameters and the laser tip used in a defo-cused mode. A balance must be maintainedbetween the ablative effects on implant con-taminants and the potential for soft tissuechanges around the implant. Using the laserin defocused mode will generally protectthe soft tissue while debridement is carriedout. Alternatively, there may be sites wherethe patient’s home care is adequate, with lit-tle or no peri-implant build-up, and soft tis-sue inflammation and supra-bony pocket-ing may exist. In this case, an ablative tech-nique is not indicated. Several different lasertypes have been evaluated for use within thegingival pocket.19 The bacteriocidal effects of

pulsed laser light may result in decreasedpocket depth and reduced collagenase activ-ity, thus allowing reattachment higher up onthe implant surface.20

If the peri-implant disease process is moreadvanced, and there exists an osseous com-ponent to the lesion, an entirely differentapproach must be employed. Bacterial colo-nization of the roughened surface or bio-active coating of the implant cannot betreated by conventional maintenance proce-dures (Figure 4).21 Treatment of the com-bined defect by laser treatment of the peri-odontal pocket may achieve symptomaticrelief of bleeding and soft tissue edema, butthis is not definitive treatment of the lesion.In this case, flap surgery must be used toexpose the implant and surroundingosseous lesion. Traditionally, granulomatouslesions have been removed using a varietyof techniques. Early techniques employedhand instrumentation and ultrasonics. Thisresults in incomplete removal of infectedtissue and alteration of the implant surface.This generally produces a fibrous interfacerather than reintegration of the implant.The next generation of treatment modalitiesinvolved the use of tetracycline paste andcitric acid (40%, ph1).22 Tetracycline mayonly be used on a non-coated implant andwhile it has an anti-bacterial effect, it mayinterfere with the calcium-phosphate bondof bone. This will actually delay osseoushealing. Citric acid is used on both titaniumand HA covered implants. However,debridement of the HA surface is incom-plete and surrounding soft and hard tissuemay be burned as a result of the acidic ph. Itmay also soften the remaining crystallineHA, making it more prone to breakdownafter surgery (Figure 5). The Er,Cr:YSGG laser appears to be ideal inthe treatment of the infected implant. SEMstudies have shown that, when used in abla-tion mode at the highest settings (6 W), noalteration of the implant surface occurseven when used on softer, commerciallypure implants. In addition, it has beenshown to be effective in completely remov-ing the most dense surface materials,including crystalline HA (Figures 6). Thetreatment includes both ablative and regen-erative techniques. Following exposure ofthe implant defect, the YSGG laser is usedto remove all granulomatous tissue to thebase of the defect. The laser tip is thenturned to the implant body and, in a defo-cused mode, is used to completely debrideand decontaminate the implant body. Caremust be taken not to use the tip too close to

the surface of the implant or sparking mayoccur. This represents removal of the titani-um oxide layer and may damage the lasertip. This layer is only a few microns thickand immediately reforms when exposed tooxygen.23 There is no measurable changethe titanium surface using SEM analysis.Research has shown that the Nd:YAG andHo:YAG lasers are contraindicated fordecontamination of the implant surface. Athigher power settings, the CO2 and Er:Yaglaser may alter the surface characteristics ofthe implant. The laser can now be used todecorticate the osseous crypt to createbleedings points and allow growth factors tocome into contact with the implant body.The last step is the use of a graft material tofill the osseous defect and a membrane toprotect the grafted area.24 When possible,the implant prosthesis and abutment areremoved and a sterilized cover screw placedin the implant to allow complete coverageby the membrane. Resorbable membranesare preferred to allow conservative recoveryof the implant after healing. Implants areallowed to heal for 3–4 months beforeuncovering if unloaded. If the implant pros-thesis cannot be removed, the procedure isidentical except for closure. It is recom-mended that a cyanoacrylate tissue glue beused to seal the peri-implant tissue collar to


Figure 4. Control hydroxyapatite coated CP-2implant.

Figure 5. HA coated implant treated with40%, ph1 citric acid for 3 minutes.

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



prevent percolation of fluid and bacteriainto the grafted site.Current research includes the use of lasersto create the implant osteotomy in place of aconventional spiral drill. Osteo-regenerationand integration of implants has beenobserved using the Erbium:YAG laser forimplant site preparation.25 However, preci-sion of the osteotomy cannot be controlledas compared to conventional implant drills.Another novel use for lasers is for decreas-ing the time of osseointegration by topicalapplication of laser light to the peri-implantsoft and hard tissue after implant place-ment. Low level light energy is absorbed byendogenous chromophores in mitochondriaand cell membranes. It can be demonstratedthat mitochondrial metabolism of fibrob-lasts increases following laser illuminationin a proscribed protocol. This photodynam-ic therapy results in increased synthesis ofDNA and RNA proteins resulting in cellproliferation and repair. By using resonancefrequency analysis of implants over sixweeks, it can be demonstrated that thetorque removal values of laser irradiatedimplants is significantly higher than a con-trol group.26

The use of lasers in oral implantology repre-sents a major paradigm change when com-pared to traditional instrumentation. Theselection of a laser-based approach is nowbased on our understanding of the biologyof soft and hard tissue healing rather thanempirical convenience. As with all relativelynew procedures the current body of knowl-edge and research protocols suggests that anew standard of care is emerging that willbenefit both practitioner and patient.

SYNOPSISConcepts of implant design and surgicalmanipulation of soft and hard tissue have

changed dramatically over the past fiftyyears. Surgical instrumentation for oralimplantology has now witnessed a para-digm shift with the introduction of lasersurgery. The precision of lasers now rivalsthat of traditional surgical armamentariumwith the added benefit of more patientcomfort and faster healing. The use of lasersfor implant procedures will enable practi-tioners to treat patients more conservativelyand enhance patient acceptance of thismodality.

References1. Stern RH, Sognnaes RF. Laser Beam Effects

on Dental Hard Tissues. J Dent Res1964;43:873.

2. Pick RM, Colvard MD. Current Status OfLasers in Soft Tissue Surgery. JPeriodontology 1993;64:589–602.

3. Kim BM, Feit MD, et al. Influence of PulseDuration on Ultra Short Laser PulseAblation of Biological Tissue. J BiomedOpt 2001;6:332–8.

4. Cernavin I, Pugatschew A, et al. LaserApplications in Dentistry: A Review Of TheLiterature. Austral Dent J. 1994;39:28–32.

5. Pick RM, Powell GL. Lasers in Dentistry.Soft Tissue Procedures. Dent Clin N Amer1993;37:281–96.

6. Walsh IJ. The Use of Lasers inImplantology: An Overview. J OralImplantology 1992;18:335–40.

7. Kreisler M, Gotz H, Duschner H, d’Hoedt B.Effect of Nd:YAG, Ho:YAG, CO2, andGaAlAs Laser Irradiation on SurfaceProperties of Endosseous Implants. Int JOral Maxiilofac Implants 2002;17,2:202–11.

8. Eversole LR, Rizoiu IM. PreliminaryInvestigations on the Utility of an Erbium,Chromium:YSGG Laser, CDA J 1995;231:41–47.

9. Wigdor HA, Walsh JT Jr., et al. Lasers inDentistry. Lasers Surg Med 1995;16:103–33.

10. Arnabat-Dominguez J, Espana-Tost AJ, etal. Erbium:YAG laser Application in theSecond Phase of Implant Surgery: A PilotStudy in 20 Patients. Int J Oral MaxillofacImplants 2003;18,1:104–12.

11. Block CM, Mayo JA, Evans GH. Effects ofthe Nd:YAG Dental Laser on Plasma-Sprayed and Hydroxyapaptite-CoatedTitanium Implants: Surface Alterationsand Attempted Sterilization. Int J OralMaxillofacial Implants 1992;7:441–9.

12. Risoiu IM, Eversole LR, Kimmel AI. Effectsof an Erbium, Chromium: Yttrium,Scandium, Gallium, Garnet Laser onMucocutaneous Soft Tissues. Oral SurgOral Med Oral Pathol Oral Radiol Endod

1996;82:386–95.13. Tarnow DP, Cho SC, Wallace SS. The Effect

of the Inter-Implant Distance on theHeight of the Inter-Implant Bone Crest. JPeriodontology 2000;71(4):546–9.

14. Eversole LR, Rizoiu I, Kimmel A. OsseousRepair Subsequent to Surgery with anErbium Hydrokinetic Laser System.International Laser Congress Abstract,September 1996:213–21.

15. Kimura Y, Yu D, Fujita A, et al. Effects ofErbium, Chromium:YSGG Laser Irradiationon Canine Mandibular Bone. J Periodontol2001;72,9:81–84.

16. Kato T, Kusakari H, Hoshimo E.Bacteriocidal Efficacy of Carbon DioxideLaser Against Bacteria-ContaminatedImplants and Subsequent CellularAdhesion to Irradiated Area. Lasers SurgMed 1998;23:299–309.

