laserinternational magazine of laser dentistry32010

i s sn 1616-6345 Vol. 2 • Issue 3/2010

| researchFrenectomy review

| interview“A man alone cannot do anything”

| social newsAALZ Greece successfully established

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_Laser is not only an expert medical or dental discipline, but also a technology which,thanks to its versatility, can be applied on its own or in addition to other treatments for a variety of different medical and dental purposes. Moreover, there is not just “the one and onlylaser”, but lasers of different wavelengths. Since students do not learn anything about laserapplication during their studies, e.g. that laser application is based on biophysical light- tissue interactions, it is highly important for every responsible dentist to acquire the neces-sary knowledge about lasers.

Integrative laser technology, applied in responsible dentistry, is a useful and reasonablecomplement to treatment of patients in most other disciplines, and it often leads to a lesspainful, minimally invasive and all-round more successful treatment.

Prof. Dr. Norbert Gutknecht-President of DGL-

editorial _ laser I

Prof Dr Norbert Gutknecht

WFLD President

Editor-in-ChiefLaser —usefuland reasonable

LASER…INNOVATION MADE IN GERMANY

F O XThe new

AD

I content _ laser

04 I laser3_2010

I editorial

03 Laser—useful and reasonable| Prof Dr Norbert Gutknecht

I case report

06 The use of the Er:YAG in laser-assisted broken abutment screw treatment| Avi Reyhanian, Steven Parker, Joshua Moshonov, Natan Fuhrman

12 Laser phototherapy in Bell’s palsy| Prof Aparecida Maria Cordeiro Marques, Luiz Guilherme Pinheiro Soares,Dr Cristina Maria do Nascimento, Alberto de Aguiar Pires Valença Neto, Roberta Cordeiro Marques, Dr Antonio Luiz Barbosa Pinheiro

I research

14 Frenectomy review| Dr M. L. V. Prabhuji, Prof Dr Madhu Preetha, Dr Ameya G. Moghe

I user report

20 The minimalinvasive laser surgical crown lengthening| Dr Thorsten Kuypers

24 The clinical use of the Er,Cr:YSGG laser in endodontic therapy| Justin Kolnick

28 Er,Cr:YSGG laser assisted GTR in periodontal surgery| Dr Elena Speranza Moll

I laser

32 “A man alone cannot do anything”| Kristin Urban

I social news

34 2010—A breakthrough for Laser Supported Dentistryin Sweden| Dr Peter Fahlstedt

36 AALZ Greece successfully established| Dimitris Strakas, Dominique Vanweersch

I meetings

38 International events 2010–2012

40 XIIth International Congress of the WFLD in Dubai| Prof Toni Zeinoun

44 Laser dentistry and Implantology Symposium in Gaziantep a great success!| Leon Vanweersch

46 “Tomorrow’s dentistry today”| Ralf Borchert

II news

48 Manufacturer News

I about the publisher

49 | submissions50 | imprint

case report 06 research 14 user report 32

social news 38 meetings 44 meetings 46

Cover image courtesy: A.R.C. Laser GmbH

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I case report _ Er:YAG

_Abstract

Dental implants are a functional and aesthetic so-lution to partial and total edentulism. Although theoverall success rate of implant dentistry is very high,over 90 % of the treatment modality is not free ofcomplications and dental implants occasionally fail.The chronic loosening or fracturing of implant screwscontinue to be a problem in restorative practices andgenerally are challenging to remove. This report de-scribes and demonstrates the management and tech-nique used for the removal of fractured screw frag-ments and the successful utilization of the Er:YAGlaser as an important auxiliary tool.

_Introduction—the problem

Success in implant-supported prosthetic replace-ment of teeth will be due to a combination of appro-priate placement criteria (receptor site quality, implantstability, osseo-induction), appropriate (non-exces-sive) loading and prevention of bacterial contamina-tion. The failure of dental implants is due not only tobiological factors, such as unsuccessful osseo-inte-gration or the development of peri-implantitis, but itmay also result from technical complications.1,2 Den-

tal implant complications may be considered underthe following main categories:

Early_ Failure/inadequate surgical preparation._ Failure of osseo-integration._ Peri-surgical infection.

Late_ Implant overloading, leading to bone loss._ Peri-implantitis._ Soft tissue complications._ Fracture of mechanical components and

aesthetic/phonetic considerations.

Failures of implant-supported restorations resultfrom technical problems and can be divided into twogroups: those relating to implant components, andthose relating to the prosthesis.3,4,5,6,7,8,9,10,11 Technicalproblems related to implant components includeabutment screw fracture.8,12

The abutment screw fracture presents a rare, butquite unpleasant failure and can be a serious prob-lem13,14, as the fragment remaining inside the implantmay prevent the implant from functioning efficiently

The use of the Er:YAG inlaser-assisted broken abutment screw treatmentAuthors_Avi Reyhanian, Israel, Steven Parker, United Kingdom, Joshua Moshonov, Israel, Natan Fuhrman, Israel

06 I laser3_2010

Fig. 2 Fig. 3Fig. 1

case report _ Er:YAG I

I 07laser3_2010

as an anchor.15 The primary reason for screw fractureis undetected screw loosing which can be due to brux-ism, an unfavorable superstructure, overloading16,17 ormalfunction.10,11,18,19 Fractures of the implant abut-ment or of the abutment screw have been observed asa consequence of screw loosening and undetected mi-cro-movements of the abutment under functionalloading20 and consequently, it is advised that the re-peated loosening of an abutment screw should alertthe clinician to possible significant contributingcauses.

However, the behavior of the implant/abutmentjoint components with respect to critical bendingforce is still unclear.20,21 Studies show that implantabutment failure occurs when lateral forces exceed370 Newtons for abutment with a joint depth of atleast 2.1 mm and 530 Newtons with a joint depth of atleast 5.5 mm.7

_Preventive recommendations

_ The number, position, dimension and design of im-plants, as well as the design of the prosthesis are crit-ical factors to be considered during the treatmentplanning phase.11,12,13,22,23 To withstand high bendingstresses, implants should be as long and as wide aspossible, used in adequate numbers, and be posi-tioned such as to allow axial loading.13,20,24,27 Implantcomponents are known to fracture more frequentlyin the posterior region and in partially dentate pa-tients compared to completely edentulous pa-tients.5,6,9,11,12,19,23,25

_ Retightening an abutment screw ten minutes afterthe initial torque applications should be routinelyperformed, and increasing the torque value for abut-

ment screws above 30 Newtons can be beneficial forthe abutment, implant stability and to decrease thepossibility of the screw becoming loose.25

_ Proper case selection, excellent surgical technique,placing an adequate restoration on the implant, ed-ucating the implant patient as to the importance ofmaintaining meticulous oral hygiene, and evaluat-ing the implant both clinically and radio-graphicallyat frequent recall visits26; reinforcing periodic main-tenance.

_ A procedure for using dimples inside the abutmentscrew cylinder above the screw, and filling the holeswith elastomeric impression material will preventthe screw-retained prosthesis from loosening.27

_ Using the correct fixation screw._ Replacing loose screws instead of retightening them. _ Immediate investigation; looseness of the prosthe-

sis is detected by the clinician or patient.28,29

_Fragment retrieval methodology

The methods employed to grasp the broken frag-ments or screw are determined according to the loca-tion of the fracture abutment—above or below thehead of the implant. If an abutment screw fracturesabove the head of the implant, an explorer, a straightprobe or haemostats30 might be successful. The tip ofthe instrument is moved carefully in a counter-clock-wise direction over the surface of the screw segmentuntil it loosens.1 If the screw fracture occurs below thehead of the implant, other methods are required. Thereare several available implant repair kits:

_ ITI® Dental Implant System (Institut Straumann AG,Switzerland), consists of drills, two drill guides andsix manual tapping instruments.8

Fig. 4 Fig. 5 Fig. 6

Fig. 7 Fig. 8 Fig. 9

I case report _ Er:YAG

08 I laser3_2010

Fig. 14 Fig. 15

Fig. 11

Fig. 13

Fig. 10

Fig. 16

Fig. 12

_ IMZ® TwinPlus Implant System1(DENTSPLYFriadent,Germany)

_ Screw Removal Kit Replace (Nobel Biocare™, YorbaLinda, California, USA)

_ Certain®-Screw Removal Kit (Biomet 3i™, Florida,USA31)

The application of these systems is to permit a holeto be drilled into the centre of the broken screw anddrive a removal wedge into the hole that engages thebroken screw when reverse torque is applied by re-moving the instrument.

If no thread damage has occurred and the screwhas not “bottomed out” or torqued into a seating stop,then the force necessary to remove the screw may beminimal.8 If none of these systems is available, an-other method for broken screw retrieval involves thefollowing procedure: after the prosthesis or abut-ment is removed, the screw hole is vigorously flushedwith an air/water spray from a 3-way syringe. Pres-surized air is applied to dry the screw hole, and a dropof mineral oil (delivered on the tip of an explorer) is in-troduced into the screw hole. A sharp 1⁄4-round burin a high-speed handpiece is activated and lightly ap-plied to the exposed side of the fractured screw. Theobjective is to have the spinning bur’s blades contactthe metal surface of the screw so that the screw willspin itself out of the hole. When repeated severaltimes, the screw can be backed out and retrieved eas-ily with forceps.8

If this technique fails, a slot can be created using asurgical drill, on the head of the fractured screw, andthen a screwdriver is used to back out the brokenabutment screw. Sometimes just a gentle touch with

the drill to the head of the broken screw will be enoughto back it out. If the hexagonal head of the screw isstripped, it should be filed away completely using around carbide bur or heatless stone, the head of theimplant should be straightened, and a new abutmentmay be rotated into the implant.

_Case study

This clinical report describes a situation in which afractured implant abutment screw was successfullyretrieved by using the Er:YAG laser as an auxiliary tool,and the advantages of this 2,940 nm wavelength ver-sus conventional methods.

_Examination

A 36-years-old male presented for treatment, re-porting the detachment of an implant-supportedcrown in the region of the upper left central incisor.The patient stated that the implant and crown hadbeen placed four years earlier and that looseness ofthe crown had occurred on two occasions during thisperiod. On both occasions, the screw had been re-tightened with no further investigation.

Clinical examination of the patient revealed amissing tooth at the location of #9 with no sign of animplant (Fig. 1). The patient brought the abutment,crown and broken screw with him (Fig. 3). Radi-ographic examination of the area showed the pres-ence of a root-form cylindrical implant, consistent inappearance with a 13 mm long, 3.75 mm diameterabutment with an internal hex. The apical part of thescrew remained threaded into the implant, but hadfractured at the level of the hexagonal lock. Although

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I case report _ Er:YAG

10 I laser3_2010

the implant was osseointegrated, there were radi-ographic signs of peri-implantitis with some crestalbone loss having occurred (Fig. 2).

_Treatment options

The treatment options available were: 1) retrievethe fractured screw, or 2) remove the old implant andinsert a new implant in one sitting. Following discus-sion with the patient and evaluation of the possibili-ties for success, it was decided to try and retrieve thefractured screw. Treatment would involve the use ofthe Er:YAG laser to perform the following, based uponaccepted research:

_ The flap incision.31,32,33

_ Ablation of granulation tissue around the im-plant.34,35,36

_ Remodelling, shaping and ablating of thebone.32,34,37,38

_ Detoxification of the infected surfaces of the im-plant.36,39,40,41,42

_ An associated osteogenic (GBR) procedure to pre-vent soft tissue in-growth and maintain the form ofthe alveolus treatment alternatives, using a moreconventional approach, would include the use oftraditional scalpel, curettage, and rotary instru-ments.

_Treatment

A dual-wave laser system with operating wave-lengths of 2,940 nm and 10,600 nm (OpusDuo™AquaLite™, Lumenis, Ltd. Yokneam, Israel) was em-ployed for this procedure. The laser operating param-eters employed for the various surgical stages were asfollows:

_ Flap Access: Wavelength: 2,940 nm (Er:YAG), 200-micron sapphire tip, in contact mode; 450 mJ perpulse at 20 Hz. Total power: 9 Watts.

_ Granulation Tissue Removal: Wavelength: 2,940 nm(Er:YAG), 1,300-micron sapphire tip, in non-contactmode; 700 mJ per pulse at 12 Hz. Total power: 8.4Watts.

_ Bone Surgery: Wavelength: 2,940 nm (Er:YAG),

1,300-micron sapphire tip, in non-contact mode;450 mJ per pulse at 20 Hz. Total power: 9 Watts.

_ Detoxification of the implant: Wavelength: 2,940 nm(Er:YAG), 1,300-micron sapphire tip, in non-contactmode; 150 mJ per pulse at 20 Hz. Total power: 3 W.

_ Decortication for GBR technique: Wavelength:2,940 nm (Er:YAG), 1,300-micron sapphire tip, innon-contact mode; 500 mJ per pulse at 17 Hz. Totalpower: 8.5 Watts.

A “V” shape incision was made with the Er:YAGlaser. An intrasulcular incision was made (after anaes-thesia) at the buccal and palatal side of the implant,together with two vertical relieving incisions: one atthe mesial side of tooth # 8 and the second at themesial side of tooth # 11 (Figs. 4 and 5).

The buccal and palatal flaps were lifted and the areaexplored (Fig. 6); there was granulation tissue aroundthe neck of the implant. The granulation tissue was ab-lated using the laser (Fig. 9). Vaporization of granula-tion tissue (if any exists) after raising a flap is efficientwith the Er:YAG laser, offering a lower risk of over-heating the bone than that posed by the current diodeor CO2 lasers.43 And often obviates the need for handinstruments. Results from both controlled clinical andbasic studies have pointed to the high potential of theEr:YAG laser and its excellent ability to effectively ab-late soft tissue without producing major thermal side-effects to adjacent tissue has been demonstrated innumerous studies.35,36,37

The broken hexagon slot was straightened, using around diamond bur and the head of the implant wasrendered smooth. A slot was created with a surgicaldrill on the head of the fractured screw, and a screw-driver was successfully used to unscrew the brokenabutment screw (Figs. 7 and 8). The Er:YAG laser wasaimed at the surface of the exposed implant for thepurpose of decontaminating the infected exposedsurfaces, without damaging them.36,40,41,42,43 Studieshave shown that Er:YAG laser energy effects on boneinclude bacterial reduction.43,44 Following this, all ac-cessible bone surfaces were exposed to laser energy toablate necrotic bone and to shape and remodel thesurface, in accordance with established clinical proto-

Fig. 17 Fig. 18 Fig.19

case report _ Er:YAG I

I 11laser3_2010

cols.32,34,38,39 Decortication of the buccal bone was thenperformed (Fig. 10). The purpose of decortication is toencourage bleeding, providing progenitor cells to thesite. A new abutment was then inserted into the im-plant (Fig. 11). All spaces between implant and existingosteotomy site were filled with a xenograft bone sub-stitute (Bio-Oss®, Geistlich Biomaterials) and coveredwith an absorbent bilayer membrane (Bio-Gide®,Geistlich Biomaterials), (Figs. 12 and 13). The mucope-riosteal flap was re-positioned and sutured with silk 3-0, paying particular attention to primary closure ofthe flap (Fig. 14).

