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Waterlase Training Seminars

TheThe Journey of Journey of

ExcellenceExcellence

Lasers will take you to the next level ofLasers will take you to the next level of

excellenceexcellence

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LASERTISSUE

INTERACTIONCold Cut vs. Thermal Cut

Thermal Relaxation

H mode vs. S mode

High vs. Low Hertz

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LASERTISSUE

INTERACTIONBiostimulation

Cold Cut vs. Thermal Cut

Thermal Relaxation

H mode vs. S mode

High vs. Low HertzCOPYRIGHTED M

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Photo-biological Effects of Lasers

Photo-chemical EffectsStimulate Chemical Reactions

Break Chemical Bonds

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Biostimulation

HeNe, & Other Lasers (650nm – 750nm)Pain Relief

Diode LASER (800nm – 950nm)Accelerated Wound Healing

Fibroblast Proliferation

Osteoblast Proliferation

Increased Synthesis of Collagen Growth

Enhanced Phagocytic Activity of Leukocytes

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Waterlase MD

Two Types of CutsCold cut

Energize water from the Laser

Thermal cut (Heat cut)Energize water in the tissue

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Cold Cut requiresHigher WattsHigher Water

Higher Air

Water does most of the cutting.Little laser absorption by the tissues

Cold Cut (Energized Water)Cold Cut (Energized Water)COPYRIG

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HARD TISSUE & FIBROTIC TISSUEGREATER DEPTH OF PENETRATION

Rapid cuttingWater does most of the cutting

Lased surface very irregularLittle laser absorption by the tissues

Cold Cut (Energized Water)Cold Cut (Energized Water)COPYRIG

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Thermal Cut (Energized Tissue)

Thermal Cut requires

Lower Watts

Little to No Water

Lower Air

The water in the tissue absorbs the laserbeam and is volatilized.

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Thermal Cut (Energized Tissue)

Soft Tissue cutting only

Little penetration of Tissues (30-40 microns)

Lased surface very smooth

Laser band-aidThe water in the tissue absorbs the laser

beam and is volatilized.

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THERMAL RELAXATION

The time that the laser energy isOFF is referred to as the thermalrelaxation time, the time duringwhich the target tissue is

allowed to cool.

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Don’t Judgethe

S settingto quickly!!!!!

I didI did

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Coagulation of the softtissue

•Long pulse (S mode, 10times longer)

•More pulses per second(50 Hz maximum)

(in both cases, water level

should be low)

T o

increase

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H mode vs. S modeH mode vs. S modeCOPYRIG

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Power = Energy x FrequencyCOPYRIG

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Power = Energy x FrequencyH Mode

HARD TISSUE CUTTING

HIGH ENERGY (H)

(COLD CUT)

LONG THERMAL RELAX.

10 to 15 Hz (no anesthesia)

20 to 25Hz (with anesthesia)

Greater Energy Penetration

High energy (200 - 300Mj)

2 - 4 Watts (10-15 HZ)

5 - 7 Watts (20-25Hz)

SOFT TISSUE CUTTING

(COLD & HEAT CUT)

SHORT THERMAL RELAX.

30 - 50 Hz

Topical Anesthesia

Less energy Penetration

Low energy (50 - 150Mj)

.50 - 2.25 Watts

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Power = Energy x FrequencySoft Tissue Cutting

H Mode (High Energy)

(Low Power &Short Pulse)

SOFT TISSUE INCISING AND

SURGERY

• High Frequency (pulses)

1. More penetration

2. Less Thermal than S

3. 30 to 50 Hz

• Lower Energy

1. Less than half

2. 100 to 200 mj

S MODE (LOW ENERGY)

(High Power & Long Pulse)

SOFT TISSUE BEVELING

AND CONTOURING

• High Frequency (pulses)

1. Minimal Penetration

2. Most Thermal

3. 30 to 50 Hz

• Higher Energy

1. Higher watts

2. 150 to 275 mjCOPYRIGHTED M

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H mode (Short pulse)vs.

S mode (Long pulse)COPYRIG

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LASER TIPSLASER TIPS

ANDAND

SETTINGSSETTINGS

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INCISING PROCEDURESCOLD Cut in H mode

Tips - Z6-6mm, Z4-9mm & G6 & C6-6mm

H mode / 10 - 15 Hz (no anesthesia)H mode / 20 - 25 Hz (with anesthesia)Watts 1.75 – 4.50Air 60%Water 30%

10 Hz @ 2Watts or 15 Hz @ 3.5 Watts

Hard TissueHard TissueCOPYRIG

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INCISING PROCEDURESCOLD Cut in H mode

Tips - T4-6mm, C6-9mm, & C3-9mmH mode / 20-40 HzWatts 1.25 – 2.50 (1.75)Air 20 - 30%Water 15 - 25%

40 T0 50 Hz more thermal & less penetration than 20 Hz

Soft Tissue CuttingSoft Tissue CuttingCOPYRIG

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INCISING PROCEDURESCOLD Cut in S mode

Tips - Z6 & Z4 - 9mmS mode / 15-50 HzWatts 1.25 – 2.50 (2.00)Air 20 - 30%Water 15 - 25%

40 T0 50 Hz more thermal (Slower cutting)

More penetration less thermal with 15 Hz (Faster Cutting)

Soft TissueSoft TissueCOPYRIG

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LASER BEVELINGCOLD Cut in S mode

Tips C12-9mm & Z6-9mmS mode / 30-50 HzWatts 2.00 - 2.75Air 15 - 20%Water 10 - 15%

