lightwaves news now featured in a special section · 2013-08-05 · pediatric laser dentistry: a...
TRANSCRIPT
• Summary of ALD’s 17th Annual Conference• Academy Committee Reports and Announcements• Student Scholar Presentations• Scientific Research: Er:YAG Laser and LAWA System• Patient Communication Before and After Laser Treatment• Infection Control
The Official Journal of the Academy of Laser Dentistry 2010 • Vol. 18 No. 2The Official Journal of the Academy of Laser Dentistry 2010 • Vol. 18 No. 2
Academy of Laser Dentistry3300 University Drive, Suite 704
Coral Springs, FL 33065
810-nm Diode Laser-Assisted Soft Tissue Procedures in OrthodonticsDr. Louis G. Chmura on page 71
Lightwaves News Now Featured in a
Special Section
Pediatric Laser Dentistry: A User’s GuideGiovanni Olivi, Fred S. Margolis, and Maria Daniela Genovese
This comprehensive guide, the first to focus on laser applications in pediatricdentistry, reviews the basic science of laser dentistry and demonstrates all fun-damental therapeutic steps with ample photos and illustrations. It is intended fordentists who are new to the laser as well as those experienced in providing lasertherapy to adults.
ISBN 978-0-86715-494-8 (B4948); Available Winter 2010
Oral Laser ApplicationEdited by Andreas Moritz
This unique book presents all conventional indications for laser-assisted den-tistry, as well as recent advancements in the field. For each indication, detailed instructions are provided in both text and illustrations to allow even novices to make successful, responsible, and immediate use of this innovative technology.An invaluable guide for all clinicians currently using or wishing to integrate laser-assisted dentistry in their practice.
592 pp; 820 illus (mostly color); ISBN 978-1-85097-150-4 (B9013); US $278
Atlas of Laser Applications in DentistryDonald J. Coluzzi and Robert A. Convissar
This clinical atlas presents an overview of intraoral laser use followed by the indications and contraindications, special considerations, and relevant risks asso-ciated with procedures in each discipline. This book is a quick study for anyonewho has invested in laser instrumentation or is contemplating such a purchase.
230 pp; 477 illus (mostly color); ISBN 978-0-86715-476-4 (B4764); US $138
CALL: (630) 736-3600 (elsewhere) 08/10
FAX: (630) 736-3633 EMAIL: [email protected] WEB: www.quintpub.comQUINTESSENCE PUBLISHING CO INC, 4350 Chandler Drive, Hanover Park, IL 60133
TO ORDER
Titles in
LASER DENTISTRYAvailable soon
Also available
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TA B L E O F CO N T E N T S
EDITOR’S VIEWRenewal ................................................36Donald J. Coluzzi, DDS
PRESIDENT’S MESSAGEAn Interview with Steven Burman, ALD President....................37
EXECUTIVE DIRECTOR’SMESSAGETime for Honest Assessment —Strategic Leadership Initiatives ......38Gail Siminovsky, CAE
COMMITTEE REPORTS ........................................39
CONFERENCE SUMMARYDentistry Changing with the Speed of Light: An Overview of the ALD’s Miami Conference ....45Charles Rhodes, DDS
INVITATION TOLEARNING ....................................47
ALD CERTIF ICATIONPROGRAM ....................................48
NOMINATIONS ........................49
ALD SEEKS AWARDSRECOMMENDATIONS ......51
ALD FELLOWSHIP AND MASTERSHIPAPPLICATIONS OPENSEPTEMBER 1 ..........................53
SCHOLARSHIPAVAILABLE FOR 2010-2011 DENTALSTUDENTS ....................................55
STUDENT SCHOLARSEr:YAG Laser Debonding ofPorcelain Veneers ..............................56Cynthia Morford, DDS, Natalie C. H. Buu, DMD, Frederick C. Finzen,DDS, Arun B. Sharma, BDS, MSc, PeterRechmann, Prof. Dr. med. dent.
Low-Level Er:YAG Laser Irradiation Enhances OsteoblastProliferation Through Activation of MAPK/ERK ......................................57Verica Aleksic, DDS, PhD, Akira Aoki,DDS, PhD, Kengo Iwasaki, DDS, PhD,Aristeo Atsushi Takasaki, DDS, PhD,
Chen-Ying Wang, DDS, YoshimitsuAbiko, DDS, PhD, Isao Ishikawa, DDS,PhD, Yuichi Izumi, DDS, PhD
Efficacy of 640-nm Diode LaserTreatment for Prevention of OralMucositis in Pediatric Cancer Patients ..................................59Adar Ben-Amy, DMD, Noel K. Childers,DDS, MS, PhD, Tabitha Jarman, DMD,Andrei Barasch, DMD, MDSc
SCIENTIF IC RESEARCHPossible Applications of an Er:YAGLaser Combined with a LaserApplication for Wide Area (LAWA)System: An In Vitro PulpalTemperature Study ............................61Bülent Gökçe, DDS, PhD, BirgülÖzpinar, DDS, PhD, Prof. Dr., Emil Litvak, DDS
PATIENT COMMUNICATIONHow to Communicate to Patients Before and After Laser Treatment ..................................64Angie Mott, RDH
INFECTION CONTROLInfection Control ................................68Frank Yung, DDS
COVER FEATURECLINICAL CASEFull-Mouth Gingivectomy andExposure of an Unerupted CuspidUsing an 810-nm Diode Laser ......71Louis G. Chmura, DDS, MS
RESEARCH ABSTRACTSLaser-Assisted Soft TissueApplications in Orthodontics..........77
The official journal of the Academy of Laser Dentistry
Editor-in-ChiefDonald J. Coluzzi, DDSPortola Valley, CA [email protected]
Managing EditorGail S. Siminovsky, CAE, Executive DirectorCoral Springs, FL [email protected]
Consulting EditorJohn G. Sulewski, MA Huntington Woods, MI [email protected]
Associate EditorsStuart Coleton, DDS, Chappaqua, NYAngie Mott, RDH, Tulsa, OKPeter Pang, DDS, Sonoma, CASteven Parker, BDS, LDS, RCS, MFGDP,
Harrogate, North Yorks, United KingdomCharles Rhodes, DDS, Charleston, WVWayne Selting, DDS, Colorado Springs, CO
PublisherMax G. MosesMember Media
1844 N. Larrabee • Chicago, IL 60614312-296-7864 • Fax: 312-896-9119
Design and LayoutDiva Design
2616 Missum Pointe • San Marcos, TX 78666512-665-0544 • Fax 609-678-0544
Editorial Office3300 University Drive, Suite 704
Coral Springs, FL 33065
954-346-3776 Fax 954-757-2598
The Academy of Laser Dentistry is a not-for-profitorganization qualifying under Section 501(c)(3) ofthe Internal Revenue Code. The Academy of LaserDentistry is an international professional member-ship association of dental practitioners and sup-porting organizations dedicated to improving thehealth and well-being of patients through theproper use of laser technology. The Academy isdedicated to the advancement of knowledge,research and education and to the exchange ofinformation relative to the art and science of theuse of lasers in dentistry. The Academy endorsesthe Curriculum Guidelines and Standards forDental Laser Education.
Copyright 2010 Academy of Laser Dentistry
Journal of Laser Dentistry
The Journal of Laser DentistryThe mission of the Journal of Laser Dentistry is toprovide a professional journal that helps to fulfillthe goal of information dissemination by theAcademy of Laser Dentistry. The purpose of theJournal of Laser Dentistry is to present informationabout the use of lasers in dentistry. All articles arepeer-reviewed. Issues include manuscripts on cur-rent indications for uses of lasers for dental applica-tions, clinical case studies, reviews of topics relevantto laser dentistry, research articles, clinical studies,research abstracts detailing the scientific basis forthe safety and efficacy of the devices, and articlesabout future and experimental procedures. In addi-tion, featured columnists offer clinical insights, andeditorials describe personal viewpoints.
RenewalDonald J. Coluzzi, DDS, Portola Valley, CaliforniaJ Laser Dent 2010;18(2):36
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E D I TO R ’ S V I E W
Coluzzi
You will notice that this issue of theJournal features a different formatthan the previous few volumes. TheAcademy’s leadership and I decidedthat you, the membership, shouldhave access to much more informa-tion about the work of the variouscommittees and other pertinentactivities, along with meaningfulclinical and scientific articles aboutthe use of lasers in dentistry. So youwill find that the contents of thisissue will include news about theAcademy, messages from the leader-ship, short committee reports, andannouncements with time value.Essentially we have merged theelectronic version of Lightwavesinto the Journal of Laser Dentistry,and have produced separatesections for each. The authors of thescientific and clinical articles wereall presenters at ALD’s 17th AnnualConference, held in April in Miami.
These revised contents give amore complete picture of the workof the Academy, as well as continuethe mission of dissemination ofinformation. You will notice thatthe membership informationsection's pages are beige toned, andthe scientific and clinical section'spages have a white background.
The contents of this issueconsist of:
M E M B E R S H I PI N F O R M AT I O N ,S EC T I O N 1 :• An interview with Dr. Steven
Burman, our President• A message from Gail Siminovsky,
our Executive Director• Reports from various committees• An overview of the Miami
Conference by Dr. Charles Rhodes• Announcements about
Nominations, Awards, StudentScholarship, and the Fellowshipand Mastership program.
SC I E N T I F I C A N DC L I N I C A LI N F O R M AT I O N ,S EC T I O N 2 :• Dr. Cynthia Morford, this year’s
first-place Student Scholarwinner, presents her abstractshowing how Er:YAG laserenergy can be used for debondingof porcelain veneer restorations.
• Dr. Verica Aleksic, this year’ssecond-place Student Scholarwinner, presents her abstractdescribing the use of an Er:YAGlaser to promote osteogenesis.
• Dr. Adar Ben-Amy, this year’sthird-place Student Scholarwinner, presents his abstract aboutthe use of a 640-nm diode laser forprevention of oral mucocitis inpediatric cancer patients.
• Dr. Bülent Gökçe offers a studyusing a proprietary scannersystem coupled to an Er:YAGlaser which changes the beamgeometry. Dr. Gokce was the 2009first-place Student Scholar winner.
• Ms. Angie Mott’s essay describescommunication suggestions tohelp the patient understanddental laser treatment.
• Dr. Frank Yung gives an overviewof infection control relating todental laser equipment.
• Dr. Louis Chmura presents anAdvanced Proficiency ClinicalCase Study. Dr. Chmuracompleted the rigorous AdvancedProficiency program at theMiami Conference, and is thefirst orthodontist to achieve thatlevel of certification.
• The Research Abstracts articleoffers insight and citations of theuse of lasers in orthodontics.
I would appreciate your feed-back on this ‘renewed’ version ofyour Journal. As always, pleasedon’t hesitate to contact me with
your comments and your articles.Keep smiling!
A U T H O R B I O G R A P H YDr. Donald Coluzzi, a 1970 graduateof the University of SouthernCalifornia School of Dentistry, is anassociate clinical professor in theDepartment of Preventive andRestorative Dental Sciences at theUniversity of California SanFrancisco School of Dentistry. He is acharter member and past presidentof the Academy of Laser Dentistry,and is currently the Editor-in-Chiefof the Journal of Laser Dentistry. Hehas used dental lasers since early1991. He has Advanced Proficiencyin Nd:YAG and Er:YAG laser wave-lengths. He is the 1999 recipient ofthe Leon Goldman Award forClinical Excellence and the 2006Distinguished Service Award fromthe Academy of Laser Dentistry, aFellow of the American College ofDentists, and a Master of theAcademy of Laser Dentistry. Dr.Coluzzi has presented about lasersworldwide, co-authored two books,and published several peer-reviewedarticles. Dr. Coluzzi may be contactedby e-mail at [email protected].
Disclosure: Dr. Coluzzi is a past andpresent presenter at various local, state,and national dental meetings. He hasno financial interest in any company. nn
Donald J. Coluzzi, DDS
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P R E S I D E N T ’ S M E S S AG E
JLD: Tell the readers a littleabout yourself.
Dr. Burman: I love helping mypatients achieve the gorgeous,healthy smiles they deserve, but Ido have a life outside the office! Iplay tennis, coach my boys in base-ball and basketball, watch the NewYork Yankees, and spend time withmy wife and daughter.
JLD: Why did you become adentist?
Dr. Burman: For as long as Ican remember, I wanted to be adentist. My grandfather was a peri-odontist, and my father, Dr. LesterBurman, recently retired fromdentistry. Since he was a foundingmember and past president of theAcademy of Laser Dentistry (ALD),I was honored to become a “secondgeneration” member, and follow inmy dad’s presidential footsteps. Weare the first father – son ALD pres-idents.
JLD: Please comment on howyou began to use lasers.
Dr. Burman: I was introducedto lasers by my dad. I had justgraduated from dental school andhe taught me how to use anNd:YAG laser for operculectomies,biopsies, and frenectomies. Whenthe U.S. Food and DrugAdministration (FDA) began trialsfor decay removal using an Er:YAGlaser, we had the opportunity toparticipate. It was a terrificlearning experience. With mygrowing interest in cosmetic
dentistry, the Nd:YAG offered me ameans of “easy” gingival recon-touring making my patients’ smilesmore beautiful.
JLD: What does the future ofdental lasers look like to you?
Dr. Burman: Lasers indentistry have progressed since Ibegan using them in 1993; however,I remain frustrated with the unin-formed dentist who insists that ascalpel is the best and necessarymethod to perform procedures thata laser can accomplish with greatercomfort to the patient. Rather thanreferring, they continue to perform“archaic dentistry” – a disservice totheir patients and their ownadvancement. As a laser dentist, Istrongly believe that we need towork harder to educate the dentalcommunity through programs andawareness. Both the ADA and theAGD are helping us to make stridesin this area, but we each need tobecome more involved locally.
JLD: What value does theAcademy of Laser Dentistryhave for you?
Dr. Burman: Each year Iattend the ALD Annual Conventionto learn and share something new.The most gratifying experience ismeeting new colleagues thatbecome new friends. I treasurethose friendships, and I continue tolearn from them. They really makedentistry “fun.” When I was firstasked to serve on a committee, Iwas hesitant. I thought it would
take up too much time or Iwouldn’t have anything tocontribute, but I quickly learnedthat problem solving with friends isrewarding and I do have a voice.Now I can say, “Make a difference,join a committee.”
JLD: What things are you goingto work on during yourPresidency?
Dr. Burman: Over the nextyear, my goal is to increasemembership and committeeinvolvement. I would also like toincrease ALD’s outreach to dentistsand dental students about the safeand beneficial use of lasers. The2011 Convention in San Diego,California, will offer interestingprofessional courses, and thechance to see the San Diego Zoo,Sea World, and the beautifulCoronado Beach resort. I hope ourmany ALD members will join usand will encourage their staff andcolleagues to attend. nn
Steven A. Burman, DMDALD President 2010-2011
An Interview with StevenBurman, ALD President
Do we have the resources to imple-ment change? At our annualmeeting in Miami in April, I intro-duced the Board to new resourcesin leadership development. I ampleased that the Board hasaccepted my proposed LeadershipInitiatives.
“Let’s take the bull by thehorns and show him we areup to the fight. According toan expert panel discussingthe overall nonprofit chal-lenges for the year 2010, ourboards need to remainstrategic, align programswith the mission, remaininnovative while keeping theeye on the bottom line,preserve the spirits bysharing successes, and ensureleadership succession isunder control. That’s a heftyorder but also the key tosuccess in this challengingclimate.”
– “Prepare for Battle,”The Report for BoardSource
Members, March 9, 2010.© BoardSource, 2010.www.boardsource.org
Society is making some funda-mental shifts now, in how peopletravel, how people buy, how peoplecommunicate, and how people learn.The world as we know it ischanging, and changing veryquickly. A few key questions: Whatdoes this societal shift mean to asso-ciations and how we do business?
What better time to re-inventourselves? What better time toreach out to our members and theprofession to CONNECT, LEAD,and LEARN together to promotelaser technology?
It’s time for an honest assess-ment of ALD’s business lines. Howdo we know what our members
need to be successful? How do webuild strategic alliances essentialfor ALD’s financial stability andremain unbiased and independent?How do we modernize our brand?Is our core mission relevant to thetimes? I believe it certainly is. Allthis might sound like “associationspeak,” and it is. It is very impor-tant for us as leaders to have aclear understanding of how associa-tions such as the Academy of LaserDentistry must change in order tobe relevant to our members.
Here are some key points:1. It is essential that we under-
stand the demographics of ourpractitioner members, thecommercial economic environ-ment, our corporate members,and the needs of the professionat large.
2. Only when our membershipfinds value will our relevancecontinue to be sustainable. Inorder to be the competent, cred-ible source for lasers indentistry, we cannot say we areby ourselves. Our members –dentists and hygienists andcorporate members – must sayALD is relevant. Some ideas: (a)revise ALD’s InformationTechnology presence – have ourWeb site change to includevideo; (b) introduce social mediaplatforms to engage membernetworking for conference andgeneral conversation.
3. Volunteer governance thinksdifferently, so we should beproblem-solving differently. Howcan we zero in on specific needsand proactively meet thoseneeds? Do we need 22 commit-tees? Would setting annualstrategic priorities work better?Would we better serve ourmembers by assigning projects
to specific individuals chargedwith and willing to acceptresponsibility for accomplishingtasks within a specific timewithin specific guidelines set bythe Board? Do we need toperform periodic review ofprograms in order to continuetheir existence?
Some ideas: (a) revise ouradministrative manual, elimi-nate some committees, andredefine new areas of neededfocus; (b) look at the meetingfootprint and model, and engageour members to volunteer asconference hosts and monitors,speakers, and sharers of theirown professional experiences;and (c) increase committee chair,board, and member communica-tion, with useful and timelyinformation.
4. ALD’s certification programneeds wings to fly and legs torun. Regulatory Agencies contin-ually look to us for guidance.This will be a primary role forthe Academy in 2010-2013. Weare currently working on alisting of States’ Scope ofPractice details to assist ourindividual and corporatemembers, to be posted onwww.laserdentistry.org andreadily available to anyone as aservice to dentistry.
5. With whom do we align andcollaborate? What strategicengagements will build ALD’sfuture? Will they include otherorganizations/lasergroups/universities? Successfulassociations have vendoralliances. In our dental world,
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E X EC U T I V E D I R EC TO R ’ S M E S S AG E
Time for Honest Assessment –Strategic Leadership Initiatives
Gail S. Siminovsky, CAE, Executive Director
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A L D CO M M I T T E E R E P O RT S 2010 - 11
A U X I L I A RYCO M M I T T E E
Committee Chair: Angie MottVice Chair: Mary Lynn SmithMembers: Jeanne Godett, Teri
Gutierrez, Gloria Monzon, NoraRafetto, Caroline Sweeney-Pang
New members are needed.
Overview of Committee ChargeThe committee works closely withthe Membership, Certification,Education, and Regulatory AffairsCommittees in addressing theneeds of auxiliary members.