17. El-Askary AS, Meffert RM, Griffen T, WhyDo Dental Implants Fail? Part I. ImplantDentistry 1999;8,2:173–83.

18. Masson ML. Using the Laser for ImplantMaintenance. Dentistry Today 1992;11:74–75.

19. Bader HI, Epstein SR. Clinical Advances ofthe Pulsed Nd:YAG Laser in PeriodontalTherapy. Pract Periodontics Aesthet Dent1997;9(6 Suppl):6–9.

20. Haas R, Dortbudak O, Mensdorff-Pouilly N,Mailath G. Elimination of Bacteria onDifferent Implant Surfaces throughPhotosensitization and Soft Laser. ClinOral Implants Res 1997;8:249–54.

21. Callan DP, O’Mahoney A, Cobb CM. Loss ofCrestal Bone around Dental Implants: ARetrospective Study. Implant Dentistry1998;74:258–66.

22. Meffert RM, Treatment of Failing DentalImplants. Curr Opin Dent 1992;2:109–44.

23. Deppe H, Horch HH, Henke J, Donath K.Peri-implant Care of Ailing Implants withthe Carbon Dioxide Laser. Int J OralMaxillofac Implants 2001;16:659–67.

24. Jovanovic SA, Kenny EB, Carranza FA,Donath K. The Regenerative Potential ofPlaque-Induced Peri-Implant BoneDefects Treated by a SubmergedMembrane Technique. An ExperimentalStudy. Int J Oral Maxillofacial Implants1993;8:13–8.

25. El-Montaser M, Devlin H, et al.Osseointegration of Titanium MetalImplants in Erbium-YAG Laser PreparedBone. Implant Dentistry 1999;81:79–82.

26. Blay A, Blay CC, Groth EB, et al. Effects ofVisible NIR Low Intensity Laser on ImplantOsseointegration In Vivo. Laser Med SurgAbstract issue. 2002:11.

MI LLER


Figure 6. HA coated implant treated withEr,Cr:YSGG laser for 3 minutes.

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM




LANAP: What Is It? As a restorative dentist, periodontaldisease not only complicates treat-ments, but, can be a stumblingblock in obtaining patient accept-ance of treatment. It is often thecase that the foundation in whichthe restorative dentistry is needed isnot stable enough to restore, oronce the periodontal disease is sta-bilized, the patient is left with com-promised esthetics. Equally impor-tant, the teeth, no matter how theyare restored, are going to be difficultfor the patient to maintain overtime. Patients, once being informedof the need for periodontal therapy

and subsequent referral to a peri-odontist, often decline treatment. Unfortunately, in many cases, oncethe patient is referred to the special-ist they don’t keep their appoint-ment, nor do they return back tothe referring dentist for furthercare. They tend to avoid dentaltreatment all together. Often, this isthe result of experiences friends andfamily members have had afterundergoing periodontal surgery. Insome cases, patients will start thera-py and stop after only one quadrantof surgery. Unfortunately, for restorative den-tists in the United States, one in

three patients have some form ofperiodontal disease.1 Patients oftenseek treatment from us for a cos-metic concern. In many of thesecases, we cannot address their ini-tial concern until the periodontaldisease has been addressed. For some time, different treatmentoptions have been tried in order tomeet these patients’ needs. In thelate 1980s, the first step towardaccomplishing this goal wasbrought to the market. AmericanDental Technologies developed thefirst laser for use in dentistry.2 Sincethen, numerous clinicians andresearchers have tried to developlaser techniques that would be


About the AuthorDavid Kimmel is a restorative dentist in Bayonet Point, Florida. He specializes in laserdentistry. He is a clinical instructor for the Institute of Advanced Laser Dentistry. Dr.Kimmel also holds a mastership certification with the World Clinical Laser Institute. Hecan be reached at [email protected].

Laser Assisted NewAttachment Procedure

By David Kimmel, DMD

ABSTRACTThis article presents a general over view of what the Laser Assisted NewAttachment Procedure (LANAP) is and the benefits of its use to patientsand the restorative dentist.

RÉSUMÉCet article donne un aperçu de LANAP et des avantages de son utilisationchez les patients et pour le dentiste.

CJRDP 2-4 2009:Layout 1 11/12/09 8:25 AM



In general, during this year, no restorativework that requires disturbing the periodon-tal tissue is done. Subgingival cleaning andprobing are discouraged. As many of thepatients that are indicated for LANAP haveavoided dentistry for years, they oftenrequire some restorative dentistry prior toLANAP as they would not be able to wait ayear before undertaking the needed restora-tive treatment. In this case, direct restora-tions are placed as needed and when indi-rect restorations are indicated, temporariesare placed with the understanding that thefinal restorations will be place at a later date.One of the remarkable aspects of LANAP ispatient acceptance. Even patients that havetraditionally avoided dental treatment orhave experienced traditional surgery in thepast, accept LANAP. They are looking foran alternative to traditional surgery and arefamiliar and comfortable with the use oflasers for LASIK treatment for their eyes.They consider laser treatment for periodon-tal disease a viable alternative. Clinically,what immediately becomes apparent is thatpost operatively there is none to minimaldiscomfort. After the procedure, the patient can see thatthe tissues feel and look healthier. SinceLANAP is not a resective procedure, therecession associated with traditional surgeryis not present. Consequently, the patients donot have the root sensitivity or longerappearing teeth. All of this reinforces to thepatient that they have made a good decisionon their treatment choices.

effective against periodontal disease. Twosuch restorative dentist and laser pioneersare Dr. Delwin McCarthy and Dr. RobertGregg. In 1998, they first published theirfindings on periodontal bone regeneration.3Later, in 2007, histological proof of not onlyosseous generation but new cementummediated attachment was published by Dr.Raymond Yukna.4 The protocol that wasdeveloped by Dr. Gregg and Dr. McCarthyhas been termed, LANAP, an acronym forLaser Assisted New Attachment Procedure. LANAP is a rather simple but elegant proto-col. It tips the scales in favour of the peri-odontal regeneration. A key component ofthe protocol is the Nd:YAG laser; specifical-ly the Periolase MVP 7 by MillenniumDental. The wavelength of this laser is 1064nm. It can be utilized to achieve peak pow-ers in the 1,000’s of joules and has the abili-ty to vary the pulse duration (length of timeof each laser pulse). This wavelength oflaser light, 1,064 nm, is selectively absorbedin pigmented tissue. This absorption of thelaser energy allows for the selective removalof diseased epithelium and the destructionof the pigmented bacteria associated withperiodontal disease (Figure 1). The highpeak powers that can be achieved with thislaser give a depth of penetration into thetissue that further allows this laser to effectperiodontal disease. The variable pulsedurations of the Periolase is a feature of thislaser that allows this laser to selectivelyremove diseased epithelium and to form athermogenic clot that acts as a barriermembrane (Figure 2). LANAP, however, isnot just about the laser. It is a protocol thatdeals with inflammation, the infectiousprocess, occlusion, tooth mobility, and anosseous component.

A Quick OverviewThere is no initial periodontal therapy start-ed prior to LANAP. The LANAP procedure(Figure 3 and Figure 4a and 4b) is generallycompleted in two visits, although, it can bedone in one. On average, each of the twovisits are two hours long. The patients areseen at a one week post op for an evaluationand then at 30 days post op to have asupragingival prophylaxis. Thereafter, pro-phylaxes are done every three months. Thepatients are closely monitored during thistime. At one year, a postoperative evaluationis done which includes full periodontalprobing and full mouth radiography. At thattime, phase 2 dentistry can be initiated onceit has been confirmed that the periodontalcondition is stable.

KIMMEL


Figure 1. Selective removal of diseased epithe-lium and decontamination of pocket utilizingthe high peak powers of the Periolase MVP7Nd: YAG laser.

Figure 2. Formation of a thermogenic clot byuse of long pulse durations of the PeriolaseMVP7.

Figure 3. The clinical steps of LANAP: (A) Charting of bone topography under anesthesia, (B) optic fibre is oriented parallel to the root surface and (C) removal of calcified plaque and cal-culus by use of Pezio ultrasonic scaler (D) A second pass with 650 us “long pulse” laser finishesdebriding the pocket and achieving hemostasis with a thermal fibrin clot. (E) Gingival tissue iscompressed against the root surface to close and aid in the stabilization of the fibrin clot. (F) Thewound is stabilized, the teeth splinted if necessary, and occlusal trauma is minimized by occlusaladjustment to promote healing. Oral hygiene is stressed and continued periodontal mainte-nance is scheduled. (G) No probing is performed for at least 9 to 12 months.

29

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



As a restorative dentist, LANAP allows amore ideal crown to root ratio and naturallyappearing gingival contours. This in turnmakes periodontal maintenance for thepatient far more manageable. It all leads tothe long term success of periodontalpatients after being treated with LANAP.What I find rewarding, is LANAP allowspatients that are fearful of dentistry to notonly seek out treatment, but to continuetheir dental care. After LANAP treatment,patients realize how much dentistry haschanged and they continue their care.

DisclosureThe author is a clinical instructor for theInstitute for Advanced Laser Dentistry. TheIALD is a division of Millennium Dental,which manufactures and sells the Periolaselaser.

