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elcome to the November 2009 issue of ILLUMINATE, your source for news and
W information on the use of lasers in the dental industry. Each month we aim to bring you a
selection of articles to keep you up to date with the latest innovations and clinical techniques
for dental laser users as well as provide you with training opportunities for that more personal touch in
your development in laser dentistry. If you have any testimonials or articles which you would like to
include or simply would like further information on laser dentistry please feel free to call on
08700 10 20 41 or email sales@henryschein.co.uk
2 ILLUMINATE | Issue 3 | November 2009 Equipment Sales 08700 10 20 41 / 029 2044 2898 | Equipment Service 08700 10 20 49 / 029 2044 2899
Your best news resource for dental lasers
Lasers in oral implantology 1. Laser ablation of the tissue overlying the cover screw.
Waterlase MD™
Instrumentation for dental implant
procedures has not changed
implant uncovering1 and has been used
by the author on more than 200
Accessories
significantly over the last few decades. patients over 6 years. This is an erbium- Waterlase Dentistry offers the
Most of these procedures share one based laser, and as a result there is a widest array of tips,
parameter in common; they are low thermal coefficient, with this specialised accessories and
primarily resective in nature. When coefficient measured by the degree of system upgrades in laser
tissue is traumatised, it goes through an temperature rise within the target issue. dentistry, allowing you to
inflammatory cascade which results in Erbium-based lasers (YAG, YSGG) are expand the versatility of
edema, erythema and discomfort for the considered cool lasers, and are your systems while
2. Histology of peri-implant gingival tissue removed by laser
patient. A period of tissue remodelling preferred for oral implantology demonstrating absence of coagulative effects. maintaining and improving
then occurs in which the production of procedures. This prevents burning, their performance.
matrix metallo-proteinases charring, and coagulation at the site of
(collagenases, elastases, and interaction and is safe to use directly on
gelatinases) occurs. These enzymes are titanium surfaces2. MD Gold™ Handpiece
the primary inducers of both soft and No anaesthetic is necessary for most of • Faster cutting efficiency reduces
hard tissue remodelling. Crestal bone these procedures and the soft tissue chair time per patient,
remodelling around implants is one may be sculpted for proper emergence allowing more
result of the action of these compounds. profile. A healing abutment or procedures
The loss of peri-implant osseous support provisional crown may be placed to per day
may cause the collapse of the start the process of papilla regrowth3. 3. Healing abutment in position, spreading the gingival • Increased cutting precision
interdental papilla, resulting in cuff laterally.
The emergence profile is sculpted to a for more minimally-invasive
compromised gingival display in the circumference slightly smaller than the techniques
aesthetic zone. healing abutment. A significantly shorter • Enhanced focal depth and user
A paradigm changing modality has healing time has been observed using friendly “sweet spot” for better
recently become available for use in the YSGG laser with the added benefits
ease of use
oral implantology. The Er,Cr;YSGG of decontamination and biostimulation
• Contra-angle, 360° rotatable,
laser (Waterlase, Biolase Technologies) of the surrounding tissue4.
has been used to treat peri-implant ultra-low mass handpiece for
At the time of placement of the final
tissue for the past 8 years. The supreme comfort and easier
contoured abutment, a radiograph is
hydrophotonic properties of the access to all areas of the
exposed and the implant/abutment 4. Removal of the healing abutment at two weeks showing
2780nm wavelength targets tissue oral cavity
interface is measured5. The distance to completely healed soft tissue surface.
along a cell layer rather than in a tissue the crest is determined and the patient • Ultra-white, shadow-free
zone. Studies indicate a cellular action is followed for up to one year. A new illumination from the handpiece
zone of only 8-15 microns, leaving radiograph is exposed and the distance enhances visibility in the
adjacent tissue undisturbed. This results to the crest is measured and compared surgical field
in pure tissue ablation rather than to the time of abutment placement6. • ComfortJet™ air/water delivery
coagulation. The absence of tissue The lack of crestal change is clear system for maximum patient
damage eliminates the precursors of the evidence of the reduction of comfort, and enhanced visibility
inflammatory cascade that may affect inflammatory infiltrate and resultant for the clinician
tissue as far as 10mm from the surgical crestal bone remodelling. This is a • Advanced materials and
site. Tissues can then go directly to significant advantage in the aesthetic 5. Final abutment at time of placement.