_Post-operative instructions

The patient was prescribed Clindamycin 150 mg x 50tabs to avoid infection. He was also given Motrin 800mg x 15 tabs for pain. Instructions were given to rinsewith Chlorhexidine 0.2 %, starting the next day for 2weeks x 3 per day.

_Management of complications and follow-up care

The following day the patient reported moderatepain and moderate swelling. There was no tissue bleed-ing and the site was closed. The flap was showing signsof attachment and was healing nicely. At ten days post-op the patient returned for inspection and removal ofsutures. The swelling had resolved, there were no signsof fistula and healing was progressing well. After fivemonths the soft tissue was completely healed withoutcomplications (Figs. 16 & 17). The soft issue had healedover the bone and there were no bony projections ob-served under the soft tissue. The prognosis is excellent.

_Conclusion

The use of osseo-integrated implant-supportedprostheses in the replacement of missing natural teethhas become an accepted clinical protocol in dentistry.Success in this area is enhanced through correct diag-nosis, treatment planning and maintenance; however,complications often occur, which may be significant

and compromise the long-term success of the implantabutment and associated prosthesis. The managementof such complications has given rise to several tech-niques to address failings, such as component fractureand bacterial contamination.

The Er:YAG (2,940 nm) laser can be employed as anauxiliary tool for the purpose of decontamination of in-fected implant surfaces and it has been shown to be ef-fective and safe. The use of the 2,940 nm wavelengthfor these procedures presents many advantages vs.conventional methods, including enhancing the surgi-cal site and less bleeding during the operation, provid-ing the practitioner a better field of visibility and re-ducing patient discomfort during its use. In addition,anecdotal claims have been made that post-operativeeffects such as pain and swelling are less pronounced.A summary of possible serious complications associ-ated with implant placement has been given, togetherwith a report of a clinical case in which the use of theEr:YAG laser has been shown to be beneficial in themanagement of the consequences of a fractured abut-ment screw._

Editorial note: The literature list can be requested fromthe Editorial Office.

Avi Reyhanian, DDS1 Shaar Haemek Street, Netanya 42292, Israel

Steven Parker, BDS, LDS, RCS, MFGDP (Harrogate, UK)30, East Parade, Harrogate HG1 5LT, United Kingdom

Joshua Moshonov, DMD25 Habanai Street, Jerusalem 96264, Israel

Natan Fuhrman, DDSInstitute of Advanced Dental EducationHaifa, Israel

_contact laser

Fig. 20 Fig. 21

I case report _ LPT

Fig. 1_Initial aspect of the patient

showing limitation of the facial

expression.

Fig. 2_Diagram showing the sites of

application of the Laser and amount

of energy delivered to each point.

Fig. 3_Aspect of the patient lips of

the affected site during the treatment

(30 days).

_Introduction

Bell’s palsy is a sudden idiopathic peripheral palsyof the facial nerve. This condition is caused by somekind of damage to the VII cranial nerve that causes ei-ther complete or partial of the facial mimics.3 It maybe associated or not to gustative disturbance, hypersalivation, and of eye and ear disturbances.8 Its diag-nosis is by the exclusion of any other causes that maycause the palsy of the facial nerve as its etiology re-mains unclear.2,11 It has been demonstrated that her-pes virus may cause this type of palsy due to reactiva-tion of the virus or by imunomediated post-viral nervedemielinization.12,13 Most cases of Bells’ palsy recoverwithout treatment. Besides the unbalance of the fa-cial esthetic and some sensorial symptoms, the acutephase of this disease is not associated to severe dis-turances.16 The condition has a annual incidence esti-mated of 20–30:100.000 people2,12 and has a goodprognosis, with spontaneous resolution in 95 % ofthe cases within 6–8 weeks.

One common symptom reported by suffers is painaround the ear prior to the clinical appearance of thefacial palsy. This pain is caused by sensorial distur-

bance of the facial nerve.18 The muscular spasm andsensitivity around the ear is an alert, an early sign, andit is due to hyper excitability of the facial nerve thatcauses the spasm of the facial muscles of the mimicand that may be provoked by centripetal impulsesgenerated by the contact of the axons of the nervewith the Nervi nervorum.6

Clinical examination evidences the lost of facialexpression on the affected side. The patient is not able,for example, of closing the eye as the eyelid does notrespond to the order to close due to the palsy of thefacial nerve. The eyeball rotates itself up. This is knownas Bell’s sign.13 Ru Lan et al. (2009) suggested thatageing increases the severity of the condition due toa reduced capacity of neural regeneration. This maybe attributed to a hyperactivity of glial cells and in-creased activity of cerebral cytokines that impair therepair of nerve cells.8 There is also some evidence thatBell’s palsy may be associated to bacterial infectionLiu et al. (2009) suggested on their study that the useof penicillin on suffers showing normal counts ofleukocytes and increased number of neutrophyls re-sulted in Best results than when anti-viral agentswere used. These aspects are indicative of a multi-fac-

Laser phototherapy inBell’s palsyA case report

Authors_Profa Aparecida Maria Cordeiro Marques*, Luiz Guilherme Pinheiro Soares*, Dr Cristina Maria do Nascimento*,Alberto de Aguiar Pires Valença Neto*, Roberta Cordeiro Marques*, Dr Antonio Luiz Barbosa Pinheiro*, Brazil

12 I laser3_2010

Fig. 2 Fig. 3Fig. 1

case report _ LPT I

torial etiology and that it may require different treat-ments according to the etiological agent.

The success of the treatment of Bell’s palsy by using laser phototherapy isolated or in associationwith other therapeutic approach has been reported onthe literature.1,16,20The ability to increase the amplitudeof the action potential and increased regeneration ofnerves are probably related to the efficacy of the pro-tocol used on cases of Bell’s palsy.7 A previous reportby Shamir et al. (2001) on a rodent model used appli-cations of � = 780nm laser light applied daily andtrans cutaneously (30 min, 21 consecutive days), tocorres ponding segments of the spinal cord and to theinjured sciatic nerve. Their results showed positive so-mato-sensorial response on 69.2 % of the animalsthat were irradiated with the laser. Controls showedonly 18.2 % of positive responses. Immunohisto-chemical analysis evidenced both increased number of total axons and improved quality of nerve repair onirradiated animals.

The treatment of Bell’s palsy aims mainly to preventcorneal damage usually by physiotherapy andsteroids.13 Physiotherapy, steroids and retroviralagents are now widely accepted for treating Bell’spalsy. Laser phototherapy is able to stimulate the me-tabolism of the damaged nerve stimulating the pro-duction of proteins associated to its growth and im-proved recovery capacity of the facial nerve.20 Ailioaie,Ailioaie, Chiran, (2004) studied nerve regeneration on31 children using Laser light (� = 670/830 nm) andfound complete regeneration on 87.5 % of the cases.Controls showed only 60 % of recovery. This work re-ports the treatment of a case of Bell’s palsy with laserphototherapy, electrotherapy and physiotherapy.

_Case report

A 52-years-old white male complaining of hemi fa-cial palsy was seen at the Laser Center of the Center ofBiophotonics of the School of Dentistry of the FederalUniversity of Bahia (Fig. 1). Laser phototherapy wascarried out during two months. A diode laser(�=790 nm/40 mW/26-29 J/cm² - Kondortech®, SãoCarlos, São Paulo, Brazil) was used and treatmentstarted 48h after the onset of the palsy. During the firstweek the treatment was carried out on daily basis(26J/cm²) on the following weeks treatment was car-ried out three times a week (29 J/cm²). The number oftotal sessions was 21. Laser light was delivered on ex-tra-oral contact points on the affected hemi face andwas carried out along the five branches of the facialnerve and at the infraorbitary and mental foramens(Fig. 2). Besides Laser phototherapy the patient wasalso submitted to TENS and physiotherapy three timesa week. The palsy weakened along the time of treat-ment as seen on Figures 3 and 4.

_Discussion

Bell’s palsy may be uni or bilateral disturbance ofthe conduction of the Facial nerve with non-specificetiology.2 Treatment of this pathology is carried outusing antiviral drugs2,12,17, steroids4,6,14,15, physiother-apy3, and acupuncture.11 The use of steroids has beenshown effective on the treatment of Bell’s palsy due toits strong anti-inflammatory effect that reduces thedamage to the nerve resulting in a better prognosis.2,15

Over the last 10 years the use of Laser photother-apy has been suggested as an associated treatmentto other types of therapeutic approaches.5,9,16,20 Thispositive effect has been attributed to the effect of thelight on nerve regeneration and consequent recoveryof normal nerve physiology. Khullar et al. (1996) sug-gested that Laser light might stimulate reinervationof the tissues by either the penetration of the axons oron adjacent Schwann’s cells inducing the compro-mised tissue to secrete proteins related to nervegrowth or the releasing of mediator of nerve growththat will affect non-damaged adjacent nerves. Theseaspects were reflected on the treatment of the pa-tient. Despite the positive result of the treatment, fur-ther studies are needed to elucidate the effect of thelaser light on nerve as well as on the etiology of Bell’spalsy.

_Conclusion

Laser phototherapy seems to positively affect theoutcome of the treatment of Bell’s palsy carried outwith other therapeutic approaches causing mainlyquicker sensorial recovery and improved quality oflife of the patients.

_Abstracts

Bell’s palsy is defined as a peripheral facial nervepalsy, idiophatic, and sudden onset and is consideredthe most common cause of this pathology. It is causedby damage to cranial nerves VII, resulting in completeor partial paralysis of the facial mimic. May be asso -ciated with taste disturbances, salivation, tearing andhyperacusis. It is diagnosed after ruling out all possi-ble etiologies, because its cause is not fully under-stood. Physical therapy, corticosteroids and antiviraltherapy have become the most widely accepted treat-ments for Bell’s palsy. Therapy with low-level laser(LLLT) may induce the metabolism of injured nerve tis-sue for the production of proteins associated with itsgrowth and to improve nerve regeneration. In mostcases, the recovery occurs without uneventfully(complications), the acute illness is not associatedwith serious disorder. This paper reports a successfultreatment of Bell’s palsy treated with Laser pho-totherapy, electrotherapy and physiotherapy._

Fig. 4_Aspect of the patient at the

end of the treatment showing the

recovery of the facial mimics

(60 days).

I 13laser3_2010

Profa Aparecida MariaCordeiro MarquesCenter of BiophotonicsSchool of DentistryFederal University of BahiaAv. Araújo Pinho, 62, CanelaSalvador, BA, CEP 40140-110, BrazilTel./Fax: +55 71 32839010E-mail:amarques@ufba.br,cidamarques77@hot -mail.com

*Center of Biophotonics,School of Dentistry, Federal University of Bahia,Av. Araújo Pinho, 62,Canela, Salvador, BA, CEP40140-110, Brazil

_contact laser

Fig. 4

I research _ frenectomy

Fig. 1_Abnormal frenal attachment.

Fig. 2_Haemostat in place &

incision made.

Fig. 3_Sutures placed.

Fig. 4_Post-op two months.

_Introduction

The word frenum is derived from the Latin word“fraenum”. Frena, are triangle-shaped folds found inthe maxillary and mandibular alveolar mucosa, andare located between the central incisors and caninepremolar area.

Frenum may be classified depending upon itsmorphology as:_Long and thin_Short and broad.

Depending upon the attachment level, frenumhas been classified as: (Placek et al. 1974)_Mucosal_Gingival _Papillary_Papillary penetrating.

When the insertion point of the frena is at the gin-gival margin it may pose a problem (Corn 1964). Thiskind of abnormal insertion of the frenum may causemarginal recession of the gingiva. Abnormal frenalinsertion can distend and retract the marginal gin-giva or papilla away from the tooth when the lip isstretched. A frenum that encroaches on the marginof the gingiva may interfere with plaque removal, andtension on this frenum may tend to open the sulcus.

This condition may be more conducive to plaque ac-cumulation and inhibit proper oral hygiene.

Aberrant frenum can be treated by frenectomy orfrenotomy procedures. The terms frenectomy andfrenotomy signify operations that differ in degree ofsurgical approach. Frenectomy is a complete removalof the frenum, including its attachment to the un-derlying bone, and may be required for correction ofabnormal diastema between maxillary central inci-sors (Friedman 1957). Frenotomy is the incision andrelocation of the frenal attachment.

Indications_The indications for frenectomy procedure include_Tension on the gingival margin (frenal-pull con-

comitant with or without gingival recession)_Facilitate orthodontic treatment_Facilitate home care.

Techniques for frenectomy_Conventional technique_Using soft tissue lasers.

Conventional techniqueConventional technique utilises traditional in-

struments like the scalpels and periodontal knives.Different procedures have been mentioned under theconventional frenectomy technique. These include

Frenectomy reviewComparison of conventional techniqueswith diode laser

Authors_Dr M.L.V. Prabhuji, Prof Dr S.S. Madhu Preetha, Dr Ameya G. Moghe, India

14 I laser3_2010

Fig. 1 Fig. 2 Fig. 3 Fig. 4

research _ frenectomy I

Dieffenbach, Schuchardt, & Mathis. The most com-mon being Dieffenbach V-plasty & Schuchardt Z-plasty.

_Armamentarium

Bard-Parker handles no. 3, No. 15 blade, mosquitohaemostat, suture material.

