Buyers Guide: Diode Lasers

Dentalcompare
Clinical Director



How a laser works

Starting at the simplest level, a laser is a machine that emits an intense beam of light at one particular wavelength. Technically, the word laser is an acronym for "Light Amplification by Stimulated Emission of Radiation" but the term has become so common, laser is now considered a word. Diode lasers use a small diode chip, very similar to what can be found in LED lighting. As current is applied, light is released from the diode in one particular wavelength. That energy is then focused through a fiber optic cord to a handpiece. 

Most lasers fall in the infrared spectrum. Depending on the wavelength, and the type of tissue to which it is applied, the energy from the laser will be absorbed by the tissue and the tissue is vaporized or ablated. Diode lasers are mostly in the near infrared spectrum, allowing them to be more readily absorbed by cells with pigment, such as hemoglobin. Considering the high blood flow in gum tissue, this makes diode lasers very useful for soft tissue applications. Because there is no pigment in tooth structure, diode lasers have no affect on enamel.

Dental Diode Laser Applications

The most powerful application of the dental diode laser is in soft tissue surgical procedures. Because you are ablating the tissue, you get simultaneous hemostasis at the site. Unlike a scalpel, a laser allows you to cut tissue without causing bleeding. Considering its mechanism of action, a laser also allows you to eliminate bacteria. Unlike with electrosurgery, there is no current applied to the body by a laser which means much less charring of tissue. A laser is useful anywhere you previously would have used the other instruments, but a laser offers some increased functionality.

Exposing Crown Margins: Put your retraction cord away. Diode lasers allow you to lightly trough tissue covering the margins of your preparation while also helping to control any bleeding. This allows a more accurate digital impression or traditional tray impression. 

Deep Pockets: The long fiber optic tip of a diode laser can access a deep pocket, eliminate granulation tissue, and decontaminate the area as well. 

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Esthetic Crown Lengthening: Diode lasers are great for quick and clean soft tissue crown lengthening. 

Gingivectomy: In cases with hypertrophic tissue, such as around orthodontic brackets, a diode laser can easily trim things back with a little anesthetic infiltration.

Treating Ulcers: Aphthous ulcers, canker sores, or cold sores can all be treated by ablating the surface of the lesion, stimulating healing and reducing pain experienced from the area. 

Shaping Gums: A diode laser can be used to shape the tissue when fabricating an esthetic ovate pontic for a bridge. Following the laser, build your provisional bridge to fill the area in. Simply give it a few weeks to heal before your final impression. 

Frenectomy: While not the most common procedure, a diode laser allows you to do a frenectomy in a few short minutes with excellent hemostasis.

Whitening: Some manufacturers also have systems developed to use the diode laser in conjunction with whitening gels for increased whitening efficiency.

What I Need to Know

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  • Cord and Tip Choices – The beam of light travels down a fiber optic tube to the tip where it interacts with the tissue. With each use the tip will break down and requires replacement for each new case. Some diode lasers come with a single fiber optic cord which requires stripping the protective sheath to expose a new section. Others come with a static cord, and replaceable tips. This eliminates the need to do any stripping, but increases the cost due to replacement cost of the tips. In some cases, you will have different tip choices depending on the location or the application where the laser is being used.
  • Continuous vs. Pulse Modes – Continuous mode in lasers allows for an uninterrupted beam to the target tissue. Comparing it to your handpiece, it is similar to depressing the pedal all the way down. Pulse mode is just that, a beam delivered with a regular pulse of laser power at regular intervals. Pulse modes can help minimize heat buildup in the target tissue. In fact, the most recent diode lasers include “comfort” settings to control the duration of high-power pulses to minimize patient discomfort.
  • Power (Watts) – Laser power is measured in watts. Usually they fall in the range of 2-7 watts, although some diodes have higher power output. The simplest way to look at what this means is in relation to how fast the laser can cut. Higher wattage lasers apply more energy, but also more heat to the targeted area. 
  • Wavelength – Each diode laser emits a particular wavelength. Most diode lasers are in the 800-1000 nm range in the infrared spectrum where hemoglobin absorbs the energy most readily. While some lasers might work at a wavelength that allows for slightly higher absorption, most of the current models on the market demonstrate excellent efficiency.
  • Portability – Choose a diode laser that is portable and easy to move from room to room. Some modern designs are even handheld and are only slightly bigger than an electric hand piece. If your laser is easily portable, you will not need a second unit until you have another operator who requires one for simultaneous use. 
  • Menu Choices – Most modern lasers come with easy to read control panels. Consider one that has all the settings pre-programmed for you depending on the procedure you are doing.
  • Training­ – While they are simple to use, consider the training you will get with your purchase of a laser. It might not be the steepest learning curve, but you will get more out of your laser if you understand all the features and applications. There are also many different study clubs and learning centers to expand on your initial knowledge base. 

Questions to Ask

The Questions to Ask
  1. Why is the wavelength of this particular diode useful?
  2. Considering the type of practice I have, what types of cases will I use the laser with?
  3. What training is available to me?
  4. How easy is this to set up, and clean up for the next patient?
  5. How easy is it to move from room to room?

Definitions

Continuous Wave Operation A laser mode where the power output is constant over time.

Diode Laser – Powered by injected electric current, diode lasers are lasers where the active medium is a semiconductor similar to those found in light emitting diodes.

Pulsed Wave Operation A laser mode where the power output is delivered in regular pulses. The power of a laser during pulsed wave operation is equal to the average power of the laser divided by the repetition rate.

Wavelength – The distance over which a wave’s shape repeats.

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