Committee WorkThe Auxiliary Committee standsready to assist the RegulatoryAffairs committee to determine theposition of the United States andCanada regarding their position onhygienists using lasers.
For more information, contactAngie Mott, [email protected].
Angie Mott
C E R T I F I C AT I O NCO M M I T T E E
Committee Chair: John GraeberVice Chair, Testing: Donald
ColuzziVice Chair, Mentoring: Mel
BurchmanVice Chair, Clinical Simulation:
John SulewskiMembership: Robert Convissar,
Emile Martin, Raminta Mastis,Angie Mott, Shigeyuki Nagai,David Roshkind, Mary LynnSmith, Caroline Sweeney,Michael Swick
Consultant, Orthodontists: LouChmura
Overview of Committee ChargeAchieve universal recognition ofALD as the premier dental lasercertification source. Providestraightforward and readily avail-able policies, applications, andadministration of the certificationprocess, allowing more practi-tioners to become certified.
John Graeber
StrategiesEstablish a separate governanceand administrative structure forthe certification program. Thatstructure will have three mainduties:1. Continue to offer online courses,
reviews, and appropriate exami-nations as well as mentors forcertification candidates;
2. Ensure that the content andscope of all testing and testingmodalities are relevant tocontemporary practices anddental and educational philoso-phies;
3. Provide certification events atthe ALD annual conference aswell as other appropriatevenues. Continue a proactiverelationship with regulatorybodies and offer ALD’s certifica-tion expertise to them in theirefforts to help ensure safe andeffective laser practitioners.
Committee Work1. A comprehensive Survey of the
Standard Proficiency / AdvancedProficiency (SP/AP) process wasdistributed to Committeemembers, examiners, officers,and recent examinees. Thesurvey indicated general accept-ance of procedures already inplace. From the 2010 Miamicourse, 22 practitioners and oneLaser Safety Officer achieved
many professional societies havestrategic business allianceswithout compromising theirintegrity by endorsing productsor services. How can ALD iden-tify the right financialsponsorships to sustain us, topropel us? We will not surviveon dues and an annual meeting
and certification as our onlybusiness lines. ALD requiresnon-dues revenue to fulfill ourmission.I believe ALD’s role is para-
mount to the success of lasertechnology in dentistry. I lookforward to working with all of youto accomplish our goals together.
We have a terrific, albeit chal-lenging, opportunity. Let’s make ithappen.
I look forward to serving you,
Gail Siminovsky, CAEExecutive Director nn
These reports summarize the work of ALD’s committees. We invite you to review our efforts on behalf of YOU our membersbecause we value your input and your membership. Please Connect…Learn…& Lead with us. Contact any chair with yourconcerns and thoughts. It’s your participation that guides the way we accomplish the work of the Academy of Laser Dentistry.
Standard Proficiency. A few ofthe Standard Proficiency candi-dates in Miami have beenoffered remediation at no cost tothem during the months leadingup to the next Conference. Onedoctor completed his AdvancedProficiency certification.
2. The Committee has reorganizedfor more efficient functioningwith the appointment of vice-chairs of online testing (DonColuzzi), mentoring (MelBurchman), and ClinicalProficiency Simulation (JohnSulewski). The StandardProficiency Course will be heldon Wednesday at the San Diegomeeting. Clinical Simulation willtake place in the afternoon onThursday, Friday, or Saturday.This is being done in order tominimize the total number ofdays spent at the annualmeeting. A list of devices avail-able for testing will be publishedin the annual meeting booklet.
3. The Committee intends todevelop a short PowerPointPresentation to be distributed tothe Recognized Course Providers(RCPs) which will encourageinterest in the Academy’sStandard and AdvancedProficiency programs.
4. The Committee is planning toenlist qualified members in theExaminer program. We willassign provisional status tothese new participants and teamthem with experienced exam-iners in an effort to raise thelevel of quality of examiner.More training in calibration isanticipated.
For more information, contact JohnGraeber, [email protected].
E D U C AT I O NCO M M I T T E E
Committee Chair: Alfred WyattVice Chair: Scott BenjaminMembership: Sebastiano
Andreana, Don Coluzzi, JeanneGodett, John Graeber, AngieMott, Peter Pang, Steven Parker,David Roshkind, John Sulewski,Michael Swick
Overview of Committee ChargeThe purpose of the EducationCommittee of the Academy ofLaser Dentistry is to promote thehighest level of instruction andknowledge pertaining to lasers indentistry. The major responsibilityfor the Education Committee is toinclude the development andimplementation of the Curriculum
Alfred Wyatt
Guidelines and Standards forLaser Dentistry Education. It isresponsible for the Academy’sRecognized Dental Laser StandardProficiency Course Providerprograms as well as educationalobjectives, learning outcomes,course or presentation synopses forall speaker presentations at dentalmeetings, or other venues whereALD is sponsoring the presenta-tion and selecting the speaker torepresent the Academy.
Committee WorkThis year, the goals of theEducation Committee includeenhancing and expanding theeducation opportunities availablethat lead to ALD Standard andAdvanced Proficiency Certification.By offering more introductory andadvanced courses in variousregions of the world, the Academywill expose more of the dentalprofession to the proper, safe, andeffective use of lasers. Likewise, theAcademy will increase its exposureas the independent source of lasereducation in the dental profession.
For more information, contactAlfred Wyatt, [email protected].
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A L D CO M M I T T E E R E P O RT S 2010 - 11
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A L D CO M M I T T E E R E P O RT S 2010 - 11
ET H I CS CO M M I T T E E
Committee Chair: Don PatthoffVice Chair: Glenda PayasMembership: Yoram Allerhand,
Scott Benjamin, Alan Goldstein,John Graeber, Larry Kotlow, PhilMayers, Wayne Selting, JohnSulewski, Ana Triliouris
New members are needed.
Overview of Committee ChargeThe Ethics Committee provides thespace and time for the Academy to:develop its conscience, deliberateon routine and complex ethicalissues, offer guidance on theAcademy’s policies and decisions,and help its members and theirpractices develop professionally. Italso aims to integrate theAcademy’s insights and experiencesregarding the safe, effective, effi-cient, and ethical use of lasers indentistry with dental and otherhealth-care organizations.
The Committee, in order topreserve the integrity of theAcademy, helps to identify, articu-late, and rank the Academy’s corevalues. It has the responsibility toexamine the Academy’s under-standing and the use of its ethicalprinciples and virtues, as well asthe Academy’s proposed code ofprofessional conduct. The aim is tohelp assure that the moral imagi-nation of the Academy remainsrelevant to the Academy’s mission.At the same time, however, it mustalso keep the Academy’s Manualcoherent with the Principles ofEthics and Code of ProfessionalConduct of the American DentalAssociation, Ethics Handbook forDentists published by the AmericanCollege of Dentists, ACHE Code of
Don Patthoff
Ethics published by the AmericanCollege of Healthcare Executives,and other appropriate and/orprofessional texts that guide eachof the Academy’s members.
The Committee, furthermore,has the task to help educate theAcademy’s membership on theresponsibilities it has undertakenand promised through its missionand core values, as well as thatwhich is being proposed within itscode. In that capacity, the EthicsCommittee assists all committees tobetter facilitate their relationshipsinside and outside the Academy.
The Ethics Committee, last ofall, investigates all complaints foralleged violations of ethics andattempts to educate offenders tobecome aware of these concerns tohelp assure respect for matters ofethics in both word and action. TheCommittee may prefer formalcharges and shall consult with theBoard of Directors in matterspertaining to repeated cases ofethical violations as well as formu-late mechanisms to addressquestions of ethical conflict throughmediation, or referral to appro-priate jurisdictions. The Committeealso makes recommendations to theBoard through the Constitutionand Bylaws Committee regardingappropriate changes in theAcademy’s structure and/or policy.
Committee Work1. The most important work of the
ethics committee this year is tohelp the Academy with its newstrategic plan.
2. Select members of the Committeewill also be following through withthe “Lasers-in-Dentistry SpecialInterest Group” within theAmerican Dental EducationAssociation (ADEA); this initiativeis in collaboration with theAcademy’s Academic RelationsCommittee. Already, severaldental schools have developedlaser education curricula suchthat their students will be ALDlaser-certified when they grad-uate. A proposal for an
Interdisciplinary Dental LaserProgram was submitted for theADEA spring meeting of 2011.This meeting is the central plan-ning place for all of dentaleducation; it is an excellent venuefor the educators, Board members,and ethics leadership within ALDto become more involved.
3. The chair of the ALD EthicsCommittee has been asked forthe third time to chair theEngineering ConferencesInternational (ECI) dentalsection to be held in July 2010in Vermont on mechanisms oflow-level light therapy.
4. These initiatives with ADEA, ECI,and others such as the work withthe Academy of General Dentistry(AGD) and the American DentalAssociation (ADA) have raised theimportance of bringing key leader-ship in other committees and theBoard together to better integrateand update current policiesregarding various forms ofconflicts of interests – not all ofwhich are financial.
5. These potential collaborativeand conflicting partnerships alsoraise the importance of consid-ering the role of organizationalethics deliberations that arise inrelationships such as that withthe ADA, AGD, ADEA, U.S. Foodand Drug Administration (FDA),ECI, as well as laser manufac-turers, business/consultantorganizations, and publishers.
6. The Professional Ethics Initiative(P.E.I.) that is now facilitated bythe American College of Dentists(ACD) in cooperation with theADA, ADEA, and the AmericanSociety for Dental Ethics (ASDE)has been officially sanctioned byall the sponsoring bodies. Thechair of ALD’s Ethics Committeeis part of that steering committeewhich developed a pilot dentalwraparound training program atthe Kennedy Institute of EthicsIntensive Bioethics Course inJune 2010.
For more information, contact DonPatthoff, [email protected].
I N T E R N AT I O N A L R E L AT I O N SCO M M I T T E E
Committee Chair: Gabi KeslerVice Chair: Arun DabarMembership: Giuseppi Iaria,
Constanza Martinez, GiovanniOlivi, Carmen Todea, Glenn van As
Overview of Committee ChargeThe Committee shall act as aliaison between the Academy andthe international dental lasercommunity and support the forma-tion of affiliated groups of the ALD,spreading ALD mission and goals.
Committee WorkThe following outlines currentChapter and Affiliated Study Clubs(changing to Affiliated Groups)activities, and other status.1. The ALD Study Club in Italy is
moderated by Drs. Iaria and Olivi.2. The ALD Study Club in
Kazahkstan is moderated by Dr.Ludmila Antonova.
3. There currently are Chapters inJapan, Romania, Israel, andCanada.
Gabi Kesler
4. The Chapter in the UK existsfor the sole purpose of collectingdues for approximately 8-10 UKmember dentists. Dr. RobertWilkinson is the key for thissubgroup of our UK members.There has been no other formalcontact other then theprocessing of dues for thisgroup. There are other membersin the UK that are not part ofthis processing group.
5. The Chapter in Chile has neverbeen formalized. Dr. ChristliebePolsini Polster is the one-personmember/entity.
6. A Chapter in Japan exists withKay Kusumoto assisting ALD inthe organization of dues, andconference and certificationpayments. Kay brings a signifi-cant number of attendees toALD’s annual meetings and alsonew members.
7. All of these Chapters should berevisited and established asAffiliated Groups.
8. There is a move to establish anaffiliated group in Turkey. Weare working with Prof. TosunTosun. A joint meeting will beheld October 21-23, 2010 inIstanbul.
9. There is now a change in termi-nology from Affiliated StudyClubs to Affiliated Groups ofALD. The terminology on ALD’sWeb site will change accordingly.
For more information, contact GabiKesler, [email protected].
L AS E R SA F ET YCO M M I T T E E
Committee Chair: Raminta MastisVice Chair: Beatrijs DeruyterMembers: Scott Benjamin, Don
Coluzzi, Penny Parker, JohnSulewski
Overview of Committee ChargeThe Laser Safety Committee is anadvocate for and a contributor to theeducation and implementation oflaser safety within the Academy ofLaser Dentistry. This Committeemay be called upon in an advisorycapacity within the dental professionand may suggest representation onnational regulatory bodies ifrequested. The Committee must befamiliar with ANSI Z136.3 Safe Useof Lasers in Health Care Facilities inthe United States and other perti-nent national and internationalstandards, and use these materialsto guide the policies, procedures, andactivities of the Academy of LaserDentistry as they apply.
Committee Work1. The Committee has revised the
Laser Safety Checklist andStandard Operating Proceduresand cross-referenced it with theExhibitor’s Rules andRegulations document.
2. Scott Benjamin has submitted hisapplication materials as theAcademy of Laser Dentistry’srepresentative on the AccreditedStandards Committee (ASC Z136).
3. The Committee has an ongoingtask of updating the library ofarticles and texts related tolaser safety.
For more information, contactRaminta Mastis,[email protected].
Raminta Mastis
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M E M B E R S H I PCO M M I T T E E
Committee Chair: Mitch LomkeVice Chair: Steve ParrettMembers: Lou Chmura, Byron
Fontenot, Charles Hoopingarner,Constanza Martinez, Angie Mott,Peter Pang, Charlie Rhodes
New members are needed.
Overview of Committee ChargeThe Committee shall promote bothnew membership and work toenhance membership retentionacross all membership categories.
Committee Work1. Contact new members via
personal phone calls and/or e-mails to connect
2. Promote a new mentorshipprogram for existing and newmembers
3. Implement an e-mail campaignto all dentists in the USA topromote membership with a linkto the ALD Web site for videoclips of simple laser clinicalprocedures
3. Continue to encourage allRecognized Course Providers(RCPs) that are conductingeither Introductory or StandardProficiency Courses to send e-mails after the course is given topromote membership.
For more information, contactMitch Lomke,[email protected].
Mitch Lomke
R EG U L ATO RY A F FA I R SCO M M I T T E E
Committee Chair: CharlesHoopingarner
Membership: Don Coluzzi,Youngshoon Fischer-Hahn, AngieMott, David Roshkind, MaryLynn Smith, Gwen Smukowski
New members are needed andwelcomed.
Overview of Committee ChargeThe duty of the Regulatory AffairsCommittee is to monitor legislationand regulations relative to the useof lasers in dentistry and to assistand educate various governmentalagencies about the use of lasers indentistry.
Committee Work1. An informational letter was sent
to all state boards offering theservices of our AdvancedProficiency (AP) members asinformation sources should theboard need expert evaluation ortestimony.
2. A similar informational letterwas sent to all local componentand state peer review commit-tees that are ADA-affiliated,again offering our services toprovide AP members to assist incomplaint resolutions.
3. At the request of the WisconsinState board, a presentation isscheduled to discuss the use of
Charles Hoopingarner
lasers in dentistry, safety issues,and the use of lasers by hygien-ists at their July meeting.
4. The regulatory affairs packetthat is used to introduce laserdentistry and to be a source ofinformation for regulatoryaffairs is being reworked andupgraded.
5. After the regulatory affairspacket is upgraded, appropriatedistribution will be carried outnationally, internationally, andto governmental agencies suchas the U.S. Department ofVeterans Affairs (VeteransAdministration).
6. In the State of Texas, the laseruse by hygienist issue wasaddressed by the Texas StateBoard of Dental Examiners anda new position was taken thathygienists could use lasers forsulcular decontamination aslong as they did not use a laser(setting) capable of cuttingtissue. The Committee providedinformation to numerous boardmembers individually as well asto representatives of theAcademy of General Dentistry(AGD) and the Texas DentalAssociation (TDA) who were inopposition to this decision. TheAGD is reconsidering its posi-tion and the TDA has beenreferred to committee for review.We will be assisting with infor-mation for that review.
7. A canvass of all state board laws,positions, and rules is beingundertaken with the purpose ofproviding a resource for the dentalpublic. Efforts will be made toupdate this list on a timely basis.
For more information, contactCharles Hoopingarner,[email protected].
SC I E N C E A N DR ES E A R C H CO M M I T T E E
Committee Chair: Peter PangVice Chair: Sebastiano AndreanaMembership: Akira Aoki, Don
Coluzzi, Ali Obeidi, GiovanniOlivi, Steven Parker, PeterRechmann, John Sulewski,Caroline Sweeney, MichaelSwick, Frank Yung
Committee membership is full.
Overview of Committee ChargeThe Committee shall review andoversee all aspects of current,evidence-based laser science, as itimpacts on education and certifica-tion processes of the Academy andhelp define contemporary teachingof the use of lasers in dentistry.
At least one member shall beappointed by the Science and
Peter Pang
Research Chair to serve on theUniversity and Academia RelationsCommittee and at least onemember shall be appointed by theScience and Research Chair toserve on the Education Committee.
The Science and ResearchCommittee is responsible for allactivities related to dental scienceand research.
Committee WorkIn past years this Committee hasbeen given the charge to writeposition papers for the Academyand Journal of Laser Dentistry.The paper, “Lasers in Oral SoftTissue Applications” is in finalreview with expected completionthis year. Other ongoing projectsconsist of answering theEducation Committee’s request fora Glossary of relevant termi-nology; providing scientificrecommendations to existing posi-tion papers and Academydocuments as advances occur; andproviding scientific peer review asneeded for various publicationsand dental organizations.
For more information, contactPeter Pang, [email protected].
U N I V E R S I T Y A N DAC A D E M I A R E L AT I O N SCO M M I T T E E
Committee Chair: SebastianoAndreana
Vice Chair: Peter RechmannMembers: Alan Goldstein, Tony
Hewlett, Gabi Kesler, Peter Pang,Don Patthoff
Overview of Committee ChargeThe purpose of this Committee is tostrengthen ALD’s relationship withother dental organizations and withacademia and organized dentistry.
Committee Work1. The Committee is reviewing the
activities done in the past by theprevious Committee membersand continuing their missions.Furthermore, the Committee ischarged with increasing the pres-ence of laser science and clinicaluse in dental schools and dentalmeetings. For this effort, we willseek collaboration with otherCommittees of the Academy.
2. As one of the goals, we will worktoward developing a list ofdental schools, both in theUnited States and as much aspossible internationally, wherelasers in dentistry is taught as acourse, and specify at what level.
3. In addition, the Committee willbe seeking ways to strengthenALD’s relationship with nationaland international dental commu-nities such as the AmericanDental Association (ADA) andFDI World Dental Federation.
For more information, contactSebastiano Andreana,[email protected]. nn
Sebastiano Andreana
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Rhodes
The Seventeenth AnnualConference and Exhibition of theAcademy of Laser Dentistry washeld at the Doral Golf Resort andSpa in Miami, Florida. “DentistryChanging with the Speed of Light”was the theme presented April 14through April 17, 2010.
Preconference activities includedan Introductory and a StandardProficiency course as well asStandard and Advanced ProficiencyClinical Simulation and Clinical CaseStudies examinations. This trulyexemplifies the core of our Academy.We educate dedicated, highly trainedpractitioners to advance the path intothe future of laser dentistry. After anexhausting day-and-half ofCertification activities for the partici-pants, a welcome reception with theExhibitors was enjoyed. Some of thenewest and leading equipment andsupplies were highlighted.