_Procedure

Dieffenbach V-plasty Surgical steps: The area is anesthetized by giving

local anesthetic injection (2 % lignocaine with1:200,000 adrenaline). After anesthesia is achieved,the frenum is held with the mosquito haemostat toits full depth. With the No. 15 blade mounted on aBard-Parker handle, an incision is made along theupper surface of the haemostat till the entire depthof the frenum extending into the vestibule. A similarincision is repeated on the under-surface of thehaemostat so that the haemostat is detached alongwith the frenal tissue within its beaks. Once this isachieved, a rhomboid area exposing the deeper con-nective tissue fibers becomes visible. With the helpof fine scissors, the deeper fibers are detached fromthe underlying periosteum. Periosteal scoring isdone with the help of surgical blade so as to preventthe reattachment of fibers. The labial mucosa is un-

dermined so as to permit the approximation of theedges. The bleeding is controlled by applying pres-sure packs.

Suturing: The diamond shaped wound is suturedusing either a 4-0 or 5-0 silk sutures in simple inter-rupted fashion. Proper approximation of the mar-gins is ensured. A periodontal dressing is placed tocover the surgical area.

Frenectomy by V-plasty may result in scar forma-tion that could prevent the mesial movement of thecentral incisors (West 1968). However, it is typicallya safe surgical procedure with no notable complica-tions.

Schuchardt Z-plastyThe main advantage of this method over the V-

plasty method was minimal scar tissue formation.The method requires a skilled operator as it is tediousto perform.

_Frenectomy using soft tissue lasers

LASER (Light Amplification by Stimulated Emis-sion of Radiation) is based on Albert Einstein’s the-ory of spontaneous and stimulated emission of ra-diation. It was Maiman in 1960 who gave the firstlaser prototype using ruby crystal. Shortly there-

I 15laser3_2010

Laser Type Wavelength Colour

Excimer laser Argon fluoride (ArF)Xenon chloride (XeCl)

193 nm308 nm

Ultraviolet Ultraviolet

Gas laser Argon Helium-Neon (HeNe)Carbon dioxide (CO2)

488 nm514 nm637 nm

10,600 nm

Blue Blue greenRed Infrared

Diode laser Indium Gallium Arsenide Phosphorus (InGaAsP)Gallium Aluminium Arsenide (GaAlAs)Galium Arsenide (GaAs)Indium Galium Arsenide (InGaAs)

655 nm677–830 nm

840 nm980 nm

Red Red-InfraredInfraredInfrared

Solid state Frequency doubled AlexandritePotassium Titanyl Phosphate (KTP)

337 nm532 nm

Ultraviolet Green

Lasers Neodymium:YAG (Nd:YAG)Holmium:YAG (Ho:YAG)Erbium,Chromium (Er,Cr: YSGG)Erbium:YSGG (Er:YSGG)Erbium:YAG (Er:YAG)

1,064 nm2,100 nm2,780 nm2,790 nm2,940 nm

InfraredInfraredInfraredInfraredInfrared

I research _ frenectomy

Fig. 5_Papillary frenal attachment.

Fig. 6_Horizontal incision made.

Fig. 7_Outline for Z-plasty.

Fig. 8_Sutures placed.

Fig. 11_Papillary penetrating

frenum.

Fig. 12_Diode laser applied.

Fig. 13_Immediate Post-operative

view.

Fig. 14_Post-op 2 days.

Fig. 15_Post-op 1 week.

Fig. 16_Post-op 2 months.

after, in 1961, Snitzer published the prototype for theNd:YAG laser. The first application of a laser to dentaltissue was reported by Goldman et al. and Stern andSognnaes, each article describing the effects of theruby laser on enamel and dentin. Lasers designed forsurgery deliver concentrated and controllable en-ergy to the tissue. For the laser to have effect the en-ergy must be absorbed. The degree of absorption inthe tissue varies as a function of wavelength andcharacteristics of target tissue. As the temperatureincreases at surgical site, the soft tissues are sub-jected to:

_Warming (37 °C to 60 °C)_Welding (60 °C to 65 °C)_Coagulation (65 °C to 90 °C)_Protein denaturisation (90 °C to 100 °C)_Drying (100 °C)_Carbonization (above 100 °C)

_Carbon dioxide laser

The carbon dioxide lasers have a wavelength of10,600 nm. The beam of this laser falls in the infraredrange and is thus invisible. This made the use of CO2

lasers awkward. Thus later on a quartz fiber incorpo-rating a 630 nm coaxial He-Ne laser was used as anaiming beam in the handpiece. The CO2 laser receivedsafety clearance from FDA in 1976 for use in soft tis-sue surgery. With the CO2 laser there is rapid intracel-lular rise of temperature and pressure leading to cel-lular rupture and release of ‘laser plume’ (vapour andcellular debris).

The CO2 laser is readily absorbed by water. Soft tis-sue consists of 75 % to 90 % water, 98 % of the inci-dent energy is converted into heat and absorbed atthe tissue surface with very little scatter or penetra-tion. Thus moist surface is essential for maximal ef-fect. With CO2 laser no contact is made with the tis-sue, and no tactile feedback occurs.

_Neodymium:YAG laser

The Nd:YAG laser has a wavelength of 1,064 nmand lies in the infrared zone like the CO2 laser. TheNd:YAG laser penetrates water upto 60 mm afterwhich it is attenuated 10 % of its original strength.Thus energy is scattered in soft tissue rather than be-ing absorbed onto the surface. The wavelength ofNd:YAG laser is attracted to colours and as a result itsscattering in heavily pigmented soft tissues like skinis almost double its absorption. This heating effect ofthe Nd:YAG laser is ideal for the ablation of poten-tially haemorrhagic abnormal tissue and forhaemostasis of small capillaries and venules. In 1990,the FDA approved soft tissue removal by means of apulsed Nd:YAG laser. In 1997, the FDA approved sul-cular debridement by means of a pulsed Nd:YAG laser.

16 I laser3_2010

Fig. 14

Fig. 5 Fig. 6 Fig. 7 Fig. 8

Fig. 10Fig. 9

Fig. 15 Fig. 16

Fig. 11 Fig. 12 Fig. 13

_Erbium:YAG laser

The Er:YAG laser was introduced in 1974 byZharikov et al. as a solid-state laser that generates alight with a wavelength of 2,940 nm. Of all lasersemitting in the near- and mid-infrared spectralrange, the absorption of the Er:YAG laser in water isthe greatest because its 2,940 nm wavelength coin-cides with the large absorption band for water. Theabsorption coefficient of water of the Er:YAG laser istheoretically 10,000 and 15,000–20,000 times higherthan that of the CO2 and the Nd:YAG lasers, respec-tively. Since the Er:YAG laser is well absorbed by all bi-ological tissues that contain water molecules, thislaser is indicated not only for the treatment of softtissues but also for ablation of hard tissues. The FDAapproved the pulsed Er:YAG laser for hard tissuetreatment such as caries removal and cavity prepara-tion in 1997, unchanged for soft tissue surgery andsulcular debridement in 1999 and for osseous sur-gery in 2004.

_Diode lasers

The diode laser is a solid-state semiconductorlaser that typically uses a combination of Gallium(Ga), Arsenide (Ar), and other elements such as Alu-minum (Al) and Indium (In) to change electrical en-ergy into light energy. The wavelength range is about800–980 nm. The laser is emitted in continuous-wave and gated-pulsed modes, and is usually oper-ated in a contact method using a flexible fiber opticdelivery system. Laser light at 800–980 nm is poorlyabsorbed in water, but highly absorbed in hemoglo-bin and other pigments (ALD 2000). Since the diodebasically does not interact with dental hard tissues,the laser is an excellent soft tissue surgical laser (Ro-manos G, 1999), indicated for cutting and coagulat-ing gingiva and oral mucosa, and for soft tissuecurettage or sulcular debridement.

The FDA approved oral soft tissue surgery in 1995and sulcular debridement in 1998 by means of adiode laser (GaAlAs 810 nm). The diode laser exhibitsthermal effects using the ‘hot-tip’ effect caused byheat accumulation at the end of the fiber, and pro-duces a relatively thick coagulation layer on thetreated surface (ALD 2000). The usage is quite similarto electrocauterization. Tissue penetration of a diodelaser is less than that of the Nd:YAG laser, while therate of heat generation is higher (Rastegar S 1992),resulting in deeper coagulation and more charring onthe surface compared to the Nd:YAG laser. The widthof the coagulation layer was reported to be in excessof 1.0 mm in an incision of bovine oral soft tissue invitro (White JM 2002). The advantages of diode lasersare the smaller size of the units as well as the lowerfinancial costs.

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I research _ frenectomy

_Argon laser

The argon laser uses argon ion gas as an activemedium and is fiber optically delivered in continu-ous wave and gated pulsed modes. This laser hastwo wavelengths, 488 nm (blue) and 514 nm (blue-green), in the spectrum of visible light. The argonlaser is poorly absorbed in water and thereforedoes not interact with dental hard tissues. How-ever, it is well absorbed in pigmented tissues, in-cluding haemoglobin and melanin, and in pig-mented bacteria.

The argon laser was approved by the FDA fororal soft tissue surgery and curing of compositematerials in 1991 and for tooth whitening in 1995.Considering the advantages of eradication of pig-mented bacteria, this laser may be useful for thetreatment of periodontal pockets.

_Alexandrite laser

The Alexandrite laser is a solid-state laser em-ploying a gemstone called Alexandrite, which ischromiumdoped: Beryllium-Aluminum-Oxidechrysoberyl (Cr+3; BeAl2O4) and is one of the fewtrichroic minerals. Rechmann & Henning first re-ported that the frequency-doubled Alexandritelaser (wavelength 337 nm, pulse duration 100 ns,double spikes, q-switched) could remove dentalcalculus in a completely selective mode withoutablating the underlying enamel or cementum.

The development of this laser for clinical use iswidely expected due to its excellent ability for se-lective calculus removal from the tooth or rootsurface without ablating the tooth structure.

_Excimer laser

Excimer lasers are lasers that use a noble-gashalide, which is unstable, to generate radiation, usu-ally in the ultraviolet region of the spectrum.Frentzen et al. demonstrated that the ArF excimerlaser, wavelength 193 nm, could effectively removedental calculus without causing any damage to theunderlying surface. The cementum surface wasclean, and only a slight roughness could be observedafter irradiation, supporting the use of excimerlasers for laser scaling. Folwaczny et al. have re-ported that the 308 nm wavelength XeCl excimerlaser could effectively ablate dental calculus with-out thermal damages or smear layer production.

_Frenectomy procedure using diode lasers

Diode laser (A.R.C. Fox™) with wavelength of810 nm was selected for the procedure. No localanaesthesia was given to the patient. The frenumwas stretched to visualize its extent. The diode laserwas applied in a contact mode with focused beamfor excision of the tissue. The ablated tissue was con-tinuously mopped using wet gauze piece. This takescare of the charred tissue and prevents excessivethermal damage to underlying soft tissue. The tissuewas lased until all the underlying muscle fibers weredissected. No sutures were placed at the end of thisprocedure. Patients were asked to take analgesicsonly if needed.

Advantages of Laser over Conventional tech-nique:_No need of local anaesthesia. Hence it’s a painless

procedure. As a result there is less patient appre-hension.

_Bloodless operative field, thus better visibility._No need of periodontal dressing, therefore no pa-

tient discomfort as a result of irritation from thedressing.

_Better healing and less scarring._Less time consuming.

18 I laser3_2010

Dr M.L.V. Prabhuji MDSDepartment of PeriodonticsKrishnadevaraya College of Dental SciencesHunasamaranhalli, Via YelahankaBangalore, 562157, IndiaE-mail: prabhujimlv@gmail.com

_contact laser

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I user report _ crown lengthening

_The surgical crown lengthening is a proce-dure, which is probably not performed as often asit should be. There are multiple medical indica-tions for this operation. Not only do we need it forexample to modify the red-white aesthetics, butthis operation should be done in many othercases. If a patient has too short clinical crowns,which would give not enough retention forrestorations we should prepare a more suitablesituation by surgical intervention. Especially withceramic-restorations, which need adhesive at-tachment, we often have problems. The prepara-tion margin should be supra- or paragingival. Thisis often not the case, so it is more difficult to havea clean and dry operation area, while attaching therestoration. If we would perform a surgical crownlengthening before preparation, things would be alot easier afterwards. Last but not least we oftenhave to distort the biological width. This will resultin chronically inflamed areas around the restora-tion. If we know that the defect of the tooth is go-ing to force us to damage the biological width, wehave to perform a surgical crown lengthening be-fore starting with the planned treatment. So whyis it, that this operation is performed so rarely? Theanswer is easy to give. The conventional treatment

with scalpel, bone milling cutter, needle andthread is not easy, is bloody and risky and often as-sociated with pain for our patients. In addition, wehave to wait several weeks for the healing processto end, which will retard the actual treatment.Therefore it is obvious, that many dentists and pa-tients will look for a compromise and will risk func-tional and/or aesthetic degradation.

To solve this problem we would need a possibil-ity to perform a surgical crown lengthening fast,save, painless and with shorter healing time. Thisis where it comes to laser dentistry. The right lasers,used in the right way, will serve us all these bene-fits.

The right treatment will now be shown by theauthor in a case presentation. The crown length-ening was done with a combination of an 810 nmdiode laser and an Er,Cr:YSGG laser.

Intentionally we wanted to show a case of theupper jaw front. In those cases we need a highamount of predictability, which is given in the lasersurgery. As well as we can present a nice docu-mentation.

The minimalinvasivelaser surgical crownlengtheningAuthor_Dr Thorsten Kuypers, Germany

20 I laser3_2010

Fig. 2 Fig. 3Fig. 1

_Clinical procedure

The following case report should show theclinical guidelines how to use different wave-lengths in this treatment. It would be possible ofcourse to perform a crown lengthening with justan erbium laser, as it absorbs mostly in water andtherefore works on gingival and on bone. But un-der clinical aspects it is our opinion, that the com-bination of diode an erbium laser is very useful.Because of the gingivectomy with a diode laser—in this case the laser “Q 810” by ARC lasers—theoperation field is not bleeding and shows goodclarity. With good clarity it is no problem to meas-ure the new biological width by ablating the bonewith an erbium laser.

At first it must be ascertained how much tissuewe have to remove and how much space existsfrom the limbus alveolaris to the top of the gin-giva. This is carried out by means of measurementwith a PA probe under anaesthesia. If the meas-urement is concluded, we are able to mark the tis-sue, which is to be removed. This is helpful for thefollowing reshaping of the gingiva (Figs. 1, 2 & 3).Then we can begin with the excision of the soft tis-sue. In this case we used 2.8 watts in the cw mode.In this setting a speedy work is reached under ex-cellent coagulation (Figs. 4 & 5). If the modelationof the gingiva is concluded, we immediately canbegin with the ablation of the bone. If we remove2–2.5 mm of bone, the basis for a new biologicalwidth is created.