componentry based on NASA
regrowth and regeneration. zone where maintenance of the
and aerospace technology
Peri-implant tissue differs considerably interdental papillae around dental
from periodontal tissue. There is no implants is problematic.
direct attachment of periodontal fibres Mirror Replacement
When compared to traditional resective
to the implant surface. In addition, there techniques, tissue stability appears to
and Refill Kits
is a larger volume of collagen and be enhanced when lasers are
smaller number of fibroblasts in peri- employed7. In the author’s study of
implant tissue. This makes the reparative uncovering over 500 implants with the
potential much lower for peri-implant YSGG laser, preservation of interdental
tissue. When the hemi-desmosomal papillae was found to be more Tip Cleaning
6. Prosthesis at one year exhibiting no crestal
attachment to the neck of the implant is predictable and crestal bone bone remodelling. and Inspection Kit
disturbed, it tends to scar down rather remodelling was significantly reduced
than reattach to the previous position on or eliminated. The YSGG laser can be
the implant surface. Secondary used for many other hard and soft tissue Tip Holder
uncovering of the implant, whether by procedures in oral implantology
flap or tissue punch, removes the including osseous recontouring and the
healed attachment apparatus. The treatment of peri-implantitis. Lasers will
attachment is reestablished more play an increasingly important role in
apically, which ultimately results in Laser Safety Glasses
dental implant procedures.
crestal bone remodelling. Healing time References
(for Er,Cr;YSGG)
1. Kornman KS, Robertson PB. Fundamental priciplesaffecting the outcomes of therapy
for this pathway may be several for osseous lesions.Periodontol 2000. 2000;22:22-43.
2. Santos MCL, Campos MIG, et al. Analysis of MMP-1and MMP-9 promoter
7. One year follow-up showing stable tissue architecture.
months. If final impressions are taken polymorphisms in early osseointegrated implant failure. JOMI, 2004;19(1):38-43.
3. Salama H, Salama MA, Garber D, Adar P. The interproximal height of bone. A
prior to full tissue maturity, gingival guidepost to predictable aesthetic strategies and soft tissue contours in anterior tooth
replacement. Pract Periodont Aesthet Dent, 1998;10(9):1131-1141.
recession may occur leading to uneven 4. Eversole LR, Rizoiu IM. Preliminary investigations on the utility of an Erbium,
Chromium YSGG laser. CDA Journal 1995; 41-47.
gingival margins and loss of papillary 5. Rizoiu IM, Eversole LR, Kimmel AI. Effects of erbium, chromium, yttrium, scandium,
gallium, garnet laser on mucocutaneous soft tissues. Oral Surg Oral Med Oral Path Oral MD Display Covers
Radiol Endod. 1996;82(4):386-395.
form. The stability and health of this 6. Mankoo T, Contemporary implant concepts in aesthetic dentistry-Part I:biologic width.
concern in the aesthetic zone. implants: A review of the literature. JOMI 2005;20(3);425-431.
8. Strabl M, Ublacker B, Backer A, et al. Comparison of the emission characteristics of
three erbium laser systems-a physical case report. J Oral Laser Applications.
The Er,Cr;YSGG laser can be used to 2004;4:263-270.
9. Miller RJ. Treatment of the contaminated implant surface using the Er,Cr ;YSGG laser.
remove gingival tissue at the time of Impl Dent. 2004;13(2):165-170.