30 Hz cuts faster, 50 Hz gives better hemostasis

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LASER Band-AidHeat Cut in H & S mode

Tips C12-9mm & Z6-9mmH&S mode / 40-50 HzWatts .50 - .75Air 20%Water 0

H mode 40 Hz deeper penetration

S mode 50 Hz best hemostasisCOPYRIGHTED M

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Z4Z4

Z6Z6

C6C6C3C3

H modeH mode

40 Hz40 Hz

25% Air 15% Water25% Air 15% WaterCOPYRIG

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tip comparisonsCOPYRIG

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COLD CUT

S 40HzS 40Hz

S 15HzS 15Hz

H 40 HzH 40 Hz

H 15 HzH 15 Hz

Z6 TipZ6 Tip

1.5 Watts1.5 Watts

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S ModeS ModeH ModeH Mode

15Hz 40Hz 50Hz 15Hz 40Hz 50Hz15Hz 40Hz 50Hz 15Hz 40Hz 50Hz

THERMAL CUTTHERMAL CUT

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Heat cut h s modeCOPYRIG

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Laser Band Aide

Z6 at .75 W15 Hz - H mode - High Thermal Damage

40 Hz - H mode - Low Thermal Damage

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BONE ABLATION

Bone Cutting (100mj)

Tip effect?

G6, C6, Z6, Z4

Hertz effect?

20 - 50 Hz

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BONE HERTZ

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BONE ABLATION


(2W at 20HZ)

Tip effect?

G6, C6, Z6, Z4

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BONE ABLATION


Tip effect

Z6

Hertz effect?20 Hz at 2 Watts = 100mj

30 Hz at 3Watts = 100mj

40 Hz at 4Watts = 100mj

50 HZ at 5 Watts = 100mjCOPYRIGHTED M

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Waterlase MDWaterlase MDFlap SurgeriesFlap Surgeries

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.

Effects of Erbium,Chromium:YSGG Laserirradiation on canine mandibular bone.

Kimura Y, Yu DG, Fujita A, Yamashita A, Murakami Y, Matsumoto K.

RESULTS: Regular holes or grooves having sharp edgesand smooth walls were produced, but no melting orcarbonization was observed.

CONCLUSION: These results showed that the Er,Cr:YSGGlaser cuts canine mandibular bone effectively withoutburning, melting, or altering the calcium: phosphorusratio of the irradiated bone.

J Periodontal. 2001 Sep;72(9):1178-82

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The Er: Yag (Er,Cr:YSGG) laser has a high

bactericidal potential at a low energy level. Er-Yag

laser removed 83% of lipopolysaccharides from root

surfaces.

Scanning electron microscopy revealed a

distinct rough surface structure in all samples

treated with Er: Yag laser irradiation. Scaled-only

samples yielded the smoothest surface, whereas

combined treatment (laser then scaling) resulted in a

variform pattern of rough and smooth areas. In all

samples, concrements were entirely removed.

H. Yamaguchi, K. Kobayashi, R. Osada, E. Sakuraba, T. Nomura, T. Arai, J. Nakamura. Effects of irradiation of an Er-Yag laser

on root surfaces. J Periodontol. 1997:68;1151-1155.

U. Schoop, A. Moritz, W. Kluger, et al. Changes in root surface morphology and fibroblast adherence after Er: Yag laser

irradiation. J Oral Laser Applications. 2002:2;83-93.

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The culturing of fibroblasts did not show

any significant differences regarding the number

and the density of the cells among the different

groups. However, significantly more spindle-

shaped cells were found on laser irradiated roots.

This indicates a better adherence of the cells to

those surfaces. The trend was better cell

adherence on lased plus scaled surfaces. Lased

root surfaces seem to provide an ideal foundation

for periodontal regeneration when compared to

scaled only surfaces.U. Schoop, A. Moritz, W. Kluger, et al. Changes in root surface morphology and fibroblast adherence after Er: Yag laser

irradiation. J Oral Laser Applications. 2002:2;83-93.

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•Biostimulation with a diode laser at 3J/cm2 can increase fibroblast

proliferation six-fold.

•Diode lasers have been utilized to close oral-antral openings through

Biostimulation.

•Irradiation with a pulsed diode laser has a biostimulating effect on

osteoblasts in vitro, which might be used in osseointegration of dental

implants.

•Low-intensity laser irradiation influences endothelial cell

proliferation and might thereby contribute to the increase in

angiogenesis and the acceleration of wound healing in vivo.Effect of low-power laser irradiation on cell growth and procollagen synthesis of cultured fibroblasts.

Pereira AN, Eduardo Cde P, Matson E, Marques MM. Lasers Surg Med. 2002:31;263-7.

Conservative closure of antro-oral communication stimulated with laser light.

Grzesiak-Janas G, Janas A. J Clin Laser Med Surg. 2001 Aug:19;181-4

Biostimulation of bone marrow cells with a diode soft laser.

Dortbudak O, Haas R, Mallath-Pokorny G. Clin Oral Implants Res. 2000 Dec:11;540-5

Direct stimulatory effect of low-intensity 670 nm laser irradiation on human endothelial cell proliferation.

Schindl A, Merwald H, Schindl L, Kaun C, Wojta J. Br J Dermatol. 2003:148; 334-6.

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THE LASER IS AGREAT TOOL IN

TRAINED HANDS...

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Surgical ProceduresSurgical ProceduresCOPYRIG

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