The ablation with an erbium laser is carriedwithout thermal damage under good visibility. Inthis case the “Waterlase MD” Cr:YSGG laser with2,780 nm wavelength by the company “Biolase”was used. The Ablation of the bone is possiblewithout a flap, minimum-invasive and withoutthermal damage. These were important factorsfor the patient to decide positive for this inter-vention. The bone-ablation is checked within thetreatment by means of using a PA probe (Fig. 6 & 7).

In this case after the surgical steps were carriedout we did a shaping of the incisors. Veneers areplanned for a nice aesthetical result. But a func-tional pre-treatment is necessary. The final situa-tion directly at the end of the crown lengtheningis nice and already gives an improved aesthetic re-sult (Fig. 8) to the patient. After one week there ishardly something to be seen (Fig. 9). The healingwas without complications; there were no scars,no swelling or pain. Merely during the day of thetreatment, the patient took a painkiller. This waspurely prophylactic on our advising. In the fol-

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I user report _ crown lengthening

lowing no more medication was necessary. Thenormal oral hygiene was taken up again after fourdays. Before that, the area of the crown lengthen-ing should be left out of the brushing procedure.Only oral rinse was used adjuvant in the first daysafter surgery. After two to three weeks the heal-ing is concluded solidly. The patient is contentedand other therapeutic measures—in this case theconstruction of the canine guidance and veneers—can be begun. This approach is only because weare working in the front tooth area. If we are work-ing for example on molars and the aesthetics arenot too important, we can do our further treat-ment after six to ten days.

_Benefits

The advantages for the dentist are obvious. Atime needing, bleeding surgical approach withflaps, stitches and the risk of afterwards appear-ing scars can be avoided. Also a solidly healed re-sult is to be realised in short time. This means thatwe can begin earlier with the next restorativetreatments.

By the non-invasive approach the dentist canachieve an increased compliance for a treatment,which no patient wants to have. We can expandour methods in aesthetic surgery, pre prostheticsurgery and simplify our work. Also the financialbenefits and the positive propaganda offer un-mistakeable advantages. For our patients the ad-vantages are also evident. A bloody, surgical in-tervention of this kind is substantially more pleas-ant by the application of laser light, than in theconventional approach. Also the post surgicalhealing is generally without any complications. A

shorter duration of the surgery and good healingalso gives the opportunity for the patient to havethis procedure done without changing his normaleveryday life. To sum up, one can say that for“laser dentists” possibilities come up which arenot to be reached conventionally. Own therapycan be improved, expanded and one can treat hispatients non-invasive, careful and with good pre-dictability. A classic „win win situation“.

_Summary

There are many Indications for a surgicalcrown lengthening. Even though the indication-list is long, this treatment is not very often done.This is probably, because it is difficult and de-manding to perform and often painful for our Pa-tients. To solve this Problem, we have the oppor-tunity to use lasers instead of the conventionaltechnique. The laser surgical crown lengtheningis done fast, not very difficult and gives a greatamount of safety and comfort to our patients._

22 I laser3_2010

Dr Thorsten Kuypers, MScPrivate PracticeNeusser Straße 60050737 Cologne, GermanyE-mail: info@laserzahnarzt-koeln.de

_contact laser

Fig. 8 Fig. 9

Fig. 5 Fig. 6

Fig. 7

Fig. 4

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AALZ_A4.pdf 07.10.2010 14:56:33 Uhr

Fig. 1_Comparison of different

wavelengths used by lasers and their

penetration depth in water/tissue.

The higher the absorption, the

greater is the ability of the laser to cut

or ablate tissue.

Fig. 2_Laser energy is emitted as a

broad cone providing better coverage

of root canal walls.

Fig. 3_RFT2 (yellow) and RFT3 (blue)

laser tips compared to hand files.

Fig. 4_Master delivery tip delivers

irrigant to the pulp chamber and

evacuates any overflow.

Fig. 5_True negative pressure apical

irrigation and evacuation provided by

macro- and microcannulas.

I user report _ Er,Cr:YSGG

_Total elimination of bacteria from infectedroot canal systems remains the most importantobjective of endodontic therapy. However, in spiteof a plethora of new products and techniques,achieving this objective contin-ues to elude our profession. His-torically, endodontic treatmenthas focused on root canal disin-fection with “entombment” of re-maining bacteria within dentinaltubules and inaccessible areas ofthe root canal system. Althoughmany factors have been impli-cated in the etiology of endodon-tic failures, it has become evidentthat these “entombed” bacteriaplay a pivotal role in the persist-ence of endodontic disease(Siqueira & Rocas 2008).

Although impressive resultshave been obtained in vitro, laserenergy alone has not been able toachieve total bacterial kill in extracted teeth. Froma clinical perspective it is apparent that a combi-nation of different treatment modalities is needed

to sterilize root canal systems. In addition, manyclinical obstacles exist that further complicatesthe clinician’s ability to achieve this goal. These in-clude, but are not limited to: restricted endodon-

tic access, complex root canalanatomy, limitations of irrigationand instrumentation techniques,inability to entomb bacteria andthe inability to reach and elimi-nate bacteria deep within thetooth structure. While the pur-pose of this article is to focus onthe clinical use of the Er,Cr:YSGGlaser with radial-firing tips, a de-finitive treatment protocol needsto be in place to reduce the intra-canal bacterial load prior to laserusage and also to facilitate deliv-ery of the laser energy to the mostcritical part of the root canal, theapical third.

The erbium,chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser emitsat a wavelength of 2,780 nm and is highly absorbedby water. The lower the penetration depth in water

The clinical use of theEr,Cr:YSGG laser inendodontic therapyAuthor_Justin Kolnick, USA

24 I laser3_2010

Fig. 2 Fig. 3Fig. 1

Fig. 4

Fig. 5

user report _ Er,Cr:YSGG I

or tissue (or the higher the absorption), the greateris the ability of the laser to cut or ablate tissue (Fig.1). Since this wavelength is very similar to the ab-sorption maximum of water in hydroxyapatite,photo-ablation occurs where water evaporates in-stantaneously, thereby ablating the surroundingtissue. Gordon et al (2007) found that it was possi-ble to achieve expansion and collapse of in-tratubular water as deep as 1,000 µm or more. Thismicropulse-induced absorption was capable ofproducing acoustic waves strong enough to dis-rupt and kill intratubular bacteria. These findingsare significant as bacteria have been identified atdepths of 1,000 µm (Kouchi et al. 1980), with E. fae-calis at depths of 800 µm (Haapasalo and Orstavik1987). Irrigants such as sodium hypochlorite havea limited effect on these bacteria with penetrationdepths of only 100 µm (Berrutti et al. 1997). In-creasing concentration, exposure time and tem-perature was recently found to improve NaOClpenetration (Zou et al. 2010). Promising bacterialkill rates using the Er,Cr:YSGG laser with radial-fir-ing tips have been reported in extracted teeth. Adisinfection reduction of 99.7% was obtained forE. faecalis at depths of 200 µm into dentin (Gordonet al. 2007) and 94.1% (1 log) at depths of 1,000 µm(Schoop et al. 2007).

The development of the radial-firing laser tip(Biolase Technology, Inc.) with a tip shape thatemits the laser energy as a broad cone, allows bet-ter coverage of the root canal walls than end-fir-ing tips (Fig. 2). This facilitates entry of the emit-ted laser energy into the dentinal tubules reachingbacteria that have penetrated deep into thedentin.

_Treatment protocol

Current techniques incorporating hand and/orrotary instrumentation, positive pressure irriga-tion, with or without sonic and ultrasonic agita-tion, fall short of total canal disinfection. Thetreatment protocol presented in this article incor-porates three main components: management ofthe working width of the root canal, negativepressure apical irrigation and intracanal lasertherapy.

Working width managementThe working width (WW) of a root canal is the

diameter of the canal immediately before reach-ing its apical constriction. Allen (2007) found that97% of canals not cleaned to their WW had resid-ual debris in the critical apical region, while 100 %of those cleaned to their WW were free of debris 1 mm from the apical constriction. Studies haveshown that we need to clean to larger sizes to re-

move bacteria and debris (Kerekes 1977, Wu2000). Conventional tapered files cannot accom-plish this without transporting the canal, creatingstrip perforations, weakening the tooth or sepa-rating instruments. The LightSpeed LSX (DiscusDental) file is a unique, extremely flexible, taper-less, nickel titanium instrument capable of clean-ing to the WW. The final apical size (FAS) is the in-strument size that completes WW preparationand is determined when the LSX file binds 4 mm (ormore) from the working length and requires a firmpush to reach WL. The customized apical prepara-tions created are critical for predictably success-ful endodontics and provide significant advan-tages:_Effective removal of infected material, debris, in-

flamed and necrotic tissue from the apical re-gion.

_Allows placement of irrigating needle to WL fornegative pressure apical irrigation.

_Facilitates placement of intracanal medicationdeeper within the canal.

_Facilitates placement of radial-firing laser tipwithin 1mm of WL.

Negative pressure apical irrigationThere are two main reasons why irrigants fail to

reach the critical last 3 mm of a root canal. Firstly,using positive pressure irrigation with a side-vented needle there is little flushing beyond thedepth of the needle (Chow 1983). Most of the irri-gant follows the path of least resistance and backsout of the canal with apical flushing penetratingonly 1–2 mm apical to the end of the needle. Toachieve effective apical flushing, the needle tipneeds to be placed 1mm from working lengthwhich dramatically increases the risk of a sodiumhypochlorite accident.

Secondly, the presence of apical vapor lock fromair trapped in the canal as well as ammonia and car-bon dioxide released from the dissolving action ofsodium hypochlorite on pulp tissue prevents pene-tration of irrigants into the apical third. This vaporlock cannot be removed with hand or rotary files,sonic or ultrasonic activation. In a recent study, va-por lock resulted in “gross retention of debris andsmear layer remnants” in the apical 0.5–1.0 mm ofclosed root canal systems (Tay et al. 2010).

The EndoVac (Discus Dental) is a true apical neg-ative pressure irrigating system that provides con-tinuous, high volume irrigation of fresh fluids to thecanal terminus with simultaneous evacuation. It iscomprised of a master delivery tip (Fig. 4) that de-livers fluid to the pulp chamber and a macro- andmicrocannula (Fig. 5) that draw the fluid from thechamber to the canal terminus by way of evacua-

I 25laser3_2010

I user report _ Er,Cr:YSGG

Fig. 6_Laser removal of smear layer

in apical third of canal (Biolase

Technology. Unpublished data).

Fig. 7_Single dentinal tubule after

laser ablation (Biolase Technology.

Unpublished data).

Fig. 8_Accessory canal after laser

ablation (Biolase Technology.

Unpublished data).

Fig. 9_Technique for laser tip

positioning in canal.

Fig. 10_Upper premolar treated with

laser protocol.

Fig. 11_Lower molar treated with

laser protocol.

Fig. 12_Lower premolar treated with

laser protocol.

Fig. 13_Lower molar treated with

laser protocol.

tion. This system eliminates vapor lock and providessuperior cleaning, disinfecting and smear layer re-moval while virtually eliminating the threat ofsodium hypochlorite accident (Schoeffel 2008).When compared to positive pressure irrigationwith a ProRinse needle, EndoVac produced canalsthat were 366 % and 671 % cleaner 1 mm and 3 mm respectively from WL (Nielsen & Baumgart-ner 2007).

When EndoVac was used in combination withLightSpeed LSX instrumentation, canals were 99 %and 99.5 % free of debris 1 mm and 3 mm respec-tively from WL (Prashanth & Shivanna 2008).

Intracanal laser therapyThe final stage of root canal preparation and dis-

infection is completed with the Waterlase MD laser(Er,Cr:YSGG) using radial-firing tips (Biolase Tech-nology Inc.).

The laser tips are available in two sizes: RFT2 andRFT3 with diameters of 275 µm and 415 µm respec-tively (Fig. 3). The RFT2 tip is inserted 1 mm short ofWL, requiring canal preparation sizes of ISO 30 ormore while the RFT3 tip is inserted to the junctionof middle and apical thirds, requiring canal sizes ofISO 45 or more. These sizes fall well within typicalworking width preparation sizes prepared with LSXfiles. Intracanal laser therapy is performed in twophases, the Cleaning Phase for smear layer and de-bris removal and the Disinfection Phase for tissueablation and bacterial elimination.

Cleaning phase (1.25 W; 50 Hz; 24 % air; 30 % water):

This phase uses water and removes smear layerand debris without using chemical irrigants. It takes2–3 minutes per canal and uses Hydrophotonics™ tocreate a powerful micro-agitation effect throughoutthe canal system.

It is generally accepted that smear layer removalfacilitates the cleaning and disinfecting of the denti-nal tubules and improves the sealing of the root canal.When merging results of two studies, the Er,Cr:YSGGwith radial-firing tips produced significantly bettersmear layer removal in the apical, middle and coronalthirds than two rotary techniques (Sung et al. 2007,Peters & Barbakow 2000). This extremely efficient ac-tion opens the dentinal tubules, lateral canals andisthmuses in preparation for disinfection (Fig. 6, 7 & 8).

Technique for cleaning phase: after completion ofaccess, working width preparation and negative-pressure irrigation:

_Use the RFT2 to perform apical and partial coronal2/3 cleaning.

_Select the recommended laser settings in the wetmode.

_Fill canal with sterile solution._Insert RFT2 tip 1 mm short of working length (WL)._Activate laser on withdrawal of tip coronally at ap-

proximately 1 mm/s. Maintain tip in contact withthe side surface of the canal wall during the entireapical to coronal pass.

_Repeat steps 4 and 5 one or two more times to en-sure that the entire inner canal has been cleaned(Fig. 9).

_Place the RFT3 tip in handpiece to perform final

26 I laser3_2010

Fig. 9

Fig. 6 Fig. 7 Fig. 8

Fig. 10 Fig. 11 Fig. 12 Fig. 13

user report _ Er,Cr:YSGG I

cleaning of the coronal 2/3._Fill canal with sterile solution._Insert the tip to the junction of apical and middle

third of the root canal._Repeat steps 5 and 6.