“I first learned about the Waterlase however it was a slow business canals. The clinical results have proven Waterlase MD™ is the biggest single
MD™ on the internet and I was intrigued compared to a conventional turbine to be outstanding and I frequently see advance in dentistry I have seen during
to see first hand this apparently and there were still occasions when I filled lateral canals on my post treatment the course of my career. My confident
amazing machine. The claims made by had to resort to placing a local. radiographs. In vitro research expectation is that within the next
the manufacturer seemed scarcely More recently a new handpiece has demonstrates that the laser disinfects the decade the majortity of UK dentists will
credible as it was billed as an all tissue been introduced which cuts as fast as interior of a root canal to a depth of wish to integrate the laser into their
laser with the ability to cut cavities and an airotor and I am better able now to 1mm which is ten times more effective clinical practices. Over the next few
treat decay without local anaesthetic in use the laser rather than a drill for many than bleach alone. I have recently issues I intend to present some treated
the majority of instances. I travelled to more clinical procedures. As my returned from an advanced laser clinical cases looking at examples of
the annual meeting of the ADA in Las experience developed and as I took assisted periodontal surgery course laser assisted surgical extractions,
Vegas in November 2006 and was further training my clinical proficiency where I learned tissue grafting crown lengthening surgery,
sufficiently impressed to order a unit increased and I started to widen the techniques along with bone and the Annapolis laser assisted periodontal
which duly arrived just before Christmas range of clinical procedures I was connective tissue regeneration surgery regime and frenectomy. In the
of that year. At that time mine was one happy to offer. I discovered that treatments. Also I have been taught the interim anyone interested in learning
of the very first units in the UK and I had osseous crown lengthening can often Annapolis method of laser assisted more can view a wealth of material
to rely on distance learning for be achieved without the need to raise a periodontal surgery which is proving a including some superb webinars on
instruction on how to use the unit. flap and that the healing and tissue very successful treatment modality for the manufacturers website:
The Waterlase MD™ had been is use in recontouring was so predictable and the management of moderate to www.biolase.com.
the States since 2002 and at that time reliable that the definitive crowns or advanced periodontal disease. As with
there were around 3,500 users so there veneers could be placed without having all laser treatments post operative Dr. Mark Cronshaw
B.Sc(Hons) BDS LDS RCS (Eng), MFHom (Dent)
was a wealth of clinical experience I to wait. As a CEREC® user I took to discomfort and sensitivity is minimal in
could draw on. The experience and both doing the osseous surgery and sharp contrast to the difficulties Dr. Mark Cronshaw is a private practitioner in
Cowes, Isle of Wight. He qualified from Guys
enthusiasm of our American colleagues placing the definitive crown all on the associated with the conventional Hospital in 1984 and is a long established and
is tremendous and following my initial same day with excellent results. approach. Again thanks to the lasers highly experienced post graduate trainer.
visit to the USA I have been back time Patients reported little other than minimal mode of operation these procedures Following his move into an exclusively private
and again. As a mature practitioner of discomfort post surgery and for are clean, simple and reliable and I practice in 2002, Dr. Cronshaw has developed an
interest in high tech dentistry, aesthetic and cosmetic
25 years this year it has helped me to aesthetic and cosmetic procedures have found myself taking on a much dentistry, minimally invasive techniques and holistic
stay fresh, motivated and very involving tissue recontouring the laser is expanded range of effective treatments care. Having studied in the USA, Mark is an
approved trainer for Biolase and the World Class
interested. My clinical experience of the easy to use, reliable and predictable many of which are historically the Laser Institute. His practice in Cowes is one of the
laser was initially confined to relatively with outstanding clinical results. province of specialised practitioners. most modern and best equipped practices in the UK
and is a showcase for state of the art equipment
simple procedures such as gingivectomy More recently I have used the laser as The response from my patients has been including the Cerec, digital imaging and video
and cavity preparation. I discovered an additional step in my endodontics as overwhelmingly positive and I have microscopy). He is an active member of the BACD,
and is a Fellow of the World Class Laser Institute.
that I could indeed perform some there are new special radial firing tips found myself enjoying my dentistry more
procedures without a local anaesthetic which help debride and sterilise root than ever before. In my opinion the Email: macron5@hotmail.com
4 ILLUMINATE | Issue 3 | November 2009 Equipment Sales 08700 10 20 41 / 029 2044 2898 | Equipment Service 08700 10 20 49 / 029 2044 2899
Your best news resource for dental lasers
6 ILLUMINATE | Issue 3 | November 2009 Equipment Sales 08700 10 20 41 / 029 2044 2898 | Equipment Service 08700 10 20 49 / 029 2044 2899
Your best news resource for dental lasers
8 sales@henryschein.co.uk | www.henryschein.co.uk Equipment Sales 08700 10 20 41 / 029 2044 2898 | Equipment Service 08700 10 20 49 / 029 2044 2899