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The Power of Lasers Thomas Giacobbi, DDS, FAGD Editorial Director, Dentaltown Magazine

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by Thomas Giacobbi, DDS, FAGD
Editorial Director, Dentaltown Magazine

Everybody is at least a bit curious about lasers in dentistry. This is a category that has matured to a point where "there is something for everyone." If you are interested in performing hard-tissue or soft-tissue procedures, you can find a laser that will suit your needs. We recently contacted four prominent personalities in the field of laser education and asked them a few questions to help you sort out why many dentists are very excited to practice laser dentistry. Once your laser curiosity is sparked, take the time to visit Dentaltown.com and interact with our active group of laser owners.
Why should a general dentist use a laser when other options exist?
Coluzzi: Lasers offer several advantages, such as significant pathogen reduction (in both hard and soft tissue); excellent control or elimination of bleeding from soft tissues; and a more comfortable post-operative course than other modalities for most procedures.

Jesse: 21st century dentistry is all about being minimally evasive, access decay to remove it. Saving precious enamel should be the main focus for all dentists. With lasers, there is less trauma to all tissue all in many prep less or no need in local anesthesia.

van As: Improvements in healing, less need for anesthetic, simpler soft tissue surgeries. More precise for many cosmetic procedures (such as smile recontouring) than a blade.

How often should dentists expect to use their new laser to justify the cost?
Coluzzi: I can offer one example. I saved 10 minutes on each "average" sub-gingival impression for indirect restorations. I calculated a savings of $22,500 a year in time.

van As: A dentist should expect to use a laser several times a day depending on which wavelength it is. The procedures can be adjunctive meaning that the laser is helping improve a procedure you already do, or it can bring whole new procedures to the practice.

Kaminer: At our course and during our lectures we tell dentists to turn their lasers on first thing in the morning. You don't turn on your compressor every time you use your hand piece, you leave it on all day. The same goes with a laser. Once turned on, you will find you are using your laser multiple times every day and it will be part of your normal routine.

What is the best approach to incorporate a laser into my daily routine?
van As: Research online and attend a non-biased course (Academy of Laser Dentistry Standard proficiency) to learn which wavelengths can do certain procedures. Learn which wavelengths could improve your practice, then research that wavelength and purchase with the intent to continue your training.

Kaminer: If the laser is turned on in the morning, you will use it every day, multiple times per day. You will use it for procedures that you may have shied away from before, and use it to replace your hand piece very often. The laser is my first choice for routine operative dentistry and at this point in my practice, patients ask for it and expect it.

Coluzzi: Identify those procedures where you could use a laser, learn how to use the device during that procedure, and make sure you have the laser handy and ready.

What should I expect with training?
Coluzzi: The learning curve is not too steep, but the laser is basically an "end-cutting" instrument. One should expect clear, detailed training from an experienced user (not a salesman) on the indications for use of that laser.

van As: If the laser is a diode, expect a DVD or to take courses that are not company sponsored, if it is an ErYAG or NdYAG laser then often training is available as part of the purchase price. Standard and advanced training is often available.

Jesse: At training you will learn how easy it is to use the laser for all procedures, how to incorporate laser use into your treatments, how to explain the operation to patients and how to generate new revenue.

Please help me sort out the many different types of lasers that are on the market. What's the fundamental difference between NdYAG; ErYAG; ErCr:YSSG; diode, etc.?
Coluzzi: Diodes and Nd:YAG are only utilized for soft tissue procedures; the erbium lasers can be used on soft and hard tissue.

van As: Erbium lasers (ErYAG and ErCr:YSGG) are all tissue lasers in that they are absorbed by water and so they cut any tissue with water in it. They are not well absorbed in hemoglobin so they do not coagulate (hemostasis) as well as dedicated soft tissue lasers.

Diode lasers are small portable lasers that can be used only to cut soft tissue. They are less expensive than other lasers, smaller and very reliable. It's a popular laser to act as an alternative to an electrosurge.

NdYAG laser is a soft tissue laser absorbed in melanin and hemoglobin. It is a wonderful laser wavelength for periodontal therapy.

CO2 laser is a long wavelength laser that is absorbed well in water and hydroxyapatite and is used as a soft tissue laser.

Why is one laser better for cavity preps and another best for periodontal disease?
Kaminer: It's all about absorption and delivery. Many companies tout their laser as being better but inherently what they are touting is wavelength. For instance, the NdYAG has been shown to be excellent for treating periodontal disease in a minimally invasive fashion. With the wavelengths inherent ability to be absorbed by pigment, and granulation and inflammatory tissue being darker in color, the wavelength become ideal or semi selective for eradicating inflamed type tissue. The hard tissue laser's energy is primarily absorbed by water and hydroxyapatite. When the energy is taken in by tooth structure, micro mini precise explosions occur on the enamel surface which we see as a preparation. Hence the ErYAG and ErCr:YSGG are great hard tissue lasers.

van As: The important issue is what the various wavelength is absorbed in. In other words, what is the Target Chromophore. In the case of the erbium lasers it is water, which absorbs the energy, expanding explosively and ablating either tissue, enamel, dentin, caries or bone – all of which have water in them. The NdYAG laser is absorbed well in melanin and by the black pigmented bacteria that are often associated with periodontal disease. It has little effect on water and so it cannot remove bone, and has little effect on hard tissue unless it is pigmented.

