Incorporating Laser Dentistry into Your Practice by Dr. Scott Pope

Dentistry is continually advancing as technology develops tools and techniques that lead to improved clinical outcomes and patient experiences. In recent years, lasers have dramatically changed our patients' perceptions of dentistry. Understanding how different laser wavelengths perform clinically will enable clinicians to incorporate the right laser into their practices and offer patients a less-invasive treatment option with less pain and faster healing.

On the right wavelength
While all lasers do certain things well, each laser's wavelength will determine its versatility and, ultimately, how it's incorporated into a practice. Some lasers' wavelengths ablate only soft tissue, while others are designed to ablate both hard and soft tissues. The versatility of an all-tissue laser that can deliver predictable anesthesia-free dentistry and control bleeding greatly expands the scope of procedures offered to patients and can be a huge asset to a dental practice. (Other advantages include shorter treatment time, less trauma with shorter healing times, reduced postoperative complications and, in most cases, painless, needle-free procedures.)

To better clarify the differences between lasers, it's important to understand the wavelength and absorption medium of each laser. On the electromagnetic spectrum, carbon dioxide (CO2) lasers operate at 9.3–10.6 micrometers (µm), while erbium lasers operate at 2.7–2.9µm. Nd:YAG (an abbreviation for their neodymium-doped yttrium aluminum garnet crystal) lasers operate at 1.064µm, and diode lasers at 0.81–0.94µm.

Each laser reacts with tissue in a different way, which is referred to as its "absorption coefficient." All erbium lasers and native 10.6µm CO2 lasers are absorbed in only water, while 9.3µm CO2 lasers can be absorbed by both water and hydroxyapatite. The latter's versatile wavelength means such lasers are able to cut enamel, dentin, bone and soft tissue.

A wide array of applications
As I thought about integrating a laser into my dental practice, I reflected on the procedures I like to do and the services I wanted to offer my patients. I ended up purchasing a 9.3µm CO2 dental laser because it allows me to treat a wide variety of situations efficiently and painlessly.

Reliably treating any type of single- or multiquadrant cavity prep without anesthesia in a single visit was exciting for both my team and our patients. With the laser, I've eliminated the two instruments that most patients fear—the needle and the drill.

We also like to use the laser to treat most soft-tissue applications—frenectomy, fibroma removal, gingivectomy, implant exposure, gingival recontouring, osseous crown lengthening, bone augmentation, and treating peri-implantitis and aphthous ulcers. Lasers enable me to perform such procedures in-house with reduced postoperative discomfort and faster healing times for patients. They really appreciate not having to be referred out, and case acceptance is higher.

All in a day's work—literally
My laser dentistry learning curve has been relatively easy, allowing me to quickly and confidently expand my areas of expertise and treatment.

My staff and I now design our daily schedule with "rocks," "pebbles" and "sand." The "rocks" represent large procedures that need dedicated time; "pebbles" are smaller and shorter procedures; the quick, flexible "sand" procedures fill in the gaps. The dental laser can be used on treatments in all three categories, but where I like it the most is at the sand level—diagnosed treatments found in hygiene that consist of decay in one or two teeth, frenectomies, removing fibromas, gingival recontouring and other soft-tissue procedures. We can easily fit the patient into our schedule and perform the treatment quickly and painlessly, because I don't need anesthetic if working on the teeth and require only topical anesthetic for any gingival treatments.

This becomes a huge advantage because I am able to leverage my time and schedule that benefits everyone. The patients love it because they don't have to reschedule another appointment and the procedures are quick, easy and painless. This can create raving fans, which every practice appreciates.

In my experience, being able to offer laser dentistry has led to expanded treatment options and a higher case-acceptance rate. Incorporating the right laser should be based on the breadth of procedures that a practice wishes to perform; for me, the most versatile laser available is the 9.3µm CO2 version, which has truly been incorporated into our daily routine treating patients.

Operating a laser
CO2 lasers that cut both hard and soft tissue don't operate like diode lasers; they can be extremely fast, accurate and virtually painless. A few other facts:

• I can change the spot size of the laser from 0.25–1.25 millimeters and modify settings for more effective treatments of hard or soft tissue.
• My Solea laser utilizes a foot pedal that allows me to operate the laser like a high-speed handpiece, with precision and complete control of the laser energy and cutting speed.
• The laser does not come in contact with tissue; the tip hovers 8–15mm above the tissue it's being used on. Thus, there is no tactile sensation, which may seem like a concern until the laser has been in your hands for a few minutes. It then feels more like a paintbrush, using brush strokes to remove tooth structure, reshape gingival tissue, access implants or remove a frenum attachment. I find this very cool, because I feel more like an artist than a dentist when I have the laser in my hand.

Case Study

Frenectomy using a dental laser
Frenectomies can be released safely and efficiently using a 9.3μm CO2 laser with predictable tissue response, quick ablation and immediate hemostasis. The exceptionally precise cutting and clear and bloodless operating conditions make this laser an ideal choice for these particular procedures. Unlike other dental lasers, 9.3μm CO2 lasers gradually vaporize tissue, offering a blood-free, suture-free patient experience with minimal discomfort.

These lasers can be used on tooth structure, soft tissue and osseous tissue. The before-and-after above represents how fast and simple a sensitive case such as a soft-tissue frenectomy can be for general dentists and their patients using a computer-driven 9.3µm CO2 laser. This frenectomy was performed with a Solea laser with topical anesthesia only, minimal bleeding, no sutures and fast healing. The entire procedure took less than 15 seconds.

The laser enabled this delicate procedure to be completed quickly, less invasively, with minimal bleeding and extremely fast healing. With traditional techniques and instruments, there would have been bleeding and an extended healing process.

Benefits of a 9.3µm CO2 laser
From simple cavity preps to gingivectomies, I use my laser for almost every procedure imaginable for most patients. While CO2 lasers are the industry standard for soft-tissue procedures, my 9.3µm CO2 laser allows me to ablate all tissues without having complicated settings to change. It's as simple as turning it on, directing the beam at the desired tissue and stepping on the variable-speed foot pedal. This simple approach has significantly increased efficiency in my office and also has provided the confidence I need to perform procedures I would have likely referred out in the past.

Learn more about lasers in dentistry and earn CE credit
Dentaltown's online CE section includes three courses about laser dentistry, which could earn you up to 4.5 hours of CE credit. To get started, go to dentaltown.com/laser-CE.