Our general session openedThursday morning with “TheChanges in Dentistry Coming inthe New Decade,” presented by ourspecial guest and keynote speaker,Ronald L. Tankersley, DDS,American Dental AssociationPresident. A very informative talk
was given concerning how we, thedentist, fit into the health carereform. He also discussed theAmerican Dental Association’ssupport of and opposition tospecifics within the bills. We wantto thank Dr. Tankersley for histime and service toward ourConference and his devotion towardour group, and hope he can returnto participate next year.
The Academy has always under-stood that we attract a very diversegroup of people concerning knowl-edge and interests as it relates tolasers. It is for this reason that wehave breakout sessions specificallydesigned to interest a range of ourcolleagues, from the beginner to themost advanced clinician. Forexample, Dr. Coluzzi helps us chooseour first or subsequent laser whileDr. Lomke teaches our nonclinicalteam members their role insupporting the patients.Contemporary topics and advancedutilization includes using lasers withimplants and some of the mostupdated material on the photobio-modulation effect of laser therapy.Thursday afternoon sessionsincluded dental hygiene and auxil-
iary programs along with discussionof utilization of the diode laser. Somevery popular events of the day werethe hands-on participation courses.Clinical integration of low-level lasertherapy, laser procedural techniques,and tips to prepare a presentationusing PowerPoint or Keynote soft-ware were all included. After aneventful day, John Charles,Entertainment Magazine’sEntertainer of the year, sang some ofour favorite songs from the last 50years, interspersed with humorousvignettes. We all had a greatrelaxing evening to an eventful day.
Friday morning started withGerald McFarland. His topic“Understanding Medical Insurancefor Dentistry,” gave us a preview ofan expanded breakout session tohelp us understand how to assistpatients to best utilize their medicalbenefits for dental procedures. Otherbreakout sessions included applica-tions for diode, erbium, CO2, andNd:YAG and Nd:YAP lasers,including demonstrations of tech-niques, and the best way to presentpatients with alternative treatmentplans. The advanced sessions relatedscience and research topics, flapless
Dentistry Changing with theSpeed of Light: An Overview of the ALD’s Miami ConferenceCharles Rhodes, DDS, Charleston, West VirginiaJ Laser Dent 2010;18(2):45-46
Charles Rhodes, DDS
The exhibition area is filled with exciting technology.Dinner guests at the President's gala enjoying the food andfriendship.
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crown lengthening vs. the conven-tional open-flap method, intraoralgrafting techniques, and surfaceevaluation of biomaterials irradiatedwith various wavelengths of lasers.The hands-on participation coursestaught biopsy methods, apicoectomyprocedures, and laser-assistedhygiene. South Beach was the venuefor Friday evening. Outstandingfood, a variety of entertainment, andgreat camaraderie all helped makeit special. A late night made forshort sleep for our final day.
“Destroy the Status Quo: How toLead Change in the Changing Worldof Dentistry” was delivered by LarryJohnson Saturday morning. Anenlightening, humorous, well-received presentation was enjoyedby a large crowd. His “PainManagement” application taught ushow to deal with pain and how toimprove our practices along with ourown personal success. By latemorning, about all the facets ofdentistry including restorative, pros-thetics, endodontics, andperiodontics had been presented.The open forum and discussion wasperfect to pull it all together at theend of our general session. A panelof experts took questions from theaudience to help in debating anytheories or techniques in transition.
The final night we concludedwith the awards ceremony andPresident’s Dinner Dance. Theawards ceremony included 23Standard Proficiency candidates,seven successful Part 2 AdvancedProficiency candidates, and one
successful Part III AdvancedProficiency candidate. Those werefollowed by Dr. Shigeyuki Nagai’sreceiving the Leon Goldman Awardfor Clinical Excellence, and Dr.Steven Parker’s receiving theDistinguished Service Award.Subsequently, a great dinner anddancing ensued. Great times werehad by all with new friends andcontinued old camaraderie. Thanksto all who attended, and weencourage you to return to SanDiego, California, March 3-5, 2011
for ALD’s next Annual Conferenceand Exhibition. It is with greatpride and accomplishment that wesee the Academy grow to representa most vital part of the future ofdentistry.
AUTHOR BIOGRAPHYDr. Charles Rhodes maintains aprivate practice in Charleston,West Virginia, concentrating inAesthetic and ReconstructiveImplant Dentistry. He holdsStandard and Advanced Proficiencyin the Nd: YAG laser wavelength.He has served on the ALD Board ofDirectors for 8 years, holding chairsin the membership and regulatoryaffairs committees. Charlescurrently is vice chair of communi-cations and an Associate Editor forthe Journal of Laser Dentistry. Dr.Rhodes holds Mastership Status inthe ALD and may be contacted by e-mail at [email protected] has no disclosures for anycommercial laser relationships. nn
(Left to right): Ms. Gail Siminovsky, Dr.Ron Tankersley, Dr. Tony Hewlett, Dr. AnaTriliouris, and Dr. Steven Burman meetoutside the lecture room.
(Left to right): Dr. Art and Mrs. Mitzi Levy, Dr. John Graeber, Ms.Gail Siminovsky, and Dr. Alfred Wyatt enjoy a fun moment.
Conference attendees intensely focused on a presentation.
The audience enjoys an evening of comedy and music withentertainer John Charles.
We continue to offer the ever-popular certification courses ofIntroductory, Standard Proficiency,and Advanced Proficiency. Thesecourses will begin on Wednesday,March 2 prior to the scientificsessions.
Our exhibit hall will be a centerof focus for our meeting. Browse,compare, and examine laser devicesand other dental equipment andservices from various high-techvendors located in one convenientsetting. Make your purchasing deci-sions while at ALD 2011.
Additional planned activitiesinclude:• Welcome Reception• Spouse and Guest Events• Fellowship and Mastership
Induction Ceremony• President’s Reception and
Awards Ceremony.
I look forward to welcoming you inSan Diego for a wonderful experi-ence. Register now at:www.laserdentistry.org/ald2011SanDiego.
David M. Roshkind, DMD, MBA,MALD, FAGDChairman, General and ScientificSessions Committee nn
Additional offerings will include:• Hands-on Workshops• Luncheon for Learning Series• Interactive Discussion Forums• Table Clinics• Laser Seminars.
Continuing education credit isavailable to all eligible partici-pants. The Academy of LaserDentistry is an ADA CERPRecognized Provider and an AGDAccepted National Sponsor.
We are honored to have as ourKeynote Speaker Dr. Samuel B.Low, President of the AmericanAcademy of Periodontology andProfessor & Associate Dean,College of Dentistry, University ofFlorida. Dr. Low will speak on “TheRole of Lasers in Periodontics.”
Dear Fellow Professionals,I personally invite you as
chairman of the General andScientific Sessions Committee to joinus for education, camaraderie,networking, and fun at our AnnualSession. As Laser Dentistry comes ofage in this 21st year of laser use indentistry, our theme is “Promoting aStandard of Excellence.” We willagain be hosted at Loews CoronadoBay Resort in San Diego, Californiafrom Thursday March 3 to SaturdayMarch 5, 2011 with preconferenceactivities beginning on March 2.
This year in addition to thecourses for general practice, hygien-ists, and office staff, we will beoffering special programming thatwill focus on the use of lasers forPediatric Dentistry and Orthodontics.
Invitation to Learning
David M. Roshkind, DMD, MBA, MALD,FAGD; Chairman, General and ScientificSessions Committee
Dr. Scott Benjamin at his course on fluorescence anddiagnosis.
A small group discussionabout laser dentistry.
The audience listens to a presentation inthe general session.
One of the breakout sessions presentingerbium laser use in Endodontics.
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C E RT I F I C AT I O N P R O G R A M
ALD Certification Program Planned in San Diego March 2-3, 2011I N T R O D U C T I O N TOL AS E R SThe One-Day Introductory Hands-On Course on March 2nd will helpparticipants recognize the wave-length and device most suitable totheir practice needs. This hands-onopportunity is instructed by experi-enced laser dentists engaged in laserresearch, education, and clinicalpractice. Gain basic understandingof laser technology, dental laserwavelengths, devices, and the safeand effective use for patient care.
STANDARD PROFICIENCYThe Two-Day Standard ProficiencyCourse on March 2nd and 3rd is thebasic level of education in dentallaser usage, and includes lecture,hands-on exercises, a clinical profi-ciency simulation examination, and a75-question, multiple-choice, onlineexamination. Candidates for stan-dard proficiency must demonstratebasic understanding of all wave-lengths, and are examined on leastone wavelength. The standard profi-ciency level defines the standard ofcare for the dental professionalaccording to the CurriculumGuidelines and Standards for DentalLaser Education, and also forms thebase credential for progressing to theAdvanced Proficiency level.
P R E R EQ U I S I T ESSuccessful completion of a recog-nized introduction-to-lasers courseis a mandatory prerequisite forStandard Proficiency Certification.The required hours needed tosatisfy this prerequisite are equal toor greater than 2.5 credit hours. Theintroductory material should beapproved at the discretion of theAcademy or the Recognize StandardProficiency Course Provider.
The candidate must own or haveaccess to a dental laser.
A DVA N C E DP R O F I C I E N C YAdvanced Proficiency representsadvanced knowledge and clinicalexperience with the dental laser.Candidates for Advanced-level recog-nition must demonstrate knowledgeof all laser wavelengths via acomprehensive online written exam-ination, advanced clinical proficiencyvia a clinical simulation using thedental laser of their choice, andmust also prepare five clinical casestudies and be prepared to present aminimum of two of them.
F O R CO M P L ET E I N F O R M AT I O NGo to www.laserdentistry.org/ald2011SanDiego/certification.cfm. nn
Dr. Don Coluzzi (right) with the successful Advanced Proficiency part 2 candidates (leftto right): Dr. Spencer Hornstein, Dr. Ed Kusek, Dr. Fred Margolis, Jeanette Miranda, RDH,and Dr Ali Obeidi.
Dr. Don Coluzzi (right) with Dr. LouChmura, who completed his AdvancedProficiency Certification.
Gloria Monzon, RDH, demonstrates asimulated procedure during the hands-on session.
Mary Lynn Smith, RDH, discusses laseruse with certification students.
Certification students performing simu-lated procedures during the hands-onsession.
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N O M I N AT I O N S
N O M I N AT I O N SEach year we solicit names ofmembers who you feel might serveas volunteer leaders of our Academy.As Chairman of Nominations for2011, I invite you to share with usany recommendations you mighthave for consideration by theNominations Committee to serve asmembers of the ALD Board ofDirectors. You may make a recom-mendation online at our ALD Website www.laserdentistry.org/about/directors.cfm. You may alsocall me directly; I would be happy tohear from any member by phone ore-mail.
C H A R AC T E R I ST I CS A N DAT T R I B U T ES O F A NI D E A L A L D B OA R DM E M B E RProven PerformanceLeadership requires knowledge,talent, skill, vitality, and the abilityto make a difference. In the associ-ation environment, that translatesinto a solid track record ofcontributing to the success ofprograms, events, or projects.
CommitmentServing as an association leader isboth an honor and a reward, but itrequires a demonstrated commit-ment to the organization and itsmission and goals.
Time to ServeParticipating fully in associationactivities requires extra time toprepare for travel and attend meet-ings.
Understanding of TeamworkMany people contribute their effortstoward the realization of an associ-ation’s goals and objectives – no onedoes it alone. Well-developed inter-personal and communication skillsare essential to effective teamwork.
Sound Judgment and IntegrityIn many instances, popularitybrings potential leaders into thelimelight of an association. Butpopularity must be tempered withgood judgment and integrity.Decisions may need to be made thatare not popular with the members.
Communication and “Teaching”SkillsBy virtue of their position, currentleaders serve as mentors andteachers to future leaders.Enthusiasm – a zest for serving theassociation – is an important ingre-dient that leaders must be able topass along to their successors.
Ability to Subordinate SpecialInterestsLeaders often emerge because oftheir special expertise or effective
representation of a specificconstituency. Leadership, however,may require subordinating thoseinterests for the greater good of theassociation.
Be Strategic ThinkersIntuitive and interpretive skillsenable leaders to understand thepeople around them, internalize thedata they receive, recognize therelationships that exist between thesystems within their world, andintegrate all these elements into acoherent whole.
The following volunteerscurrently serve on the Academy ofLaser Dentistry Board of Directorsand Executive Committee. Terms ofservice are noted. ExecutiveCommittee terms are for 1 year.Board of Directors terms are for 3years. Three positions are open onthe Board of Directors.
2010 B OA R D O FD I R EC TO R SThe following volunteers currentlyserve on the Academy of LaserDentistry Board of Directors and
Drs. Steven Parrett and Mitch Lomke, andMs. Angie Mott.
Drs. Shigeyuki Nagai, Mitch Lomke, TonyHewlett, Scott Benjamin, and Don Patthoff.
Drs. Steve Burman, Scott Benjamin, andConstanza Martinez.
Ana Triliouris, DDS, NominationsChairman
Nominations Committee Seeks Your Input for Leadership 2011
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Executive Committee. Terms ofservice are noted. ExecutiveCommittee terms are for one year;Board of Directors terms are forthree years. Three positions areopen for the Directors-at Large, asnoted in boldface below.President: Steven Burman, DMDPresident-Elect: Ana Triliouris, DDSVice President: Arthur Levy, DMDTreasurer: Glenda Payas, DMDSecretary: Scott Benjamin, DMDImmediate Past President: Tony
Hewlett, DDS
D I R EC TO R S - AT- L A R G EDon Coluzzi, DDS — Appointed,
ex officio as EditorDouglas Gilio, DDS 2010-2013 —
1st TermCharles Hoopingarner, DDS 2009-
2012 — 1st TermGabi Kesler, DMD 2008-2011 —
2nd TermMitch Lomke, DDS 2008-2011 —
1st TermDr. Constanza Martinez 2008-
2011 — 1st TermAngie Mott, RDH 2009-2012 —
2nd TermPeter Pang, DDS 2009-2012 —
1st TermSteven Parrett, DDS 2009-2012 —
1st TermRaminta Mastis, DDS 2010-2013 —
1st TermShigeyuki Nagai, DDS, 2010-2013
— 1st Term
Please make your nominationssoon, and thank you for contributingto the continued excellence of theAcademy of Laser Dentistry.
Sincerely,Ana Triliouris, DDS
President Elect, Nominations ChairE-mail: [email protected]: 516-378-7222
A L D N O M I N AT I O N SCO M M I T T E E M E M B E R S2010-2011 Nominations Committee Ana Triliouris, DDS, President-
Elect, Merrick, NY
Tony Hewlett, Immediate PastPresident, Stanwood, WA
Stu Coleton, DDS, Chappaqua, NYAlan Goldstein, DMD, New York, NYSteven Parker, BDS, LDS, RCS,
MFGDP, Harrogate, UKGail Siminovsky, CAE, Executive
Director
A Nominating Committeeconsisting of no more than five (5)members of the Academy in goodstanding shall be appointed by thePresident and approved by theBoard of Directors. It shall consistof the President-Elect as chair, theImmediate Past President, and upto three members in good standingwho shall have had prior AcademyBoard of Directors experience andwho are not seeking elective officein the forthcoming term. nn
Drs. Constanza Martinez, Glenda Payas,Art Levy, Raminta Mastis, and Peter Pang.
Dr. Steven Burman (right) awardingrecognition plaques to Drs. John Graeber(left) and Alfred Wyatt (center), who bothcompleted six years of service on theBoard of Directors.
Dr. Lester Burman (far left), 2001 ALDPresident, installs the new ExecutiveCommittee (left to right): Dr. Tony Hewlett,Immediate Past President; Dr. AnaTriliouris, President-elect; Dr. Art Levy, VicePresident; Dr. Glenda Payas, Treasurer; andDr. Scott Benjamin, Secretary.
Newly installed President, Dr. StevenBurman, delivers his remarks and hopesfor his coming year.
Dr. Steven Burman acknowledges ourExecutive Director, Ms. Gail Siminovsky,CAE.
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AWA R D S
ALD Seeks AwardsRecommendationsRespond by October 15
R ECO M M E N DAT I O N SSO U G H T F O RAC A D E MY AWA R D SOur Awards Committee is asking foryour help in selecting the bestpossible candidates, from around theglobe, for the three prestigiousAcademy of Laser Dentistry Awards.With the wealth of knowledge,passion, and work provided by ourmembership, this is no easy task!Your Nominations Committee,speaking for the Academy of LaserDentistry, will be selecting recipientsfor three awards honoring leaders inthe field of lasers in dentistry.During the 18th Annual Conference,we hope to present the T.H. MaimanAward for excellence in dental laserresearch, the Leon Goldman Awardfor clinical excellence, and theDistinguished Service Awardhonoring outstanding commitmentand contribution to the Academy.
To make a recommendation tothe ALD Awards Committee, pleasecomplete the AwardsRecommendations form atwww.laserdentistry.org/login.cfm orcontact any member of the AwardsCommittee listed below byOctober 15, 2010. The awards willbe announced by December 1.Award recipients will be presentedwith their awards during thePresident’s Awards Reception andhonored during the President’sDinner Dance at the AnnualAcademy of Laser DentistryConference in San Diego onSaturday, March 5, 2011.
In the following section, theAwards and the former recipientsare listed. The Awards Committeein 2005 developed criteria for theaward selection process, some ofwhich are required, as indicated.
All honorees must be present at theupcoming Annual Meeting andmust accept their award in person.
The T.H. Maiman Award ispresented for excellence in dentallaser research, and is named inhonor of Dr. Theodore H. Maimanwho developed the first dental laserin 1960. Past recipients are: Dr.Joel White in 1993; Dr. Lynn Powell1995; Dr. Richard Blankenau 1996;Dr. Terry D. Myers 1998; Dr. PeterRechmann 1999; Dr. FrederickParkins 2000; Dr. Akira Aoki 2001;Dr. John Featherstone 2002; Dr.Craig Gimbel 2003; Dr. Linda Otis2006; Prof. Raimund Hibst 2008;and Dr. Daniel Fried 2009.
The criteria for selection of acandidate for the T.H. MaimanAward for excellence in researchare listed. The candidate shouldhave been:• Published in peer-reviewed
dental journals as first or secondauthor - REQUIRED
• Affiliated with an accrediteddental school or university
• Listed as the primary investi-gator in dental laser research(laboratory or clinically based)
• A recipient of government grantsobtained for dental laser/photonicresearch.The Leon Goldman Award is
presented for clinical excellence,and is named in honor of Dr. LeonGoldman, who, in 1965, was thefirst physician to report on laserexposure to a vital human tooth.Past recipients are: Dr. Kim Kutschin 1993; Dr. Robert Pick 1995; Dr.Steven Parker 1998; Dr. Donald J.Coluzzi and Dr. Robert E. Barr1999; Dr. Janet Hatcher Rice 2000;Ms. Nora M. Raffetto, RDH 2001;Dr. Duane H. Beers 2002; Dr. GabiKesler 2004; Dr. Glenn van As2006; Dr. Frank Yung and Dr.Giovanni Olivi 2007; Dr. StuColeton 2009; and Dr. ShigeyukiNagai 2010.