References1. Eke P, et al. CDC periodontal disease sur-

veillance project: background, objectivesand progress report. J Periodontal2007;78:1366–71.

2. Meyers TD, et al. First soft tissue study uti-lizing a pulsed Nd:YAG dental laser.Northwest Dent 1989;68(2):14–17.

3. Yukna R, et al. Histlogic evaluation of anNd:YAG laser-assisted new attachmentprocedure in humans. Int J PeriodonticsRestorative Dent 2007;577–87.

4. Gregg RH and McCarthy D. Laser ENAP forperiodontal bone regeneration. DentToday 1998;17(5):88–91.


TH E LASER ASSISTED N EW ATTACHMENT PROCEDU RE

Figure 4. Preoperative clinical radiograph (a) and photo (b) of typical LANAP case.

Figure 5. Twelve months post LANAP with only minor recession and resolution of a 9 mm pocket.

a

a

b

b

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM





Use of the 810 nm Diode Laser:

Soft Tissue Management and OrthodonticApplications of Innovative Technology

By David M. Sarver, DMD, MS

ABSTRACTInnovative technologies such as the diode laser have provided consider-able benefit to dental patients and professionals. Facilitating efficientcutting of tissue and subsequent coagulation, the soft tissue laserenhances tissue healing and can reduce postsurgical complications. Dueto the conservative nature of treatment accomplished with the laser, thistechnology is very useful in orthodontic procedures. The diode laser isutilized in both esthetic enhancement of the smile, and treatment man-agement of soft tissue issues that impede efficient orthodontic treat-ment. Its clinical application will be illustrated in a series of orthodonticcases.

RÉSUMÉLes avantages des technologies innovatrices telles que le laser à diodesont considérables pour les patients et les dentistes. En facilitant lacoupe efficace du tissu et la coagulation qui s’ensuit, le laser pour les tis-sus mous améliore la cicatrisation et peut réduire les complications post-opératoires. En raison de la nature conservatrice du traitement réalisé parlaser, cette technologie est très utile pour les traitements orthodon-tiques. Le laser à diode est utilisé à la fois pour l’amélioration esthétiquedu sourire et la gestion du traitement des problèmes de tissus mous quiempêchent une correction orthodontique efficace. Son application clin-ique sera illustrée dans une série de cas en orthodontie.

About the AuthorDavid Sarver is in private practice in Vestavia Hills, AL. Dr. Sarver may be contacted at [email protected].

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM




Over the last several years, laser tech-nology has helped dental profession-

als improve the level of care provided totheir patients. For orthodontic proce-dures, lasers are now being used toreshape gingival soft tissues for estheticfinishing and solve issues involvingaltered tooth eruption. This advancedlaser technology is significantly and effi-ciently improving the design, health, andoverall appearance of orthodontic patients’smiles, while also enhancing their chair-side experiences. Orthodontists’ interest insmile design has dramatically increased asa result of both their collaboration withdentists in interdisciplinary treatment andas the potential of laser-assisted dentistryis more readily understood by orthodon-tists.One contemporary dental laser is the 810nm diode laser (i.e., Odyssey, IvoclarVivadent, Amherst, NY), which has numer-ous benefits for orthodontic treatments. It ismanageable in size and low in cost. Becausein most cases only topical anesthesia is nec-essary, the orthodontist does not need tointroduce injection syringes to the patient;this is particularly beneficial in the openorthodontic clinic where siblings are oftenobserving treatment. Additionally, patientsare not burdened with the profound sensa-tion of local anesthesia and its prolongedeffects.1,2

The diode laser separates and coagulates atthe same time, facilitating immediate hemo-stasis and resulting in minimal bleeding.Healing is rapid and there is a reducedpotential for infection. Postoperative com-plications are minimal and sutures areunnecessary. The diode laser has an affinityfor only soft tissue, thereby preventing dam-age to the surrounding bone and enamel – a significant advantage for the orthodontist.Finally, orthodontic procedures can beaccomplished in less time and in fewer vis-its.1,2

Effect of the 810 nm Laser on SoftTissueDental laser energy has an affinity for dif-ferent tissue components. The 810 nmdiode laser, for example, has energy andwavelength characteristics that specificallytarget the soft tissues. It has an affinity forhemoglobin and melanin, which are thecomponents that provide color – or pig-mentation – to the tissue. Other wave-lengths of lasers are attracted to water,which is located at the surface of the tissue.Since the 810 nm diode laser has an affinity

for hemoglobin and melanin, it is more effi-cient and better equipped to address deepersoft tissue problems.5–8

The light energy released by the diode lasertransforms into heat, resulting in the vapor-ization of cells, a process referred to as thephotothermal effect. The diode laser’s opti-cal fiber is the mechanism that delivers thisenergy to the tissue. The degree to whichthe tissue absorbs this energy depends onits affinity to the laser’s wavelength, the cli-nician-selected energy output (which is dic-tated by the darkness of the tissue), the timeof exposure, and the characteristics of thetargeted tissue.1,3 The absorbed energyincreases the temperature of the targetedtissue, immediately resulting in a sequenceof tissue reactions (e.g., which ranges fromwarming and welding to coagulation, pro-tein denaturalization, vaporization, drying,and carbonization depending on theamount of heat used) according to the spe-cific desire and under the direct control ofthe clinician.4

This instantaneous reaction is termed abla-tion. Ablation is the separation of the tissue,which results in an incision that is sealed,sanitized, and protected by a biodressing(Figure 1). This is of paramount importancebecause it is what enables clinicians to mod-ify soft tissues in a clear field without bleed-ing. Whereas a surgical scalpel cuts tissue viafriction, the diode laser does so throughlight energy that is delivered in either a con-tinuous or pulsed mode. When used in thecontinuous mode, soft tissue absorbs con-tinuous energy, thereby resulting in higherlevels of heat. The more heat generated, themore postoperative discomfort may beexperienced by the patient. The pulsedmode, however, allows for beneficial cool-ing between pulses of energy. Therefore, forsoft tissue procedures, it is this author’s rec-ommendation that the diode laser generallybe used at a low power setting (e.g., 1.0 Wto 1.8 W) and in the pulse mode.

Use of the Diode Laser inOrthodontic Smile DesignOrthodontists often focus on occlusal goals,arranging the teeth in the most estheticposition possible, and then reshaping incisaledges at the end of treatment. They occa-sionally overlook the other elements of anesthetic smile (e.g., ideal incisal contour,height/width proportion, embrasures, con-tacts, gingival contour (Figure 2) that canbe precisely corrected or enhanced with thesoft tissue diode laser.

The patient in Figure 3, for example, hadundergone orthodontic treatment, but herfinished smile was not as esthetic as it couldbe. The gingival heights of the anterior teethwere not ideal, which resulted in an asym-metric smile. The right central incisor had anarrow gingival apex and asymmetric gingi-val shape, while the left central incisor had aflat gingival shape and was disproportion-ately short (Figure 4). The diode laser wasused to recontour the gingival shape (Figure5); four weeks postoperatively, the patient’ssmile had significantly improved (Figure 6).Precise shaping was possible due to the“tactile feedback” of the laser’s fiber. Asthere was virtually no bleeding, the clearsurgical field enabled the clinician to easilyvisualize the intended tissue contour.In orthodontic smile design, the methodused for bracket placement depends on theneeds of each individual case. For accuratebracket placement, however, the entirecrown should always be visible. It is oftenideal to address compromised tooth propor-tion prior to orthodontic bracket place-ment. To do so, the orthodontist first meas-

Figure 1. The cutting action of the diode laserseals and coagulates as it proceeds, resultingin a very clean surgical margin termed a bio-dressing.

Figure 2. Many orthodontists can benefitfrom a greater understanding of the impactof height/width ratios, gingival shape, andgingival contour on esthetics.

USE OF THE 810 NM DIODE LASER: SOFT TISSUE MANAGEMENT AND ORTHODONTIC APPLICATIONS OF INNOVATIVETECHNOLOGY

32

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



SARVER


ures the amount of incisal display when thepatient’s lips are at rest and in a smile. Inthis case, only 5 mm of the maxillaryincisors were displayed in her smile dueto delayed passive eruption (Figure 7). Asa result of the gingival encroachment, thebracket would have had to be placed wellbelow the center of the tooth (Figure 8),but this would result in incisor intrusionand even less tooth display on smile.After probing the anterior teeth and tak-ing into account the biologic width, it wasdetermined that a gingivectomy/gingivo-plasty using the 810 nm diode laser wouldprovide adequate crown exposure to per-mit more ideal bracket placement (Figure9). Specifically, the patient would gain 5 mm in crown length and with normalreestablishment of the attachment appara-tus would yield a 4-mm gain in incisalheight.At the bracket placement appointment,the diode laser was used to remove theexcess gingival tissue. The result was adramatic increase in crown access anddisplay that would permit proper bracket

placement after the laser procedure(Figures 10 and 11.)The diode can also be used to finishsmiles in orthodontic treatment, such aswhen the patient has disproportionatecrown width and height (Figure 12). Thegingival margins of the patient’s lateralincisors were slightly below the gingivalheights of the central incisors andcanines. One treatment option was toorthodontically intrude the lateral inci-sors so the gingival margins more closelyapproximated the ideal width and heightand to place porcelain veneers to restorethe length of the tooth. The other optionwas to use the diode laser to lengthen thelateral incisors to improve tooth propor-tion, then to remove the brackets and re-bond them, thereby extruding the anteri-or teeth to more closely match the smilearc (Figure 13). Once the Odyssey softtissue laser was used to lengthen the later-al incisors (Figure 14), realignment wascompleted to enhance the esthetics of thepatient’s smile (Figure 15).

