Dr. Christopher H. Dalton B.D.

S (Wales) 7 Bishops Road

Whitchurch
Dental Surgeon Cardiff
CF14 1LT

Telephone: Cardiff 029 2061 7703

Lasers in Dentistry
After nearly forty years in Clinical Dentistry I am proud to admit that I still get very

excited at the prospect of purchasing and then using innovative equipment

and mastering their associated techniques. This is especially important when it makes

the ‘dental experience’ more acceptable to our patients. After so many years and

seeing so many milestones in Dentistry it is this concept that maintains my

enthusiasm for this ‘Wonderful Profession’ of ours. The boundaries of dentistry are

constantly expanding in all directions, like ripples in a pool of water.

It was with this excitement that I took delivery of the Biolase Waterlase MD and

the Biolase ezlase, earlier this year, after seeing and using them at the Dental

Showcase held at the NEC last year.

So many of the procedures and materials taken for granted today by our profession

were barely dreamt about forty years ago. For example modern resins with their

specific bonding systems have revolutionised adhesive dentistry. As a student I had

the choice of only two makes of composite resin namely, Concise and Adaptic,

only bonding to enamel using phosphoric acid. Silicates were still widely used for

anterior teeth which if not lined properly could devitalise a tooth because of their

acidity. I must add that ‘dycal’ was the material of choice to line under these

early resins.

The list is almost endless and I can mention ultra-sonics, fibre optics on handpieces,

implants, micro motors especially with torque control, rotary techniques in

endodontics, cad-cam (CEREC) and ozone ( a very powerful oxidising agent and

disinfectant) . All of these have helped to make our work easier, more enjoyable and

most importantly the outcome more predictable. As our knowledge of cross-infection

has improved so has the need to sterilise all of our equipment for example,

handpieces. Our sterilisation rooms now use thermo- disinfectors to clean instruments,

vacuum autoclaves for sterilisation with dedicated vacuum autoclaves to clean, oil and

sterilise our handpieces.

There has certainly been a revolution in dentistry.

Lasers must be included in this revolution as they give a technological breakthrough

that gives us the capability to work on hard and soft tissues. When used on soft

tissues there is less trauma and thus reduced post operative complications which make

the procedure often less traumatic for the patient.

Lasers ( Light Amplification by Stimulated Emission of Radiation ) are named for the

active medium that is charged with energy inside the laser unit to create laser light.

The Waterlase MD Er,Cr:YSGG receives its name from the elements yttrium,

scandium, gallium, and garnet doped with erbium and chromium. When this crystal is

energised a monochromatic wavelength of light is emitted at a wavelength of 2780

nanometers. Incidentally this wavelength of light is well absorbed by water and

hydroxyapatite making the Waterlase MD Er,Cr:YSGG absolutely perfect for cutting

enamel, dentine, bone and soft tissue. The absorption of laser energy by water is

most important for hard tissue applications. The atomised water droplets, emitted from

the waterlase , once energised give a hydrophotonic cutting action which can quickly

remove hard tissue. This is done by a combination of water particle excitation and

micro-expansion with the resulting forces mechanically separating the targeted surface.

For soft tissue applications the water delivery is reduced by varying amounts and the
laser can cut an incision as narrow as 200 microns with very reduced or minimal

bleeding. The Waterlase MD (Biolase) utilises a single wavelength laser that allows its

use on all oral tissues and has been cleared for such use by the FDA. ( US Food

and Drug Administration 2000).

In contrast to the waterlase, the Biolase ezlase is a diode laser where the active

medium is a semi-conductor similar to that found in a light emitting diode. It emits

a wavelength of 940 nanometers. This wavelength is very efficiently absorbed by

pigmented tissues, melanin and haemoglobin which again makes this laser ideal for

use on soft tissue and provides great haemostasis. The biolase ezlase is a small unit

always at hand and straight forward to use. One unique use of the ezlase is that

when used with the bleaching wand it can give much relief to patients suffering with

generalised muscle and joint pain. This is termed biostimulation.

In clinical use I have not been disappointed with either of these lasers.

The ezlase is readily at hand, quick to prepare and easy to use, which makes it ideal

when one needs to trough around crown preps or remove small amounts of soft

tissue. It goes hand in hand with cad-cam dentistry. Of course it can be used for

much more and other soft tissue indications are incision, excision and vaporization.

The waterlase is truly a unique piece of equipment because of its ability to cut hard

tissue and I have had some amazing success in treating nervous children. When used

out of focus this low level laser therapy can achieve an analgesic effect on the pulp

prior to the restorative procedure. At pulse energies below the ablation threshold

of tooth structure, the erbium laser energy penetrates into the tooth structure and

is directed along the hydroxyapatite crystals toward the dental pulp. Here, the pulses

of energy coincide with the natural bio-resonance frequency of Type C and other

nerve fibres in the dental pulp. The action of this type of low level laser energy is
to cause a disruption in the action of the Na-K pump in the cell membrane resulting

in a loss of impulse conduction and thus an analgesic effect. (Oral Laser Application

A Moritz, et al, Quintessence). This effect has been extremely useful with needle

phobic children who thankfully were not dental phobic!

However with the variation in tip selection including the radially firing endo and

now periodontal tips I feel in common with other users that the waterlase has even

greater potential in the field of endodontics, periodontics and many other associated

soft tissue techniques.

We are very fortunate to be practising Dentistry in the twenty first

century as we are now gaining the understanding and have the techniques to give

twenty first century treatment. Medical research is confirming that inflammation in

the body is a significant factor in many of the chronic diseases of aging ( heart

disease, diabetes, cancer, Alzheimer’s disease). The mouth is a significant source of

inflammation when periodontal disease is present and if left untreated it is not

unreasonable to assume that this may well increase the risk for these serious systemic

diseases. This is a new age of dental medicine and as never before, the decisions we

make and the advice we give can have far reaching consequences.

In conclusion I would like to refer you to a quotation from the Autobiography of

Sir Jackie Stewart ‘Winning Is Not Enough’

Sir Jackie Stewart was born in Milton, Dunbarton. In the early 1960’s he dominated

the British Club and European F3 motor racing scenes. He moved to Formula 1 in

1965 and he scored twenty seven Grand Prix victories. He went on to win three

world championships –’69, ’71 and ’73.

During his time as a racing driver and subsequently his business career he always

believed that real lasting success is not only defined by the accumulation of winning
but also by the manner of victory.

He quoted the following equation to represent this:

Winning (over a long period of time)

+ Integrity
+ Care
= Success.

Winning is Not Enough. The Autobiography by Sir Jackie Stewart

Copyright (c) 2007. Reproduced by permission of Headline Publishing Group Ltd.

I can not think of a better quotation to commend to a lifetime or prospective lifetime

in our ‘Profession of Dentistry’

Christopher Howard Dalton.

Suggested Reading;

Oral Laser Application.

A Moritz. Quintessence