The criteria for selection of acandidate for the Leon GoldmanAward for clinical excellence arelisted. The candidate should have:• ALD Membership – REQUIRED• Advanced Proficiency Recognition
– REQUIRED• Presentations at ALD’s annual
meetings that are documented sothe Committee may review clin-ical presentations of theirprofessional work in order todetermine clinical excellence –REQUIRED
• Actively promoted clinicaldentistry utilizing lasers to thedental profession
• Recognized clinical excellenceutilizing lasers in dentistry inpeer-reviewed publications
• Established dental laser educa-tion in dental schools orcontinuing education programs.
Art Levy, DMD, Awards Chairman
Dan Fried, PhD, (right) receiving hisaward from Mrs. Theordore Maiman.
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The Academy’s DistinguishedService Award is presented foroutstanding commitment and contri-bution to the Academy. Pastrecipients are: Dr. Stewart Rosenbergin 1993; Dr. Scott Brundrett 1995;Mr. John Sulewski 1996; Universityof California, San Francisco 1997; Dr.David M. Roshkind 1998; Dr. Alan J.Goldstein 1999; Dr. WilliamSiminovsky 2000; Dr. Stuart Coleton2002; Dr. Donald Patthoff 2003; Dr.Tony Hewlett 2004; Dr. Joel White2005; Dr. Donald Coluzzi 2006; Dr.Art Levy 2007; Dr. Lester Burman
2008; Dr. Dennis Pietrini 2009; andDr. Steven Parker 2010.• The criteria for selection of a
candidate for the DistinguishedService Award are listed. Thecandidate should have:
• ALD membership – REQUIRED• ALD Board of Directors service –
REQUIRED• Committee Chair service –
REQUIRED• Leadership and participation in
the Academy far above the call ofduty.
N E E D A D D I T I O N A LI N F O R M AT I O N ?For recent ALD Award Recipients,visit www.laserdentistry.org/about/awards.cfm. As always we welcomeyour comments directly by phone(954) 346-3776 or e-mail [email protected].
T H E 2010 - 2011AWA R D S CO M M I T T E E :Chairman: Art Levy, DMD, Chester,
NJ, 908-879-6386,[email protected]
Stu Coleton, DDS, Chappaqua, NY,914-238-3981, [email protected]
Craig Gimbel, DDS, Denville, NJ,973-476-8976 Cell,[email protected]
Tony Hewlett, Immediate PastPresident, Stanwood, WA, 360-629-4597, [email protected]
Steven Parker, BDS, LDS, RCS,MFGDP, Harrogate, UnitedKingdom, 44-1423-50-4399,[email protected]
Gail Siminovsky, CAE, ExecutiveDirector, 954-346-3776,[email protected]
Visit www.laserdentistry.org/login.cfm before October 15, 2010 tosend in your recommendation. nn
Dr. Ana Triliouris (right) presenting Dr.Shigeyuki Nagai with his Leon GoldmanClinical Excellence award in Miami April2010.
Dr. Ana Triliouris (right) presenting Dr.Steven Parker with his DistinguishedService award in Miami April 2010.
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F E L LOW S H I P A N D M A ST E R S H I P
Your Academy wants to help you toachieve your personal and profes-sional goals. We’ll show you how! Ifyou’ve already achieved StandardProficiency, please don’t stopthere. Reach higher for that nextlevel of Advanced Proficiency inyour chosen wavelength. However,your individual skills developmentand yearn to learn don’t have tostop there. As chair of theMembership Committee, I announcewith great pride the Academy ofLaser Dentistry’s awarding of newhonor designations that serve torecognize the outstanding achieve-ments of our qualifying members inthe dynamic and challenging worldof laser dentistry. These honordesignations are:
Fellow of the Academy of LaserDentistry & Master of the Academy of LaserDentistryEach award is based upon severalcriteria including accumulation of aspecific number of laser-related CEcredits, most of which can beearned at our annual conferences.The requirements required for eachhonor can be found on the ALDWeb site, www.laserdentistry.org.
Application for 2011 Fellows andMasters is open September 1, 2010to December 31, 2010. Submit atwww.laserdentistry.org/fellowship/index.cfm.
Our next Academy annualconference will take place in SanDiego in March 2011!REGISTER TODAY!ALD 2011 Lasers in DentistryMarch 3-5, 2011Loews Coronado Bay Resort,San Diegowww.laserdentistry.org/ald2011SanDiego/
We’re here for you! Bring yourstaff. We’ll teach you the specific
dental laser skills that you desire.Our practice management
courses will show you how to inte-grate this technology into yourpractice. Our goal is to give you thereal knowledge and technical skillsthat you can take right back to theoffice on Monday. The excitementis already building for our ALD2011 Conference in San Diego.If you have any further questions,please call the ALD office 954-346-3776. We can’t wait to see youagain.
Warm Regards,
Mitch Lomke, DDS
ALD 2010 FELLOWSHIPRECIPIENTSEugenia Anagnostaki, DDS,
Rethymno, GreeceLouis Chmura, DDS, MS, Marshall,
MichiganSpencer Hornstein, DDS, Bethesda,
MarylandEdward R. Kusek, DDS, Sioux
Falls, South Dakota
Ali Obeidi, DDS, Houston, TexasSteven Parrett, DDS,
Chambersburg, Pennsylvania
They join the 2009 ALDFellows:Keith Brewster, DDS, Dallas, TX;Jimmy K.H. Chan, DMD, NorthVancouver, BC, Canada; DellGoodrick, DDS, Santa Clarita,CA; Tony Hewlett, DDS,Stanwood, WA; CharlesHoopingarner, DDS, Houston, TX;Hubert Stieve, Dr. med. dent,Rendsburg, Germany; AnaTriliouris, DDS, Merrick, NY.
2008 ALD Fellows:Frank Greider, DDS, Houston, TX;Donald Patthoff, DDS,Martinsburg, WV; Janet Press,RDH, Las Vegas, NV.
ALD 2010 MASTERSHIPRECIPIENTArun A. Darbar, BDS, Leighton
Buzzard, UK
ALD Fellowship and Mastership Applications Open September 1
Dr. Mitch Lomke (3rd from right) with the newest ALD Fellowship award recipients: Dr.Steven Parrett, Dr. Ali Obedi, Dr. Eugenia Anagnostaki, Dr. Lou Chmura, Dr. Ed Kusek,and Dr. Spencer Hornstein.
Mitch Lomke, DDS, Membership Chairman
Dr. Darbar joins the 2009 ALDMasters:
Steven Burman, DMD, Manalapan,NJ; Ambrose Chan, BDS,Caringbah, Australia; BeatrysDeruyter, DDS, Liedekerke,Belgium; Giovanni Olivi, DMD,Roma, Italy; Peter Pang, DDS,Sonoma, CA; Charles Rhodes, DDS,Charleston, WV; Caroline Sweeney,MBA, MA, BSc, Sonoma, CA;Michael Swick, DMD, ConneautLake, PA.
2008 ALD Masters:Mel Burchman, DDS, Langhorne,PA; Stu Coleton, DDS, Chappaqua,NY; Donald Coluzzi, DDS, Portola
Valley, CA; Robert Convissar, DDS,New York, NY; Emile Martin, DDS,Syracuse, NY; John Graeber, DMD,East Hanover, NJ; Omar Kassam,BDS LDS RCS and Shelly Kassam,BDS LDS RCS, Vancouver, BC,Canada; Lawrence Kotlow, DDS,Albany, NY; Art Levy, DDS, Chester,NJ; Mitch Lomke, DDS, Olney, MD;Fred Margolis, DDS, Buffalo Grove,IL; Raminta Mastis, DDS, St. ClairShores, MI; Angie Mott, RDH,Tulsa, OK; Penny Parker, RDN andSteven Parker, BDS, LDS MFGDP,Harrogate, UK; Glenda Payas,DMD, Tulsa, OK; David Roshkind,DMD, Gainesville, FL; Grace Sun,DDS, Los Angeles, CA; Glen van As,
BSc, DMD, North Vancouver, BC,Canada; Joel M. White, DDS, MS,San Francisco, CA. nn
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Dr. Mitch Lomke awarding Dr. ArunDarbar his Mastership award.
CALL FOR ABSTRACTSThe 18th Annual Conference of the Academy of Laser Dentistry, with the theme of“Laser Dentistry: Promoting a Standard of Excellence,” is March 3-5, 2011 at theLoews Coronado Bay Resort in San Diego, CA.
The planning committee seeks a variety of topics that address the future of dentistry,especially as it relates to the use of lasers and light technology in clinical applica-tions in daily practice, scientific research, clinical tips and techniques, and practicemanagement and business administration for the entire team.
NEW SUBMISSION PROCESS FOR THE 2011 ALD CONFERENCE If you are interested in submitting an abstract for presenting at the ALD’s 2011Conference, please visit www.laserdentistry.org/abstracts/index.cfm.
IMPORTANT DATES TO REMEMBER:Abstract Submission Deadline: October 1, 2010 Acceptance Notification Date: November 15, 2010
At any time you may contact the General & Scientific Sessions Chairman by sending an email to [email protected].
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Scholarship Available for 2010-2011 Dental StudentsThe Academy of Laser Dentistry(ALD) is pleased to announce the2011 Dr. Eugene M. SeidnerStudent Scholarship withSponsorship from Henry Schein.The program, started in 2004, isnamed for Dr. Seidner, 1997-1998President of the ALD, and isdesigned to promote dental lasereducation among dental students.
This program encourages under-graduate and graduate dentalstudents to broaden their under-standing of lasers in dentistry,provides financial award to enablestudents to present their work atthe Academy’s annual meetings ineither poster presentations or scien-tific and clinical lectures; andencourages the investigation of thevarious laser wavelengths and theirtissue interactions and the correctand safe use of lasers in dentistry.
Scholarships will be presentedto up to three dental students toattend and present their workduring ALD’s 18th AnnualConference, March 3-5, 2011 in SanDiego. The selection is based on anabstract of laser research or clinicalcase studies submitted for presen-tation. Funding for each successfulcandidate will cover one year ofALD membership, StandardProficiency Dental Laser Courseapplication fees, full conferenceregistration, round-trip coach airtransportation, up to 5 nights hotel
accommodation at the LoewsCoronado Resort and Spa, plus asmall cash award for first ($500),second ($250), and third ($100)place.
S P EC I A L AWA R D F O RP E D I AT R I C D E N T I ST RYThrough a generous annual pledgespecifically earmarked for pediatricdental students, ALD is pleased toimplement a special recognitionaward within the Dr. EugeneSeidner Student Scholarshipprogram for pediatric dentalstudents. This donation recognizesthe commitment to pediatric dentaleducation by ALD member Dr.Lawrence Kotlow, a pediatric dentistpracticing in Albany, New York.
2010 ST U D E N TSC H O L A R S H I P AWA R DR EC I P I E N TS :Cynthia Morford, DDSUniversity of California San
Francisco School of Dentistry,San Francisco, California
Er:YAG Laser Debonding ofPorcelain Veneers
Verica Aleksic, DDSTokyo Medical and Dental
University, Tokyo, JapanLow-Level Er:YAG Laser
Irradiation Enhances OsteoblastProliferation Through Activationof MAPK/ERK
Adar Ben-Amy, DMDUniversity of Alabama at
Birmingham, Birmingham,Alabama
Efficacy of 640-nm Diode LaserTreatment for Prevention of OralMucositis in Pediatric CancerPatients
Criteria for eligibility are deter-mined by the applicant’sdemonstrated academic achievementin the study of lasers in dentistry.Applicants must be undergraduatedental students, graduate studentsin general practice, and graduatestudents in any specific dentalspecialty. Application forms andinstructions are available atwww.laserdentistry.org or www.laserdentistry.org/ald2011SanDiego/scholarship.cfm, orby contacting the Academy office.
Apply today! nn
Ana Triliouris, DDS, Student Scholarship Chairman
ALD is pleased to collaborate
with Henry Schein, Inc. for
ongoing funding of this
educational program.
Dr. Ana Triliouris introducing the three 2010 Student Scholar finalists.
Er:YAG Laser Debonding of Porcelain VeneersCynthia Morford, DDS, Natalie C. H. Buu, DMD, Frederick C. Finzen, DDS, Arun B. Sharma, BDS,
MSc, Peter Rechmann, Prof. Dr. med. dent.University of California San Francisco School of Dentistry, San Francisco, California
J Laser Dent 2010;18(2):56
Removal of porcelain veneers usingEr:YAG lasers has been describedin case reports. The aim of thisstudy was to systematically investi-gate the use of an Er:YAG laser forveneer removal without destroyingthe veneer as well as withoutaggressive destruction or removalof underlying tooth substance.
Materials and Methods: In a firststep, Fourier Transform Infrared(FTIR) Spectroscopy (Nicolet™ FT-IR Spectrometer, Thermo FisherScientific, Waltham, Mass., USA) wasused on two different, flat veneermaterials (IPS Empress® Esthetic,IPS e.max Press HT, IvoclarVivadent, Inc, Amherst, N.Y., USA)to learn which infrared laser wave-lengths are transmitted through theveneer material and how strongabsorption of the veneer materials isin the infrared spectral range.
A laser energy meter (EnergyMax 400, Molectron Detector, Inc.,Portland, Ore., USA) was used todetermine the energy transmissiondependence on veneer thickness forthe Er:YAG laser wavelength (2940nm). In addition, the FTIR charac-teristics and ablation thresholds ofa veneer bonding cement (RelyX™Veneer Cement shade A1, 3MESPE, St. Paul, Minn., USA) weredetermined.
Next, 25 extracted anterior inci-sors (n = 12 for IPS EmpressEsthetic, n = 13 for IPS e.max PressHT) were prepared for labialveneers placing; impressions weremade, veneers were produced (2different porcelains), thickness ofthe veneers were determined(Mitutoyo micrometer, MitutoyoAmerica, Aurora, Ill., USA), and theveneers were placed using a cement(RelyX™ Veneer Cement shade A1).An Er:YAG laser (LiteTouch™,Syneron™ Dental Lasers, Yokneam,Israel; wavelength 2940 nm, pulserepetition rate 10 Hz, pulse energy135 mJ/pulse [laser energy meas-ured independently at the fiber tip],free-running pulse, with a meas-ured pulse duration of 150 µs atthis energy level, 1,100-µm straightquartz fiber tip, contact mode, airspray). Three samples per veneermaterial were stored for 5 days insaline solution at room temperatureprior to debonding. All otherveneers were removed immediatelyafter bonding. Incident LightMicroscopy (Olympus B 50,MicroPublisher RTV 3.3 MP, ImagePro software, Olympus, CenterValley, Pa., USA) andEnvironmental Scanning ElectronMicroscopy (ESEM, ISI SX-40A,Topcon Instruments, Inc.,Livermore, Calif., USA) were usedto evaluate the interface ofveneer/cement and cement/toothstructure in order to better under-stand the debonding process.
R ES U LTSIn all test samples, porcelainveneers can easily and completelybe removed from the teeth with anEr:YAG laser. Moreover, underlying
tooth substances can be totallypreserved. The removal process istime-efficient. In the case of theIPS Empress Esthetic veneers, themajority of the veneers fracturedduring the removal. In contrast, allIPS e.max Press HT veneersremained intact during the laserremoval process.
CO N C LU S I O N SUsing an Er:YAG laser to debondporcelain veneers allows thedentist to reuse the veneer in caseswhen a veneer initially was“misplaced.” The need of redoingthe veneer can be omitted. Removalof old veneers is simplified andtooth substance is maximallypreserved to place a new veneer.
This presentation discussesinvestigational devices that havenot yet received U.S. FDA approvalor clearance for the specified clin-ical indications, or describesoff-label uses.
A U T H O R B I O G R A P H YDr. Cynthia Morford grew up in theSan Francisco Bay Area, California.She attended the University ofCalifornia, Berkeley for her under-graduate education and laterattended the University ofCalifornia, Los Angeles for herdental degree. Dr. Morford iscurrently a second-year resident inthe Postgraduate Prosthodonticprogram at University ofCalifornia, San Francisco. Dr.Morford may be contacted by e-mail at [email protected].
Disclosure: Dr. Morford has nocommercial or financial interest rela-tive to this presentation. nn
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Morford et al.
Cynthia Morford, DDS
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Low-Level Er:YAG Laser Irradiation EnhancesOsteoblast Proliferation Through Activation ofMAPK/ERKVerica Aleksic1, DDS, PhD, Akira Aoki1, DDS, PhD, Kengo Iwasaki2, DDS, PhD, Aristeo Atsushi
Takasaki1, DDS, PhD, Chen-Ying Wang3, DDS, Yoshimitsu Abiko4, DDS, PhD, Isao Ishikawa2, DDS,
PhD, Yuichi Izumi1, DDS, PhD1Tokyo Medical and Dental University (TMDU), Tokyo, Japan; 2Tokyo Women’s Medical University, Tokyo, Japan; 3National Taiwan
University, Taipei, Republic of China; 4Nihon University School of Dentistry, Matsudo, Japan
J Laser Dent 2010;18(2):57-58
Based on various advantageouseffects, the Er:YAG laser has beenrecently considered as one of themost promising laser systems forperiodontal and peri-implant therapy.
It has been reported in ananimal study that an increasedamount of new bone formation wassignificantly enhanced followingEr:YAG laser irradiation (MizutaniK, Aoki A, Takasaki AA, KinoshitaA, Hayashi C, Oda S, Ishikawa I.Periodontal tissue healing followingflap surgery using an Er:YAG laserin dogs. Lasers Surg Med2006;38(4):314-324). One of thepotential explanations for signifi-cant new bone formation might berelated to the effect of low-levelEr:YAG laser irradiation (low-levellaser therapy, photobiomodulation).
In osteogenesis, several in vitrostudies using different laser deviceshave previously demonstrated thepositive effects of low-level irradia-tion in promoting new boneformation by inducing proliferationand differentiation of osteoblasts.
Since no studies have reported theeffect of low-level Er:YAG irradia-tion on osteoblasts, the aim of thisstudy is to investigate the potentialphotobiomodulatory effect of theEr:YAG laser on osteoblasts.
M AT E R I A LS A N DM ET H O D SAn Er:YAG laser apparatus(VersaWave®, HOYA ConBio®,Fremont, Calif., USA) has a wave-length of 2.94 µm, an output energyrange of 30 to 350 mJ/pulse, amaximum pulse repetition rate of50 Hz, and a pulse duration of 200µs. Laser irradiation was performedperpendicularly to the bottom of aculture dish at a distance of 15 cm.The laser energy was emitted fromthe handpiece without mounting acover sleeve and contact tip inorder to completely irradiate theMC3T3-E1 mouse osteoblast cellsin a 35-mm tissue culture dish.