Management of Altered ToothEruption via CombinedLaser/Orthodontic TherapyOrthodontists are under constant pressurefrom patients and parents to finish treat-ment in a timely manner. An unexpectedbenefit of the soft tissue laser is the abilityto control tissue response due to poor oralhygiene and to remove tissue so that clini-cians can access slowly erupting or evenunerupted teeth.When orthodontic patients do not followadequate oral hygiene regimens, theremoval of orthodontic appliances mayresult in enlarged interdental papillae andgingival margins (Figure 16).In order to remove the enlarged papillaefrom this patient, the laser’s tip was wipedacross the bulky tissue, and ablationreduced the bulky papillae and removedpseudopockets, facilitating improved clean-ing (Figure 17). When treating the enlargedgingival margins, the author again tookadvantage of the laser’s precision to shapethe gingival margins against the tooth’s

Figure 3. Case 1. Once ortho-dontic treatment was finishedand appliances removed, theesthetic finish was less thanoptimal.

Figure 4. Tooth #8(11) had anarrow gingival apex andasymmetric gingival shape,while tooth #9(21) had a flatgingival shape and was dis-proportionately short.

Figure 5. The diode laser wasused to reshape tooth #9 (i.e.,its marginal shape andlength); tooth #8 was mademore symmetric.

Figure 6. At four weeks post-operatively, the patient hadfully healed. The final smilewas significantly enhanced bythe finishing contouring pro-vided.

Figure 7. Case 2. This 12-year-old patient illustrates howsoft tissue management priorto bracket placement canfacilitate the goals of theorthodontist in smile design.

Figure 8. Due to the gingivalencroachment, the orthodon-tic bracket must be placedwell below the center of thetooth, resulting in incisorintrusion and further decreas-ing incisor display.

Figure 9. After periodontalprobing, it was determinedthat sufficient tooth heightcould be gained to place thebracket more superiorly,resulting in a favorable out-come.

Figure 10. At the appointmentfor orthodontic applianceplacement, anterior crownheight of the central incisorswas increased to more than10 mm.

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



USE OF THE 810 NM DIODE LASER: SOFT TISSUE MANAGEMENT AND ORTHODONTIC APPLICATIONS OF INNOVATIVETECHNOLOGY


Figure 11. Because of the clearfield provided by the biodress-ing, brackets could be placedin the desired position in asingle visit.

Figure 12. Case 3. This patient’smaxillary lateral incisors weredisproportionate in terms ofwidth and height; the gingivalmargins also required man-agement with the laser.

Figure 13. The diode laser wasused to lengthen the lateralincisors. The brackets werethen removed and re-bonded,extruding the anterior teethto more closely match thesmile arc.

Figure 14. The lateral incisorswere lengthened to meet theproportionality requirementsof the anterior teeth; bracketswere placed to finish theanterior tooth position.

Figure 15. The final smile wasgreatly improved, the smilearc was idealized, and toothproportion was now esthetic.

Figure 16. Case 4. Poor oralhygiene, despite repeatedreinforcement instructionsfrom the orthodontist, result-ed in hypertrophic gingivaand papillae, creatingpseudopockets, which wereeven more difficult to keepclean.

Figure 17. The hypertrophicpapillae were ablated and thegingiva recontoured to pro-vide a better cleaning envi-ronment.

Figure 18. At 4 weeks, there isa much more attractive andhealthy intraoral picture.

Figure 19. Case 5. Orthodontictreatment can be impeded byaltered tooth eruption.Management of treatmentcan be facilitated by tissuemodification with the diodelaser.

Figure 20. A small windowwas opened in attached gingi-val tissue. Note the clean mar-gins and the availability ofthe tooth surface for prepara-tion and bonding of a bracket.

Figure 21. A bracket was bond-ed to the canine surface andthe archwire was engaged.

Figure 22. At 6 weeks, thecanine had moved enough toreset the bracket more ideally.

Figure 23. After an additional6 weeks, the canine tooth hadbeen moved into its final posi-tion for the case to be fin-ished.

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



SARVER


2. Sarver DM. Principles of cosmetic den-tistry in orthodontics. Part 1. Shape andproportionality of anterior teeth. Am JOrthod Dentofacial Orthop2004;126:749–753.

3. Research, Science and Therapy Committeeof the American Academy ofPeriodontology. Lasers in periodontics. JPeriodontol 2002;73:1231–1239.

4. Sarver DM, Yanosky M. Principles of cos-metic dentistry in orthodontics. Part 3.Laser treatments for tooth eruption andsoft tissue problems. Am J OrthodDentofacial Orthop 2005;127:262–264.

5. Miyasaki MA. Shedding light on the softtissue laser. Signature 2004;11(1):11–13.

6. Patino MG, Neiders ME, Andreana S, et al.Collagen. An overview. Implant Dent2002;11(3):280–285.

7. Patino MG, Neiders ME, Andreana S, et al.Collagen as an implantable material inmedicine and dentistry. J Oral Implantol2002;28(5):220–225.

8. Patino MG, Neiders ME, Andreana S, et al.Cellular inflammatory response toporcine collagen membranes. JPeriodontal Res 2003;38(5):458–464.

Reprinted with permission from Pract ProcedAesthet Dent. 2006 Oct;18(9):suppl 7-13.

eliminate the pain – they simply offer tem-porary relief. The diode laser is providing awelcome solution. With the diode laser, ittakes approximately one day for the ulcer toheal and disappear. Patients are pleasedbecause the pain from the ulcer is eliminat-ed immediately, and the process takes amatter of minutes.

ConclusionDiode lasers exemplify how critical technol-ogy is in modern dentistry. As clinicians arebecoming more knowledgable about thebenefits of laser use in therapy, they aregrowing more comfortable with applyinglasers to several different procedures.Whether orthodontists are correcting exces-sive gingival display or aiding in crownlengthening, laser technology is dramatical-ly increasing the level of care to patients.Not only are lasers making a practice moreeffective and efficient, but they are also pro-viding a more comfortable patient experi-ence.

References1. Rossmann JA, Cobb CM. Lasers in peri-

odontal therapy. Periodontol 20001995;150–164.

crown. In this case, the patient exhibited animmediate response to the laser and,approximately four weeks postoperatively,showed marked improvement (Figure 18).In the past, orthodontic treatment was oftendelayed or compromised by the incompleteor late eruption of the targeted teeth.Partially erupted teeth can be of particularconcern when the clinician must placeorthodontic brackets. When a tooth waspartially erupted, treatment options werelimited. The clinician either had to wait forthe tooth to erupt through the tissue or havea periodontist remove the tissue – both ofwhich added time to the treatment process.With the diode laser, however, orthodontistshave the ability to remove the covering tis-sue (Figures 19 through 23). Due to thelaser’s ability to immediately seal the incisionwith a biological dressing, the brackets couldbe placed on the patient in a single visit.

Additional ApplicationsAphthous ulcers continue to be one of themost uncomfortable conditions orthodonticpatients experience, and these ulcers canprolong treatment. There are treatmentsavailable, but most of the options do not

We hope you enjoyed reading CanadianJournal of Restorative Dentistry andProsthodontics, the official journal of theCanadian Academy of Restorative Dentistryand Prosthodontics.

If you are not a member of the CanadianAcademy of Restorative Dentistry andProsthodontics and would like to continueto receive CJRDP, please visit our website today!

$47.25

SUBSCRIBETODAY

(GST included)

for only

Nous espérons que vous avez apprécié lire leJournal canadien de dentisterie restauratrice etde prosthodontie, le journal officiel del’Académie canadienne de dentisterie restauratrice et de prosthodontie.

Si vous n’êtes pas membre de l’Académie canadienne de dentisterie restauratrice et deprosthodontie et que vous voudriez continuer àrecevoir le Journal, nous vous invitons à visiternotre site web dès aujourd’hui !

