Academy of Laser Dentistry President-Elect Dr. Tony Hewlett took some time out of his busy schedule to answer a few questions from Dentalcompare. We think you’ll find his enthusiasm about laser dentistry infectious and enlightening.
Dentalcompare: How long have you been using lasers in your practice? Describe how you were introduced to laser dentistry?
Dr. Hewlett: I purchased my first laser in 1992 after reading all I could about dental lasers and attending several CDE classes on lasers. My staff and I came to the conclusion that incorporating a laser would allow us to improve the quality of care we provided in the practice. At that time there was only one choice in dental lasers--the American Dental Technologies Nd:YAG, which incidentally is still functioning well in my practice.
At the time we believed that the Nd:YAG would do all of the procedures that we wanted it to do, it soon became clear that it didn't. It remains, however, a very good soft tissue laser.
Since then I have purchased several other lasers--an argon laser for soft tissue applications and quick composite curing, a diode laser, and an Er:YAG laser for hard tissue procedures on bone and tooth structures.
DC: What have been the greatest benefits of incorporating laser treatment?
Dr. H: The biggest plus for me is the personal satisfaction that I get knowing that I can provide the highest quality of care possible. For example, when I use the laser for crown and bridge troughing, the margins of the preparation are crystal clear—and by the way, my dental lab loves it—and there is no bleeding and no packing of cord.
When I perform any soft tissue procedures like biopsies, fibroma removals, gingivectomies, or frenectomies there is no post operative bleeding, post op pain is minimal, I don't need sutures and the use of local anesthetics is minimal (frequently, I don't need local anesthetic at all, just a topical).
When I use my Er:YAG laser for cavity preparation, it is nice to see them complete the procedure with any anesthetic at all. The ability to prepare and restore teeth, especially on children, without the injection of local anesthetics is a very big practice builder.
DC: Can you outline a couple of specific cases (common procedures) where a laser successfully replaced or enhanced traditional treatment?
Dr. H: Frenectomies are procedures that I didn't perform before I purchased a laser. Now, with no bleeding and no sutures, my patients leave my office feeling like they didn't actually have anything done. The post op pain is very minimal, they don't bleed, and most of the time I use only a few drops of anesthetic or just topical anesthetic. And most of these patients are children. so the parents watch and are amazed at how well their kids are doing!
Cosmetic gingival recontouring is another great use of the laser. The procedure is quick, very easy, and very comfortable. And the results are predictable, the tissue margins stay right where you leave them, and post-op swelling, bleeding, and recession are eliminated.
DC: What are some strategies for dentists considering incorporating laser treatment? Start with a diode and then move on to other wavelength? What are good resources to educate themselves? How long is the typical learning curve?
Dr. H: The learning curve for a diode laser is quite short. I would recommend obtaining as much training as possible and then attend advance learning opportunities such as the Academy of Laser Dentistry annual conference.
The most important factor for successfully integrating a laser into a dental practice is confidence that you are trained and using the laser correctly. Diode lasers are very safe when used correctly-- they are contact lasers and the laser tissue interaction is at the tip of the laser. There is a guide beam of HeNe beam laser (similar to a laser pointer) that guides you while vaporizing the correct tissue.
The same is true for a hard tissue Er:YAG or Er,Cr:YSSG laser. The training is the key to satisfaction and success, the learning curve is a little longer than the diode but still easily attainable.
DC: What are some of the common misconceptions among non-laser dentists?
Dr. H: Some practitioners think that dental lasers are unsafe and unproven, and that there is not enough research pout there to justify the purchase. My answer to that is that it's time to get on board.
Unlike the first wave in the early 90s when I started using a laser, the research has caught up to the clinical use, the FDA has approved the use of lasers and the uses are clearly stated by the manufacturers. Clearly, dental lasers are safe when used correctly.
We have always been worried about under-trained dentists having problems and creating a bad image for all dental lasers but that hasn't been the case. I don't know of any negative outcomes that are the result of the use of lasers.
General tips
The Journal of Laser Dentistry, the official journal of the ALD, provided some helpful 'laundry lists' of considerations for doctors planning to incorporate lasers into their practices.
Laser variables:
- Range of applications
- Precision
- Controllability (factory pre-sets, pulse duration and frequency)
- Delivery systems
- Limitations
- Safety
- Infection control
- Cost, including initial, maintenance, CE and replacements
- Control panel displays
- Foot pedals
- Portability
- Features and accessories
- Training, warranty and service provided by the company
Important questions:
- What features do I want or need?
- What procedures do I perform that could be assisted with laser technology?
- What procedures have been cleared for marketing by the FDA?
- How much training and certification do I need?
- How do I successfully incorporate laser technology into my practice?
- How long has the device been on the market and what is the company’s track record?
- Is consistent technical support available from the company?
After you buy:
- Attend manufacturer training.
- Sign up for a Standard Proficiency Dental Laser Certification Course that includes lecture, hands-on exercises, written examination and clinical simulation exams.
- Start slowly. Remember there is a learning curve and your confidence will increase over time.
- Don’t use new technology on new patients initially. Start with existing patients until you build your confidence.
- Remember dental laser education is continual.