Disinfection phase (.75 W; 20 Hz; 10% air; 0% water)As stated previously, the laser energy emitted

from the Er,Cr:YSGG laser is highly absorbed by waterin tissue and micro-organisms resulting in instanta-neous photo-ablation. In addition, the resulting mi-cro-pulse expansion and collapse of intratubular wa-ter produce acoustic waves strong enough to disruptand kill intratubular bacteria.

This effect is most effective in a dry mode as thelaser energy is not absorbed by the water spray andcan exert its full effect on the bacteria. This was con-firmed by Gordon et al (2007) who achieved a 99.7%kill rate for E. faecalis in the dry mode. Technique forthe disinfection phase is the same as the cleaningphase but with different laser settings in the drymode.

_Clinical applications

While this protocol is recommended for all en-dodontic treatments (Fig. 10, 11 12 & 13), it is mostvaluable in the following clinical situations:

_Infected cases with apical, lateral and/or furcal ra-diolucencies.

_Retreatments with periapical periodontitis._Acutely inflamed cases, especially those diagnosed

with Cracked Tooth Syndrome._Internal and external resorption._Persistent infections not responding to conven-

tional endodontic treatment._Unexplained, prolonged post-operative discomfort.

_Summary

A root canal cleaning, shaping and disinfectionprotocol has been described that maximizes the re-moval of tissue, debris, smear layer and bacteria fromroot canal systems. Utilizing a combination of work-ing width management with LightSpeed LSX instru-ments, high volume apical negative pressure irriga-tion and evacuation with the EndoVac system and in-tracanal laser therapy with radial-firing tips using theWaterlaseMD laser, the ability to totally eliminatebacteria from infected root canal systems may soonbe within our grasp._

_Bibliography

Allen F: In vivo study of apical cleaning. General Dentistry449–456 (2007).

Berutti E, Marini R, Angeretti A: Penetration ability of different ir-rigants into dentinal tubules. J Endod 23:725–727 (1997).Chow TW: Mechanical effectiveness of root canal irrigation. JEndod 9:11:475–478 (1983).Gordon W, Atabakhsh VA, Meza F, Doms A, Nissan R, Rizoiu I,Stevens R: The antimicrobial efficacy of the erbium,chromium:yt-trium-scandium-gallium-garnet laser with radial emitting tips onroot canal dentin walls infected with Enterococcus faecalis. JADA138:7:992–1002 (2007). Haapasalo M, Orstavik D: In vitro infection and disinfection ofdentinal tubules. J Dent Res 66:8:1375–9 (1987).Kerekes K, Tronstad L: Morphometric observations on rootcanals of human molars. J Endod 3: 114–8 (1977).Kouchi Y, Ninomiya J, Yasuda H, Fukui K, Moriyama T, OkamotoH: Location of streptococcus mutans in the dentinal tubules ofopen infected root canals. J Dent Res 59:2038–2046 (1980). Nielsen BA, Baumgartner JC: Comparison of the EndoVac Sys-tem to Needle Irrigation of Root Canals. J Endod 33:5:611–615(2007).Peters O, Barbakow F: Effects of Irrigation on Debris and SmearLayer on Canal Walls: A Scanning Electron Microscopic Study. JEndod 26:1:6–10 (2000).Prashanth, Shivanna V: Evaluation of New System for Root CanalIrrigation to Conventional: An Ex Vivo Study. Discus Dental, Cul-ver City, CA: The EndoFiles Newsletter (2008).Schoeffel J: The EndoVac Method of Endodontic Irrigation, Part2– Efficacy. Dentistry Today 27:1 (2008).Schoop U, Barylyak A, Goharkhay K, Beer F, Wernisch J, Geor-gopoulos A, Sperr W, Moritz A: The impact of anerbium,chromium:yttrium-scandium-gallium-garnet laser withradial-firing tips on endodontic treatment. Lasers Med Sci24:1:59–65 (2007).Siqueira JF, Rocas IN: Clinical Implications and Microbiology ofBacterial Persistence after Treatment Procedures. J Endod34:11: 1291–1301 (2008).Sung E, Rankin DD, Rizoiu I, Chueh P: Biolase Technology, un-published study (2008). Tay FR, Gu L, Schoeffel GL, Wimmer C, Susin L, Zhang K, ArunSN, Kim J, Looney JW, Pashley DJ: Effect of Vapor Lock on RootCanal Debridement by using a Side-vented Needle for Positive-pressure Irrigant Delivery. J Endod 36:4:745–750 (2010).Wu MK, R’oris A, Barkis D, Wesselink P: Prevalence and extentof long oval canals in the apical third. Oral Surgery, Oral Medi-cine, Oral Pathology 89:6:739–743 (2000). Zou L, Shen Y, Li W, Haapasalo M: Penetration of SodiumHypochlorite into Dentin. J Endod 36:5:793–796 (2010).

I 27laser3_2010

Justin Kolnick DDS 222 Westchester Avenue, Suite 402, White Plains, NY 10604, USATel.: + 1 914 946 2218Fax: + 1 914 946 2232E-mail: info@westchesterendo.com

_contact laser

I user report _ periodontal surgery

_Abstract

Objectives: This case report describes the appli-cation of an Er,C;YSGG laser in regenerative peri-odontal surgical therapy.

Materials and methods: A patient with extensiveperiodontal tissue breakdown is treated with anEr,Cr:YSGG laser for granulation tissue removal,bone decorticalization and root decontamination.In the regenerative procedure demineralised bovinebone mineral and collagen membranes were used.Following clinical parameters were recorded atbaseline, at 3 months, 6 months, 1year, and at 2 yearsand 5 years: Plaque Index (PI), Bleeding On Probing(BOP), Periodontal Pocket Probing Depth (PPD), Re-cession (REC), Clinical Attachment Level (CAL).

Results: The operated sites demonstrated un-eventful healing. Radiographically remineralisationwas observed at six months. At one year follow up,significant periodontal pocket reductions and clin-ical attachment level gains were registered.

Conclusion: In this case reports it may be ac-knowledged that the Er,Cr:YSGG laser could be ap-plied for debridement and decontamination of boththe root and the bone defect in guided tissue regen-eration procedures. Further investigation is neededto identify in which treatment protocol in periodon-tology the Er,Cr:YSGG laser can be integrated andwith what benefits.

_Background

The application of laser in periodontology iswidely discussed especially as the several laser sys-tems with their specific wavelength have a differentimpact on periodontal tissues. Excellent knowledgeof laser applications is essential, which requires theoperator to go through a learning curve to avoid ad-verse effects. During laser irradiation the power set-tings play a significant role and must be regulatedappropriately in order to avoid detrimental effectsto the irradiated tissues (Ishikawa I. 2002). Peri-odontal tissue destruction is treated according tothe type of defect and the location, posterior or an-

Er,Cr:YSGG laser assisted GTR in periodontal surgeryAuthor_Dr Elena Speranza Moll, Italy

28 I laser3_2010

Fig. 2 Fig. 3Fig. 1

terior, in the mouth. Regenerative therapy is indi-cated in case of intraosseous defects of which theradiographic angle and number of walls determinewhich kind of procedure needs to be applied andwhich kind of materials need to be used. The diffi-culty of guided tissue regeneration and other treat-ments of the periodontium lies in the fact that weare dealing with roots, which have an avascular sur-face in which, both the multiple specialized celltypesand the microbial environment are involved in allhealing processes.

_Materials and methods

The Er,Cr:YSGG laser (Biolase Inc. San Clemente,CA) with a 2,780 nm wavelength, in the far-in-

frared spectrum, is a class 4 laser, witha pulse repetition rate of 10 Hz to 50 Hzand power output from 0.25 to 8 Watt,and pulse energy of 300 mJ. The flexibleoptical trunk fibre is connected to astraight or angled hand piece. The laserbeam is accompanied by a water and airspray. The water/air spray represents ahydrating and cooling agent reducingthermal effects. Both Air and Water set-tings can be modified from 0-100 %.Radiation of the Er,Cr:YSGG laser is ab-sorbed mainly by water and calcium hy-

droxyapatite. With a pulse duration of 90 or 150µsec the Er,Cr:YSGG laser has a high ablation effi-ciency and low thermal impact on the surroundingtissues (Straßl, 2004) ”Comparison of the emissioncharacteristics of three Erbium laser systems—aphysicals case report.” (JOLA 2004).

A 44 year, female, with incidental, severe adultperiodontitis (Vd Velden U., 2005). As far as medicalconditions and life style concerned: the patient wasnegative for tobacco but she suffered from severeII grade obesity (BMI 35–39.9) and stress. Familyhistory resulted positive for periodontitis. Intra-oral exams (Fig.1) demonstrated the central upperleft incisor with extensive bone-loss on the distal,resulting in a black triangle at the soft tissue out-

user report _ periodontal surgery I

I 29laser3_2010

Fig. 10 Fig. 11 Fig. 12

Fig. 4 Fig. 5 Fig. 6 Fig. 7

Fig. 8 Fig. 9

I user report _ periodontal surgery

line. Second grade mobility, probably due to occlusaltrauma was evident. Periodontal pocket probingdepths were buccal 7 mm (Fig. 2), distal 9 mm (Fig. 3),mesial 3 mm and lingual 3 mm.

The plaque index (PI) and bleeding on probing(BOP) < 15 % and the patient demonstrated highstandards of oral hygiene. Radiographic exams (Fig.4) showed a vital tooth with a normal root length.A wide angled non supportive bone defect waspresent at the distal side of the root.

Follow up was monitored with radiographs, withBOP- and PI-indexes and PPD, REC, CAL were regis-tered. The occlusion was corrected by eliminationof the pre-contact, no splint was placed.

After infiltration anaesthetics, the soft tissue in-cisions are made with a by Takei in 1995 proposedpapilla preserve technique reflecting the lingualpapilla to the buccal. The laser’s angled handpiecemounts a chisel shaped tip, with which in contactmode the flapdesign is made. Laser power settingson 2.0 Watt, 30 % Air, 10 % Water, and 30 Hz.

Granulation tissues were removed (Fig. 5) withlaser power settings on 2,5 Watt, 40 % Air, 20 % Wa-ter, and 25 Hz. Root-conditioning (Fig. 6) is per-formed holding the tip in a 1,5–2 mm distance fromthe root, in overlapping vertical and horizontalstrokes, until the root-surface has a whitish etchedaspect, with laser settings 1,5 Watt, 30 % Air, 20 %Water, and 20 Hz. The wide non-sustaining defect(Fig.7) was filled with the demineralised bovinebone mineral (Fig.8) to avoid collapse of the soft tis-sue into the defect. The bone substitute (Bio-Oss,Geistlich Biomaterials) was then covered with a re-sorbable collagen membrane (Bio-Gide, GeistlichBiomaterials) to avoid fibroblast in-growth. Afterreleasing the buccal flap, the papilla is repositionedand sutures are placed and the wound is perfectlyclosed without tension. Patient received post-op-erative instructions.

_Results

Initial healing was uneventful although thetooth demonstrated I-grade mobility, which dimin-ished in the first three months to zero. After twoweeks sutures were removed and oral hygiene wasresumed with brushing carefully the operated site.At six months remineralisation of the defect was ev-ident on radiographic exam (Fig. 9). At one year sig-nificant CAL gains have been found, both on thebuccal as on the distal. To further close the black tri-angle a composite filling was made on the mesialside of tooth 22 (Fig.10). The PPD on the buccal wentfrom 7 mm at baseline to 2 mm and had a CAL-gainof 6 mm which remained stable (Fig.11). The PPD onthe distal went from 9 mm to 4 mm in the first 12months (Fig.12). and measured at 60 months 3 mm(Fig.13), with a final CAL-gain of 9 mm Radiographicfollow-up showed regular alve olar bone outlinewith lamina dura at 60 months (Fig.14).

_Discussion

According to evidence based therapy, a combina-tion of barrier membranes and bone substitutes, is astandardized approach to treat wide non supportivebone defects (Camelo M. 1998). To be able to intro-duce the laser treatment in regenerative periodontalsurgery, for debriding and decontaminating thebone defect , it needs to be taken in considerationthat much knowledge in laser-dentistry is still expe-rience based and widely discussed. Especially be-cause there are many kinds of wavelengths, as wellas very little evidence based research (Ishikawa I.2008). In periodontal regenerative surgery the con-ditioning of rootsurfaces appropriately, is likely to beimportant for enhancing predictability of regenera-tive therapies (AAP, 2005). The introduction of theEr,Cr laser to debride the defect and decontaminate

30 I laser3_2010

Fig. 13 Fig. 14

mesial baseline 12 mnts 24 mnts 60 mnts

PPD 3 mm 3 mm 4 mm 3mm

REC 0 mm 1 mm 0 mm 1 mm

CAL 3 mm 4 mm 4 mm 4 mm

buccal baseline 12 mnts 24 mnts 60 mnts

PPD 7 mm 2 mm 2 mm 2 mm

REC 3 mm 2 mm 2 mm 2 mm

CAL 10 mm 4 mm 4 mm 4 mm

Tab. 1

Tab. 2

the root is based on several findings. It is reportedthat this laser is suitable for the disinfection of eventhe deeper layers of dentin, because of its bacterici-dal effect (Schoop U. 2004). With the appropriatesettings, an Er,Cr:YSGG laser is capable of perform-ing scaling and root planing to remove calculus, andbecause of its short pulse, it may be especially suit-able for the micro-morphology of the root surface(Hakki SS. 2010). Due to high absorption in water oflaser energy, an effective ablation with a very thinsurface interaction occurs on the irradiated tissues,and without any major thermal damage to the irra-diated and surrounding tissues (Straßl M. 2004,Wang X. 2005). To avoid smearlayer caused by hand-instruments or detrimental effects of chemical root-conditioning (Blomlof J. & Lindskog S.1995), the Er,Crlaser is used to clean and etch the exposed rootsur-face. Furthermore the Er-wavelength seems to givecomparable results to ultra sonic devices (Crespi R.2007), without leaving a smearlayer however.

The AAP consensus statement declared, that re-search should be focused on identifying factors thatcan detoxify roots and also influence appropriate cellattachment (AAP 2005). Regeneration of periodontaltissues is reported in studies, where laser’s deconta-minative capacity created right circumstances for fi-broblast attachment on root-surfaces (Feist IS. 2003),and in case reports this might have induced to clini-cal improvements in periodontal healing (Schwarz F.2003). Er-laserwavelenght is capable to ablate peri-odontopathic bacteria with thermal vaporization,and its bacteriacidal effect on the diseased root sur-faces appears to be superior to that of the ultrasonicscaler (Akiyama F. 2010). Furtheremore, the Er,Cr laserirradiation to perforate the alveolar bone of the de-fect to release blood, containing growth factors,could be advantageous for wound healing of bonetissues as comparative studies on bone healing sug-gested (Pourzarandian A. 2004). The application of Er-wavelenght seem to be slightly more effective whenplateled derived growth factors are involved for re-generation purposes and therefore a promisingtreatment alternative (Belal M.H. 2007).