Diode lasers are sold with many different wavelengths and wattages. What is the impact of these differences on the performance of the laser?
Coluzzi: Wavelength and power (wattage) are two factors; however, another equally significant factor is pulse duration and pulse interval. The four available wavelengths, taken by themselves, have more similarities than differences. Other "features" and parameters are way more important in the "performance."

Kaminer: Most dental laser gurus in the know will contend that, for the most part, a diode is a diode is a diode. Whether a diode falls in the 810nm wavelength range, or the 940nm wavelength range they will cut soft tissue very well with great hemostasis. Companies will say they are trying to maximize the wavelength's ideal properties by choosing a wavelength within the range that diodes fall into but clinically they are extremely similar in function if not identical. The main difference in the 810 wavelengths vs. the 900's absorption. The 900s are more deeply absorbed, leading to better coagulation but potentially more post-op damage and pain. The 810 is a good cutter and good coagulator. The differences are small and many people believe the differences lie more in marketing than anything else.

What can we expect from lasers in the future?
van As: For the future I am sure that erbium lasers will improve the speed of cut, decrease in size and cost and become more common as the price drops. Soft tissue diodes will become commonplace as their prices drop to below $5K.

Jesse: Lasers are becoming more popular as a treatment modality in medicine and dentistry worldwide and this will continue. Lasers will become smaller and less expensive as technology advances.

Coluzzi: Lasers might become more portable with more effectiveness for treatment – such as very short pulses in diodes to avoid conductive "hot tip" effects. I look forward to the majority of the profession embracing the advantages of lasers.

Kaminer: The future of lasers rests in the field of caries detection and scanners. Our next generation of lasers will have scanners built in that will allow us to program a specific size prep, press a button and the laser will cut till the setting is reached. Built-in caries detection into units will happen as well. And finally size of units will decrease. That being said the technology is here and being used effectively by many dentists. If more dentists can see the value then price becomes meaningless.
Respondents
Donald J. Coluzzi, DDS, is a 1970 graduate of the University of Southern California School of Dentistry. He recently retired after 35 years from his general dental practice in Redwood City, CA, but continues as an Associate Clinical Professor at the University of California San Francisco School of Dentistry Department of Preventive and Restorative Dental Sciences. He is past president of the Academy of Laser Dentistry and holds Advanced Proficiency certificates on Nd:YAG and Er:YAG wavelengths. He has received the Leon Goldman Award for Clinical Excellence and the Distinguished Service Award from the Academy of Laser Dentistry. He is also editor-in-chief of the Journal of Laser Dentistry. Location: Redwood, California.

James T. Jesse, DDS, graduated from Loma Linda University's School of Dentistry in 1973. He has been running a private practice in Colton, California for the past 34 years. In addition to his practice, Dr. Jesse has returned to his Alma Mater as an assistant professor teaching applications of the YSGG laser. He is also part time faculty at Columbia University's School of Dentistry in New York. Dr. Jesse is an active member of the American Dental Association, the California Dental Association, and the Academy of Operative Dentistry. Dr. Jesse also lectures nationally and internationally, with the Masters of Laser Dentistry group, on various topics including laser application in dentistry and endodontics. Location: Colton, California.

Ron Kaminer, DDS, is a 1990 graduate of the State University of New York at Buffalo School of Dental Medicine. He maintains two offices, in Hewlett and Oceanside, New York, has used lasers since 1989, and has lectured around the world on topics related to lasers and minimally invasive dentistry. He holds a mastership from the World Clinical Laser Institute, and holds proficiency from the Academy of Laser Dentistry in hard tissue and soft tissue wavelengths. He is the founder and co-director of the Masters of Laser training program and is an instructor and advisor for numerous companies, including Lares, AMD Lasers, GC America and Ultradent. Location: Hewlett & Oceanside, New York. Lasers owned: diode, erbium, ErCrYSGG & CO2.

Glenn van As, BSc, DMD, graduated from the University of British Columbia in 1987 and is internationally known for digital documentation of laser procedures captured with the operating microscope. He achieved Advanced Proficiency from the Academy of Laser Dentistry and received the 2006 Leon Goldman Award for clinical excellence. He is also a founder and past president of the Academy of Microscope Enhanced Dentistry. Location: North Vancouver, British Columbia, Canada. Lasers owned: Versawave & DioDent by Hoya ConBio; Odyssey 2.4G & Navigator by Ivoclar.
Dentaltown Magazine
September 2025
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