47.25$Souscrivez dès aujourd’hui

seulement

www.andrewjohnpublishing.com/CJRDP/CJRDP.html

(TPS incluse)(GST included)

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM




Today, lasers are widely used inendodontics, periodontics,

and dental surgery. Sirona’s com-

pact and powerful SIROLaserAdvance now plays an indispensa-ble role in my CEREC treatment

procedures. I use it for hemostasispurposes and to define the prepa-ration margins.It is essential to prevent bleeding atall stages of the CEREC procedure.The contamination of the anti-reflective powder with blood duringimpression-taking is especially criti-cal. The data can be flawed, result-ing in incorrect height readings andinaccurate dimensions of the proxi-mal box. To achieve an absolutelyclean environment I apply a rubber

SIROLaser Advance DeliversExcellent Results in

Connection with CeramicRestorations

By Dr. Helmut Goette

ABSTRACTIf bleeding occurs during impression-taking and treatment, this can havea serious impact on the quality of ceramic restorations. The CEREC userDr. Helmut Goette deploys the SIROLaser Advance to overcome this prob-lem. In this article he describes his therapy approach with reference to atypical case.

RÉSUMÉLes avantages des technologies innovatrices telles que le laser à diodesont considérables pour les patients et les dentistes. En facilitant lacoupe efficace du tissu et la coagulation qui s’ensuit, le laser pour les tis-sus mous améliore la cicatrisation et peut réduire les complications post-opératoires. En raison de la nature conservatrice du traitement réalisé parlaser, cette technologie est très utile pour les traitements orthodon-tiques. Le laser à diode est utilisé à la fois pour l’amélioration esthétiquedu sourire et la gestion du traitement des problèmes de tissus mous quiempêchent une correction orthodontique efficace. Son application clin-ique sera illustrée dans une série de cas en orthodontie

About the AuthorDr. Helmut Goette is a dentist in Bickenbach,Germany, and a certified CEREC trainer and lec-turer.

PRODUCT PROFI LE / PROFI L DE PRODU IT

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



I chose CEREC Blocs (shade: S2-M) for therestoration. Adhesive bonding was per-formed by means of Syntac-Heliobond(Ivoclar Vivadent) in combination withTetric EvoCeram (Ivoclar Vivadent), shadeA2. The restoration was inserted with theaid of an ultrasonic handpiece. Hemostasisremained effective throughout the treatmentprocess. As a result repeated laser therapywas not required prior to adhesive bonding.

SummaryI am using the SIROLaser Advance forCEREC treatment with great success. It isideal for hemostasis during impression-tak-ing and treatment, as well as for gum con-touring and for the correction of the prepa-ration margin.

Please note this article was first published inthe German Laser Journal.

ous bleeding occurred in the mesial proxi-mal box (Figure. 1).With the aid of the SIROLaser Advance Iarrested this bleeding and then exposed anddefined the preparation margin (Figure 2).For this purpose I selected the “periodontalgerm reduction”-program preset (1.5 W and10 Hz). In addition I prepared a distal box,and defined an additional preparation mar-gin with the aid of the SIROLaser Advance.The outcome was a clear and dry represen-tation of the operation site for the prepara-tion. The CEREC bluecam optical impres-sion yielded a clearly defined 3-D model.The automatic detection function had notrouble in marking the preparation margins(Figure 3). Thanks to the rubber dam, theoptical impression and the adhesive bond-ing of the restoration were performed underabsolutely dry conditions (Figure 4).

dam and use the SIROLaser Advance toarrest any bleeding.Bleeding is especially problematical duringadhesive bonding. Blood and saliva contam-ination can destroy the etched microreten-tive enamel and dentine surfaces. Properadhesive bonding is then impossible, andtreatment failure is the consequence. Acombination of the SIROLaser Advance anda rubber dam effectively rule out such con-tamination.

Case Study: Hemostasis Prior toImpression-Taking.A 38-year-old male patient came to mydental practice complaining of bite oversen-sitivity in tooth 25. The oral examinationrevealed an extended glass-ionomer fillingwith a replacement palatinal cusp and amissing mesial contact point. I recommend-ed a replacement filling, as glass ionomer isnot indicated for cusp replacement and thiswas the cause of the oversensitivity. Thetooth was vital. A radiograph did not revealany signs of periapical periodontitis. Afterthe defective filling had been removed copi-

GOETTE


Figure 1. Pronounced sulcus bleeding following the removal of old fill-ing.

Figure 2. Clear, dry representation of the operation site following lasertherapy.

Figure 3. The automatic margin detector functions perfectly. Figure 4. Thanks to the rubber dam, the try-in of the restoration takesplace under dry conditions.

Goette: “With the SIROLaser Advance and the rubber damI achieve an absolutely clean environment.”

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



DENTAL MATERIALS / MATÉRIAUX DENTAI R ES

Influence of Light Cure andStorage Time on the

Diametral Tensile Strengthof a Resin-based Luting

CementBy Anderson Pinheiro de Freitas, DDS, MSc, PhD, Luciana Fávaro Francisconi, DDS, Paulo Afonso Silveira Francisconi, DDS, MSc, PhD and Gildo Coelho Santos Jr. DDS, MSc, PhD

ABSTRACTTo evaluate the influence of light cure and storage time on the diametraltensile strength (DTS) of a dual resin-based luting cement 20 specimenswere prepared with the aid of a metallic matrix with 2 mm x 4 mm ofdiameter, which was filled with Rely-X ARC (3M ESPE, St Paul, MN), andrandomly distributed into 4 different groups (n = 10): light cured for 40seconds and stored in distilled water at 37ºC for 1 hour (Group 1) or 24hours (Group 2); chemically cured in a dark room and stored in distilledwater for 1 hour (Group 3), or 24 hours (Group 4). After storage, the speci-mens were submitted to a diametral tensile strength test on a Universal


About the AuthorsGildo Coelho Santos Jr., (pictured), is assistant professor, Department of RestorativeDentistry, Schulich School of Medicine & Dentistry, University of Western Ontario,Canada. Anderson Pinheiro de Freitas, is associate professor, Department of Dental Clinics,School of Dentistry, Federal University of Bahia, Brazil. Luciana Fávaro Francisconi, is with the Bauru School of Dentistry, University of SãoPaulo, Bauru, SP, Brazil.

Paulo Afonso Silveira Francisconi, is associate professor, Department of Dentistry, Endodonticsand Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.Correspondence may be directed to Gildo Coelho Santos Jr., at: [email protected].

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



An adequate cure of resin-based lutingcements is an important requirement

for restoration stability and biocompati-bility.1 Many of the resin cements com-mercially available on the market todayare categorized as dual-cure materials.These materials are chemically curedwhen the base paste and the catalyst aremixed, and light cured when they are sub-mitted to light.2 In their composition onecan find peroxides and amines, which arefound in chemical cure systems, as well ascamphoroquinone, a photosensitizer,which is used in light-cure materials.3

Dual-cure cements bring advantages ofboth kinds of cements (light cured or chem-ically cured),3 such as providing an ade-quate cure in deep areas and an increase inworking time.4 Studies have shown that themechanical properties of resin-based lutingcements correlate well with the degree ofconversion of particles forming thesecements.5 Additionally, it is known thatcomponents of the resin that did not sharethe reaction may be harmful to the restora-tion, causing local tissue irritation and pos-sibly an increased potential for secondarycaries lesions.6 Also, fracture toughness isan intrinsic property of these materials andis the measure of a material’s resistance tocrack propagation.7,8 In general, higher frac-

ture toughness value indicate more effectivecure.6

The aim of this study was to evaluate theinfluence of light cure and storage time onthe diametral tensile strength (DTS) of aresin-based luting cement in order to eluci-date important properties of these materialsand their clinical applicability. The nullhypothesis considered was that the kind ofthe cure and the storage time do not inter-fere with the diametral tensile strength ofthe resin cement used in this experience.

Material and MethodsTo evaluate the influence of light cure andstorage time on the diametral tensilestrength of resin-based luting cements, 40specimens were made and randomly divid-ed into four different groups. The speci-mens were obtained from dual cure resincement commercially available, Rely-X ARC(3M/ESPE, St. Paul, MN, USA), a double-paste mixing material indicated for bondingindirect restorations. It has working timeapproximately two minutes and self-curingtime of approximately 10 minutes. The sam-ples were obtained by using a metallicmatrix with a 2 mm thickness containingcircular perforations of 4 mm diameter.These matrixes were filled with cement aftermanipulation according to the manufactur-er’s instructions.

Figure 1. Metallic matrix.

Each group was submitted to one of the following procedures (n = 10):• Group I: light cured during

40 seconds and stored for one hour • Group 2: light cured during

40 seconds and stored for 24 hours • Group 3: chemically cured in a dark

room and stored one hour • Group 4: chemically cured in a dark

room and stored for 24 hours

The light activation was achieved with aquartz-tungsten-halogen curing unit (XL3000 – 3M Dental Products, St Paul, MN)

SANTOS ET AL.


Test Machine (Instron 8872). The means and the standard deviation of each group in MPa were:Group 1 80.0 ± 5.7; Group 2 80.2 ± 10.2; Group 3 59.7 ± 3.0; Group 4 70.3 ± 8.3. Statistical analysisrevealed that, (1) light-cured groups exhibited the highest diametral tensile strength, regardlessthe storage time, and (2) storage time caused an increase in the final diametral tensile strengthof the chemically cured groups.