_Clinical relevance statement & conclusions

The application of an Er,Cr:YSGG laser with2,780nm wavelength, which substitutes the scalpelblade, root conditioning agents and hand- or ultra-sonic instruments, demonstrate the possibility to in-tegrate laser treatment successfully in various stagesof advanced periodontal therapy. Clinically theEr,Cr:YSGG laser seems to contribute with its decon-taminative capacities to create ideal circumstancesfor regenerative procedures which resulted in signif-icant CAL-gain in this case report.

Randomized controlled clinical trials and more ba-sic studies have to be encouraged and performed toconfirm the status of Er,Cr:YSGG laser treatment asan adjunct in traditional periodontal surgical therapy.

_About the author

Dr Elena Speranza Moll graduated in Dentistry atthe University of Amsterdam, The Netherlands. She es-tablished herself opening her office in the outskirts ofFlorence in Italy. She specialized mainly in Periodontol-ogy and Implantology. In 2003 she completed the post-graduate course on Laser Dentistry at the University ofFlorence. In 2004 on Laser Oral Surgery held by the L’Istituto Nazionale Tumori in Milan. She is since 1995member of the SIdP, Italian Society of Periodontologyand since 2003 of the International Society for OralLaser Applications. She has participated to mod I and IIof the Academy of Oral Laser Applications based in Vienna. She has lectured in national and internationalcongresses and has given courses on the integration oflaser techniques in evidence based treatment ap-proaches in advanced periodontal and basic implan-tology treatments._

Editorial note: The literature list can be requestedfrom the editorial office.

user report _ periodontal surgery I

I 31laser3_2010

Dr Elena Speranza MollPrivate practiceVia Amilcare Ponchielli, 21 B50018 Scandicci FIItalyE-mail: esmoll@tiscali.it

odontoatria-laser@libero.itTel.: +39 055 755347 / +39 335 625-0092

_contact laser

distal baseline 12 mnts 24 mnts 60 mnts

PPD 9 mm 4 mm 3 mm 3 mm

REC 4 mm 2 mm 2 mm 1 mm

CAL 13 mm 6 mm 5 mm 4 mm

mesial baseline 12 mnts 24 mnts 60 mnts

PPD 5 mm 2 mm 2 mm 2 mm

REC 2 mm 3 mm 3 mm 3 mm

CAL 7 mm 5 mm 5 mm 5 mm

Tab. 3

Tab. 4

I laser _ interview

_The World Federation of Laser Dentistry(WFLD) recently elected a new president. ProfJean-Paul Rocca will take over the position fromProf Norbert Gutknecht, who has served a two yearsmandate. Our Editorial Office spoke with Prof Roccaabout what he would like to achieve during his term.

Prof Rocca, you were elected as President ofthe WFLD. Could you tell us some on your per-son?

I consider myself as a discreetperson and your question is awk-ward. I’m a full time professor in theNice Sophia Antipolis Universityand university hospital. I have beenthe Dean of this Faculty and I’m ac-tually in charge of clinical researchunit. I passed two PhD (a long timeago): one in endodontics and one inhuman biology (bacteriology). I’malso the director for the EuropeanMaster degree in Oral Laser Appli-cations in Nice and a laboratory so-called laser technology and oral ap-plications. I love my children, I likesmiling and I’m crazy about classical music. Is it OK?

WFLD is a well-known scientific society. Asnew President, what will be your role?

WFLD is the first scientific society in the field oforal laser applications. WFLD being a federation ofscientific associations my role, as you say, consistsfirst of all to entertain good relationship with thosenational scientific associations and enhance theirnumber as WFLD partners. Moreover individualmembers are welcomed; they join our society be-cause they know perfectly that they will get the op-portunity to hear at international opinion leaders’

experience in the field of oral lasers’ applicationsand subsequently to improve standards on thistechnology. I observed, with a non masked satis-faction, that this number is increasing year afteryear.

The second role consists in opening our societyto an increasing number of young clinicians andsearchers. As you can imagine, future successes inoral laser medicine and surgery depends on ex-

changes, advancement and dis-semination of basic and clinicalresearch. Subsequently, we have aduty: they have to be consideredas our future and they are the keyfor new progresses.

The third role consists in devel-oping our five divisions (NorthAmerica, South America, Middle-East-Africa, Asian-Pacific and Eu-rope).

Do you think WFLD can pre-tend to manage a leadership all

over the world?This question is surprising but the answer could

be very short: yes!

I saw in your eyes that “yes” was not sufficientand I will explain why and how.

Once again dissemination pass threw meetings,communications and therefore exchanges. Divi-sions were created five years ago by Prof. Nam-mour and it’s a nice surprise to see their activitiesare growing up in a significant mode and covereach two years the whole continents.

“A man alone cannotdo anything”Author_Kristin Urban, Germany

32 I laser3_2010

laser _ interview I

Divisions’ activities are not in competition withNational activities. National scientific associationsare also acting seriously and many WFLD membersare involved in those diligences too.

Moreover publications serve this objective. I ob-serve that a lot of WFLD members publish highlevel scientific publications in referenced journals.Lasers in Medical Science and your journal, laser—International Magazine of Laser Dentistry are offi-cial journals of our society. One is dedicated to ba-sic research and the second one to clinical obser-vations. Thanks to Prof Gutknecht who was and isso much involved in that great mission. So, yes:WFLD can pretend!

How WFLD could play a role in scientific dis-semination?

I think I answered clearly previously. Generalmeetings, Division meetings, National scientificassociations activities affiliated with WFLD, publi-cations aim at this objective.

With whom do you collaborate? Is the Pres-ident a powerful person working alone?

I’m convinced, since a very long period, that aman alone cannot do anything. A team representsa laboratory producing ideas to be discussed andeventually adopted.

WFLD is composed of an executive committee(ExCo) of ten persons. The executive board includesan immediate past-president (Norbert Gutknecht),the president, the president elect (Aldo Brugnera),the secretary (Kenji Yoshida), the treasurer (CarloFornaini) and a colleague in charge of the websiteand newsletter (Mathias Frentzen). Members arerepresented by the chairpersons of the five divi-sions (Carlos de Paula Eduardo, Loh Hong Saï, ToniZeinoun, Georgios Romanos, Adam Stabholz). Thatmeans ten persons, nine countries represented.Since March 2010 were joined two co-chairper-sons (Norbert Gutknecht and Samir Nammour):their mission consists in controlling the legal com-portment of our society.

In those conditions, do you still think the Presi-dent works alone?

So, you consider WFLD to be a democratic as-sociation?

Once again the answer is: yes, without anydoubt.

Democracy is strictly observed. The ExCo iselected (general assembly) for a two years longmandate. Re-election of the President is possiblebut I observe that the tradition is a two years long

mandate. I agree with that kind of attitude. Democ-racy, respecting this turn-over of responsibilities,must be respected even if it’s true that a two yearslong mandate is a very short one. In fact, efficacy isnot disturbed due to the role of the past-presidentacting as a counsellor, if needed. Moreover, re-sponsibilities are moving on also in the five divi-sions.

Finally, all continents are involved in the deci-sions and in WFLD Divisions all countries of eachcontinents are, mandate after mandate, repre-sented.

You told that WFLD is a non-profit associa-tion. But members have to pay fees. Is there anycontradiction?

Of course, no!!!! Annual fees in WFLD are verylow: 20 euros for students, 80 euros for members,150 euros for members with the journal, 250 eurosfor national associations and it’s more than fouryears we did not ask for increasing amounts!

There are no contradictions in paying dues, eachyear, and a non-profit scientific society!! Expensesdo exist and may I tell you that a financial report isproduced and submitted for approval by the ExCoand by members during the general assembly. Inany case, if a President forget to present this report,the two legal co-chairmen would, at once, inter-fere.

What are your next meetings?May I first congratulate the persons in charge of

the last meeting, held in Dubai on March 2010. TheChairman of the congress: Toni Zeinoun as well asSamir Nammour in charge of the excellent scien-tific programme and Norbert Gutknecht acting asWFLD President.

The future is composed of a general meeting tobe held in Barcelona (2012). Next year the ExCo willpropose for 2014 (at the moment we have two can-didates but it’s a secret!!!). Moreover don’t forgetthat we have our five Division meetings each un-even year. You are invited to look at our website(www.wfld.org) and you will get details.

Do you have a wish?I hope, WFLD to continue on that way: to stim-

ulate the research and coordinate clinical studies.

Due to the fact I’m neither a magician nor a fakir,acting close with the WFLD team, I hope to be ableto demonstrate my personal engagement andserve efficiently this scientific association.

Prof Rocca, thank you very much.

I 33laser3_2010

I social news _ ILSD

_The Opening of the ILSD/AALZ EducationalCenter in Akersberga outside Stockholm, Sweden,represents a breakthrough for the development ofLasers in Dentistry in this northern area of Europe.

The co-operation between the world leading ed-ucational Institute in this field, AALZ, the AachenDental Laser Center at RWTH Aachen University, andILSD, The Institute for Laser Supported Dentistry,Sweden, underline the need of an international net-work for evidence based knowledge. After a timewhen the first boom of lasers in Swedish Dental Clin-ics had declined due to the absence of qualified edu-cation, dentists in the Nordic Countries can now re-ceive University level education in a wide range of in-dividually designed courses.

Nordic dentists with non or little experience fromlasers are now implementing new treatment proto-

cols in there daily practice. Diagnostics, cariology,periodontology, endodontics, surgery, pediatrics aresome of the specialities in dentistry where patientsand operator experience obvious benefits from thisknowledge.In workshops at ILSD the dental staff aretrained in different wavelengths and parameters foreach specific indication. Live-demonstrations trans-ferred via intranet along with instructive videos/fotodocumentation, accompanies the scientificallybased lecture material.

In addition, the first days in sunny June 2010 thefirst workshop ”Lasers in Periodontics” for Dental Hy-gienists was carried out. This group of dental carespecialists responded very well and a new era in Pro-phylactics for Hygienists may be born.

To ensure a remained high quality, DDS, MSc Pe-ter Fahlstedt at ILSD Sweden is, together with other

2010—A breakthrough for Laser Supported Dentistryin SwedenAuthor_Dr Peter Fahlstedt, Sweden

34 I laser3_2010

social news _ ILSD I

international co-workers of AALZ, continually up-dated at RWTH University by the Scientific leaderProfessor Norbert Gutknecht. New research resultsare penetrated and if accepted taking the place of”out to date” material in the lectures. One of the maingoals for ILSD is to encourage and support differentnational research projects, constituting a referencefor needed objective facts. A number of projects areinitiated and will hopefully contribute to higherknowledge and acceptance of laser as a primarychoice of safe, precise and predictable treatmentmethods when discomfort, infections and inflam-mations are unwanted.

In January 6–9, 2011, the second internationalScandinavian Mastership Course will starting upwith participants traveling from around the globe.The leading lecture team from AALZ will during fourdays perform the first part of this one-year-certifi-

cation course in this english spoken practical Fellow-ship Course. We welcome international dentists toparticipate in order to build up a long lasting worldwide network of well educated dentists in Laser Sup-ported Dentistry.

For extensive information, please go into ourweb-site: www.ilsd.se_

I 35laser3_2010

ILSD/AALZ Educational Center SwedenDr Peter Fahlstedt

Co-operator AnnCharlotte FahlstedtE-mail: peter.fahlstedt@ilsd.se or annchas.fahlstedt@ilsd.se

_contact laser

I social news _ AALZ Greece

_Laser assisted dentistry is already a reality fordentists worldwide. The possibilities for successfultreatments using a laser as stand alone or supple-mentary to conventional techniques equipment areincreased. Simultaneously the dentists realize thatapart from a modern tool for every day practice, laseris a technology that involves a biophysical back-ground and scientific knowledge that is not providedby the standard academic studies in dentistry.

AALZ has been since 1991 the leader in this field. Incooperation with the Clinic for Conservative Den-tistry, Periodontology and Preventive Dentistry at theUniversity of Excellence RWTH Aachen, the AachenDental Laser (AALZ) has created the first dental lasereducation institute in Germany. Known for its re-search in laser-assisted dentistry, it cooperates na-tionally and internationally with major research facil-ities. Recognized from dentists globally for its educa-tion system AALZ had already been the obvious choicefor the Greek dentist who wants to keep up with fu-ture-oriented dental surgery.

AALZ Greece was founded in Greece for that rea-son and the Greek dental community welcomed ithighly. The local scientific co-Workers of AALZ incharge are Dr Antonis Kallis MSc and Dr DimitrisStrakas MSc. The training courses that are offered byAALZ Greece are:

_Laser Safety Officer Course

One-day course with official certification as aLaser Safety Officer (LSO). The innovative treatmentmethods of laser therapy include risks for both practi-tioners and their teams as well as for patients if funda-mental technical, biological and physical informationabout the application and laser safety measures are notor insufficiently known. Dentists will be prepared forsafely using lasers by giving them an in-depth under-standing of laser physics and laser-tissue interaction.After completing succesfully the examination they willreceive the “Laser Safety Officer” certificate. Our lasersafety courses meet the requirements of the trade as-sociations for obtaining expertise as a Laser Safety Of-

AALZ Greece successfully establishedAuthors_Dimitris Strakas, Greece, Dominique Vanweersch, Germany

36 I laser3_2010

social news _ AALZ Greece I

ficer. They are officially recognized according to theguidelines of BGV B2 (orientated to EN 60825-1 andANSI Z136.1) and State Radiation Protection Office.

_ “Introduction to Laser Dentistry”Course

Over the course of three hours, we inform you neu-trally and objectively about how the various laser sys-tems work and are applied. Using practical demonstra-tions, we show the effect that different laser systemshave on various types of tissue. A therapeutic overviewof the individual wavelengths aims to help participantsto decide on the appropriate system for their treatmentemphasis.

