Dentalcompare: When did you first get involved in laser dentistry?
Glenn van As: I purchased my first laser in 1997. It was an Argon laser, weighed close to 200 pounds, cost over 50K, and had two wavelengths: 488 nm (blue) for curing composites and 514.5 nm (green) for cutting and coagulating. We nicknamed it the Zamboni because it was huge, not portable, and had limited functionality. It did, however, start me on the pathway through lasers to the point now where we have multiple soft-tissue diode lasers in the office (one per operatory) and 2 hard-tissue erbium lasers as well. I have obtained Standard and Advanced levels of proficiency in laser dentistry from the Academy of Laser Dentistry and presently own a Mastership in the field as well. Lasers have become a routine daily part of my daily practice and are a key part of our microscopic and cosmetic general dental practice.
DC: Can you describe a laundry list of several key benefits (clinical, ROI, etc) of having a diode laser in the practice? What have been the most notable benefits for YOUR practice?
GVA: Diode lasers are making huge inroads into dentistry as the "soft-tissue handpiece". These units are cost effective (some are priced now at 2500.00 USD), reliable, small, portable, light and practical to have as part of your armamentarium in each operatory.
Clinically, they allow you to replace your electrosurge for many procedures, providing the opportunity to work on soft tissue with less need for anesthetic. In addition, unlike with monopolar electrosurgical units, you can work around metals (amalgam, braces, implants and crowns) without fear of creating iatrogenic damage to the pulp, bone or soft tissue. Lasers disinfect so they can be used many times in periodontal pockets and endodontic situations as an adjunct to traditional methodologies. In addition, there is less lateral thermal damage with lasers allowing the clinician the confidence to take impressions on the same day as crown troughing or gingivectomies are completed. Lasers allow you to treat cases more simply, with less stress while increasing the ROI by implementing new procedures into your office.
The two main areas where lasers have changed the way I practice--They make my life simpler, and they increase ROI. They make restorative dentistry easier by removing tissue as a barrier to the restorations in regular restorative dentistry. They also can be used to create symmetry and harmony in the soft tissues so that cosmetic dentistry looks beautiful in not only the whites (teeth) but the pinks as well (gingiva). After all the gingiva and the lips are the frames for our pictures (teeth). Prior to having a laser, there were many procedures I referred out or ignored. Two examples of this included fibroma removals, and frenectomies. I found that with the laser, a lack of sutures and less bleeding made these two simple but profitable procedures easy to implement into my practice. In addition, using lasers in conjunction with veneers and anterior indirect restorations can really help eliminate minor soft tissue asymmetries in the gingival heights. Of course one must always consider biologic width and bone locations when using a soft tissue laser, but in many instances minor alterations of soft tissue makes these cosmetic cases go from good to great!
DC: For dentists considering their first purchase of a diode laser, what are some of the core questions to ask? Are there any common misconceptions or over-expectations to beware of?
GVA: I think for a first diode laser, many dentists are concerned with whether one unit will cut faster, quicker , easier than another. For 95% of procedures 2.5 watts of energy is more than enough to complete the task. Thick tissue covering implants or teeth ( impacted soft tissue covered teeth) may need either more time and patience, or a little more power.Other than that, I am primarily using 0.8-1.4 watts for the majority of my soft tissue laser dentistry. So if you consider that a "diode is a diode" and that they all will work well, the clinician looking to integrate lasers into their practice should focus on price, portability, support, training, style as opposed to one working faster , or better than another. All diodes are semiconductor technology and very reliable with little need for repair so concentrate on the issues surround the unit when choosing which one.
As for misconceptions, lasers are end-cutting and not side-cutting, so although the learning curve is there, it is not extensive. You simply have to learn to slow down your hand movements and let the light cut the tissue instead of rapidly dragging the laser across the tissue to physically cut the tissue. In addition, I think that many people are looking for diode lasers to solve all their "hard core" periodontal needs. My experience has been that diodes can help with tissue appearance and help with decreasing bleeding on probing, but that diodes primarily are intended for mild to moderate periodontal disease and not severe situations where pockets are 6mm and higher. They will help with bacterial disinfection in a similar fashion to Arestin but they are an adjunct to traditional treatment of scaling and root planing, good home care, and things like Periostat.
DC: For dentists considering their first purchase of a diode laser, what are some of the best educational/information/training resources?
GVA: As for educational components. There is a fair amount of information on the Internet (on youtube.com, look for glennvanas). In addition, many one-day courses are available (advancedlasertraining.com) and many dental laser companies have training videos and DVDs that come with the laser itself. A search on many of the monthly trade journals will show articles discussing clinical techniques and I am presently starting to do some limited attendance workshops out of our office in North Vancouver.
DC: What is your message to dentists hesitant about incorporating a diode laser into the practice?
GVA: The exciting thing is that lasers are now becoming "mainstream" and accepted as the soft-tissue handpiece. Yes, with integrating any new technology in the office there will be a small learning curve, but patients are very receptive to laser technology probably due to LASIK eye surgery. If you look now there is a whole "buzz" about lasers and many are turning to diodes as their electrosurgery replacement. Universities are beginning to integrate laser technology into their graduate and undergraduate dental programs and more and more research is coming out on the benefits of lasers for both soft-tissue surgery and Low Level Laser Therapeutical benefits (LLLT).
So if you haven't yet integrated laser technology into your office, what is stopping you from "Seeing the Light"? Who knows--you might just find that--"Lazin is Amazin!"