RÉSUMÉPour évaluer l’influence de la photopolymérisation et de la durée de conservation sur la forcede traction ultime d’un ciment de scellement à base de résine composite double, 20 échantil-lons ont été préparés avec l’aide d’une matrice métallique de 2 mm sur 4 mm de diamètre,laquelle était remplie de Rely-X-ARC (3M ESPE, St-Paul, MN) et distribués au hasard dans 4groupes différents (n = 10) : photopolymérisation pendant 40 secondes et conservés dans del’eau distillée à 37 ˚C pendant une heure (Groupe 1) ou 24 heures (Groupe 2); durcissement chim-ique dans une pièce sombre et conservés dans de l’eau distillée pendant une heure (Groupe 3)ou 24 heures (Groupe 4). Après l’entreposage, les échantillons ont été soumis à un test de forcede traction ultime sur une machine d’essai universelle (Instron 8872). Les moyennes et l’écart-type de chaque groupe en MPa étaient : Groupe 1 : 80,0 ± 5,7; Groupe 2 : 80,2 ± 10,2; Groupe 3 :59,7 ± 3,0; Groupe 4 : 70,3 ± 8,3. L’analyse statistique a révélé que (1) les groupes de pho-topolymérisation avaient la force de traction la plus élevée, peu importe la durée de conserva-tion et (2) le temps de conservation a entraîné une augmentation de la force de traction ultimedes groupes à durcissement chimique.

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



INFLUENCE OF LIGHT CURE AND STORAGE TIME ON THE DIAMETRAL TENSILE STRENGTH OF A RESIN-BASED LUTING CEMENT

with 570 mw/cm2 of potency, for 40 sec-onds. Chemical cure only, without the pres-ence of light, was made possible by protect-ing the samples surface with a polyesterstrip covered with a black protector.The samples were stored in distilled water at37ºC during 24 hours. For the DTS tests,after the storage time established for eachgroup, the specimens were positioned in auniversal Testing machine (Instron 8872)which had a constant speed of 0.5mm/minute, with a cell load of 100 N, thusallowing a reading with an accuracy of 5 g.

Figure 2. Disc specimen mounted inthe testing deviceassembled for DTStesting.

The discs were placed in this machine intheir vertical position related to their diam-eter with a sheet of absorbent paperbetween the disc and the machine surfaces.Load was applied until failure occurred.DTS values were calculated using the for-mula:9

Where σx is DTS, P is the force (N), D isspecimen diameter (mm) and T is thickness(mm). Means and standard deviations (SD)were calculated and data statistically ana-lyzed with one-way ANOVA and Tukey-Kramer test.

ResultsMean values +/− standard deviationsobtained for each group were (in Kgf/cm2):Group 1 80.0 +/− 5.7; Group 2 80.2 +/−10.2; Group 3 59.7 +/− 3.0; Group 4 70.3+/− 8.3. The distributions of the results forthe four groups were normally distributed.Values obtained were submitted to statisti-cal analysis, Anova-2 Way test for eachgroup individually reveled that there were astatistically significant difference betweenthe groups (p = .014). A Tukey-Kramer testrevealed that there was statistically signifi-cant difference (p < .05) between groups asshown at Table 1.

Table 1. Mean diametral tensile strengthvalues (MPa ± SD)

Group 1 80.0 ± 5.7 aGroup 2 80.2 ± 10.2 aGroup 3 59.7 ± 3.0 bGroup 4 70.3 ± 8.3 c

Same letter represent mean values that arenot significantly different (P > .05)

Discussion and ConclusionsA luting cement having appropriate proper-ties and utilizing appropriate handling dur-ing cementation procedures is essential toachieve clinical success with bondedrestorations. The final result must be anintimate bond between the restoration andthe tooth structure via the medium of theresin cement, suitable to withstand the rig-ors of the oral environment.9

According to Wathen (2000)10, adhesive lut-ing procedures, when properly executed,restore the ability of the tooth to withstandforces to that of an intact tooth. Therefore,the choice of using of an appropriate resinluting cement when indicated can provideprostheses with higher long-term clinicalfunction.While halogen-light activation is a valuableadjunct to facilitate the polymerization ofluting cements, some products are formu-lated as to be too dependent on light activa-tion, which this may lead to an inadequatecure and poorer clinical performance.11

However, if a cure occurs not only by lightactivation, but also by chemical activationwhen light intensity is weak, such as in thecase of metallic or ceramic crowns that pre-vents the action of the light on the resincement due to their opacity, a higher degreeof success may be possible.3,5

To evaluate the properties of the resincements it is necessary to use some extrinsicanalysis criteria due to the fact that directmeasures of cement conversion cannot beeasily accomplished. Polymerization is stud-ied indirectly by measuring flexuralstrength, the modulus of elasticity, surfacehardness, and other measures that are indi-cators of the resin cement properties.1 DTSvalues may therefore indicate the cohesiveresistance of a resin cement and thus pro-vide a numerical parameter for evaluatingthe degree of conversion of the monomersduring polymerization.In the present study, the extent of polymer-ization of the cement cured by the chemicalcomponent alone was significantly lowerthan that presented by chemical and lightcuring together. These findings are in agree-ment with other studies.2,12,13

The increase on the DTS values after 24hours, when the cement was cured withoutbenefit of light, indicates that dual-curedresin cements may be used for cementationof opaque prostheses. In these cases, lightcuring of the margins provides an initial

stability for the crown, which is comple-mented and completed by the chemicalreactions.1

After the statistical analysis and discussionof the results, the authors concluded that:1. The light cured groups exhibited the

highest DTS values, independent ofthe storage time;

2. Storage time in distilled water causedan increase in the final DTS of thechemically cured groups and did notinterfere with the light cured ones.

DisclosureThe authors declare no competing financialinterests.

References1. Hofmann N, Papsthart G, Hugo B, Klaiber

B. Comparison of photo-activation versuschemical or dual- curing of resin-basedluting cements regarding flexuralstrengh, modulus and surface hardness. JOral Rehabil 2001;68:1022–28.

2. El-Badrawy WA, El-Mowafy OM. Chemicalversus dual curing of resin inlay cements.J Prosthet Dent 1995;73:515–24.

3. Lee IB, Um CM. Thermal analysis on thecure speed of dual cured resin cementsunder pocelain inlays. J Oral Rehabil2001;28:186–97.

4. Peutzfeldt A. Dual-cure resin cements: invitro wear and effect of quantity ofremaining double bonds, filler volume,and light curing. Acta Odont Scand1995;53:29–34.

5. Darr AH, Jacobsen PH. Conversion of dualcure luting cements. J Oral Rehabil1995;22:43–47.

6. Dewald JP, Ferracane JL. A comparison offour modes of evaluating depth of cure oflight-activated composites. J Dent Res1987;66:727–30.

7. Kovarik RE, Ergle JW, Fairhurst CW. Effectsof specimen geometry on the measure-ment of fracture toughness; Dent Mater1991;7:166–69.

8. Johnson WW, Dhuru VB, Brantley WA.Composite microfiller content and itseffect onfracture toughness and diame-tral tensile strength. Dent Mater1993;9:95–98.

9. Peumans M, Van Meerbeek B, LambrechtsP, Vanherle G. Porcelain veneers: a reviewof the literature. J Dent 2000;28:163 77.

10. Wathen WF. The laws of physics have notchanged. Quintessence Int 2000;31:3.

11. Watts DC, Cash AJ, Chauhan J, Rathore S.Variables influencing hardness develop-ment in dual cure composite luting mate-rials. J Dent Res 1994;73:801.

12. Ferracane JL, Berge HX. Fracture tough-ness of experimental dental compositesaged in ethanol. J Dent Res1995;74:1418–23.

13. Rueggeberg FA, Caughman WF. The influ-ence of light exposure on polymerizationof dual-cure resin cements. Oper Dent1993;18:48–55.


CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



Laser-Assisted GingivalTissue Procedures in

Esthetic DentistryBy Ernesto A. Lee, DMD, DCD

ABSTRACTSoft tissue lasers are increasing in popularity among clinicians in partdue to their potential value in preprosthetic gingival procedures. Theability of soft tissue lasers to control moisture and facilitate hemostasisappears particularly promising for clinicians excising gingival tissues,performing esthetic crown lengthening, and using resective techniquesfor gingival troughing—and these applications will grow as practitionersbecome more familiar with such technologies. This presentation high-lights the use of the 810 nm diode laser for perio-restorative proceduresin the anterior maxilla.

RÉSUMÉLes lasers pour les tissus mous sont de plus en plus en demande par lescliniciens en partie en raison de leur valeur potentielle pour les interven-tions préprothétiques des gencives. La capacité des lasers pour les tissusmous de contrôler l’humidité et de faciliter l’hémostase semble partic-ulièrement prometteuse pour les cliniciens faisant une excision des tis-sus gingivaux, un allongement de couronne et utilisant des techniquesde résection pour les creux gingivaux. Ces applications se développerontau fur et à mesure que les practiciens connaissent mieux ces technolo-gies. Cette présentation souligne l’utilisation d’un laser à diode de 810nm pour le traitement périodontique de restauration du maxillaireinférieur.