_Workshops on specific wavelengths

Dentists gain in an one-day clinical workshop on aspecific wavelength an official certificate from theRWTH Aachen University Hospital. Lasers function withdiverse wavelengths that have distinctive effects ontissue. Depending on the tissue to be treated, there arespecific types of lasers for optimal use in the diversefields of application. Each wavelength-specific work-shop gives you scientific-based knowledge on possibletreatments using the appropriate laser:Solid-state lasers: Nd:YAG, Er:YAG, Er,Cr:YSGG Gas laser: CO2

Diode lasers: 655 nm, 810 nm, 940 nm, 980 nm

_Mastership Course „Lasers in Dentistry“

“One-year clinical specialization course for selectedwavelengths”—This offer is geared towards dentistswho would like to specialize in certain wavelengths. Inthis one-year certification course participants aretaught to fundamental physical and technical knowl-edge and how to recognize primary, secondary, and ter-tiary indications on ten attendance days split into mod-ules. After successful completion of the course, partic-ipants acquire a certificate from RWTH Aachen Uni -versity, identifying them as a “Lasers in Dentistry"

specialist. On January 30, 2010, the first LSO Coursetook place in Athens. The first ten participants from allover Greece had a long but fruitful day of laser safetylectures and of course the normal anxiety of the writ-ten exam at the end of the day. After successfully com-pleting the multiple choice test the participants re-ceived their Laser Safety Officer certificates from RWTHAachen University.

On June 18, the second LSO Course, organized byAALZ Greece took place in Loutraki, Athens, with 13participants. In the venue facilities of a five-star Hotel,the participants received the fundamental knowledgeon laser physics and laser safety in order to successfullyanswer the test on the end of the day.

_Upcoming Events and Courses

AALZ Greece has already planned the following activities:_Exhibitor on the Panhellenic Congress in Athens

22–24 October 2010_Laser Safety Officer Course—15 November 2010 _One-year Mastership Course. Module 1 starting date

—15,16 November 2010 _Workshop on diode lasers—January 2011

AALZ Greece is a pioneer in laser education inGreece. It is another corner of the world in which AALZprovides recognized and accredited training andhelps you meet your goal of becoming a laser special-ist. _

I 37laser3_2010

Dr Antonis KallisDr Dimitris StrakasTel.: +30 21 06251577 Fax: +30 21 06254856E-mail: aalzgreece@gmail.com Website: www.aalz.gr

_contact laser

38

I meetings _ events

2010

19th Annual Scientific Meeting of EAOWhere: Glasgow, ScotlandDate: 06–09 October 2010Website: www.eao.org

13th Congress of APALMSWhere: Nagano, JapanDate: 08 & 09 October 2010E-mail: asagai@shinano-iryo.or.jp

Annual Congress of DGLWhere: Berlin, GermanyDate: 29 & 30 October 2010Website: www.dgl-online.de

LASER START UP 2010Where: Berlin, GermanyDate: 29 & 30 October 2010Website: www.startup-laser.de

International Laser Dentistry SymposiumWhere: Sydney, AustraliaDate: 1 & 2 November 2010Website: www.wfld-org.info

Start Mastership Course „Lasers in Dentistry“Greece Where: Athens, GreeceDate: 15 & 16 November 2010Websites: www.aalz.gr, www.aalz.de

Greater New York Dental MeetingWhere: New York, NY, USADate: 26 November–1 December 2010Website: www.gnydm.org

2011

Start Mastership Course „Lasers in Dentistry“Scandinavia—Batch 2 Where: Akersberga/Stockholm, SwedenDate: 07–10 January, 2011Websites: www.ilsd.se, www.aalz.de

34th International Dental ShowWhere: Cologne, GermanyDate: 22–26 March 2011E-mail: ids@koelnmesse.deWebsite: www.ids-cologne.de

3rd European Congress World Federation forLaser Dentistry (WFLD)Where: Rome, ItalyDate: 10 & 11 June 2011Website: www.wfld-org.info

2012

LaserOptics BerlinWhere: Berlin, GermanyDate: 19–21 March 2012Website: www.laser-optics-berlin.de

International events

laser3_2010

Anschnitt DIN A4 16.11.2009 9:33 Uhr Seite 1

Fig. 1_President of WFLD,

Prof Dr Norbert Gutknecht.

Fig. 2_Organizing Chairman,

Prof Toni Zeinoun.

I meetings _ WFLD

_The annual meeting and the activities of theWFLD Executive Committee was held in Dubai from 7 to 8 March 2010 two days a head of the Dubai Con-gress. The agenda was then discussed; important deci-sions were made and prepared to be presented to thegeneral assembly in the closing ceremony. The report ofthe Executive Committee will be presented in the Gen-

eral Assembly by the General Secretary of the WFLDProfessor Aldo Brugnera.

The WFLD congress in Dubai was characterized bythe participation of 144 speakers and researchers com-ing from 27 countries discussing for three days all thescientific issues in two halls: WFLD I and WFLD II. In ad-dition to that, a poster session was organized with theparticipation of 80 poster presenters. Many dental fac-ulties from Europe and South America were exposingtheir researches and developments in the laser field.This congress was held with the conjunction of theAEEDC Congress in Dubai in the Convention and Exhi-bition Center.

On the 9th of March, the congress started at 8:30with an opening ceremony. The chairman of the Or-ganizing Committee as well of the Middle East andAfrica division, Professor Toni Zeinoun inaugurated theCongress by thanking all the speakers and the WFLD Di-visions for their involvement in the Dubai Congress.

XIIth International Congressof the WFLD in DubaiAuthor_Prof Toni Zeinoun, Lebanon

40 I laser3_2010

Fig. 2Fig. 1

meetings _ WFLD I

Professor Zeinoun specifically thanked PresidentGutknecht for all his efforts in contributing to theprogress of the WFLD, the official society for laser indentistry in the world. He additionally thanked Mr Abdul Salam Al Madani from Index for hosting the XIIth International Congress in Dubai. Following on, ProfZeinoun presented the chairperson of the ScientificCommittee of the AEEDC Dr Nasser Malik. Dr Malik un-derlined the strong involvement of WFLD during thistwo years represented by Professor Norbert Gutknecht,the President of WFLD, and Professor Toni Zeinoun, theOrganizing Chairman, and thanked them for all theirefforts in contributing tothe success of the scientificmeeting in the region. Af-terwards Prof Gutknechtthanked in his speech allthe participants in the con-gress and the AEEDC for hercollaboration in hostingthe XIIth International Con-gress of WFLD.

The Organizing Chair-man commented on thefilm showing the historyand developments of theWFLD. Simultaneously,this film introduced andshowed the countries andall the speakers participat-ing in the Congress. Thefilm was prepared by MmeCarla Zeinoun and DrThéophile Rahall and got a good review from the au-dience.

According to the Executive Committee decisions, Aplaque of appreciation was presented by the Organiz-ing Chairman and the President of WFLD to Index Hold-ing represented by General Manager Mr Anas AlMadani and Dr Nasser Malik representing the Scientific

Committee of AEEDC for their contribution and majorefforts in hosting this congress. In addition to that, theOrganizing Chairman and Prof Gutknecht awarded aplaque of appreciation representing a life membershipto the Past Presidents of WFLD: Prof Samir Nammour,Prof Loh Hong Sai and Prof Isao Ishikawa.

All the badges and files of the speakers were takenfrom the WFLD Desk Office which was situated in theexhibition center. The Organizing Committee was de-livering all the documents to the participants in thecongress.

This first day was char-acterized by the meetingof the country representa-tives and the affiliated as-sociations. The decisionsof the Executive Commit-tee were discussed and,the congress of Barcelona2012 was introduced byProf Toni Espana and ProfJoseph Arnabat. A meetingof the European and SouthAmerica division took alsoplace.

For the first day, the Or-ganizing Committee pre-pared a touristic programwhich included a dinner onthe deck of the Sundibadboat for all the WFLD par-

ticipants and their accompanists. In the same time, theExecutive Committee of WFLD was invited to a VIP Galadinner in the Rotana Hotel, where President Gutknechtand Prof Zeinoun were decorated by Mr Abdul Salam AlMadani the President of Index Holding. Also, PresidentGutknecht and the Chairman Prof Zeinoun presentedtwo plaques of appreciation to the representatives ofthe Dubai health authority Dr Tareq Koory, and to Mr

Fig. 3_WFLD Executive Board.

Fig. 4_Prof Dr Norbert Gutknecht and

Prof Toni Zeinoun together with

Abdul Salam Al Madani (middle),

President of Index Holding.

Fig. 5_Scientific Chairman,

Prof Samir Nammour.

I 41laser3_2010

Fig. 3 Fig. 4

Fig. 5

I meetings _ WFLD

Fig. 6_WFLD members celebrated

the XXIIth anniversary of the society

and where the spouses of the execu-

tive committees Mme Gutknecht,

Nammour, Brugnera, Loh Hong Sai

and Zeinoun cut the cake of the event

with the new President of WFLD Prof

Jean Paul Rocca.

Abdul Salam Al Madani for their hosting, cooperationand collaboration in the success of the WFLD con-gress.

The second day was characterized by the scientificposter sessions. The jury of the Scientific Committeeviewed and discussed the posters with their presen-ters in two sessions. The meeting of the North Amer-ican division and Asian division took place on the 10th

of March. The AEEDC Gala dinner was held in theHayat Regency Hotelin the presence of the Prince ofDubai. The Executive Committees were presented byProf Norbert Gutknecht, Aldo Brugnera and Toni Zei-noun. A table of honor was reserved for the ExecutiveCommittees of WFLD and special attention from Mr AlMadani to his guest.

On the third day, the meeting of the Middle Eastand African division took place; as well as the meet-ing of the jury of the Scientific Committee which des-ignated the best poster and best oral presentation.The first award of oral presentation was designed toDr Ambrose Chan from Australia and the first awardfor poster presentation was designed for Dr V. Aleksicfrom Japan. During his final statement, at the closureceremony, the Organizing Chairman thanked all theparticipants and invited the Chairman of the Scien-tific Committee Prof Samir Nammour to reward thebest oral and best poster presenter. According toWFLD Executive Committee, the best oral and posterpresenter were rewarded by the Chairman of Scien-tific Committee Prof Nammour. A plaque of appreci-ation were delivered by the President Prof NorbertGutknecht and Prof Zeinoun according to the Execu-tive Committee decision.

The TOP 3 in the poster presentation1st Dr V. Aleksic (Japan)2nd Dr Sheila C.Gouw Soares (Brazil)3rd Dr Alyne Simoes (Brazil)

The TOP 3 in the best oral presentation 1st Dr Ambrose Chan (Australia) 2nd Dr Marina Stella Bello Silva (Brazil) 3rd Dr Lahmouzi Jamila (Belgium)

The General assembly began with the participationof Mr Abdul Salam Al Madani. He congratulated theWFLD Executive Committee especially Prof Toni Zei-noun and the President Prof Norbert Gutknecht for theexcellent organization and the success of the congress.Then he presented trophies to the organizing commit-tee members and the invited speakers. A photo with theexecutive members was taken to commemorate themoment.

The General assembly of WFLD continued giving theapproval for the report of Executive Committees andthe decision of the divisions of WFLD. Prof Gutknechtpresent the executive committees decisions:

_The creation of legal affairs posts. Prof NorbertGutknecht and Prof Samir Nammour were voted forthese posts for a period of six years.

_The election of president elect Prof Aldo Brugnera. _The election of Carlo Fornaini from Italia as a treasurer

of WFLD._The election of Kenji Yushida from Japan as a general

secretary of WFLD._The election of Adam Stabholz as a new chairman for

the European division.

Prof Aldo Brugnera and Prof Abiko report to theGeneral secretary and Treasurer. And the general as-sembly approved the two reports. Prof Gutknecht in-vited his team to present a report about the new modal-ities of our website where members can enter and paidtheir duties by pay pal directly. Then the president in-vited the Spanish team to present the WFLD congress2012 in Barcelona. A film for the occasion was exposed.The Organizing Chairman announced the finishing ofthe general assembly and invited the Spanish team (Dr Toni Espana and Dr Joseph Arnabat) to come to thestadium where he presents the flag of WFLD to theteam and where the XIIIth International Congress ofWFLD will take place in Barcelona at may 2012.

Finally, the last social activities of the congress wasthe Gala dinner who was held in restaurant Al Tannourin Dubai were Lebanese food and Arabic musical pro-gram were presented.

WFLD members celebrated the XXIIth anniversary ofthe society and where the spouses of the executivecommittees Mme Gutknecht, Nammour, Brugnera, LohHong Sai and Zeinoun cut the cake of the event with thenew President of WFLD Prof Jean Paul Rocca.

A plaque of appreciation was delivered to the PastPresident of WFLD Prof Norbert Gutknecht and for theChairman of Scientific Committee Prof Samir Nam-mour for all their efforts contributing to the success of the congress by the WFLD Organizing Chairman Prof Toni Zeinoun._

42 I laser3_2010

Fig. 6

Unbenannt-5 1 11.10.2010 15:29:21 Uhr

I meetings _ Gaziantep

_The first Idealclub Knowledge Sharing Daysand Gaziantep Implantology and Laser symposium,in cooperation with Aachen Dental Laser Center(AALZ) and International Implant Education Center(IFZI), from June 4–6 in Gaziantep was a great suc-cess. Due to the timeless efforts of Hülya Kazak(President of Idealclub, founded by AALZ and IFZI)and her organizing team the symposium hall waswith 250 participants from Turkey, Syria and otherborder countries fully booked, and many more inter-ested dentists had to be disappointed because thecongress was sold out! The symposium was held inthe brand new hotel Novotel in the center ofGaziantep.

The symposium program was focused on the up-to-date and fascinating combination of oral im-plantology and the support of laser dentistry in dailyclinical practice, and the participants got theirmoney’s worth with the excellent scientific pro-gram, the national and international outstandingpresentations and the execution of after-congresspostgraduate courses in laser dentistry and oral im-plantology. The industrial exhibition was very wellattended and the companies were leaving very sat-isfied at the end of the event.

Under the presidency of Prof Dr Aslihan Üsümezand Dr Zafer Kazak MSc the first day was more fo-cused on oral implantology with presentations fromwell known lecturers, like Prof Dr Manfred Lang, ProfDr Aslan Gökbuget, Prof Dr Selim Pamuk, Prof Dr CetinSevük and Dr Gassan Yücel. The importance of state-of-the-art oral implantology in daily practice wasdemonstrated in the presentations, where the audi-torium appreciated the clinical integration of the dif-ferent in the implantology market represented sys-tems.