Experiment 1Effect of low-level Er:YAG laser oncell proliferation
First, the laser was fixed at 30Hz and 30 sec, and energy levels of23 to 68 mJ/pulse (fluence: 2.1 to6.4 J/cm2) was applied. Second, thelaser was fixed at 30 Hz and 23mJ/pulse, and irradiation time was30-120 sec (fluence: 2.1 to 8.6J/cm2). Third, the laser was fixed at23 mJ/pulse and 30 sec and thepulse rate was 10 to 50 Hz (fluence:
0.7 to 3.6 J/cm2). All irradiationswere performed in the absence ofthe culture medium. Irradiation inthe presence of culture medium wasalso performed by applying 0.5 mlof medium, slightly covering the cellsurface. The energy level was set to23 mJ/pulse, pulse rate to 30 Hz,and irradiation time was 1 to 4minutes (fluence: 4.3 to 17.2 J/cm2).At days 1 and 3 following Er:YAGlaser irradiation, cell viability wasdetermined by cell counting. Thedegree of cell death at day 1 wasdetermined by measuring thelactate dehydrogenase (LDH) levels.
Experiment 2Effect of low-level Er:YAG laser onmitogen-activated protein kinase(MAPK) pathways
The involvement of MAPK path-ways in laser-enhanced cellproliferation was investigated byexamining the effect of specificMAPK inhibitors (added prior toirradiation) and phosphorylation ofMAPKs by Western blotting.Er:YAG laser irradiation wasperformed at 23 mJ/pulse and 30Hz for 60 sec (fluence: 4.3 J/cm2) inthe absence of medium.
The one-way analysis of vari-ance (ANOVA) test was used for allgroup comparisons, and post hocTukey’s test was used to comparedifferences between each group. AP value of < 0.05 was consideredsignificant.
Aleksic et al.
Verica Aleksic, DDS, PhD
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R ES U LTSThe low-level Er:YAG laserenhanced the proliferation ofosteoblasts in an energy-, time-,and pulse-dependent manner. Atvarious combinations of irradiationparameters, significantly increasedcell proliferation was observed atfluences of approximately 1.0 to15.1 J/cm2, with no increase inLDH activity.
Regarding the effect of low-levelEr:YAG laser on MAPK pathways,inhibition of laser-enhanced prolif-eration was observed after celltreatment with MAPK/ERK (extra-cellular signal-regulated kinase)inhibitor U0126. Further, Westernblotting analysis revealed inductionof MAPK/ERK phosphorylation 5min following irradiation comparedto nonirradiated control cells.
CO N C LU S I O N SAt various combinations of irradia-tion parameters, low-level Er:YAGlaser irradiation promotesosteoblast proliferation mainly bythe activation of the MAPK/ERKpathway. These findings suggestfaster bone tissue healing followingEr:YAG laser therapy, as well as anumber of advantageous clinicaltherapeutic effects.
This presentation discussesinvestigational devices that havenot yet received U.S. FDA approvalor clearance for the specified clin-ical indications, or describesoff-label uses.
A U T H O R B I O G R A P H YDr. Verica Aleksic has graduated asthe best student of her generationfrom Faculty of Dentistry, Universityof Banjaluka, Bosnia andHerzegovina, in 2004. She joinedTokyo Medical and DentalUniversity’s (TMDU’s)Periodontology Department for aPhD course as a winner of theMonbukagakusho Scholarship in2005. Additionally, she is a memberof Advanced International SuperStudents (AISS) of the Global Centerof Excellence (GCOE) Program,“International Research Center forMolecular Science in Tooth and BoneDiseases,” TMDU. Dr. Aleksic ismarried and has one child. Dr.Aleksic may be contacted by e-mailat [email protected].
Disclosure: Dr. Aleksic has nocommercial or financial interest relative to this article. nn
Aleksic et al.
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Efficacy of 640-nm Diode Laser Treatment forPrevention of Oral Mucositis in PediatricCancer PatientsAdar Ben-Amy, DMD, Noel K. Childers, DDS, MS, PhD,
Tabitha Jarman, DMD, Andrei Barasch, DMD, MDScThe University of Alabama at Birmingham, Alabama
J Laser Dent 2010;18(2):59-60
Oral mucositis is a morbid andcostly side effect of cancer treatmentin pediatric patients. No preventiveor therapeutic methods have beenvalidated for this condition. Recentevidence has shown that exposure oftissues to low-power (soft) laserscan promote wound healing in vitroand in vivo. Several studies testingthe efficacy of laser for the reduc-tion of incidence, duration, and/orseverity of cancer therapy-inducedoral mucositis have been performed.Results of these studies have beenencouraging but most authors agreethat this subject requires more clin-ical study. Generally, there is apaucity of studies that addresspreventive measures for therapy-induced mucositis in pediatriccancer patients.
Objectives of our study:• To test the hypothesis that laser
application during cytotoxictherapy will reduce incidence,severity, and duration of oropha-ryngeal mucositis in pediatriccancer patients.
• To study the duration of hospitalstay of children treated for malig-nancy.
We have tested a promising andrelatively novel approach toprevention of therapy-inducedmucositis in children receivingcytotoxic treatment for malignantdiseases. This strategy has beensuccessful in adults and, ifconfirmed, may become the stan-dard of care for oral mucositis inpediatric cancer patients.Prevention of oral mucositis and/orreduction in its signs and symp-toms can significantly improve thequality of life of the patients,reduce the hospitalization costs,and, most importantly, increase thesurvival rate of these patients.
M AT E R I A LS A N DM ET H O D SWe performed a prospective,randomized, double-blind study ofthe effect of diode He-Ne lasertherapy on incidence, severity, andduration of oral mucositis in pedi-atric cancer patients. Eightsubjects were between the ages of3 and 18 years with a diagnosedmalignancy who underwentchemotherapy at the Hematology/Oncology Department, TheChildren’s Hospital (TCH),Birmingham, Alabama. Laser expo-sure started on the first day ofchemotherapy and continued eachday of the cytotoxic treatment (4 to7 days). Daily treatment lasted 15-30 minutes. We used a 640-nmdiode laser (Scalar Wave Laser,Loveland, Colo., USA) with a fiber-optic and handpiece attachment forclinical application. This instru-
ment is light and portable and canbe used at the bedside. The partici-pants were able to sit or lie insupine position while the laserprocedure was performed. Theparticipants wore protective wave-length-specific eye goggles. Sterileplastic protective sleeves wereused to cover the laser handpiece.We irradiated the buccal, labial,soft palate, and floor of the mouthmucosa on half of the mouth. Theside that was treated wasrandomly selected. Each area wasirradiated for 40 seconds. Theenergy density was 4.5 J for eachcm2 of exposed tissue. This dosehas been selected based onprevious studies. The contralateralside received a sham treatment forthe same amount of time, with thelaser turned off. To reduce bias,neither the patient nor the exam-iners knew which side was treated.For incidence, duration, andseverity of mucositis we used astudent T-test for paired variablesto compare OMAS (Oral MucositisAssessment Scale) and FACES(Wong-Baker FACES Pain RatingScale) scores from the treated vs.untreated sides of the mouth ateach encounter point. Number ofdays of hospitalization werecompared to the historical controlgroup and were tested for correla-tion with mucositis scores. Subjectswere matched by age, gender, typeof malignancy, and chemotherapyprotocol. Chi-square and Fisher’sexact tests were used for theseanalyses.
Ben-Amy et al.
Adar Ben-Amy, DMD
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R ES U LTSOnly 2 children developed ulcerativemucositis. However, mean oralmucositis (P = 0.27) and pain (P = 0.62) scores failed to showstatistical significance between thetreated and untreated sides.Similarly, total hospital days fortreated children were not differentfrom the control.
CO N C LU S I O N STo our knowledge, this is one ofvery few studies to test laser effects
for cytotoxic therapy-inducedmucositis in a pediatric population.Soft laser exposure was well toler-ated in pediatric cancer patientsand oral mucositis incidence wasvery low. Larger studies are neededto support the routine use of thesedevices for mucositis prevention.
This presentation discussesinvestigational devices that havenot yet received U.S. FDA approvalor clearance for the specified clin-ical indications, or describesoff-label uses.
A U T H O R B I O G R A P H YDr. Adar Ben-Amy is a 2002Graduate Tel Aviv UniversitySchool of Dentistry and completeda Pediatric Dentistry Residency atthe University of Alabama Schoolof Dentistry in 2009. Dr. Ben-Amymay be contacted by e-mail [email protected].
Disclosure: Dr Ben-Amy has nocommercial or financial interest rela-tive to this article. nn
Ben-Amy et al.
Laser Dentistry & Culinary Tour of the Italian Riviera May 1-6, 2011
This week-long tour will o�er dentists and their partners a unique opportunity to further their dental education and learn advanced laser subjects while vacationing in one of Italy ‘s most breathtaking regions and cooking alongside master chefs.
Designed with the busy (but gourmet) dentist in mind, this tour is open to a maximum of 24 participants, allowing for intimate learn-ing sessions with Dr. Convissar and relaxing group activities both in and out of the kitchen.
Dr. Robert Convissar, named one of the “Top 100 Leaders in Dental Continuing Education” for the past 6 years by Dentistry Today Magazine, coauthor of 4 laser dentistry textbooks, and a pioneer in the �eld of laser dentistry, will lecture for 12 hours during our culinary tour of the Italian Riviera.
R cooking
Join a top leader in dental continuing education and a James Beard-nominated cookbook author for an exclusive dentists’ culinary tour of the Italian Riviera...
The rest of the week will be spent savoring the fabulous foods and wines of this glorious Northern Italian region with New York City-based cooking teacher and James Beard-nominated cook-book author Micol Negrin, founder of Rustico Cooking. You’ll enjoy hands-on cooking lessons, wine tastings, gelato classes, and sightseeing in Porto�no, Cinque Terre, Camogli, and other seaside towns…
If you ever wanted to discover the hidden beauties and the unique culinary specialties of the Italian Riviera, and learn all you ever needed to know about laser dentistry, this is the trip for you. During laser lectures, non-dentist partners will be further explor-ing the secrets of Italian cuisine and honing their culinary skills.
For more information, visit www.rusticocooking.com/laserdentist.htm or call 917-602-1519
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Possible Applications of an Er:YAG LaserCombined with a Laser Application for WideArea (LAWA) System: An In Vitro PulpalTemperature StudyBülent Gökçe1, DDS, PhD; Birgül Özpinar1, DDS, PhD, Prof. Dr.; Emil Litvak2, DDS1Ege University School of Dentistry Department of Prosthodontics, Izmir, Turkey; 2Qiryat Ono, Israel
J Laser Dent 2010;18(2):61-63
I N T R O D U C T I O NHeat is generated during laserapplications, which, if notcontrolled, can cause hard tissuedestruction and pulpal necrosis.Previous studies have shown thatboth high-speed handpieces and anEr:YAG laser both used on dentalhard tissue cause pulp temperatureincreases of various degrees.1-2 Astudy by Zach and Cohen3 usingMacaca rhesus monkeys demon-strated that a pulpal temperaturerise of 5.6° C can cause pulpalnecrosis. (Editor’s note: The Zachand Cohen study’s data expressedthe temperature rise as 10° F.)
The authors have tested an add-on accessory, patented by one ofthem, which is a scanner system
that allows an existing dental laserbeam to interact with a larger targetarea, and termed the system LaserApplication for Wide Area (LAWA).Representational different beamshapes produced are shown inFigure 1. The LAWA handpieceenables surface scanning duringlaser application that is designed toprevent the possibility of repetitiveinteractions at the exact same tissuepoint, thus helping to prevent a localtemperature increase at that point.
O B J EC T I V EThis study was conducted tocompare in vitro pulp chambertemperature changes induced by anEr:YAG laser and an Er:YAG laserwith LAWA system using the samelaser parameters.
M AT E R I A LS A N DM ET H O D SSpecimen preparationTwenty intact and noncarioushuman maxillary first premolarsextracted for orthodontic reasonswere collected. The teeth werecleaned of any residual tissue tags,pumiced and washed under running
tap water, and stored in a solutionof 0.1% thymol until use. The rootsof the teeth were mounted in indi-vidual self-curing resin blocks(Meliodent, Bayer Dental, Newbury,UK) with the long axis orientedperpendicular to the surface of theresin block to 1 mm below thecementoenamel junction.
To facilitate the positioning ofthe thermocouples into the pulpchamber, standardized tunnel-shaped preparations (diameter = 2mm) involving the pulp chamberwere made on the mesial surfacesof the teeth with a round diamondbur (lot 0092667, Diatech,Coltène/Whaledent AG, Altstätten,Switzerland) under copious water.The thickness of the distal approx-imal wall was measured with adecimal caliper (A. SchweickhardtGmbH & Co. KG, Tuttlingen,Germany) and prepared to allow astandard 2 mm of enamel/dentinthickness on their sound distalsurfaces. Those teeth that hadgreater enamel/dentin thicknesswere reduced with a paralleldiamond bur under water spray.
Laser application and tempera-ture change measurementsThe specimens were randomlyassigned to Er:YAG laser andEr:YAG+LAWA system groups (n = 10/group). The probe of a ther-mocouple was placed inside the pulpchamber through the tunnel up tothe mesial/distal pulpal wall of thepulp chamber. The pulp chamber wasfilled with warm 10% gelatin solution
Gökçe et al.
Bülent Gökçe, DDS, PhD
Figure 1: The laser beam can be shaped into the desired form with the LAWA system byusing a vertically and horizontally moving mirror system placed inside the handpiece.The red aiming beam depicts the exact shape of the invisible Er:YAG radiant energy. a:vertical-short line; b: vertical-long line; c: horizontal line; d: rectangle; e: square.
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and allowed to solidify. The gelatinsolution filled the pulpal chambers,eliminating the dead space andholding the thermocouple in placewithin the pulp chamber. Bothgroups used an Er:YAG laser (FidelisII, Fotona d.d., Ljubljana, Slovenia,EU) emitting pulsed infrared radia-tion at a wavelength of 2.94micrometers at 300mJ (10 pulses/sec,300-msec pulse duration) from aquartz noncontact tip with a diam-eter of 900 µm. An externalwater-cooling system sprayed 10 mlof water per minute. For the firstgroup, the beam was aligned perpen-dicular to the specimens at distanceof 1 mm and moved in a sweepingfashion, screening the test surfacewith a uniform motion to form arectangle of 1 mm x 2 mm by handover an average period of 155 secondsexposure period over the entire area.
For the second group, the samelaser and water spray parameterswere used with the addition of theLAWA device, which provided a1200-Hz horizontal, 50-Hz verticalscan rate and formed a rectangle of1 mm x 2 mm. The handpiece washeld still during application.
The temperature increases wererecorded with a thermocouple(HH501DK, Omega Engineering,Inc., Stamford, Conn., USA) whichwas linked to a notebook computer(Toshiba, Satellite A105-S4004,Tokyo, Japan) with specific software(IR-Graph v. 1.02, RaytekCorporation, Santa Cruz, Calif.,USA) that recorded the readingsthat were made every 0.125 seconds.The laser was applied until the ther-mocouple indicated a suddentemperature increase in the pulpchamber. The temperature variationwas determined as the increase frombaseline temperature to the highesttemperature recorded after theinitial tooth preparation. Data werecollected for a 20-second stable base-line period prior to testing and for aperiod of up to 360 seconds after thepreparation had been completed toensure that the temperaturesreturned to the baseline levels.
Statistical AnalysisStatistical analysis was performedusing software (SAS® System forWindows®, release 8.02/2001, SASInstitute Inc., Cary, N.C., USA). Theresults obtained from the meantemperature changes of each groupwere statistically analyzed(Kruskal Wallis and Mann-WhitneyU) to determine the significantdifferences between the meanpreparation durations. The level ofsignificance was chosen as 0.05.
R ES U LTSSignificant differences between thetwo test groups (P < 0.05) wereobserved. The mean temperaturerise values (mean temperature ±SD) of Er:YAG group (4.47 ± 0.51°C) was significantly higher thanthe Er:YAG+LAWA group (2.43 ±0.53° C) (P < 0.05). This is depictedin Figure 2.
CO N C LU S I O N SIn vitro pulp chamber temperature
increases with Er:YAG laser withand without the LAWA systemunder water cooling were belowthose deemed to be harmful for thepulp. The use of the LAWA systemappears to prevent the local temper-ature increases that might resultfrom the multiple interactions atthe same point on the target tissue.
A U T H O R B I O G R A P H I ESDr. Bülent Gökçe graduated in1998 and practices in the EgeUniversity School of DentistryDepartment of Prosthodontics. Hereceived his PhD in 2004 andAssociate Professorship in 2010.He is a national and internationalspeaker and has authored and co-authored several articles. Dr.Gökçe may be contacted by e-mailat [email protected].
Dr. Birgül Özpinar is a full-timeprofessor in the Ege UniversitySchool of Dentistry Department ofProsthodontics. She is a nationaland international speaker and has
Gökçe et al.
Figure 2: Intrapulpal temperature rises occurring following Er:YAG laser andEr:YAG+LAWA irradiation by time.
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Gökçe et al.
authored and co-authored severalarticles. Dr. Özpinar may becontacted by e-mail [email protected].
Dr. Emil Litvak graduated in1987 from Hadassah Dental Schoolin the Jerusalem HebrewUniversity and practices dentistryin private practice. He is a founderof B.E.D. Laser Technologies Ltd., acompany that is developing newtechnology, methods, and applica-tions for the Er:YAG laser indentistry, and holds the patent forthe LAWA method, device, and
application. Dr. Litvak may becontacted by e-mail at [email protected].
Disclosures: Drs. Gökçe and Özpinarhave no commercial or financialinterest relative to this manuscript.Dr. Litvak is a distributor of Fotonamedical lasers in Israel, Kazakhstan,Kyrgyzstan, and Azerbaijan. He isalso a patent owner of LAWA.
R E F E R E N C ES1. Cavalcanti BN, Lage-Marques
JL, Rode SM. Pulpal tempera-
ture increases with Er:YAG laserand high-speed handpieces. JProsthet Dent 2003;90(5):447-451.
2. Glockner K, Rumpler J,Ebeleseder K, Städtler P.Intrapulpal temperature duringpreparation with the Er:YAG lasercompared to the conventionalburr: An in vitro study. J Clin LaserMed Surg 1998;16(3):153-157
3. Zach L, Cohen G. Pulp responseto externally applied heat. OralSurg Oral Med Oral Pathol1965;19(4):515-530. nn
How to Communicate to Patients Before and After TreatmentAngie Mott, RDH, Tulsa, OklahomaJ Laser Dent 2010;18(2):64-67
From this article the followingcommunication objectives can bemet:• Specify how we communicate
with our patients.• Recognize what our patients hear
when we are talking to them.• Identify how to properly intro-
duce a patient to the concept oflaser treatment.
• Understand the value ofpretreatment instructions forlaser care.