About the AuthorErnesto Lee is clinical associate professor, Postdoctoral Periodontal Prosthesis, University of

Pennsylvania School of Dental Medicine, Philadelphia, PA; visiting professor, Advanced AestheticDentistry Program, New York University College of Dentistry, New York, NY. He is also in private practice

in Bryn Mawr, PA. He may be reached at [email protected].

41


CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



LASER-ASSISTED GI NGIVAL TISSU E PROCEDU RES I N ESTH ETIC DENTISTRY

Though soft tissue lasers have not beenwidely accepted by the dental com-

munity, they offer the potential toenhance preprosthetic gingival proce-dures while exhibiting decreased biologicside effects. An evaluation of their clinicalbenefits is necessary to ascertain theadvantages of their application in restora-tive dentistry procedures.

Laser-Assisted Gingivectomy /GingivoplastyThe removal of gingival tissue for restora-tive purposes is usually performed in orderfor a clinician to gain access and delivertreatment to areas located below the gingi-val margin. Depending on the particularclinical scenario, one or more surfaces maybe involved around a single tooth or multi-ple teeth. Additionally, situations may pres-ent where gingival excision is required forthe purposes of facilitating moisture controlthroughout the restorative procedure, eventhough the area to be treated is locatedsupragingivally (e.g., in cases where gingivalinflammation is present, posing a risk ofbleeding in conjunction with the attendantincrease in crevicular fluid flow).Alternatives for gingival tissue removalinclude the use of a scalpel, electrosurgery,and/or lasers.1,2 The traditional surgicalapproach utilizing a scalpel blade exhibitsthe disadvantage of eliciting bleeding, whichis a concern particularly if restorative den-tistry is to be performed subsequently.Alternatively, electrosurgery has been uti-lized effectively to excise gingival tissue,while simultaneously providing adequatehemostasis,1 and is therefore preferred bymany restorative dentists. Heat generationwith this technique, however, occurs to adegree where irreversible damage to thealveolar crest may result,1,3 leading to reces-sion and exposure of restorative margins,which negatively affects the esthetic zone.Lasers offer the potential of increased oper-ator control and minimal collateral tissuedamage. Diode lasers, specifically, operate ata wavelength that is easily absorbed by thegingival tissues,4 while posing little risk ofdamaging the tooth structure. Despite this,caution should still be exercised to avoidthermal injury resulting from excessive heatgeneration.

Esthetic Crown LengtheningDespite the clinical naiveté expressed bymany surgeons, esthetic crown lengtheningis a technically demanding endeavor thatrequires gingival incisions exhibiting a

higher degree of precision than thatachieved with a scalpel blade, regardless ofthe operator’s skill level. The fine tip of thediode laser offers superb control and can beeasily manipulated to precisely create thegingival margin contours required to suc-cessfully perform esthetic crown lengthen-ing procedures (Figure 1).Prior to any such treatment, the area shouldbe probed and bone sounding (i.e., biologicwidth) should be performed. The amountof attached gingiva, the location of the crestof bone, and how much crown lengtheningis needed will determine if a full flap andosseous recontouring is the appropriatemethod of treatment versus a gingivectomywith a scalpel or a dental laser.Additionally, since esthetic demands are thedriving force behind treatment,5 a provi-sional restoration must be frequently placedduring the same appointment. Laser inci-sions are completed while achieving excel-lent hemostasis so that inadequate moisturecontrol is not a factor interfering with thefabrication of the temporary and adjunctiverestorative procedures.The 810 nm soft tissue diode laser (i.e.,Odyssey, Ivoclar Vivadent, Amherst, NY)offers unprecedented control of the tissuesculpting procedure. Fine revisions of theincision line are achieved with ease with adegree of coagulation, resulting in excellenthemostasis and a clean surgical field.6 Thediode laser exhibits little or no affinity forthe dental hard tissues, metal alloys, orporcelain and, therefore, may be utilized inclose proximity to the root surface or exist-ing restorations or implants.4 This can beaccomplished with little or no effect on thecementum layer, without concerns of con-ducting an electrical current through thetooth structure or an existing metallicrestoration, and without the potentialoccurrence of thermal injury to the pulp(Figure 2).From a technical perspective, the diodelaser may be used with the fiber tip either incontact to cut or in close proximity to treatthe target area. The unit under evaluationincludes an aiming light to facilitate guid-ance of the laser beam during non-contactuse. Placement of the tip directly in contactwith the surgical site for cutting, however,enhances tactile feedback while providingthe operator with a sense of familiarity rela-tive to other dental cutting or drilling pro-cedures. Power settings are adjustable, andthe laser beam may be delivered in a con-stant or pulsed mode.7

The gingivectomy technique with a diodelaser is slightly different than electrosurgery.Since the energy is concentrated at the tip ofthe fiber and tissue penetration is shallow,the laser beam must be oriented along theincision plane while the ablation isadvanced through the layers (Figure 2). Inthe author’s experience, this results in softtissue removal that is somewhat slower thanwhat is possible with electrosurgery,although operative control is significantlyincreased. Alternatively, the laser beam maybe applied in a constant mode to providefaster cutting, but this could lead toincreased thermal transfer to the adjacenttissues. Temperatures higher than 200°Cwill result in carbonization and formationof a charred layer, which absorbs heat andmay interfere with adequate energy transferfrom the laser. Removal of the carbonizedresidue from the tooth structure may becumbersome, and could become an estheticconcern when translucent all-ceramicrestorations will be placed subsequently.The operator must adjust his or her tech-nique and laser settings to achieve anacceptable balance between optimum cut-ting efficiency and the reduction of charredlayer formation.In addition, depending on the degree ofgingival tissue excised and the periodontalbiotype, an external bevel gingivectomymay be required to develop natural con-tours from the new gingival margin loca-tion. This surgical beveling was traditionallyperformed with a scalpel, knife, surgicalnippers, or a round diamond, resulting in alarge, bleeding surface wound that wouldcontribute to the patient’s postoperative dis-comfort. In contrast, preparing the externalbevel gingivectomy with a diode laser pro-duces a bloodless environment as well as aclean surgical field that lends itself to thesuccessful completion of the restorative pro-cedure at hand (Figure 3).6

The degree of coagulation and hemostasisachieved with the diode laser results in adry operating field that facilitates the imme-diate fabrication of a provisional restoration,avoiding the exposure of subgingival rootsurfaces and open embrasure spaces. This isa distinct advantage in the management ofthe esthetically aware patient. Laser surgeryis well tolerated by the tissues, and theshort-term healing response comparesfavorably to scalpel incisions and electro-surgery (Figure 4).6


CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



Pre-Impression Gingival TroughingImpression procedures are the key factor in the fabrication of indirectrestorations.8 The intraoral structures must be replicated in vivo andprecisely duplicated in the laboratory environment. Exposure of sub-gingival finish lines in conjunction with adequate moisture control areprerequisites for the achievement of accurate impressions.1,8 A double-cord retraction technique has been advocated to mechanically displacethe sulcus, providing access to the finish line so that it may be ade-quately captured by the impression material.8 Although capable ofyielding excellent results, the double retraction cord technique is con-sidered cumbersome by many clinicians. An alternative method uti-lizes electrosurgery to resect the gingival wall of the sulcus, thereforecreating a trough along the finish line where the impression materialwill be subsequently syringed.1 One problem with electrosurgery, how-ever, is the fact that lateral heat generation will cause necrosis of thealveolar crest. Recession has been a consistent side effect of this tech-nique, which is detrimental within the esthetic zone. Additionally,hemostasis is not always effective with plasmatic extravasation occur-ring as a result of soft tissue trauma (Figure 5).Diode lasers offer clinicians the potential of utilizing a resective tech-nique for gingival troughing, which simplifies the impression proce-dure while providing adequate hemostasis and allowing improvedcontrol of heat transfer to the adjacent tissues (Figure 6).6 Providedthat necrosis of the alveolar crest is avoided, healing following gingivalexcision with a diode laser should lead to the regeneration of the den-togingival complex to preoperative or near preoperative gingival mar-gin levels. Therefore, thermal energy generation and transfer must becontrolled by using the laser beam in a pulsed mode whenever possi-ble, as well as implementing the use of cooling methods such as run-ning an air current or incorporating a water spray throughout the pro-cedure.The quality and duration of hemostasis achieved facilitate the comple-tion of multiple accurate impressions (Figure 7). This is becoming ofparticular importance given the increasing popularity of zirconiaframeworks, which cannot be soldered to compensate for impressioninaccuracies as is the case with metalceramic techniques.

ConclusionDiode laser units are characterized by their compact dimensions andrelatively low cost. Their use in pre-prosthetic soft tissue managementoffers a number of potential advantages. Gingival excision and estheticcrown lengthening procedures can be performed with unprecedentedlevels of precision while achieving excellent hemostasis. Though diodelasers demonstrate great effectiveness when utilized for gingivaltroughing prior to taking definitive impressions, questions still remainregarding heat generation and transfer to the adjacent tissues.Assuming that a protocol can be developed to consistently apply thistechnique without eliciting alveolar crest necrosis, diode lasers wouldbe a welcomed addition to the restorative dentist’s armamentarium, interms of clinical effectiveness, practicality, and cost efficiency.