The second day was focused on the use of laserdentistry in daily practice and the mountain of ad-vantages by using the several laser wavelengths in theright way. Prof Dr Norbert Gutknecht, Executive Di-rector of the WFLD and President of the DGL, startedthis day with his—as usual—outstanding presenta-tion about evidence based laser dentistry in dailypractice. The fully packed auditorium appreciatedhighly his clear message concerning the evidencebased use of the different wavelengths in the severalfields of laser supported dentistry. Also the other pre-sentations from Prof Dr Aslan Üsümez, Prof Dr SerhatYalcin, Prof Dr Hakan Ozyuvaci and Dr Ilay Maden MScshowed the advantages of the supporting use of

Laser dentistry and Implantology Symposium in Gaziantep a great success!Author_Leon Vanweersch, Germany

44 I laser3_2010

meetings _ Gaziantep I

lasers in the several fields of dentistry against classi-cal treatment methods. The big amount of questionsafter the presentations and the lively discussionsshowed the interest of the auditorium in the topicsand the intention to learn more about this exitingtherapy technology.

The big advantage of having two different maintopics in this symposium was certainly the introduc-tion of a new therapy to those dentists who were inter-ested in the “other” subject. Furthermore the presenta-tions, which showed laser supported oral implantologycases were very much appreciated, especially whenshowing not only the medical advantages but also thefinancial advantages for the business of a dentist.

Another benefit for the audience was certainly thepossibility to have discussions with two pioneers ofimplant and laser therapy, Prof Gutknecht and ProfLang, especially for those dentists, which use thesetherapies in their practice having the possibility toshare their experiences with them of these outstand-ing scientists.

The hotel venue was perfectly suited for the sym-posium because the convenient location in the center

of Gaziantep provided all possibilities for short excur-sions to the old town and his historical sites during thebreaks and after the programs. Also the cultural pro-gram was exiting.

After a visit to the Gaziantep national mosaic mu-seum the organizers invited on Saturday for a dinnerparty in a historical venue of the old town with the, es-pecially in Turkey, very famous Gaziantep food spe-cialties and traditional Turkish dances. During thisevening we saw “one” big implantology and laserfamily enjoying the excellent food and dancing.

On the days after the symposium Idealclub andAALZ executed the modules 3 and 4 of the mastershipcourse “Laser Therapy in Dentistry” certificated byRWTH Aachen University. This mastership course is aone-year clinical specialisation course in laser den-tistry, running in different countries around the worldby AALZ. The second version of this successful TurkishMastership Course will start on Friday, October 1, 2010in Istanbul._

We thank the organizers and the symposium pres-idents for offering such a highly professional sympo-sium in the beautiful city of Gaziantep.

I 45laser3_2010

I meetings _ Mumbai

“Tomorrow’s dentistry today”Author_Ralf Borchers, DDS, M.Sc.

46 I laser3_2010

_From 2–4 April 2010, the Indian Academy ofLaser Dentistry (IALD) held its 4th International Con-ference in Mumbai, India. This event was perfectlyoperated by the organizing committee under theleadership of Dr Suchetan Pradhan, MSc, President ofthe IALD and Director of Pradhan Dental Centre,Mumbai (India).

Location of the conference was the brand new“Courtyard Marriot” hotel near Airport Mumbai,which had opened its doors just one day before thecongress started. This was certainly a good choice bythe organizers because service and catering were ex-cellent.

The pre-conference course on 2nd April, under thetopic “Fun with Lasers”, was a promising lead up withalready 75 participants. After a general introductionof laser history, laser physics and an overview of in-dications, a wide spectrum of treatment cases wasshown and discussed. Afterwards a couple of work-stations were waiting for the participants to get apicture of practical laser treatment by hands- on ex-periences with different types of lasers. The demandon the workstations and booths of the additionallyheld dental exhibition remained high the followingtwo days and was accepted by the exhibitors withgreat pleasure.

On 3rd and 4th April the main conference offered awide range of lectures covering scientific reports,case studies, facial rejuvenation and marketing of alllaser systems used in dentistry. To ensure a great va-

riety the lectures were held by international presen-ters and professors from India, Israel, Canada, USAand Germany.

The audience, at least more than 250 dentists perday, followed the lectures highly interested and awhole bunch of questions was waiting for everyspeaker after he ended his/her lecture. The atmos-phere was very good and familiar and everybody wasvery active to help the beginners in laser dentistrymaking their way in becoming specialists in thisunique and extraordinary field of dentistry.

As a consequence of the conference a large partof the audience requested further education in laserdentistry. Many of them were informed by Dr RalfBorchers, MSc (Germany) about the postgraduatemaster program “Lasers in Dentistry”, which is of-fered in Dubai (UAE) and Aachen (Germany) by theworldwide well known AALZ Aachen Laser Center(Germany) with its Scientific Director Professor Dr Norbert Gutknecht, President of the German So-ciety for Lasers in Dentistry (DGL) and Executive Di-rector of the World Federation for Laser Dentistry(WFLD).

Additionally, the Pradhan Dental Centre, Mumbai(India) is offering a laser education program of con-stitutive modules in cooperation with the AALZAachen and experienced laser dentists from Ger-many. It was a successful conference which madeevery participant leaving with a smile and an im-provement of knowledge in laser dentistry._

www.dentistryme.com

9 - 11 November 2010 • Abu Dhabi National Exhibition Centre, UAE

Member OfOrganised BySupported By

CME

Accreditation

Media Partners

+971 4 336 7334 +971 4 336 4021 dentistry@iirme.com

The conference will feature the most up-to-date information on the diagnosis and treatments available from international experts including:

Renowned Dental PersonalityProf Nasser Barghi,Professor and Head of Division – Esthetic Dentistry, University of Texas, San Antonio, USA

Award Winner: Excellence in Dental EducationProf Patricia Reynolds,Director of Flexible Learning – Dental Institute,King’s College, UK

Diplomate of the American Board of Oral MedicineProf Juan Yepes, Associate Professor and Director of Radiology, University of Kentucky, USA

Register your delegate place todaywww.dentistryme.com

Unbenannt-1 1 20.09.2010 9:31:56 Uhr

Laservision

New multi-use lasersafety eyecaps for patients

During medical laser treatment eyeprotection of the patients is ex-tremely important. By offering thecompletely novel laser safety eye-caps “CAP2PROTECT” LASERVISIONtakes care of this challenge and pro-vides patients excellent eye protec-tion for laser treatment in the facial

area. Present eye caps are made in most cases out ofrigid material like metal or plastics. They are typicallyconnected together with a nose bridge and hold in po-sition by an additional head strap. In contrast to that

the new LASERVISIONeye caps feature a uniqueself-adhesive effect. Thiseffect is a basic materialcharacteristic and does-n’t become lost even aftermultiple reuses. The ad-hesive part of the capkeeps it securely in a po-sition which protects the

eye of the patient against incident laser radiation andstray light from all directions. As designed for themedical market, the caps are of course suitable forsterilisation. In order to increase laser protection andmechanical stability the eye caps feature an addi-tional metal insert on the top side. Due to its small sizeand thickness the wearing comfort is not affected atall.

LASERVISION GmbH & Co. KG

Siemensstr. 6

90766 Fuerth, Germany

E-mail: info@lvg.com

Website: www.uvex-laservision.com

I manufacturer _ news

Manufacturer NewsSirona

New laser makes entry into thepremium class even easier

The successful SIROLaser Advance gets a “little brother”: TheSIROLaser Xtend offers all the important features in a familiar effi-cient form. Newcomers benefit from intuitive operation, favourableprice-performance ratio and the ability to easily upgrade the laser.With the SIROLaser Xtend, Sirona, the dental technology leader, is nowable to bring another diode laser on the market that meets all den-tal requirements for lasers, but is especially easy to oper-ate and goes easy on the budget. As the “little brother”of the successful SIROLaser Advance, the entry-level model provides complete investmentprotection despite leaner technology be-cause the SIROLaser Xtend can be upgraded to in-

clude all the functionality of Advance with the exception of the wireless footcontrol. In regards to operation, users of the SIROLaser Xtend do not have tocompromise because like the Advance professional model with colour touch-screen, the “little” diode laser features clearly structured menu navigation and

self-explanatory icons for intuitive and straightforward ease of use. Theseamlessly activated finger switch integrated in the ergonomically shaped

handpiece makes activating the laser easy. Also the range of applicationsleaves no wish unmet: Preset therapy programmes ensure quick and

painless treatment of patients in periodontology, endodontics andsurgery, but also for herpes, aphthous ulcers and sensitive tooth

necks.

Sirona Dental Systems GmbH

Fabrikstraße 31

64625 Bensheim, Germany

E-mail: contact@sirona.de

Website: www.sirona.com

KaVo

Greater performance for more efficiency

The KaVo KEY 3 LASER with its gentle, effective and low-pain ap-plication in periodontics, conservative dentistry, endodonticsand surgery has been established in dental practices foryears. Together with a new periodontic handpiece, KaVo pre-sented the KEY 3 plus LASER with greater performance than itspredecessors and variable pulse lengths at IDS 2009.Through greater ablation speed in hard dental tissue and bone,treatment length is significantly reduced compared to conven-tional LASERs. Fine ablation with variable pulse length also permitsfinishing the cavity margins. As a result, better aesthetics can beachieved than with conventional technologies. KEY3 LASERs already in the market can be easily up-graded, with a very positive effect upon valuepreservation of existing systems.

In periodontics, the unique feedback system of the KEY 3 LASER allows the se-lective, complete and low-pain removal of calculus, with excellent protection ofthe root support structures. Bacteria are killed and any biofilm on the tooth sur-face is dehydrated and deactivated. The new periodontic handpiece 2261 issmall and features an impressively easy exchange of application tips.

In conservative therapy, the Er:YAG LASER is suitable for caries prepa-ration, enamel/dentine conditioning and fissure sealing. With the aidof the special, caries contact handpiece, the diseased tissue may beremoved with direct intimate contact of the tooth surface, while us-ing the feedback system. Furthermore, the KEY 3 plus LASER is suitable for numerous otherindications in endodontics and surgery, such as drying and sterilis-ing the root canal, implant exposure and root tip resection.

KaVo Dental GmbH

Bismarckring 39

88400 Biberach/Riss, Germany

E-mail info@kavo.com

Website: www.kavo.com

48 I laser3_2010

I 49laser3_2010

about the publisher _ submission guidelines I

laser3_2010

submission guidelines:Please note that all the textual components of your submissionmust be combined into one MS Word document. Please do not submit multiple files for each of these items:

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_We require images in TIF or JPEG format._These images must be no smaller than 6 x 6 cm in size at 300 DPI._These image files must be no smaller than 80 KB in size (or theywill print the size of a postage stamp!).

Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files downto meet our requirements but send us the largest files available.(The larger the starting image is in terms of bytes, the more lee-way the designer has for resizing the image in order to fill up morespace should there be room available).

Also, please remember that images must not be embedded intothe body of the article submitted. Images must be submitted separately to the textual submission.

You may submit images via e-mail, via our FTP server or post a CD containing your images directly to us (please contact us for the mailing address, as this will depend upon the country fromwhich you will be mailing).

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Questions?Eva Kretzschmanne.kretzschmann@oemus-media.de

Copyright Regulations _laser international magazine of laser dentistry is published by Oemus Media AG and will appear in 2010 with one issue every quarter. The

magazine and all articles and illustrations therein are protected by copyright. Any utilization without the prior consent of editor and publisher is inad-mi ssible and liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.

Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to theeditorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right tocheck all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicitedbooks and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, representthe opinion of the afore-mentioned, and do not have to comply with the views of Oemus Media AG. Responsibility for such articles shall be borne by the author.Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumedfor information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is Leipzig, Germany.

PublisherTorsten R. Oemus oemus@oemus-media.de

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Lutz V. Hillerhiller@oemus-media.de

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Loh Hong SaiAsia & Pacific Division

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Editorial BoardMarcia Martins Marques, Leonardo Silberman,Emina Ibrahimi, Igor Cernavin, Daniel Heysselaer,Roeland de Moor, Julia Kamenova, T. Dostalova,Christliebe Pasini, Peter Steen Hansen, Aisha Sul-tan, Ahmed A Hassan, Marita Luomanen, PatrickMaher, Marie France Bertrand, Frederic Gaultier,Antonis Kallis, Dimitris Strakas, Kenneth Luk, Mu-kul Jain, Reza Fekrazad, Sharonit Sahar-Helft, La-jos Gaspar, Paolo Vescovi, Marina Vitale, CarloFornaini, Kenji Yoshida, Hideaki Suda, Ki-Suk Kim,Liang Ling Seow, Shaymant Singh Makhan, Enri-que Trevino, Ahmed Kabir, Blanca de Grande, JoséCorreia de Campos, Carmen Todea, Saleh GhabbanStephen Hsu, Antoni Espana Tost, Josep Arnabat,Ahmed Abdullah, Boris Gaspirc, Peter Fahlstedt,Claes Larsson, Michel Vock, Hsin-Cheng Liu, SajeeSattayut, Ferda Tasar, Sevil Gurgan, Cem Sener,Christopher Mercer, Valentin Preve, Ali Obeidi,Anna-Maria Yannikou, Suchetan Pradhan, RyanSeto, Joyce Fong, Ingmar Ingenegeren, Peter Klee-mann, Iris Brader, Masoud Mojahedi, Gerd Voll-and, Gabriele Schindler, Ralf Borchers, StefanGrümer, Joachim Schiffer, Detlef Klotz, HerbertDeppe, Friedrich Lampert, Jörg Meister, ReneFranzen, Andreas Braun, Sabine Sennhenn-Kirch-ner, Siegfried Jänicke, Olaf Oberhofer, ThorstenKleinert

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Published byOemus Media AGHolbeinstraße 2904229 Leipzig, GermanyTel.: +49 341 48474-0Fax: +49 341 48474-290kontakt@oemus-media.dewww.oemus.com

Printed byMessedruck Leipzig GmbHAn der Hebemärchte 604316 Leipzig, Germany

laserinternational magazine of laser dentistryis published in cooperation with the World Federa-tion for Laser Dentistry (WFLD).

WFLD President

University of Aachen Medical FacultyClinic of Conservative DentistryPauwelsstr. 3052074 Aachen, GermanyTel.: +49 241 808964Fax: +49 241 803389644ngutknecht@ukaachen.dewww.wfld-org.info

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