• Learn what might be appropriatepostoperative instructions aftercommon laser procedures.
• Determine how we collect fees forlaser procedures.Communication is successful
only when both the sender and thereceiver understand the sameinformation as a result of thecommunication. What does thismean to you? What is being said?More importantly, how do we sayit?
Before we know what we say, weneed to know what each questionmeans.
For instance, what are Open-Ended Questions? Asking patientsopen-ended questions requiresthem to provide some type ofresponse, which can even lead tomore questions.
Closed-ended questions are thetype of questions you want to stay
away from. A closed questionusually receives a single word orvery short response — for example,“Are you enjoying your day?” Theanswer is “Yes” or “No.” “Where doyou work?” The answer is generallyvery simple and easy. Don’t leadyour patients with these types ofquestions, it will end conversation.The only time that closed-endedquestions are good is to wrap upconversations.
As you observe others, you canidentify some common signs andsignals that give away whetherthey are feeling confident or not.Typical things to look for in confi-dent people include:Posture – standing tall with shoul-
ders backEye contact – solid with a smiling
faceGestures with hands and arms
– purposeful and deliberateSpeech – slow and clearTone of voice – moderate to low.
Here are some tips to keep in mind:• 99% of communication is body
language.• Be confident in what you say and
how you say it.• If you act afraid of your fees or
procedure, you are telling yourpatient that you don’t believe inwhat you are saying.
We need to know what the patient’sneeds are:• Everyone in the office must be on
the same page.• You must also understand the
patient’s needs.• Some of the things that will help
explain the disease to thepatients are: a periodontaldisease chart, X-rays, intraoralcamera.
Additional tips to keep in mind:• Finances may be an issue, so
offer suggestions for payment.• Show compassion. If you share
with them your concerns andwillingness to help them achievetheir goals, you will gain thelevel of trust.
• Set up the treatment options in amanageable amount, so as not tooverwhelm the patient.
Key questions:• Can you understand the need for
this treatment?• Are you willing to have this
treatment completed?• Ask questions…Make the patient
want the treatment.
What about presenting a change infinancial options to existingpatients?
Patient: “Can’t you just bill melike you always do?”
• Response 1: “In order to keep ourcosts down for you we have elimi-nated our billing. However, wehave some great savings for youwith our new payment options.Let me go over the savings withyou.”
• Response 2: “We don’t want toraise our fees simply to cover ourbilling expenses so we’ve imple-mented some great savings foryou with our new paymentoptions. Let me go over thosewith you.”
• Response 3: “We know you counton us to control costs wheneverpossible so we have eliminatedour billing and replaced it withsome great new options. We havesome great savings that I wouldlove to go over with you.”
• Response 4: “We have had our
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Angie Mott, RDH
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practice analyzed and found ourcosts for operation have gone up.Our accountant has found one ofthe biggest costs was that wewere trying to run a bankingbusiness. We found that it wasnot time- or cost-effective for us,so we have searched for a finan-cial partner to provide ourpatients some great savings. Letme share those with you.”
CO M M U N I C AT I N GYO U R G U I D E L I N ESAll dental practices want to controltheir appointment books effectively.However, most practices unknow-ingly give their patients control,believing that most patients canvisit the office only early in themorning or late in the day. Thishowever, may not be the case.
We give patients control when we say…
“When would you like to comein?”
or“When will it be convenient foryou to come back in?”
Instead we should say…“The Doctor can see you Mondayat 9:30 or Tuesday at 10:40.”
By saying that “the Doctor cansee you…” makes it more difficultfor the patient to refuse the doctor.
Confirming appointments:• Other than dental practices, very
few professionals confirmappointments.
• Many practices believe patientswill not keep their appointmentsunless they receive a confirma-tion call.
• The truth is that some appoint-ments should be confirmed, butmany appointments are notnecessary to confirm.
• Many confirmation calls are notnecessary and can be avoided ifwe simply ask whether thepatient will require a confirma-tion call.
• “Mrs. Smith, most of ourpatients do not need a confir-mation call. Is that going to bethe same for you?” Instead of:“I am calling to confirm yourappointment on…”
• If needed, call two days beforeappointment to confirm: “Thisis Donna from Dr. Jones’ office.I was calling to see if you hadany questions regarding yourreservation with Dr. Jones on_______”
Last-minute cancellation• Instead of “When would you like
to reschedule…” try:• “Oh no, I know that Dr. Jones
is going to be disappointed. Hehad two hours of his time setaside just for you. Hold on aminute and let me go checkwith his schedule… He wantedto know if there was any waythat I could help you keep thisappointment?”
Help make the patient feelcomfortable• Slow down. Often we get excited
with explaining our treatmentand financial options, and weforget that the patients may beoverwhelmed, nervous, scared,and excited.
• Take the time to explain andreassure your patients,answering all of their questions.Give them your personal busi-ness card and tell them to callyou, if they have additional ques-tions.
• Use visual aids, mirror, X-rays,photos.
• Listen to your patients, try to putyourself in their shoes.
• We need to spend just as muchtime answering our patient’squestions and concerns as we docompleting treatment.
• When our patients feel comfort-able with understanding thetreatment plan and financialoptions provided for them, theyare more likely to complete treat-ment and pay for it.
Body language• By developing your awareness of
the signs and signals of bodylanguage, you can more easilyunderstand other people, andmore effectively communicatewith them.
• Use this awareness as a hugetool for you; it will allow you toguide the conversation in thedirection you want.
What to say…or not to say.Below are phrases and words thatwe say that can mean differentthings to our patients. Considerthese statements when speaking toyour patients:
Eliminate these comments:• Just a cleaning or recall• Gross scaling• Inflammation• A little bit of…• Booked• Cancellation list• Insurance coverage• Cost• Work.
And, try these instead…• Continued care• Initial Periodontal Therapy (IPT)• Infection• Bone loss…tell it like it is• Scheduled• Priority list• Insurance assistance or benefits
your employer has chosen for you• Investment• Treatment/Procedure.
As technology continues tochange, we have to relay thosechanges in our offices and to ourpatients, but sometimes we have tobe ready for…What if a patientsays…
“I just want to stay with 6months.”
Our response should be:“Well, that’s fine, I just want toremind you that the continuedcare appointment that I will bedoing today will not reach the
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infection located in those 4- and5-mm pockets. As long as you areaware of this, we can continue onwith the appointment.”
Then there are the times thatpatients will say…
“I’m in a hurry today, I justwant my teeth cleaned.”
To that we can respond:“That’s fine, I will do my best toget you finished up today to keepyou on schedule, but please keepin mind that I am concerned withthese findings and at your nextappointment, I would like toexplain to you what I havefound.”
Or what about when our patientssay…
“I don’t want to hear this…”
From this point we have to go backto research.
“We have new information and myjob is just to let you know aboutyour dental health. It will be yourdecision to determine what yourtreatment plan will be.”
Depending on the treatmentthat you provide to your patients,there are value statements thatyou should consider saying.
First, for your PeriodontalTherapy treatment:• More advanced and detailed
procedures exist to help youcontrol your infection
• Postponing therapy will put youat risk for more permanent boneloss
Second, for your Six-Week – 3-Month Therapy:• This is the most important
appointment of the entire series• It includes full-mouth repetitive
therapy to disrupt the bacteriathat have grown back
• The hygienist will collect the datafor the doctor to evaluate yourhealing.
And for the SupportivePeriodontal Therapy:• The hygienist will disrupt the
bacteria in the areas that you areunable to reach
• We will closely monitor yourperiodontal health to detectrecurrence of infection.
• The hygienist will determine theinterval of further treatment tobe able to maintain your dentalhealth.
Finally, for Continued Care:• The hygienist will do a perio-
dontal screening to check for anysigns of gum disease.
• The hygienist will determine theinterval of further treatment tobe able to maintain your dentalhealth.
There are other key phrasesthat are important to understand,since so many dental offices usethem.
What about Watch vs.Completing Treatment?• If we watch it, what are the
chances that it will get worse?
And don’t forget… “Will my insurance ‘cover’ this?”
“We will do our best to maximizeyour insurance. Your insurancetypically assists with about 40%.”
or“That will depend on the insur-ance policy that your employerhas chosen for you.”
“I have been here every sixmonths to have my teeth cleaned;you have never mentioned thisbefore, why now?”
“As you know, technologycontinues to change and thedoctor and I want to provide thebest possible care for you. We haverecently changed our standards togive you the best possible care.”
or“The Surgeon General and theAmerican Dental Associationhave recently joined forces real-
izing that we need to make agreater effort in treating gumdisease.”
Of course the patient will alwayshave some questions, such as:“Will it hurt?”
“We will make you as comfortableas possible. If you need it, we canuse some topical or local anes-thetic, similar to when you havea filling done. You may have totake a pain reliever after treat-ment, whatever you typicallytake for a headache.”
“Will my insurance coverlasers?”
“Lasers are a fairly new conceptwith insurance companies, andtypically they do not have abenefit for lasers. What we willdo is incorporate the lasertherapy into existing codes tomaximize your insurance bene-fits for you.”
“My gums have always bled…”“We know that bleeding gums arenot healthy – just like if you hada cut on your arm, would you beconcerned about the bleedingtaking place?”
So, start the appointment bysaying…• “We are so excited to see you
today to tell you about all thechanges in dentistry (or ouroffice) since your last visit.”
• “What we have been doing in thepast has not been working…”
• “This infection will not go awaywithout treatment.”
After charting, if there isbleeding you can say…
“I am really concerned about theinfection and the amount ofbleeding that I am finding today.”
Finish by saying:“Just as everyone heals differ-ently from a cold, people healdifferently after periodontaltreatment. They didn’t get thisway overnight. They may takesome time to heal.”
Mott
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This works well for the firstrecall appointment after perio-dontal therapy and if there arestill areas of concern.
What about after treatment,what do we tell patients then?Postoperative Instructions:• After a patient has received laser
dental care, there are some post-operative instructions thatshould be given.
• Before the patient is dismissed,place some vitamin E on yourfinger or a Q-tip and place it onthe areas of treatment.
• The patient should be informedto continue taking any prescribedmedication as normal.
• Instruct the patient to avoid eatingcrunchy foods such as potato chips,tortilla chips, pretzels, popcorn,anything that can get lodged intopockets for the next 24-48 hours.
• Tell the patient to avoid acidicand salty items for the next fewdays as well.
• If the patient uses a battery-powered toothbrush, tell him/herto take it easy for a few days andalways use it on a low setting.
• Using a manual toothbrush is asafe alternative.
• Floss should be used in a contactmode, just breaking through thecontact without snapping it intogum tissue.
• Make sure that you haveanswered all of your patients’questions and provide them witha postoperative handout of theinstructions that you have justprovided them.
• Tell them to call you with any“questions” that they may have.
Here is what some of ourAcademy of Laser Dentistrydoctors have to say for advice…Dr. Alfred Wyatt (College Park,Georgia) says…
“Prior to treating my patientswith lasers, I attempt to high-light the benefits that will help
them feel more comfortable withacceptance of the device. Thisincludes fewer needles, killsbacteria, creates less trauma(thus less pain), and reducesbleeding. I prefer not to go into adetailed explanation because itopens more curiosity that leadssometimes to anxiety. That, Iwant to avoid.”
Dr. Stu Coleton’s (Chappaqua, NewYork) advice is…
“One of the pleasant things wecan both enjoy by using the laseris there will be very little, if any,bleeding during the procedure soI won’t have to place stitches. If Idon’t put them in today, I won’thave to remove them in the nextvisit.”
“I’m planning to remove thesores in your mouth by using thelaser today. I anticipate yourleaving the office today withabsolutely no pain in your mouth.”
“I will be able to remove thatspot of decay I showed you onyour son’s tooth without givinghim an injection of Novocain™.”
Dr. Steve Burman (Manalapan,New Jersey) suggests…
“I always try to give an exampleof what they are going to expectafter the procedure. Patients wantto know 3 things...How long, howmuch, and is it going to hurt?”
“The team must always let thepatient know what an expert thedoctor is and what his creden-tials are.”
“The Team, especially thehygienists, should see the doctordo a procedure, and see each stepof follow-up. This will give thema familiarity with the procedureso they can give first-handaccounts. Also, this gives them achance to ask the patient abouttheir experience months laterafter an area heals.”
“We may show pictures ofprevious cases, or use our dental
patient education software toshow or explain the procedure.”
Doug Gilio (Visalia, California)says…
“Whatever I present to thepatient can vary depending onthe type of procedure. However, ifI feel the laser is part of thetreatment plan, I tell the patientthe laser treatment generally willcause less discomfort and thehealing period will be reduced. Inmy experience this comment isaccurate over 90% of the time.”
So in closing, we need to andhave to Create the Value!! Many ofus are great clinicians, but withoutthe communication tools in placewe can’t make the treatmenthappen. So…• Believe• Educate• Use your knowledge, and• Take the time to visit with your
patients.
A U T H O R B I O G R A P H YMs. Angie Mott has been a clinicalhygienist for more than 20 years.Recently she was named as theDental Hygiene Program Directorfor the Las Vegas Institute (LVI).She is a member of the Academy ofLaser Dentistry, where sheobtained her Advanced LevelProficiency, her Educator Status,and received her ALD RecognizedCourse Provider 2007 and herMastership with ALD in 2008. Ms.Mott is currently serving asAuxiliary Chair for the ALD Boardof Directors and serves on theRegulatory Affairs, Education,Membership, Advertising, and theScientific Sessions Committees. Ms.Mott may be contacted by e-mail [email protected].
Disclosure: Ms. Mott has no commer-cial or financial interest relative tothis presentation. nn
Mott
Infection ControlFrank Yung, DDS, Toronto, Ontario, CanadaJ Laser Dent 2010;18(2):68-70
More than 20 years ago, a dentalpatient named Kimberly Bergaliswas diagnosed with AIDS(Acquired Immune DeficiencySyndrome). The source of herhuman immunodeficiency virus(HIV) was her dentist. Even thoughthe exact route of her transmissionis still not known, this first-provenspreading of the HIV from dentistto patient – and the intense subse-quent coverage by the media – setoff tremendous confusion and panicamong dental patients. It was herunfortunate death in 1991 thatchanged the dental professionalmost overnight, prompting allsorts of new regulations and guide-lines, including the sterilization ofdental instruments. The document,Guidelines for Infection Control inDental Health-Care Settings–2003,was published by the U.S. Centersfor Disease Control and Prevention(CDC) on December 19, 2003,providing some of the current andavailable scientific rationale forperforming infection control prac-tices, for which recommendationswere made.1 These suggestionswere followed closely by variousgoverning dental health organiza-tions including the U.S.Occupational Safety and HealthAdministration (OSHA) and HealthCanada.
In dentistry, we are seeingpatients from different walks of lifeevery day and they are bringing all
kinds of pathogens to the dentaloffices. It is our responsibility toarrest these pathogens and attemptto prevent them from infecting andspreading beyond our practices.Following the CDC recommendedinfection control guidelines andprocedures can help stop andprevent transmission of infectiousorganisms through blood, oral andrespiratory secretions, and contam-inated equipment during the courseof dental treatment. One factor toconsider in assessing the risk ofcontamination is the type of bodysubstances to which dental healthcare personnel (DHCP) are exposedto. It is generally understood thathuman blood has a high infectiouspotential.2 In addition to bacteriaand fungi, human saliva was foundto be capable of harboring manykinds of infectious viruses.3-4
Without the benefits of a quick andreliable reference, DHCP have toassume that everyone is a potentialcarrier. This is the fundamentalreason why dental practices shouldhave a universal infection preven-tion protocol.
Among many other relatedissues, the CDC guidelines explainhow to wear surgical gloves prop-erly and how to implement a gloveprotocol. These recommendationswill help properly prevent contami-nation from our patients’ oraltissues and fluids. Regardingsurgical masks, laser ablation ofhuman tissue or dental restora-tions can cause thermal destructionand can create smoke by-productscontaining dead and live cellularmaterial (including blood frag-ments), viruses, and possible toxicgases and vapors. One concern isthat aerosolized infectious materialin the laser plume, such as theherpes simplex virus (HSV) andhuman papillomavirus (HPV) maycome into contact with the nasalmucosa of the laser operator andnearby DHCP. Although noevidence exists that HIV or hepa-titis B virus (HBV) have beentransmitted via aerosolization andinhalation, there are scientificstudies which confirm the risk ofthis possible route of contamina-tion.5-6 The risk for DHCP from
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Figure 1: An example of a high-filtration-rate protective mask, which is recommendedfor use with dental lasers.
Frank Yung, DDS
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exposure to laser plumes andsmoke is real; and, along with othermeasures such as strong high-volume suction, the use of a highfiltration mask is strongly recom-mended (Figure 1).
Sterilization is a multi-stepprocedure which must beperformed carefully and correctlyby the DHCP to help ensure thatall instruments are uniformly ster-ilized and safe for patient use.Cleaning, which is the first basicstep in all decontamination andsterilization processes, involves thephysical removal of debris andreduces the number of microorgan-isms on an instrument or device. Ifvisible debris or organic matter isnot removed, it can interfere withthe disinfection or sterilizationprocess. Proper monitoring of steril-ization procedures should include acombination of process indicatorsand biological indicators, andshould be assessed at least once aweek (Figure 2).
Patient care items are generallydivided into three groups,depending on their intended useand the potential risk of diseasetransmission. Critical elements areitems which penetrate soft tissue,touch bone, or contact the blood-stream. They have the highest riskof transmitting infection andshould be heat-sterilized betweenpatient uses. Examples of criticalitems include surgical instruments,periodontal scalers, surgical dentalburs, optical fibers (Figure 3), andcontact tips (Figure 4). Therefore, itis absolutely important to examine,cleave, polish, and sterilize opticalfibers and contact tips after eachuse. Alternatively, sterile, single-use disposable devices can be used.Semi-critical items are items whichcome in contact with only mucousmembranes and do not penetratesoft tissues. As such, they have alower risk of transmission.Examples of semi-critical instru-ments include dental mouthmirrors, amalgam condensers,and impression trays. Most of theequipment in this category is
Yung
Figure 2: An example of the submission of indicators to a testing service for assessmentof office sterilization equipment’s effectiveness.
Figure 4: An example of sterilized rigid glass tips and handpieces.
Figure 3: An example of sterilized optical fibers and handpieces.
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heat-tolerant, and should thereforebe heat-sterilized between patientuses. For heat-sensitive instru-ments, high-level disinfection isappropriate. Noncritical items areinstruments and devices that comein contact only with intact(unbroken) skin, which serves asan effective barrier to microorgan-isms. These items carry such a lowrisk of transmitting infections thatthey usually only require cleaningand low-level disinfection.Examples of instruments in thiscategory include X-ray head/cones,blood pressure cuff, low-level laseremission devices, and laser safetyglasses. For low-level laser therapy,the use of a transparent barriersimilar to disposable sleeves forcuring lights is acceptable. Forsafety glasses, the use of a low-level disinfectant is suitable as longas it has a label claim approved byOSHA for removing HIV and HBV.