LEE


Figure 1. Diode lasers provide unsurpassed operator control, allowingfor precise tracing of a pre-established incision design.

Figure 2. Gingival excision is achieved in layers with excellent hemo-stasis and a clean surgical field.

Figure 3. The diode laser may be utilized to perform a bloodless exter-nal bevel gingivectomy, facilitating the immediate placement of pro-visional restorations.

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



LASER-ASSISTED GI NGIVAL TISSU E PROCEDU RES I N ESTH ETIC DENTISTRY

References1. Shillingburg HT Jr., Hobo S, Whitsett LD, et

al. Fluid control and soft tissue manage-ment. Fundamentals of FixedProsthodontics, 3rd ed. Carol Stream IL;1997:257–79.

2. Sarver DM, Yanosky M. Principles of cos-metic dentistry in orthodontics: Part 2.Soft tissue laser technology and cosmeticgingival contouring. Am J OrthodDentofac-Orthoped 2005;127(1):85–90.


Figure 4. Post-operative appearance two weeks following laser-assist-ed esthetic crown lengthening with immediate provisionalization.

Figure 7. Access to preparation margins coupled with adequate mois-ture control results in consistently successful impression taking.

Figure 5. Preoperative view of abutment(s) prior to definitive impres-sions. Please note inflamed tissues and presence of bleeding.

Figure 6. Gingival troughing with the diode laser exposes finish lineswhile providing excellent hemostasis. Heat transfer to the alveolarcrest must be carefully monitored.

3. Kalkwarf KL, Krejci RF, Edison AR,Reinhardt RA. Lateral heat production sec-ondary to electrosurgical incisions. OralSurg Oral Med Oral Pathol 1983;55:344–48.

4. Patino MG, Neiders ME, Andreana S, et al.Cellular inflammatory response toporcine collagen membranes. JPeriodontal Res 2003;38(5):458–64.

5. Kois JC. Altering gingival levels: Therestorative connection. Part 1: Biologic

variables. J Esthet Dent 1994;6(1):3–9.6. Rossmann JA, Cobb CM. Lasers in peri-

odontal therapy. Periodontol 2000 1995;9:150–64.

7. Colluzzi DJ. Fundamentals of dentallasers: Science and instruments. Dent ClinNorth Am 2004;48:751–70.

8. Lee EA. Predictable elastomeric impres-sionsin advanced fixed prosthodontics: Acomprehensive review. Pract PeriodontAesthet Dent 1999;11(4):497–504.

Reprinted with permission from Pract Proced Aesthet Dent. 2006 Oct;18(9):suppl 2–6.

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



I N DUSTRY N EWS / NOUVELLES DE L ' I N DUSTR I E


Smile ReminderIntroduces New Extend

Platform for ExternalMessaging & Patient

Acquisition

Extend Platform’s First Feature, ZubuMail,Launched at ADA 2009

Leading patient communicationservice Smile Reminder unveiled

at the American Dental Association’s150th Annual Session in Honolulu,Hawaii, its brand new Extend Platform and ZubuMail, the first of aseries of features on the new platform. ZubuMail, an external com-munication and patient acquisition tool, is intended to increase theefficiency and profitability of dental practices nationwide by leverag-ing data-targeting models to create customized direct mail cam-paigns that are both precise and cost effective. “Doing efficient and effective external marketing is an integral part ofbuilding a practice in the dental industry,” says Smile Reminder VP ofMarketing Mark Olson. “Our Extend Platform and ZubuMail willaddress this need by providing the right strategically-driven technolo-gies to help dental practices grown and thrive. ZubuMail is an excellentexample of making direct mail more efficient and effective.”Developed specifically to pin-point the best possible candidates for pro-cedures like veneers, TMJ, ortho, implants, sleep apnea, and muchmore, ZubuMail aims to provide dental practices with a better andsmarter direct mail solution for building revenue and acquiring newpatients. With customization on every level, ZubuMail allows for highly effectiveand efficient direct mail campaigns intended to boost revenue by bring-ing in new patients for specific products and procedures. www.smilereminder.com

ProDriveUpgrades the

Kavo SuperTorquesUpgraded Cut

Performance, SmootherCutting and SuperiorHand Piece Precision

ProDrive Systems announced theexpansion of upgrade turbine

models designed to outperformfriction grip and increase handpiece performance. ProDrive intro-duces the line of upgrade turbinesdesigned for Kavo 630, 640, and647/649 Super Torque hand pieces.Unlike traditional friction gripdesign, ProDrive1s patented engagedturbine and triangular bur systemlock together for noticeably improvedcut performance, superior controland improved precision. The patent-ed design provides long-term durableand reliable performance, comparedto friction grip design, which degradeprematurely. ProDrive Turbines shipwith a comprehensive 1-year warran-ty, including bearings.ProDrive Systems are availablethrough authorized dealers across theUnited States and Canada. ContactProDrive Systems or your local dealerto experience the ProDrive differ-ence.www.prodrivesystems.com

If you have a press release you would like us to consider for Industry News, please forward them to

Scott Bryant, managing editor at:[email protected]

Si vous avez un communiqué de presse à soumettreaux Nouvelles de l’Industrie, veuillez le transmettre àScott Bryant, Gestion de la Rédaction:[email protected]

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



I N DUSTRY N EWS / NOUVELLES DE L ' I N DUSTRI E

BIOMET 3iCanada

Introduces theirAlliance withBisco Canada

Two leading dental companiesannounced their official partnership

on November 1, 2009. BIOMET 3iCanada, a leader in implant dentistrywith one of the most comprehensiveimplant product lines, and Bisco Canada,a pioneer and leader in restorative dentalmaterials, have created a unique synergypartnership to bring higher value to den-tists in Western Canada. This unprecedented Western Canadianalliance combines and offers the exceptionalscientific pedigrees of both companies tothe dental marketplace in a more efficientmanner. The focal point of this alliance willbe to provide many opportunities to helpdentists develop, promote and deliver highstandards of patient care in their practiceswhile providing support and servicethrough Bisco Canada’s talented customerservice team based out of Richmond, BC.The convergence of BIOMET 3i Canadaand Bisco Canada’s strengths will only resultin better dentistry.Please do not hesitate to contact eitherBisco Canada 800.667.8811 or BIOMET 3i Canada 800.363.1980 for more informa-tion on how this partnership can compre-hensively elevate your clinical experience.


U.S. DentistsSoon to Have

New Anti-snoring Device

Calgary-based MPowRx Health andWellness Products Inc. (MPowRx)

announced today that the United StatesPatent and Trademark Office has grantedUnited States Patent 7,533,674 entitled“Tongue Retention Device.” The awardedpatent broadly covers the MPowRx™;Snoring Solution and underscores theinnovate nature of the device. This patentcomplements a previously awarded USDesign Patent D461,240 entitled “TongueRetention Device.”The MPowRx™ Snoring Solution(www.isleepsound.com), distributed inCanada by a leading national distributorPatterson Dental (www.pattersondental.com), is being embraced by dental profes-sionals who recognize the large unmet clinical need in the treatment of snoring. “We are excited to extend this clinicallyproven device to the 56 million American’swho suffer from snoring,” says NancyMarkley of MPowRx. The MPowRx™;Snoring Solution was developed by notedDr. Leslie Dort, Calgary dentist and dentalsleep medicine researcher, in response togrowing incidence, and unmet need for asimple, cost effective and clinically proventreatment. www.isleepsound.com

WebDental.comGoes Social

Popular Dental Industry WebSite Launches Social Network

WebDental.com announced that after13 years of serving the dental

industry as a trusted informationresource, the website has launched a newonline community to bring dentists closerto their colleagues.When WebDental.com was created 13 yearsago, Cary Feuerman, DMD. and GiovanniCastellucci, DMD set out to create the bestonline dental information resource.Originally the site served as a directory,sharing information from other disparatedental resources online. Patients were alsoable to find the nearest dental officethrough the site. To Feuerman and Castellucci’s surprise, themost popular section of the site was a com-munity forum where dentists could useextremely limited tools to ask questionsand share information directly with otherdental professionals. Based upon over-whelming demand for increased one-on-one communication between dentists,hygienists, lab technicians and oral surgeons,WebDental.com was completely rebuilt asan online community to better facilitatethose conversations. “We are extremely happy, but not surprisedby the overwhelming reaction to the newsite,” said Cary Feuerman, co-founder ofWebDental. “In a short time, we haveattracted some of the best dental profession-als from around the world to contribute tothe site and share their experiences andinsight.”The new WebDental has re-launched withadded features including: • Member Blog Posts • Industry Events Calendar • Industry Specialty Discussion Groups • Videos • Twitter Account • Facebook Fan Page www.webdental.com

CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



CJRDP 2-4 2009:Layout 1 11/12/09 8:26 AM



cjrd volume 2, issue 4 (pdf)

Documents