The disposal of used instru-ments and excised biologicaltissues should be managed sepa-rately. The cleaved optical fiber,broken contact tips, or disposablefibers should be disposed properlyin a sharps container. Harvestedbiological waste should be placed ina container labeled with abiohazard symbol. To protect indi-
viduals handling and transportingbiopsy specimens, each specimenmust be placed in a sturdy, leak-proof container with a secure lid toprevent leakage during transport.
By following these guidelines,the spread of pathogens amongdental patients, dental health carepersonnel, and their families can beprevented, and the passing ofKimberly Bergalis will not havebeen in vain.
A U T H O R B I O G R A P H YDr. Frank Yung graduated withhonors from the Faculty of Toronto,Canada in 1980. He achievedAdvanced Proficiency in the use ofdiode and Er:YAG lasers. Hereceived Educator Certification in2005 and was awarded the ALDLeon Goldman for ClinicalExcellence award in 2007. Dr. Yungis also a Fellow of the AmericanSociety for Lasers in Medicine andSurgery and maintains member-ship in the Society for Oral LaserApplications and the AmericanDental Education Association. Dr.Yung may be contacted by e-mail [email protected].
Disclosure: Dr. Yung has no commer-cial or financial interest relative tothis article.
R E F E R E N C ES1. Kohn WG, Collins AS, Cleveland JL,
Harte JA, Eklund KJ, Malvitz DM.Guidelines for environmental infec-tion control in health-care facilities.MMWR Recomm Rep 19 Dec2003;52(RR-17):1-116.
2. CDC. Department of Health andHuman Services. Centers forDisease Control and Prevention.Bloodborne Pathogens in HealthcareSettings. www.cdc.gov/ncidod/dhqp/bp.html. Accessed July 21, 2010.
3. Madinier I, Doglio A, Cagnon L,Lefèbvre J-C, Monteil RA. Southernblot detection of human papillo-maviruses (HPVs) DNA sequencesin gingival tissues. J Periodontol1992;63(8):667-673.
4. Amit R, Morag A, Ravid Z, HochmanN, Ehrlich J, Zakay-Rones Z.Detection of herpes simplex virus ingingival tissue. J Periodontol1992;63(6):502-506.
5. Baggish MS, Poiesz BJ, Joret D,Williamson P, Refai A. Presence ofhuman immunodeficiency virusDNA in laser smoke. Lasers SurgMed 1991;11(3):197-203.
6. Matchette LS, Faaland RW, RoystonDD, Ediger MN. In vitro productionof viable bacteriophage in carbondioxide and argon laser plumes.Lasers Surg Med 1991;11(4): 380-384. nn
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Full-Mouth Gingivectomy and Exposure of anUnerupted Cuspid Using an 810-nm Diode LaserLouis G. Chmura, DDS, MS, Marshall, MichiganJ Laser Dent 2010;18(2):71-76
P R ET R E AT M E N TA. Outline of Case1. Clinical DescriptionA 10-year, 4-month-old white malepresented for orthodontic treat-ment in the mixed dentition. Hewas placed in a pre-orthodonticguidance program until 11 years, 3months, when Phase I orthodontictreatment was initiated to align hisupper incisors which addressed hisconcern about his appearance. Theextent of oral hygiene issuesbecame apparent during the initialphase (Figure 1) and he receivedprofessional advice to improve histooth brushing during and afterthat treatment time.
Phase II treatment goals werethe correction of all misaligned teethand the establishment of a Class Iocclusion with anterior guidance.When the patient was 13 years and9 months old, Phase II treatment
began and the gingival inflamma-tion had been corrected. However,the patient exhibited generalizedgingival hypertrophy, an uneruptedupper right cuspid, and incompleteeruption of other teeth (Figures 2-3).In order to begin treatment whilefacial skeletal growth was ideal andstill obtain access for ideal place-ment of brackets, the treatment planproposed that the upper right cuspidshould be surgically exposed. Toallow access for orthodontic bracketplacement, a suggestion was madeto perform upper and lower facialgingivectomies at all tooth sites.
2. Medical HistoryThe patient was in excellenthealth. He had an allergy to peni-cillin but not to anesthetics andwas taking no medications. Therewas no history of bleeding or clot-ting disorders.
3. Dental HistoryThe patient had been seen regu-larly every six months by hisprimary care dentist. He had somerestorations in the primary denti-tion, and had small restorations inthe permanent first molars and thelower left second molar. Thepatient had a history of poor oralhygiene that had been correctedbetween Phase I and Phase IIorthodontic treatment, as demon-strated by the remaininghypertrophy but lack of inflamma-tion. There was no decalcificationof the tooth enamel surfaces, and itwas therefore considered appro-priate to begin the Phase IItreatment.
4. OcclusionThe patient presented with amildly convex profile, a mildly longlower facial height, and mildlyproclined molars. His left molarswere Class I and right molars wereClass II, with no missing teeth andthe upper cuspids not completelyerupted. The upper midline wascoincident with the facial midline,but the left side was Class II. Heappeared to show too much gingivaon smiling, particularly on the leftcentral, but this was largely anissue of excessive gingival tissuerather than a skeletal discrepancy.
5. TMJTemporomandibular joint examina-tion by palpation and radiographicevaluation revealed no abnormali-ties. The patient had 10-mm lateralexcursions and 50 mm maximumopening, both normal. He did notdeviate on opening and reported nodifficulties or sounds on opening orin lateral excursions.
Chmura
Louis G. Chmura, DDS, MS
Figure 1: Anterior view of dentitionduring Phase I treatment. Note somemarginal chronic inflammation.
Figure 2: Anterior view of dentition at thestart of Phase II treatment. Note similarinflammation as in Figure 1.
Figure 3: View of unerupted maxillaryright cuspid.
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6. Radiographic ExaminationPanoramic radiographs were takenbefore orthodontic treatment began(Figure 4) and in preparation forfinishing (Figure 15). Radiographsshowed normal root anatomy withthe upper cuspids erupting in anormal direction.
The final panoramic view wasderived from a three-dimensionalimage (i-CAT® Cone Beam 3-DImaging, Imaging SciencesInternational, Harfield, Pa., USA)and confirmed the presence ofretained third molars. These teethwould be removed after the comple-tion of the orthodontic treatment.Radiographically there was noevidence of hard tissue pathologyin either film.
7. Soft Tissue ExaminationGeneral oral soft tissue: There wasno clinical evidence of soft-tissuepathology or of airway concerns.
Gingival soft tissues: Thegeneral level of oral hygiene wasgood at the initial examination andhad improved dramatically beforebonding. The patient exhibitedgeneralized hypertrophy of thegingival tissue, including increasedpocket depth midbuccally (approxi-mately 2-5 mm) and various clinicalcrown lengths (Figure 5). There wasadequate keratinized tissuethroughout, including facially onthe unerupted upper right cuspid.
8. Hard Tissue StatusCommensurate with age and devel-opment, all teeth were present withno evidence of carious lesions, nobony abnormalities, and an exces-sive facial height and convexprofile. He had bimaxillary procum-bency and a mild Class IIrelationship on the left side, withthe lower midline shifted to the left.
Tooth vitality test: This was notperformed as there was no evidenceof its need.
Mobility: There was no evidenceof any abnormal tooth mobility.
Percussion: Percussion testswere not necessary, as there was no
evidence of any apical pathology.
9. Other TestsIt was decided that no other testswere appropriate since the patientwas a healthy teenager who wasbeing seen by his primary caredentist for routine examinationevery six months. There were no clin-ical signs or symptoms of pathology,other than the gingival hypertrophy.
B. Diagnosis and Treatment Plan1. Provisional DiagnosisA provisional diagnosis was madeof (1) insufficient eruption ofpermanent teeth for ideal ortho-dontic bracket placement, and (2)an unerupted upper right cuspid.
2. Final DiagnosisThe final diagnosis confirmed theprovisional one, and consisted of:• Insufficient eruption of perma-
nent teeth for ideal bracket
placement. This was not likely toimprove in the short term
• Unerupted upper right cuspid• Phase II orthodontic treatment
should proceed.
3. Treatment Plan Outline• Probe pockets to establish loca-
tion of cementoenamel junctions(CEJs), depth of pockets, andpotential positions for gingivalcrests.
• Establish maximum targetlengths for all teeth that allowfor bonding of orthodonticbrackets while leaving at least 1mm of keratinized tissue and atleast 1 mm of pocket depth, so asto not violate biologic width orpocket depth limitations.
• Perform gingivectomies to allowproper bracket placement andmore complete oral hygiene.
• Expose upper right cuspid toallow proper bracket placement.
Chmura
Figure 4: Panoramic radiograph taken approximately 9 months prior to the start ofPhase II treatment.
Figure 5: Periodontal probing data with measurements taken only at the mid-buccalsulcular depth and the long axis of the maxillary teeth.
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• Continue to encourage excellenthome care to assure oral hygienehealth.
4. Indication and ContraindicationsA. INDICATIONS
Treatment: Indications for gingivalrecontouring were to allow ortho-dontic treatment to begin at theideal age and developmental stage.Modern orthodontic appliances aredesigned to be bonded in themiddle of the clinical crown toreduce the need for wire bends, andto achieve the best possible results.
Ideally, orthodontic treatmentshould start when the secondmolars are erupted and beforegrowth slows down. In males, thisis approximately 13 to 14 years ofage. Starting at this time allowstreatment to begin and end in theleast amount of time. The patientwas ready for Phase II orthodontictreatment at 13 years, 9 months.
An additional goal was to use aprocedure that provided the leastdiscomfort and potential complica-tions for the patient. Since theprospective treatment involvedsolely soft tissue procedures, anear-infrared laser that is betterabsorbed in melanin and hemo-globin and more poorly absorbed bytooth structure was appropriate.
Because the practitionerintended to bond brackets immedi-ately after the soft tissue surgicalprocedure, the hemostatic qualityof laser-assisted gingivectomy (dueto hemoglobin and melanin chro-mophores) is particularlyadvantageous.
B. CONTRAINDICATIONS
Treatment: There were no absolutecontraindications for this proce-dure, but the following aspectswere recognized:• Aesthetic considerations: The
upper lip line was fairly normalfor his age, but the less-than-ideal eruption gives the patientthe appearance of a “gummy”smile.
• Pocket Depth: Since the
midlabial pockets are 2-5 mm, itwas considered appropriate toincrease visible crown lengths by1-4 mm (leaving a 1-mm pocketdepth) and expose the upperright cuspid, leaving at least 1mm of keratinized tissue. Thiswas deemed sufficient to allowfor proper bonding of brackets.
• Biologic width (i.e., the sum ofthe connective tissue attachment,epithelial attachment, andsulcular depth relative to theosseous crest) was respectedsince at least 1 mm of pocketdepth was to be preserved.
• Laser: Any laser use carries somerisk of tissue damage or poorresults, particularly if usedimproperly. Significant riskfactors would be thermal damageto adjacent nontarget tissues.
• Wavelength: Preference should begiven to a laser that is well-absorbed in soft tissue andless-absorbed in hard tissues.
5. PrecautionsBenefits of using an 810-nm diodelaser include selective targeting ofsoft tissue, hemostasis, and satis-factory and predictable healing.
It is appropriate to use minimalpower and proper technique, mini-mizing the risk of tissue damage.
After such a procedure, it isimportant that the patient followhome care instructions to maximizehealing and stability, and to mini-mize potential complications.
6. Treatment AlternativesThe following alternatives to laser-assisted treatment may beconsidered:• Delay placing brackets and await
additional eruption of the teethand recession of gingiva. This isnot likely to occur in the shortrun, and waiting complicatesorthodontic treatment dramati-cally by starting after growth iscomplete and active bone remod-eling slows down.
• Place brackets in a less-than-idealposition and attempt to compen-
sate with wire bends. This alter-native has the negative effect ofseverely complicating orthodontictreatment, probably extending thetreatment time for a young manwith a history of less-than-idealhygiene, and making it even moredifficult for him to clean properlyby placing the brackets very closeto the gingival crests. In addition,there would be an indeterminatedelay while waiting for the upperright cuspid to emerge.
• Alternative methods for softtissue removal include a scalpelor electrosurgery, which coulddelay the start of treatmentwhile healing. With the properlaser procedure, bonding can takeplace immediately due to excel-lent hemostasis and developmentof a dry field.
7. Informed ConsentAll alternatives and risks werereviewed with the patient andparents, along with potential asso-ciated risks at the time of theprocedures. The consent form wassigned by the patient’s parents andattested to by a witness.
T R E AT M E N TA. Treatment ObjectivesThe upper right cuspid would beexposed with an 810-nm diodelaser, and excess gingival tissue onremaining teeth excised to allow forproper bonding of orthodonticappliances. The gingival contouringwould proceed with the objectivesto leave at least a 1-mm pocket andat least 1 mm of keratinized tissueto avoid violating biologic width, toavoid relapse, and to avoidremoving all keratinized tissue.
B. Laser Operating Parameters:Laser: An 810-nm diode laser(Spectralase® Diode laser, SpectrumInternational, Inc., Concord, Calif.,USA) was used. The operatingfeatures are as follows:• Wavelength: 810 +/-10 nm• Coaxial aiming beam: Diode
Class I laser 650 nm, 2 milliWatt
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• Emission mode: Continuous Wave(CW) or Pulsed at 10 Hz (Pulsewidth 50 msec)
• Maximum power output: 3.0 Watts• Delivery system: Standard SMA
905 connector with single corefiber-optic tube (200-µm diam-eter) with handpiece anddisposable cannula tip.
Laser settings:• Cuspid exposure: 0.9 W CW,
contact mode, spot size 200 µmwith light initiation. Total expo-sure duration: 45 seconds
• Gingivectomy: 0.9 W CW, contactmode, spot size 200 µm with lightinitiation. Total exposure dura-tion: 12 minutes.
C. Treatment Delivery Sequence:1. Preliminary to Patient TreatmentPrior to the treatment, thefollowing safety aspects wereperformed and supervised by thelaser safety officer:• The operating space was secured
and the proper laser warningsign was placed at the edge of thecontrolled area;
• The laser was set up and testedfor proper operation and propercleave;
• All supplies and sterile instru-ments were properly arranged.The patient’s information andcharting notes were reviewed;
• The patient and parent weregiven proper eye protection towear, and the dentist and assis-tant wore proper eye protectionand facial masks qualified tofilter particles to 0.1 micron.
2. Treatment SequenceThe periodontal charting wasreviewed (Figure 5) and the goal ofexposing enough crown length toallow bonding of orthodonticbrackets, while leaving at least 1 mmof pocket depth to avoid violatingbiologic width, was confirmed. Inaddition, bulky papillae would bereduced in size and beveled tonormal physiologic contours toreduce potential for relapse.
Ideal gingival contouring goalswere considered: (a) that the zenithof the facial gingival crests shouldbe slightly distal to the central axisof the tooth; (b) that the centralincisor and cuspid crown lengthsshould be the same; (c) that thelateral incisor crown length shouldbe approximately 1 mm shorter;and (d) that the intended crownlengths could be achieved withoutany osseous crown lengthening.
The gingival tissues wereisolated with lip stretchers anddried. Topical anesthetic (20% lido-caine, 4% tetracaine, 2%phenylephrine in a viscous gel,with peppermint flavoring) wasapplied to all surgical sites. Afterthree minutes, the excess anes-thetic paste was removed and thetissues tested for sharpness sensi-tivity using a periodontal probe.
The laser was test-fired with apower setting of 0.9 W CW. Thelaser beam was directed onto artic-ulating paper to establish patencyof beam emission in the deliverysystem.
3. Cuspid ExposureAfter the panoramic radiograph wasreviewed and the upper right cuspidwas palpated to determine theactual position, a small amount ofgingiva was removed with the laserto expose the incisal third of thecuspid crown. A periodontal probewas used to establish the cemento-enamel junction of the tooth andconfirm the amount of soft tissuethat could be removed. The exposureprogressed, starting at the height ofthe contour of the planned gingivalcrest and with a light brushingstroke, the laser fiber was movedtoward the mesial aspect, keepingthe fiber angled approximately 45degrees to the surface of the tooth.This technique was repeated untilthe overlying soft tissue was freedon the mesial, and then a similarmovement was performed on thedistal until that tissue was removed.The laser delivery tip was keptmoving and continuous high-speed
evacuation was used to remove thelaser plume and to provide someexternal tissue cooling.
4. Gingivectomy/GingivoplastyAs stated previously, laser-assistedgingivectomy and gingivoplastyprocedures were performed at alltooth sites to provide sufficient toothexposure area for bracket bondingand to maximize esthetics as well asto preserve the biologic width.
At each site, an initial incisionwas made at the predetermined,most superior midpoint of thegingival margin. The incision wasextended mesially and distallyusing a light brush stroke, keepingthe fiber tip in light contact andangled at 45 degrees to the under-lying tooth surface. Once again, thelaser delivery tip was kept movingand continuous high-speed evacua-tion was used to remove the laserplume and to provide someexternal tissue cooling.
The maxillary clinical crowns(from the first molars to the centralincisors on both sides) wereexposed, and then the mandibularanterior and bicuspid gingivaltissues were treated (Figures 6-7).
Chmura
Figure 6: Left lateral, immediate-postop-erative view of laser gingival contouring.
Figure 7: Anterior immediate-postopera-tive view of cuspid exposure and gingivalcontouring.
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During the surgery, any coagu-lated tissue buildup on the fiberend was removed with water-mois-tened gauze to avoid excessive heatbuildup at the tip.
Full upper and lower braceswere bonded immediately (to takeadvantage of the dry field) andwires were placed (Figures 8-9).
D. Postoperative InstructionsThe patient and parent were shownthe results of the procedures andwere reassured that the soft tissuesappeared normal immediately afterthe laser procedure.
The patient was given 9 vitaminE gel tabs, with instructions to cutinto the tablets and rub theVitamin E oil on the affectedgingival sites several times a dayfor the first three days.
The patient and parent weretold that tissue healing wouldbegin immediately and the discol-oration should resolve within a fewdays.
The patient was encouraged tokeep the areas scrupulously cleanto promote healing and instructionwas given in the use of a very softtoothbrush with fluoridated tooth-paste for the first few days,dependent on the patient’s toler-ance. The patient was also toldthat, if there were excessivediscomfort with the brush, he coulduse a cotton swab as a temporaryalternative.
The patient was instructed toavoid highly salted or spicy foodsfor the first week and to call theoffice if there were any concerns orproblems.
Acetaminophen tablets wererecommended for any postoperativepain, and the patient was sched-uled for a two-week postoperativeappointment.
E. ComplicationsComplications following laser softtissue surgery can include pain,tissue swelling and deformation,bleeding, and infection. None ofthese occurred in this case. Withoutproper oral hygiene, it is possible toget re-growth of tissue. At follow-upvisits, noted below, there was sometissue hypertrophy.
F. PrognosisIn general, laser-assisted soft tissueprocedures accomplished withproper technique have a very goodprognosis. Care was exercised sothat least 1 mm of pocket depthand at least 1 mm of keratinizedtissue remained, and the gingivalcontours were established asideally as possible to minimizerelapse. The importance of home
care was emphasized to the patientand his parents, since there wasinflammation and hypertrophyduring the Phase I treatment.
F O L LOW- U P C A R EA. Assessment of TreatmentDuring and immediately after theprocedures, the majority of thegingival crests were healthy pinkwith few areas of darker tissue(Figures 6-7). Immediately after thesurgery, orthodontic brackets werebonded and wires placed (Figure 8-9) to begin tooth movement.
At two weeks (Figure 10), therewas significant orthodontic move-ment and the patient presentedwith excellent healing, but withmild erythema around the cervicalmargins. Proper brushing tech-niques were once againdemonstrated and encouragementwas offered for the recommendedhome care protocol.
At three months (Figures 11-12),there was significant hypertrophyand generalized inflammation andat 6 months (Figures 13-14) it hadworsened, with significant swellingof the interdental papillae andgeneralized hypertrophy. Further
Chmura
Figure 8: Anterior view of orthodonticbrackets and wires placed immediatelyafter laser surgery. Note adequate crownexposure for bracket placement andhealthy amount of remaining attachedkeratinized tissue.
Figure 9: Right lateral view of bracket andwire placement. As in Figure 8, there isminor gingival bleeding due to thevarious steps used in bonding, but it didnot interfere with the procedure.
Figure 10: Anterior view at the two-weekpostoperative interval. Note tissue ishealing, with slight marginal erythema.
Figure 11: Anterior view at the three-month postoperative interval. Note tissueinflammation.
Figure 12: Right lateral view at the three-month postoperative interval showinginflammation as in Figure 11. The rightcuspid has been repositioned well.
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oral hygiene instruction was given.There did not appear to be anyevidence of crestal bone loss on thepanoramic film (Figure 15). Analternative orthodontic system,SureSmile® (OraMetrix,® Inc.,Richardson, Texas, USA) was alsoconsidered to reduce treatmenttime and the negative consequencesof the continued poor home care.
B. ComplicationsThe only long-term complication wasdue to the continuing poor oralhygiene, which was not laser-related.With ongoing orthodontic treatment,there has been a regrowth ofgingival hypertrophy and swelling ofthe interproximal papillae. Thepatient was constantly encouraged toimprove his home care and parentalguidance was reinforced.
C. Long-Term ResultsThe primary laser treatment goalswere achieved. Access for idealplacement of brackets was achievedwhich allowed orthodontic treat-ment to begin at an ideal time.Unfortunately, it is likely that addi-tional surgical soft tissue
procedures will be required at theend of orthodontic treatment, tocorrect the hypertrophy caused bythe less-than-ideal home care.
D. Long-Term PrognosisWith improved home care, the long-term prognosis is good. It isanticipated that with improved oralhygiene, the inflammation willdisappear and the developinghypertrophy will arrest. Additionalgingivectomy will be necessary atthe end of orthodontic treatment toprovide proper contours.
A U T H O R B I O G R A P H YLouis G. Chmura completed hisDDS in 1985 and his MS inOrthodontics in 1987, both from theUniversity of Michigan. He is inprivate practice in Marshall,Michigan and is an active memberof the American Association ofOrthodontists, the American DentalAssociation, and the Academy ofLaser Dentistry (ALD). He became aDiplomate of the American Board ofOrthodontics in 1983. Dr. Chmurahas been actively involved in using
soft tissue lasers since 2005. Heearned Standard Proficiency in CO2and diode laser wavelengths fromthe ALD as well as AssociateFellowship in Er,Cr:YSGG laser bythe World Clinical Laser Institute.He is the author of “Soft TissueLasers in Orthodontics” (a chapterin Principles and Practice of LaserDentistry, edited by Robert A.Convissar. St. Louis, Mo.: MosbyElsevier, 2011) and numerous arti-cles on the various uses of lasers inorthodontic practice. Dr. Chmurahas presented nationally on “SoftTissue Lasers in Orthodontics,” andthrough the Orthodontic LaserTraining Institute and EggheadOrtho (eggheadortho.com) hasprovided numerous laser courses,including introductory webinars aswell as in-office, hands-on coursesfor orthodontists and their staff. Inaddition, he has co-taught severalALD Standard Proficiency courses.Dr. Chmura may be contacted by e-mail at [email protected].
Disclosure: Dr Chmura has receivedhonoraria from AMD Lasers andSpectra Lasers. nn
Chmura
Figure 13: Anterior view at the six-monthpostoperative interval. Note inflammationand gingival hypertrophy.
Figure 14: Right lateral view at the six-month postoperative interval. Inflammationand hypertrophy as in Figure 13.
Figure 15: Panoramic radiograph at thesix-month postoperative interval. Toothalignment is progressing normally.
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In his case study involving laser-assisted full-mouthgingivectomy and exposure of an unerupted cuspid(pages 71-76), orthodontist Dr. Louis G. Chmuradescribes the indications for soft tissue surgery and bene-fits of using a diode laser during orthodontic treatment.
A review of the literature reveals long-standing interestin investigating an extensive range of possible applications(both experimental and clinical) of laser technology inorthodontics, represented by various laser wavelengthsand spanning some 35 years of research, including:• Laser reflection measurement of tooth mobility and
tooth movements• Microwelding of orthodontic appliances• Laser welding of orthodontic archwires• Holographic determination of centers of rotation
produced by orthodontic forces• Tooth position measurements on dental casts using
holographic images• Holographic measurement of incisor extrusion• Holographic analysis of the relationship between
craniofacial morphology and the initial reactions tohigh-pull headgear traction
• Mechanisms of maxillary expansion using laser holo-graphic interferometry methods
• Determination of center of resistance of anteriorteeth during intrusion using the laser reflection andholographic interferometry
• Holographic storage and analysis of dental casts• Laser metrology determination of maxillary protraction• Bonding of orthodontic brackets• Debonding of orthodontic ceramic brackets• Selective ablation of orthodontic composite• Laser etching of teeth for orthodontic bracket place-
ment• Laser spectroscopic determination of surface rough-
ness of orthodontic archwires• Laser profilometric determination of surface rough-
ness of orthodontic wires• Laser specular reflectance for analyzing surface
roughness of orthodontic wires• Blood flow changes in gingival tissues due to
displacement of teeth• Blood flow changes in maxillary canines during
retraction
• Laser Doppler flowmetry for assessing tooth vitalityafter osteotomy
• Low-level laser irradiation effect on fluoride releaseof orthodontic bonding materials
• Low-level therapy for reduction of orthodonticpostadjustment pain
• Low-level laser irradiation to stimulate bone regener-ation
• Low-level laser irradiation to accelerate orthodontictooth movement velocity/rate
• Low-level laser irradiation for bone remodelingduring tooth movement
• Low-level laser inhibition of open gingival embrasurespace after orthodontic treatment
• Confocal laser scanning microscopic determination ofalveolar bone remodeling
• Laser scanning for analyzing three-dimensionaldental casts
• Laser scanner determination of tooth positions• 3-D laser scanning for crown width measurements• 3-D laser scanning for measuring 3-dimensional
tooth movements• 3-D laser scanning for facial soft tissue analysis• Laser fluorescence detection of white spot lesions
around orthodontic brackets• Laser fluorescence detection of caries lesions around
brackets• Prevention of dental caries during orthodontic treat-
ment• Demineralization resistance of enamel adjacent to
orthodontic brackets• Treatment of orthodontic elastic band-induced peri-
odontitis• Reduction of orthodontically induced gingival hyper-
plasia• Gingivoplasty during orthodontic treatment• and numerous other soft tissue surgical applications
during and after orthodontic treatment, some ofwhich are described in greater detail below.Sarver and Yanosky1-2 discuss such soft tissue
surgical applications in two broad categories: cosmeticgingival contouring, and solving tooth eruption and softtissue problems that impede efficient orthodonticfinishing.
Editor’s Note: The following four abstracts are offered as topics of current interest. Readers are
invited to submit to the editor inquiries concerning laser-related scientific topics for possible
inclusion in future issues. We’ll scan the literature and present relevant abstracts.
L AS E R - ASS I ST E D SO F T T I SS U E
A P P L I C AT I O N S I N O R T H O D O N T I CS
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In the former category, the authors identify thefollowing applications: improving gingival shape andcontour, lengthening crowns, idealizing tooth propor-tionality, and resolving crown/height asymmetries. Inthe latter category, they specify a number of applica-tions: Gaining access for bracket placement on partiallyerupted teeth; managing the tissue on impactedcanines; removing redundant tissue created by spaceclosure; removing operculae on second molars;removing redundant tissue due to poor oral hygiene;and treating aphthous ulcers. Sarver and Yanoskyconclude that increased efficiency of treatment is one ofthe main advantages in using lasers in orthodontics.
Sarver and Yanosky3 respond to criticism that theyadvocate laser surgery for an adolescent patient imme-diately after appliance removal to reduce gingivalhypertrophy (given that “clinical signs of gingivalinflammation have been reported to significantlyimprove once plaque-retentive appliances areremoved”) without first controlling the inflammatorycomponent by nonsurgical means:
As any orthodontist in practice for more than 6months can testify, many adolescents do not prac-tice excellent, or even good, oral hygiene, despiteour efforts to encourage it. This results in swellingand hypertrophy of the gingiva close to thebracket, which in turn complicates effectiveplaque removal. …[T]his patient, in spite of 2years of our encouraging good oral hygiene, hadshown no particular interest in it [and] had notshown any compliance with oral hygiene. Our clin-ical judgment was made to immediately removethe pseudopockets, thus increasing the possibilityand effectiveness of good oral hygiene.
Hilgers and Tracey4 outline similar soft tissue applica-tions using diode lasers: gingival recontouring andsculpting, frenectomy, access gingivectomy (uncoveringunerupted teeth), gingivectomy of hypertrophic tissue,operculum removal, and treatment of aphthous ulcers andherpetic lesions. They indicate the diode laser typicallyallows them to perform single-appointment procedures,using only topical anesthetic, with little pain or bleeding.
The additional abstracts presented below illustratehow various lasers may be used to facilitate soft tissuetreatment during and after orthodontic therapy.
For U.S. readers, certain carbon dioxide, Nd:YAG,argon, Ho:YAG, Er:YAG, Nd:YAP, Er,Cr;YSGG, diode,
and frequency-doubled Nd:YAG lasers have beencleared by the U.S. Food and Drug Administration forintraoral soft tissue surgery.
As always, clinicians are advised to review the specificindications for use of their lasers and to review theiroperator manuals for guidance on operating parametersbefore attempting similar techniques on their patients.
R E F E R E N C ES1. Sarver DM, Yanosky M. Principles of cosmetic dentistry in
orthodontics: Part 2. Soft tissue laser technology andcosmetic gingival contouring. Am J Orthod DentofacialOrthop 2005;127(1):85-90.
2. Sarver DM, Yanosky M. Principles of cosmetic dentistry inorthodontics: Part 3. Laser treatments for tooth eruptionand soft tissue problems. Am J Orthod Dentofacial Orthop2005;127(2):262-264.
3. Jarjoura K. Soft tissue lasers. Am J Orthod DentofacialOrthop 2005;127(5):527-528; author reply 528.
4. Hilgers JJ, Tracey SG. Clinical uses of diode lasers inorthodontics. J Clin Orthod 2004;38(5):266-273. nn
For additional background on the use of lasers forsoft tissue applications in orthodontic treatment,readers are referred to clinical cases and researchabstracts in previous issues of the Journal of LaserDentistry, the Journal of the Academy of LaserDentistry, and Wavelengths.1. Gama SK, De Araújo TM, Pozza DH, Pinheiro
ALB. Use of the CO2 laser on orthodontic patientssuffering from gingival hyperplasia. PhotomedLaser Surg 2007;25(3):214-219. In: ResearchAbstracts. J Laser Dent 2008;16(3):142.
2. Gilio DA. Adjunctive orthodontic treatment:Hyperplastic tissue removal using the Nd:YAGlaser with contact tip. Wavelengths 2001;9(3):20.
3. Litvak E. Clinical application of an Er:YAG laser-assisted gingivectomy after orthodontictreatment. J Acad Laser Dent 2005;13(4):22-24.
4. Sarver DM, Yanosky M. Principles of cosmeticdentistry in orthodontics: Part 3. Laser treatmentsfor tooth eruption and soft tissue problems. Am JOrthod Dentofacial Orthop 2005;127(2):262-264. In:Research Abstracts. J Laser Dent 2008;16(2):103.
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Objective: The aim of this clinical study was to observeand evaluate the surgical management efficiency of softtissues during orthodontic treatment. Materials andMethods: Thirty-seven young patients were selectedand treated by laser-assisted surgery before or duringorthodontic treatment and were classified by sex, age,and type of surgical management. Three differentwavelengths were used (diode 810 nm, diode 980 nm,and Nd:YAG 1064 nm) in different surgical situations:maxillary vestibular and lingual frenectomies, surgicalexposure and alignment of ectopic or retained teeth,and re-contouring gingival overgrowth. Results: In allevaluated patients, the laser treatment was performed
without local anesthesia or sutures. Only topical anes-thetic was needed. Conclusion: The use of thesewavelengths of laser energy was a noticeable aid in thesurgical management of soft tissues before or duringorthodontic treatment. The benefits of laser treatmentinclude reduced bleeding during surgery with conse-quent reduced operating time and rapid postoperativehemostasis, thus eliminating the need for sutures. Thelack of need for anesthetics and sutures, as well asimproved postoperative comfort and healing, make thistechnique particularly useful for very young patients.
Copyright 2007 Mary Ann Liebert, Inc. nn
N D : YAG A N D D I O D E L AS E R I N T H E S U R G I C A L M A N AG E M E N T O F SO F TT I SS U ES R E L AT E D TO O R T H O D O N T I C T R E AT M E N T
C. Fornaini, MD, DDS1-3; J.P. Rocca, DDS, PhD1; M.F. Bertrand, DDS, PhD1; E. Merigo, DDS2;
S. Nammour DDS, MSc, PhD, HT3; P. Vescovi, DDS2
1Laboratory of Surfaces – Interfaces in Odontology, University of Nice – Sophia Antipolis and Centre Hospitalier Universitaire – Hopital
St. Roch, Nice, France; 2Faculty of Medicine and Surgery, Dental School, University of Parma, Italy; 3University of Liège, Faculty of
Medicine, Department of Dental Sciences, Liège, Belgium
Photomed Laser Surg 2007;25(5):381-392
Several studies have shown that gingivitis is commonin children and adolescents. Introduction of orthodonticdevices may exacerbate the gingival inflammation. Oneof the more difficult tasks during orthodontic therapyfor adolescents is maintenance of adequate oralhygiene. Orthodontically induced gingival hyperplasiain adolescents, its etiology, and treatment alternativesare discussed. Three instances in which Nd:YAG and
CO2 laser therapy was used are described. The patientsexperienced no pain during or after the procedure, andno medications were needed. Blood loss was negligibleduring the procedures, and healing was uneventful.Laser gingivectomy compares favorably to conventionaltechniques (i.e., scalpel surgery or electrosurgery).
Copyright 1996 Academy of General Dentistry nn
L AS E R T R E AT M E N T O F O R T H O D O N T I C A L LY I N D U C E D G I N G I VA LH Y P E R P L AS I A
Robert A. Convissar DDS, FAGD1; Lawrence B. Diamond, DDS1; Cynthia D.L. Fazekas, DMD2
1New York Hospital Medical Center of Queens, New York; 2Catholic Medical Center of Queens, New York, New York
Gen Dent 1996;44(1):47-51
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Soft-tissue lasers have numerous applications in ortho-dontics, including gingivectomy, frenectomy,operculectomy, papilla flattening, uncovering temporaryanchorage devices, ablation of aphthous ulcerations,exposure of impacted teeth, and even tooth whitening.As an adjunctive procedure, laser surgery has helpedmany orthodontists to enhance the design of a patient’ssmile and improve treatment efficacy. Before incorpo-rating soft-tissue lasers into clinical practice, theclinician must fully understand the basic science, safetyprotocol, and risks associated with them. The purpose of
this article is to provide an overview regarding safe andproper use of soft-tissue lasers in orthodontics. Diodeand erbium soft-tissue lasers offer many advantages inregard to esthetic finishing, practice efficiencies, andinterdisciplinary treatment options. Clinicians interestedin incorporating soft-tissue lasers into their practiceshould obtain proficiency certification, provide properstaff training, attend continuing education courses,consider membership in the Academy of Laser Dentistry,and recognize the inherent risks of laser surgery.
Copyright 2008 American Association of Orthodontists nn
SO F T-T I SS U E L AS E R S I N O R T H O D O N T I CS : A N OV E R V I E W
Neal D. Kravitz1, Budi Kusnoto2
1Post-doctoral candidate, Kravitz Orthodontics, Chantilly, Virginia; 2Clinical chair, Department of Orthodontics,
University of Illinois, Chicago, Illinois
Am J Orthod Dentofacial Orthop 2008;133(4 Suppl):S110-114
Aim: Modern technology has perfected a new instru-ment that has become almost indispensable in moderndentistry, in accordance with the philosophy of mini-mally invasive therapy: the laser. The aim of this workis to evaluate the effectiveness and efficacy of lasertechnology to solve mucogingival problems associatedwith orthodontic treatment. Some laser wavelengthswork both on hard and soft tissues (2780 nm, 2940 nm),other lasers, such as the 810-nm diode, have a verygood surgical and haemostatic action on soft tissuesand an important analgesic and biostimulating effectthat can help the healing of both TMJ painful symp-toms as well as the pain following active orthodontictreatment. Several cases connected to orthodontictherapy are presented. Materials and Methods:Different laser systems (diode laser at 810 nm;
Er,Cr:YSGG laser at 2780 nm; erbium:YAG laser at2940 nm) were used, both for soft tissue surgery andenamel etching, and for biostimulating effect. Thesewavelengths were used with different parameters foreach case, according to international current studies inview of minimally invasive therapy. Results: The casesreported showed very quick and good healing of thelaser treated tissues. These treatments, necessary forthe orthodontic therapy or for its completion, becomeextremely simple, safe and rapid and the orthodonticspecialist can perform them himself. Conclusion: Thelaser technique is very effective in many operative andsurgical procedures during orthodontic therapy.Further studies are however necessary to set the treat-ment protocols in orthodontic biostimulation.
Copyright 2010 European Journal of Paediatric Dentistry nn
U S E O F L AS E R T EC H N O LO GY I N O R T H O D O N T I CS : H A R D A N D SO F T T I SS U E L AS E R T R E AT M E N TS
M.D. Genovese, MD, DDS1; G. Olivi2
1Rome, Italy; 2University of Genova DI.S.TI.BI.MO., Genoa, Italy
Eur J Paediatr Dent 2010;11(1):44-48
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